Citation

Calver L, Isbister GK. Br. J. Clin. Pharmacol. 2014; 77(5): 880-886.

Copyright

(Copyright © 2014, John Wiley and Sons)

DOI

10.1111/bcp.12272

PMID

unavailable

Abstract

Aims To investigate the QT interval after high dose droperidol using continuous 12-lead Holter recordings.

METHODS This was a prospective study of patients given droperidol with a continuous Holter recording. Patients were recruited from the DORM II study which included patients with aggression presenting to the emergency department. Patients initially received 10 mg droperidol as part of a standardized sedation protocol. An additional 10 mg dose was given after 15 min if required and further doses at the clinical toxicologist's discretion. Continuous 12-lead Holter recordings were obtained for 2-24 h utilizing high resolution digital recordings with automated QT interval measurement. Electrocardiograms were extracted hourly from Holter recordings. The QT interval was plotted against heart rate (HR) on the QT nomogram to determine if it was abnormal. QTcF (Fridericia's HR correction) was calculated and >500 ms was defined as abnormal.

RESULTS Forty-six patients had Holter recordings after 10-40 mg droperidol and 316 QT-HR pairs were included. There were 32 abnormal QT measurements in four patients, three given 10 mg and one 20 mg. In three of the four patients QTcF >500 ms but only in one taking methadone was the timing of QTcF >500 ms consistent with droperidol dosing. Of the three other patients, one took amphetamines, one still had QT prolongation 24 h after droperidol and one took a lamotrigine overdose. No patient given >30 mg had a prolonged QT. There were no arrhythmias.

CONCLUSION QT prolongation was observed with high dose droperidol. However, there was little evidence supporting droperidol being the cause and QT prolongation was more likely due to pre-existing conditions or other drugs. © 2013 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of The British Pharmacological Society.

Language: en

Keywords

Humans; adolescent; Adult; Aged; Female; Male; Middle Aged; adult; human; Adolescent; female; male; Prospective Studies; Aged, 80 and over; emergency department; aged; aggression; Electrocardiography; suicide attempt; article; clinical article; sedation; intravenous drug abuse; priority journal; hallucination; middle aged; drug safety; follow up; QT interval; puerperal depression; methadone; hepatitis C; drug megadose; amphetamine derivative; prospective study; lamotrigine; heart rate; heart arrhythmia; QT prolongation; droperidol; electrocardiogram; inhalation; electrocardiography; liquefied petroleum gas; Holter monitoring; very elderly; drug effects; Droperidol; Holter recording