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PROPOFOL

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Overview

What is Propofol?

Propofol Injectable Emulsion, USP is a sterile, nonpyrogenic emulsion containing 10 mg/mL of propofol suitable for intravenous administration.  Propofol is chemically described as 2,6-diisopropylphenol.  The structural formula is:

 CHO                           M.W. 178.27

Propofol is slightly soluble in water and, thus, is formulated in a white, oil-in-water emulsion.  The pKa is 11.  The octanol/water partition coefficient for propofol is 6761:1 at a pH of 6 to 8.5.  In addition to the active component, propofol, the formulation also contains soybean oil (100 mg/mL), glycerol (22.5 mg/mL), egg lecithin (12 mg/mL); and disodium edetate (0.005%); with sodium hydroxide to adjust pH.  The Propofol Injectable Emulsion, USP is isotonic and has a pH of 7 to 8.5.



What does Propofol look like?



What are the available doses of Propofol?

Sorry No records found.

What should I talk to my health care provider before I take Propofol?

Sorry No records found

How should I use Propofol?

Propofol Injectable Emulsion is an IV sedative-hypnotic agent that can be used as described in the table below.

Table 3.  Indications for Propofol Injectable Emulsion

Safety, effectiveness and dosing guidelines for Propofol Injectable Emulsion have not been established for MAC Sedation in the pediatric population; therefore, it is not recommended for this use (see ).

Propofol Injectable Emulsion is not recommended for induction of anesthesia below the age of 3 years or for maintenance of anesthesia below the age of 2 months because its safety and effectiveness have not been established in those populations.

In the Intensive Care Unit (ICU), Propofol Injectable Emulsion can be administered to intubated, mechanically ventilated adult patients to provide continuous sedation and control of stress responses only by persons skilled in the medical management of critically ill patients and trained in cardiovascular resuscitation and airway management.

Propofol Injectable Emulsion is not indicated for use in Pediatric ICU sedation since the safety of this regimen has not been established (see ).

Propofol Injectable Emulsion is not recommended for obstetrics, including Cesarean section deliveries.  Propofol Injectable Emulsion crosses the placenta, and as with other general anesthetic agents, the administration of Propofol Injectable Emulsion may be associated with neonatal depression (see ).

Propofol Injectable Emulsion is not recommended for use in nursing mothers because Propofol Injectable Emulsion has been reported to be excreted in human milk, and the effects of oral absorption of small amounts of propofol are not known (see ).

Propofol blood concentrations at steady state are generally proportional to infusion rates, especially in individual patients.  Undesirable effects such as cardiorespiratory depression are likely to occur at higher blood concentrations which result from bolus dosing or rapid increases in the infusion rate.  An adequate interval (3 to 5 minutes) must be allowed between dose adjustments to allow for and assess the clinical effects.

Shake well before use.  Do not use if there is evidence of excessive creaming or aggregation, if large droplets are visible, or if there are other forms of phase separation indicating that the stability of the product has been compromised.  Slight creaming, which should disappear after shaking, may be visible upon prolonged standing.

When administering Propofol Injectable Emulsion by infusion, syringe or volumetric pumps are recommended to provide controlled infusion rates.  When infusing Propofol Injectable Emulsion to patients undergoing magnetic resonance imaging, metered control devices may be utilized if mechanical pumps are impractical.

Changes in vital signs indicating a stress response to surgical stimulation or the emergence from anesthesia may be controlled by the administration of 25 mg (2.5 mL) to 50 mg (5 mL) incremental boluses and/or by increasing the infusion rate of Propofol Injectable Emulsion. 

For minor surgical procedures (e.g., body surface) nitrous oxide (60% to 70%) can be combined with a variable rate Propofol Injectable Emulsion infusion to provide satisfactory anesthesia.  With more stimulating surgical procedures (e.g., intra-abdominal), or if supplementation with nitrous oxide is not provided, administration rate(s) of Propofol Injectable Emulsion and/or opioids should be increased in order to provide adequate anesthesia.

Infusion rates should always be titrated downward in the absence of clinical signs of light anesthesia until a mild response to surgical stimulation is obtained in order to avoid administration of Propofol Injectable Emulsion at rates higher than are clinically necessary.  Generally, rates of 50 to 100 mcg/kg/min in adults should be achieved during maintenance in order to optimize recovery times.

Other drugs that cause CNS depression (hypnotics/sedatives, inhalational anesthetics, and opioids) can increase CNS depression induced by propofol.  Morphine premedication (0.15 mg/kg) with nitrous oxide 67% in oxygen has been shown to decrease the necessary propofol injection maintenance infusion rate and therapeutic blood concentrations when compared to non-narcotic (lorazepam) premedication.


