Propolipid (Propofol)
Intravenous General Anesthetic for Anesthesia Induction, Maintenance, and Sedation
Propolipid is a brand of propofol, the most widely used intravenous general anesthetic worldwide. It is administered exclusively in hospital settings by trained anesthesiologists to induce and maintain general anesthesia during surgery, to sedate patients on mechanical ventilation in intensive care, and to provide procedural sedation. Propofol is known for its rapid onset of action (30–40 seconds) and quick recovery profile, making it the standard of care in modern anesthesia practice.
Quick Facts: Propolipid (Propofol)
Key Takeaways
- Propofol is a short-acting intravenous anesthetic that produces unconsciousness within 30–40 seconds and allows rapid, smooth recovery.
- It must only be administered by physicians trained in anesthesia or intensive care, with continuous monitoring of heart rate, blood pressure, and breathing.
- Propolipid contains soybean oil and egg phospholipids — it is contraindicated in patients allergic to soy, peanuts, or eggs.
- Propofol must not be used for ICU sedation in patients aged 16 years or younger due to the risk of propofol infusion syndrome (PRIS).
- Common side effects include pain at the injection site, low blood pressure, and changes in breathing pattern; most resolve rapidly after the infusion is stopped.
What Is Propolipid (Propofol) and What Is It Used For?
Quick Answer: Propolipid is a brand name for propofol, a general anesthetic given intravenously to induce unconsciousness for surgery, maintain anesthesia, and provide sedation in intensive care and during medical procedures. It is one of the most commonly used anesthetics in the world.
Propofol belongs to a group of medicines called general anesthetics. These medications are used to produce a state of controlled unconsciousness (general anesthesia) so that surgical operations and other medical procedures can be performed without the patient experiencing pain or awareness. Propofol can also be used at lower doses to produce sedation — a state in which the patient is relaxed and drowsy but not fully unconscious.
The mechanism of action of propofol involves enhancement of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor in the central nervous system. This increases chloride ion conductance, hyperpolarizes neuronal membranes, and reduces overall neuronal excitability. Propofol also modulates glycine receptors and has additional effects on sodium channels, contributing to its anesthetic properties.
Propofol is formulated as a white oil-in-water emulsion because the active substance itself is not soluble in water. The emulsion contains soybean oil as the lipid phase, purified egg phospholipids as an emulsifier, and glycerol for tonicity adjustment. This lipid formulation is an important consideration because it means that propofol is contraindicated in patients with allergies to soy or peanuts.
Approved Indications
Propolipid is approved for the following clinical uses:
- Induction of general anesthesia — producing unconsciousness at the start of a surgical procedure in adults, adolescents, and children (older than 1 month for 10 mg/ml; older than 3 years for 20 mg/ml).
- Maintenance of general anesthesia — keeping the patient unconscious throughout the duration of surgery via continuous intravenous infusion or repeated bolus injections.
- Sedation in intensive care — providing sedation for patients older than 16 years who are receiving mechanical ventilation in an intensive care unit (ICU), for up to 7 days maximum.
- Procedural sedation — providing sedation during diagnostic examinations and surgical procedures, either alone or in combination with local or regional anesthesia, in adults and children (older than 1 month for 10 mg/ml; older than 3 years for 20 mg/ml).
Propofol has become the most widely used intravenous anesthetic globally since its introduction in the late 1980s. Its popularity stems from its remarkably rapid onset of action (typically 30–40 seconds), smooth induction characteristics, short duration of effect, rapid and clear-headed recovery, and antiemetic (anti-nausea) properties at sub-hypnotic doses. These pharmacokinetic advantages make propofol particularly well-suited to ambulatory (outpatient) surgery and procedures requiring rapid turnover.
Propofol must only be administered in hospitals or appropriately equipped treatment facilities by physicians who are trained in anesthesia or intensive care medicine. Continuous monitoring of cardiovascular function, respiratory function, and oxygen saturation is mandatory throughout the administration of propofol.
What Should You Know Before Receiving Propolipid?
