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Propofol

Medically reviewed by Drugs.com. Last updated on Oct 23, 2020.

Pronunciation

(PROE po fole)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Emulsion, Intravenous:

Diprivan: 100 mg/10 mL (10 mL); 200 mg/20 mL (20 mL); 500 mg/50 mL (50 mL); 1000 mg/100 mL (100 mL) [contains edetate disodium, egg phospholipids (egg lecithin), glycerin, soybean oil]

Fresenius Propoven: 2000 mg/100 mL (100 mL) [contains egg phosphatides, soybean oil]

Generic: 1000 mg/100 mL (100 mL); 200 mg/20 mL (20 mL); 500 mg/50 mL (50 mL)

Emulsion, Intravenous [preservative free]:

Diprivan: 200 mg/20 mL (20 mL) [contains edetate disodium, egg phospholipids (egg lecithin), soybean oil]

Fresenius Propoven: 200 mg/20 mL (20 mL); 500 mg/50 mL (50 mL); 1000 mg/100 mL (100 mL) [contains egg phosphatides, soybean oil]

Generic: 1000 mg/100 mL (100 mL); 200 mg/20 mL (20 mL); 500 mg/50 mL (50 mL)

Brand Names: U.S.

  • Diprivan
  • Fresenius Propoven

Pharmacologic Category

  • General Anesthetic

Pharmacology

Propofol is a short-acting, lipophilic intravenous general anesthetic. The drug is unrelated to any of the currently used barbiturate, opioid, benzodiazepine, arylcyclohexylamine, or imidazole intravenous anesthetic agents. Propofol causes global CNS depression, presumably through agonism of GABAA receptors and perhaps reduced glutamatergic activity through NMDA receptor blockade.

Distribution

Large volume of distribution; highly lipophilic; Vd:

Children 4 to 12 years: 5 to 10 L/kg

Adults: 2 to 10 L/kg; after a 10-day infusion, Vd approaches 60 L/kg; decreased in the elderly

Metabolism

Hepatic to water-soluble sulfate and glucuronide conjugates (~50%)

Excretion

Urine (~88% as metabolites, 40% as glucuronide metabolite); feces (<2%)

Onset of Action

Anesthetic: Bolus infusion (dose dependent): 9 to 51 seconds (average: 30 seconds)

Duration of Action

3 to 10 minutes depending on the dose, rate and duration of administration; with prolonged use (eg, 10 days ICU sedation), propofol accumulates in tissues and redistributes into plasma when the drug is discontinued, so that the time to awakening (duration of action) is increased; however, if dose is titrated on a daily basis, so that the minimum effective dose is utilized, time to awakening may be within 10 to 15 minutes even after prolonged use

Half-Life Elimination

Biphasic: Initial: 40 minutes; Terminal: 4 to 7 hours (after 10-day infusion, may be up to 1 to 3 days)

Protein Binding

97% to 99%

Special Populations: Elderly

With increasing age, the dose requirement decreases because of occurrence of higher peak plasma concentrations.

Use: Labeled Indications

General anesthesia: Induction of anesthesia in patients ≥3 years of age; maintenance of anesthesia in patients ≥2 months of age.

Mechanically ventilated patients in the ICU, sedation: Sedation of intubated, mechanically ventilated adults in the ICU.

Monitored anesthesia care sedation: Initiation and maintenance of monitored anesthesia care sedation in adults.

Sedation and regional anesthesia: Combined sedation and regional anesthesia in adults.

Note: Consult local regulations and individual institutional policies and procedures.

Off Label Uses

Procedural sedation, outside the operating room

Based on the American College of Emergency Physicians (ACEP) clinical policy for procedural sedation and analgesia in the emergency department, propofol may be safely administered to patients for procedural sedation. According to the ACEP, the combination of propofol and ketamine may also be safely administered; however, to date, clinical trials have not shown this combination to be more efficacious than either agent alone [ACEP [Godwin 2014]].

Based on the 2018 update to the ACEP clinical practice guideline for emergency department procedural sedation with propofol, propofol is recommended for procedural sedation [ACEP [Miller 2019]].

Status epilepticus, refractory

Based on the American Epilepsy Society comprehensive review on treatment of refractory convulsive status epilepticus, propofol can be used for the treatment of refractory status epilepticus in adults; however, clinical data on outcomes are lacking [AES [Vossler 2020]].

Based on the Neurocritical Care Society guidelines for the evaluation and management of status epilepticus, propofol can be used for the treatment of refractory status epilepticus in adults [NSG [Brophy 2012]].

Contraindications

Hypersensitivity to propofol or any component of the formulation; hypersensitivity to eggs, egg products, soybeans, or soy products; when general anesthesia or sedation is contraindicated.

