Butyrophenone antipsychotic / antiemetic Pregnancy: A limited amount of clinical data has shown no increase in malformative risk and droperidol has not been shown to be teratogenic in rats, but animal studies are insufficient regarding effects on pregnancy and embryonal/foetal, parturition and postnatal development. Temporary extrapyramidal neurological disturbances have been described in newborns of mothers on long-term high-dose neuroleptics. As a precautionary measure it is preferable not to administer droperidol during pregnancy; in late pregnancy, if administration is necessary, monitoring of the newborn's neurological functions is recommended. Butyrophenone neuroleptics are excreted in breast milk - treatment during breastfeeding should be limited to a single administration and repeat administration is not recommended.

Droperidol

Brand names: Xomolix

Droperidol is a butyrophenone antipsychotic used in low doses as an antiemetic, particularly for the prevention and treatment of postoperative and opioid-related nausea and vomiting.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Prevention and treatment of post-operative nausea and vomiting (PONV), adults: 0.625 mg to 1.25 mg (0.25 to 0.5 mL of the 2.5 mg/mL solution).

Route: For intravenous use

Frequency: Administration is recommended 30 minutes before the anticipated end of surgery; repeat doses may be given every 6 hours as required

Max: For prevention of nausea and vomiting induced by morphine derivatives during post-operative patient controlled analgesia (PCA): up to a maximum daily dose of 5 mg droperidol

Elderly (over 65 years): 0.625 mg (0.25 mL). Renal or hepatic impairment: 0.625 mg (0.25 mL). SECOND INDICATION - prevention of nausea and vomiting induced by morphine derivatives during post-operative patient controlled analgesia (PCA), adults: 15 to 50 micrograms droperidol per mg of morphine, up to a maximum daily dose of 5 mg droperidol; no data are available in PCA for the elderly (over 65 years) or for renal and hepatic impairment, and PCA use is not indicated in children or adolescents. The dosage should be adapted to each individual case, taking into account age, body weight, use of other medicinal products, type of anaesthesia and surgical procedure. Continuous pulse oximetry should be performed in patients with identified or suspected risk of ventricular arrhythmia and should continue for 30 minutes following single intravenous administration. Patients at risk of cardiac arrhythmia should have serum electrolytes and creatinine assessed and QT prolongation excluded before administration. US labelling (for cross-check only, not the preferred source) differs: maximum recommended initial dose 2.5 mg IM or slow IV with additional 1.25 mg doses administered with caution, and it states droperidol is not recommended for any use other than perioperative nausea and vomiting in patients for whom other treatments are ineffective or inappropriate. Source for the posology above: eMC SPC for Droperidol 2.5mg/ml Solution for Injection.

Paediatric dose

Route: Intravenous

Frequency: Administered 30 minutes before the anticipated end of surgery; repeat doses may be given every 6 hours as required

Max: 1.25 mg

eMC section 4.2 verbatim, for prevention and treatment of post-operative nausea and vomiting: 'Children (2 to 11 years) and adolescents (12 to 18 years): 10 to 50 microgram/kg (up to a maximum of 1.25 mg).' Expressed as a RANGE in the source, so no single dosePerKg value is recorded. Children below the age of 2 years: not recommended. Droperidol is not indicated in children or adolescents for prevention of nausea and vomiting induced by morphine derivatives during patient controlled analgesia. Continuous pulse oximetry should be performed in patients with identified or suspected risk of ventricular arrhythmia and continued for 30 minutes after a single intravenous administration. Verify all under-18 dosing against a children's formulary before prescribing.