What interacts with Propofol?

Propofol Injectable Emulsion is contraindicated in patients with a known hypersensitivity to Propofol Injectable Emulsion or any of its components.


Propofol Injectable Emulsion is contraindicated in patients with allergies to eggs, egg products, soybeans or soy products.



What are the warnings of Propofol?

(For further information about the description of tardive dyskinesia and its clinical detection, please refer to and .)

Use of Propofol Injectable Emulsion has been associated with both fatal and life-threatening anaphylactic and anaphylactoid reactions. 

For general anesthesia or monitored anesthesia care (MAC) sedation, Propofol Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.  Sedated patients should be continuously monitored, and facilities for maintenance of a patent airway, providing artificial ventilation, administering supplemental oxygen, and instituting cardiovascular resuscitation must be immediately available.  Patients should be continuously monitored for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation.  These cardiorespiratory effects are more likely to occur following rapid bolus administration, especially in the elderly, debilitated, or ASA-PS III or IV patients.

For sedation of intubated, mechanically ventilated patients in the Intensive Care Unit (ICU), Propofol Injectable Emulsion should be administered only by persons skilled in the management of critically ill patients and trained in cardiovascular resuscitation and airway management.

Use of Propofol Injectable Emulsion infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death.  The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal failure.  The following appear to be major risk factors for the development of these events: decreased oxygen delivery to tissues; serious neurological injury and/or sepsis; high dosages of one or more of the following pharmacological agents: vasoconstrictors, steroids, inotropes and/or prolonged, high-dose infusions of propofol (> 5 mg/kg/h for > 48h).  The syndrome has also been reported following large-dose, short-term infusions during surgical anesthesia.  In the setting of prolonged need for sedation, increasing propofol dose requirements to maintain a constant level of sedation, or onset of metabolic acidosis during administration of a propofol infusion, consideration should be given to using alternative means of sedation.

Abrupt discontinuation of Propofol Injectable Emulsion prior to weaning or for daily evaluation of sedation levels should be avoided.  This may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation.  Infusions of Propofol Injectable Emulsion should be adjusted to maintain a light level of sedation through the weaning process or evaluation of sedation level (see ).

Propofol Injectable Emulsion should not be coadministered through the same IV catheter with blood or plasma because compatibility has not been established.  tests have shown that aggregates of the globular component of the emulsion vehicle have occurred with blood/plasma/serum from humans and animals.  The clinical significance of these findings is not known.


What are the precautions of Propofol?

General

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Adult and Pediatric Patients

A lower induction dose and a slower maintenance rate of administration should be used in elderly, debilitated, or ASA-PS III or IV patients (see ).  Patients should be continuously monitored for early signs of hypotension and/or bradycardia.  Apnea requiring ventilatory support often occurs during induction and may persist for more than 60 seconds.  Propofol Injectable Emulsion use requires caution when administered to patients with disorders of lipid metabolism such as primary hyperlipoproteinemia, diabetic hyperlipemia, and pancreatitis.

Very rarely the use of Propofol Injectable Emulsion may be associated with the development of a period of postoperative unconsciousness which may be accompanied by an increase in muscle tone.  This may or may not be preceded by a brief period of wakefulness.  Recovery is spontaneous. 

When Propofol Injectable Emulsion is administered to an epileptic patient, there is a risk of seizure during the recovery phase.

Attention should be paid to minimize pain on administration of Propofol Injectable Emulsion.  Transient local pain can be minimized if the larger veins of the forearm or antecubital fossa are used.  Pain during intravenous injection may also be reduced by prior injection of IV lidocaine (1 mL of a 1% solution).  Pain on injection occurred frequently in pediatric patients (45%) when a small vein of the hand was utilized without lidocaine pretreatment.  With lidocaine pretreatment or when antecubital veins were utilized, pain was minimal (incidence less than 10%) and well-tolerated.  There have been reports in the literature indicating that the addition of lidocaine to Propofol in quantities greater than 20 mg lidocaine/200 mg Propofol results in instability of the emulsion which is associated with increases in globule sizes over time and (in rat studies) a reduction in anesthetic potency.  Therefore, it is recommended that lidocaine be administered prior to Propofol administration or that it be added to Propofol immediately before administration and in quantities not exceeding 20 mg lidocaine/200 mg Propofol.

Venous sequelae, i.e., phlebitis or thrombosis, have been reported rarely (
Intra-arterial injection in animals did not induce local tissue effects.  Accidental intra-arterial injection has been reported in patients, and, other than pain, there were no major sequelae.