Note: Although the manufacturer's labeling lists egg allergy as a contraindication, available studies (mostly retrospective) and an American Academy of Allergy, Asthma, and Immunology statement have suggested that propofol may be used safely in soy- or egg-allergic patients (AAAAI [Lieberman 2015]; AAAAI 2019; Asserhøj 2016; Dziedzic 2016; Murphy 2011). In patients with more severe soy or egg allergy, some experts recommend the use of an alternative anesthetic or a small trial dose of propofol prior to full dose administration (Sicherer 2020).

Canadian labeling: Additional contraindication (not in US labeling): Hypersensitivity to lipid emulsions; sedation of children ≤18 years of age receiving intensive care.

Dosing: Adult

Note: The FDA has issued an emergency use authorization (EUA) during the coronavirus disease 2019 (COVID-19) pandemic to permit the emergency use of the unapproved product Fresenius Propoven 2% (propofol 20 mg/mL) emulsion. Because Fresenius Propoven 2% contains double the concentration of propofol (20 mg/mL) compared to the FDA-approved propofol products (10 mg/mL), there is a risk of unintentional overdose. Health care providers should review the Fact Sheet for Health Care Providers for key differences between products: https://www.fda.gov/media/137889/download.

Prior to use, consult local/state regulations and institutional policies and procedures regarding administration and monitoring requirements; dosing practices may vary. For dosing in obese patients, use ideal body weight or adjusted body weight for initial weight-based dosing, unless otherwise indicated (Erstad 2020).

General anesthesia:

Note: For dosing in obese patients, use adjusted body weight for initial weight-based dosing (Schumann 2020). Individualize dosing based on patient factors and concomitant anesthetic agents.

Induction of anesthesia: Note: In high-risk patients (eg, debilitated, American Society of Anesthesiologists - Physical Status [ASA-PS] 3 or 4, hemodynamically compromised), avoid rapid bolus administration to minimize hypotension. Induction doses may be administered in divided doses.

Healthy adults, ASA-PS 1 or 2: IV: Usual total dose: 1 to 2.5 mg/kg.

Hemodynamic compromise or hypovolemia: IV: Usual total dose: 0.5 to 1.5 mg/kg.

Debilitated or ASA-PS 3 or 4: IV: Usual total dose: 0.5 to 1.5 mg/kg.

Maintenance of anesthesia:

Healthy adults, ASA-PS 1 or 2:

Continuous IV infusion: Usual dosing range: 50 to 200 mcg/kg/minute; titrate to clinical response.

Debilitated or ASA-PS 3 or 4:

Continuous IV infusion: Usual dosing range: 50 to 100 mcg/kg/minute; titrate to clinical response.

Rapid sequence intubation outside the operating room (induction): Note: May cause dose-related hypotension; consider alternative agent in patients who are hemodynamically unstable. Refer to local/state regulations and institutional policies and procedures regarding administration and monitoring requirements.

IV: 1.5 to 2 mg/kg once; usual dose range: 1 to 3 mg/kg. Note: Continuous infusion may be started if longer sedation is required (see "Mechanically Ventilated Patients in the ICU, Sedation") (Caro 2020; Roberts 2019; Stollings 2014).

Sedation:

Mechanically ventilated patients in the ICU, sedation: Note: Used as part of a multimodal strategy (eg, combination of sedatives and analgesics) for ICU sedation and preferred over a benzodiazepine due to less risk of prolonged sedation and improved time to extubation; titrate to maintain a light level of sedation (eg, Richmond Agitation Sedation Scale 0 to −2) or clinical effect (eg, ventilator synchrony) (SCCM [Devlin 2018]).

Continuous IV infusion: Initial: 5 mcg/kg/minute; increase by 5 to 10 mcg/kg/minute every 5 to 10 minutes until goal sedation level is achieved. Usual maintenance dose: 5 to 50 mcg/kg/minute. Maximum dose (not well defined; may vary by institution): 60 to 80 mcg/kg/minute. Daily awakening trials or use of nurse-protocolized sedation are recommended; generally, titrate down slowly to avoid rapid awakening. If agitated after discontinuation of continuous infusion, then restart at ~50% of the previous maintenance dose (Jakob 2012; Kress 2000; Roberts 2009; SCCM [Barr 2013]; SCCM [Devlin 2018]).

Monitored anesthesia care: Note: For dosing in obese patients, use adjusted body weight for initial weight-based dosing (Schumann 2020). Doses should be individualized based on patient factors and concomitant sedatives and analgesics.