Quick Answer: You should not receive Propolipid if you are allergic to propofol, soy, or peanuts. Tell your anesthesiologist about all medical conditions, especially heart disease, lung disease, liver or kidney problems, epilepsy, or if you are pregnant or breastfeeding.
Contraindications
Propolipid must not be used in the following situations:
- Known allergy to propofol, soy, peanuts, or any other ingredient in the formulation (including egg phospholipids).
- ICU sedation in children and adolescents aged 16 years or younger — safety has not been established in this population for this indication, and the risk of propofol infusion syndrome is significantly higher.
Warnings and Precautions
Propofol should not be used, or should be used only with extreme caution and intensive monitoring, in patients with:
- Advanced heart failure or other serious cardiac disease
- Severe respiratory insufficiency (breathing problems)
- Dehydration (hypovolemia) or circulatory failure
- Raised intracranial pressure — propofol can reduce blood pressure, which in combination with elevated intracranial pressure may decrease cerebral perfusion
- Epilepsy or history of seizures
- Abnormal blood lipid levels — lipid levels should be monitored in patients receiving total parenteral nutrition
In general, propofol should be administered with caution in elderly or debilitated patients, as they are more sensitive to the cardiovascular and respiratory depressant effects of the drug. Reduced doses are typically required in these populations.
Propofol may increase the risk of epileptic seizures, vagal bradycardia (slowing of the heart rate through a nerve reflex), and hemodynamic instability, particularly in obese patients receiving high doses or in patients who are dehydrated. Involuntary movements may occur during sedation with propofol; the anesthetic team will take these into account during procedures.
Prolonged, high-dose propofol infusions (typically exceeding 4 mg/kg/hour for more than 48 hours) carry a risk of propofol infusion syndrome (PRIS), a potentially fatal condition characterized by metabolic acidosis, rhabdomyolysis, hyperkalemia, hyperlipidemia, cardiac failure, and renal failure. ICU sedation with propofol should not exceed 7 days, and infusion rates above 4 mg/kg/hour are not recommended.
Pregnancy and Breastfeeding
Propofol should only be used during pregnancy when it is absolutely necessary and the benefits outweigh the potential risks. If you are pregnant, suspect you may be pregnant, or are planning to become pregnant, you should inform your anesthesiologist before any procedure.
Propofol passes into breast milk. You should not breastfeed during administration of propofol, and breast milk should be discarded for 24 hours after receiving propofol. After this period, breastfeeding may be safely resumed.
Driving and Operating Machinery
After receiving propofol, you may feel drowsy for a period of time. You should not drive a vehicle, operate machinery, or engage in activities requiring full alertness until the effects have completely worn off. If you are discharged shortly after receiving propofol, you should not drive and should not go home unaccompanied. Ask your physician when you may safely resume these activities and return to work.
Soy Oil and Sodium Content
Propolipid contains refined soybean oil. Do not use this medicine if you are allergic to peanuts or soy. The product contains less than 1 mmol (23 mg) sodium per 100 ml, meaning it is essentially sodium-free.
How Does Propolipid Interact with Other Drugs?
Quick Answer: Propofol interacts with many medications used during anesthesia, including opioids, benzodiazepines, muscle relaxants, and other anesthetics. These combinations generally require dose adjustments. Rifampicin and valproate also have clinically significant interactions with propofol.
It is essential to inform your anesthesiologist about all medications you are taking, have recently taken, or plan to take. Propofol is used in a clinical setting where many other medications may be administered simultaneously, and the anesthetic team is trained to manage these interactions. However, some interactions require special attention.
