Interactions/Toxicology

Propofol should be avoided in use with other CNS depressants such as alcohol, azelastine, bromperidol, flunarizine, kratom, olopatadine, orphenadrine, oxomemazine, and thalidomide.

Propofol may enhance the QTc- prolonging effect on QT-prolonging agents and combination may increase the risk for ventricular arrhythmias.

Propofol may cause bradycardia and should be used with caution with other medications such as betablockers, neostigmine, neuromuscular blockers, and opioids.

Propofol can cause hypertriglyceridemia, which can lead to acute pancreatitis.

Propofol may cause severe hypotension and should be used with caution in those with hypovolemia, sepsis, and shock.

Propofol abuse has been linked to mortality rates greater than 33%.

References

White PF, Warner DS. Propofol: its role in changing the practice of anesthesia. Anesthesiology. 2008; 109:1132–1136.

doi:10.1097/ALN.0b013e31818ddba8 https://www.sciencedaily.com/releases/2013/03/130318131212 .htm https://www.health.harvard.edu/blog/propofol-the-drug-thatkilled-michael-jackson201111073772#:~:text=Aglio%20showed%20me%20a%20small

Study shows rising rate of propofol abuse by health care professionals. ScienceDaily. Accessed October 12, 2022.

Propofol: the drug that killed Michael Jackson. Harvard Health. Accessed October 12, 2022.

Propofol. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 12, 2022. http://online.lexi.com

Statement on Safe Use of Propofol. www.asahq.org. https://www.asahq.org/standards-and-guidelines/statementon-safe-use-of-propofol

Propofol Injectable Emulsion. Package insert. Dr. Reddy's Laboratories Inc; 2017

Office of the Federal Register. Schedules of Controlled Substances: Placement of Propofol Into Schedule IV; Proposed Rule. 2010.

Propofol Drug Test. Health Street. Accessed October 13, 2022. https://www.health-street.net/drugtests/substances/prescription/propofol/#:~:text=to%20Quick% 20Links-

Laws & Restrictions

In a statement by AANA and ASA:

“Whenever propofol is used for sedation/anesthesia, it should be administered only by persons trained in the administration of general anesthesia, who are not simultaneously involved in these surgical or diagnostic procedures. ... failure to follow these recommendations could put patients at increased risk of significant injury or death.”

In 2010, the US DEA proposed the classification of propofol as a schedule IV controlled substance, which was not successful.

There are currently no federal or state laws surrounding propofol use or administration, and it is not considered a controlled substance.

Monitoring/Drug Screens

Per the American Society of Anesthesiologists, vital signs should be taken continuously during propofol administration to monitor signs of hypotension, bradycardia, apnea, airway obstruction, or oxygen desaturation, as well as to assess consciousness. Exhaled CO2 should also be monitored.

Exposed neonates should be monitored for hypotonia and sedation.

Propofol can be detected by Health Street’s Propofol Hair Test approximately 90 days back, although it is not normally included in standard drug tests.

Professional Opinion

In my opinion, I believe that propofol should be considered a controlled substance due to the increasing abuse by healthcare professionals and the high instances of mortality (>33%) resulting from abuse. I also find that the proven physical dependence after use qualifies the drug to be classified as a controlled substance.

Since propofol is an IV drug and is only available for use in in-patient settings, classification as a controlled substance would not directly affect patient acquisition for anesthesia, but instead would increase security of storage and decrease the ease of access for medical professionals.

- Lauren Martinez