propofol (Rx)

Brand and Other Names:Diprivan
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL

Anesthesia

Induction

  • <55 years ASA I/II: 40 mg IVP q10sec until onset (2-2.5 mg/kg IV when not premedicated with oral benzodiazepines or intramuscular opioids)  
  • >55 years or debilitated or ASA III/IV: 20 mg IVP q10sec until onset (1-1.5 mg/kg); do not use rapid bolus because as it will increase likelihood of undesirable cardiorespiratory depression, including hypotension, apnea, airway obstruction, and/or oxygen desaturation

Maintenance

  • <55 years ASA I/II: 0.1-0.2 mg/kg/min IV; administered in a variable rate infusion with nitrous oxide 60% to 70% and oxygen provides anesthesia for patients undergoing general surgery; maintenance infusion should immediately follow induction dose to provide satisfactory or continuous anesthesia during induction phase
  • Intermittent bolus: Increments of 25-50 mg (2.5-5 mL) may be administered with nitrous oxide in adults undergoing general surgery; administer incremental boluses when changes in vital signs indicate response to surgical stimulation or light anesthesia
  • >55 years 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 for 3-5 min; titrate to desired clinical effect; monitor respiratory function; administered as slow infusion or slow injection while monitoring cardiorespiratory function  
  • Slow injection: 0.5 mg/kg administered over 3-5 min; titrate to clinical response
  • Elderly: Do not use rapid bolus dose administration; administer over 3-5 min; reduce dose to approximately 80% of usual adult dose according to their condition, response, and changes in vital signs

Maintenance

  • Variable rate of infusion method preferable over intermittent bolus dose method
  • Variable rate infusion method: 0.025-0.075 mg/kg/min IV during first 10-15 min sedation maintenance; subsequently decrease infusion rates over time to 25 to 50 mcg/kg/min and adjust clinical response; allow approximately 2 min for onset of peak drug effect to titrate to clinical response; titrate downward in absence of clinical signs of light sedation until mild response to stimulation obtained to avoid sedative administration at rates higher than clinically necessary
  • Intermittent bolus method: Administer 10-20 mg increments and titrate to desired level of sedation
  • Elderly: 0.02-0.06 mg/kg/min IV; do not use rapid bolus dose administration; reduce rate of administration to 80% of usual adult dose according to their condition, response, and changes in vital signs

Postoperative Nausea/Vomiting

20 mg IV; may repeat

ICU Patient

Initiation: 0.005 mg/kg/min IV for at least 5 min; titrate to desired clinical effect; increase by 5-10 mcg/kg/min over 5-10 min intervals until desired sedation level achieved; allow a minimum of 5 min between adjustments for onset of peak effect  

For medical ICU patients or patients who recovered from effect of general anesthesia or deep sedation, rate of administration of 50 mcg/kg/min or more may be required to achieve adequate sedation

Maintenance: 0.005-0.05 mg/kg/min IV individualized and titrated to clinical response; (0.005 mg/kg/min increment increase q5min)

Discontinuation: Avoid discontinuation prior to weaning or for daily evaluation of sedation levels; may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation

Dosage Forms & Strengths

injectable solution

  • 10mg/mL

Anesthesia

Induction

  • <3 years: Not recommended
  • 3-16 years ASA I/II: 2.5-3.5 mg/kg IVP over 20-30 sec when not premedicated or when lightly premedicated with oral benzodiazepines or intramuscular opioids; younger patients may required higher induction doses than older children; lower dosage recommended for children ASA III/IV  

Maintenance

  • 2 months-16 years ASA I/II: 0.125-0.3 mg/kg/min IV; after 30 min, if clinical signs of light anesthesia are absent, decrease infusion rate; children 5 years or younger may require larger infusion rates compared to older children
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Interactions

Interaction Checker

and propofol

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              Serious - Use Alternative (32)

              • abametapir

                abametapir will increase the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP2B6 substrates. If not feasible, avoid use of abametapir.

              • benzhydrocodone/acetaminophen

                benzhydrocodone/acetaminophen, propofol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).

