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com monograph license data us dailymed propofol pregnancy category au c dependence liability physical very high psychological no data addiction liability moderate 2 routes of administration intravenous drug class gaba a receptor agonist sedative general anesthetic atc code n01ax10 who legal status legal status au s4 prescription only br class c1 other controlled substances 3 ca only uk pom prescription only us only 4 se rx only 5 in general prescription only pharmacokinetic data protein binding 95 99 metabolism liver glucuronidation onset of action intravenous 15 30 seconds 6 elimination half life 1 5 31 hours 6 duration of action 5 10 minutes 6 excretion liver identifiers iupac name 2 6 di propan 2 yl phenol cas number 2078 54 8 y pubchem cid 4943 iuphar bps 5464 drugbank db00818 y chemspider 4774 y unii yi7vu623sf kegg d00549 y chebi chebi 44915 y chembl chembl526 y comptox dashboard epa dtxsid6023523 echa infocard 100 016 551 chemical and physical data formula c 12 h 18 o molar mass 178 275 g mol 1 3d model jsmol interactive image solubility in water δg solv h 2 o 4 39 kcal mol 7 smiles cc c c1cccc c1o c c c inchi inchi 1s c12h18o c1 8 2 10 6 5 7 11 9 3 4 12 10 13 h5 9 13h 1 4h3 y key olbcvfgfozpwhh uhfffaoysa n y verify propofol 8 is the active component of an intravenous anesthetic used for induction and maintenance of general anesthesia propofol was first marketed under the brand name diprivan intravenous administration is used to induce unconsciousness after which anesthesia may be maintained using a combination of medications propofol is manufactured as part of a sterile injectable emulsion using soybean oil and lecithin which gives it a white milky color 9 compared to other anesthetics recovery from propofol induced anesthesia is generally quick and infrequently associated with such side effects as drowsiness nausea vomiting 10 11 propofol may be used before diagnostic procedures requiring anesthesia in the management of refractory status epilepticus and for induction or maintenance of anesthesia before and during surgery it may be administered as a bolus or an infusion or as a combination of the two first synthesized in 1973 by john b glen a british veterinary anesthesiologist working for imperial chemical industries ici later astrazeneca 12 propofol was introduced for therapeutic use as a lipid emulsion in the united kingdom and new zealand in 1986 propofol diprivan received fda approval in october 1989 it is on the world health organization s list of essential medicines 13 uses edit anesthesia edit to induce general anesthesia propofol is the drug used almost exclusively having largely replaced sodium thiopental 14 it is often administered as part of an anesthesia maintenance technique called total intravenous anesthesia using either manually programmed infusion pumps or computer controlled infusion pumps in a process called target controlled infusion tci 15 propofol is also used to sedate people who are receiving mechanical ventilation but not undergoing surgery such as patients in the intensive care unit 16 in critically ill patients propofol is superior to lorazepam both in effectiveness and overall cost 17 propofol is relatively inexpensive compared to medications of similar use due to shorter icu stay length 17 one of the reasons propofol is thought to be more effective although it has a longer half life than lorazepam is that studies have found that benzodiazepines like midazolam and lorazepam tend to accumulate in critically ill patients prolonging sedation 17 propofol has also been suggested as a sleep aid for critically ill adults in an icu setting however its effectiveness in replicating the mental and physical aspects of sleep for people in the icu is unclear 16 propofol can be administered via a peripheral iv or central line propofol is often paired with fentanyl for pain relief in intubated and sedated people 18 the two drugs are molecularly compatible in an iv mixture form 18 propofol is also used to deepen anesthesia to relieve laryngospasm it may be used alone or followed by succinylcholine its use can avoid the need for paralysis and in some instances the potential side effects of succinylcholine 19 routine procedural sedation edit propofol is safe and effective for gastrointestinal endoscopy procedures colonoscopies etc its use in these settings results in a faster recovery compared to midazolam 20 it can also be combined with opioids or benzodiazepines 21 22 23 because of its rapid induction and recovery time propofol is also widely used for sedation of infants and children undergoing mri procedures 24 it is also often used in combination with ketamine with minimal side effects 25 status epilepticus edit status epilepticus may be defined as seizure activity lasting beyond five minutes and needing anticonvulsant medication several guidelines recommend the use of propofol for the treatment of refractory status epilepticus 26 other uses edit assisted death in canada