Propofol is the most widely used intravenous general anaesthetic in the world: the "white milk" that puts patients to sleep in seconds before surgeries and procedures. It is only administered by professionals trained in anaesthesia.
Also known as: Diprivan
Propofol plus midazolam adds respiratory depression, profound sedation and hypotension; requires dose reduction and airway support.
Synergism between benzodiazepine and IV anaesthetic at the GABA-A receptor; Diprivan label: reduce maintenance dose by ~25–30% when sedatives are co-administered.
Saturation, capnography, blood pressure, sedation level.
Apnoea, hypotension, rapid desaturation.
Reduce the propofol dose (~25–30%); only in a setting with oximetry, airway support and resuscitation available.
DailyMed — Diprivan (propofol) Injectable Emulsion label [RLD], Warnings: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5ec25932-6c21-4cd5-8f60-80761f2e20a6; Midazolam HCl Injection label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f051776f-94c5-4e34-80ed-f45b9c36881e
Clonidine potentiates propofol sedation and hypotension, reducing anaesthetic requirements but increasing haemodynamic instability risk.
Central α2 agonist: additive sedation and blunting of the sympathetic response to intubation (labels: reduce anaesthetics in α2-agonist patients).
Blood pressure, heart rate, anaesthetic depth.
Prolonged hypotension, bradycardia, need for vasopressors.
Reduce the propofol induction dose; monitor blood pressure and heart rate; never stop clonidine abruptly pre-operatively.
DailyMed — Diprivan (propofol) and Clonidine HCl Tablet labels: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5ec25932-6c21-4cd5-8f60-80761f2e20a6
No documented food or drink interactions.
Propofol is a lipid emulsion — contraindicated in severe hypertriglyceridaemia and lipid-associated pancreatitis.
Monitor triglycerides in infusions > 48 h (propofol infusion syndrome).
Site monograph (propofol — monitor triglycerides in infusions > 48 h).
Propofol causes significant hypotension — caution/contraindication in uncorrected hypovolaemia and hypotension.
Correct hypovolaemia before induction; reduce dose in elderly.
Site monograph (propofol — reduce dose in elderly, hypovolaemia).
No specific Annex 1 entry; propofol crosses the placenta rapidly and, at anaesthetic induction doses, is associated with neonatal depression (hypotonia, respiratory depression) — which is why caesarean induction preferentially uses thiopental or single low-dose propofol with rapid outcome. It should not be used for prolonged maintenance in labour.
Caution: use only as a single low induction dose if alternatives are unavailable; avoid continuous maintenance during labour (neonatal depression).
Compatible — rapid elimination (short context-sensitive half-time) allows breastfeeding once the mother is awake and stable.
EMC-UK (MHRA) — Propofol SmPC (Diprivan): https://www.medicines.org.uk/emc/product/3447/smpc (section 4.6).
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Sedation/anaesthesia in ~ 30 s (one arm-brain time); awakening 5–15 min after stopping infusion.
GABA-A receptor positive modulator (potentiates Cl− current) and mild sodium channel inhibitor; suppresses stress response and memory.
IV exclusive; 3-compartment distribution with adipose depot (awakening still rapid after short infusion, slower after long).
High hepatic clearance (CYP2B6, CYP2C9, glucuronidation) exceeding hepatic flow (extrahepatic pulmonary and renal clearance also described).
~ 30–60 min (terminal elimination half-life ~ 4–24 h; variable context-sensitive half-time).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
