DROPERIDOL VERSUS HALOPERIDOL FOR ACUTE AGITATION IN THE EMERGENCY DEPARTMENT: A REVIEW OF EFFICACY, SAFETY, AND CLINICAL OUTCOMES

Acute agitation is a common and potentially dangerous presentation in the emergency department. When verbal de-escalation is unsuccessful or cannot be safely performed, medications may be required to rapidly control agitation and allow further medical evaluation. Haloperidol has historically been one of the most commonly used antipsychotic medications for this purpose. However, droperidol has gained renewed interest because of its rapid onset of action and effectiveness in controlling acute agitation. This review compares droperidol and haloperidol for the treatment of acute agitation in the emergency department, focusing on time to adequate sedation, need for repeat or rescue medications, adverse effects, QT prolongation, extrapyramidal symptoms, respiratory complications, and practical considerations for emergency physicians. Available evidence suggests that both medications are effective, but droperidol may provide faster and more reliable control of agitation and may decrease the need for additional medication. Concerns regarding QT prolongation remain important with both medications, although serious cardiac events associated with droperidol appear uncommon at doses typically used in emergency medicine. Current emergency medicine guidelines support droperidol as an effective option for severe agitation while continuing to recognize haloperidol as an appropriate treatment.