Healthy adults, ASA-PS 1 or 2:

Continuous IV infusion: Initial: 25 to 75 mcg/kg/minute; titrate to adequate sedation. Note: If rapid effect is desired, may initiate with a higher infusion rate (eg, 100 to 150 mcg/kg/minute for 3 to 5 minutes) or administer an initial bolus (eg, 0.25 to 0.5 mg/kg) (Rosero 2020; manufacturer's labeling).

or

IV: Intermittent bolus: 10 to 20 mg; may give additional doses as needed to achieve adequate sedation (Rosero 2020; manufacturer labeling).

Debilitated or ASA-PS 3 or 4: Use reduced dose. Bolus slowly and avoid rapid repeat dosing.

Procedural sedation, outside the operating room (off-label use): Note: Monitor respiratory and cardiovascular systems; refer to local/state regulations and institutional policies and procedures regarding administration and monitoring requirements.

IV: Initial: 0.5 to 1 mg/kg, followed by 0.25 to 0.5 mg/kg every 1 to 3 minutes, as needed, to achieve adequate sedation (ACEP [Miller 2019]; Roberts 2019). Some experts use a combination of propofol and ketamine (0.5 to 0.75 mg/kg dose for each drug) (ACEP [Godwin 2014]).

Status epilepticus, refractory (off-label use):

Note: Used as an alternative or adjunctive agent to midazolam, barbiturates, or ketamine after conventional intermittent therapies have failed. Mechanical ventilation and hemodynamic support required; continuous EEG is recommended. Titrate doses to cessation of electrographic seizures or burst suppression (Legriel 2017; NCS [Brophy 2012]; Rai 2018). Optimal regimen and dose are uncertain; refer to institutional protocol.

IV: Loading dose: 1 to 2 mg/kg, followed by 0.5 to 2 mg/kg every 3 to 5 minutes until seizures are suppressed; maximum total dose: 10 mg/kg (Legriel 2017; NCS [Brophy 2012]; Rai 2018).

Continuous IV infusion: After initial loading dose, begin continuous infusion at an initial rate of 20 mcg/kg/minute; titrate to cessation of electrographic seizures or burst suppression. Usual dose range: 30 to 60 mcg/kg/minute. Maximum dose (not well defined and may vary by institution): 200 mcg/kg/minute. Use caution with doses >80 mcg/kg/minute for >48 hours (Legriel 2017; NCS [Brophy 2012]; Rai 2018).

For breakthrough status epilepticus, administer bolus of 0.5 to 2 mg/kg every 3 to 5 minutes in addition to increasing continuous infusion rate by 5 to 10 mcg/kg/minute every 5 minutes (Legriel 2017; NCS [Brophy 2012]; Rai 2018).

Note: Generally, a period of at least 24 hours of electrographic suppression is suggested prior to down titrating the continuous infusion; withdraw gradually by decreasing the dose 15% to 20% every 3 hours while continuing conventional therapies (Drislane 2020; Legriel 2017; NCS [Brophy 2012]).

Dosing: Geriatric

Refer to adult dosing. Prior to use, consult local/state regulations and institutional policies and procedures regarding administration and monitoring requirements. Dosage must be individualized and titrated to the desired clinical effect. Wait at least 3 to 5 minutes between dosage adjustments to clinically assess drug effects. Smaller doses are generally required in elderly patients and when used with opioids.

Dosing: Pediatric

Note: FDA has issued an emergency use authorization (EUA) during the coronavirus disease 2019 (COVID-19) pandemic to permit the emergency use of the unapproved product, Fresenius Propoven 2% (propofol 20 mg/mL) emulsion for ICU sedation in mechanically-ventilated patients >16 years of age. Fresenius Propoven 2% (20 mg/mL) is composed of medium and long-chained triglycerides and is double the concentration of the FDA-approved propofol 1% (10 mg/mL) products (eg, Diprivan). There is a risk of unintentional overdose and extra precaution should be used to ensure appropriate product selection. Health care providers should review the Fact Sheet for Health Care Providers for key differences between products: https://www.fda.gov/media/137889/download.

Note: Consult local regulations and individual institutional policies and procedures; should only be used by experienced personnel who are not actively engaged in the procedure or surgery; if used in a nonintubated and/or nonmechanically ventilated patient, qualified personnel and appropriate equipment for rapid institution of respiratory and/or cardiovascular support must be immediately available.

Dosage must be individualized based on total body weight and titrated to the desired clinical effect; wait at least 3 to 5 minutes between dosage adjustments to clinically assess drug effects; smaller doses are required when used with opioids; the following are general dosing guidelines (see "Abbreviations, Acronyms, and Symbols" section in front section for explanation of ASA-PS classes).

