Dosing and uses of Diprivan (propofol)
Adult dosage forms and strengths
injectable solution
- 10mg/mL
Anesthesia
Induction
- <55 years: 40 mg IVP q10sec until onset (2-2.5 mg/kg)
- >55 years or debilitated or ASA III/IV: 20 mg IVP q10sec until onset (1-1.5 mg/kg)
Maintenance
- <55 years old: 0.1-0.2 mg/kg/min IV
- >55 years old or debilitated or ASA III/IV: 0.05-0.1 mg/kg/min IV
MAC Sedation
Initiation
- 0.1-0.15 mg/kg/min IV
Maintenance
- 0.025-0.075 mg/kg/min IV
- Geriatric: 0.02-0.06 mg/kg/min IV
Postoperative Nausea/Vomiting
20 mg IV; may repeat
ICU Patient
Initiation: 0.005 mg/kg/min IV
Maintenance: 0.005-0.05 mg/kg/min IV (0.005 mg/kg/min increment increase q5min)
Pediatric dosage forms and strengths
injectable solution
- 10mg/mL
Anesthesia
Induction
- 3-16 years: 2.5-3.5 mg/kg IVP over 20-30 sec
Maintenance
- 2 months to 16 years: 0.125-0.3 mg/kg/min IV
Diprivan (propofol) adverse (side) effects
>10%
Hypotension (peds 17%; adults 3-26%)
Apnea lasting 30-60 sec (peds 10%; adults 24%)
Apnea lasting >60 sec (peds 5%; adults 12%)
Movement (peds 17%; adults 3-10%)
Injection site burning/stinging/pain (peds 10%; adults 18%)
1-10%
Respiratory acidosis during weaning (3-10%)
Hypertriglyceridemia (3-10%)
Hypertension (peds 8%)
Rash (peds 5%; adults 1-3%)
Pruritus (1-3%)
Arrhythmia (1-3%)
Bradycardia (1-3%)
Cardiac output decreased (1-3%; concurrent opioid use increases incidence)
Tachycardia (1-3%)
<1%
Arterial hypotension
Anaphylaxis
Asystole
Bronchospasm
Cardiac arrest
Seizures
Opisthotic rxn
Pancreatitis
Pulmonary edema
Phlebitis
Thrombosis
Renal tubular toxicity
Warnings
Contraindications
Lack of ventilatory support
Severe cardiac dysfunction
Documented hypersensitivity, egg allergy, soybean/soy allergy
Sedation in pediatric ICU patients
Use in labor and delivery (including cesarean section) may cause neonatal depression
Cautions
Drug vehicle (emulsion) is capable of supporting rapid growth of microorganisms; proper aseptic technique is imperative
Closely monitor patients with anemia, hepatic impairment, myxedema, or renal impairment
Risk of potentially fatal propofol infusion syndrome in ICU patients
Do not give bolus to ASA III/IV patients; rapid bolus doses will increase cardiorespiratory effects (ie, hypotension, apnea, airway obstruction)
Significant hypertriglyceridemia may be observed during infusion of propofol; 0.1 g lipid (1.1 kcal) per 1 mL propofoL
Accidental extravasation may result in tissue necrosis
Risk of chills, fever, body aches
Propofol infusion syndrome may occur; this is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, and cardiac and renal failure (esp with prolonged, high-dose infusions >5 mg/kg/hr for >48 hr)
Anxiety, agitation, and resistance to mechanical ventilation may occur with abrupt withdrawaL
Pregnancy and lactation
Pregnancy category: B
Lactation: Excreted in breast milk; effect on nursing infant not known
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Diprivan (propofol)
Mechanism of action
Short-acting, lipophilic sedative/hypnotic; causes global CNS depression, presumably through agonist actions on GABAa receptors
Absorption
Onset: 30-45 sec
Duration: 3-10 min (dose-dependent duration; dissipation is function of drug redistribution from CNS)
Distribution
Protein bound: 97-99%
Metabolism
Metabolized by hepatic conjugation to inactive compound
Elimination
Half-life: 40 min (initial); 24-72 hr (after 10-day infusion)
Excretion: Urine, feces
Administration
IV Incompatibilities
Y-site: Amikacin, amphotericin B, atracurium, bretylium, calcium chloride, ceftazidime (?), ciprofloxacin, cisatracurium, diazepam, digoxin, doxorubicin, gentamicin, levofloxacin, methotrexate, methylprednisolone sodium succinate, metoclopramide, minocycline, mitoxantrone, morphine sulfate (at high conc of morphine, compatible at 1 mg/mL), netilmicin, phenytoin, tobramycin, verapamiL
Do not mix with other drugs prior to administration
IV Compatibilities
Solution: D5W, LR, D5/LR, D5/0.45% NaCl, D5/0.2% NaCL
Syringe: ondansetron, thiopentaL
Y-site (partial list): Acyclovir, buprenorphine, dopamine, dobutamine, epinephrine, fentanyl, furosemide, hydromorphone, ketamine, lidocaine, meperidine, midazolam (?), nitroglycerin, KCl, MgSO4, vecuronium
IV Preparation
Does not need to be diluted (available form: 10 mg/mL); however, may be further diluted in D5W to 2 mg/mL
IV Administration
To reduce pain associated with injection, use larger veins of forearm or antecubital fossa; lidocaine IV (1 mL of a 1% solution) may also be used prior to administration
Do not use filter with <5 micron for administration
Soybean fat emulsion is used as a vehicle for propofoL
Strict aseptic technique must be maintained in handling, although a preservative has been added
Do not administer through the same IV catheter with blood or plasma
American College of Critical Care Medicine recommends use of a central vein for administration in an ICU setting
Storage
Store at room temp; refrigeration is not recommended
Protect from light
Do not use if there is evidence of separation of phases of emulsion
