Droperidol and Ondansetron-induced QT Interval Prolongation

Authors:
Publisher website
Google Scholar
Abstract
DROPERIDOL and 5-hydroxytryptamine type 3 receptor antagonists belong to the most effective antiemetics for prevention or treatment of postoperative nausea and vomiting.1 In 2001, the US Food and Drug Administration issued a “black box” warning regarding the potential for proarrhythmic events related to QT interval prolongation with droperidol use.1As a consequence, 5-hydroxytryptamine type 3 antagonists became the most used antiemetics, in particular in the United States.2 However, setrons share with droperidol the property to block the human ether-a-go-go–related gene (HERG) cardiac potassium channel underlying their theoretical proarrhythmic potential.3,4 Electrocardiographic data from patients in clinical studies are conflicting.5–8 In previous reports, White et al. 7 failed to demonstrate a statistically significant QT interval prolongation with 1.25 mg droperidol. In a study that was not placebo controlled, we found significant QT interval prolongation with 0.75 mg droperidol but also after 4 mg ondansetron.8 Despite the weak evidence for cardiac arrhythmic events in the clinical experience accumulated so far with these antiemetics, a new QT study was deemed to be important for a definitive assessment of the effects of these agents on the QT interval. Such a study was requested by the Food and Drug Administration but was stopped because of adverse neurologic effects induced by droperidol.2

This publication has 21 references indexed in Scilit: