Columns, Patient Care

Study Compares Safety & Effectiveness of Droperidol & Haloperidol in Patient Sedation

Issue 3 and Volume 39.

BAD REPUTATION 

Macht M, Mull AC, McVaney KE, et al. Comparison of droperidol and haloperidol for use by paramedics: Assessment of safety and effectiveness. Prehosp Emerg Care. Jan. 24, 2014. [Epub ahead of print.]

In April 2013, we reviewed an Australian article suggesting droperidol’s effective use in sedation. Now, let’s look at further research on its efficacy.

Droperidol is an atypical antipsychotic drug in the same family as haloperidol and is generally given in the acute care setting for rapid behavioral control and sedation.

In 2001, droperidol received a “black box warning” from the U.S. Food and Drug Administration due to reported cases of QTc prolongation and torsades de pointes, falling out of favor for its sister drug, haloperidol. Now, multiple research studies suggest droperidol might be safe after all.

Methods: Billed as a “before-after” study coming to us from the Denver Health Paramedic Division, the authors used retrospective review to see if there was an increase in adverse events among patients when droperidol replaced haloperidol for behavioral emergencies occurring in January 2009.

Patient charts and EMS reports were reviewed for events such as hypotension, apnea, seizures or cardiac problems following the administration of either medication. The patient’s QTc was also collected by researchers to compare rates of QTc prolongation between patients given haloperidol and those given droperidol.

After removing patients who weren’t transported, 532 total patients were studied with 218 (41%) receiving prehospital droperidol and 314 (59%) receiving haloperidol. The median age of all patients was 31 and a large number of patients were male.

Results: No deaths were reported in the study group following the administration of either antipsychotic.

Only one (0.5%) patient in the droperidol group required antiarrhythmic drugs whereas five (2%) patients in the haloperidol group required an antiarrhythmic. Median QTc length was similar in both patient groups with 448 milliseconds in the haloperidol group versus 453 milliseconds in the droperidol group.

It’s worth noting only 78 (25%) haloperidol patients had ECG information available (i.e., were made available in chart or doctor’s note) where 166 (76%) of droperidol patients had an ECG made available. Only 10% (22) of patients who got droperidol required re-sedation within 30 minutes compared with 13% (41) of patients in the haloperidol group.

Discussion: The more research we see about the safety and efficacy of droperidol, the more it seems we can put to bed the fears of using it. Despite being relatively small and retrospective in nature, this is among the largest of the cohort studies comparing haloperidol and droperidol. The average dose of droperidol needed to achieve sedation was 2.9 mg compared to 7.9 mg of haloperidol. Prior research has shown that it’s large doses of this class of atypical antipsychotics that cause arrhythmia as well as neuroleptic malignancy.

It’s difficult to judge the safety and efficacy of a medication on a single piece of research, so please see our April 2013 column (“Droperidol or Olanzapine?” JEMS April 2013, p. 33). We love seeing EMS-based research that brings cutting-edge medicine in line with provider safety.

Thanks to Denver Health and the Denver- area hospitals for the great research. 

BOTTOM LINE

What we know: Droperidol has garnered a bad reputation due to the risk of cardiac arrhythmia.

What this study adds: Another piece of solid research showing that droperidol is safer than previously thought.

 

WATCH BOX

NO BLOOD GLUCOSE TEST? 

Beskind DL, Rhodes SM, Stolz U, et al. When should you test for and treat hypoglycemia in prehospital seizure patients?

Prehosp Emerg Care. Jan. 24, 2014. [Epub ahead of print.]

Part of a major study of 76,548 seizure calls answered by EMS in 40 states and Washington D.C., the authors examined multiple aspects of responses to seizure patients and found that checking blood glucose measurements delayed administration of benzodiazepines by up to 5.9 minutes. With multiple research studies indicating rapid administration of benzodiazepines as the most effective treatment to break seizures and prevent lasting damage, the authors feel that the benefit gained from foregoing blood glucose measurement until after administration of benzodiazepines outweighs the risks associated with lasting hypoglycemia. Stay tuned; we’ll likely see more on this topic soon.