Significant Drug Interactions
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Rifampicin | Increases propofol clearance via CYP2B6 induction, potentially reducing anesthetic effect | Higher propofol doses may be required |
| Midazolam | Additive sedation and respiratory depression; co-administration reduces propofol requirement | Lower propofol doses needed for induction |
| Fentanyl / Opioids | Synergistic sedation and cardiorespiratory depression; fentanyl increases propofol blood levels | Dose reduction required; enhanced monitoring |
| Suxamethonium | Mutual potentiation of bradycardia (slow heart rate) | Monitor heart rate closely |
| Valproate | Reduces propofol clearance, increases blood levels | Lower propofol doses may be needed |
| Ciclosporin | Propofol may increase ciclosporin concentrations due to inhibition of metabolism | Monitor ciclosporin levels |
| Neostigmine | Risk of increased bradycardia when combined with propofol | Atropine pretreatment may be required |
| Benzodiazepines | Enhanced sedation and respiratory depression | Reduced induction dose of propofol |
Other Important Considerations
Propofol's sedative effects are potentiated by virtually all other central nervous system depressants, including other general anesthetics, regional anesthetics, inhalational anesthetics, analgesics (pain medications), and parasympatholytics (medicines used to treat conditions such as asthma, painful spasms, or Parkinson's disease).
Alcohol: Do not consume alcohol after receiving propofol until you have fully recovered. Alcohol can intensify residual sedation and impair cognitive function.
Food and drink: You should not eat, drink, or consume alcohol until you have fully recovered from propofol anesthesia or sedation.
What Is the Correct Dosage of Propolipid?
Quick Answer: Propofol dosing is individualized by the anesthesiologist based on patient age, weight, and clinical response. For adults, induction typically requires 1.5–2.5 mg/kg, and maintenance requires 4–12 mg/kg/hour. Children generally require higher weight-based doses than adults. Propofol is always administered in a controlled clinical setting.
Propolipid is administered only in hospitals or appropriate treatment facilities by or under the direct supervision of physicians trained in anesthesia or intensive care. The dosing is always individualized. Your anesthesiologist will determine the correct dose based on your age, body weight, physical condition, the type of procedure, and your clinical response during administration.
Adult Dosing
Induction of General Anesthesia
Most adults require 1.5 to 2.5 mg propofol per kg body weight, administered as an intravenous bolus. The drug is typically titrated against response (approximately 40 mg every 10 seconds until onset of anesthesia). Onset of unconsciousness usually occurs within 30–40 seconds.
Maintenance of General Anesthesia
Anesthesia is maintained with a continuous intravenous infusion at a rate of 4 to 12 mg/kg/hour. The rate is adjusted according to the depth of anesthesia required and the patient's clinical response. Supplementary analgesics, muscle relaxants, and other medications are used as needed.
Procedural Sedation (Adults)
For sedation during surgical or diagnostic procedures, most patients require 0.5 to 1 mg/kg administered over 1–5 minutes for induction of sedation. Maintenance sedation is achieved with an infusion of 1.5 to 4.5 mg/kg/hour, with supplementary boluses of 10–20 mg as needed to deepen sedation.
ICU Sedation (Adults >16 years)
For sedation of mechanically ventilated patients in intensive care, satisfactory sedation is usually achieved at a continuous infusion rate of 0.3 to 4.0 mg/kg/hour. Infusion rates exceeding 4.0 mg/kg/hour are not recommended due to the risk of propofol infusion syndrome. The maximum duration of ICU sedation should not exceed 7 days.
Pediatric Dosing
Propofol is not recommended for use in neonates or children younger than 1 month (10 mg/ml) or younger than 3 years (20 mg/ml). Dosing should be adjusted based on age and body weight. Special caution is required when administering propofol to children under 3 years of age, although available safety data is reassuring.
| Indication | Age Group | Dose |
|---|---|---|
| Induction (>8 years) | Children >8 years | ~2.5 mg/kg IV |
| Induction (1 month–3 years) | Infants/Toddlers | 2.5–4 mg/kg IV |
| Maintenance of anesthesia | Children >1 month | 9–15 mg/kg/hour infusion |
| Procedural sedation (initiation) | Children >1 month | 1–2 mg/kg IV |
| Procedural sedation (maintenance) | Children >1 month | 1.5–9 mg/kg/hour infusion |
Younger children, particularly those between 1 month and 3 years of age, generally require higher weight-based doses than older children and adults for both induction and maintenance of anesthesia. This is due to the larger volume of distribution and higher clearance rate in young children.