Intentional injection into subcutaneous or perivascular tissues of animals caused minimal tissue reaction.  During the post-marketing period, there have been rare reports of local pain, swelling, blisters, and/or tissue necrosis following accidental extravasation of Propofol Injectable Emulsion.

Perioperative myoclonia, rarely including convulsions and opisthotonos, has occurred in association with Propofol Injectable Emulsion administration.

Clinical features of anaphylaxis, including angioedema, bronchospasm, erythema, and hypotension, occur rarely following Propofol Injectable Emulsion administration.

There have been rare reports of pulmonary edema in temporal relationship to the administration of Propofol Injectable Emulsion, although a causal relationship is unknown.

Rarely, cases of unexplained postoperative pancreatitis (requiring hospital admission) have been reported after anesthesia in which Propofol Injectable Emulsion was one of the induction agents used.  Due to a variety of confounding factors in these cases, including concomitant medications, a causal relationship to Propofol Injectable Emulsion is unclear.

Propofol Injectable Emulsion has no vagolytic activity.  Reports of bradycardia, asystole, and rarely, cardiac arrest have been associated with Propofol Injectable Emulsion.  Pediatric patients are susceptible to this effect, particularly when fentanyl is given concomitantly.  The intravenous administration of anticholinergic agents (e.g., atropine or glycopyrrolate) should be considered to modify potential increases in vagal tone due to concomitant agents (e.g., succinylcholine) or surgical stimuli.

Intensive Care Unit Sedation

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Adult Patients

The administration of Propofol Injectable Emulsion should be initiated as a continuous infusion and changes in the rate of administration made slowly (>5 min) in order to minimize hypotension and avoid acute overdosage (see ).

Patients should be monitored for early signs of significant hypotension and/or cardiovascular depression, which may be profound.  These effects are responsive to discontinuation of Propofol Injectable Emulsion, IV fluid administration, and/or vasopressor therapy.  In the elderly, debilitated, or ASA-PS III or IV patients, rapid (single or repeated) bolus administration should not be used during sedation in order to minimize undesirable cardiorespiratory depression, including hypotension, apnea, airway obstruction, and oxygen desaturation.

As with other sedative medications, there is wide interpatient variability in Propofol Injectable Emulsion dosage requirements, and these requirements may change with time.

Failure to reduce the infusion rate in patients receiving Propofol Injectable Emulsion for extended periods may result in excessively high blood concentrations of the drug.  Thus, titration to clinical response and daily evaluation of sedation levels are important during use of Propofol Injectable Emulsion infusion for ICU sedation, especially when it is used for long durations.

Opioids and paralytic agents should be discontinued and respiratory function optimized prior to weaning patients from mechanical ventilation.  Infusions of Propofol Injectable Emulsion should be adjusted to maintain a light level of sedation prior to weaning patients from mechanical ventilatory support.  Throughout the weaning process, this level of sedation may be maintained in the absence of respiratory depression.  Because of the rapid clearance of Propofol Injectable Emulsion, abrupt discontinuation of a patient's infusion may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation, making weaning from mechanical ventilation difficult.  It is therefore recommended that administration of Propofol Injectable Emulsion be continued in order to maintain a light level of sedation throughout the weaning process until 10 to 15 minutes prior to extubation, at which time the infusion can be discontinued.

Since Propofol Injectable Emulsion is formulated in an oil‑in-water emulsion, elevations in serum triglycerides may occur when Propofol Injectable Emulsion is administered for extended periods of time.  Patients at risk of hyperlipidemia should be monitored for increases in serum triglycerides or serum turbidity.  Administration of Propofol Injectable Emulsion should be adjusted if fat is being inadequately cleared from the body.  A reduction in the quantity of concurrently administered lipids is indicated to compensate for the amount of lipid infused as part of the Propofol Injectable Emulsion formulation; 1 mL of Propofol Injectable Emulsion contains approximately 0.1 g of fat (1.1 kcal).

EDTA is a strong chelator of trace metals -- including zinc.  Although with Propofol Injectable Emulsion there are no reports of decreased zinc levels or zinc deficiency-related adverse events, Propofol Injectable Emulsion should not be infused for longer than 5 days without providing a drug holiday to safely replace estimated or measured urine zinc losses.

In clinical trials mean urinary zinc loss was approximately 2.5 to 3 mg/day in adult patients and 1.5 to 2 mg/day in pediatric patients.

In patients who are predisposed to zinc deficiency, such as those with burns, diarrhea, and/or major sepsis, the need for supplemental zinc should be considered during prolonged therapy with Propofol Injectable Emulsion.

