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Diprivan

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Diprivan

Diprivan

SIDE EFFECTS

General

Adverse event information is derived from controlled clinical trials and worldwide marketing experience. In the description below, rates of the more common events represent US/Canadian clinical study results. Less frequent events are also derived from publications and marketing experience in over 8 million patients; there are insufficient data to support an accurate estimate of their incidence rates. These studies were conducted using a variety of premedicants, varying lengths of surgical/diagnostic procedures, and various other anesthetic/sedative agents. Most adverse events were mild and transient.

Anesthesia And MAC Sedation In Adults

The following estimates of adverse events for DIPRIVAN Injectable Emulsion include data from clinical trials in general anesthesia/MAC sedation (N=2889 adult patients). The adverse events listed below as probably causally related are those events in which the actual incidence rate in patients treated with DIPRIVAN Injectable Emulsion was greater than the comparator incidence rate in these trials. Therefore, incidence rates for anesthesia and MAC sedation in adults generally represent estimates of the percentage of clinical trial patients which appeared to have probable causal relationship.

The adverse experience profile from reports of 150 patients in the MAC sedation clinical trials is similar to the profile established with DIPRIVAN Injectable Emulsion during anesthesia (see below). During MAC sedation clinical trials, significant respiratory events included cough, upper airway obstruction, apnea, hypoventilation, and dyspnea.

Anesthesia In Pediatric Patients

Generally the adverse experience profile from reports of 506 DIPRIVAN Injectable Emulsion pediatric patients from 6 days through 16 years of age in the US/Canadian anesthesia clinical trials is similar to the profile established with DIPRIVAN Injectable Emulsion during anesthesia in adults (see Pediatric percentages [Peds %] below). Although not reported as an adverse event in clinical trials, apnea is frequently observed in pediatric patients.

ICU Sedation In Adults

The following estimates of adverse events include data from clinical trials in ICU sedation (N=159 adult patients). Probably related incidence rates for ICU sedation were determined by individual case report form review. Probable causality was based upon an apparent dose response relationship and/or positive responses to rechallenge. In many instances the presence of concomitant disease and concomitant therapy made the causal relationship unknown. Therefore, incidence rates for ICU sedation generally represent estimates of the percentage of clinical trial patients which appeared to have a probable causal relationship.

Incidence greater than 1% - Probably Causally Related

  Anesthesia/MAC Sedation ICU Sedation
Cardiovascular: Bradycardia Bradycardia
Arrhythmia [Peds: 1.2%]  
Tachycardia Nodal [Peds: 1.6%]
Hypotension* [Peds: 17%] (see also CLINICAL PHARMACOLOGY) Decreased Cardiac Output
  Hypertension [Peds: 8%] Hypotension 26%
Central Nervous System: Movement* [Peds: 17%]  
Injection Site: Burning/Stinging or Pain, 17.6% [Peds: 10%]  
Metabolic/Nutritional:   Hyperlipemia*
Respiratory: Apnea (see also CLINICAL PHARMACOLOGY) Respiratory Acidosis During Weaning*
Skin and Appendages: Rash [Peds: 5%] Pruritus [Peds: 2%]  
Events without an * or % had an incidence of 1% to 3%
*Incidence of events 3% to 10%

Incidence less than 1% - Probably Causally Related

  Anesthesia/MAC Sedation ICU Sedation
Body as a Whole: Anaphylaxis/Anaphylactoid Reaction Perinatal Disorder
[Tachycardia]
[Bigeminy]
[Bradycardia]
[Premature Ventricular Contractions]
[Hemorrhage]
[ECG Abnormal]
[Arrhythmia Atrial]
[Fever]
[Extremities Pain]
[Anticholinergic Syndrome]
 
Cardiovascular: Premature Atrial Contractions Syncope  
Central Nervous System: Hypertonia/Dystonia, Paresthesia Agitation
Digestive: [Hypersalivation]
[Nausea]
 
Hemic/Lymphatic: [Leukocytosis]  
Injection Site: [Phlebitis]
[Pruritus]
 
Metabolic: [Hypomagnesemia]  
Musculoskeletal: Myalgia  
Nervous: [Dizziness]
[Agitation]
[Chills]
[Somnolence]
[Delirium]
 
Respiratory: Wheezing
[Cough]
[Laryngospasm]
[Hypoxia]
Decreased Lung Function
Skin and Appendages: Flushing, Pruritus  
Special Senses: Amblyopia
[Vision Abnormal]
 
