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RIPOL 20 MG/ML (2%) EMULSION FOR INJECTION/INFUSION
Ripol 20 mg/ml (2%) emulsion for injection/infusion
Read all of this leaflet carefully before you start using this medicine.
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if
their symptoms are the same as yours.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
In this leaflet:
1. What Ripol 20 mg/ml is and what it is used for
2. Before you use Ripol 20 mg/ml
3. How to use Ripol 20 mg/ml
4. Possible side effects
5. How to store Ripol 20 mg/ml
6. Further information
WHAT RIPOL 20 MG/ML IS AND WHAT IT IS USED FOR
Ripol 20 mg/ml belongs to a group of medicines called ‘general anaesthetics’. General anaesthetics are
used to cause unconsciousness (sleep) so that surgical operations or other procedures can be
performed. They can also be used to sedate you (so that you are sleepy but not completely asleep).
Ripol 20 mg/ml will be given to you as an injection by a doctor.
Ripol 20 mg/ml is used to:
Induce and maintain general anaesthesia in adults and paediatric patients over3 years of age
Sedate patients over16 years of age receiving artificial respiration in intensive care
sedate adults and paediatric patients over3 years of age during diagnostic and surgical procedures,
alone or in combination with local or regional anaesthesia
BEFORE YOU RECEIVE RIPOL 20 MG/ML
Do not use Ripol 20 mg/ml
in patients allergic (hypersensitive) to propofol or any of the other ingredients of Ripol 20
in patients allergic to peanut or soya. This is because Ripol 20 mg/ml contains soya-bean oil.
in patients 16 years of age or younger for sedation in intensive care.
Take special care with Ripol 20 mg/ml
if you have any other health problems, such as problems with your heart, breathing, kidneys or
if your body has lost lots of water (you are hypovolaemic).
if you have ever had a fit or convulsion
if you have ever been told that you have very high levels of fat in your blood. In these cases
your doctor might have to determine your blood fat levels.
if you have ever been told that your body has problems using fat. In these cases your doctor
might have to determine your blood fat levels.
If you have had a head injury together with a high pressure in your head.
if you have a condition called hereditary predisposition to acute porphyria.
if you are eldery or debilitated, or severely overweight.
Ripol 20 mg/ml is not recommended in children under 3 years of age.
If you are able to go home shortly after receiving propofol you should not go home unaccompanied.
If you are not sure if any of the above apply to you, talk to your doctor or nurse before recieving Ripol
Using other medicines
Please tell your doctor if you are taking or have recently taken any other medicines, including
medicines obtained without a prescription. This includes medicines, herbal remedies, health foods or
supplements that you have bought yourself.
Take special care when taking/receiving the following medicines:
Certain premedications (your anaesthesist knows which medicines can be influenced)
Other anaesthetics (including general, local or volatile anaesthetics)
Strong painkillers (fentanyl or opiods)
Parasympatholytic agents (medicines used to treat e. g. painful cramps of organs, asthma or
Benzodiazepines (medicines used to treat anxiety)
Suxamethonium (muscle relaxant)
Neostigmin (medicine used to treat a disease called myasthenia gravis)
Ciclosporin (medicine used to prevent transplant rejection)
Using Ripol 20 mg/ml with food and drink
When receiving propofol you should avoid drinking alcohol for at least 8 hours before and after
administration of Ripol 20 mg/ml.
Pregnancy and breast-feeding
If you are pregnant you should receive Ripol 20 mg/ml only if absolutely necessary. If you are trying
to get pregnant or if you are breast-feeding, talk to your doctor or nurse before receiving this medicine.
You should not breast-feed while receiving propofol and breast milk must be discarded for 24 hours
after receiving propofol.
Driving and using machines
After having Ripol 20 mg/ml you may still feel sleepy for some time. Do not drive or use any tools or
machines until you are sure the effects have worn off.
If you are able to go home shortly after receiving propofol, do not drive a car.
Ask your doctor when you can start doing these activities again and when you can go back to work.
Important information about some of the ingredients of Ripol 20 mg/ml
This medicinal product contains soya-bean oil. If you are allergic to peanut or soya, do not use this
medicine (see above “Do not use Ripol 20 mg/ml”).
This medicinal product contains less than 1 mmol sodium (23 mg) per 100 ml, i.e. essentially ‘sodiumfree’.
HOW TO USE RIPOL 20 MG/ML
You will be given Ripol 20 mg/ml by, or under the direct supervision of your anaesthesist or intensive
care doctor. It will be given to you as an injection or infusion (drip) into a vein. This is usually in the
back of your hand or in your forearm.
Your doctor will give you the injection using a needle or through a fine plastic tube called a
For maintenance of anaesthesia or sedation your medicine may be given as an intravenous
infusion (drip) using an electric pump which automatically control the rate at which the infusion
is given. This may be done if you are having a long operation or if you are in an Intensive Care
The dose of Ripol 20 mg/ml will vary depending on other medicines including premedication, your
age, body weight and physical condition. The doctor will give you the correct dose to start and to
sustain anaesthesia or to achieve the required level of sedation (sleepiness), by carefully watching your
responses and vital signs (pulse, blood pressure, breathing etc.).