Anesthesia, general: Note: Increase dose in patients with chronic alcoholism (Fassoulaki 1993); decrease dose with acutely intoxicated (alcoholic) patients.

Induction of general anesthesia: Children and Adolescents (healthy) 3 to 16 years, ASA-PS 1 or 2: IV: 2.5 to 3.5 mg/kg over 20 to 30 seconds; use a lower dose for ASA-PS 3 or 4.

Maintenance of general anesthesia: Infants ≥2 months, Children, and Adolescents (healthy), ASA-PS 1 or 2: IV infusion: General range: 125 to 300 mcg/kg/minute (7.5 to 18 mg/kg/hour); Initial dose immediately following induction: 200 to 300 mcg/kg/minute; then decrease dose after 30 minutes if clinical signs of light anesthesia are absent; usual infusion rate after initial 30 minutes: 125 to 150 mcg/kg/minute (7.5 to 9 mg/kg/hour); younger pediatric patients may need higher infusion rates than older pediatric patients.

Procedural sedation: Limited data available: Infants, Children, and Adolescents: IV:

Repeated bolus method: Usual initial dose: 1 mg/kg; reported range for initial dose: 1 to 2 mg/kg; follow initial dose with 0.5 mg/kg every 3 to 5 minutes as needed until adequate level of sedation achieved (ACEP [Godwin 2014]; Bedirli 2012; Cho 2010; Ince 2013; Krauss 2006).

IV bolus followed by continuous infusion: Initial bolus: 1 to 2 mg/kg; continuous infusion: Reported initial rate and titration are variable (Machata 2010; Srinivasan 2012; Vespasiano 2007). In a large report of a pediatric sedation program in >4,000 patients (age range: 1 month to 21 years), after an initial bolus of at least 2 mg/kg, an infusion was started at an initial rate of 9 mg/kg/hour (150 mcg/kg/minute) and titrated as required; supplemental doses of 1 to 2 mg/kg were used as needed; however, hypotension occurred in up to 42.5% of patients undergoing MRI and 23.2% of patients undergoing other procedures (Vespasiano 2007). In a smaller trial of 138 young pediatric patients (age range: 3 months to 6 years), after a 1 mg/kg bolus, an infusion was initiated at an initial rate of 5 mg/kg/hour (83 mcg/kg/minute) and then titrated upward in 1 mg/kg/hour increments (to a maximum of 8 mg/kg/hour [133 mcg/kg/minute]) with additional boluses of 0.5 mg/kg given as needed to achieve adequate sedation level (Machata 2010).

Propofol with concurrent ketamine; emergency department procedures: IV: 0.5 to 0.75 mg/kg (ACEP [Godwin 2014]).

Note: When utilized by an organized service with trained and credentialed personnel, propofol use for procedural sedation outside of the operating room was shown to have low risk for serious adverse outcomes (Cravero 2009; Kamat 2015).

Status epilepticus; refractory: Limited data available: Children and Adolescents: Note: Several experts have expressed concern when using propofol for this indication in infants and children due to the risk for propofol-related infusion syndrome, particularly when administered in conjunction with a ketogenic diet or when given at high doses for prolonged periods of time (Baumeister 2004; Iyer 2009). Neurocritical Care Society guidelines for status epilepticus state that use of propofol in young children is contraindicated (NCS [Brophy 2010]):

Initial propofol infusion: IV: Loading dose 1 to 2 mg/kg, then initiate continuous IV infusion at 1.2 mg/kg/hour (20 mcg/kg/minute); titrate to desired effect (eg, burst suppression on EEG); usual range: 1.8 to 12 mg/kg/hour (30 to 200 mcg/kg/minute) (NCS [Brophy 2012]). Note: Use caution when administering high doses (>4 mg/kg/hour [>65 mcg/kg/minute]) for extended periods of time (>48 hours); monitor closely for adverse effects (eg, PRIS) (NCS [Brophy 2012]).

Breakthrough seizure while on propofol infusion: IV: Increase infusion rate by 0.3 to 0.6 mg/kg/hour (5 to 10 mcg/kg/minute) every 5 minutes with or without an additional 1 mg/kg bolus (NCS [Brophy 2012]).

Reconstitution

Does not need to be diluted; however, propofol may be further diluted in 5% dextrose in water to a concentration of ≥2 mg/mL.

Administration

Note: FDA has issued an emergency use authorization (EUA) during the coronavirus disease 2019 (COVID-19) pandemic to permit the emergency use of the unapproved product, Fresenius Propoven 2% (propofol 20 mg/mL) emulsion. Because Fresenius Propoven 2% contains double the concentration of propofol (20 mg/mL) compared to the FDA-approved propofol products (10 mg/mL), there is a risk of unintentional overdose. Health care providers should review the Fact Sheet for Health Care Providers for key differences between products: https://www.fda.gov/media/137889/download.

