Propofol Injectable Emulsion
Name: Propofol Injectable Emulsion
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Propofol injectable emulsion is an I.V. sedative-hypnotic agent that can be used as described in the table below.
TABLE 3: INDICATIONS FOR PROPOFOL INJECTABLE EMULSION
|Indication||Approved Patient Population|
|Initiation and maintenance of Monitored Anesthesia Care (MAC) sedation||Adults only|
|Combined sedation and regional anesthesia||Adults only (See PRECAUTIONS)|
|Induction of General Anesthesia||Patients ≥ 3 years of age|
|Maintenance of General Anesthesia||Patients ≥ 2 months of age|
|Intensive Care Unit (ICU) sedation of intubated, mechanically ventilated patients||Adults only|
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 PRECAUTIONS - Pediatric Use.)
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 PRECAUTIONS - Pediatric Use.)
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 PRECAUTIONS.)
Propofol 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 PRECAUTIONS.)
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 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 syndrome is most often associated with prolonged, high-dose infusions (> 5 mg/kg/h for > 48h) but 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 PRECAUTIONS.)
Propofol injectable emulsion should not be coadministered through the same I.V. catheter with blood or plasma because compatibility has not been established. In vitro 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.
There have been reports in which failure to use aseptic technique when handling propofol injectable emulsion was associated with microbial contamination of the product and with fever, infection, sepsis, other life-threatening illness, and death. Do not use if contamination is suspected. Discard unused portions as directed within the required time limits (see DOSAGE AND ADMINISTRATION - Handling Procedures).
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 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
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.
Incidence greater than 1% - Probably Causally Related
|Anesthesia/MAC Sedation||ICU Sedation|
|Cardiovascular:||Bradycardia Arrhythmia [Peds: 1.2%] Tachycardia Nodal [Peds: 1.6%]||Bradycardia|
|Hypotension* [Peds: 17%] (see also CLINICAL PHARMACOLOGY)||Decreased Cardiac Output|
|Central Nervous System:||[Hypertension Peds: 8%] Movement* [Peds: 17%]||Hypotension 26%|
|Injection Site:||Burning/Stinging or Pain, 17.6% [Peds: 10%]|
|Respiratory:||Apnea (see also CLINICAL PHARMACOLOGY)||Respiratory Acidosis During Weaning*|
|Skin and Appendages:||Rash [Peds: 5%]|
|Pruritus [Peds: 2%]|
|Events without an * or % had an incidence of 1% to 3%|
|*Incidence of events 3% to 10%|
|Incidence less than 1% - Probably Causally Related|
|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, Paresthesia||Agitation|
|Injection Site:||[Phlebitis], [Pruritus]|
|Nervous:||[Dizziness], [Agitation], [Chills], [Somnolence], [Delirium]|
|Respiratory:||Wheezing, [Cough], [Laryngospasm], [Hypoxia]||Decreased Lung Function|
|Skin and Appendages:||Flushing, Pruritus|
|Special Senses:||Amblyopia, [Vision Abnormal]|
|Urogenital:||Cloudy Urine||Green Urine|
|Incidence less than 1% - Causal Relationship Unknown|
|Anesthesia/MAC Sedation||ICU Sedation|
|Body as a Whole:||Asthenia, Awareness, Chest Pain, Extremities Pain, Fever, Increased Drug||Fever, Sepsis, Trunk Pain, Whole Body Weakness|
|Cardiovascular:||Effect, Neck Rigidity/Stiffness, Trunk Pain Arrhythmia, Atrial Fibrillation, Atrioventricular Heart Block, Bigeminy, Bleeding, Bundle Branch Block, Cardiac Arrest, ECG Abnormal, Edema, Extrasystole, Heart Block, Hypertension, Myocardial Infarction, Myocardial Ischemia, Premature Ventricular Contractions, ST Segment Depression, Supraventricular Tachycardia, Tachycardia, Ventricular Fibrillation||Arrhythmia, Atrial Fibrillation, Bigeminy, Cardiac Arrest, Extrasystole, Right Heart Failure, Ventricular Tachycardia|
|Central Nervous System:||Abnormal Dreams, Agitation, Amorous Behavior, Anxiety, Bucking/Jerking/Thrashing, Chills/Shivering/Clonic/Myoclonic Movement, Combativeness, Confusion, Delirium, Depression, Dizziness, Emotional Lability, Euphoria, Fatigue, Hallucinations, Headache, Hypotonia, Hysteria, Insomnia, Moaning, Neuropathy, Opisthotonos, Rigidity, Seizures, Somnolence, Tremor, Twitching||Chills/Shivering, Intracranial Hypertension, Seizures, Somnolence, Thinking Abnormal|
|Digestive:||Cramping, Diarrhea, Dry Mouth, Enlarged Parotid, Nausea, Swallowing, Vomiting||Ileus, Liver Function Abnormal|
|Hematologic/Lymphatic:||Coagulation Disorder, Leukocytosis|
|Injection Site:||Hives/Itching, Phlebitis, Redness/Discoloration|
|Metabolic/Nutritional:||Hyperkalemia, Hyperlipemia||BUN Increased, Creatinine Increased, Dehydration, Hyperglycemia, Metabolic Acidosis, Osmolality Increased|
|Respiratory:||Bronchospasm, Burning in Throat, Cough, Dyspnea, Hiccough, Hyperventilation, Hypoventilation, Hypoxia, Laryngospasm, Pharyngitis, Sneezing, Tachypnea, Upper Airway Obstruction||Hypoxia|
|Skin and Appendages:||Conjunctival Hyperemia, Diaphoresis, Urticaria||Rash|
|Special Senses:||Diplopia, Ear Pain, Eye Pain, Nystagmus, Taste Perversion, Tinnitus|
|Urogenital:||Oliguria, Urine Retention||Kidney Failure|
Read the entire FDA prescribing information for Propofol (Propofol Injectable Emulsion)Read More »
Highlights for propofol
PROPOFOL is an anesthetic. It is used to produce relaxation and sleep before or during surgery. It is also used in patients on a ventilator.
This drug can cause serious side effects. See which side effects you should report to your doctor right away.
Know how to use your medication, and learn what might happen if you miss a dose.
Talk to your healthcare provider if you have any of these conditions.
Know what to watch for and get tips for reducing your risks while taking this drug.
Propofol Side Effects
Side effects that you should report to your doctor or health care professional as soon as possible:
- allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
- breathing problems
- changes in vision
- dark urine
- fast, irregular heartbeat
- feeling faint or lightheaded, falls
- low blood pressure
- muscle pain or weakness
- numbness or tingling in the hands or feet
- stomach pain
- trouble passing urine or change in the amount of urine
- uncontrollable muscle spasm
- unusual weakness
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
- pain at site where injected
How to Use propofol
This medicine is for infusion into a vein. It is given by a health care professional in a hospital or clinic setting.
Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for children as young as 2 months old for selected conditions, precautions do apply.What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
- heart disease
- high cholesterol
- an unusual or allergic reaction to propofol, anesthetics, eggs, soy, peanuts, benzyl alcohol, sulfites, other medicines, foods, dyes, or preservatives
- pregnant or trying to get pregnant
This does not apply.What should I watch for while using this medicine?
Your condition will be monitored carefully while you are receiving this medicine.
You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medicine. Avoid alcoholic drinks.Where should I keep my medicine?
This drug is given in a hospital or clinic and will not be stored at home.