              • calcium/magnesium/potassium/sodium oxybates

                propofol, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • carbamazepine

                carbamazepine will decrease the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug.

              • ceritinib

                ceritinib increases levels of propofol by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Avoid concurrent use of CYP2C9 substrates known to have narrow therapeutic indices or substrates primarily metabolized by CYP2C9 during treatment with ceritinib; if use of these medications is unavoidable, consider dose.

              • doxapram

                doxapram, propofol. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

              • epinephrine

                propofol increases levels of epinephrine by unknown mechanism. Avoid or Use Alternate Drug.

              • epinephrine racemic

                propofol increases levels of epinephrine racemic by unknown mechanism. Avoid or Use Alternate Drug.

              • fedratinib

                propofol will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

              • fentanyl

                fentanyl, propofol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl intranasal

                fentanyl intranasal, propofol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl transdermal

                fentanyl transdermal, propofol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl transmucosal

                fentanyl transmucosal, propofol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fexinidazole

                fexinidazole will decrease the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. Coadministration may decrease plasma concentrations of CYP2B6 substrates owing to fexinidazole inducing CYP2B6.

                fexinidazole and propofol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              • hydrocodone

                hydrocodone, propofol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).

              • isocarboxazid

                isocarboxazid increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • ivosidenib

                ivosidenib will decrease the level or effect of propofol by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2C9 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

              • lefamulin

                lefamulin and propofol both increase QTc interval. Avoid or Use Alternate Drug.

              • lonafarnib

                propofol will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              • metoclopramide intranasal

                propofol, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • norepinephrine

                propofol increases levels of norepinephrine by decreasing metabolism. Contraindicated.

              • phenelzine

                phenelzine increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • phenylephrine

                propofol increases levels of phenylephrine by decreasing metabolism. Contraindicated.

              • phenylephrine PO

                propofol increases levels of phenylephrine PO by decreasing metabolism. Contraindicated.

              • pirfenidone

                propofol will increase the level or effect of pirfenidone by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid; coadministration of pirfenidone and moderate CYP1A2 inhibitors result in moderately increased exposure to pirfenidone; if unable to avoid, decrease dose of moderate CYP1A2 inhibitor

              • ponesimod

                ponesimod, propofol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

              • rasagiline

                rasagiline increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • rifampin

                rifampin will decrease the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug.

              • selegiline

                selegiline increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • sodium oxybate

                propofol, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • sufentanil SL

                sufentanil SL, propofol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • tranylcypromine

                tranylcypromine increases levels of propofol by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              Monitor Closely (185)

              • acebutolol

                propofol, acebutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • alfentanil

                propofol and alfentanil both increase sedation. Use Caution/Monitor.

              • alpelisib

                alpelisib will decrease the level or effect of propofol by pharmacodynamic synergism. Modify Therapy/Monitor Closely.

              • alprazolam

                propofol and alprazolam both increase sedation. Use Caution/Monitor.

              • amitriptyline

                propofol and amitriptyline both increase sedation. Use Caution/Monitor.

              • amobarbital

                propofol and amobarbital both increase sedation. Use Caution/Monitor.

              • amoxapine

                propofol and amoxapine both increase sedation. Use Caution/Monitor.

              • apalutamide

                apalutamide will decrease the level or effect of propofol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Coadministration of apalutamide, a weak CYP2C9 inducer, with drugs that are CYP2C9 substrates can result in lower exposure to these medications. Evaluate for loss of therapeutic effect if medication must be coadministered.

              • apomorphine

                propofol and apomorphine both increase sedation. Use Caution/Monitor.

                apomorphine and propofol both increase QTc interval. Use Caution/Monitor.

              • atenolol

                propofol, atenolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • avapritinib

                propofol will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • axitinib

                propofol increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • baclofen

                propofol and baclofen both increase sedation. Use Caution/Monitor.

              • belladonna and opium

                propofol and belladonna and opium both increase sedation. Use Caution/Monitor.

              • benazepril

                propofol, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              • benperidol

                propofol and benperidol both increase sedation. Use Caution/Monitor.

