Adverse reactions : תופעות לוואי

4.8   Undesirable Effects
General
Induction and maintenance of anaesthesia or sedation is generally smooth with minimal evidence of excitation. The most commonly reported ADRs are pharmacologically predictable side effects of an anaesthetic/sedative agent, such as hypotension. The nature, severity and incidence of adverse events observed in patients receiving Propofol-Lipuro 1% may be related to the condition of the recipients and the operative or therapeutic procedures being undertaken.

The following definitions of frequencies are used:
Very common (≥1/10), common (≥1/100 to <1/10), uncommon ((≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000) and not known (cannot be estimated from the available data).

Table of Adverse Drug Reactions

System Organ Class                Frequency                    Undesirable Effects Immune system disorders           Very rare                    Anaphylaxis – may include angi- oedema, bronchospasm, erythema and hypotension
Metabolism and Nutritional        Not known (9)                Metabolic acidosis (5), hyperkalae- disorder                                                       mia (5), hyperlipidaemia (5) Psychiatric disorders             Not known (9)                Euphoric mood. Drug abuse and drug dependence (8)
Nervous system disorders          Common                       Headache during recovery phase 
Rare                         Epileptiform movements, includ- ing convulsions and opisthotonus during induction, maintenance and recovery
Very rare                    Postoperative unconsciousness

Not known (9)                Involuntary movements
Cardiac disorders                 Common                       Bradycardia (1) 
Very rare                    Pulmonary oedema

Not known (9)                Cardiac arrhythmia (5), cardiac failure (5), (7)
Vascular disorders                Common                       Hypotension (2) 
Uncommon                     Thrombosis and phlebitis

Respiratory, thoracic and me-     Common                       Transient apnoea during induction diastinal disorders
Not known (9)                Respiratory depression (dose de- pendent)
Gastrointestinal disorders        Common                       Nausea and vomiting during re- covery phase
Very rare                       Pancreatitis

Hepatobiliary disorders           Not known (9)                   Hepatomegaly (5), Hepatitis, acute hepatic failure (11).
Musculoskeletal and connec-       Not known (9)                   Rhabdomyolysis (3), (5) tive tissue disorders
Renal and urinary disorders       Very rare                       Discolouration of urine following prolonged administration
Not known (9)                   Renal failure(5)

Reproductive system and           Very rare                       Sexual disinhibition breast disorders
Not known                       Priapism
General disorders and admin-      Very common                     Local pain on induction (4) istration site conditions
Very rare                       Tissue necrosis (10) following acci- dental extravascular administra- tion
Not known (9)                   Local pain, swelling following ac- cidental extravascular administra- tion
Investigations                    Not known (9)                   Brugada type ECG (5), (6) Injury, poisoning and proce-      Very rare                       Postoperative fever dural complications

(1)
Serious bradycardias are rare. There have been isolated reports of progression to asystole.
(2)
Occasionally, hypotension may require use of intravenous fluids and reduction of the administration rate of Propofol-Lipuro 1%.
(3)
Very rare reports of rhabdomyolysis have been received where Propofol-Lipuro 1% has been given at doses greater than 4 mg/kg/hr for ICU sedation.
(4)
May be minimised by using the larger veins of the forearm and antecubital fossa. With Propofol-Lipuro 1% local pain can also be minimised by the co-administration of lidocaine.
(5)
Combinations of these events, reported as “Propofol infusion syndrome”, may be seen in seriously ill pa- tients who often have multiple risk factors for the development of the events, see section 4.4.
(6)
Brugada-type ECG - elevated ST-segment and coved T-wave in ECG.
(7)
Rapidly progressive cardiac failure (in some cases with fatal outcome) in adults. The cardiac failure in such cases was usually unresponsive to inotropic supportive treatment.
(8)
Abuse of and drug dependence on propofol, predominantly by health care professionals.
(9)
Not known as it cannot be estimated from the available clinical trial data.
(10)
Necrosis has been reported where tissue viability has been impaired.
(11) After both long- and short-term treatment and in patients without underlying risk factors.

Dystonia/dyskinesia have been reported.

Local
The local pain which may occur during the induction phase of Propofol-Lipuro 1% anaesthesia can be minimised by the co-administration of lidocaine (see "Dosage and Administration") and by the use of the larger veins of the forearm and antecubital fossa. Thrombosis and phlebitis are rare. Accidental clinical extravasation and animal studies showed minimal tissue reaction. Intra-arterial injection in ani- mals did not induce local tissue effects.

Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It al- lows continued monitoring of the benefit/risk balance of the medicinal product.
Any suspected adverse events should be reported to the Ministry of Health according to the National Regulation by using an online form (https://sideeffects.health.gov.il).