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CIPEPOFOL – A “NEW PROPOFOL” FROM CHINA

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The introduction of propofol was one of the most important discoveries in the history of anesthesia. On May 29, 2026, the United States Food and Drug Administration approved cipepofol (Cypsedo®) for the induction of general anesthesia in adults undergoing surgery. Cipepofol is an analog of propofol, with several significant advantages. The new drug was developed by Haisco Pharmaceutical Co., Ltd., Sichuan, China. Most of the clinical studies to date were conducted in Australia and China.  Compared to propofol, cipepofol has increased potency and decreased side effects. Cipepofol has yet to be widely used in the U.S. anesthesia marketplace, and most American anesthesia providers have never heard of it as of September 2026, but the new drug has been adopted by over 3,300 medical institutions in China and used on more than 40 million patients there. 

Propofol has been the main intravenous anesthetic for the induction and maintenance of general anesthesia for decades. I remember administering propofol as an investigational medication at Stanford Hospital in the 1980s when my professor Paul White MD was studying the drug. Compared to thiopental—the previous standard of care anesthesia intravenous induction agent, which had an elimination half-life of 5.5 – 26 hours—propofol led to remarkably awake patients within minutes after their general anesthetic. When we rolled our propofol patients into the Post Anesthesia Care Unit, other colleagues marveled at how alert our patients were after the new drug. Propofol has been on the World Health Organization’s List of Essential Medicines since 2007. 

Cipepofol shares the desirable pharmacokinetic properties of propofol, including rapid onset and short duration of action, but has the advantages of reduced post-induction hypotension, markedly less injection pain, and less hemodynamic instability. At the chemistry level, the principal distinction between propofol and cipepofol is the replacement of one methyl group with a cyclopropyl group. See below:

This modification produces superior affinity for gamma-aminobutyric acid (GABAA) receptors, and potentiation of GABAA receptor–mediated inhibitory neurotransmission. This produces central nervous system depression and leads to significantly improved anesthetic potency compared to propofol. The induction dose of propofol ranges from 1.5 to 2.5 mg/kg, while the induction dose of cipepofol is only 0.4 to 0.5 mg/kg. Both drugs have poor aqueous solubility and are formulated as lipid emulsions of 10% soybean oil for propofol and 5% soybean oil for cipepofol. The greater potency of cipepofol allows administration of a smaller injection volume to achieve equivalent anesthetic effects. The decreased lipid concentration and decreased volume of cipepofol decreases the overall amount of lipid, which minimizes the lipid-mediated vascular irritation seen with propofol.

Like propofol, cipepofol is rapidly distributed to the central nervous system and undergoes rapid clearance, producing a fast onset of action (30–60 seconds) and a short duration of effect (5–10 minutes). Cipepofol is metabolized in the liver. Approximately 85% of a cipepofol dose is recovered in urine as inactive metabolites.

In some publications, cipepofol is referred to as ciprofol. 

Multiple publications validate the safety and utility of cipepofol. A 2024 single center randomized clinical trial at the Zhejiang University School of Medicine in China studied 122 adults with aortic stenosis scheduled for transcatheter aortic valve replacement (TAVR).  Anesthesia was induced with either cipepofol or propofol. The cipepofol group demonstrated a significantly lower incidence of postinduction hypotension (70.5% vs 88.5%; P = .01) and required a smaller median dose of norepinephrine during the first 15 minutes postinduction. The authors concluded “cipepofol at an equipotent dose provided superior hemodynamic stability during anesthesia induction in patients undergoing TAVR, especially for older patients with severe aortic valve stenosis.”

In a 2024 study of 144 elderly patients receiving cipepofol + remifentanil or propofol + remifentanil for total intravenous anesthesia (TIVA) for elective laparoscopic major abdominal surgery, cipepofol was non-inferior in terms of clinical course. Cipepofol caused less injection pain (2.8% vs. 27.8%, P < 0.001), less hypotension (33.3% vs. 54.2%, P = 0.012), but had an increased incidence of bradycardia (38.9 % vs. 23.6 %, P = 0.048).

A 2025 study randomized 196 patients undergoing gynecological surgery into cipepofol and propofol groups. All patients received total intravenous anesthesia. Compared to the propofol group, the hemodynamics in the cipepofol group were more stable, the depth of anesthesia was better, the number of additional medications was significantly reduced, and the incidence of postoperative adverse reactions was significantly reduced. The awakening time in the cipepofol group was significantly longer than in the propofol group (7.57 vs 5.52 minutes).

In a 2025 study of 38 pediatric patients, cipepofol demonstrated safety for the induction and maintenance of general anesthesia in pediatric patients aged 2 years and older. The regimen included a bolus injection of 0.5 mg/kg for induction, followed by an initial maintenance infusion of 1.4 mg/kg/hour for children aged 12-17 years. The authors recommended that an “age-specific dose regimen for children aged 2-11 years should be improved by further large-scale prospective studies.”

A 2026 clinical trial evaluated the safety and efficacy of cipepofol versus propofol for the induction of anesthesia and sedation in elderly patients undergoing gastroscopy. All the enrolled patients were over the age of 65 years and were randomly assigned to be administered intravenous cipepofol 0.3 mg/kg or propofol 1.5 mg/kg. Four hundred thirty-one patients received cipepofol and 440 received propofol. The cipepofol patients had a significantly lower incidence of respiratory-related adverse events compared to propofol patients (22.3 % vs. 33.9 %). The primary endpoints were incidence of respiratory-related adverse events including respiratory depression (respiratory rate < 8 breaths/min lasting for >30 seconds), apnea (loss of thoracic movement for >15 seconds) and hypoxemia (SpO2 < 93 % lasting for >15 seconds).

In a 2026 meta-analysis of 34 trials including 5,162 patients, cipepofol was associated with a 65% lower risk of intraoperative hypotension compared to propofol, 44% less respiratory depression, 19% less injection pain, and 62% less hypoxemia.

With these advantages, will cipepofol take over the market for intravenous induction agents in the United States? No. Despite the 2026 approval of cipepofol, in the near future propofol will remain the most widely used intravenous anesthetic, because it’s available as a low-cost generic medication. A typical induction dose of propofol for a 70-kilogram adult is 200 mg. The acquisition cost of a 20 ml (200 mg) ampule of propofol is as low as $5 per vial. Cipepofol is not yet commercially available in the United States marketplace, but the typical induction dose of cipepofol for a 70-kilogram adult will be 30 – 35 mg. A posted price on the internet for a 50 mg vial of cipepofol is $885, a prohibitively high number.

The economics of newly developed anesthetics is pertinent. A friend of mine is a former Stanford University Chairman of Anesthesiology who left academia in 2006 to become a pharmaceutical Vice President and Global Head, first at Novartis and then at AstraZeneca. When I asked him 10 years ago what new anesthesia drugs were in the pipeline, he answered, “None, and there probably will be very few new ones. The drugs we have now are inexpensive generic drugs, and they work very well. The research and development costs to bring a new anesthetic drug to market are very expensive, and unless that new drug is markedly better, a new drug will not push the inexpensive generic drugs out of use.”

The advantages of cipepofol are not significant enough for healthcare systems to purchase the new drug at inflated prices compared to propofol. If the manufacturers of cipepofol choose to market the drug at prices only slightly higher than generic propofol, you may find the opportunity to hold a vial of cipepofol in your hands. Will the Chinese choose to offer a 50 mg vial of cipepofol at $10 to $20, which is still a 2.5-5 times higher price than propofol? If they do, will hospitals and surgery centers elect to spend a 2.5-5 times higher price for intravenous sedation?

The discovery of cipepofol is important for at least one reason. Years in the future, when cipepofol is available as a generic drug and its price is comparable to propofol, it will likely replace propofol because of its advantages of reduced post-induction hypotension, decreased injection pain, and lower hemodynamic instability.

Stay tuned and stay informed.

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