Bedside Snapshot

Use It For: Post-intubation and ICU sedation of ventilated adults; induction for RSI in stable patients; brief deep procedural sedation (cardioversion, reductions)
Adult Dose: Induction: 1–2.5 mg/kg IV titrated (1–1.5 mg/kg if older or ASA III–IV)
Procedural sedation: 1 mg/kg IV, then 0.5 mg/kg every 3 min; less and slower if older or frail
ICU: start 5 mcg/kg/min; usual 5–50 mcg/kg/min
Pediatric Dose: Induction (3–16 yr): 2.5–3.5 mg/kg IV titrated; ED sedation: 1 mg/kg IV, then 0.5 mg/kg every 3 min (off-label). Not indicated for PICU sedation
Onset / Duration: IV bolus: 30–40 sec / about 6 min after a 1 mg/kg sedation dose, longer with repeat doses or opioids; infusion: waking in 10–15 min if titrated daily, slower after days at high rates
Do Not Give / Hold If: Known hypersensitivity to propofol or any component; past anaphylaxis to egg or soy products; no airway or ventilation backup; MAP <65 mmHg or uncorrected shock; unexplained acidosis or rising CK on an infusion
Watch For: Hypotension (MAP); apnea and obstruction (EtCO₂, SpO₂); bradycardia (ECG); PRIS on long or high-dose infusions (pH, lactate, CK, K⁺, ECG)
Reversal / Rescue: No reversal agent. Stop or slow the drug; jaw thrust and BVM; legs up, fluids, vasopressor; atropine for bradycardia. PRIS: stop propofol, early CRRT
Must Remember: No analgesia and no antidote: treat pain first. Infusions run in mcg/kg/min (max 4 mg/kg/hr unless benefit outweighs risk); discard vial and tubing 12 hr after spiking

Indications

Emergency & Prehospital

Post-intubation sedation: the infusion takes over once the induction agent wears off. Pair it with an analgesic (see RSI). Prehospital use depends on the agency.
Induction for rapid sequence intubation: for the hemodynamically stable patient. In shock, avoid it or cut the dose sharply. The label calls this induction of general anesthesia.

ED / ICU / Transport

ICU sedation of ventilated adults: the 2018 PADIS guideline prefers it over benzodiazepines. For light sedation, the 2025 PADIS focused update makes dexmedetomidine the first choice (conditional recommendation).
Brief deep procedural sedation: cardioversion, fracture and joint reduction, abscess drainage. Clinicians trained in airway rescue give it. The FDA label calls it MAC sedation in adults.
Interfacility transport of ventilated patients: the ICU or OR infusion carries on.
Refractory status epilepticus: a continuous infusion, titrated to EEG under neurocritical care direction. Off-label, specialist care.

Other Uses

Induction of general anesthesia: age 3 years and older (FDA-labeled)
Maintenance of general anesthesia: age 2 months and older (FDA-labeled)
Sedation with regional anesthesia in adults (FDA-labeled)

Dosing & Administration

Doses below follow the FDA label unless a row says it is off-label or differs from it.

Available Forms

10 mg/mL (1%) injectable emulsion: single-dose vials of 200 mg in 20 mL, 500 mg in 50 mL and 1,000 mg in 100 mL
Vehicle: soybean oil 100 mg/mL, egg phospholipid and glycerol, about 0.1 g fat (1.1 kcal) per mL. Diprivan adds disodium edetate (EDTA) to slow microbial growth. Some generics, e.g., Hospira, use benzyl alcohol 1.5 mg/mL with sodium benzoate instead. That one carries a gasping-syndrome warning in neonates and infants. Others, e.g., Sagent, use sodium metabisulfite 0.25 mg/mL. That is a sulfite, and it can cause allergic-type reactions in susceptible people, including anaphylactic symptoms and life-threatening asthma attacks. Those reactions are more common in people with asthma. Pick another product for a known sulfite-sensitive patient. Read the product label. The EDTA advice (zinc holiday, urinalysis) applies only to EDTA products.
EMS / transport: usually the 50 mL or 100 mL vial, hung undiluted on a pump for infusions. Stocking depends on the agency.