At high doses (2 to 3 grams per day), EDTA has been reported, on rare occasions, to be toxic to the renal tubules.  Studies to date in patients with normal or impaired renal function have not shown any alteration in renal function with Propofol Injectable Emulsion containing 0.005% disodium edetate.  In patients at risk for renal impairment, urinalysis and urine sediment should be checked before initiation of sedation and then be monitored on alternate days during sedation.

The long-term administration of Propofol Injectable Emulsion to patients with renal failure and/or hepatic insufficiency has not been evaluated.

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Neurosurgical Anesthesia

When Propofol Injectable Emulsion is used in patients with increased intracranial pressure or impaired cerebral circulation, significant decreases in mean arterial pressure should be avoided because of the resultant decreases in cerebral perfusion pressure.  To avoid significant hypotension and decreases in cerebral perfusion pressure, an infusion or slow bolus of approximately 20 mg every 10 seconds should be utilized instead of rapid, more frequent, and/or larger boluses of Propofol Injectable Emulsion.  Slower induction, titrated to clinical responses, will generally result in reduced induction dosage requirements (1 to 2 mg/kg).  When increased ICP is suspected, hyperventilation and hypocarbia should accompany the administration of Propofol Injectable Emulsion (see ).

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Cardiac Anesthesia

Slower rates of administration should be utilized in premedicated patients, geriatric patients, patients with recent fluid shifts, and patients who are hemodynamically unstable.  Fluid deficits should be corrected prior to administration of Propofol Injectable Emulsion.  In those patients where additional fluid therapy may be contraindicated, other measures, e.g., elevation of lower extremities, or use of pressor agents, may be useful to offset the hypotension which is associated with the induction of anesthesia with Propofol Injectable Emulsion.

Information for Patients

Patients should be advised that performance of activities requiring mental alertness, such as operating a motor vehicle, or hazardous machinery or signing legal documents may be impaired for some time after general anesthesia or sedation.

Drug Interactions

The induction dose requirements of Propofol Injectable Emulsion may be reduced in patients with intramuscular or intravenous premedication, particularly with narcotics (e.g., morphine, meperidine, and fentanyl, etc.) and combinations of opioids and sedatives (e.g., benzodiazepines, barbiturates, chloral hydrate, droperidol, etc.).  These agents may increase the anesthetic or sedative effects of Propofol Injectable Emulsion and may also result in more pronounced decreases in systolic, diastolic, and mean arterial pressures and cardiac output.

During maintenance of anesthesia or sedation, the rate of Propofol Injectable Emulsion administration should be adjusted according to the desired level of anesthesia or sedation and may be reduced in the presence of supplemental analgesic agents (e.g., nitrous oxide or opioids).  The concurrent administration of potent inhalational agents (e.g., isoflurane, enflurane, and halothane) during maintenance with Propofol Injectable Emulsion has not been extensively evaluated.  These inhalational agents can also be expected to increase the anesthetic or sedative and cardiorespiratory effects of Propofol Injectable Emulsion.

Propofol Injectable Emulsion does not cause a clinically significant change in onset, intensity or duration of action of the commonly used neuromuscular blocking agents (e.g., succinylcholine and nondepolarizing muscle relaxants). 

No significant adverse interactions with commonly used premedications or drugs used during anesthesia or sedation (including a range of muscle relaxants, inhalational agents, analgesic agents, and local anesthetic agents) have been observed in adults.  In pediatric patients, administration of fentanyl concomitantly with Propofol Injectable Emulsion may result in serious bradycardia.

Carcinogenesis, Mutagensis, Impairment of Fertility

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Carcinogenesis

Long-term studies in animals have not been performed to evaluate the carcinogenic potential of propofol.

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Mutagenesis

Propofol was not mutagenic in the bacterial reverse mutation assay (Ames test) using strains TA98, TA100, TA1535, TA1537 and TA1538.  Propofol was not mutagenic in either the gene mutation/gene conversion test using or cytogenetic studies in Chinese hamsters.  In the mouse micronucleus assay with Chinese Hamsters propofol administration did not produce chromosome aberrations.

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Impairment of Fertility

Female Wistar rats were administered either 0, 10, or 15 mg/kg/day propofol intravenously from 2 weeks before pregnancy to day 7 of gestation did not show impaired fertility.  Male fertility in rats was not affected in a dominant lethal study at intravenous doses up to 15 mg/kg/day for 5 days.

