2026 Eastern States Conference

Authors: 
Josephine Gresko, PharmD  
Tammy Nguyen, PharmD  
Savanna Scott, PharmD, BCEMP  
Katie Smithwick, PharmD, BCPP, BCPS  
 
Learning Objective: 
Audience members will compare and contrast efficacy and safety outcomes for droperidol and haloperidol when used for acute agitation in the emergency department (ED).   
 
Background/Objective: 
The objective of this quality improvement project was to characterize and compare droperidol versus haloperidol for agitation in the ED at VCU Medical Center.  
 
Methods: 
This quality improvement project consisted of a single center retrospective medical record review. The primary outcome was proportion of patients requiring additional medications for agitation within 15 minutes of initial droperidol or haloperidol administration. Secondary outcomes characterized the total antipsychotic dose, concomitant medications, and time to redosing any medication for agitation. Additional safety outcomes included patients requiring intubation, electrocardiogram monitoring, and proportion of patients experiencing extrapyramidal symptoms. All adult patients who received droperidol or haloperidol for acute agitation in the ED between October 11, 2024 and October 11, 2025 were included. Patients who received droperidol or haloperidol for any other indication were excluded. Descriptive statistics were used for demographic data. Continuous data was analyzed using t-test and categorical data using Fisher's exact or chi-square.   
 
Results: 
Of the 758 patients reviewed, 429 were excluded. Of those included, 59 received droperidol and 270 received haloperidol. Baseline characteristics were similar, except adults over 65 years were more likely to receive haloperidol (p=0.001). There was no statistically significant difference in the percentage of patients who required additional medications for agitation within 15 minutes of initial droperidol (24%) or haloperidol (16%) administration (p=0.224). The median doses used were 2.5 mg for droperidol and 5 mg for haloperidol. Time to redosing medications was similar between groups.  Haloperidol was more often given with concomitant lorazepam (p=0.012) or diphenhydramine (p=0.029). No other significant differences in outcomes were found. 
 
Conclusions: 
Droperidol and haloperidol had similar rates of treatment failure for agitation in this patient sample. However, lower doses of droperidol were given compared to published literature. Both antipsychotics demonstrated similar adverse effect profiles. Next steps include optimizing educational strategies for VCU Health ED providers surrounding use of droperidol in agitation, as regimens used do not reflect American College of Emergency Physicians’ recommendations, nor previous literature.  
 
Self-Assessment Question: 
True or false: Based on this retrospective review, droperidol is more effective at treating agitation in the ED compared to haloperidol.   
(False)