Monograph

N01AX10 - Propofol

Not porphyrinogenic

Rationale

No interactions with CYP- metabolism of other drugs noted. Thus no evidence pointing to capacity for CYP-induction or mechanism based CYP inhibition. Vast clinical experience of tolerance in acute porphyria.

Chemical description

Diisopropylphenol.

Therapeutic characteristics

General anaesthetic used for induction and maintenance of general anaesthesia, sedation of ventilated patients under intensive care and sedation under surgical or diagnostic procedures.

Metabolism and pharmacokinetics

Rapidly metabolized mainly by CYP2B6 to inactive conjugates which are excreted by urine. Substrate of CYPs 1A2, 2A6, 2C18, 2C19, 2C8, 2B6, 2C9, 2E1, 3A4. Inhibitor of CYPs 1A1, 1A2, 1B1, 2C9, 2D6, 2E1, 3A4 (Rendic, S., 2002). No molecular groupings or other evidence of possible mechanism based CYP-inhibition. No interactions with CYP-metabolism of other drugs noted.

Personal communication

Thunell, S. Many reports of tolerance in acute porphyria.

Published experience

Used uneventfully as an anaesthetic induction agent in 13 patienets with PV. No significant increase of porphyrin precursors or porphyrins were detected by urinary monitoring over a period from before administration to 5 days after (Meissner, P.N. et al, 1991). Used uneventfully to manage status epilepticus in 12 year old male with active AIP (Bhatia, R. et al, 2008). Used uneventfully on two occasions in 43 year old female with AIP (Mitterschiffthaler, G. et al, 1988). Used uneventfully to manage status epilepticus in 26 year old female with active AIP (Pandey, C.K. et al, 2003). Uneventful use in 30 year old female with latent AIP (Pazvanska, E.E. et al, 1999). Used uneventfully on two occasions as anaesthesia in 35 year old female with HCP (Sarantopoulos, C.D. et al, 2000). Used uneventfully on two occasions to induce anaesthesia in 57 year old female with latent AIP (Shaw I.H. & McKeith I.G., 1998). Used unevntfully in 63 year old AIP woman (McLouglin, C, 1989). Female PV patient experienced rise in urinary excretion of porphyrins without associated clinical manifestations following sedation with propofol (Bichel, T. et al, 1993).

IPNet drug reports

Uneventful use reported in 4 patients with acute porphyria.

Similar drugs

Explore alternative drugs in similar therapeutic classes N01A / N01AX or go back.

References

#	Citation details	PMID
*	Scientific articles
1.	McLouglin, C. Use of propofol in a patient with porphyria. Br J of Anaesth 1989; 62(1):114.
2.	Pandey CK, Singh N, Bose N, Sahay S, Gabapentin and propofol for treatment of status epilepticus in acute intermittent porphyria. J Postgrad Med. 2003; 49(3):285.	14597800
3.	Rendic, S. Summery of information on human CYP enzymes: human P450 metabolism. Drug metabolism reviews 2002; 34(1&2), 83-448.
4.	Sarantopoulos, C.D.; Bratanow, N.C.; Stowe, D. F.; Kampine, J.P. Uneventful Propofol Anesthesia in a Patient with Coexisting Hereditary Coproporphyria and Hereditary Angioneurotic Edema. Anesthesiology: 2000; 92(2):607.	31831506
5.	Use of propofol anesthesia and adjunctive treatment with levetiracetam and gabapentin in managing status epilepticus in a patient of acute intermittent porphyria. Bhatia R, Vibha D, Srivastava MV, Prasad K, Tripathi M, Bhushan Singh M. Epilepsia. 2008 May;49(5):934-6.
6.	Total intravenous anesthesia in South-African genetic porphyria (variegate porphyria). Bichel T, Joris J, Jacquet N, Lamy M. Acta Anaesthesiol Belg. 1993;44(1):25-9.	8342401
7.	v. anaesthetic induction agent in variegate porphyria. Meissner PN, Harrison GG, Hift RJ. Propofol as an i. Br J Anaesth. 1991 Jan;66(1):60-5.	1997060
8.	Safe use of propofol in a patient with acute intermittent porphyria. Mitterschiffthaler G, Theiner A, Hetzel H, Fuith LC. Br J Anaesth. 1988;60(1):109-11.
9.	Uneventful propofol anaesthesia in a patient with acute intermittent porphyria. Pazvanska EE, Hinkov OD, Stojnovska LV. Eur J Anaesthesiol. 1999;16(7):485-92.
10.	Propofol and electroconvulsive therapy in a patient at risk from acute intermittent porphyria. Shaw IH, McKeith IG. Br J Anaesth. 1998;80(2):260-2.
*	Drug reference publications
11.	Sweetman SC, editor. Martindale: The complete drug reference. Propofol. Pharmaceutical Press 2009.
*	Summary of Product Characteristics
12.	Norwegian medicines agency. Summary of Product Characteristics (SPC). Propofol-Lipuro.

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