The Effect of Concomitant Sirolimus and Propofol Therapy on Triglyceride Concentrations in Critically Ill Patients

Background: Sirolimus and propofol are both independently associated with the development of hypertriglyceridemia (HTG) during therapy. To date, there are no published reports describing synergistic or additive drug interaction resulting in HTG with concomitant use of these medications. Study Question: To identify the occurrence of HTG in patients receiving concomitant sirolimus and propofol infusion therapy. Methods: Adult patients receiving sirolimus and a continuous propofol infusion for at least 12 hours from January 2005 to August 2009 were retrospectively evaluated. Data included Acute Physiology and Chronic Health Evaluation II score, weight, length of propofol therapy, and baseline triglyceride (TG) concentrations. The major outcome was incidence of HTG (TGs $ 500 mg/dL). Minor outcomes included the change in TG concentration from therapy initiation and manifestations of propofolrelated infusion syndrome (PRIS). Results: Sixteen patients were included in the analysis, with 8 (50%) of the patients developing HTG. The patients in this case series had the following mean values: Acute Physiology and Chronic Health Evaluation II score of 20.2 6 5.3, weight of 76.3 6 21.2 kg, and baseline TG concentrations of 181.3 6 89.7 mg/dL. Indications for sirolimus therapy included hematopoietic stem-cell transplantation (n 5 15) and heart transplantation (n 5 1). Mean length of propofol infusion was 99.8 6 88.5 hours. The mean TG concentration during infusion was 515.6 6 468.1 mg/dL. Fourteen (87.5%) patients had an increase of $ 100 mg/dL, 12 (75%) patients had an increase of $ 200 mg/dL, and 6 (37.5%) patients had an increase of $ 300 mg/dL in TG concentrations during therapy. Eleven patients developed one manifestation of PRIS, excluding HTG, and one patient had more than 2 new onset PRISmanifestations during propofol therapy. Conclusions: Coadministration of propofol and sirolimus can potentially result in HTG, which may warrant more frequent monitoring. Further analysis is needed to examine the mechanism and clinical impact of this interaction.