              • betaxolol

                propofol, betaxolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • bisoprolol

                propofol, bisoprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • brompheniramine

                propofol and brompheniramine both increase sedation. Use Caution/Monitor.

              • buprenorphine

                propofol and buprenorphine both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                propofol and buprenorphine buccal both increase sedation. Use Caution/Monitor.

              • buprenorphine, long-acting injection

                propofol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

              • butabarbital

                propofol and butabarbital both increase sedation. Use Caution/Monitor.

              • butalbital

                propofol and butalbital both increase sedation. Use Caution/Monitor.

              • butorphanol

                propofol and butorphanol both increase sedation. Use Caution/Monitor.

              • cannabidiol

                propofol will increase the level or effect of cannabidiol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP2C19 inhibitor.

                cannabidiol will increase the level or effect of propofol by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit CYP2C9 activity. Consider reducing the dose when concomitantly using CYP2C9 substrates.

                cannabidiol will increase the level or effect of propofol by Other (see comment). Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit UGT1A9 activity. Consider reducing the dose when concomitantly using UGT1A9 substrates.

              • captopril

                propofol, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

              • carbinoxamine

                propofol and carbinoxamine both increase sedation. Use Caution/Monitor.

              • carisoprodol

                propofol and carisoprodol both increase sedation. Use Caution/Monitor.

              • carvedilol

                propofol, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • celiprolol

                propofol, celiprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • cenobamate

                cenobamate will decrease the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                cenobamate, propofol. Either increases effects of the other by sedation. Use Caution/Monitor.

              • chloral hydrate

                propofol and chloral hydrate both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                propofol and chlordiazepoxide both increase sedation. Use Caution/Monitor.

              • chlorpheniramine

                propofol and chlorpheniramine both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                propofol and chlorpromazine both increase sedation. Use Caution/Monitor.

              • chlorzoxazone

                propofol and chlorzoxazone both increase sedation. Use Caution/Monitor.

              • cilostazol

                propofol increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider decreasing cilostazol dose; moderate CYP2C19 inhibitors may increase serum levels of 3,4-dehydrocilostazol (active metabolite).

              • cinnarizine

                propofol and cinnarizine both increase sedation. Use Caution/Monitor.

              • clemastine

                propofol and clemastine both increase sedation. Use Caution/Monitor.

              • clomipramine

                propofol and clomipramine both increase sedation. Use Caution/Monitor.

              • clonazepam

                propofol and clonazepam both increase sedation. Use Caution/Monitor.

              • clorazepate

                propofol and clorazepate both increase sedation. Use Caution/Monitor.

              • clozapine

                propofol and clozapine both increase sedation. Use Caution/Monitor.

              • codeine

                propofol and codeine both increase sedation. Use Caution/Monitor.

              • cyclizine

                propofol and cyclizine both increase sedation. Use Caution/Monitor.

              • cyclobenzaprine

                propofol and cyclobenzaprine both increase sedation. Use Caution/Monitor.

              • cyproheptadine

                propofol and cyproheptadine both increase sedation. Use Caution/Monitor.

              • dantrolene

                propofol and dantrolene both increase sedation. Use Caution/Monitor.

              • desflurane

                desflurane and propofol both increase sedation. Use Caution/Monitor.

              • desipramine

                propofol and desipramine both increase sedation. Use Caution/Monitor.

              • dexchlorpheniramine

                propofol and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                propofol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmedetomidine

                propofol and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • dextromoramide

                propofol and dextromoramide both increase sedation. Use Caution/Monitor.

              • diamorphine

                propofol and diamorphine both increase sedation. Use Caution/Monitor.

              • diazepam

                propofol and diazepam both increase sedation. Use Caution/Monitor.

              • diazepam intranasal

                propofol will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.

              • dichlorphenamide

                dichlorphenamide, propofol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

              • diethylpropion

                propofol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • difenoxin hcl

                propofol and difenoxin hcl both increase sedation. Use Caution/Monitor.