edit a lethal dose of propofol is used for medical assistance in dying in canada to induce deep coma and death quickly but rocuronium is always given as a paralytic ensuring death even when the patient has died as a result of an initial propofol overdose 27 capital punishment edit the use of propofol as part of an execution protocol has been considered although no person has been executed using this agent this is largely due to european manufacturers and governments banning the export of propofol for such use 28 29 recreational use edit recreational use of the drug via self administration has been reported 30 31 but is relatively rare due to its potency and the level of monitoring required for safe use critically a steep dose response curve makes recreational use of propofol very dangerous and deaths from self administration continue to be reported 32 33 the short term effects sought via recreational use include mild euphoria hallucinations and disinhibition 34 35 recreational use of the drug has been described among medical staff such as anesthetists who have access to the drug 36 37 it is reportedly more common among anesthetists on rotations with short rest periods as usage generally produces a well rested feeling 38 long term use has been reported to result in addiction 36 39 attention to the risks of off label use of propofol increased in august 2009 after the release of a coroner s report finding that musician michael jackson was killed by a mixture of propofol and the benzodiazepine drugs lorazepam midazolam and diazepam on 25 june 2009 40 41 42 43 according to a 22 july 2009 search warrant affidavit unsealed by the district court of harris county texas jackson s physician conrad murray administered 25 milligrams of propofol diluted with lidocaine shortly before jackson s death 41 42 44 manufacturing edit propofol as a commercial sterile emulsified formulation is considered difficult to manufacture 45 46 47 it was initially formulated in cremophor for human use but this original formulation was implicated in an unacceptable number of anaphylactic events it was eventually manufactured as a 1 emulsion in soybean oil 48 sterile emulsions represent complex formulation the stability of which is dependent on the interplay of many factors such as micelle size and distribution 49 50 side effects edit there is considerable variability in a patient s response to propofol at times showing profound sedation with small doses one of propofol s most common side effects is pain on injection especially in smaller veins due to activation of the sensory nerve pain receptor trpa1 51 this can be mitigated by pretreatment with lidocaine 52 or slower infusion in a large vein antecubital fossa propofol may lead to low blood pressure related to vasodilation reports of blood pressure drops of 30 or more are thought to be at least partially due to inhibition of sympathetic nerve activity 53 this effect is related to the dose and rate of propofol administration it may also be potentiated by opioid analgesics 54 transient apnea and cerebrovascular effects have followed induction doses propofol has more pronounced hemodynamic effects relative to many intravenous anesthetic agents 55 propofol can also decrease systemic vascular resistance myocardial blood flow and oxygen consumption possibly through direct vasodilation 56 there are also reports that it may cause green discoloration of the urine 57 although propofol is widely used in the adult icu setting the side effects associated with the medication seem to be more concerning in children in the 1990s multiple reported deaths of children in icus associated with propofol sedation prompted the fda to issue a warning 58 as a respiratory depressant propofol frequently produces apnea the persistence of apnea can depend on factors such as premedication dose administered and rate of administration and may sometimes persist for longer than 60 seconds 59 possibly as the result of depression of the central inspiratory drive propofol may produce significant decreases in respiratory rate minute volume tidal volume mean inspiratory flow rate and functional residual capacity 55 propofol administration also results in decreased cerebral blood flow cerebral metabolic oxygen consumption and intracranial pressure 60 in addition propofol may decrease intraocular pressure by as much as 50 in patients with normal intraocular pressure 61 a more serious but rare side effect is dystonia 62 mild myoclonic movements are common as with other intravenous hypnotic agents propofol appears to be safe for use in porphyria and has not been known to trigger malignant hyperthermia citation needed propofol is also reported to induce priapism in some individuals 63 64 and has been observed to suppress rem sleep and to worsen the poor sleep quality in some patients 65 rare side effects include 66 anxiety changes in vision cloudy urine coughing up blood delirium or hallucinations difficult urination difficulty swallowing dry eyes mouth nose or throat