Intravenous Induction and maintenance of general anaesthesia
Adult: Induction of anaesthesia: As 1% or 2% emulsion: Usual dose: 1.5-2.5 mg/kg; titrate dose at a rate of 20-40 mg every 10 seconds until clinical response is achieved. Doses may be given via IV inj (using 1% emulsion) or IV infusion (using 1% or 2% emulsion). Maintenance of anaesthesia: As 1% or 2% emulsion: Usual dose: 4-12 mg/kg/hour via IV infusion. Alternative maintenance dose using 1% emulsion: 25-50 mg via repeat bolus inj given according to clinical requirement. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Induction of anaesthesia: As 1% or 2% emulsion: Usual dose: 1-1.5 mg/kg; titrate dose at a rate of 20 mg every 10 seconds until clinical response is achieved. Doses may be given via slow IV inj (using 1% emulsion) or IV infusion (using 1% or 2% emulsion). Maintenance of anaesthesia: As 1% or 2% emulsion: Usual dose: 3-6 mg/kg/hour via IV infusion. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Child: Induction of anaesthesia: As 1% emulsion: ≥1 month Usual dose: 2.5-4 mg/kg via slow IV inj or IV infusion, adjusted according to age, body weight, and clinical response. As 2% emulsion: ≥3 years Usual dose: 2.5-4 mg/kg via IV infusion, adjusted according to age, body weight, and clinical response. Maintenance of anaesthesia: As 1% emulsion: ≥1 month Usual dose: 9-15 mg/kg/hour via IV infusion. As 2% emulsion: ≥3 years Usual dose: 9-15 mg/kg/hour via IV infusion. Dosage recommendations and approved starting age may vary among countries and between individual products (refer to specific product guidelines).
Intravenous Sedation
Adult: Alone or in combination with local or regional anaesthesia for surgical and diagnostic procedures: Induction of sedation: As 1% emulsion: 0.5-1 mg/kg via slow IV inj over 1-5 minutes. Maintenance of sedation: As 1% or 2% emulsion: 1.5-4.5 mg/kg/hour via IV infusion. If rapid increase in depth of sedation is needed, IV infusion may be supplemented by 10-20 mg IV bolus inj using 1% emulsion. Dose and rate of administration must be individualised and titrated based on the clinical response and desired level of sedation. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Reduction of dose and rate of administration may be necessary. Child: Alone or in combination with local or regional anaesthesia for surgical and diagnostic procedures: Induction of sedation: As 1% emulsion: ≥1 month 1-2 mg/kg via slow IV inj. Maintenance of sedation: As 1% emulsion: ≥1 month Usual dose: 1.5-9 mg/kg/hour via IV infusion. If rapid increase in depth of sedation is needed, IV infusion may be supplemented by up to 1 mg/kg IV bolus inj. As 2% emulsion: ≥3 years Usual dose: 1.5-9 mg/kg/hour via IV infusion. Dose and rate of administration must be individualised and adjusted based on the clinical response and desired level of sedation. Dosage recommendations and approved starting age may vary among countries and between individual products (refer to specific product guidelines).
Intravenous Sedation
Adult: For ventilated patients in the ICU: As 1% or 2% emulsion: Usual dose: 0.3-4 mg/kg/hour via IV infusion. Infusion rate depends on the desired depth of sedation. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Child: For ventilated patients in the ICU: >16 years Same as adult dose.
What are the brands available for Propofol in Singapore?
Baxter Propofol
Fresofol MCT/LCT
Propofol-lipuro
Recofol 10 mg/mL
Recofol 20 mg/mL
Recofol N
Special Patient Group
Induction and maintenance of general anaesthesia:
Debilitated patients or American Society of Anesthesiologists - Physical Status (ASA-PS) Grade III or IV patients: Induction of anaesthesia: As 1% or 2% emulsion: Usual dose: 1-1.5 mg/kg; titrate dose at a rate of 20 mg every 10 seconds until clinical response is achieved. Doses may be given via slow IV inj (using 1% emulsion) or IV infusion (using 1% or 2% emulsion). Maintenance of anaesthesia: As 1% or 2% emulsion: Usual dose: 3-6 mg/kg/hour via IV infusion. Dosage or treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Reconstitution
1% emulsion for IV inj or infusion: May dilute with dextrose 5% in water to a concentration of ≥2 mg/mL. Recommendations may vary between countries or individual products (refer to specific product guidelines).
Contraindications
Use in children aged ≤16 years for sedation in ICU setting.
Special Precautions
Patient with cardiac impairment or CV disease, respiratory impairment or disease, epilepsy or seizures, hypovolaemia; lipid metabolism disorders (e.g. diabetic hyperlipaemia, hyperlipoproteinaemia, pancreatitis); increased intracranial pressure or impaired cerebral circulation, risk factors for propofol-related infusion syndrome (e.g. decreased oxygen delivery, serious neurological injury, sepsis). Debilitated patient or ASA-PS Grade III or IV patient. Not recommended to be used with electroconvulsive therapy or for obstetric anaesthesia, including caesarean section deliveries. Avoid abrupt withdrawal before weaning or daily wake-up evaluations. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Cardiac conduction disturbances (e.g. bradycardia, tachycardia, ECG abnormality); severe hypotension; risk of convulsions (particularly in epileptic patients); transient local inj site pain; involuntary movements (when used for sedation during operative procedures); drug abuse and dependence. Rarely, immediate hypersensitivity reactions (e.g. anaphylaxis, angioedema, bronchoconstriction); post-operative unconsciousness, which may be accompanied by increased muscle tone. Gastrointestinal disorders: Nausea, vomiting (during recovery phase). Hepatobiliary disorders: Hepatitis, hepatic failure. Nervous system disorders: Headache (during recovery phase). Psychiatric disorders: Euphoric mood. Reproductive system and breast disorders: Priapism. Respiratory, thoracic and mediastinal disorders: Apnoea, cough, hyperventilation (during induction). Vascular disorders: Hot flushes (during induction); thrombosis, phlebitis. Potentially Fatal: Propofol-related infusion syndrome including metabolic acidosis, hyperlipidaemia, hypertriglyceridemia, hyperkalaemia, rhabdomyolysis, renal failure, hepatomegaly, Brugada-type ECG (elevated ST-segment and coved T-wave), arrhythmias, heart failure, and asystole.