              • dimenhydrinate

                propofol and dimenhydrinate both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                propofol and diphenhydramine both increase sedation. Use Caution/Monitor.

              • diphenoxylate hcl

                propofol and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

              • dipipanone

                propofol and dipipanone both increase sedation. Use Caution/Monitor.

              • dopexamine

                propofol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                propofol and dosulepin both increase sedation. Use Caution/Monitor.

              • doxepin

                propofol and doxepin both increase sedation. Use Caution/Monitor.

              • doxylamine

                propofol and doxylamine both increase sedation. Use Caution/Monitor.

              • droperidol

                propofol and droperidol both increase sedation. Use Caution/Monitor.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF decreases levels of propofol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Elvitegravir is a moderate CYP2C9 inducer.

              • esketamine intranasal

                esketamine intranasal, propofol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • esmolol

                propofol, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • estazolam

                propofol and estazolam both increase sedation. Use Caution/Monitor.

              • ethanol

                propofol and ethanol both increase sedation. Use Caution/Monitor.

              • etomidate

                etomidate and propofol both increase sedation. Use Caution/Monitor.

              • fenfluramine

                propofol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • finerenone

                propofol will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

              • flibanserin

                propofol will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

              • fluphenazine

                propofol and fluphenazine both increase sedation. Use Caution/Monitor.

              • flurazepam

                propofol and flurazepam both increase sedation. Use Caution/Monitor.

              • fluvoxamine

                fluvoxamine will increase the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • fostemsavir

                propofol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

              • haloperidol

                propofol and haloperidol both increase sedation. Use Caution/Monitor.

              • hydromorphone

                propofol and hydromorphone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                propofol and hydroxyzine both increase sedation. Use Caution/Monitor.

              • iloperidone

                propofol and iloperidone both increase sedation. Use Caution/Monitor.

              • imipramine

                propofol and imipramine both increase sedation. Use Caution/Monitor.

              • isavuconazonium sulfate

                propofol will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ivacaftor

                propofol increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

              • ketamine

                ketamine and propofol both increase sedation. Use Caution/Monitor.

              • ketotifen, ophthalmic

                propofol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

              • labetalol

                propofol, labetalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • lasmiditan

                lasmiditan, propofol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                lemborexant will decrease the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Monitor CYP2B6 substrate for adequate clinical response. Consider increasing the CYP2B6 substrate dose according to specific prescribing recommendations.

                propofol will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

                lemborexant, propofol. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • levorphanol

                propofol and levorphanol both increase sedation. Use Caution/Monitor.

              • linezolid

                linezolid increases levels of propofol by pharmacodynamic synergism. Use Caution/Monitor.

              • lofepramine

                propofol and lofepramine both increase sedation. Use Caution/Monitor.

              • lofexidine

                propofol and lofexidine both increase sedation. Use Caution/Monitor.

              • lomitapide

                propofol increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

              • loprazolam

                propofol and loprazolam both increase sedation. Use Caution/Monitor.

              • lorazepam

                propofol and lorazepam both increase sedation. Use Caution/Monitor.

              • lormetazepam

                propofol and lormetazepam both increase sedation. Use Caution/Monitor.

              • loxapine

                propofol and loxapine both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                propofol and loxapine inhaled both increase sedation. Use Caution/Monitor.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor, propofol. affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2B6 substrates. .

                lumacaftor/ivacaftor, propofol. affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C9 substrates. .

              • maprotiline

                propofol and maprotiline both increase sedation. Use Caution/Monitor.

              • meperidine

                propofol and meperidine both increase sedation. Use Caution/Monitor.

              • meprobamate

                propofol and meprobamate both increase sedation. Use Caution/Monitor.

              • metaxalone

                propofol and metaxalone both increase sedation. Use Caution/Monitor.

              • methadone

                propofol and methadone both increase sedation. Use Caution/Monitor.

              • methocarbamol

                propofol and methocarbamol both increase sedation. Use Caution/Monitor.

              • metoprolol

                propofol, metoprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • midazolam

                propofol and midazolam both increase sedation. Use Caution/Monitor.

