To the Editor:—
I read with interest the recent article and accompanying editorial regarding the black box warning on the package insert for droperidol.1,2Nuttall et al. 2indicate that droperidol is a safe, effective, and inexpensive antiemetic and that the black box warning on the package insert is not needed. In addition, they seem to believe that their use of droperidol is prevented by the presence of the boxed warning.2
I was surprised that according to their study,2the use of droperidol completely stopped after the addition of the black box warning. In contrast, midazolam, succinylcholine, and ketorolac all have black box warnings and still appear to be widely used by anesthesiologists.3Furthermore, the presence of a black box warning on a medication's package insert is not the same as the withdrawal of a medication, so clinicians are still able to use it if they choose to.
In view of the events surrounding the withdrawal of rofecoxib (Vioxx)4and other medications,5the US Food and Drug Administration should make every effort to protect patients from drugs that may be dangerous and to alert physicians of these dangers.
At my institution, antiemetics other than droperidol seem to be adequate for the prevention or treatment of postoperative nausea and vomiting, so we are to able to get along without droperidol. Moreover, ondansetron is now available as a generic medication, so this alternative to droperidol should be cheaper.6
Holy Redeemer Hospital and Medical Center, Meadowbrook, Pennsylvania. firstname.lastname@example.org