High-Alert Medication: ISMP lists IV general anesthetics as high-alert. The common errors are infusion unit mix-ups (propofol runs in mcg/kg/min, dexmedetomidine in mcg/kg/hr), the wrong patient weight and bolus dosing in fragile patients. Double-check the weight, the mcg/kg/min dose, the mL/hr pump rate and the line on your own at every start and every handoff.

Adult Dosing

Indication	Dose & Route	Repeat / Max	Notes
Induction of anesthesia / RSI	1–2.5 mg/kg IV, titrated to loss of consciousness: 2–2.5 mg/kg in healthy adults under 65; 1–1.5 mg/kg in older, debilitated or ASA III–IV patients	Single titrated dose; no fixed max: titrate to effect	High-alert No rapid bolus in older or ASA III–IV patients. Hemodynamically unstable: correct volume first, give slowly and reduce further (label cardiac range 0.5–1.5 mg/kg), or choose ketamine or etomidate. Apnea is expected.
Procedural sedation, bolus (ED) (off-label bolus)	1 mg/kg IV, then 0.5 mg/kg IV every 3 min as needed	No fixed max: titrate to effect; initial doses above 1 mg/kg are associated with more respiratory depression	High-alert Older, debilitated or ASA III–IV: lower doses given more slowly; label MAC advice is no rapid single or repeated boluses, about 80% of the usual dose given over 3–5 min. No analgesia: give the opioid first (e.g., fentanyl) and let it take effect. A second clinician whose main job is monitoring is highly recommended; capnography and airway equipment at the bedside.
Procedural (MAC) sedation, infusion	Start 100–150 mcg/kg/min IV for 3–5 min, or 0.5 mg/kg slow IV over 3–5 min; then 25–75 mcg/kg/min	Titrate to effect; taper toward 25–50 mcg/kg/min; older or ASA III–IV: about 80% of the adult dose	High-alert Label method. Allow about 2 min for peak effect between changes. Extra 10–20 mg boluses raise apnea risk.
ICU / post-intubation sedation (ventilated adult)	Start 5 mcg/kg/min (0.3 mg/kg/hr) IV infusion; increase by 5–10 mcg/kg/min every 5 min or longer to the sedation goal	Usual 5–50 mcg/kg/min; do not exceed 4 mg/kg/hr (about 67 mcg/kg/min) unless benefits outweigh risks	High-alert Treat pain first; target light sedation. A 10–20 mg bolus only to deepen quickly when hypotension is unlikely. Dosing weight: see Special Populations.
Maintenance of general anesthesia	100–200 mcg/kg/min IV (6–12 mg/kg/hr); older or ASA III–IV: 50–100 mcg/kg/min	Titrate down 30–50% in the first 30 min; usual maintenance 50–100 mcg/kg/min	High-alert Operating-room dosing; relevant when receiving a patient from anesthesia. Not a sedation rate.
Refractory status epilepticus (off-label)	Per neurocritical care protocol, titrated to EEG seizure or burst suppression (Neurocritical Care Society status epilepticus guideline, 2012, still the current edition)	Use caution above 80 mcg/kg/min for more than 48 hr; label PRIS risk factor: over 5 mg/kg/hr (about 83 mcg/kg/min) for over 48 hr	High-alert Specialist use with continuous EEG and mechanical ventilation; the loading dose often causes hypotension in critically ill patients. Taper rather than stop abruptly.

Pediatric Dosing

Indication	Dose (per kg) & Route	Max Single / Max Total	Notes
Induction of anesthesia (3–16 yr)	2.5–3.5 mg/kg IV, titrated to loss of consciousness	Single titrated dose; no fixed max: lower dose for ASA III–IV	High-alert Younger children may need the higher end. Use measured or length-based weight (Broselow). Apnea is common.
Procedural sedation, bolus (ED) (off-label in children)	1 mg/kg IV, then 0.5 mg/kg IV every 3 min as needed	Initial 1 mg/kg (not above the adult dose); total titrated to effect	High-alert Label: MAC sedation not established in children. ED studies and the 2026 multidisciplinary sedation guidelines (all ages) support use by sedation-trained teams. Fentanyl co-administration can cause serious bradycardia.
Maintenance of general anesthesia (2 months–16 yr)	200–300 mcg/kg/min IV for the first 30 min, then usually 125–150 mcg/kg/min	Label range 125–300 mcg/kg/min; decrease after 30 min if no signs of light anesthesia	High-alert Anesthesia setting. Intermittent alternative: 1–4 mg/kg IV, then 0.5–2 mg/kg as needed.
PICU sedation	Not FDA-indicated: specialist PICU protocols only. One trial: 9% vs 4% mortality (not statistically significant; causality not established). The label notes infusions are routinely used in PICUs.	—	Avoid prolonged or high-dose infusions; PRIS was first described in children. Abrupt stops after long infusions cause agitation and tremor.
Infants under 2 months; induction under 3 yr	Not established (label): anesthesia-specialist use only	—	See weight-based dosing.

Continuous Infusion

Setting	Example Concentration	Start	Titrate	Usual Range / Max
ICU sedation, ventilated adult	10 mg/mL undiluted (example, institution-specific)	5 mcg/kg/min	+5–10 mcg/kg/min every 5 min or longer to RASS goal	5–50 mcg/kg/min; max 4 mg/kg/hr (about 67 mcg/kg/min) unless benefits outweigh risks
Procedural (MAC) sedation, adult	10 mg/mL undiluted (example, institution-specific)	100–150 mcg/kg/min for 3–5 min	Allow about 2 min per change; titrate down when sedated	25–75 mcg/kg/min, then 25–50 mcg/kg/min

Pump rate for 10 mg/mL propofol

mL/hr = mcg/kg/min × weight (kg) × 0.006 (e.g., 20 mcg/kg/min × 80 kg = 9.6 mL/hr)

Preparation & Administration

Dilution: it comes ready to use. If you must dilute, use D5W only, and never go below 2 mg/mL. That floor protects emulsion stability.
Aseptic handling: disinfect the stopper, use a sterile vent spike, draw up immediately and label the syringe with the opening time. Single-dose vial: never re-enter or use for more than one patient.
12-hour rule: finish within 12 hours of opening or spiking. After that, discard the vial, the tubing and any unused drug. In anesthesia or MAC use, discard at the end of the procedure if that comes sooner.
Push rate: titrate induction doses to response. Give sedation loading doses slowly (label: 0.5 mg/kg over 3–5 min). Older, debilitated or ASA III–IV patients never get a rapid bolus.
Line: a large forearm or antecubital vein cuts down on injection pain. A peripheral line is acceptable, and phlebitis and thrombosis are rare. Do not run it through the same catheter as blood or plasma.
Injection pain: lidocaine 1 mL of 1% (10 mg) IV just before, or mixed immediately before use at no more than 20 mg lidocaine per 200 mg propofol.
Filter / pump: no in-line filter under 5 micron; run infusions on a syringe or volumetric smart pump. Shake well; do not use if the emulsion has separated.

Dosing Notes:

Unit check: 1 mg/kg/hr equals about 16.7 mcg/kg/min.
After long infusions, you will often need to drop the rate by up to half to hold the same depth.
The renal and hepatic notes sit in Special Populations.

Contraindications & Precautions

Contraindications

Known hypersensitivity to propofol or any component
History of anaphylaxis to eggs, egg products, soybeans or soy products (current Diprivan label, section 4; the label Highlights and some other labels use broader egg or soy allergy wording, so check the product in use)
No capability to manage the airway, ventilate and resuscitate (setting, not a drug contraindication)

Precautions

Shock, hypovolemia, sepsis or poor myocardial function: profound hypotension is the risk. Correct volume first, reduce the dose, push slowly and have a vasopressor ready.
Older, debilitated or ASA III–IV: peak levels run higher. Use lower doses and no rapid bolus. Apnea may last over 60 sec.
Raised ICP or poor cerebral perfusion: induce slowly (label neurosurgical dose 1–2 mg/kg) or use an infusion. Avoid MAP drops, because they lower cerebral perfusion pressure. The ICP fall was shown with controlled ventilation and hypocarbia. Set the CO₂ target by neurocritical care protocol.
Lipid disorders or pancreatitis (primary hyperlipoproteinemia, diabetic hyperlipemia): keep an eye on triglycerides.
Epilepsy: seizures can come up during recovery.
Children: watch for bradycardia, especially with fentanyl. The label does not indicate it for PICU or procedural (MAC) sedation.

Hold / Reassess If

MAP <65 mmHg: stop up-titration, give fluids, start a vasopressor; reduce or stop propofol
HR <50/min with poor perfusion: reduce the dose; atropine
Non-intubated patient with flat EtCO₂ waveform or SpO₂ <90%: stop dosing, airway maneuvers, ventilate
Unexplained metabolic acidosis, rising lactate, CK or K⁺, or new coved ST elevation in V1–V3: stop propofol, evaluate for PRIS
Rising dose needed to hold the same sedation level, or triglycerides ≥400 mg/dL: reassess and consider an alternative sedative

No analgesia, no reversal: Propofol only sedates. It does not treat pain. Deepen it to cover pain and you drive the blood pressure down, and there is no antidote to undo that. Give analgesia first. Then titrate propofol to a sedation goal.

Adverse Effects & Toxicity

Common

Hypotension: arterial pressure often drops, and sometimes by more than 30% after induction.
Apnea at induction: in adults given 2–2.5 mg/kg, apnea ran 30–60 sec in 24%. It ran over 60 sec in 12%.
Injection pain: it hit 45% of children who had a small hand vein and no lidocaine. With lidocaine or an antecubital vein, it fell under 10%.
Bradycardia (no vagolytic effect) and lower cardiac output. Both get worse with positive-pressure ventilation and opioids.
Hypertriglyceridemia comes with longer infusions. Pooled incidence in ICU cohorts is about 28%.
Myoclonus and involuntary movements. Green urine shows up during ICU infusions. Cloudy urine has been reported with anesthesia or MAC sedation (label). The green is a harmless color change from phenolic metabolites. By itself, it is not a sign of kidney injury.
Extravasation (rare, postmarketing): local pain, swelling, blisters or tissue necrosis

Serious / Life-Threatening

Effect	Recognition	Management
Cardiovascular collapse	Falling MAP after a bolus or rate increase; worse in shock, sepsis, older patients	Stop or slow propofol, raise legs, fluids, vasopressor (e.g., norepinephrine or push-dose phenylephrine)
Bradycardia, asystole	Slowing HR, especially in children given fentanyl, or with succinylcholine or vagal stimuli	Atropine or glycopyrrolate; ACLS/PALS if arrest
Apnea / airway obstruction	Flat or absent EtCO₂ waveform, falling SpO₂, no chest rise	Jaw thrust, BVM with O₂, airway adjunct; usually brief
Propofol infusion syndrome (PRIS)	Unexplained metabolic acidosis, rhabdomyolysis, hyperkalemia, lipemia, AKI, Brugada-like ECG, cardiac failure; mortality about 50% in published cases	Stop propofol immediately; switch sedative; treat K⁺ and acidosis; early CRRT; ECMO reported for refractory shock
Anaphylaxis	Angioedema, bronchospasm, erythema, hypotension	Stop propofol; epinephrine IM, or titrated IV epinephrine by clinicians experienced in its use in monitored patients; airway, fluids, anaphylaxis protocol
Pancreatitis (rare)	Abdominal pain or intolerance of feeds with high triglycerides	Stop propofol; check lipase and triglycerides
Sepsis from contaminated product	Fever or bacteremia after breaks in aseptic technique or hang times over 12 hr	Discard product and tubing; cultures; treat sepsis

Overdose & Toxicity Management

Signs: cardiorespiratory depression: apnea, hypotension, bradycardia.
Management: stop propofol; ventilate with oxygen; raise the legs, give IV fluids, vasopressors and anticholinergics as needed.
No antidote. After a bolus, effects wear off within minutes. After long or high-rate infusions, recovery is slower. For PRIS, early CRRT clears water-soluble metabolites. Consider ECMO for refractory shock.

Monitoring

Parameter	When / How Often	Target / Act If
Clinical: BP	Baseline, then frequently during induction, boluses and titration; continuous or per ICU protocol on infusions	MAP <65 mmHg: stop up-titration, fluids, vasopressor; reduce or stop propofol
Clinical: SpO₂ and waveform EtCO₂	Continuous for every sedation and infusion	Flat or absent waveform, rising EtCO₂ or SpO₂ <90%: airway maneuvers, ventilate, check tube and circuit
Clinical: ECG and HR	Continuous	Bradycardia: reduce dose, atropine. New coved ST elevation in V1–V3 or new arrhythmia on an infusion: stop propofol, think PRIS
Clinical: sedation (RASS) and pain (CPOT or BPS)	After each titration and per ICU protocol, plus a daily sedation evaluation (label)	Deeper than ordered: reduce the rate. Pain present: treat pain before adding propofol
Laboratory: triglycerides	Baseline if at risk (lipid disorder, pancreatitis, parenteral lipids); after about 2 days of infusion, then per institutional protocol	Triglycerides ≥400 mg/dL (common threshold; varies): reduce propofol, cut other lipids, consider an alternative sedative
Laboratory: PRIS screen	CK on prolonged infusions (e.g., daily after 48 hr, per institutional protocol); pH, lactate, K⁺, creatinine and liver enzymes with prolonged or high-dose infusions (interval per institutional protocol)	Unexplained acidosis, rising CK, lactate, K⁺ or creatinine, or new liver enlargement or enzyme rise: stop propofol, switch sedative, treat
Laboratory: urinalysis	Before and on alternate days in patients at risk of renal impairment (EDTA product)	New abnormalities: review renal function and the product
Infusion safety	Every titration and handoff	Confirm weight, mcg/kg/min, mL/hr, vial spike time and tubing change (12 hr); log lipid calories (1.1 kcal/mL)
Clinical: recovery after procedural sedation	Until back to baseline mental status and vital signs	Do not leave the patient unmonitored; airway observed until awake

Interactions & Compatibility

Clinically Significant Interactions

Drug / Class	Effect	What To Do
Opioids, benzodiazepines, other sedatives, inhaled anesthetics	Additive sedation and apnea; larger falls in BP and cardiac output	Lower propofol doses; titrate one drug at a time; continuous SpO₂ and EtCO₂
Fentanyl in children	Serious bradycardia (label)	Continuous ECG; anticholinergic ready
Valproate	Higher propofol blood levels	Reduce the propofol dose; watch for oversedation and cardiorespiratory depression
Succinylcholine, vagal stimuli	Bradycardia (propofol has no vagolytic effect)	Consider IV atropine or glycopyrrolate
Clevidipine, parenteral nutrition lipids	Added lipid load and triglycerides	Count total lipid calories; reduce other lipids; monitor triglycerides

IV Compatibility

Do not mix propofol with other drugs before administration (lidocaine is the only labeled exception, at no more than 20 mg per 200 mg).
Y-site compatible fluids (label): D5W, lactated Ringer's, LR with D5W, D5W with 0.45% NaCl, D5W with 0.2% NaCl.
Diluent: D5W only, not below 2 mg/mL. Not through the same catheter as blood or plasma (emulsion aggregation).
Verify with an institutional compatibility resource.

Special Populations

Pediatrics: labeled for induction from age 3 years and for maintenance from 2 months. Not indicated for PICU or procedural (MAC) sedation. The label notes deaths in children with respiratory infections on ICU sedation. FDA warns that repeated or long (over 3 hr) anesthetic exposure under age 3 may affect brain development. Do not delay a needed procedure over that. Doses: Pediatric Dosing table.
Neonates: safety is not established. Use by anesthesia specialists only. Benzyl alcohol-preserved generics carry a gasping-syndrome warning in neonates and infants, so count benzyl alcohol from every source. Watch neonates for hypotonia and sedation after maternal exposure.
Pregnancy: decades of data, mostly from cesarean deliveries, show no drug-associated risk of birth defects, miscarriage or adverse maternal or fetal outcomes. Propofol crosses the placenta, though, and can cause neonatal depression. Prolonged third-trimester exposure (over 3 hr) falls under the same neurodevelopment caution. Do not withhold an indicated emergency anesthetic or sedative.
Lactation: propofol passes into milk in variable amounts. No adverse effects in breastfed infants have been reported. The label says to weigh the benefits of breastfeeding against the mother's need for the drug.
Older Adults: a smaller volume of distribution means higher peak levels. Use lower induction doses (1–1.5 mg/kg), slower rates and no rapid bolus.
Renal Impairment: no dose adjustment is established, because chronic renal impairment does not change the pharmacokinetics. On an EDTA product, get a urinalysis before and on alternate days in patients at risk.
Hepatic Impairment: pharmacokinetics do not change in chronic cirrhosis. Acute liver failure and long-term use have not been studied. Titrate to effect.
Obesity / Dosing Weight: the label gives no obesity dosing weight, and protocols differ between lean, adjusted and total body weight. For procedural sedation, the 2026 multidisciplinary guidelines advise ideal body weight for most drug doses. Start boluses at the low end. Reassess infusions daily.
Prolonged infusions (Diprivan, EDTA): do not run an infusion longer than 5 days without a drug holiday. The holiday replaces urinary zinc losses. Consider supplemental zinc sooner in burns, diarrhea or major sepsis.

Field & Transport Considerations

Scope: critical-care transport teams run propofol infusions in ventilated patients. Paramedic use for post-intubation sedation depends on the agency. It varies by state and agency protocol.
Storage & Stability: store it per the product label. Diprivan and the Sagent sulfite product are kept at 4–25 °C (40–77 °F). The Hospira benzyl alcohol product is kept at 20–25 °C (68–77 °F). Do not freeze it. Shake before use and discard if the emulsion separates. A hot or freezing vehicle compartment falls outside label storage.
Carried Concentration: 10 mg/mL only. The milky-white emulsion looks like clevidipine and IV lipid emulsion. Label every syringe and line.
Infusions in Transport: use a smart pump with a drug library and a dedicated or clearly labeled line. Check the vial spike time and tubing time before departure. If 12 hours will pass en route, hang a new vial and set. Carry enough volume for the trip plus delays.
Hemodynamics en route: positive-pressure ventilation and hypovolemia both deepen propofol hypotension. Have a vasopressor ready before transfer.
Handoff Essentials: current rate in mcg/kg/min and mL/hr, weight used, start time and duration, last titration, analgesic running, RASS and pain score, last triglycerides or CK if on infusion over 48 hr, vial and tubing times.
Diversion: it is not federally controlled, yet abuse and deaths are reported. Secure stock and account for waste per agency policy.

Clinical Pearls

The shock trap: Propofol lowers preload and afterload. It also blunts sympathetic tone. A standard induction dose in a septic or bleeding patient can cause arrest. Resuscitate first. Then cut the dose, push slowly or choose another agent.

Propofol vs dexmedetomidine (CCRN, CFRN): The later A2B trial had 1,404 adults with a light-sedation target. It found no faster extubation (subdistribution HR 1.09, 95% CI 0.96 to 1.25). It did find more agitation (RR 1.54) and heart rate below 50/min (RR 1.62). When you need deeper sedation or rapid titration, propofol is the first choice.

Lipid calories count: At 1.1 kcal/mL, a 10 mL/hr infusion delivers about 264 kcal/day of fat. Loop in the dietitian. Adjust parenteral lipids and watch triglycerides.

Think PRIS early: Unexplained metabolic acidosis, rising CK or a Brugada-like ECG on a propofol infusion is PRIS until proven otherwise. Risk climbs above 5 mg/kg/hr for over 48 hr. It climbs too with catecholamines, steroids, sepsis or brain injury. Cases still occur at lower doses.

Wean, do not slam off: Stop it abruptly and the patient wakes fast, gets anxious and fights the ventilator. Lighten the infusion. Keep light sedation until 10–15 minutes before extubation.

Brain-injured patient (FP-C, CCP-C): Propofol lowers cerebral metabolic rate, cerebral blood flow and ICP (shown with controlled ventilation). It also wears off fast enough for neuro checks. Here's the catch: a falling MAP lowers cerebral perfusion pressure. Pair it with a vasopressor plan. The Brain Trauma Foundation severe TBI guideline (4th edition) recommends propofol for ICP control. It does not recommend it to improve mortality or 6-month outcome. It warns that high-dose propofol can cause significant morbidity (see PRIS).

Pharmacology

Mechanism of Action

Positive modulation of GABA-A receptors, which boosts inhibitory signaling. The result is hypnosis and amnesia, with no analgesia.
Lower preload and afterload with reduced sympathetic activity. The result is hypotension, worse with positive-pressure ventilation, hypovolemia and opioids.
No vagolytic activity. That means bradycardia can follow vagal stimuli or succinylcholine.
Reduced cerebral blood flow, metabolic rate and ICP (with controlled ventilation). Intraocular pressure falls too.

Pharmacokinetics

Route	Onset	Peak	Duration
IV bolus	30–40 sec (one arm-brain circulation)	Blood-brain equilibration half-time 1–3 min	About 6 min after a 1 mg/kg sedation dose; longer with repeat or larger doses and with opioids or benzodiazepines
IV infusion	Allow 3–5 min between dose changes (label); about 2 min to peak effect in MAC sedation; at least 5 min between ICU titrations	Steady state proportional to rate	Waking in 10–15 min if titrated daily; slower after days at high rates

Half-life: plasma levels drop fast after a bolus. About half of that early fall comes from redistribution and the rest from metabolism. The terminal half-life runs 1–3 days after a 10-day infusion, because tissue stores have built up.
Distribution: very lipophilic. After a 10-day infusion, the steady-state volume approaches 60 L/kg. That is why rates often need to fall by up to half over time.
Metabolism: the liver conjugates it into inactive metabolites. Glucuronide accounts for about 50% of the dose. Clearance runs 23–50 mL/kg/min.
Elimination: urine carries the metabolites out.

Names & Classification

Generic Name: Propofol (2,6-diisopropylphenol) injectable emulsion, 1% (10 mg/mL)
Brand Names: Diprivan; multiple generic propofol emulsions (additives differ)
Pharmacologic Class: GABA-A receptor positive modulator (alkylphenol)
Therapeutic Class: IV general anesthetic; sedative-hypnotic
Controlled Substance: Not controlled (federal); abuse and diversion reported
ISMP High-Alert: Yes: ISMP high-alert medication (general anesthetic agents, IV)
Look-Alike / Sound-Alike: No name pair commonly reported; the practical risk is mixing up milky-white emulsions (clevidipine, IV lipid emulsion) on pumps

References

Fresenius Kabi USA. (2025). DIPRIVAN (propofol) injectable emulsion, for intravenous use: Full prescribing information (revised 04/2025). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d1ae9e26-ffd6-43df-bbd6-869cdede6afe
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Walsh, T. S., Parker, R. A., Aitken, L. M., McKenzie, C. A., Emerson, L., Boyd, J., et al., for the A2B Trial Investigators. (2025). Dexmedetomidine- or clonidine-based sedation compared with propofol in critically ill patients: The A2B randomized clinical trial. JAMA, 334(1), 32–45. https://pmc.ncbi.nlm.nih.gov/articles/PMC12090071/
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Hendrix, A. N., Kerrison, C. H., Holley, Z. C., Makani, A., Norris, A., Orcutt, G., et al. (2026). Propofol and hypertriglyceridemia in the ICU: A systematic review and meta-analysis of recent observational data. Cureus, 18(5), e108132. https://pmc.ncbi.nlm.nih.gov/articles/PMC13224726/
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