Alshehri Abdulmajeed M, Crowley Kaitlin E, Lupi Kenneth E, Kim Christine S, DeGrado Jeremy R, Marino Kaylee
Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3360, Riyadh, 11481, Saudi Arabia.
King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
BMC Emerg Med. 2024 Dec 18;24(1):232. doi: 10.1186/s12873-024-01158-9.
Droperidol is a first-generation antipsychotic medication that has been used for various indications in the emergency department (ED); however, its use has been controversial due to reports of QT prolongation and the risk of torsades de pointes (TdP). The aim of the study is to evaluate the safety of droperidol administration in the ED.
This was a retrospective study, conducted at an academic level I trauma center. System-generated reports were used to identify all droperidol administrations in the ED from the time that droperidol was reintroduced to the institutional formulary on July 1, 2019 through January 31, 2023. The major safety endpoint was a composite of the incidence of QTc interval prolongation, incidence of TdP, ventricular arrhythmia, or hypotension.
A total of 327 administrations of droperidol were identified in 245 patients in the ED. The composite safety endpoint occurred in 30 (9.1%) administrations. None of these events were classified as "probable" or "definite" on the Naranjo adverse drug reaction probability scale. No episodes of TdP or serious ventricular arrhythmia were reported. Higher cumulative droperidol dose and creatinine clearance < 60 mL/min were associated with an increased odds of developing QTc prolongation (OR 1.27 [CI 1.04-1.56]) and (OR 1.01 [CI 1.0-1.02]), respectively.
The study supports the use of low dose droperidol for various indications in the ED. There were no serious adverse events reported that could be directly attributed to droperidol use; however, it is crucial to consider the potential dose dependent impact on QTc prolongation.
氟哌利多是第一代抗精神病药物，已在急诊科用于多种适应症；然而，由于有QT间期延长和尖端扭转型室速（TdP）风险的报道，其使用一直存在争议。本研究的目的是评估在急诊科使用氟哌利多的安全性。
这是一项在一级学术创伤中心进行的回顾性研究。利用系统生成的报告来识别2019年7月1日氟哌利多重新纳入机构处方集至2023年1月31日期间急诊科所有的氟哌利多用药情况。主要安全终点是QTc间期延长发生率、TdP发生率、室性心律失常或低血压的综合指标。
在急诊科的245例患者中共识别出327次氟哌利多用药。30次（9.1%）用药出现了综合安全终点。根据Naranjo药物不良反应概率量表，这些事件均未被归类为“可能”或“肯定”。未报告TdP或严重室性心律失常事件。较高的氟哌利多累积剂量和肌酐清除率<60 mL/min分别与QTc延长（OR 1.27 [CI 1.04 - 1.56]）和（OR 倍数 1.01 [CI 1.0 - 1.02]）发生几率增加相关。
该研究支持在急诊科使用低剂量氟哌利多治疗多种适应症。未报告可直接归因于使用氟哌利多的严重不良事件；然而，考虑其对QTc延长的潜在剂量依赖性影响至关重要。
