Abstract
Background
Patients with acute and chronic pain syndromes such as migraine headache, fibromyalgia,
and sickle cell disease represent a significant portion of emergency department (ED)
visits. Certain patients may have tolerance to opioid analgesics and often require
large doses and prolonged time in the ED to achieve satisfactory pain mitigation.
Droperidol is a unique drug that has been successfully used not only as an analgesic
adjuvant for the past 30 years, but also for treatment of nausea/vomiting, psychosis,
agitation, sedation, and vertigo.
Objectives
In this review, we examine the evidence supporting the use of droperidol for analgesia,
adverse side effects, and controversial United States (US) Food and Drug Administration
(FDA) black box warning.
Discussion
Droperidol has myriad pharmacologic properties that may explain its efficacy as an
analgesic, including: dopamine D2 antagonist, dose-dependent GABA agonist/antagonist,
α2 adrenoreceptor agonist, serotonin antagonist, histamine antagonist, muscarinic
and nicotinic cholinergic antagonist, anticholinesterase activity, sodium channel
blockade similar to lidocaine, and μ opiate receptor potentiation.
Conclusion
Droperidol is an important adjuvant for patients who are tolerant to opioid analgesics.
The FDA black box warning does not apply to doses below 2.5 mg.
Keywords
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Article info
Publication history
Published online: September 14, 2010
Accepted:
July 5,
2010
Received in revised form:
April 9,
2010
Received:
January 16,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