Pregnancy

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Teratogenic Effects

Pregnancy Category B

Reproduction studies have been performed in rats and rabbits at intravenous doses of 15 mg/kg/day (approximately equivalent to the recommended human induction dose on a mg/mbasis) and have revealed no evidence of impaired fertility or harm to the fetus due to propofol.  Propofol, however, has been shown to cause maternal deaths in rats and rabbits and decreased pup survival during the lactating period in dams treated with 15 mg/kg/day (approximately equivalent to the recommended human induction dose on a mg/m basis). The pharmacological activity (anesthesia) of the drug on the mother is probably responsible for the adverse effects seen in the offspring.  There are, however, no adequate and well-controlled studies in pregnant women.  Because animal reproduction studies are not always predictive of human responses, this drug should be used during pregnancy only if clearly needed.

Labor and Delivery

Propofol Injectable Emulsion is not recommended for obstetrics, including cesarean section deliveries.  Propofol Injectable Emulsion crosses the placenta, and as with other general anesthetic agents, the administration of Propofol Injectable Emulsion may be associated with neonatal depression.

Nursing Mothers

Propofol Injectable Emulsion is not recommended for use in nursing mothers because Propofol Injectable Emulsion has been reported to be excreted in human milk and the effects of oral absorption of small amounts of propofol are not known.

Pediatric Use

The safety and effectiveness of Propofol Injectable Emulsion have been established for induction of anesthesia in pediatric patients aged 3 years and older and for the maintenance of anesthesia aged 2 months and older.

Propofol Injectable Emulsion is not recommended for the induction of anesthesia in patients younger than 3 years of age and for the maintenance of anesthesia in patients younger than 2 months of age as safety and effectiveness have not been established.

In pediatric patients, administration of fentanyl concomitantly with Propofol Injectable Emulsion may result in serious bradycardia (see ).

Propofol Injectable Emulsion is not indicated for use in pediatric patients for ICU sedation or for MAC sedation for surgical, nonsurgical or diagnostic procedures as safety and effectiveness have not been established.

There have been anecdotal reports of serious adverse events and death in pediatric patients with upper respiratory tract infections receiving Propofol Injectable Emulsion for ICU sedation.

In one multicenter clinical trial of ICU sedation in critically ill pediatric patients that excluded patients with upper respiratory tract infections, the incidence of mortality observed in patients who received Propofol Injectable Emulsion (n=222) was 9%, while that for patients who received standard sedative agents (n=105) was 4%.  While causality has not been established, Propofol Injectable Emulsion is not indicated for sedation in pediatric patients until further studies have been performed to document its safety in that population (see and ).

In pediatric patients, abrupt discontinuation following prolonged infusion may result in flushing of the hands and feet, agitation, tremulousness and hyperirritability.  Increased incidences of bradycardia (5%), agitation (4%), and jitteriness (9%) have also been observed.

Geriatric Use

The effect of age on induction dose requirements for propofol was assessed in an open-label study involving 211 unpremedicated patients with approximately 30 patients in each decade between the ages of 16 and 80.  The average dose to induce anesthesia was calculated for patients up to 54 years of age and for patients 55 years of age or older.  The average dose to induce anesthesia in patients up to 54 years of age was 1.99 mg/kg and in patients above 54 it was 1.66 mg/kg.  Subsequent clinical studies have demonstrated lower dosing requirements for subjects greater than 60 years of age.

A lower induction dose and a slower maintenance rate of administration of Propofol Injectable Emulsion should be used in elderly patients. In this group of patients, rapid (single or repeated) bolus administration should not be used in order to minimize undesirable cardiorespiratory depression including hypotension, apnea, airway obstruction, and/or oxygen desaturation.  All dosing should be titrated according to patient condition and response (see and ).


What are the side effects of Propofol?

General

Adverse event information is derived from controlled clinical trials and worldwide marketing experience.  In the description below, rates of the more common events represent US/Canadian clinical study results.  Less frequent events are also derived from publications and marketing experience in over 8 million patients; there are insufficient data to support an accurate estimate of their incidence rates.  These studies were conducted using a variety of premedicants, varying lengths of surgical/diagnostic procedures, and various other anesthetic/sedative agents.  Most adverse events were mild and transient.

Anesthesia and MAC Sedation in Adults

The following estimates of adverse events for Propofol Injectable Emulsion include data from clinical trials in general anesthesia/MAC sedation (N=2889 adult patients).  The adverse events listed below as probably causally related are those events in which the actual incidence rate in patients treated with Propofol Injectable Emulsion was greater than the comparator incidence rate in these trials.  Therefore, incidence rates for anesthesia and MAC sedation in adults generally represent estimates of the percentage of clinical trial patients which appeared to have probable causal relationship.