Dose adjustments

Renal

Renal impairment (PONV indication): 0.625 mg (0.25 mL). No data are available in renal impairment for the patient controlled analgesia indication. Renal failure, particularly chronic dialysis, is listed as a risk factor requiring careful evaluation for cardiac arrhythmia before administration.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to droperidol, to any of the excipients, or to butyrophenones
Known or suspected prolonged QT interval (QTc greater than 450 msec in females and greater than 440 msec in males), including congenital long QT interval and a family history of congenital QT prolongation
Concomitant treatment with medicinal products known to have a risk of torsades de pointes through QT prolongation
Hypokalaemia or hypomagnesaemia
Bradycardia (less than 55 beats per minute), or known concomitant treatment leading to bradycardia
Phaeochromocytoma
Comatose states
Parkinson's disease
Severe depression

Side effects

Drowsiness and sedation - the most frequently reported events
Cardiac: tachycardia and dizziness (common); cardiac arrhythmias including ventricular arrhythmias (uncommon); cardiac arrest (rare); torsade de pointes and electrocardiogram QT prolonged (very rare); sudden death (frequency not known)
Vascular: hypotension (common), syncope (uncommon)
Movement disorders and neurological: dystonia and oculogyration (uncommon); extrapyramidal disorder, convulsions and tremor (rare); epileptic fits, Parkinson's disease, psychomotor hyperactivity and coma (very rare)
Psychiatric: anxiety, restlessness/akathisia, confusional states and agitation (common to uncommon); dysphoria (rare); hallucinations (very rare)
Neuroleptic malignant syndrome and symptoms associated with it (changes in body temperature, stiffness, fever, altered mental status, autonomic instability); anaphylactic reaction, angioedema and hypersensitivity; bronchospasm and laryngospasm; blood dyscrasias; inappropriate antidiuretic hormone secretion

Interactions

Medicinal products known to prolong the QT interval or with a risk of torsades de pointes - contraindicated concomitantly (SPC section 4.3). Possible pharmacodynamic interactions occur with class I or III antiarrhythmics, QT-prolonging antihistamines, antimalarials, calcium channel blockers, QT-prolonging neuroleptics and antidepressants (US label)
Medicinal products likely to induce electrolyte imbalance (hypokalaemia and/or hypomagnesaemia) such as potassium-wasting diuretics, laxatives and glucocorticoids - caution is necessary to prevent QT prolongation (SPC section 4.4)
Other CNS depressants (barbiturates, tranquillisers, opioids, general anaesthetics) - additive or potentiating effects; the required dose of droperidol will be less than usual, and after droperidol the dose of other CNS depressant drugs should be reduced
Metoclopramide and other neuroleptics - concomitant use may lead to an increase in extrapyramidal symptoms and should be avoided (SPC section 4.4)
Strong CYP1A2 and CYP3A4 inhibitors - may decrease the rate at which droperidol is metabolised and prolong its pharmacological action; caution advised (SPC section 4.4)
NOTE: SPC section 4.5 was not retrieved as a separate section in this bundle; the entries above come from SPC sections 4.3 and 4.4 and from the US label Drug Interactions section - verify against the full UK SPC section 4.5

Clinical monograph

How it works

It antagonises central dopamine D2 receptors, including those in the chemoreceptor trigger zone, producing antiemetic and, at higher doses, neuroleptic effects.

Prescribing in practice

It can prolong the QT interval and has been associated with serious ventricular arrhythmias, so it should be avoided in patients with QT prolongation, significant electrolyte disturbance or other risk factors, and an ECG may be warranted.
It may cause sedation, hypotension and extrapyramidal reactions such as dystonia and akathisia.
The risk of arrhythmia is increased by concurrent use with other QT-prolonging medicines.

Monitoring

Assess for QT-prolongation risk factors, correct electrolytes, and monitor ECG and blood pressure where indicated.

Counselling the patient

Warn the patient that drowsiness may occur after administration.
Advise reporting palpitations, fainting or abnormal involuntary movements.

Evidence & guidelines

QT-related cautions reflect MHRA and SPC warnings; its antiemetic efficacy is supported by perioperative practice.

Reference: AAGBI; SAMBA PONV guideline; MHRA Drug Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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