IV: Administer intermittent bolus or by continuous IV infusion. Prior to use, consult local/state regulations and institutional policies and procedures regarding administration and monitoring requirements. Strict aseptic technique must be maintained in handling although a preservative has been added. Do not use if contamination is suspected. Do not administer through the same IV catheter with blood or plasma. Tubing and any unused portions of propofol vials should be discarded after 12 hours.

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 or it may be added to propofol immediately before administration in a quantity not to exceed 20 mg lidocaine per 200 mg propofol. Do not use filter <5 micron for administration.

Dietary Considerations

Propofol is formulated in an oil-in-water emulsion. If on parenteral nutrition, may need to adjust the amount of lipid infused. Propofol emulsion contains 1.1 kcal/mL. Soybean fat emulsion is used as a vehicle for propofol. Formulations also contain egg phospholipids (egg lecithin) and glycerol.

Storage

Store between 4°C to 22°C (40°F to 72°F); refrigeration is not required. Do not freeze. Shake well before use. Withdraw from vial into a syringe immediately after sterile vented spike inserted. Administration should begin immediately and completed within 12 hours after the vial has been opened. Do not use if there is evidence of separation of phases of emulsion.

Drug Interactions

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy

Alfentanil: May enhance the adverse/toxic effect of Propofol. Specifically the development of opisthotonus (severe hyperextension and spasticity resulting in arching or bridging position) and/or tonic clonic seizures. Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Consider therapy modification

Amisulpride (Oral): May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy

Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Avoid combination

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Consider therapy modification

Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Bradycardia-Causing Agents: May enhance the bradycardic effect of other Bradycardia-Causing Agents. Monitor therapy

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Bromperidol: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. Avoid combination

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Consider therapy modification

Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Ceritinib: Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Consider therapy modification

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Dofetilide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Dofetilide. Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Consider therapy modification

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy

EPHEDrine (Systemic): Propofol may enhance the therapeutic effect of EPHEDrine (Systemic). Monitor therapy

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

FentaNYL: Propofol may enhance the CNS depressant effect of FentaNYL. Management: Consider alternatives to this combination when possible. If the combination is used, monitor more closely for bradycardia, apnea, and excessive CNS depression. Propofol induction dose requirements may be reduced. Pediatric patients may be at greater risk. Consider therapy modification

Fexinidazole [INT]: Bradycardia-Causing Agents may enhance the arrhythmogenic effect of Fexinidazole [INT]. Avoid combination

Flibanserin: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Flibanserin. Monitor therapy

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Consider therapy modification

Haloperidol: QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of Haloperidol. Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Ivabradine: Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. Monitor therapy

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy

Lacosamide: Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide. Monitor therapy

Lemborexant: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Lemborexant. Management: The maximum recommended dosage of lemborexant is 5 mg, no more than once per night, when coadministered with weak CYP3A4 inhibitors. Consider therapy modification

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Consider therapy modification

Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Monitor therapy

Lisuride: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Lomitapide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Lomitapide. Management: Patients on lomitapide 5 mg/day may continue that dose. Patients taking lomitapide 10 mg/day or more should decrease the lomitapide dose by half. The lomitapide dose may then be titrated up to a max adult dose of 30 mg/day. Consider therapy modification

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Consider therapy modification

Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Monitor therapy

Midazolam: May increase the serum concentration of Propofol. Propofol may increase the serum concentration of Midazolam. Monitor therapy

Midodrine: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

NiMODipine: CYP3A4 Inhibitors (Weak) may increase the serum concentration of NiMODipine. Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Avoid combination

Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Consider therapy modification

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Avoid combination

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Consider therapy modification

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Pimozide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Pimozide. Avoid combination

Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Monitor therapy

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

RifAMPin: May enhance the hypotensive effect of Propofol. Management: Avoid this combination if possible. Use of propofol in a patient who has been taking rifampin may result in clinically significant hypotension. Consider therapy modification

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Monitor therapy

Ropivacaine: Propofol may increase the serum concentration of Ropivacaine. Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Monitor therapy

Ruxolitinib: May enhance the bradycardic effect of Bradycardia-Causing Agents. Management: Ruxolitinib Canadian product labeling recommends avoiding use with bradycardia-causing agents to the extent possible. Monitor therapy

Siponimod: Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. If combined, consider obtaining a cardiology consult regarding patient monitoring. Consider therapy modification

