Coronavirus: Warning on donating propofol anaesthetic medicine to the NHS

We are grateful to the many veterinary practices who have been kindly offering to donate ventilators and anaesthetic equipment/gases to help their medical colleagues in the NHS who are working on the frontline against the COVID-19 pandemic.

However, two RCVS Specialists in Veterinary Anaesthesia, Dr Georgina Beaumont and Joanne Michou, have advised that veterinary practices should take care not to donate certain veterinary formulations of the anaesthetic propofol, as these contain a preservative that can be toxic to human patients under certain circumstances.

In an email sent to colleagues, which was shared with the RCVS, they said:

We understand that some colleagues are being asked to release stock to the NHS, which potentially could include propofol. It is extremely important to understand that drugs can be formulated in different ways and contain excipients that in different species can cause toxicity and/or death.

Propofol Plus (Zoetis) contains propofol 10 mg/ml with benzyl alcohol 20 mg/ml as a preservative and should NOT be given to the NHS for use in humans.

The data sheet states:

• ‘In humans, parenterally administered benzyl alcohol has been associated with a fatal toxic syndrome in neonates’.
• This product should not be used for induction and maintenance of general anaesthesia by incremental doses that would exceed total dose limits specified above, due to the potential for toxic effects caused by the preservative, benzyl alcohol’.

The EMA states that parenteral preparations for humans with benzyl alcohol as an excipient should state in the package leaflet that:

• The minimum amount of benzyl alcohol at which toxicity may occur is not known.

Unpreserved propofol preparations e.g. Propofol-Lipuro Vet (B Braun, Virbac) do not contain preservative and contain the following excipients: soya-bean oil, medium-chain triglycerides, glycerol, egg lecithin, sodium oleate and water for injections, the same excipients as in the human products.

It is essential that before any propofol is released to the NHS, this safety checklist is followed:

• Confirm it is a preservative-free formulation.
• Ensure you direct the enquiry for stock requisition to the procurement team so the product can be double checked and the transfer logged.
• Give a copy of the data sheet to your NHS contact when the propofol is transferred.

The RCVS would like to thank Georgina and Joanne for making colleagues aware of this issue and to Professor John Innes for passing their email on to the RCVS so that we could share it with the entire profession.