Anesthesiology had 2 articles in the same journal about a year ago proving what we all have seen- drop is safe.
Paul White also wrote one that was very well done also. The comment that accompanied the article was also very good.
Its in the process now and the black box label may well be removed.
I would be suprised, since the FDA has said that the black box warning does not apply to the doses we typically use because this is an off label use and the black box warning only applies to approved dosages - thus we should have no excuse not to use it.
A couple of things about droperidol vs all 5-HT3's. The NNT (numbers needed to treat) for both for prevention is 4 to 5, and zofran is still more expensive than droperidol. Second, the NNT for treatment for zofran is 3. Bottom line, 5-HT3's are better treatment drugs then prevention (from a cost stand point).
What concerns me most about the black box warning is that there has NEVER been a case report in a peer reviewed journal of an adverse cardiac event in the doses we use - yet every 5-HT3 has had such reports. Also, many people have reviewed the "data" that the FDA used to make their decision. It has been reported by some that 9 of the adverse events came from the same hospital on the same day - very fishy if you ask me - and finally, when the FDA made the decision, they were without a head. I think something dirty went on under the table.
I use it much. What I like so much about it is once you have used a 5-HT3 and the patient still yacks, you can't (or shouldn't) redose the 5-HT3 because it is absolutely useless. However, there is a dose effect with droperidol, such that if .625 doesn't work, give another dose and it will have more of an effect, if this doesn't, you can repeat it. There IS a dose reponse. I find this very useful sometimes.