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification

Tacrolimus (Systemic): CYP3A4 Inhibitors (Weak) may increase the serum concentration of Tacrolimus (Systemic). Monitor therapy

Terlipressin: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Avoid combination

Tofacitinib: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy

Triazolam: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Triazolam. Management: Consider triazolam dose reduction in patients receiving concomitant weak CYP3A4 inhibitors. Consider therapy modification

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy

Ubrogepant: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Ubrogepant. Management: In patients taking weak CYP3A4 inhibitors, the initial and second dose (given at least 2 hours later if needed) of ubrogepant should be limited to 50 mg. Consider therapy modification

Valproate Products: May enhance the therapeutic effect of Propofol. Monitor therapy

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Consider therapy modification

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Cardiovascular: Hypotension (adults: 3% to 26%; children: 17%)

Central nervous system: Involuntary body movements (children: 17%; adults: 3% to 10%)

Local: Burning sensation at injection site (adults: ≤18%; children: ≤10%), pain at injection site (includes stinging; adults: ≤18%; children: ≤10%)

Respiratory: Apnea (30 to 60 seconds duration: adults: 24%, children: 10%; >60 seconds duration: adults: 12%, children: 5%)

1% to 10%:

Cardiovascular: Hypertension (children: 8%), bradycardia (1% to 3%), cardiac arrhythmia (1% to 3%), low cardiac output (1% to 3%; concurrent opioid use increases incidence), tachycardia (1% to 3%)

Dermatologic: Skin rash (children: 5%; adults: 1% to 3%), pruritus (1% to 3%)

Endocrine & metabolic: Hypertriglyceridemia (3% to 10%), respiratory acidosis (during weaning; 3% to 10%)

<1%, postmarketing, and/or case reports: Agitation, amblyopia, anaphylaxis, anaphylactoid reaction, anticholinergic syndrome, asystole, atrial arrhythmia, atrial premature contractions, bigeminy, chills, cloudy urine, cough, decreased lung function, delirium, dizziness, drowsiness, fever, flushing, hair discoloration (green), hemorrhage, hypertonia, hypomagnesemia, hypoxia, infusion-related reaction (propofol-related infusion syndrome), infusion site reaction (including pain, swelling, blisters and/or tissue necrosis following accidental extravasation), laryngospasm, leukocytosis, limb pain, loss of consciousness (postoperative; with or without increased muscle tone), myalgia, myoclonus (rarely including seizure and opisthotonos), nail discoloration (nailbeds green), nausea, pancreatitis, paresthesia, phlebitis, pulmonary edema, rhabdomyolysis, sialorrhea, syncope, thrombosis, urine discoloration (green), ventricular premature contractions, visual disturbance, wheezing

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis/hypersensitivity reactions: May rarely cause hypersensitivity, anaphylaxis, anaphylactoid reactions, angioedema, bronchospasm, and erythema; medications for the treatment of hypersensitivity reactions should be available for immediate use. Use with caution in patients with history of hypersensitivity/anaphylactic reaction to peanuts; a low risk of cross-reactivity between soy and peanuts may exist. According to the manufacturer, use is contraindicated in patients who are hypersensitive to eggs, egg products, soybeans, or soy products. However, available studies (mostly retrospective) and an American Academy of Allergy, Asthma, and Immunology statement have suggested that propofol may be used safely in soy- or egg-allergic patients (AAAAI [Lieberman 2015]; AAAAI 2019; Asserhøj 2016; Dziedzic 2016; Murphy 2011). In patients with more severe soy or egg allergy, some experts recommend the use of an alternative anesthetic or a small trial dose of propofol prior to full dose administration (Sicherer 2020).

• ECG effects: In most cases, propofol does not significantly affect the QT interval (Staikou 2014). However, prolongation of the QT interval, usually within normal limits, has occurred in case reports and small prospective studies and may be dose dependent (Hume-Smith 2008; Kim 2008; McConachie 1989; Saarnivaara 1990; Saarnivaara 1993; Sakabe 2002). Shortening of the QT interval has also occurred (Erdil 2009; Tanskanen 2002).

• Hypertriglyceridemia: Because propofol is formulated within a 10% fat emulsion, hypertriglyceridemia is an expected side effect. Patients who develop hypertriglyceridemia (eg, ≥400 mg/dL) are at risk of developing pancreatitis. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3 to 7 days thereafter. Monitor serum triglycerides when infusions last >48 hours or infusion rates are >50 mcg/kg/minute (Devlin 2005). An alternative sedative agent should be employed if significant hypertriglyceridemia occurs. Use with caution in patients with preexisting hyperlipidemia as evidenced by increased serum triglyceride levels or serum turbidity.

