Section 13 · Monograph
Propofol
Reviewed Nov 2026FDA label
DiprivanGeneral anesthetic
- Forms
- IV emulsion: 10mg/mL (20, 50, 100mL)
- Dose
- ICU sedation: start 5mcg/kg/min, titrate by 5-10mcg/kg/min every 5-10 min; maintenance 5-50mcg/kg/min | Refractory status epilepticus (off-label): 1-2mg/kg bolus then EEG-titrated infusion
- MOA
- GABA-A potentiation
Indications
- Induction and maintenance of general anesthesiaFDA-labeled
- Sedation of intubated, mechanically ventilated ICU patientsFDA-labeled
- Monitored anesthesia care sedationFDA-labeled
Off-Label Uses
- Refractory status epilepticus (anesthetic coma, EEG-guided)Off-label
- Sedation with ICP and metabolic-demand control in neurocritical careOff-label
Mechanism of Action
- Positive allosteric modulation of GABA-A receptors with additional sodium channel and NMDA effects, producing rapid sedation and anticonvulsant activity
Full Dosing
Adult / usual
- ICU sedation: start 5mcg/kg/min for at least 5 minutes; titrate by 5-10mcg/kg/min every 5-10 minutes; usual maintenance 5-50mcg/kg/min
- Refractory status epilepticus (off-label): 1-2mg/kg IV bolus (repeat as needed), then infusion titrated to EEG seizure suppression or burst suppression
- Strict aseptic technique; change tubing and vials every 12 hours; counts as lipid calories (1.1kcal/mL)
Contraindications
- Known hypersensitivity to propofol or any component of the emulsion
Drug Interactions
- Opioids, benzodiazepines and other sedatives: additive hypotension and respiratory depression
- Valproate may reduce propofol requirements
Adverse Effects
- Hypotension and bradycardia
- Respiratory depression and apnea
- Propofol infusion syndrome (metabolic acidosis, rhabdomyolysis, hyperkalemia, cardiac failure) — risk rises with doses above about 4mg/kg/h for more than 48 hours
- Hypertriglyceridemia and pancreatitis
- Pain on injection
Monitoring Parameters
- Continuous blood pressure, heart rate and ventilation
- Triglycerides after 48 hours of infusion
- CK, lactate and bicarbonate if infusion syndrome suspected
Pregnancy & Lactation
- Limited data; use if benefit justifies risk
- Present in milk in small amounts