              • midazolam intranasal

                propofol will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

                midazolam intranasal, propofol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • midodrine

                propofol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mifepristone

                mifepristone will increase the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • mirtazapine

                propofol and mirtazapine both increase sedation. Use Caution/Monitor.

              • morphine

                propofol and morphine both increase sedation. Use Caution/Monitor.

              • moxonidine

                propofol and moxonidine both increase sedation. Use Caution/Monitor.

              • nabilone

                propofol and nabilone both increase sedation. Use Caution/Monitor.

              • nadolol

                propofol, nadolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • nalbuphine

                propofol and nalbuphine both increase sedation. Use Caution/Monitor.

              • nebivolol

                propofol, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • nitisinone

                nitisinone will increase the level or effect of propofol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Nitisinone inhibits CYP2C9. Caution if CYP2C9 substrate coadministered, particularly those with a narrow therapeutic index.

              • nortriptyline

                propofol and nortriptyline both increase sedation. Use Caution/Monitor.

              • olanzapine

                propofol and olanzapine both increase sedation. Use Caution/Monitor.

              • opium tincture

                propofol and opium tincture both increase sedation. Use Caution/Monitor.

              • orphenadrine

                propofol and orphenadrine both increase sedation. Use Caution/Monitor.

              • osilodrostat

                osilodrostat and propofol both increase QTc interval. Use Caution/Monitor.

              • oxazepam

                propofol and oxazepam both increase sedation. Use Caution/Monitor.

              • oxycodone

                propofol and oxycodone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                propofol and oxymorphone both increase sedation. Use Caution/Monitor.

              • paliperidone

                propofol and paliperidone both increase sedation. Use Caution/Monitor.

              • papaveretum

                propofol and papaveretum both increase sedation. Use Caution/Monitor.

              • papaverine

                propofol and papaverine both increase sedation. Use Caution/Monitor.

              • penbutolol

                propofol, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • pentazocine

                propofol and pentazocine both increase sedation. Use Caution/Monitor.

              • pentobarbital

                propofol and pentobarbital both increase sedation. Use Caution/Monitor.

              • perphenazine

                propofol and perphenazine both increase sedation. Use Caution/Monitor.

              • phendimetrazine

                propofol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenobarbital

                propofol and phenobarbital both increase sedation. Use Caution/Monitor.

              • phenylephrine

                propofol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine PO

                propofol increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • pholcodine

                propofol and pholcodine both increase sedation. Use Caution/Monitor.

              • pimozide

                propofol and pimozide both increase sedation. Use Caution/Monitor.

              • pindolol

                propofol, pindolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • primidone

                propofol and primidone both increase sedation. Use Caution/Monitor.

              • procarbazine

                procarbazine increases levels of propofol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension.

              • prochlorperazine

                propofol and prochlorperazine both increase sedation. Use Caution/Monitor.

              • promethazine

                propofol and promethazine both increase sedation. Use Caution/Monitor.

              • propranolol

                propofol, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • propylhexedrine

                propofol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                propofol and protriptyline both increase sedation. Use Caution/Monitor.

              • quazepam

                propofol and quazepam both increase sedation. Use Caution/Monitor.

              • quetiapine

                propofol and quetiapine both increase sedation. Use Caution/Monitor.

              • ramelteon

                propofol and ramelteon both increase sedation. Use Caution/Monitor.

              • risperidone

                propofol and risperidone both increase sedation. Use Caution/Monitor.

              • rucaparib

                rucaparib will increase the level or effect of propofol by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C9 substrates, if clinically indicated.

              • secobarbital

                propofol and secobarbital both increase sedation. Use Caution/Monitor.

              • selegiline transdermal

                selegiline transdermal increases levels of propofol by pharmacodynamic synergism. Use Caution/Monitor.

              • sevoflurane

                propofol and sevoflurane both increase sedation. Use Caution/Monitor.

