Drug Shortage Detail - Propofol Emulsion Injection

by | Tuesday, March 16, 2021 | 0 comment(s)

Drug Shortage Detail

Products Affected - Description

  • Propofol intravenous emulsion injection, Dr. Reddy's, 10 mg/mL, 100 mL vial, 10 count, NDC 43598-0549-10
  • Propofol intravenous emulsion injection, Dr. Reddy's, 10 mg/mL, 20 mL vial, 10 count, NDC 43598-0265-58
  • Propofol intravenous emulsion injection, Dr. Reddy's, 10 mg/mL, 20 mL vial, 25 count, NDC 43598-0265-25
  • Propofol intravenous emulsion injection, Dr. Reddy's, 10 mg/mL, 50 mL vial, 20 count, NDC 43598-0548-21
  • Propofol intravenous emulsion injection, Hikma, 10 mg/mL, 100 mL vial, 10 count, NDC 00641-6196-10
  • Propofol intravenous emulsion injection, Hikma, 10 mg/mL, 20 mL vial, 10 count, NDC 00641-6194-10
  • Propofol intravenous emulsion injection, Hikma, 10 mg/mL, 50 mL vial, 20 count, NDC 00641-6195-20
  • Propofol intravenous emulsion injection, Pfizer, 10 mg/mL, 100 mL vial, 10 count, NDC 00409-4699-24
  • Propofol intravenous emulsion injection, Pfizer, 10 mg/mL, 100 mL vial, 10 count, NDC 00069-0248-10
  • Propofol intravenous emulsion injection, Pfizer, 10 mg/mL, 20 mL vial, 10 count, NDC 00069-0209-10
  • Propofol intravenous emulsion injection, Pfizer, 10 mg/mL, 20 mL vial, 25 count, NDC 00409-4699-30
  • Propofol intravenous emulsion injection, Pfizer, 10 mg/mL, 50 mL vial, 20 count, NDC 00069-0234-20
  • Propofol intravenous emulsion injection, Pfizer, 10 mg/mL, 50 mL vial, 20 count, NDC 00409-4699-33
  • Propofol intravenous emulsion injection, Sagent, 10 mg/mL, 100 mL vial, 10 count, NDC 25021-0608-51
  • Propofol intravenous emulsion injection, Sagent, 10 mg/mL, 50 mL vial, 20 count, NDC 25021-0608-50
  • Propofol intravenous emulsion injection, Teva, 10 mg/mL, 100 mL vial, 10 count, NDC 00591-2136-68
  • Propofol intravenous emulsion injection, Teva, 10 mg/mL, 20 mL vial, 25 count, NDC 00591-2136-95
  • Propofol intravenous emulsion injection, Teva, 10 mg/mL, 50 mL vial, 20 count, NDC 00591-2136-51

Reason for the Shortage

  • Dr. Reddy's has propofol on shortage due to increased demand.[1]
  • Fresenius Kabi has Diprivan available but may experience intermittent back order due to increased demand. Check wholesaler for inventory.[2]
  • Hikma has propofol on shortage due to increased demand.[3]
  • Pfizer has propofol on shortage due to increased demand.[4]
  • Sagent has propofol on shortage due to increased demand.[5]
  • Teva has propofol on shortage due to shipping delays related to COVID-19.[6]

Available Products

  • Mayoprofol intravenous emulsion injection, Mayo Biotech, 10 mg/mL, 20 mL vial, 10 count, -0269-10
  • Propofol-Lipuro intravenous emulsion injection, B|Braun, 10 mg/mL, 20 mL vial, 5 count, -0269-05
  • Nirfol intravenous emulsion injection, AcuLife, 10 mg/mL, 20 mL vial, 10 count, -0269-29
  • Neorof Propofol intravenous emulsion injection, Neon Labs, 10 mg/mL, 20 mL vial, 25 count, -0608-20
  • Implications for Patient Care

    • For mechanically ventilated adults with COVID-19 and moderate to severe ARDS - patients without persistent ventilator dyssynchrony, use of intermittent boluses of neuromuscular blocking agents (NMBAs) as needed over continuous infusions.

    • For mechanically ventilated adults with COVID-19 and moderate to severe ARDS - patients with persistent ventilator dyssynchrony, use of continuous NMBAs up to 48 hours along with other lung recruiting measures.

    • Critically ill patients requiring deep sedation should not use dexmedetomidine (with or without NMBAs).
  • These recommendations are in alignment with the Surviving Sepsis Campaign: Guidelines on the Management of the Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) and 2018 PADIS clinical practice guidelines


Alternative Agents & Management

  • Historically, providers commonly used benzodiazepines to sedate critically ill patients. Practice has shifted over the last decade to lighter sedation and the minimization of benzodiazepine use due to an association with prolonged mechanical ventilation.[8-9] In a time of drug shortages and supply delays, ICU providers may have to resort to older sedation practices that are out of favor. The tables below contain sedation and monitoring strategies to targeted sedation goals (eg, RIKER) for mechanically intubated adults.
  • Summary of sedative use considerations:
  • Propofol is preferred over benzodiazepines, especially in the setting of prolonged intubation and deep sedation.
  • An elevated triglyceride is not considered a strict exclusion to propofol use, but continued monitoring and strategies for dose-reduction are encouraged if triglyceride is >400 mg/dL to minimize risk of pancreatitis.
  • Due to limited supply or other contraindications to propofol, a benzodiazepine may be an alternative agent.
  • If midazolam supply is limited, consider allocating to patients with moderate to severe renal or hepatic dysfunction. For all others, consider lorazepam as the benzodiazepine of choice to preserve midazolam supply.
  • Midazolam has a higher propensity than lorazepam to accumulate metabolites that produce CNS depression and altered mental status. Half-life elimination is especially prolonged in cirrhosis, CHF, and obesity.
  • There is little use for dexmedetomidine as a primary sedative agent when patients require deep sedation for ventilator compliance.
  • Ketamine and phenobarbital may be considered as adjunctive agents for sedation, but not as primary sedatives for ICU sedation.
  • Consider the use of scheduled atypical anti-psychotic agents for hyperactive delirium.
  • Intravenous agents are preferred in the setting of NMBA use due to concern over impaired absorption of enteral agents.
  • Narcotics and paralytics put patients at high risk for ileus and aggressive bowel regimens should addressed.
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