Dosing & Uses
Dosage Forms & Strengths
- <55 years old: 0.1-0.2 mg/kg/min IV
- >55 years old or debilitated or ASA III/IV: 0.05-0.1 mg/kg/min IV
- 0.025-0.075 mg/kg/min IV
- Geriatric: 0.02-0.06 mg/kg/min IV
20 mg IV; may repeat
Serious - Use Alternative
Significant - Monitor Closely
Hypotension (peds 17%; adults 3-26%)
Apnea lasting 30-60 sec (peds 10%; adults 24%)
Apnea lasting >60 sec (peds 5%; adults 12%)
Movement (peds 17%; adults 3-10%)
Injection site burning/stinging/pain (peds 10%; adults 18%)
Respiratory acidosis during weaning (3-10%)
Hypertension (peds 8%)
Rash (peds 5%; adults 1-3%)
Cardiac output decreased (1-3%; concurrent opioid use increases incidence)
Renal tubular toxicity
Lack of ventilatory support
Severe cardiac dysfunction
Documented hypersensitivity, egg allergy, soybean/soy allergy
Sedation in pediatric ICU patients
Use in labor and delivery (including cesarean section) may cause neonatal depression
Drug vehicle (emulsion) is capable of supporting rapid growth of microorganisms; proper aseptic technique is imperative
Closely monitor patients with anemia, hepatic impairment, myxedema, or renal impairment
Risk of potentially fatal propofol infusion syndrome in ICU patients
Do not give bolus to ASA III/IV patients; rapid bolus doses will increase cardiorespiratory effects (ie, hypotension, apnea, airway obstruction)
Significant hypertriglyceridemia may be observed during infusion of propofol; 0.1 g lipid (1.1 kcal) per 1 mL propofol
Accidental extravasation may result in tissue necrosis
Risk of chills, fever, body aches
Propofol infusion syndrome may occur; this is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, and cardiac and renal failure (esp with prolonged, high-dose infusions >5 mg/kg/hr for >48 hr)
Anxiety, agitation, and resistance to mechanical ventilation may occur with abrupt withdrawal
General anesthetics and sedation drugs in young children and pregnant women
- Brain development
- Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
- Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
- Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
Pregnancy & Lactation
Pregnancy category: B
Lactation: Excreted in breast milk; effect on nursing infant not known
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Short-acting, lipophilic sedative/hypnotic; causes global CNS depression, presumably through agonist actions on GABAa receptors
Onset: 30-45 sec
Duration: 3-10 min (dose-dependent duration; dissipation is function of drug redistribution from CNS)
Protein bound: 97-99%
Metabolized by hepatic conjugation to inactive compound
Half-life: 40 min (initial); 24-72 hr (after 10-day infusion)
Excretion: Urine, feces
Y-site: Amikacin, amphotericin B, atracurium, bretylium, calcium chloride, ceftazidime (?), ciprofloxacin, cisatracurium, diazepam, digoxin, doxorubicin, gentamicin, levofloxacin, methotrexate, methylprednisolone sodium succinate, metoclopramide, minocycline, mitoxantrone, morphine sulfate (at high conc of morphine, compatible at 1 mg/mL), netilmicin, phenytoin, tobramycin, verapamil
Do not mix with other drugs prior to administration
Solution: D5W, LR, D5/LR, D5/0.45% NaCl, D5/0.2% NaCl
Syringe: ondansetron, thiopental
Y-site (partial list): Acyclovir, buprenorphine, dopamine, dobutamine, epinephrine, fentanyl, furosemide, hydromorphone, ketamine, lidocaine, meperidine, midazolam (?), nitroglycerin, KCl, MgSO4, vecuronium
Does not need to be diluted (available form: 10 mg/mL); however, may be further diluted in D5W to 2 mg/mL
To reduce pain associated with injection, use larger veins of forearm or antecubital fossa; lidocaine IV (1 mL of a 1% solution) may also be used prior to administration
Do not use filter with <5 micron for administration
Soybean fat emulsion is used as a vehicle for propofol
Strict aseptic technique must be maintained in handling, although a preservative has been added
Do not administer through the same IV catheter with blood or plasma
American College of Critical Care Medicine recommends use of a central vein for administration in an ICU setting
Store at room temp; refrigeration is not recommended
Protect from light
Do not use if there is evidence of separation of phases of emulsion
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.