What effects does Propofol (propofol) have on lipid profiles?

From the Guidelines

Propofol can cause significant elevations in serum triglycerides and other lipid parameters, particularly with prolonged infusions, due to its formulation in a lipid emulsion. This effect is a major consideration in the management of patients receiving propofol, especially in ICU settings where prolonged infusions are common 1. The lipid emulsion in propofol, typically 10% soybean oil, directly contributes to increased lipid levels in the bloodstream during administration. Key points to consider include:

• The effect of propofol on lipid profiles is dose-dependent and duration-dependent, with significant hypertriglyceridemia potentially developing in patients receiving prolonged infusions 1.
• Clinicians should monitor lipid profiles in patients receiving extended propofol therapy, particularly those with pre-existing hyperlipidemia, pancreatitis risk, or metabolic disorders 1.
• If significant elevations occur (triglycerides >500 mg/dL), consider reducing the propofol infusion rate, implementing propofol holiday periods, or switching to alternative sedatives. The most recent evidence from 2021 suggests that monitoring serum triglycerides is recommended when patients are receiving propofol, and clinicians should be aware of other potential causes of hypertriglyceridemia, such as cytokine storms in COVID-19 patients 1. In terms of management, it is essential to balance the need for sedation with the potential risks of propofol-induced hypertriglyceridemia, and to consider alternative sedatives or strategies to minimize lipid elevations 1.

From the FDA Drug Label

Propofol injectable emulsion use requires caution when administered to patients with disorders of lipid metabolism such as primary hyperlipoproteinemia, diabetic hyperlipemia, and pancreatitis Since propofol injectable emulsion is formulated in an oil-in-water emulsion, elevations in serum triglycerides may occur when propofol injectable emulsion is administered for extended periods of time. Patients at risk of hyperlipidemia should be monitored for increases in serum triglycerides or serum turbidity Administration of propofol injectable emulsion should be adjusted if fat is being inadequately cleared from the body. A reduction in the quantity of concurrently administered lipids is indicated to compensate for the amount of lipid infused as part of the propofol injectable emulsion formulation; 1 mL of propofol injectable emulsion contains approximately 0.1 g of fat (1.1 kcal).

Propofol can cause elevations in serum triglycerides due to its formulation in an oil-in-water emulsion. Key points to consider:

• Monitoring: Patients at risk of hyperlipidemia should be monitored for increases in serum triglycerides or serum turbidity.
• Adjusting administration: Administration of propofol injectable emulsion should be adjusted if fat is being inadequately cleared from the body.
• Reducing concurrently administered lipids: A reduction in the quantity of concurrently administered lipids is indicated to compensate for the amount of lipid infused as part of the propofol injectable emulsion formulation 2.

From the Research

Effects of Propofol on Lipid Profiles

• Propofol can cause hypertriglyceridemia, a condition characterized by elevated levels of triglycerides in the blood 3, 4, 5.
• The use of propofol in critically ill patients has been associated with an increased risk of developing hypertriglyceridemia, particularly when used in combination with other lipid emulsions 3, 5.
• Studies have shown that propofol infusion can lead to a significant increase in serum triglyceride levels, which can be a risk factor for pancreatitis 3, 4, 5.
• However, some studies have found that the use of propofol in a medium- and long-chain triglyceride emulsion may reduce the risk of hypertriglyceridemia compared to traditional long-chain triglyceride emulsions 6.
• Short-term propofol administration in children has been shown to cause a small, transient increase in serum triglycerides and pancreatic enzymes, but this does not appear to have any clinically significant effects 7.

Mechanisms and Risk Factors

• The exact mechanisms by which propofol causes hypertriglyceridemia are not fully understood, but it is thought to be related to the lipid emulsion used in the propofol formulation 3, 6.
• Risk factors for propofol-induced hypertriglyceridemia include high doses of propofol, long-term infusion, and concomitant use of other lipid emulsions 3, 5.
• Patient factors, such as age, weight, and underlying medical conditions, may also play a role in the development of hypertriglyceridemia 5.

Clinical Implications

• Monitoring of serum triglyceride levels is recommended in patients receiving propofol, particularly those at high risk of developing hypertriglyceridemia 3, 5.
• Clinicians should be aware of the potential risks of propofol-induced hypertriglyceridemia and take steps to minimize these risks, such as using alternative sedatives or adjusting the propofol dose 4, 5.