• Hypotension: The major cardiovascular effect of propofol is hypotension especially if patient is hypovolemic or if bolus dosing is used. Hypotension may be substantial with a reduction in mean arterial pressure occasionally exceeding 30%. Use with caution in patients who are hemodynamically unstable, hypovolemic, or have abnormally low vascular tone (eg, sepsis).

• Injection-site reaction: Transient local pain may occur during IV injection; lidocaine 1% solution may be administered prior to administration or may be added to propofol immediately prior to administration to reduce pain associated with injection (see Administration).

• Myoclonus: Perioperative myoclonus (eg, convulsions and opisthotonos) has occurred with administration.

• Propofol-related infusion syndrome: Propofol-related infusion syndrome (PRIS) is a serious side effect with a high mortality rate (up to 33%) characterized by dysrhythmia (eg, bradycardia or tachycardia), heart failure, hyperkalemia, lipemia, metabolic acidosis, and/or rhabdomyolysis or myoglobinuria with subsequent renal failure. Risk factors include poor oxygen delivery, sepsis, serious cerebral injury, and the administration of high doses of propofol (usually doses >83 mcg/kg/minute or >5 mg/kg/hour for >48 hours), but has also been reported following large dose, short-term infusions during surgical anesthesia. PRIS has also been reported with lower-dose infusions (Hemphill 2019; Krajčová 2015; Roberts 2009). The onset of the syndrome is rapid, occurring within 4 days of initiation. The mechanism of the syndrome has yet to be determined. Alternate sedative therapy should be considered for patients with escalating doses of vasopressors or inotropes, when cardiac failure occurs during high-dose propofol infusion, when metabolic acidosis is observed, or in whom lengthy and/or high-dose sedation is needed (Corbett 2008; SCCM [Barr 2013]).

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with severe cardiac disease (ejection fraction <50%) or hypotension; may have more profound adverse cardiovascular responses to propofol. In a scientific statement from the American Heart Association, propofol has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: moderate) (AHA [Page 2016]).

• Increased intracranial pressure: Use with caution in patients with increased intracranial pressure or impaired cerebral circulation; substantial decreases in mean arterial pressure and subsequent decreases in cerebral perfusion pressure may occur; consider continuous infusion or administer as a slow bolus.

• Infection risk: Propofol vials and prefilled syringes have the potential to support the growth of various microorganisms despite product additives intended to suppress microbial growth. To limit the potential for contamination, strictly adhere to recommendations in product labeling for handling and administering propofol.

• Pancreatitis: Use with caution in patients with preexisting pancreatitis; use of propofol may exacerbate this condition.

• Respiratory disease: Use with caution in patients with respiratory disease.

• Seizure disorder: Use with caution in patients with a history of epilepsy or seizures; seizure may occur during recovery phase.

Concurrent drug therapy issues:

• Opioids: Concomitant use may lead to increased sedative or anesthetic effects of propofol, more pronounced decreases in systolic, diastolic, and mean arterial pressures and cardiac output; lower doses of propofol may be needed. In addition, fentanyl may cause serious bradycardia when used with propofol in pediatric patients. Alfentanil use with propofol has precipitated seizure activity in patients without any history of epilepsy.

Special populations:

• American Society of Anesthesiologists - Physical Status (ASA-PS) 3 or 4 patients: Use a lower induction dose, a slower maintenance rate of administration, and avoid rapidly delivered boluses in ASA-PS 3 or 4 patients to reduce the incidence of unwanted cardiorespiratory depressive events.

• Debilitated patients: Use a lower induction dose, a slower maintenance rate of administration, and avoid rapidly delivered boluses in debilitated patients to reduce the incidence of unwanted cardiorespiratory depressive events.

• Elderly: Use a lower induction dose, a slower maintenance rate of administration, and avoid rapidly delivered boluses in elderly patients to reduce the incidence of unwanted cardiorespiratory depressive events.

• Pediatric neurotoxicity: In pediatric and neonatal patients <3 years of age and patients in third trimester of pregnancy (ie, times of rapid brain growth and synaptogenesis), the repeated or lengthy exposure to sedatives or anesthetics during surgery/procedures may have detrimental effects on child or fetal brain development and may contribute to various cognitive and behavioral problems. Epidemiological studies in humans have reported various cognitive and behavioral problems including neurodevelopmental delay (and related diagnoses), learning disabilities, and ADHD. Human clinical data suggest that single, relatively short exposures are not likely to have similar negative effects. No specific anesthetic/sedative has been found to be safer. For elective procedures, risk vs benefits should be evaluated and discussed with parents/caregivers/patients; critical surgeries should not be delayed (FDA 2016).