Patient Counseling Information
This drug may impair mental alertness, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor cardiac function, blood pressure, oxygen saturation; ABG (prolonged infusions); blood lipid concentration (if at risk of fat overload or when used for sedation for >3 days). Assess for signs and symptoms of propofol-related infusion syndrome during prolonged infusions or early signs of hypotension, airway obstruction, and oxygen desaturation during sedation for surgical and diagnostic procedures. ICU sedation: Obtain serum triglycerides before treatment initiation and every 3-7 days thereafter.
Overdosage
Symptoms: Cardiovascular and respiratory depression.
Management: Supportive and symptomatic treatment. Provide artificial ventilation with oxygen for respiratory depression. CV depression may be managed by repositioning the patient (raising the legs or lowering the head), increasing the IV fluid flow rate, or using plasma expanders and pressor agents.
Drug Interactions
Enhanced sedative, anaesthetic and cardiorespiratory depressant effects with other CNS depressants (e.g. benzodiazepines, opioids, other general anaesthetics). Increased risk of profound hypotension with rifampicin. Valproic acid may increase the serum levels of propofol.
Food Interaction
Enhanced sedative effect with alcohol.
Action
Description: Overview: Propofol is a short-acting general anaesthetic and a sedative and hypnotic agent. Mechanism of Action: The exact mechanism of action has not been fully elucidated; however, propofol is believed to exert its CNS depressant effect by enhancing the inhibitory function of γ-aminobutyric acid (GABA) through the ligand-gated GABAA receptors. It also blocks the N-methyl-D-aspartate (NMDA) subtype of glutamate receptors by channel-gating modulation. Pharmacodynamics: Propofol in combination with hypocarbia increases cerebrovascular resistance. It reduces cerebral blood flow, cerebral metabolism, and intracranial pressure, but does not affect cerebrovascular reactivity to changes in arterial carbon dioxide tension.
Its haemodynamic effect during the induction of anaesthesia varies. If spontaneous ventilation is maintained, arterial hypotension occurs as the major CV effect with little to no change in heart rate and no appreciable decrease in cardiac output. If ventilation is controlled or assisted, increased incidence and degree of cardiac output depression occur. Additionally, propofol is frequently associated with apnoea during the induction of anaesthesia. During maintenance of anaesthesia, propofol causes a reduction in spontaneous minute ventilation. This reduction is usually associated with an increase in carbon dioxide tension, which may be marked depending on the rate of administration and concurrent drugs used. Onset: Anaesthesia: 9-51 seconds (average: 30 seconds). Duration: 3-10 minutes (depending on dose, duration, and rate of administration). Pharmacokinetics: Distribution: Extensively distributed in the body. Crosses the placenta; enters breast milk (small amounts). Volume of distribution: 2-10 L/kg; 60 L/kg (after 10-day infusion). Plasma protein binding: 97-99%. Metabolism: Extensively metabolised in the liver into water-soluble sulfate and glucuronide conjugates. Excretion: Via urine (approx 88% as metabolites, 40% as glucuronide metabolite); faeces (<2%). Elimination half-life: Initial: 40 minutes. Terminal: 4-7 hours (after 10-day infusion).
Chemical Structure
Propofol Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4943, Propofol. https://pubchem.ncbi.nlm.nih.gov/compound/Propofol. Accessed Sept. 30, 2025.
Storage
Store between 4-25°C. Do not freeze. Storage recommendations may vary between individual products. Refer to detailed product guidelines.
N01AX10 - propofol ; Belongs to the class of other general anesthetics.
References
Brayfield A, Cadart C (eds). Propofol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/09/2025.Joint Formulary Committee. Propofol. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/09/2025.Paediatric Formulary Committee. Propofol. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 10/09/2025.Pharmacy Retailing (NZ) Limited. Diprivan 1% and 2% Injection data sheet 13 February 2025. Medsafe. http://www.medsafe.govt.nz. Accessed 10/09/2025.Propofol 10 mg/mL Emulsion for Injection/Infusion (Farmak Pharmaceuticals UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/09/2025.Propofol 20 mg/mL (2%) Emulsion for Injection/Infusion (Sandoz Limited). MHRA. https://products.mhra.gov.uk. Accessed 10/09/2025.Propofol Injection, Emulsion (Amneal Pharmaceuticals Private Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/09/2025.Propofol-Lipuro 1% (10 mg/mL) Emulsion for Injection or Infusion (B. Braun Medical Industries Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/09/2025.Propofol-Lipuro 2% (20 mg/mL) Emulsion for Injection or Infusion (B. Braun Medical Industries Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/09/2025.Propofol. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 10/09/2025.Propofol. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 10/09/2025.Propofol. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 10/09/2025.
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