propofol (Rx)

Brand and Other Names:Diprivan
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
more...

Anesthesia

Induction

  • <55 years ASA I/II: 40 mg IVP q10sec until onset (2-2.5 mg/kg IV when not premedicated with oral benzodiazepines or intramuscular opioids) 
  • >55 years or debilitated or ASA III/IV: 20 mg IVP q10sec until onset (1-1.5 mg/kg); do not use rapid bolus because as it will increase likelihood of undesirable cardiorespiratory depression, including hypotension, apnea, airway obstruction, and/or oxygen desaturation

Maintenance

  • <55 years ASA I/II: 0.1-0.2 mg/kg/min IV; administered in a variable rate infusion with nitrous oxide 60% to 70% and oxygen provides anesthesia for patients undergoing general surgery; maintenance infusion should immediately follow induction dose to provide satisfactory or continuous anesthesia during induction phase
  • Intermittent bolus: Increments of 25-50 mg (2.5-5 mL) may be administered with nitrous oxide in adults undergoing general surgery; administer incremental boluses when changes in vital signs indicate response to surgical stimulation or light anesthesia
  • >55 years or debilitated or ASA III/IV: 0.05-0.1 mg/kg/min IV

MAC Sedation

Initiation

  • 0.1-0.15 mg/kg/min IV for 3-5 min; titrate to desired clinical effect; monitor respiratory function; administered as slow infusion or slow injection while monitoring cardiorespiratory function 
  • Slow injection: 0.5 mg/kg administered over 3-5 min; titrate to clinical response
  • Elderly: Do not use rapid bolus dose administration; administer over 3-5 min; reduce dose to approximately 80% of usual adult dose according to their condition, response, and changes in vital signs

Maintenance

  • Variable rate of infusion method preferable over intermittent bolus dose method
  • Variable rate infusion method: 0.025-0.075 mg/kg/min IV during first 10-15 min sedation maintenance; subsequently decrease infusion rates over time to 25 to 50 mcg/kg/min and adjust clinical response; allow approximately 2 min for onset of peak drug effect to titrate to clinical response; titrate downward in absence of clinical signs of light sedation until mild response to stimulation obtained to avoid sedative administration at rates higher than clinically necessary
  • Intermittent bolus method: Administer 10-20 mg increments and titrate to desired level of sedation
  • Elderly: 0.02-0.06 mg/kg/min IV; do not use rapid bolus dose administration; reduce rate of administration to 80% of usual adult dose according to their condition, response, and changes in vital signs

Postoperative Nausea/Vomiting

20 mg IV; may repeat

ICU Patient

Initiation: 0.005 mg/kg/min IV for at least 5 min; titrate to desired clinical effect; increase by 5-10 mcg/kg/min over 5-10 min intervals until desired sedation level achieved; allow a minimum of 5 min between adjustments for onset of peak effect 

For medical ICU patients or patients who recovered from effect of general anesthesia or deep sedation, rate of administration of 50 mcg/kg/min or more may be required to achieve adequate sedation

Maintenance: 0.005-0.05 mg/kg/min IV individualized and titrated to clinical response; (0.005 mg/kg/min increment increase q5min)

Discontinuation: Avoid discontinuation prior to weaning or for daily evaluation of sedation levels; may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
more...

Anesthesia

Induction

  • <3 years: Not recommended
  • 3-16 years ASA I/II: 2.5-3.5 mg/kg IVP over 20-30 sec when not premedicated or when lightly premedicated with oral benzodiazepines or intramuscular opioids; younger patients may required higher induction doses than older children; lower dosage recommended for children ASA III/IV 

Maintenance

  • 2 months-16 years ASA I/II: 0.125-0.3 mg/kg/min IV; after 30 min, if clinical signs of light anesthesia are absent, decrease infusion rate; children 5 years or younger may require larger infusion rates compared to older children
Next:

Interactions

Interaction Checker

and propofol

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            >10%

            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%)

            1-10%

            Respiratory acidosis during weaning (3-10%)

            Hypertriglyceridemia (3-10%)

            Hypertension (peds 8%)

            Rash (peds 5%; adults 1-3%)

            Pruritus (1-3%)

            Arrhythmia (1-3%)

            Bradycardia (1-3%)

            Cardiac output decreased (1-3%; concurrent opioid use increases incidence)

            Tachycardia (1-3%)

            <1%

            Arterial hypotension

            Anaphylaxis

            Asystole

            Bronchospasm

            Cardiac arrest

            Seizures

            Opisthotic rxn

            Pancreatitis

            Pulmonary edema

            Phlebitis

            Thrombosis

            Renal tubular toxicity

            Previous
            Next:

            Warnings

            Contraindications

            Documented hypersensitivity, egg allergy, soybean/soy allergy

            Cautions

            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

            May cause hypotension, especialy if patient is hypovolemic or if bolus dosing is used; reduction in mean arterial pressure may exceed 30%; use caution in patients who arehemodynamically unstable, hypovelimic, or have abnormally low vascular tone

            Use with caution in patients with severe cardiac disease (<50% ejection fraction) or hypotension; may have more profound adverse cardiovascular responses to propofol

            Use with caution in patients with increased intracranial pressure or impaired cerebral circulation; mean arterial pressure may decrease substantially; cerebral perfusion may subsequently decrease; consider continuous infusion or administer as a slow bolus

            Prefilled syringes may have potential to support growth of various microorganisms dispite additives intended to suppress microbial growth; strictly adhere to recommendations in product labeling for handling and administering propofol

            Use caution in patients with respiratory disease and history of epilepsy or seizures; seizures may occur during recovery phase

            Propofol lacks analgesic properties; pain management requires specific use of analgesic agents, at effective dosages; titrate propofol separately from analgesic agent

            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)

            Perioperative myoclonus reported with administration

            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
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Excreted in breast milk; effect on nursing infant not known

            Pregnancy Categories

            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.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Short-acting, lipophilic sedative/hypnotic; causes global CNS depression, presumably through agonist actions on GABAa receptors

            Absorption

            Onset: 30-45 sec

            Duration: 3-10 min (dose-dependent duration; dissipation is function of drug redistribution from CNS)

            Distribution

            Protein bound: 97-99%

            Metabolism

            Metabolized by hepatic conjugation to inactive compound

            Elimination

            Half-life: 40 min (initial); 24-72 hr (after 10-day infusion)

            Excretion: Urine, feces

            Previous
            Next:

            Administration

            IV Incompatibilities

            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

            IV Compatibilities

            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

            IV Preparation

            Does not need to be diluted (available form: 10 mg/mL); however, may be further diluted in D5W to 2 mg/mL

            IV Administration

            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

            Storage

            Store at room temp; refrigeration is not recommended

            Protect from light

            Do not use if there is evidence of separation of phases of emulsion

            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.

            Tier Description
            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.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous