Propofol Corden 20 Mg/Ml (2%) Emulsion For Injection/Infusion
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Propofol Corden 20 mg/ml (2%) emulsion for injection/infusion
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
1 ml emulsion for injection/infusion contains 20 mg propofol.
Each 50 ml vial contains 1000 mg propofol.
Excipients:
1 ml emulsion for injection/infusion contains 100 mg soya-bean oil, refined and 0.0018 mmol (0.04 mg) sodium.
Each 50 ml vial contains 5 g soya-bean oil, refined and 0.09 mmol (2 mg) sodium.
For a full list of excipients, see section 6.1.
3 PHARMACEUTICAL FORM
Emulsion for injection/infusion.
White aqueous isotonic oil-in-water emulsion.
Osmolarity: 285 to 320 mOsm/Kg. pH is in the range of 6.0 - 8.5.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Propofol Corden 20mg/ml is a short-acting intravenous general anaesthetic for:
- Induction and maintenance of general anaesthesia in adults and paediatric patients > 3 years of age
- Sedation for diagnostic and surgical procedures, alone or in combination with local or regional anaesthesia in adults and paediatric patients > 3 years of age
- Sedation of ventilated patients > 16 years of age in the intensive care unit
4.2 Posology and method of administration
Propofol Corden 20mg/ml must only be administered in hospitals or adequately equipped day therapy units by physicians trained in anaesthesia or in the care of patients in intensive care.
Circulatory and respiratory functions should be constantly monitored (e.g. ECG, pulse oxymetry) and facilities for maintenance of a patient airways, artificial ventilation, and other resuscitation facilities should be immediately available at all times.
For sedation during surgical and diagnostic procedures Propofol Corden 20mg/ml should not be administered by the same person conducting the surgical or diagnostic procedure.
Propofol Corden 20mg/ml has no analgesic properties and therefore supplementary analgesic agents are generally required in addition to Propofol Corden 20mg/ml.
Posology
The dose of Propofol Corden 20mg/ml should be individually adapted according to the patient’s response.
Rapid bolus administration (single or repeated) should not be used in the elderly as this may lead to cardiorespiratory depression.
Propofol Corden 20mg/ml should not be used for bolus injection as this may lead to cardiorespiratory depression.
General anaesthesia in adults
Induction of anaesthesia
For induction of anaesthesia Propofol Corden 20mg/ml must be titrated (2040mg propofol every 10 seconds) against the response of the patient until clinical signs show the onset of anaesthesia.
Usually an adult patient below 55 years will require 1.5 to 2.5mg propofol/kg body weight.
In patients over 55 years and in patients of ASA (American Society of Anaesthesiologists) classification III and IV, especially in those with impaired cardiac function the requirements will generally be less and the total dose of Propofol Corden 20mg/ml may be reduced to a minimum of 1mg propofol/kg body weight. These patients also need lower rates of administration (approximately 2ml corresponding to 20mg propofol every 10 seconds).
Maintenance of anaesthesia
Anaesthesia can be maintained by administering Propofol Corden 20mg/ml either by continuous infusion or repeat bolus injections (Propofol Corden 10mg/ml only).
Continuous Infusion:
When using a continuous infusion for maintenance of anaesthesia generally doses of 4 to 12mg propofol/kg body weight/hr should be given. In elderly patients, patients in unstable general conditions, patients with impaired cardiac function or hypovolaemic patients and patients of ASA grades III and IV, the dosage of Propofol Corden 20mg/ml may be further reduced depending on the patient’s condition and on the applied anaesthetic method.
Repeat Bolus Injection:
For maintenance of anaesthesia using repeat bolus injections dosages of 25mg up to 50mg (=2.5 up to 5ml Propofol Corden 10mg/ml) should be administered depending on the clinical requirements.
Sedation of mechanically ventilated patients during intensive care
Adults and adolescents (> 16 years of age)
When used to provide sedation for mechanically ventilated patients under intensive care conditions, the administration of Propofol Corden 20mg/ml as continuous infusion it is recommended. The rate of administration has to be adapted to the level of sedation required.
A satisfactory level of sedation can generally be achieved with a dosage of 0.3 - 4.0mg propofol/kg body weight/hr (see section 4.4).
Administering Propofol Corden 20mg/ml through a TCI-system for sedation in intensive care is not recommended.
It is recommended that blood lipid levels be monitored should Propofol Corden 20mg/ml be administered to patients thought to be at particular risk of fat overload. Administration of Propofol Corden 20mg/ml should be adjusted appropriately if the monitoring indicates that fat is being inadequately cleared from the body. If the patient is receiving other intravenous lipid concurrently, a reduction in quantity should be made in order to take account of the amount of lipid infused as part of the Propofol Corden 20mg/ml formulation; 1.0ml of Propofol Corden 20mg/ml contains approximately 0.1g of fat.
If the duration of sedation is in excess of 3 days, lipids should be monitored in all patients.
Sedation for diagnostic and surgical interventions in adult patients
To provide sedation during surgical and diagnostic interventions, doses and administration rates need to be adapted to the clinical response.
Most patients will require 0.5 to 1.0mg propofol/kg body weight over 1 to 5 minutes for induction of sedation.
For maintenance of sedation the Propofol Corden 20mg/ml infusion should be titrated until the desired level of sedation is achieved. Generally 1.5 to 4.5mg propofol/kg body weight/hr will be required.
The infusion may be supplemented by bolus injections of 10 to 20mg (1 to 2ml Propofol Corden10mg/ml) if a deeper level of sedation is rapidly required.
In patients older than 55 years and in patients of ASA classification III and IV the rate of administration and dosage may need to be reduced.
If lower doses are needed, Propofol Corden 10mg/ml can be used as an alternative.
Paediatric population
General anaesthesia in paediatric patients (>3 years of age)
Propofol Corden 20mg/ml is not recommended for induction and maintenance of anaesthesia in paediatric patients between 1 month and 3 years old, because the 20mg/ml strength is difficult to titrate in paediatric patients because of the very small volumes that are necessary (see section 4.4).
In these patients the use of Propofol Corden 10mg/ml is recommended. Induction of anaesthesia
For induction of anaesthesia Propofol Corden 20mg/ml should be titrated slowly until clinical signs show the onset of anaesthesia. The dose should be adjusted according to age and/or body weight. Most patients over 8 years of age require approximately 2.5mg propofol/kg body weight for induction of anaesthesia.
In younger patients, dose requirements may be higher (2.5 - 4mg/kg body weight).
Maintenance of anaesthesia
A satisfactory level of anaesthesia can generally be attained with a continuous infusion using a dosage of 9 - 15mg propofol/kg body weight/hr. The dose needs to be individually adapted and special attention needs to be given to obtain adequate analgesia.
In younger patients, dose requirements may be higher.
For ASA III and IV patients lower doses are recommended (see also section 4.4)
Sedation of ventilated paediatric patients during intensive care Propofol Corden 20mg/ml is contraindicated in paediatric patients of 16 years of age or younger in the indication for sedation in intensive care (see section 4.3).
Sedation for diagnostic and surgical interventions in paediatric patients (>3 years of age)
Doses and administration rates should be adjusted according to the required level of sedation and the clinical response. Most paediatric patients require 1 -2mg propofol/kg body weight for onset of sedation. Maintenance of sedation may be accomplished by titrating Propofol Corden 20mg/ml infusion to the desired level of sedation. Most patients require 1.5 - 9 propofol/kg body weight/hr.
In ASA III and IV patients lower doses may be required.
Method of administration
Containers should be shaken before use. If two layers can be seen after shaking, the emulsion should not be used.
Propofol Corden 20mg/ml is administered intravenously as an injection or as a continuous infusion, undiluted.
Prior to use, the ampoule neck and rubber stopper should be disinfected using a medicinal alcohol (spray or dipped swab). After use, any remaining contents must be discarded (see section 6.6).
Propofol Corden 20mg/ml does not contain antimicrobial preservatives and is capable of supporting the growth of microorganisms. The emulsion must be drawn aseptically into a sterile syringe or infusion system immediately after spiking the vial.
Administration must commence without delay. During infusion sterility of Propofol Corden 20mg/ml as well as the infusion system must be maintained.
Medicinal products or liquids that are added to a running Propofol Corden 20mg/ml infusion should be added close to the cannula.
Propofol Corden 20mg/ml must not be administered via infusion systems that are provided with a microbiological filter.
The contents of one vial of Propofol Corden 20mg/ml and any infusion equipment are intended for single use in one patient.
Any remainder must be discarded immediately after use.
Propofol Corden 20mg/ml must not be diluted.
Infusion of Propofol Corden 20mg/ml
When Propofol Corden 20mg/ml is administered as a continuous infusion, it is recommended that equipment such as burettes, drop counter, syringe pumps or volumetric infusion pumps should always be used to control infusion rates.
As applies to parenteral administration of all kinds of fat emulsions, the duration of use for one infusion system for a continuous infusion of Propofol Corden 20mg/ml must not exceed 12 hours. The infusion system and the container must be discarded and replaced after a maximum of 12 hours.
The simultaneous administration of Propofol Corden 20mg/ml together with an infusion solution of glucose 50mg/ml (5%), sodium chloride 9mg/ml (0.9%) intravenous infusion solution or a combination solution of glucose 40mg/ml (4%) and sodium chloride 1.8mg/ml (0.18%) close to the Y-connector near the place of injection, is possible.
Any Propofol Corden 20mg/ml remaining at the end of the infusion period or after changing the system needs to be discarded and destroyed.
To reduce pain on the injection site lidocaine may be injected immediately before the use of Propofol Corden 20mg/ml. For the specific risks of lidocaine see sections 4.4 and 4.8.
The infusion system should be rinsed before administration of muscle relaxants like atracurium and mivacurium when using the same infusion system for Propofol Corden 20mg/ml.
Duration of administration
Propofol Corden 20mg/ml can be administered for a maximum of 7 days.
4.3 Contraindications
- Hypersensitivity to the active substance or to any of the excipients
- Hypersensitivity to soya or peanut
- Sedation in the intensive care unit in paediatric patients of 16 years of age or younger (see section 4.4)
4.4 Special warnings and precautions for use
In patients with cardiac, respiratory, renal or hepatic impairment, or in elderly, debilitated, hypovolaemic or epileptic patients Propofol Corden should be administered with caution and with a reduced administration rate (see section 4.2).
Propofol clearance is blood flow dependent, therefore, concomitant medication which reduces cardiac output will also reduce propofol clearance. If possible, cardiac, circulatory or pulmonary insufficiency and hypovolaemia should be compensated before administration of Propofol Corden 20mg/ml.
Before anaesthesia of an epileptic patient, it should be checked that the patient has received the antiepileptic treatment. Although several studies have demonstrated efficacy in treating status epilepticus, administration of propofol in epileptic patients may also increase the risk of seizure.
Propofol Corden 20mg/ml should be administered with caution when used to sedate patients undergoing some interventions where spontaneous movements are particularly undesirable, such as ophthalmic surgery.
Use of propofol is not recommended with electroconvulsive therapy.
In patients with severe cardiac impairment it is recommended that Propofol Corden 20mg/ml is given with great caution and under intensive monitoring.
During induction of anaesthesia, hypotension and transient apnoea may occur depending on the dose and use of premedications and other agents.
The risk of relative vagotonia may be increased because propofol lacks vagolytic activity. The intravenous administration of an anticholinergic agent before induction, or during maintenance of anaesthesia should be considered, especially in situations where the vagal tone is likely to predominate or when Propofol Corden 20mg/ml is used in conjunction with other agents likely to cause bradycardia.
Paediatric patients
Propofol Corden 20mg/ml is not recommended in paediatric patients <3 years of age since the 20mg/ml strength is difficult to be adequately titrated in small paediatric patients due to the extremely small volumes needed. For these patients Propofol Corden 10mg/ml is recommended.
The safety and efficacy of Propofol Corden 20mg/ml for (background) sedation in paediatric patients younger than 16 years of age have not been demonstrated (see section 4.3).
The use of Propofol Corden 20mg/ml is not recommended for newborn infants younger than 1 month as this patient population has not been fully investigated. Pharmacokinetic data (see section 5.2) indicate that clearance is considerably reduced in neonates with a very high inter-individual variability. Relative overdose could occur administering doses recommended for older children resulting in severe cardiovascular depression.
Although no causal relationship has been established, serious undesirable effects (including cases with fatal outcome) during (background) sedation in paediatric patients younger than 16 years of age have been reported during unlicensed use. These effects mostly concerned occurrence of metabolic acidosis, hyperlipidaemia, rhabdomyolysis and/or cardiac failure. These effects were most frequently seen in children with respiratory tract infections who received dosages in excess of those advised in adults for sedation in intensive care.
Similarly rare reports have been received of occurrence of metabolic acidosis, rhabdomyolysis, hyperkalaemia and/or rapidly progressive cardiac failure (in some cases with fatal outcome) in adults treated for more than 58 hours with dosages in excess of 5mg propofol/kg body weight/hr. This exceeds the maximum dosage of 4mg/kg body weight per hour, which is now recommended for sedation in intensive care. The affected patients mainly (but not exclusively) had serious head injuries associated with raised intracranial pressure (ICP). In such cases the cardiac failure was usually unresponsive to inotropic supportive treatment.
Prescribers are reminded not to exceed the dosage of 4mg propofol/kg body weight/hr.
Prescribers should be alert to these possible undesirable effects and decrease the dosage or switch to an alternative sedative at the first sign of occurrence of symptoms. Patients with raised ICP should be given appropriate treatment to support the cerebral perfusion pressure during these treatment modifications.
Special care should be taken in patients with high intracranial pressure and low arterial pressure as there is a risk of significant decrease of the intracerebral perfusion pressure.
Special care should be applied in patients with disorders of fat metabolism and in other conditions where lipid emulsions must be used with caution.
It is recommended that blood lipid levels should be monitored if Propofol Corden 20mg/ml is administered to patients thought to be at particular risk of fat overload and in all patients if duration of sedation is in excess of 3 days. Administration of Propofol Corden 20mg/ml should be adjusted appropriately if the monitoring indicates that fat is being inadequately cleared from the body. If the patient is receiving other intravenous lipid (e.g. parenteral nutrition) concurrently, a reduction in quantity should be made in order to take account of the amount of lipid infused as part of the Propofol Corden 20mg/ml formulation; 1.0ml of Propofol Corden 20mg/ml contains approximately 0.1g of fat.
Due to the higher doses to be usually applied in patients with severe overweight, the increased risk of adverse haemodynamic effects should be taken into consideration.
As with other intravenous anaesthetic and sedative agents, patients should be instructed to avoid alcohol before and for at least 8 hours after administration of Propofol Corden 20mg/ml.
Dilutions of Propofol Corden 10mg/ml emulsion for injection/infusion with lidocaine solution must not be used in patients with hereditary predisposition to acute porphyria.
In rare cases there may be a phase of postoperative unconsciousness that may be accompanied by an increased muscle tone. The occurrence of such an event is not related to whether the patient was awake or not. Although consciousness returns spontaneously; unconscious patients should be kept under close observation.
Full recovery from general anaesthesia should be confirmed prior to discharge. This medicinal product contains less than 1mmol sodium (23mg) per 100ml, i.e. essentially ‘sodium- free’.
4.5 Interaction with other medicinal products and other forms of interaction
Propofol Corden 20mg/ml can be used in combination with other active substances for anaesthesia (premedications, volatile anaesthetics, analgesics, muscle relaxants, local anaesthetics). Until now no severe interactions with these active substances have been reported. Some of these centrally acting active substances may exhibit a circulatory and respiratory depressive effect, thus leading to increased effects when used together with Propofol Corden 20mg/ml.
Concomitant use of benzodiazepines, parasympatholytic agents or volatile anaesthetics has been reported to prolong the anaesthesia and to reduce the respiratory rate.
When used in addition to local anaesthesia the dosage of Propofol Corden 20mg/ml may need to be reduced.
After additional premedication with opioids there may be a higher incidence and longer duration of apnoea.
Bradycardia and cardiac arrest may occur after treatment with suxamethonium or neostigmine.
It should be taken into consideration that concomitant use of propofol and active substances for premedication, volatile agents or analgesic agents may potentiate anaesthesia and cardiovascular side effects. Concomitant use of central nervous depressants e.g. alcohol, general anaesthetics, narcotic analgesics will result in intensification of their sedative effects.
After administration of fentanyl, the blood level of propofol may be temporarily increased with an increase in the rate of apnoea.
Leucoencephalopathy has been reported with administration of lipid emulsions such as propofol in patients receiving ciclosporin.
4.6 Fertility, pregnancy and lactation
Pregnancy
There are no or limited amount of data from the use of propofol in pregnant women. Propofol Corden 20mg/ml should not be used during pregnancy unless the clinical condition of the woman requires treatment with propofol.
Propofol crosses the placenta and may be associated with depression of neonatal vital functions (see section 5.3). High doses (more than 2.5mg propofol/kg body weight for induction or 6mg propofol/kg body weight/hr for maintenance of anaesthesia) should be avoided.
Breastfeeding
Propofol/metabolites are excreted in human milk of treated women. Breastfeeding should be discontinued during treatment with propofol and breast milk must be discarded for 24 hours after administration of propofol.
4.7 Effects on ability to drive and use machines
After administration of Propofol Corden 20mg/ml the patient should be kept under observation for an appropriate period of time. The patient should be instructed not to drive, operate machinery, or work in potentially hazardous situations. The patient should not be allowed to go home unaccompanied and should be instructed to avoid consumption of alcohol.
4.8 Undesirable effects
Commonly observed side effects of propofol are hypotension and respiratory depression. These effects depend on the propofol dose administered but also on the type of premedication and other concomitant medication. Specifically,
the following side effects have been observed. The frequency categories are defined as follows:
Very common (>1/10)
Common (>1/100 to <1/10)
Uncommon (>1/1,000 to <1/100)
Rare (>1/10,000 to <1/1,000)
Very rare (<1/10,000)
Not known (cannot be estimated from the available data)
|
^"""frequencies System""-Organ Class"\ |
Very common |
Common |
Uncommon |
Rare |
Very rare |
Not known |
|
Immune system disorders |
Severe hypersensitivity reaction (anaphylaxis) -including angiooedema, bronchospasm, erythema and hypotension | |||||
|
Psychiatric disorders |
Sexual disinhibition during recovery period |
Euphoria, drug abuse (predominantly by health care professionals) | ||||
|
Nervous system disorders |
Minimal excitation, headache during recovery period |
Epileptiform movements including convulsions and opisthotonus, vertigo, shivering and sensations of cold during recovery period |
Postoperative unconsciousness (see section 4.4) |
Spontaneous movements and myocloni during induction of anaesthesia | ||
|
Cardiac disorders |
Bradycardia1 |
Cardiac arrhythmia4, | ||||
|
Vascular disorders |
Mild to moderate hypotension |
Marked hypotension2, thrombosis, phlebitis | ||||
|
Respiratory, thoracic and mediastinal disorders |
Hyperventilation transient apnoea, coughing during induction of anaesthesia |
Coughing during maintenance of anaesthesia |
Coughing during recovery period |
Pulmonary oedema | ||
|
Gastrointestinal disorders |
Singultus during induction of anaesthesia, nausea and vomiting during recovery period |
Pancreatitis after administration of propofol (a causal relationship could not be established) | ||||
|
Hepatobiliary |
Hepatomegaly4 |
|
^\Frequencies System"\^ Organ Class'\ |
Very common |
Common |
Uncommon |
Rare |
Very rare |
Not known |
|
disorders | ||||||
|
Renal and urinary disorders |
Discolouration of urine following prolonged administration | |||||
|
General disorders and administration site conditions |
Local pain occurring during the initial injection |
Hot flushes during induction of anaesthesia |
Post-operative fever |
Rhabdomyolysis, metabolic acidosis, hyperkalaemia, hyperlipidaemia, cardiac failure, sometimes with fatal outcome (most of these effects have been observed in patients in intensive care with doses exceeding 4mg propofol/kg body weight/hr; see section 4.4), severe tissue responses after accidental paravenous application | ||
|
Investigations |
during general anaesthesia bradycardia with progressive severity (asystole) may occur. The intravenous administration of an anticholinergic medicinal product prior to induction or during maintenance of anaesthesia should be considered (see section 4.4).
of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via www.mhra.gov.uk/yellowcard
4.9 Overdose
Accidental overdosage is likely to cause cardiorespiratory depression. Respiratory depression should be treated by artificial ventilation with oxygen. Cardiovascular depression would require lowering of the patient's head and, if severe, use of plasma expanders and pressor agents.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Anaesthetics, general; other general anaesthetics, ATC code: N01AX10
After intravenous injection of propofol, onset of the hypnotic effect occurs rapidly. Depending on the rate of injection, the time to induction of anaesthesia is between 30 and 40 seconds. The duration of action after a single bolus administration is short due to the rapid metabolism and excretion (4 - 6 minutes).
With the recommended dosage schedule a clinically relevant accumulation of propofol after repeated bolus injection or after infusion has not been observed. Patients recover consciousness rapidly.
Bradycardia and hypotension occasionally occur during induction of anaesthesia probably due to a lack of vagolytic activity. The cardio-circulatory situation usually normalises during maintenance of anaesthesia.
Paediatric patients
Limited studies on the duration of propofol based anaesthesia in paediatric patients indicate safety and efficacy is unchanged up to a duration of 4 hours. Literature evidence of use in paediatric patients documents use for prolonged procedures without changes in safety or efficacy.
5.2 Pharmacokinetic properties
After intravenous administration about 98% of propofol is bound to plasma protein.
Propofol is extensively distributed (central distribution volume from 0.2 to 0.79 l/kg body weight; steady-state volume is 1.8 - 5.3 l/kg body weight) and rapidly cleared from the body (total body clearance: 1.5-2 l/minute). Clearance occurs by metabolic processes, mainly in the liver where it is blood flow dependent to form inactive conjugates of propofol (glucuronides) and its corresponding metabolite quinol (glucuronides and sulphate compounds), which are excreted in urine (88% of the administered dose). All metabolites are inactive. Only 0.3% of the administered dose is excreted unchanged in the urine.
During elimination the decline of blood levels is slower. The elimination halflife during the B-phase is in the range of 30 to 60 minutes. Subsequently a third deep compartment becomes apparent, representing the re-distribution of propofol from weakly perfused tissue.
Clearance is higher in children compared with adults.
After a single dose of 3mg/kg intravenously, propofol clearance/kg body weight increased with age as follows: Median clearance was considerably lower in neonates <1 month old (n=25) (20ml/kg/min) compared to older children (n= 36, age range 4 months - 7 years). Additionally inter-individual variability was considerable in neonates (range 3.7 - 78ml/kg/min). Due to this limited trial data that indicates a large variability, no dose recommendations can be given for this age group.
5.3 Preclinical safety data
Non-clinical data reveal no special hazard for humans based on conventional studies on repeated dose toxicity or genotoxicity.
Carcinogenicity studies have not been conducted.
Reproductive toxicity studies have shown effects related to pharmacodynamic properties of propofol only at high doses. Teratogenic effects have not been observed.
In local tolerance studies, intramuscular injection resulted in tissue damage around the injection site.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Soya-bean oil, refined Purified egg phospholipids Glycerol
Sodium hydroxide (for pH-adjustment)
Water for injections
6.2 Incompatibilities
This medicinal product must not be diluted with injection or infusion solutions.
The neuromuscular blocking agents, atracurium and mivacurium should not be given through the same infusion system as Propofol Corden 20mg/ml without prior flushing.
6.3 Shelf life
Shelf life before opening Ampoules/vials: 2 years Shelf life after first opening/dilution To be used immediately.
Must not be diluted.
Chemical and physical in-use stability of the medicinal product has been demonstrated for 24 hours at 25°C.
From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user.
6.4 Special precautions for storage
Store below 30°C.
Do not freeze.
Keep the vial/ampoule in the outer carton in order to protect from light.
6.5 Nature and contents of container
50ml emulsion for injection/infusion in colourless Type I glass vials with bromobutyl rubber stopper in the pack size of 1 vial.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal
The simultaneous administration of Propofol Corden 20mg/ml together with an intravenous infusion solution of glucose 50mg/ml (5%) or sodium chloride 9mg/ml (0.9%) intravenous infusion solution or a combination solution of glucose 40mg/ml (4%) and sodium chloride 1.8mg/ml (0.18%) close to the Y-connector near the place of injection, is possible.
For single use only.
Parenteral products should be inspected visually for particulate matter prior to administration. If particulate matter is evident emulsion should not be used.
Containers should be shaken before use. If two layers can be seen after shaking, the emulsion should not be used.
Prior to use, the ampoule neck and rubber stopper should be disinfected using a medicinal alcohol (spray or dipped swab).
Any remaining contents after use should be discarded.
Any unused product or waste material should be disposed of in accordance with local requirements.
7 MARKETING AUTHORISATION HOLDER
Corden Pharma S.p.A.
Viale dell’Industria 3 20867 Caponago (MB)
Italy
8 MARKETING AUTHORISATION NUMBER(S)
PL 35885/0002
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
14/06/2012
10 DATE OF REVISION OF THE TEXT
09/04/2015
this may require a lowering of the administration rate and/or fluid replacement therapy; if necessary vasoconstrictive medicinal products. Account should be taken of the possibility of a severe drop in blood pressure in patients with impaired coronary or cerebral perfusion or those with hypovolaemia.
The local pain which may occur during the initial injection of propofol can be minimised by the co-administration of lidocaine (see section 4.2) and by injection or infusion into the larger veins of the forearm and antecubital fossa.
Upon co-administration of lidocaine the following undesirable effects may occur: giddiness, vomiting, drowsiness, convulsions, bradycardia, cardiac arrhythmia and shock.
Combinations of these events, reported as “Propofol infusion syndrome”, may be seen in seriously ill patients who often have multiple risk factors for the development of the events (see section 4.4).
Brugada-type ECG - elevated ST-segment and coved T-wave in ECG.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance