Oliceridine added to endoscopy sedation cut top-up doses for older adults but raised hypotension

Design

Multicentre, double-blind, placebo-controlled 2×2 factorial randomised trial

Population

360 adults aged 65-80 having bidirectional endoscopy

Primary outcome

Time to full alertness after initial sedative dose

Effect

-1.42 min (95% CI -2.43 to -0.40); hypotension +15.6 points

A multicentre double-blind factorial trial, published in Drug Design, Development and Therapy on 23 October 2026, randomised 360 adults aged 65 to 80 having same-session gastroscopy and colonoscopy to oliceridine or placebo, combined with propofol or ciprofol.

Oliceridine shortened time to full alertness after the initial dose by 1.4 minutes (95% CI 0.4 to 2.4) and reduced the need for supplemental sedative by 16.7 percentage points, with discharge readiness 1.6 minutes sooner. But when timed from the final sedative dose there was no difference, and hypotension was 15.6 percentage points more common. Propofol produced slightly faster awakening than ciprofol, below the prespecified clinically important difference.

The trade is fewer top-up doses against more hypotension in an older group where low blood pressure matters. The small time gains are unlikely to change practice on their own.

• Weigh the reduction in sedative top-ups against a higher rate of hypotension when adding an opioid adjunct for older patients.
• Monitor blood pressure closely when combining an opioid with propofol in older adults.
• Do not expect meaningfully faster recovery from adding oliceridine.
• Oliceridine availability varies; this is not a reason to change established sedation protocols.

Why it matters

Opioid adjuncts are often added routinely; this quantifies the blood pressure cost in older patients.

Don't overread it

The awakening benefit vanished when timed from the last dose, and interaction findings were exploratory.

The statistics, in plain English

The 1.4-minute faster awakening is statistically significant but clinically small. The hypotension risk difference of 15.6 points (7.6 to 23.6) is a firmer finding.

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