Propolipid must not be used for sedation in intensive care units in children and adolescents aged 16 years or younger. Safety has not been demonstrated in this population for this indication, and the risk of propofol infusion syndrome is unacceptably high.
Elderly Patients
Elderly patients are more sensitive to the effects of propofol and generally require lower doses for both induction and maintenance of anesthesia. The induction dose should be administered more slowly and titrated against response. Maintenance infusion rates are also typically lower than in younger adults. Close monitoring of cardiovascular parameters is essential, as elderly patients are more susceptible to propofol-induced hypotension.
Overdose
In the unlikely event that an excessive dose of propofol is administered, the anesthesiologist will immediately take measures to support cardiovascular function and breathing. This may include stopping the propofol infusion, establishing or maintaining an airway, providing mechanical ventilation with supplemental oxygen, administering intravenous fluids, and using vasopressors (medications that increase blood pressure) if necessary. Because propofol has a short half-life, the effects of overdose typically resolve rapidly once the drug is discontinued.
What Are the Side Effects of Propolipid?
Quick Answer: The most common side effect is pain at the injection site. Other common effects include low blood pressure, changes in heart rate, breathing changes, hiccups, coughing, headache, and nausea. Most side effects are transient and resolve quickly due to propofol's short duration of action.
Like all medicines, propofol can cause side effects, although not everybody gets them. Many side effects occur during anesthesia while the drug is being administered and the patient is sedated or unconscious. The anesthetic team continuously monitors for these effects and provides appropriate treatment immediately if they occur.
Side Effects During Anesthesia
Very Common
May affect more than 1 in 10 patients
- Local pain at the injection site (during injection, before unconsciousness)
Common
May affect up to 1 in 10 patients
- Low blood pressure (hypotension)
- Slow or fast heart rate (bradycardia/tachycardia)
- Changes in breathing pattern (slow breathing, apnea)
- Hiccups
- Coughing (may also occur on awakening)
Uncommon
May affect up to 1 in 100 patients
- Swelling, redness, or blood clots at the injection site (thrombosis/phlebitis)
Rare
May affect up to 1 in 1,000 patients
- Involuntary movements, twitching, or seizures (may also occur after awakening)
Very Rare
May affect up to 1 in 10,000 patients
- Severe allergic reaction (anaphylaxis) with breathing difficulty, skin swelling and redness, hot flushes
- Pulmonary edema (fluid in the lungs causing shortness of breath)
- Discolored urine
Side Effects After Anesthesia (On or After Awakening)
Common
May affect up to 1 in 10 patients
- Headache
- Nausea or vomiting
- Coughing
Rare
May affect up to 1 in 1,000 patients
- Dizziness, chills, and feeling cold
- Euphoria or sexual disinhibition
Very Rare
May affect up to 1 in 10,000 patients
- Delayed unconsciousness after surgery (recovery occurs spontaneously)
- Pancreatitis (severe abdominal pain)
- Post-operative fever
Adverse Effects Reported With Unknown Frequency
The following adverse effects have been reported during post-marketing surveillance but their exact frequency cannot be established:
- Cardiovascular: Irregular heartbeat, ECG changes (Brugada-type pattern), cardiac failure
- Hepatic: Liver enlargement, hepatitis, acute liver failure (symptoms may include jaundice, dark urine, abdominal pain)
- Renal: Kidney failure
- Metabolic: Metabolic acidosis, hyperkalemia, hyperlipidemia (components of propofol infusion syndrome)
- Musculoskeletal: Rhabdomyolysis (breakdown of muscle tissue)
- Other: Involuntary movements, tissue injury from extravasation (accidental injection outside the vein), priapism (prolonged, painful erection)
- Misuse: Drug abuse and dependence have been reported, primarily among healthcare professionals
Severe allergic reactions (anaphylaxis) to propofol are very rare but require immediate emergency treatment. Signs include difficulty breathing, swelling of the face or throat, skin rash, and a rapid drop in blood pressure. In a hospital setting, the anesthetic team is prepared to manage these reactions immediately.
