BLACK BOX WARNING
- should be administered only by trained personnel experienced in airway management and resuscitation
propofol
Brand: Diprivan
⚠ BBW ISMP High Alert Prototype Drug
Drug Class: intravenous general anesthetic
Drug Family: anesthetic
Subclass: alkylphenol anesthetic
Organ Systems: cns
Mechanism of Action
Enhances inhibitory neurotransmission by potentiating GABA-A receptor chloride conductance, producing anesthesia, sedation, and amnesia. Rapidly redistributes from brain to peripheral tissues, accounting for its ultra-short duration after single bolus. Also has antiemetic properties.
GABA-A receptor (positive allosteric modulator)
Indications
- induction and maintenance of general anesthesia
- ICU sedation for mechanically ventilated patients
- procedural sedation
Contraindications
- hypersensitivity to propofol
Adverse Effects
Common
- injection site pain
- apnea at induction
- hypotension
- bradycardia
- respiratory depression
Serious
- propofol infusion syndrome (PRIS) — rare but fatal: metabolic acidosis, rhabdomyolysis, hyperkalemia, cardiac failure during prolonged high-dose infusion
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | highly lipophilic; protein binding >98%; Vd ~60 L/kg |
| Metabolism | hepatic glucuronidation and sulfation to inactive metabolites |
| Excretion | primarily renal as conjugates |
| Half-life | 0.5-1.5 hours terminal; short context-sensitive half-time after brief infusions |
| Onset | 15-45 seconds IV |
| Peak | 1-2 minutes |
| Duration | 5-10 minutes after single induction dose |
| Protein Binding | >98% |
| Vd | 60 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| opioids | synergistic anesthetic effect; dose reduction of both needed | major |
| benzodiazepines | additive CNS and respiratory depression | major |
Nursing Considerations
- Propofol infusion syndrome (PRIS) risk is highest with doses >4-5 mg/kg/hour for >48 hours; monitor daily for metabolic acidosis, high anion gap, hypertriglyceridemia, and CK elevation.
- Propofol is a lipid emulsion; strict aseptic technique is mandatory; discard any opened vials after 12 hours.
- Monitor serum triglycerides in ICU patients on propofol infusion; lipid emulsion contributes 1.1 kcal/mL to caloric intake.
- Injection site pain is common; administering through a large vein or pre-treating with lidocaine reduces pain.
Clinical Pearls
- Propofol rapid onset and offset make it ideal for procedural sedation; antiemetic properties are an additional clinical benefit.
- PRIS is rare but fatal; risk factors include high doses, prolonged infusion, critical illness with carbohydrate restriction, and mitochondrial dysfunction.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.