Propofol


Full Generic Medicine Info
Dosage/Direction for Use

Intravenous
Induction and maintenance of general anaesthesia
Adult: As 1% emulsion given via IV inj or infusion or as 2% emulsion given via infusion: Induction: 40 mg every 10 seconds, titrated until clinical response is achieved. Usual dose: 1.5-2.5 mg/kg. Maintenance: 4-12 mg/kg/hr continuous infusion. Alternatively, 25-50 mg intermittent bolus inj of 1% emulsion. Target-controlled infusion (TCI) delivery system may also be used based on target blood concentrations, refer to detailed product guideline.
Child: As 1% emulsion for >1 monthgiven via infusion or intermittent bolus inj or as 2% emulsion for >3 years given via infusion: Induction: 2.5-4 mg/kg. Maintenance: 9-15 mg/kg/hr.
Elderly: Induction: 20 mg every 10 seconds until onset of induction. Maintenance: 3-6 mg/kg/hr.

Intravenous
Sedation
Adult: In surgical and diagnostic procedures: Initially, 6-9 mg/kg/hr infused over 3-5 minutes. Alternatively, 0.5-1 mg/kg via slow injection over 1-5 minutes. Maintenance: 1.5-4.5 mg/kg/hr via infusion. Additional 10-20 mg incremental bolus inj as 1% emulsion may be given if rapid increase in the depth of sedation is required. As 1% or 2% emulsion: In intensive care setting: Induction and maintenance: 0.3-4 mg/kg/hr via infusion over 5 minutes. Rate of administration may be individualised and titrated based on desired depth of sedation.
Child: As 1% emulsion for >1 month or as 2% emulsion for >3 years: In surgical and diagnostic procedures: 1-2 mg/kg given via infusion. Dose and rate of administration is adjusted according to the required depth of sedation and clinical response. Maintenance: 1.5-9 mg/kg/hr via infusion. May be supplemented with up to 1 mg/kg via bolus inj as 1% emulsion if rapid increase of depth of sedation is required.
Elderly: As 1% or 2% emulsion: Induction: Same as adult dose. Avoid rapid bolus inj. Maintenance: 80% of adult dose. Individualise dosage according to response.
Contraindications
Sedation in ICU setting in children <16 years.
Special Precautions
Patient with lipid metabolism disorders such as hypertriglyceridaemia or pancreatitis, or risk of fat overload; cardiac impairment; pulmonary insufficiency or respiratory depression; increased intracranial pressure or impaired cerebral circulation; hypovolaemia, unstable haemodynamics, abnormal low vascular tone (e.g. sepsis); risk factors for PRIS (e.g. decreased oxygen delivery, sepsis, serious cerebral injury). Patient predisposed to zinc deficiency (e.g. diarrhoea, major sepsis, burns). ASA grade 3 or 4, debilitated and epileptic patient. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation. . Avoid abrupt discontinuation; taper infusion dose to prevent withdrawal (for prolonged infusions). Not recommended for obstetric anaesthesia including caesarean section deliveries. Patient Counselling This drug may impair ability to drive or operate machinery. Monitoring Parameters Monitor cardiac input, blood pressure, oxygen saturation (during monitored anaesthesia care sedation); ABG (prolonged infusions). Monitor signs and symptoms of PRIS. Monitor serum triglycerides prior to initiation of therapy for ICU sedation and every 3-7 days thereafter; zinc level after 5 days of treatment.
Adverse Reactions
Significant: ECG effects (e.g. QT shortening/prolongation), hypertriglyceridaemia, hypotension, injection-site reaction, perioperative myoclonus (e.g. convulsions, opisthotonos), involuntary movement, Rarely, postoperative unconsciousness with or without an increase in muscle tone, anaphylaxis, hypersensitivity reactions. Cardiac disorders: Cardiac arrhythmia, low cardiac output, tachycardia. Gastrointestinal disorders: Nausea and vomiting. Metabolism and nutrition disorders: Respiratory acidosis. Nervous system disorders: Headache. Psychiatric disorders: Depression, confusion. Respiratory, thoracic and mediastinal disorders: Cough, laryngospasm. Skin and subcutaneous tissue disorders: Rash, pruritus. Vascular disorders: Hypertension.
Potentially Fatal: Propofol-related infusion syndrome (PRIS) (e.g. lactic acidosis, hyperlipidaemia, hyperkalaemia, rhabdomyolysis). Abuse and dependence.
Overdosage
Symptoms: Cardiovascular and respiratory depression. Management: Provide artificial ventilation with oxygen for respiratory depression. Reposition patient by raising the legs and lowering the head; increase IV fluids flow rate or administering plasma expanders and pressor agents to manage cardiovascular depression.
Drug Interactions
Additive sedative/anaesthetic and cardiorespiratory depressant effect with other CNS depressants. Profound hypotension with rifampicin. Valproate may increase serum levels of propofol.
Food Interaction
Enhanced sedative effect with alcohol.
Action
Propofol is a short-acting, liphophilic general anaesthetic. It is thought to produce sedative/anaesthetic effects through positive modulation of inhibitory function of the neurotransmitter GABA through the GABAA receptors and possibly reduced glutamatergic activity through NMDA receptor blockade.
Onset: 9-51 seconds (average: 30 seconds).
Duration: 3-10 minutes.
Distribution: Crosses the placenta, enters breastmilk (small amounts). Volume of distribution: 2-10 L/kg; 60 L/kg (10-day infusion). Plasma protein binding: 97-99%.
Metabolism: Metabolised in the liver to water-soluble sulfate and glucuronide conjugates.
Excretion: Via urine (Approx 88% as metabolites, 40% as glucuronide metabolite); faeces (<2%). Elimination half-life: Initial: 40 minutes; Terminal: 4-7 hours; 24-72 hours (10-day infusion).
Storage
Intravenous: Store between 20-25°C. Do not freeze.
CIMS Class
Anaesthetics- local & general
ATC Classification
N01AX10 - propofol ; Belongs to the class of other general anesthetics.
Disclaimer: This information is independently developed by CIMS based on propofol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 CIMS. All rights reserved. Powered by CIMSAsia.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in