              • sotalol

                propofol, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • stiripentol

                stiripentol, propofol. affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP2B6 inhibitor and inducer. Monitor CYP2B6 substrates coadministered with stiripentol for increased or decreased effects. CYP2B6 substrates may require dosage adjustment.

                stiripentol, propofol. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                propofol and sufentanil both increase sedation. Use Caution/Monitor.

              • tapentadol

                propofol and tapentadol both increase sedation. Use Caution/Monitor.

              • tazemetostat

                propofol will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • temazepam

                propofol and temazepam both increase sedation. Use Caution/Monitor.

              • thioridazine

                propofol and thioridazine both increase sedation. Use Caution/Monitor.

              • thiothixene

                propofol and thiothixene both increase sedation. Use Caution/Monitor.

              • timolol

                propofol, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • tinidazole

                propofol will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • topiramate

                propofol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                propofol and tramadol both increase sedation. Use Caution/Monitor.

              • trazodone

                propofol and trazodone both increase sedation. Use Caution/Monitor.

              • triazolam

                propofol and triazolam both increase sedation. Use Caution/Monitor.

              • triclofos

                propofol and triclofos both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                propofol and trifluoperazine both increase sedation. Use Caution/Monitor.

              • trimipramine

                propofol and trimipramine both increase sedation. Use Caution/Monitor.

              • triprolidine

                propofol and triprolidine both increase sedation. Use Caution/Monitor.

              • valproic acid

                valproic acid increases effects of propofol by pharmacodynamic synergism. Use Caution/Monitor.

              • xylometazoline

                propofol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ziconotide

                propofol and ziconotide both increase sedation. Use Caution/Monitor.

              • ziprasidone

                propofol and ziprasidone both increase sedation. Use Caution/Monitor.

              • zotepine

                propofol and zotepine both increase sedation. Use Caution/Monitor.

              Minor (14)

              • amitriptyline

                propofol, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • amoxapine

                propofol, amoxapine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • clomipramine

                propofol, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • desipramine

                propofol, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • dosulepin

                propofol, dosulepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • doxepin

                propofol, doxepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • imipramine

                propofol, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • lofepramine

                propofol, lofepramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • maprotiline

                propofol, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • nortriptyline

                propofol, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • protriptyline

                propofol, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • ruxolitinib

                propofol will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • trazodone

                propofol, trazodone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

              • trimipramine

                propofol, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

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              Adverse 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

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              Warnings

              Contraindications

              Documented hypersensitivity, egg allergy, soybean/soy allergy

              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

              May cause hypotension, especialy if patient is hypovolemic or if bolus dosing is used; reduction in mean arterial pressure may exceed 30%; use caution in patients who arehemodynamically unstable, hypovelimic, or have abnormally low vascular tone

              Use with caution in patients with severe cardiac disease (<50% ejection fraction) or hypotension; may have more profound adverse cardiovascular responses to propofol

              Use with caution in patients with increased intracranial pressure or impaired cerebral circulation; mean arterial pressure may decrease substantially; cerebral perfusion may subsequently decrease; consider continuous infusion or administer as a slow bolus

              Prefilled syringes may have potential to support growth of various microorganisms dispite additives intended to suppress microbial growth; strictly adhere to recommendations in product labeling for handling and administering propofol

              Use caution in patients with respiratory disease and history of epilepsy or seizures; seizures may occur during recovery phase

              Propofol lacks analgesic properties; pain management requires specific use of analgesic agents, at effective dosages; titrate propofol separately from analgesic agent

              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)

              Perioperative myoclonus reported with administration

              Anxiety, agitation, and resistance to mechanical ventilation may occur with abrupt withdrawal

              General anesthetics and sedation drugs in young children and pregnant women

              • Brain development
                • Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
                • Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
                • Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
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              Pregnancy & 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.

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              Pharmacology

              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

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              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

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              propofol intravenous
              -
              10 mg/mL vial
              propofol intravenous
              -
              10 mg/mL vial
              propofol intravenous
              -
              10 mg/mL vial
              propofol intravenous
              -
              10 mg/mL vial
              propofol intravenous
              -
              10 mg/mL vial
              propofol intravenous
              -
              10 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              propofol intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.