Droperidol has a black box warning regarding the QT interval prolongation. Our department has studied this extensively and found it to be a greatly exaggerated danger.
Here are two abstracts
QT Lengthening after Parenteral Droperidol Administration
Stephen W Smith, Marc Martel, Michelle Biros, Marsha Zimmerman and Peter ChaseHennepin County Medical Center: Minneapolis, MN SAEM, St. Louis 2002
Objectives: Recently, the Food and Drug Administration (FDA) warned of a prolonged QT interval and torsade de pointes as a complication of droperidol (DROP). We sought to determine the frequency of a significantly prolonged QT interval (LQT) in patients who received DROP, and to compare this with the QT interval of patients not receiving DROP. Methods: The EmSTAT electronic patient database was searched from January 1, 1997, through November 30, 2001, for all patients who received DROP. Those who had an electrocardiogram (ECG) ordered at least 30 minutes after administration of DROP were identified. These ECGs were reviewed and the computerized corrected QT intervals (QTc) were recorded. A medication-induced QTc of less than 480 ms is generally considered safe; we defined LQT by QTc greater than 480 ms. Medical records of patients with LQT were further reviewed for previous ECGs, contributing medical conditions, and adverse events. The QTc's of 100 consecutive patients who did not receive DROP were reviewed as controls. Data were analyzed with descriptive statistics and Fisher's exact test. Results: 15,374 patients received 18,020 doses of DROP; 682 had an ECG recorded after DROP, 450 were obtained at least 30 minutes after administration. LQT was found in 17 patients, 1 had left bundle branch block (LBBB), 1 had a paced rhythm, 1 had right bundle branch block (RBBB), resulting in a total of 14 with a normal QRS and LQT (3.1%). Four of these 14 had previously documented LQT not associated with DROP. None had an adverse event related to LQT. Of 100 consecutive patients in the control group, 4 had LQT (4.0%) (p = 0.76) Conclusions: Our study does not support an effect of DROP on the frequency of LQT.
QT Prolongation and Cardiac Arrhythmias Associated with Droperidol Use in Critical Emergency Department Patients
Marc Martel, James Miner, Seth Lashkowitz, Mark Danahy, Joseph Clinton and Michelle BirosHennepin County Medical Center: Minneapolis, MN SAEM Boston 2003
Background: QT prolongation and torsade de pointes (TdP) have been reported as a complication of droperidol (Drop). Objectives: To determine the change in the corrected QT interval (QTc) and the incidence of cardiac arrhythmias in critically ill patients who received Drop. Methods: The medical records of all critical care ED patients from 1/1/1997 to 12/31/2001 were hand searched for those who received Drop and an ECG in the ED. Drop dose, ECG time, QTc intervals, and cardiac rhythm were reviewed. ECGs with atrial fib/flutter, right or left bundle branch block, or paced rhythms were excluded. Data was analyzed in 3 groups, patients with an ECG recorded only before Drop, only after Drop, and those with ECGs both before and after Drop. Data was analyzed using descriptive statistics and chi-squared. Results: 11,583 charts were reviewed, 1172 patients received Drop, and 396 had both an ECG and Drop in the ED. 44 patients were excluded due to abnormal rhythm, bundle branch block, or paced rhythm. 96 patients had an ECG only before Drop (mean 33.3min prior), average dose of 2.75mg, and mean QTc of 435.0ms (95% CI 428.1–441.9ms). 186 patients had an ECG only after Drop (mean 25.9min after), average dose of 3.68mg, and mean QTc of 433.3ms (95% CI 427.8 to 438.8ms). 114 patients had ECGs before and after Drop (mean time 28.2min before, 108.8min after), average dose of 2.21mg, and mean QTc of 435.7ms (95% CI 426.7–444.7ms) and 435.8ms (95% CI 427.5–444.1ms) before and after Drop, respectively. The mean ratio of the QTc before and after Drop is 1.005 (95% CI 0.985–1.025). 2 patients had ventricular arrhythmias in the before Drop group, 3 in the after Drop group, and 4 in the before and after Drop group (p = 0.5). 1 patient had an unrecorded event of TdP with a QTc of 466ms after conversion. Conclusions: We detected no statistical difference in the change of the QTc interval or occurrence of ventricular arrhythmias in critically ill patients who received Drop.