Droperidol, QT prolongation, and sudden death: What is the evidence?

Louise W. Kao, Mark A. Kirk, Stephanee J. Evers, Stephen H. Rosenfeld

Research output: Contribution to journalReview article

96 Scopus citations

Abstract

Study objective: Droperidol is a butyrophenone commonly used as an antiemetic and antipsychotic in the United States since US Food and Drug Administration (FDA) approval in 1970. Its labeling has recently been revised, with a black box warning for cases of QT prolongation leading to torsades de pointes and death. A black box warning is applied when serious adverse drug reactions are uncovered for medications. We sought to examine the evidence of a causal association suggested by the black box warning to aid clinicians in their risk-benefit analyses regarding further use of droperidol. Methods: A literature search was undertaken to determine the evidence regarding the association between droperidol and QT prolongation or torsades de pointes. The evidence was then evaluated by using evidence-based medicine principles. In addition, a review of the FDA regulatory process is presented. Results: Three clinical studies, 1 published abstract, and 7 case reports were reviewed. Available postmarketing surveillance data (MedWatch reports) were also reviewed. Applying the criteria of evidence-based medicine and Hill's criteria, the evidence is not convincing for a causal relationship between therapeutic droperidol administration and life-threatening cardiac events. Conclusion: The recent black box warning appears to have originated from postmarketing surveillance data rather than data reported in the peer-reviewed medical literature. Ongoing monitoring of drug safety and more definitive study appear appropriate.

Original languageEnglish (US)
Pages (from-to)546-558
Number of pages13
JournalAnnals of emergency medicine
Volume41
Issue number4
DOIs
StatePublished - Apr 1 2003

ASJC Scopus subject areas

  • Emergency Medicine

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