Droperidol

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Droperidol
File:Droperidol.svg
Systematic (IUPAC) name
1-{1-[4-(4-fluorophenyl)-4-oxobutyl]-1,2,5,6-tetrahydropyridin-4-yl]-1,3-dihydro-2H-benzimidazol-2-one
Clinical data
Pregnancy
category
Routes of
administration
Intraveneous, Intramuscular
Pharmacokinetic data
Metabolism Hepatic
Biological half-life 2.3 hours
Identifiers
CAS Number 548-73-2
ATC code N01AX01 (WHO) N05AD08
PubChem CID 3168
DrugBank APRD00939
Chemical data
Formula C22H22FN3O2
Molar mass 379.428 g/mol[[Script error: No such module "String".]]
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Droperidol (Droleptan, Dridol, Inapsine) is an antidopaminergic drug used as an antiemetic and antipsychotic. Droperidol is also often used for neuroleptanalgesic anesthesia and sedation in intensive-care treatment.

History and use

Discovered at Janssen Pharmaceutica in 1961, droperidol is a butyrophenone, and is a potent D2 (dopamine receptor) antagonist with some histamine and serotonin antagonist activity.[1] It has a central antiemetic action and effectively prevents postoperative nausea and vomiting in adults using doses as low as 0.625 mg.[2] It has also been used as an antipsychotic in doses ranging from 5 to 10 mg given as an intramuscular injection, generally in cases of severe agitation in a psychotic patient who is refusing oral medication. Its use in intramuscular sedation has been replaced by intramuscular preparations of haloperidol, midazolam, clonazepam and olanzapine. Some practitioners recommend the use of 0.5 mg to 1 mg intravenously for the treatment of vertigo in an otherwise healthy elderly patients who have not responded to Epley maneuvers.

Black box warning

In 2001, the FDA changed the labeling requirements for droperidol injection, to include a so-called "Black Box Warning", citing concerns of QT prolongation and torsades de pointes. The evidence for this is disputed, with 9 reported cases of torsades in 30 years and all of those having received doses in excess of 5 mg.[3] QT prolongation is a dose-related effect,[4] and it appears that droperidol is not a significant risk in low doses.

Side effects

Dysphoria, sedation, hypotension resulting from peripheral alpha adrenoceptor blockade, prolongation of QT interval which can lead to Torsades de Pointes, and extrapyramidal side effects such as dystonic reactions/neuroleptic malignant syndrome.[citation needed]

Chemistry

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Janssen, P. A. J.; 1963, Belgian Patent BE 626307 .

References

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Further reading

  • Scuderi PE: Droperidol: Many questions, few answers. Anesthesiology 2003; 98: 289-90
  • Lischke V, Behne M, Doelken P, Schledt U, Probst S, Vettermann J. Droperidol causes a dose-dependent prolongation of the QT interval. Department of Anesthesiology and Resuscitation, Johann Wolfgang Goethe-University Clinics, Frankfurt am Main, Germany.
  • Emergency Medicine Magazine : http://www.emedmag.com/html/pre/tri/1005.asp


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