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

• Edetate disodium: Some formulations contain edetate disodium which may lead to decreased zinc levels in patients with prolonged therapy (>5 days) or a predisposition to zinc deficiency (eg, burns, diarrhea, or sepsis). A holiday from propofol infusion should take place after 5 days of therapy to allow for evaluation and necessary replacement of zinc.

• Sulfites: Some formulations may contain sulfites.

Other warnings/precautions:

• Abrupt discontinuation: Avoid abrupt discontinuation prior to weaning or daily wake up assessments. Abrupt discontinuation can result in rapid awakening, anxiety, agitation, and resistance to mechanical ventilation; wean the infusion rate so the patient awakens slowly. Discontinue opioids and paralytic agents prior to weaning. Long-term infusions can result in some tolerance; taper propofol infusions to prevent withdrawal.

• Analgesic supplementation: Propofol lacks analgesic properties; pain management requires specific use of analgesic agents, at effective dosages, propofol must be titrated separately from the analgesic agent.

• Experienced personnel: Use requires careful patient monitoring, should only be used by experienced personnel who are not actively engaged in the procedure or surgery. If used in a nonintubated and/or nonmechanically ventilated patient, qualified personnel and appropriate equipment for rapid institution of respiratory and/or cardiovascular support must be immediately available. Use to induce moderate (conscious) sedation in patients warrants monitoring equivalent to that seen with deep anesthesia. Consult local regulations and individual institutional policies and procedures.

Monitoring Parameters

Cardiac monitor, blood pressure, oxygen saturation (during monitored anesthesia care sedation), arterial blood gas (with prolonged infusions). With prolonged infusions (eg, ICU sedation), monitor for signs and symptoms of propofol-related infusion syndrome: Metabolic acidosis, hyperkalemia, rhabdomyolysis or elevated CPK, hepatomegaly, and progression of cardiac and renal failure.

ICU sedation: Assess and adjust sedation according to scoring system (Richmond Agitation-Sedation Scale or Sedation-Agitation Scale) (SCCM [Devlin 2018]); assess CNS function daily. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3 to 7 days thereafter, especially if receiving for >48 hours with doses ≥50 mcg/kg/minute (Devlin 2005); use IV port opposite propofol infusion or temporarily suspend infusion and flush port prior to blood draw.

Diprivan: Monitor zinc levels in patients predisposed to deficiency (burns, diarrhea, major sepsis) or after 5 days of treatment.

Pregnancy Considerations

Propofol crosses the placenta and may be associated with neonatal CNS and respiratory depression.

Based on animal data, repeated or prolonged use of general anesthetic and sedation medications that block N-methyl-D-aspartate (NMDA) receptors and/or potentiate gamma-aminobutyric acid (GABA) activity may affect brain development. Evaluate benefits and potential risks of fetal exposure to propofol when duration of surgery is expected to be >3 hours (Olutoye 2018).

Propofol is not recommended by the manufacturer for obstetrical use, including cesarean section deliveries. However, in cases where general anesthesia is needed for cesarean delivery, propofol has been used as an induction agent (ACOG 209 2019; Devroe 2015).

The ACOG recommends that pregnant women should not be denied medically necessary surgery, regardless of trimester. If the procedure is elective, it should be delayed until after delivery (ACOG 775 2019).

Note: A propofol 2% emulsion, Fresenius Propoven, was approved for emergency use during the coronavirus disease 2019 (COVID-19) pandemic. This formulation is double the concentration of FDA-approved products. It should not be used in pregnant women unless no other FDA-approved products are available to maintain sedation in patients who require mechanical ventilation in an ICU setting.

Patient Education

What is this drug used for?

• It is used to put you to sleep for surgery.

• It is used to calm you before a procedure.

• It is used to cause sleep during a procedure.

• It may be given to you for other reasons. Talk with the doctor.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Feeling sleepy

• Cough after waking up

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Pancreatitis like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up

• High or low blood pressure like very bad headache, dizziness, passing out, or change in eyesight

• Trouble breathing, slow breathing, or shallow breathing

• Fast or slow heartbeat

• Trouble controlling body movements, twitching, change in balance, trouble swallowing or speaking

• Severe injection site redness, burning, pain, swelling, blistering, skin sores, or leaking of fluid

• Propofol infusion syndrome like confusion; very sleepy; very tired or weak; dark urine or not able to pass urine; fast breathing; fast heartbeat or abnormal heartbeat; severe stomach pain, upset stomach, or throwing up; muscle pain or weakness; or shortness of breath, a big weight gain, or swelling of the arms or legs

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Propofol FDA fact sheets – Health care provider; Patient

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.