Urogenital: Cloudy Urine Green Urine

Incidence less than 1% - Causal Relationship Unknown

  Anesthesia/MAC Sedation ICU Sedation
Body as a Whole: Asthenia, Awareness, Chest Pain, Extremities Pain, Fever, Increased Drug Effect, Neck Rigidity/Stiffness, Trunk Pain Fever, Sepsis, Trunk Pain, Whole Body Weakness
Cardiovascular: Arrhythmia, Atrial Fibrillation, Atrioventricular Heart Block, Bigeminy, Bleeding, Bundle Branch Block, Cardiac Arrest, ECG Abnormal, Edema, Extrasystole, Heart Block, Hypertension, Myocardial Infarction, Myocardial Ischemia, Premature Ventricular Contractions, ST Segment Depression, Supraventricular Tachycardia, Tachycardia, Ventricular Fibrillation Arrhythmia, Atrial Fibrillation, Bigeminy, Cardiac Arrest, Extrasystole, Right Heart Failure, Ventricular Tachycardia
Central Nervous System: Abnormal Dreams, Agitation, Amorous Behavior, Anxiety, Bucking/Jerking/Thrashing, Chills/Shivering/Clonic/Myoclonic Movement, Combativeness, Confusion, Delirium, Depression, Dizziness, Emotional Lability, Euphoria, Fatigue, Hallucinations, Headache, Hypotonia, Hysteria, Insomnia, Moaning, Neuropathy, Opisthotonos, Rigidity, Seizures, Somnolence, Tremor, Twitching Chills/Shivering, Intracranial Hypertension, Seizures, Somnolence, Thinking Abnormal
Digestive: Cramping, Diarrhea, Dry Mouth, Enlarged Parotid, Nausea, Swallowing, Vomiting Ileus, Liver Function Abnormal
Hematologic/ Lymphatic: Coagulation Disorder, Leukocytosis  
Injection Site: Hives/Itching, Phlebitis, Redness/Discoloration  
Metabolic/ Nutritional: Hyperkalemia, Hyperlipemia BUN Increased, Creatinine Increased, Dehydration, Hyperglycemia, Metabolic Acidosis, Osmolality Increased
Respiratory: Bronchospasm, Burning in Throat, Cough, Dyspnea, Hiccough, Hyperventilation, Hypoventilation, Hypoxia, Laryngospasm, Pharyngitis, Sneezing, Tachypnea, Upper Airway Obstruction Hypoxia
Skin and Appendages: Conjunctival Hyperemia, Diaphoresis, Rash
  Urticaria  
Special Senses: Diplopia, Ear Pain, Eye Pain,  
  Nystagmus, Taste Perversion,  
  Tinnitus  
Urogenital: Oliguria, Urine Retention Kidney Failure

Drug Abuse And Dependence

There are reports of the abuse of propofol for recreational and other improper purposes, which have resulted in fatalities and other injuries. Instances of self-administration of DIPRIVAN Injectable Emulsion by health care professionals have also been reported, which have resulted in fatalities and other injuries. Inventories of DIPRIVAN Injectable Emulsion should be stored and managed to prevent the risk of diversion, including restriction of access and accounting procedures as appropriate to the clinical setting.

Read the Diprivan (propofol) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

The induction dose requirements of DIPRIVAN Injectable Emulsion may be reduced in patients with intramuscular or intravenous premedication, particularly with narcotics (e.g., morphine, meperidine, and fentanyl, etc.) and combinations of opioids and sedatives (e.g., benzodiazepines, barbiturates, chloral hydrate, droperidol, etc.). These agents may increase the anesthetic or sedative effects of DIPRIVAN Injectable Emulsion and may also result in more pronounced decreases in systolic, diastolic, and mean arterial pressures and cardiac output.

During maintenance of anesthesia or sedation, the rate of DIPRIVAN Injectable Emulsion administration should be adjusted according to the desired level of anesthesia or sedation and may be reduced in the presence of supplemental analgesic agents (e.g., nitrous oxide or opioids). The concurrent administration of potent inhalational agents (e.g., isoflurane, enflurane, and halothane) during maintenance with DIPRIVAN Injectable Emulsion has not been extensively evaluated. These inhalational agents can also be expected to increase the anesthetic or sedative and cardiorespiratory effects of DIPRIVAN Injectable Emulsion.

DIPRIVAN Injectable Emulsion does not cause a clinically significant change in onset, intensity or duration of action of the commonly used neuromuscular blocking agents (e.g., succinylcholine and nondepolarizing muscle relaxants).

No significant adverse interactions with commonly used premedications or drugs used during anesthesia or sedation (including a range of muscle relaxants, inhalational agents, analgesic agents, and local anesthetic agents) have been observed in adults. In pediatric patients, administration of fentanyl concomitantly with DIPRIVAN Injectable Emulsion may result in serious bradycardia.

Read the Diprivan Drug Interactions Center for a complete guide to possible interactions

Last reviewed on RxList: 6/23/2014
This monograph has been modified to include the generic and brand name in many instances.

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