Propofol is a short-acting sedative-hypnotic that’s used to initiate and maintain general anesthesia. It also decreases levels of consciousness along with a loss of memory for sedation during minor medical procedures. It is administered intravenously.

The drug was discovered in 1977. It is considered an effective and safe medication when used properly in the clinical setting. It has largely replaced the drug sodium thiopental because propofol clears from a patient’s body faster and, therefore, recovery from anesthesia is more rapid. It has been referred to as the “milk of amnesia” because of its milky appearance.

It is sometimes used off-label for “non-medical” sedation, and the Missouri Supreme Court ruled to allow the drug to be used as part of the lethal cocktail given to execute prisoners condemned to death. For that reason, the United Kingdom banned exports of propofol drug products to the United States, and countries in the European Union are threatening to do the same. According to the Death Penalty Information Center, no other state allows its use in the execution process at present.

Profofol became the drug of focus in the death of Michael Jackson in which the drug was used in combination with other sedative and hypnotic drugs in what turned out to be a lethal cocktail.

Recreational use of the drug is rare because of its use only in a clinical setting, its high potency and the need for monitoring to assure safe use. There are reports, however, of recreational use among medical staff, notably anesthetists, who have easy access to the drug. Common side effects with recreational use include extreme respiratory depression, decreased heart rate and possible oxygen deprivation. More extreme, but rare, side effects include dystonia, a neurological movement disorder that resembles a tremor. Seizures and priapism, a long-lasting erection, are also reported side effects.

Although propofol is most effective when given intravenously, there have been studies in which the drug was given orally with mild sedative results. If one considers that the drug given intravenously produces 100% bioavailability (100% therapeutic effect), an oral dose of the same quantity was shown to be only about 20% effective.

In animal studies, a 16-fold higher oral dose was needed to produce a similar sedative effect as compared to an intravenous dose. This is because of the drug’s limited water-soluble nature (oil soluble), and the fact that the stomach lining and liver filter out the potency of the drug before it can enter the blood stream.

I find propofol to be an interesting drug and might use it one day in a murder mystery. Maybe you will too!

Thoughts? Comments? I’d love to hear them!