You may need several different medicines to keep you asleep or sleepy, free from pain, breathing in a
healthy way and to keep your blood pressure steady. The doctor will decide which medicines you need
and when you need them.
For induction of anaesthesia most adult patients aged less than 55 years are likely to require 1.5
to 2.5 mg propofol/kg body weight.
For maintenance of anaesthesia generally doses of 4 to 12 mg propofol/kg body weight/hr or
repeat bolus injections (using Ripol 10 mg/ml) dose increments of 25 mg to 50 mg are given.
Dose requirements may be lower for elderly patients.
Adults and adolescents older than 16 years of age
For sedation of adults and adolescents older than 16 years of age during intensive care the dose
should be adjusted according to the level of sedation required. Using continous infusion doses
of 0.3 to 4.0 mg propofol/kg body weight/hr are typically given. Rates of infusion greater than
4.0 mg propofol/kg body weight/hr are not recommended.
For sedation for diagnostic and surgical procedures in adults and adolescents older than 16 years
of age generally doses of 0.5 to 1 mg propofol/kg body weight over 1 to 5 minutes are required
for onset of sedation. Maintenance of sedation will require 1.5 to 4.5 mg propofol/kg body
weight/hr. Additionally, single administration of 10 to 20 mg propofol/kg body weight can be
given if a rapid increase of the level of sedation (sleepiness) is required.
Paediatric patients younger than 3 years of age
Ripol 20 mg/ml is not recommended for induction and maintenance of anaesthesia in paediatric
patients between 1 month and 3 years old, because the 20 mg/ml strength is difficult to titrate in
paediatric patients because of the very small volumes that are necessary.
Paediatric patients older than 3 years of age
For induction of anaesthesia most paediatric patients over 8 years are likely to require
approximately 2.5 mg propofol/kg body weight.
In patients younger than 8 years the dose might be higher (2.5-4 mg propofol/kg body weight).
For maintenance of anaesthesia using continuous infusion doses of 9 to 15 mg propofol/kg body
weight/hr usually achieve satisfactory anaesthesia. In younger patients, dose requirements may
Paediatric patients older than 3years of age
For sedation of paediatric patients during diagnostic and surgical interventions the dose
should be adjusted according to the level of sedation required. Most paediatric patients require
doses of 1 – 2 mg propofol/kg body weight for onset of sedation. Maintenance of sedation will
require 1.5-9 mg propofol/kg body weight/hr.
Ripol 20 mg/ml must not be used in paediatric patients of 16 years of age or younger in the
indication for sedation in intensive care.
Duration of treatment
When used for sedation, Ripol 20 mg/ml must not be administered for more than 7 days.
If you received more Ripol 20 mg/ml than you should
Your doctor will ensure that you receive the right amount of propofol for you and for the procedure
you are undergoing. However, different people need different doses and if you do receive too much for
you, your anaesthesist may need to take measures to make sure your heart and breathing are
adequately supported. This is why anaesthetic drugs are only administered by doctors trained in
anaesthesia or in the care of patients in intensive care.
If you have any further questions on the use of this product, ask your anaesthesist or intensive care
POSSIBLE SIDE EFFECTS
Like all medicines, Ripol 20 mg/ml can cause side effects, although not everybody gets them.
affects more than 1 user in 10
affects 1 to 10 users in 100
affects 1 to 10 users in 1,000
affects 1 to 10 users in 10,000
affects less than 1 user in 10,000
frequency cannot be estimated from the available data
Side effects that can happen during anaesthesia
The following side effects can happen during anaesthesia (while the injection is being given to you or
when you are sleepy or asleep). Your doctor will be looking out for these. If they happen, your doctor
will give you appropriate treatment.
A feeling of pain at the site of the injection (while the injection is being given, before you fall
Slow heart beat
Mild to moderate low blood pressure
Changes in your breathing pattern
Marked low blood pressure
Cough (may also happen when you wake up)
Twitching and shaking of your body, or fits (may also happen when you wake up)
Serious allergic reaction which causes difficulty in breathing or dizziness
Build up of fluid in the lungs which can make you very breathless (may also happen when you
Unusual colour of urine (may also happen when you wake up)
Spontaneous movements and fits
Side effects that can happen after anaesthesia
The following side effects can happen after anaesthesia (when you are waking up or after you have
Feeling sick (nausea), being sick (vomiting)
Swelling and redness or blood clots at the vein along the injection site
Feeling sexually aroused
Dizziness, chills and sensations of cold
Being unconscious after the operation (when this has happened, the patients have recovered
Inflamed pancreas (pancreatitis) which causes severe stomach pain (a causal relationship could
not be shown)
Fever following surgery
Changes in ECG (Brugada type ECG)
Irregular heart beat
Increase in liver size
Breakdown of muscle cells (rhabdomyolysis), increase in acidity of your blood, high potassium
and fat levels in your blood, heart failure with fatal outcome (seen when propofol is used in
intensive care at higher doses than recommended)
Severe skin and tissue reaction following accidental application beside the vein
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please
tell your doctor or pharmacist.
