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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            Contraindicated (1)

            • mavacamten

              propofol will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Contraindicated. Strong or moderate CYP2C19 inhibitors may increase mavacamten systemic exposure, resulting in heart failure due to systolic dysfunction.

            Serious - Use Alternative (33)

            • 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.

            • ropeginterferon alfa 2b

              ropeginterferon alfa 2b and propofol both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.

            • 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 (190)

            • 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.

            • atogepant

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

            • 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.

            • daridorexant

              propofol and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • 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.

            • difelikefalin

              difelikefalin and propofol both increase sedation. 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.

            • ganaxolone

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

            • 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.

              mirtazapine and propofol both increase QTc interval. 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.

            • warfarin

              propofol will increase the level or effect of warfarin by Other (see comment). Use Caution/Monitor. Warfarin's less potent R-enantiomer is metabolized in part by CYP3A4 (and also CYP1A2 and CYP2C19). Monitor INR more frequently if coadministered with inhibitors of these isoenzymes and adjust warfarin dose if needed.

            • 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 (15)

            • 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.

            • ruxolitinib topical

              propofol will increase the level or effect of ruxolitinib topical 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
            propofol intravenous
            -
            10 mg/mL vial
            Diprivan intravenous
            -
            10 mg/mL vial
            Diprivan intravenous
            -
            10 mg/mL vial
            Diprivan 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) 2022 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.
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            • 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.