If you experience any side effects after being discharged from hospital, including side effects not listed above, contact your physician or pharmacist promptly.
How Should Propolipid Be Stored?
Quick Answer: Propolipid should be stored below 25°C and must not be frozen. It is for single use only and must be used immediately after opening. Infusion systems must be changed every 12 hours.
Propolipid is stored and handled by hospital pharmacy staff and anesthesia personnel. The following storage requirements apply:
- Store at temperatures not exceeding 25°C (77°F)
- Do not freeze
- Keep out of sight and reach of children
- Do not use after the expiry date printed on the syringe and outer packaging (the expiry date refers to the last day of the stated month)
- The pre-filled syringe must be shaken before use; if two layers are visible after shaking, the emulsion must not be used
- Use only homogeneous preparations and undamaged syringes
After opening, the product must be used immediately. Propolipid is for single use only — any unused product must be discarded. Administration systems for undiluted propofol must be changed every 12 hours after the syringe has been opened. This is because propofol is a lipid emulsion without antimicrobial preservatives, which means it provides an excellent growth medium for microorganisms if contaminated.
For Propolipid 10 mg/ml, dilutions prepared with glucose 50 mg/ml solution, sodium chloride 9 mg/ml solution, or mixtures with preservative-free lidocaine 10 mg/ml injection solution (minimum 2 mg propofol per ml) must be prepared aseptically immediately before administration and used within 6 hours. Propolipid 20 mg/ml must be administered undiluted and must not be mixed with other solutions for injection or infusion.
What Does Propolipid Contain?
Quick Answer: The active ingredient is propofol (10 mg/ml or 20 mg/ml). The emulsion also contains refined soybean oil, medium-chain triglycerides, purified egg phospholipids, glycerol, oleic acid, sodium hydroxide, and water for injections.
Propolipid is a white oil-in-water emulsion for intravenous injection or infusion, supplied in pre-filled syringes of glass or plastic.
Active Substance
Each ml of Propolipid 10 mg/ml emulsion contains 10 mg propofol. Each ml of Propolipid 20 mg/ml emulsion contains 20 mg propofol.
Excipients (Inactive Ingredients)
- Soybean oil, refined — the lipid phase of the emulsion (important allergen information: contraindicated in soy/peanut allergy)
- Medium-chain triglycerides — contribute to the lipid emulsion stability
- Purified egg phospholipids — act as an emulsifier to stabilize the oil-in-water emulsion
- Glycerol — tonicity agent to make the solution isotonic with blood
- Oleic acid — emulsion stabilizer
- Sodium hydroxide — pH adjustment
- Water for injections — vehicle
Available Pack Sizes
Propolipid is available in the following pre-filled syringe presentations:
- Propolipid 10 mg/ml: 5 glass syringes of 10 ml, 6 plastic syringes of 10 ml, 5 glass syringes of 20 ml, 6 plastic syringes of 20 ml
- Propolipid 20 mg/ml: 1 plastic syringe of 50 ml
The marketing authorization holder is Fresenius Kabi AB, Uppsala, Sweden, and the product is manufactured by Fresenius Kabi Austria GmbH, Graz, Austria.
Frequently Asked Questions About Propolipid (Propofol)
Propofol (sold as Propolipid, Diprivan, and other brands) is an intravenous general anesthetic used to induce and maintain general anesthesia during surgery, to sedate patients receiving mechanical ventilation in intensive care units (ICU), and to provide sedation during diagnostic and surgical procedures. It is the most widely used intravenous anesthetic in the world due to its rapid onset (30–40 seconds), smooth induction, and fast recovery profile.
Propofol 10 mg/ml can be used for general anesthesia and procedural sedation in children older than 1 month. Propofol 20 mg/ml is approved for children older than 3 years. However, propofol must never be used for ICU sedation in children and adolescents aged 16 years or younger due to the risk of propofol infusion syndrome (PRIS). Children typically require higher weight-based doses than adults because of their larger volume of distribution and faster metabolic clearance.
