Drugs found in Michael Jackson’s body are a mix that can cause serious, even life-threatening adverse effects.
Traces of propofol, midazolam, lorazepam, diazepam, lidocaine and ephedrine were detected by the coroner, according to multiple news sources. This disclosure prompts public interest in what these drugs are all about. Here is more information from Food and Drug Administration (FDA) approved product labeling as reflected in PDR.net, except the information about ephedrine is from the University of Maryland Medical Center.
This is a hypnotic drug that induces sleep by acting directly on the brain. It is rapidly inactivated, so it must be given continuously to maintain its effect. It is usually given in 10 second boluses into a vein until the desired effect is reached, then a maintenance dose is given either by a continuous drip or repeated boluses. Propofol has multiple drug interactions. For example, its effect is increased in the presence of narcotics and benzodiazepines.
Under the label’s Warnings/Precautions section, the clinician is advised to monitor the patient’s blood oxygen saturation and look for signs of low blood pressure, slow heart rate, and cardiovascular depression, as well as apnea (breathing stopped) or airway obstruction. Propofol may cause cessation of the heart beat (asystole). It should not be used on more than five consecutive days without a “drug holiday,” an interval to allow the body to recoup zinc losses.
A benzodiazepine, it is a short-acting central nervous system depressant with a half life of about 3 hours. It may have increased sedative effects when used with other CNS depressants such as Demerol, and sleeping agents such as secobarbital. It may cause extra long sedation if used with a number of drugs called CYP450 3A4 inhibitors. Its label carries a Black Box Warning pointing out it can cause respiratory depression and even respiratory arrest (stopped breathing) in some settings. It can cause a fall in blood pressures, and sometimes causes agitation. (“Black Box Warnings” are especially serious warnings printed within a black text box on the product’s package insert.)
This drug is available as a pill and as a liquid for intravenous use. It is a benzodiazepine, and interacts with GABA-benzodiazepine receptors. This class of drugs have been called tranquilizers. Lorazepam can cause dizziness, weakness, and respiratory depression. Its half-life is about 12 hours.
Another benzodiazepine, its half-life is about 48 hours. It may cause drowsiness, and sometimes paradoxical reactions (the opposite of what is expected).
This drug is available as a cream and jelly to be applied to intact skin to numb it. It is also available for injection to numb a small area. If it enters the blood stream, it can cause nervousness, drowsiness, respiratory depression and even cardiac arrest. Its half-life is about one and a half to two hours.
Ephedrine can be in non-prescription medications and in Chinese herbal preparations such as ma huang, although products containing ephedrine are generally banned in the USA. Licensed Chinese practitioners may still prescribe ma huang in the USA. Ephedrine has been used as a stimulant similar to dexedrine. It acts like adrenalin, and may cause heart beat irregularities. Its half-life is about three to six hours.