Usual Adult Dose for Nausea/Vomiting

Dosage: The dosage should be individualized. Factors to be considered in determining dose are age, body weight, physical status, underlying pathological condition, use of other drugs, the type of anesthesia to be used, and the surgical procedure involved. Vital signs and ECG should be monitored closely.

Maximum Dosage: The maximum recommended initial dose is 2.5 mg IM or slow IV. Additional 1.25 mg doses of droperidol may be administered to achieve the desired effect. The additional doses should be administered with caution and only if the potential benefit outweighs the potential risk.

Use: To reduce the incidence of nausea and vomiting associated with surgical and diagnostic procedures

Usual Adult Dose for Nausea/Vomiting - Postoperative

Dosage: The dosage should be individualized. Factors to be considered in determining dose are age, body weight, physical status, underlying pathological condition, use of other drugs, the type of anesthesia to be used, and the surgical procedure involved. Vital signs and ECG should be monitored closely.

Maximum Dosage: The maximum recommended initial dose is 2.5 mg IM or slow IV. Additional 1.25 mg doses of droperidol may be administered to achieve the desired effect. The additional doses should be administered with caution and only if the potential benefit outweighs the potential risk.

Use: To reduce the incidence of nausea and vomiting associated with surgical and diagnostic procedures

Usual Pediatric Dose for Nausea/Vomiting

Dosage: The dosage should be individualized. Factors to be considered in determining dose are age, body weight, physical status, underlying pathological condition, use of other drugs, the type of anesthesia to be used, and the surgical procedure involved. Vital signs and ECG should be monitored closely.

Children 2 to 12 years:
Postoperative nausea and vomiting (PONV):
Prophylaxis, if high risk for PONV: 0.01 to 0.015 mg/kg/dose IM or IV given near the end of surgery Maximum dose: 1.25 mg
Administer additional doses after at least 6 hours with caution and only if potential benefit outweighs risks.
(Previous reports suggested a higher dose of 0.075 mg/kg as effective; however, due to side effects associated with the higher doses, doses greater than 0.05 mg/kg are considered excessive and no longer recommended.)

Treatment (not first line): IV:
Manufacturer recommendations: 0.1 mg/kg/dose. Administer additional doses with extreme caution and only if potential benefit outweighs risks.

Alternate dosing: Doses as low as 0.01 to 0.015 mg/kg/dose (up to 0.03 mg/kg) may be effective for breakthrough nausea and vomiting
Maximum initial dose: 0.1 mg/kg
Administer additional doses after at least 6 hours with caution and only if potential benefit outweighs risks.

Use: To reduce the incidence of nausea and vomiting associated with surgical and diagnostic procedures

Usual Pediatric Dose for Nausea/Vomiting - Postoperative

Dosage: The dosage should be individualized. Factors to be considered in determining dose are age, body weight, physical status, underlying pathological condition, use of other drugs, the type of anesthesia to be used, and the surgical procedure involved. Vital signs and ECG should be monitored closely.

Children 2 to 12 years:
Postoperative nausea and vomiting (PONV):
Prophylaxis, if high risk for PONV: 0.01 to 0.015 mg/kg/dose IM or IV given near the end of surgery Maximum dose: 1.25 mg
Administer additional doses after at least 6 hours with caution and only if potential benefit outweighs risks.
(Previous reports suggested a higher dose of 0.075 mg/kg as effective; however, due to side effects associated with the higher doses, doses greater than 0.05 mg/kg are considered excessive and no longer recommended.)

Treatment (not first line): IV:
Manufacturer recommendations: 0.1 mg/kg/dose. Administer additional doses with extreme caution and only if potential benefit outweighs risks.

Alternate dosing: Doses as low as 0.01 to 0.015 mg/kg/dose (up to 0.03 mg/kg) may be effective for breakthrough nausea and vomiting
Maximum initial dose: 0.1 mg/kg
Administer additional doses after at least 6 hours with caution and only if potential benefit outweighs risks.

Use: To reduce the incidence of nausea and vomiting associated with surgical and diagnostic procedures

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

The initial dose of droperidol should be appropriately reduced in elderly, debilitated, and other poor risk patients. The effect of the initial dose should be considered in determining incremental doses.

Precautions

US BOXED WARNINGS:

• CARDIOVASCULAR: Cases of QT prolongation and/or serious arrhythmias (e.g., torsade de pointes) have been reported in patients receiving droperidol at doses at or below recommended doses. Some cases have occurred in patients with no known risk factors for QT prolongation and some cases have been fatal.
• Due to its potential for serious proarrhythmic effects and death, droperidol should only be used in patients who do not show an acceptable response to other drugs, either because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse effects from those drugs.
• All patients should undergo a 12-lead ECG prior to administration of droperidol to determine if a prolonged QT interval (i.e., QTc greater than 440 msec for males or 450 msec for females) is present. If there is a prolonged QT interval, droperidol should not be administered. If the potential benefit of treatment is thought to outweigh the risks of serious arrhythmias, ECG monitoring should be performed prior to treatment and continued for 2 to 3 hours after completing treatment to monitor for arrhythmias.
• Droperidol is contraindicated in patients with known or suspected QT prolongation, including patients with congenital long QT syndrome.
• Droperidol should be administered with extreme caution to patients who may be at risk for development of prolonged QT syndrome (e.g., congestive heart failure, bradycardia, use of a diuretic, cardiac hypertrophy, hypokalemia, hypomagnesemia, or administration of other drugs known to increase the QT interval). Other risk factors may include age over 65 years, alcohol abuse, and use of agents such as benzodiazepines, volatile anesthetics, and IV opiates. Droperidol should be initiated at a low dose and adjusted upward cautiously.

Dialysis

Data not available

Other Comments

During treatment with droperidol, routine monitoring of vital signs is recommended. In addition, in order to reduce the risk of ventricular arrhythmias, an electrocardiogram (ECG) is recommended prior to any surgical procedure to assess for QT prolongation. ECG monitoring is also recommended during the surgical procedure and for at least 7 hours after the end of the procedure.

ECG monitoring and full cardiac resuscitation facilities should be available when droperidol is administered.

For intravenous administration, droperidol may be diluted in 250 mL of normal saline, 5% glucose, or lactated Ringers solution.

Droperidol injection should be stored at 20 to 25 degrees C (68 to 77 degrees F) and protected from light.