Generic Propofol

I have heard a lot of people complaining about the same thing. I always thought they were cry-babies. I use a lot of fentanyl, lidocaine, and gas to induce. I cannot say I have noticed a difference.

Yes, but it seems unpredictable.

as if quality control sucks.

jetproppilot said:

Have used generic propofol ever since the patent-protection expired and generic came available.

Never noticed a difference....but over the last few months I, as well as many colleagues, have noticed a potency difference....i.e. its taking more propofol to induce somebody.

100-150 mg used to be plenty, now it seems more and more people require 200mg, and sometimes more.

Have also noticed many people cough after the white stuff goes in.

Anybody else experiencing this?

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Yes, it is less potent most of the times and unpredictable, we switched back to brand name Deprivan.

I think we should go back to Methohexital, what a great drug
Do they still make it?

Planktonmd said:

I think we should go back to Methohexital, what a great drug
Do they still make it?

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Guess you don't provide anesthesia for ECTs?

And, for generic propofol, guess I never noticed a difference. Then again, I've only ever used the generic stuff.

-copro

jetproppilot said:

Have also noticed many people cough after the white stuff goes in.

Anybody else experiencing this?

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This may help (even though generic propofol contains 0.25 mg/mL sodium metabisulfite it may help to explain the cough):

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1368138&blobtype=pdf
"Inhaled metabisulphite produced dose dependent bronchoconstriction in all atopic nonasthmatic and all atopic asthmatic subjects who were non-selected volunteers. Inhaled metabisulphite had a metallic taste and caused cough at concentrations above 25 mg ml-1."

quaker1996 said:

This may help (even though generic propofol contains 0.25 mg/mL sodium metabisulfite it may help to explain the cough):

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1368138&blobtype=pdf
"Inhaled metabisulphite produced dose dependent bronchoconstriction in all atopic nonasthmatic and all atopic asthmatic subjects who were non-selected volunteers. Inhaled metabisulphite had a metallic taste and caused cough at concentrations above 25 mg ml-1."

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And...
http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Demonstrated that the sulfite preservative prevented the bronchodilation that propofol normally provides. In sheep.

coprolalia said:

Guess you don't provide anesthesia for ECTs?

And, for generic propofol, guess I never noticed a difference. Then again, I've only ever used the generic stuff.

-copro

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Actually no, We don't do ECT's anymore, but when we did a few years ago, Methohexital was not always available, and there were times when we used Etomidate for ECTs.
The reason I mentioned Methohexital is because you can actually substitute Propofol with it and use the exact same doses, which is convenient.
Now for your second statement I find it a bit difficult to understand:
You only used the generic but you did not see a difference between the generic and the Deprivan?

Planktonmd said:

Now for your second statement I find it a bit difficult to understand:
You only used the generic but you did not see a difference between the generic and the Deprivan?

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It's called "irony". I have nothing to which to compare generic propofol, therefore it seems to work just fine for me. Haven't noticed any stability/potency issues.

-copro

coprolalia said:

It's called "irony". I have nothing to which to compare generic propofol, therefore it seems to work just fine for me. Haven't noticed any stability/potency issues.

-copro

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Ok,
Sorry for missing your "irony".

We have definitely noticed the change. We do a lot of spine cases with TIVA. Lately, everyone has started to notice more pt movement. We complained to pharmacy and will be most likely switching back to Diprivan.

No coughing but lots of sneezing with the generic stuff- also more patients c/o intense burning with the generic vs "brand name"- even when mixed with lido.

haven't noticed any difference in potency but i will be looking for it now...

Hmmm... I'm getting the feeling we need a double-blind, head-to-head study.

-copro

We had some issues as well. It seems the sulfite may be the culprit. Anyway, we switched back to Diprivan.

fval28 said:

No coughing but lots of sneezing with the generic stuff- also more patients c/o intense burning with the generic vs "brand name"- even when mixed with lido.

haven't noticed any difference in potency but i will be looking for it now...

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You know, I read this yesterday and thought a lot more about it. I have a serious concern about what you've written here. I have never had anyone sneeze when I've given them propofol. The mechanism for sulfite-induced rhinorrhea or mucosal hypersensitivity happens far too slow to be elicited by a propofol bolus, and therefore your's begs for a clearer explanation.

This is a highly unusual reaction, and since you've noticed "lots of sneezing" as a clinician you are compelled to report this to the FDA. You should also generate a case series for publication, if you can reconstruct which patients this happened to.

https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

Please do the right thing. Everyone else should pay attention to this, and make note of patients who "sneeze" during induction with generic propofol. This is not a trivial matter, and begs further explanation.

-copro

I guess we only use the generic here as well. HAvent seen 'Diprivan' since I was an MS-3