worried about droperidol's black box warning?

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Drop is a great substance. Probably much less risky than a taser.
 
pgg said:
Every hospital I work at has taken droperidol off formulary. Can't get it.

Haloperidol works just as well though.
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I don't think it is available in the US anymore.
 
How are you guys dosing your haldol? I usually give a 1mg IV every 20-30 minutes prn..
 
As a postop PRN antiemetic, 0.5 mg q5min to a max of 2 mg.

When I use it intraop, I give 0.5 mg about 10-15 min before wake up. My non-antiemetic indication for giving it then is the young, strong male who looks like he's going to wake up angry.
 
pgg said:
As a postop PRN antiemetic, 0.5 mg q5min to a max of 2 mg.

When I use it intraop, I give 0.5 mg about 10-15 min before wake up. My non-antiemetic indication for giving it then is the young, strong male who looks like he's going to wake up angry.
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I use precedex for those folks too. I generally use haldol for the angry guys after precedex fails and for the old folks who wake up more than a little delirious.
 
Anyone know the relative potency of single shot clonidine vs single shot precedex? Im quite used to bolusing iv clonidine when indicated but my hosp ironically (cost-wise) makes precedex much more readily available.
 
pgg said:
When I use it intraop, I give 0.5 mg about 10-15 min before wake up. My non-antiemetic indication for giving it then is the young, strong male who looks like he's going to wake up angry.
Click to expand...

I used droperidol for this when it was available.
Now, I like Precedex > Ketamine > Haldol for anti-crazy.
 
cchoukal said:
Tardive dyskinesia is forever, extrapyramidal side effects are not, and would not be expected at these doses (1-2 mg, vs the hundreds of mg/day given to psychotic patients).
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I was under the impression that EPS was very common at doses of haloperidol WAY lower than hundreds of mg.


This study gave 21 healthy men 4 mg of haloperidol and claims that most had EPS:
http://www.ncbi.nlm.nih.gov/pubmed/10350027

Rosebush et al, prospectively studied the neuroleptic side effect profile of 350 consecutive neuroleptic-naïve patients admitted to an acute care psychiatric hospital. Despite a low average daily dose of haloperidol (e.g. 3.7 mg), more than 50% of patients suffered extrapyramidal side effects with 127 episodes of acute dystonia that required immediate benztropine treatment.
Rosebush PI, Mazurek MF. Neurologic side effects in neuroleptic-naive patients treated with haloperidol or risperidone. Neurology 1999;52:782-785.

Remember the side effects of haloperidol: a case report. https://www.researchgate.net/public...the_side_effects_of_haloperidol_a_case_report
 
Right, so at 100-300% the dose that's routinely used, yes, it sounds like there are side effects. In clinical practice in the ICU, I can't say I've seen this, but I guess it's a function of how hard you look.
 
cchoukal said:
Right, so at 100-300% the dose that's routinely used, yes, it sounds like there are side effects. In clinical practice in the ICU, I can't say I've seen this, but I guess it's a function of how hard you look.
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True, I was just responding to the 'hundreds of mg' part.
 
fakin' the funk said:
I used droperidol for this when it was available.
Now, I like Precedex > Ketamine > Haldol for anti-crazy.
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I'm sure precedex works well, but it seems like an unnecessarily expensive tool here. Good pain control and low dose haldol (2mg) have worked well for me with potential brawlers. Also helps kill two birds with the anti-emetic.
A ketamine dose for anti-crazy sedation (beyond pain control dosing), would be too heavy for too long I would think. And if they aren't sedated enough with it, you might be playing with fire.
 
Pooh & Annie said:
I'm sure precedex works well, but it seems like an unnecessarily expensive tool here. Good pain control and low dose haldol (2mg) have worked well for me with potential brawlers. Also helps kill two birds with the anti-emetic.
A ketamine dose for anti-crazy sedation (beyond pain control dosing), would be too heavy for too long I would think. And if they aren't sedated enough with it, you might be playing with fire.
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Precedex works very well. TBH, I don't know how expensive it is, but I would be loath to crack a big vial for single case. The brawlers tend to come in clusters though.

Getting haldol from pharmacy to me in the OR would take 1-2 hours and raise a lot of eyebrows in my work setting/hospital. That's a logistical situation. It's annoying.

Ketamine 5-20mg after emergence, if someone wakes up brawling or noncooperative, isn't "too heavy for too long" -- it gives a 1000-yard stare for 5-10 minutes -- and I don't know what fire you're talking about.
 
fakin' the funk said:
Precedex works very well. TBH, I don't know how expensive it is, but I would be loath to crack a big vial for single case. The brawlers tend to come in clusters though.

Getting haldol from pharmacy to me in the OR would take 1-2 hours and raise a lot of eyebrows in my work setting/hospital. That's a logistical situation. It's annoying.

Ketamine 5-20mg after emergence, if someone wakes up brawling or noncooperative, isn't "too heavy for too long" -- it gives a 1000-yard stare for 5-10 minutes -- and I don't know what fire you're talking about.
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Dosing for the 1000 yard stare/k-hole doesn't wear off in 5-10 minutes, in my experience. And the fire I'm talking about is the ketamine without sedation dysphoria/agitation/terrors. I love using ketamine too. I just think in higher doses it can have problematic effects of not used cautiously at the end of a case.
 
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