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Propofol: Indications, Dosing, Side Effects and Interactions
Propofol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Propofol: Indications, Dosing, Side Effects and Interactions
Propofol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Induction of anaesthesia using 0.5% or 1% injection**
- **Adult** (By Slow Intravenous Injection, Or By Intravenous Infusion): 55 years and over Usual dose 1-1.5 mg/kg, to be administered at a rate of 20 mg every 10 seconds until response.
**Induction of anaesthesia using 2% injection**
- **Adult** (By Intravenous Infusion): 55 years and over Usual dose 1-1.5 mg/kg, to be administered at a rate of 20 mg every 10 seconds until response.
**Maintenance of anaesthesia using 2% injection**
- **Adult** (By Intravenous Infusion): Usual dose 4-12 mg/kg/hour, for debilitated patients use dose for elderly.
- **Elderly** (By Intravenous Infusion): Usual dose 3-6 mg/kg/hour.
**Induction of sedation**
- **Adult** (By Slow Intravenous Injection): for surgical and diagnostic procedures using 0.5% or 1% injection Initially 0.5-1 mg/kg, to be administered over 1-5 minutes, dose and rate of administration adjusted according to desired level of sedation and response.
**Induction of anaesthesia using 0.5% or 1% injection for propofol**
- **Child 1 month-16 years** (By slow intravenous injection, or by intravenous infusion): Usual dose 2.5-4 mg/kg, dose adjusted according to age, body-weight and response.
- **Child 17 years** (By slow intravenous injection, or by intravenous infusion): Usual dose 1.5-2.5 mg/kg, to be administered at a rate of 20-40 mg every 10 seconds until response.
**Induction of anaesthesia using 2% injection for propofol**
- **Child 3-16 years** (By intravenous infusion): Usual dose 2.5-4 mg/kg, dose adjusted according to age, body-weight and response.
- **Child 17 years** (By intravenous infusion): Usual dose 1.5-2.5 mg/kg, to be administered at a rate of 20-40 mg every 10 seconds until response.
**Maintenance of anaesthesia using 1% injection for propofol**
- **Child 1 month-16 years** (By continuous intravenous infusion): Usual dose 9-15 mg/kg/hour, dose adjusted according to age, body-weight and response.
- **Child 17 years** (By continuous intravenous infusion): Usual dose 4-12 mg/kg/hour, adjusted according to response.
**Maintenance of anaesthesia using 2% injection for propofol**
- **Child 3-16 years** (By continuous intravenous infusion): Usual dose 9-15 mg/kg/hour, dose adjusted according to age, body-weight and response.
- **Child 17 years** (By continuous intravenous infusion): Usual dose 4-12 mg/kg/hour, adjusted according to response.
**Sedation of ventilated patients in intensive care using 1% or 2% injection for propofol**
- **Child 16-17 years** (By continuous intravenous infusion): Usual dose 0.3-4 mg/kg/hour, adjusted according to response.
**Induction of sedation for surgical and diagnostic procedures using 0.5% or 1% injection for propofol**
- **Child 1 month-16 years** (By slow intravenous injection): Initially 1-2 mg/kg, dose and rate of administration adjusted according to desired level of sedation and response.
- **Child 17 years** (By slow intravenous injection): Initially 0.5-1 mg/kg, to be administered over 1-5 minutes, dose and rate of administration adjusted according to desired level of sedation and response.
**Maintenance of sedation for surgical and diagnostic procedures using 0.5% injection for propofol**
- **Child 17 years** (Initially by intravenous infusion): Initially 1.5-4.5 mg/kg/hour, dose and rate of administration adjusted according to desired level of sedation and response, followed by (by slow intravenous injection) 10-20 mg, (if rapid increase in sedation required).
**Maintenance of sedation for surgical and diagnostic procedures using 1% injection for propofol**
- **Child 1 month-16 years** (Initially by intravenous infusion): Usual dose 1.5-9 mg/kg/hour, dose and rate of administration adjusted according to desired level of sedation and response, followed by (by slow intravenous injection) up to 1 mg/kg, (if rapid increase in sedation required).
- **Child 17 years** (Initially by intravenous infusion): Initially 1.5-4.5 mg/kg/hour, dose and rate of administration adjusted according to desired level of sedation and response, followed by (by slow intravenous injection) 10-20 mg, (if rapid increase in sedation required).
**Maintenance of sedation for surgical and diagnostic procedures using 2% injection for propofol**
- **Child 3-16 years** (Initially by intravenous infusion): Usual dose 1.5-9 mg/kg/hour, dose and rate of administration adjusted according to desired level of sedation and response.
- **Child 17 years** (Initially by intravenous infusion): Initially 1.5-4.5 mg/kg/hour, dose and rate of administration adjusted according to desired level of sedation and response, followed by (by slow intravenous injection) 10-20 mg, using 0.5% or 1% injection (if rapid increase in sedation required).
Cautions
Acute circulatory failure (shock); cardiac impairment; cardiovascular disease; elderly; epilepsy; fixed cardiac output; hypotension; hypovolaemia; raised intracranial pressure; respiratory impairment
Side effects
Common or very common Apnoea; arrhythmias; headache; hypotension; localised pain; nausea; vomiting Uncommon Thrombosis Rare or very rare Epileptiform seizure (may be delayed); movement disorders; pancreatitis; post procedural complications; pulmonary oedema; sexual dysfunction; urine discolouration Frequency not known Drug dependence; euphoric mood; heart failure; hepatomegaly; hyperkalaemia; hyperlipidaemia; metabolic acidosis; renal failure; respiratory depression; rhabdomyolysis Side-effects, further information Bradycardia Bradycardia may be profound and may be treated with intravenous administration of an antimuscarinic drug. Pain on injection Pain on injection can be reduced by intravenous lidocaine. Propofol infusion syndrome Prolonged infusion of propofol doses exceeding 4mg/kg/hour may result in potentially fatal effects, including metabolic acidosis, arrhythmias, cardiac failure, rhabdomyolysis, hyperlipidaemia, hyperkalaemia, hepatomegaly, and renal failure.
Interactions
**Other interactions (6):**
- Propofol has been used in association with spinal and epidural anaesthesia and with commonly used premedicants, neuromuscular blocking medicinal products, inhalational medicinal products and...
- Lower doses of propofol may be required where general anaesthesia or sedation is used as an adjunct to regional anaesthetic techniques.
- The concurrent administration of other CNS depressants such as pre-medication medicinal products, inhalation medicinal products, analgesic medicinal products may add to the sedative, anaesthetic and...
- Profound hypotension has been reported following anaesthetic induction with propofol in patients treated with rifampicin.
- A need for lower propofol doses has been observed in patients taking valproate.
- When used concomitantly, a dose reduction of propofol may be considered.
Pregnancy
May depress neonatal respiration if used during delivery. Max. dose for maintenance of anaesthesia 6 mg/kg/hour.
Breast feeding
Breast-feeding can be resumed as soon as mother has recovered sufficiently from anaesthesia.
Hepatic impairment
Manufacturer advises caution.
Renal impairment
Use with caution.
Medicinal forms
Injection
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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