The adverse experience profile from reports of 150 patients in the MAC sedation clinical trials is similar to the profile established with Propofol Injectable Emulsion during anesthesia (see below).  During MAC sedation clinical trials, significant respiratory events included cough, upper airway obstruction, apnea, hypoventilation, and dyspnea.

Anesthesia in Pediatric Patients

Generally the adverse experience profile from reports of 506 Propofol Injectable Emulsion pediatric patients from 6 days through 16 years of age in the US/Canadian anesthesia clinical trials is similar to the profile established with Propofol Injectable Emulsion during anesthesia in adults (see Pediatric percentages [Peds %] below).  Although not reported as an adverse event in clinical trials, apnea is frequently observed in pediatric patients.

ICU Sedation in Adults

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The following estimates of adverse events include data from clinical trials in ICU sedation (N=159 adult patients).  Probably related incidence rates for ICU sedation were determined by individual case report form review.  Probable causality was based upon an apparent dose response relationship and/or positive responses to rechallenge.  In many instances the presence of concomitant disease and concomitant therapy made the causal relationship unknown.  Therefore, incidence rates for ICU sedation generally represent estimates of the percentage of clinical trial patients which appeared to have a probable causal relationship.

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Incidence greater than 1% - Probably Causally Related

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Incidence less than 1% - Probably Causally Related

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Incidence less than 1% - Causal Relationship Unknown

              Anesthesia/MAC Sedation              ICU Sedation
Cardiovascular:BradycardiaBradycardia
Arrhythmia [Peds: 1.2%]
Tachycardia Nodal [Peds: 1.6%]
Decreased Cardiac Output
Hypertension [Peds: 8%]Hypotension 26%
Central Nervous System:
Movement* [Peds: 17%]
Injection Site:
Metabolic/Nutritional:Hyperlipemia*
Respiratory:
Skin and Appendages:
           Anesthesia/MAC Sedation         ICU Sedation
Body as a Whole:Anaphylaxis/Anaphylactoid Reaction
Perinatal Disorder
[Tachycardia]
[Bigeminy]
[Bradycardia]
[Premature Ventricular Contractions]
[Hemorrhage]
[ECG Abnormal]
[Arrhythmia Atrial]
[Fever]
[Extremities Pain]
[Anticholinergic Syndrome]
Cardiovascular:Premature Atrial Contractions
Syncope
Central Nervous System:Hypertonia/Dystonia, ParesthesiaAgitation
Digestive:[Hypersalivation]
[Nausea]
Hemic/Lymphatic: [Leukocytosis]
Injection Site:[Phlebitis]
[Pruritus]
Metabolic:[Hypomagnesemia]
Musculoskeletal:Myalgia
Nervous:
Respiratory:Decreased Lung Function
Skin and Appendages: Flushing, Pruritus
Special Senses:
Urogenital:Cloudy UrineGreen Urine
      Anesthesia/MAC Sedation                            ICU Sedation
Body as a Whole:Fever, Sepsis, Trunk Pain, Whole Body Weakness
Cardiovascular:
Central Nervous System:
Digestive:Ileus, Liver Function Abnormal
Hematologic/Lymphatic:Coagulation Disorder, Leukocytosis
Injection Site:
Metabolic/Nutritional:Hyperkalemia, Hyperlipemia
Respiratory:Hypoxia
Skin and Appendages:Rash
Special Senses:
Urogenital:Oliguria, Urine RetentionKidney Failure



What should I look out for while using Propofol?

Propofol Injectable Emulsion is contraindicated in patients with a known hypersensitivity to Propofol Injectable Emulsion or any of its components.

Propofol Injectable Emulsion is contraindicated in patients with allergies to eggs, egg products, soybeans or soy products.

Use of Propofol Injectable Emulsion has been associated with both fatal and life-threatening anaphylactic and anaphylactoid reactions. 

For general anesthesia or monitored anesthesia care (MAC) sedation, Propofol Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.  Sedated patients should be continuously monitored, and facilities for maintenance of a patent airway, providing artificial ventilation, administering supplemental oxygen, and instituting cardiovascular resuscitation must be immediately available.  Patients should be continuously monitored for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation.  These cardiorespiratory effects are more likely to occur following rapid bolus administration, especially in the elderly, debilitated, or ASA-PS III or IV patients.

For sedation of intubated, mechanically ventilated patients in the Intensive Care Unit (ICU), Propofol Injectable Emulsion should be administered only by persons skilled in the management of critically ill patients and trained in cardiovascular resuscitation and airway management.

Use of Propofol Injectable Emulsion infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death.  The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal failure.  The following appear to be major risk factors for the development of these events: decreased oxygen delivery to tissues; serious neurological injury and/or sepsis; high dosages of one or more of the following pharmacological agents: vasoconstrictors, steroids, inotropes and/or prolonged, high-dose infusions of propofol (> 5 mg/kg/h for > 48h).  The syndrome has also been reported following large-dose, short-term infusions during surgical anesthesia.  In the setting of prolonged need for sedation, increasing propofol dose requirements to maintain a constant level of sedation, or onset of metabolic acidosis during administration of a propofol infusion, consideration should be given to using alternative means of sedation.

Abrupt discontinuation of Propofol Injectable Emulsion prior to weaning or for daily evaluation of sedation levels should be avoided.  This may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation.  Infusions of Propofol Injectable Emulsion should be adjusted to maintain a light level of sedation through the weaning process or evaluation of sedation level (see ).

Propofol Injectable Emulsion should not be coadministered through the same IV catheter with blood or plasma because compatibility has not been established.  tests have shown that aggregates of the globular component of the emulsion vehicle have occurred with blood/plasma/serum from humans and animals.  The clinical significance of these findings is not known.


What might happen if I take too much Propofol?

If overdosage occurs, Propofol Injectable Emulsion administration should be discontinued immediately.  Overdosage is likely to cause cardiorespiratory depression.  Respiratory depression should be treated by artificial ventilation with oxygen.  Cardiovascular depression may require repositioning of the patient by raising the patient's legs, increasing the flow rate of intravenous fluids, and administering pressor agents and/or anticholinergic agents.


How should I store and handle Propofol?

Store at 25°C (77°F); excursions permitted to 15°C-30°C (59°F-86°F) [see USP Controlled Room Temperature].Propofol Injectable Emulsion, USP is available as follows:Propofol undergoes oxidative degradation, in the presence of oxygen, and is therefore packaged under nitrogen to eliminate this degradation path.Store between 4° to 25°C (40° to 77°F).  Do not freeze.  Shake well before use.  Propofol Injectable Emulsion, USP is available as follows:Propofol undergoes oxidative degradation, in the presence of oxygen, and is therefore packaged under nitrogen to eliminate this degradation path.Store between 4° to 25°C (40° to 77°F).  Do not freeze.  Shake well before use.  Propofol Injectable Emulsion, USP is available as follows:Propofol undergoes oxidative degradation, in the presence of oxygen, and is therefore packaged under nitrogen to eliminate this degradation path.Store between 4° to 25°C (40° to 77°F).  Do not freeze.  Shake well before use. 


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Clinical Information

Chemical Structure

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Clinical Pharmacology

Propofol Injectable Emulsion is an intravenous sedative-hypnotic agent for use in the induction and maintenance of anesthesia or sedation.  Intravenous injection of a therapeutic dose of propofol induces hypnosis, with minimal excitation, usually within 40 seconds from the start of injection (the time for one arm-brain circulation).  As with other rapidly acting intravenous anesthetic agents, the half-time of the blood-brain equilibration is approximately 1 to 3 minutes, accounting for the rate of induction of anesthesia.  The mechanism of action, like all general anesthetics, is poorly understood.  However, propofol is thought to produce its sedative/anesthetic effects by the positive mondulation of the inhibitory function of the neurotransmitter GABA through the ligand-gated GABA receptors.

Non-Clinical Toxicology
Propofol Injectable Emulsion is contraindicated in patients with a known hypersensitivity to Propofol Injectable Emulsion or any of its components.

Propofol Injectable Emulsion is contraindicated in patients with allergies to eggs, egg products, soybeans or soy products.

Use of Propofol Injectable Emulsion has been associated with both fatal and life-threatening anaphylactic and anaphylactoid reactions. 

For general anesthesia or monitored anesthesia care (MAC) sedation, Propofol Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.  Sedated patients should be continuously monitored, and facilities for maintenance of a patent airway, providing artificial ventilation, administering supplemental oxygen, and instituting cardiovascular resuscitation must be immediately available.  Patients should be continuously monitored for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation.  These cardiorespiratory effects are more likely to occur following rapid bolus administration, especially in the elderly, debilitated, or ASA-PS III or IV patients.

For sedation of intubated, mechanically ventilated patients in the Intensive Care Unit (ICU), Propofol Injectable Emulsion should be administered only by persons skilled in the management of critically ill patients and trained in cardiovascular resuscitation and airway management.

Use of Propofol Injectable Emulsion infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death.  The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal failure.  The following appear to be major risk factors for the development of these events: decreased oxygen delivery to tissues; serious neurological injury and/or sepsis; high dosages of one or more of the following pharmacological agents: vasoconstrictors, steroids, inotropes and/or prolonged, high-dose infusions of propofol (> 5 mg/kg/h for > 48h).  The syndrome has also been reported following large-dose, short-term infusions during surgical anesthesia.  In the setting of prolonged need for sedation, increasing propofol dose requirements to maintain a constant level of sedation, or onset of metabolic acidosis during administration of a propofol infusion, consideration should be given to using alternative means of sedation.

Abrupt discontinuation of Propofol Injectable Emulsion prior to weaning or for daily evaluation of sedation levels should be avoided.  This may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation.  Infusions of Propofol Injectable Emulsion should be adjusted to maintain a light level of sedation through the weaning process or evaluation of sedation level (see ).

Propofol Injectable Emulsion should not be coadministered through the same IV catheter with blood or plasma because compatibility has not been established.  tests have shown that aggregates of the globular component of the emulsion vehicle have occurred with blood/plasma/serum from humans and animals.  The clinical significance of these findings is not known.

Adult and Pediatric Patients

A lower induction dose and a slower maintenance rate of administration should be used in elderly, debilitated, or ASA-PS III or IV patients (see ).  Patients should be continuously monitored for early signs of hypotension and/or bradycardia.  Apnea requiring ventilatory support often occurs during induction and may persist for more than 60 seconds.  Propofol Injectable Emulsion use requires caution when administered to patients with disorders of lipid metabolism such as primary hyperlipoproteinemia, diabetic hyperlipemia, and pancreatitis.

Very rarely the use of Propofol Injectable Emulsion may be associated with the development of a period of postoperative unconsciousness which may be accompanied by an increase in muscle tone.  This may or may not be preceded by a brief period of wakefulness.  Recovery is spontaneous. 

When Propofol Injectable Emulsion is administered to an epileptic patient, there is a risk of seizure during the recovery phase.

Attention should be paid to minimize pain on administration of Propofol Injectable Emulsion.  Transient local pain can be minimized if the larger veins of the forearm or antecubital fossa are used.  Pain during intravenous injection may also be reduced by prior injection of IV lidocaine (1 mL of a 1% solution).  Pain on injection occurred frequently in pediatric patients (45%) when a small vein of the hand was utilized without lidocaine pretreatment.  With lidocaine pretreatment or when antecubital veins were utilized, pain was minimal (incidence less than 10%) and well-tolerated.  There have been reports in the literature indicating that the addition of lidocaine to Propofol in quantities greater than 20 mg lidocaine/200 mg Propofol results in instability of the emulsion which is associated with increases in globule sizes over time and (in rat studies) a reduction in anesthetic potency.  Therefore, it is recommended that lidocaine be administered prior to Propofol administration or that it be added to Propofol immediately before administration and in quantities not exceeding 20 mg lidocaine/200 mg Propofol.

Venous sequelae, i.e., phlebitis or thrombosis, have been reported rarely (
Intra-arterial injection in animals did not induce local tissue effects.  Accidental intra-arterial injection has been reported in patients, and, other than pain, there were no major sequelae.

Intentional injection into subcutaneous or perivascular tissues of animals caused minimal tissue reaction.  During the post-marketing period, there have been rare reports of local pain, swelling, blisters, and/or tissue necrosis following accidental extravasation of Propofol Injectable Emulsion.

Perioperative myoclonia, rarely including convulsions and opisthotonos, has occurred in association with Propofol Injectable Emulsion administration.

Clinical features of anaphylaxis, including angioedema, bronchospasm, erythema, and hypotension, occur rarely following Propofol Injectable Emulsion administration.

There have been rare reports of pulmonary edema in temporal relationship to the administration of Propofol Injectable Emulsion, although a causal relationship is unknown.

Rarely, cases of unexplained postoperative pancreatitis (requiring hospital admission) have been reported after anesthesia in which Propofol Injectable Emulsion was one of the induction agents used.  Due to a variety of confounding factors in these cases, including concomitant medications, a causal relationship to Propofol Injectable Emulsion is unclear.

Propofol Injectable Emulsion has no vagolytic activity.  Reports of bradycardia, asystole, and rarely, cardiac arrest have been associated with Propofol Injectable Emulsion.  Pediatric patients are susceptible to this effect, particularly when fentanyl is given concomitantly.  The intravenous administration of anticholinergic agents (e.g., atropine or glycopyrrolate) should be considered to modify potential increases in vagal tone due to concomitant agents (e.g., succinylcholine) or surgical stimuli.

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Interactions

Interactions

A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).