as with any other general anesthetic agent propofol should be administered only where appropriately trained staff and facilities for monitoring are available with proper airway management a supply of supplemental oxygen artificial ventilation and cardiovascular resuscitation 67 because of propofol s formulation using lecithin and soybean oil it is prone to bacterial contamination despite the presence of the bacterial inhibitor benzyl alcohol consequently some hospital facilities require the iv tubing for continuous propofol infusions to be changed after 12 hours this is a preventive measure against microbial growth and potential infection 68 propofol infusion syndrome edit main article propofol infusion syndrome a rare but serious side effect is propofol infusion syndrome this potentially lethal metabolic derangement has been reported in critically ill patients after a prolonged infusion of high dose propofol sometimes in combination with catecholamines and or corticosteroids 69 interactions edit the respiratory effects of propofol are increased if given with other respiratory depressants including benzodiazepines 70 pharmacology edit pharmacodynamics edit propofol s proposed mechanism of action 71 72 73 suggests potentiation of gaba a receptor activity by acting as a gaba a receptor positive allosteric modulator which slows receptor channel closing time at high doses propofol may activate gaba a receptors in the absence of gaba behaving as a gaba a receptor agonist as well 74 75 76 propofol analogs also seem to act as sodium channel blockers 77 78 some research suggested significant endocannabinoid system contributions to propofol s unique anesthetic properties as endocannabinoids also play an important role in the physiologic control of sleep pain processing and emesis 79 80 an eeg study on patients undergoing general anesthesia with propofol found that it causes a prominent reduction in the brain s information integration capacity 81 a 2026 study using neuropixels detected hippocampus activity distinguishing sounds and recognizing language under general anesthesia with propofol 82 propofol inhibits fatty acid amide hydrolase which metabolizes the endocannabinoid anandamide aea activation of the endocannabinoid system by propofol possibly via inhibition of aea catabolism generates a significant increase in the whole brain content of aea contributing to the sedative properties of propofol via cb1 receptor activation 83 this may explain the psychotomimetic and antiemetic properties of propofol by contrast there is a high incidence of postoperative nausea and vomiting after administration of volatile anesthetics which contribute to a significant decrease in the whole brain content of aea that can last up to forty minutes after induction 80 pharmacokinetics edit a 20 ml ampoule of 1 propofol emulsion as sold in australia by sandoz propofol is highly protein bound in vivo and is metabolized by conjugation in the liver 84 the half life of elimination of propofol has been estimated to be between 2 and 24 hours however its duration of clinical effect is much shorter because propofol is rapidly distributed into peripheral tissues when used for iv sedation a single dose of propofol typically wears off within minutes onset is rapid in as little as 15 30 seconds 6 propofol s versatility allows it to be used for short or prolonged sedation and general anesthesia and unlike opioid medications its use is not associated with nausea these characteristics of rapid onset and recovery along with its amnestic effects 85 have led to its widespread use for sedation and anesthesia history edit john b glen a veterinarian and researcher at imperial chemical industries ici spent thirteen years developing propofol an effort for which he was awarded the 2018 lasker award for clinical research originally developed as ici 35868 propofol was chosen after extensive evaluation and structure activity relationship studies of the anesthetic potencies and pharmacokinetic profiles of a series of ortho alkylated phenols 86 first identified as a drug candidate in 1973 propofol entered clinical trials in 1977 using a form solubilized in cremophor el 87 however due to anaphylactic reactions to cremophor this formulation was withdrawn from the market and subsequently reformulated as an emulsion of a soya oil and propofol mixture in water the emulsified formulation was relaunched in 1986 by ici whose pharmaceutical division later became a constituent of astrazeneca under the brand name diprivan the preparation contains 1 propofol 10 soybean oil and 1 2 purified egg phospholipid as an emulsifier with 2 25 glycerol as a tonicity adjusting agent and sodium hydroxide to adjust the ph diprivan contains edta a common chelation agent that also acts alone bacteriostatically against some bacteria and synergistically with some other antimicrobial agents newer generic formulations contain sodium metabisulfite as an antioxidant and benzyl a...
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