Butyrophenone·Psychiatry - Acute Calming & Sedation

Droperidol

Acute behavioral disturbance, severe nausea/vomiting, procedural sedation adjunct

ED SEDATIONDroleptanS4TGA

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

10 mg STAT

Half-life

2 h

High risk: QTc Risk

CRITICAL RISK

Sedation

RAPID

Cautions

Avoid / Cautions

Known prolonged QTc > 500 ms, Parkinson's disease, severe CNS depression. Pregnancy Category C.

Where it stands

Rapid Summary

Overview

Highly potent, ultra-fast-acting butyrophenone. The gold standard in emergency departments for severe, undifferentiated behavioral disturbance and violence.

Clinical Focus

Infamous for dose-dependent QTc prolongation. Black Box warning in the US, though Australian ED guidelines strongly endorse its use in acute agitation.

Bottom Line

Droperidol is a potent butyrophenone antiemetic and antipsychotic for acute agitation, but prolongs QTc significantly and requires ECG monitoring before administration.

Formulation & Access

Brand Names

Droleptan

Parenteral

Ampoules (10 mg/2 mL) for IM or IV use.

Prescribing & PBS

Hospital emergency/ED supply. S4.

Indications & Use

Primary

TGA

Acute behavioral disturbance, severe nausea/vomiting, procedural sedation adjunct.

Clinical Place

The first-line chemical restraint in WA Health EDs for violent, uncooperative patients. Faster and more reliable than IM Haloperidol.

Quick reference

Class & Role

Butyrophenone — Highly potent, ultra-fast-acting butyrophenone.

Route / Formulation

Ampoules (10 mg/2 mL) for IM or IV use. (Droleptan)

Usual Dose & Max

IM 5-10 mg STAT. May repeat 5 mg after 15 mins if no effect. (Use 10 mg for violently agitated adults). Max 10 mg (STAT IM dose) or 20 mg/day.

Key Indication Doses

Severe Acute Agitation (Code Black): IM 5-10 mg STAT. May repeat 5 mg after 15 mins if no effect. (Use 10 mg for violently agitated adults). Severe Nausea/Vomiting: IV 0.625 - 1.25 mg STAT (Off-label, highly effective antiemetic). Elderly / Frail: Max 2.5 - 5 mg STAT. High risk of excessive sedation and EPS.

Best Uses

Droperidol is a potent butyrophenone antiemetic and antipsychotic for acute agitation, but prolongs QTc significantly and requires ECG monitoring before administration.

Key Risks

Cardiovascular: QTc prolongation and Torsades de Pointes. Hypotension (due to alpha-1 blockade). Neurological: Extrapyramidal side effects (EPS), acute dystonia, severe akathisia (often emerges 24h later). Respiratory: Does not depress respiratory drive (unlike benzodiazepines).

Key Interactions

Other QTc prolonging agents (Amiodarone, Sotalol, Macrolides). Additive sedation with Benzodiazepines/Opioids.

Monitoring

Perform a baseline ECG as soon as the patient is calm enough to permit it to check QTc. Monitor SpO2, RR, and Sedation Score. Droperidol lowers the seizure threshold slightly; observe if given for alcohol withdrawal.

Clinical Pearl

Droperidol fixes the violent agitation in 10 minutes, but 12 hours later the patient may become severely restless, pacing, and unable to sit still. This is Droperidol-induced akathisia, NOT a return of their underlying psychosis. Treat with Diazepam or Benzatropine.

Access

Droleptan

Brand: Droleptan

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Butyrophenone·Psychiatry - Acute Calming & Sedation

Droperidol

Acute behavioral disturbance, severe nausea/vomiting, procedural sedation adjunct

ED SEDATIONDroleptanS4TGA

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

10 mg STAT

Half-life

2 h

High risk: QTc Risk

CRITICAL RISK

Sedation

RAPID

Cautions

Avoid / Cautions

Known prolonged QTc > 500 ms, Parkinson's disease, severe CNS depression. Pregnancy Category C.

Where it stands

Rapid Summary

Overview

Highly potent, ultra-fast-acting butyrophenone. The gold standard in emergency departments for severe, undifferentiated behavioral disturbance and violence.

Clinical Focus

Infamous for dose-dependent QTc prolongation. Black Box warning in the US, though Australian ED guidelines strongly endorse its use in acute agitation.

Bottom Line

Droperidol is a potent butyrophenone antiemetic and antipsychotic for acute agitation, but prolongs QTc significantly and requires ECG monitoring before administration.

Formulation & Access

Brand Names

Droleptan

Parenteral

Ampoules (10 mg/2 mL) for IM or IV use.

Prescribing & PBS

Hospital emergency/ED supply. S4.

Indications & Use

Primary

TGA

Acute behavioral disturbance, severe nausea/vomiting, procedural sedation adjunct.

Clinical Place

The first-line chemical restraint in WA Health EDs for violent, uncooperative patients. Faster and more reliable than IM Haloperidol.

Quick reference

Class & Role

Butyrophenone — Highly potent, ultra-fast-acting butyrophenone.

Route / Formulation

Ampoules (10 mg/2 mL) for IM or IV use. (Droleptan)

Usual Dose & Max

IM 5-10 mg STAT. May repeat 5 mg after 15 mins if no effect. (Use 10 mg for violently agitated adults). Max 10 mg (STAT IM dose) or 20 mg/day.

Key Indication Doses

Best Uses

Droperidol is a potent butyrophenone antiemetic and antipsychotic for acute agitation, but prolongs QTc significantly and requires ECG monitoring before administration.

Key Risks

Key Interactions

Other QTc prolonging agents (Amiodarone, Sotalol, Macrolides). Additive sedation with Benzodiazepines/Opioids.

Monitoring

Clinical Pearl

Access

Droleptan

Brand: Droleptan

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.