Jul 1, 2009

Physiology of Propofol drug abuse

Is Propofol, or Diprivan what Michael Jackson Used for ( Drug) Abuse ?

According to Cherilyn Lee, a registered nurse who operates a Los Angeles-based nutritional counseling business, in California, “Jackson was complaining of insomnia and pleaded for her to get him some (Diprivan)". Other reports claim Propofol was recovered from his residence. This conversation reportedly occurred in April of this year. Preliminary reports say that M.J died of cardiac arrest, which is within the possible effects of unmonitored Diprivan use. (A rapid bolus injection can result in undesirable cardiorespiratory depression including hypotension, apnea, airway obstruction, and oxygen desaturation.)

Diprivan is a general anesthetic, used to start or maintain anesthesia during certain surgeries, tests, or procedures. It is available in a white vial of 20, 50 and 100 ml (containing 10mg/ml.).Most adults require 2 to 2.5 mg/kg of the drug ( approx. 10 ml). DIPRIVAN Injectable Emulsion is an IV sedative-hypnotic agent and can cause potentiation of other narcotic drugs and benzodiazepines when used together. The most common side-effects include Change in mood or emotions; dizziness; drowsiness; lack of coordination. It is given intravenously, usually within the operation theater or in a clinic. It has a rapid onset of action ( less than 1 min) and short duration of action (approximately 10 min but is dose dependent).It has direct cardiodepressant effects, leading to decreased blood pressure and heart rate in higher doses. Its actions causing decreased heart rate and respiratory rate mean that use of propofol is done only under continuous monitoring of vital signs.Diprivan is not meant for use in pediatrics and elderly population since its safety has not been established in these populations. Prolonged use of propofol results in accumulation of the drug in body tissue and increases the duration of action as well as chances of overdose.

Rarely, Cases of death due to propofol have been discussed in medical literature. All these cases have occured in hospital settings only.It is definitely not meant for home use and this is the first time I have heard of Diprivan being used as a drug of abuse outside hospital settings.

Euphoria, sexual hallucinations and disinhibition have been described on recovery of propofol anaesthesia. These effects could explain the recreational use of the drug. Moreover, several experimental studies strongly suggest the potential for abuse and dependence on propofol,and few cases of abuse and dependency have been described, mostly in medical professionals. As propofol is generally not recognized as a substance of abuse, and because of its safe profile, it is important to remember that rare adverse reactions of propofol could produce death in a context of abuse, even at therapeutic dose range, in the absence of ventilatory and medical assistance.

British Journal of Anaesthesia 2006 97(2):268; doi:10.1093/bja/ael168

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