The most common side effect is local pain at the injection site, affecting more than 1 in 10 patients. Common effects include low blood pressure (hypotension), changes in breathing pattern, slow or fast heart rate, hiccups, and coughing. After anesthesia, headache, nausea, and vomiting are common. A local anesthetic such as lidocaine can be co-administered to reduce injection site pain. Most side effects are transient and resolve quickly due to propofol's short half-life.
Propofol is not water-soluble, so it must be formulated as a lipid emulsion. Refined soybean oil serves as the lipid phase of this emulsion. The formulation also contains purified egg phospholipids as an emulsifier. Because of this, propofol is strictly contraindicated in patients with known allergies to soy or peanuts. Patients with egg allergy should inform their anesthesiologist, though the egg phospholipid component is highly purified and allergic reactions are extremely rare.
Propofol infusion syndrome (PRIS) is a rare but potentially fatal complication associated with prolonged, high-dose propofol infusions, particularly in critically ill patients. It is characterized by metabolic acidosis, rhabdomyolysis (muscle breakdown), hyperkalemia (high potassium), hyperlipidemia, cardiac failure, and renal failure. The risk increases with infusion rates exceeding 4 mg/kg/hour and durations longer than 48 hours. To mitigate this risk, ICU sedation with propofol should not exceed 7 days and infusion rates above 4 mg/kg/hour are not recommended. PRIS is the primary reason why propofol must not be used for ICU sedation in patients aged 16 or younger.
Propofol has one of the fastest onset times of any intravenous anesthetic. Unconsciousness typically occurs within 30–40 seconds of injection. Recovery is also remarkably rapid — patients usually regain consciousness within 5–10 minutes after the infusion is stopped, with minimal residual sedation or “hangover” effect compared to other anesthetics. This rapid onset and offset profile is one of the key reasons propofol has become the global standard for intravenous anesthesia.
References
This article is based on the following peer-reviewed sources and international guidelines:
- European Medicines Agency (EMA). Propofol – Summary of Product Characteristics. EMA Product Database. Available at: ema.europa.eu.
- U.S. Food and Drug Administration (FDA). Diprivan (propofol) Injectable Emulsion – Prescribing Information. FDA Drug Label. Available at: accessdata.fda.gov.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). Propofol is listed as an essential anesthetic agent. Available at: who.int.
- British National Formulary (BNF). Propofol. NICE Evidence – British National Formulary. Available at: bnf.nice.org.uk.
- Sahinovic MM, Struys MMRF, Absalom AR. Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clinical Pharmacokinetics. 2018;57(12):1539–1558. doi:10.1007/s40262-018-0672-3.
- Hemphill S, McMenamin L, Bellamy MC, Hopkins PM. Propofol infusion syndrome: a structured literature review and analysis of published case reports. British Journal of Anaesthesia. 2019;122(4):448–459. doi:10.1016/j.bja.2018.12.025.
- Krajcova A, Waldauf P, Andel M, Duska F. Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports. Critical Care. 2015;19:398. doi:10.1186/s13054-015-1112-5.
- Sneyd JR, Rigby-Jones AE. New drugs and technologies, intravenous anaesthesia is on the move (again). British Journal of Anaesthesia. 2010;105(3):246–254. doi:10.1093/bja/aeq190.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising board-certified specialists in anesthesiology, pharmacology, and intensive care medicine. All content follows the GRADE evidence framework and is based on the highest available level of evidence (Level 1A where applicable).
iMedic Medical Editorial Team — Specialists in Anesthesiology and Clinical Pharmacology
iMedic Medical Review Board — Independent expert review following EMA, FDA, and WHO guidelines
Conflict of Interest Statement: The iMedic editorial team receives no pharmaceutical industry funding. All content is independently produced and reviewed. We maintain strict editorial independence in accordance with our editorial standards.