HOW TO STORE RIPOL 20 MG/ML
Keep out of the reach and sight of children.
Do not use Ripol 20 mg/ml after the expiry date which is stated on the label after EXP. The expiry
date refers to the last day of that month.
Store below 30°C.
Do not freeze.
Keep the vial/ampoule in the outer carton in order to protect from light.
Shelf life before opening
Ampoules/vials: 18 months.
Shelf life after first opening/dilution
To be used immediately.
Must not be diluted.
Chemical and physical in-use stability of the reconstituted product has been demonstrated for 24 hours
From a microbiological point of view, the product should be used immediately. If not used
immediately, in-use storage times and conditions prior to use are the responsibility of the user.
Do not use Ripol 20 mg/ml if you notice particulate matter.
Medicines should not be disposed of via wastewater or household waste. Your doctor or hospital
pharmacist are responsible for the correct storage, use and disposal.
What RIPOL 20 MG/ML contains
The active substance(s) is propofol. 1 milliliter emulsion for injection/infusion contains 20 mg
The other ingredients are soya-bean oil, refined; egg phospholipids, purified; glycerol; sodium
hydroxide (for pH-adjustment); water for injections.
What Ripol 20 mg/ml looks like and contents of the pack
Ripol 20 mg/ml emulsion for injection/infusion is a white aqueous isotonic oil-in-water emulsion. It is
available in 20 ml Type I glass ampoules, or 20, 50 and 100 ml Type I glass vials with bromobutyl
1 x 50 ml vial
Not all pack sizes may be marketed.
Marketing Authorisation Holder
YES Pharmaceutical Development Services GmbH
Bahnstr. 42 – 46
CORDEN PHARMA S.p.A.
Viale dell’Industria 3 E
Reparto via Galilei 17
This medicinal product is authorised in the Member States of the EEA under the following
Ripol 20 mg/ml Emulsion zur Injektion/Infusion
Ripol 20 mg/ml Emulsione per Infusione
Ripol 20 mg/ml Emulsie voor injectie / infusie
Ripol 20 mg/ml Emulsion for injection/infusion
This leaflet was last approved in 05/2012.
-------------------------------------------------------The following information is intended for medical or healthcare professionals only:
Method of administration
For intravenous use.
Administering Ripol 20 mg/ml through a TCI-system for sedation in intensive care is not
For single use only.
Parenteral products should be inspected visually for particulate matter prior to administration. If
particulate matter is evident emulsion should not be used.
Containers should be shaken before use. If two layers can be seen after shaking, the emulsion should
not be used.
Ripol 20 mg/ml is administered intravenously as an injection or as a continuous, undiluted.
Prior to use, the ampoule neck and rubber stopper should be disinfected using a medicinal alcohol
(spray or dipped swab). After use, any remaining contents must be discarded.
Ripol 20 mg/ml does not contain antimicrobial preservatives and is capable of supporting the growth
of microorganisms. The emulsion must be drawn aseptically into a sterile syringe or infusion system
immediately after spiking the vial.
Administration must commence without delay. During infusion sterility of Ripol 20 mg/ml as well as
the infusion system must be maintained.
Medicinal products or liquids that are added to a running Ripol 20 mg/ml infusion should be added
close to the cannula.
Ripol 20 mg/ml must not be administered via infusion systems that are provided with a
The contents of one vial of Ripol 20 mg/ml and any infusion equipment are intended for single use in
Any remainder must be discarded immediately after use.
Ripol 20 mg/ml must not be diluted.
Infusion of Ripol 20 mg/ml
When Ripol 20 mg/ml is administered as a continuous infusion, it is recommended that equipment
such as burettes, drop counter, syringe pumps or volumetric infusion pumps should always be used to
control infusion rates.
As applies to parenteral administration of all kinds of fat emulsions, the duration of use for one
infusion system for a continuous infusion of Ripol 20 mg/ml must not exceed 12 hours. The infusion
system and the container must be discarded and replaced after a maximum of 12 hours.
The simultaneous administration of Ripol 20 mg/ml together with an infusion solution of glucose
50 mg/ml (5%), sodium chloride 9 mg/ml (0.9%) intravenous infusion solution or a combination
solution of glucose 40 mg/ml (4%) and sodium chloride 1.8 mg/ml (0.18%) close to the Y-connector
near the place of injection, is possible.
Any Ripol 20 mg/ml remaining at the end of the infusion period or after changing the system needs to
be discarded and destroyed.
To reduce pain on the injection site lidocaine may be injected immediately before the use of Ripol 20
The infusion system should be rinsed before administration of muscle relaxants like atracurium and
mivacurium when using the same infusion system for Ripol 20 mg/ml.
Any remaining contents after use should be discarded.
Any unused product or waste material should be disposed of in accordance with local requirements.
Source: Medicines and Healthcare Products Regulatory Agency
Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.