Dosing & Uses
Dosage Forms & Strengths
inhalation solution
- 100mL
- 250mL
Anesthesia Induction & Maintenance
Use calibrated vaporizer
Induction: 1.5-3% can produce surgical anesthesia in 7-10 minutes
Maintenance: 1-2.5% with nitrous oxide
Additional 0.5-1% may be needed if given with oxygen alone
Safety & efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- dronedarone
isoflurane and dronedarone both increase QTc interval. Contraindicated.
- thioridazine
isoflurane and thioridazine both increase QTc interval. Contraindicated.
Serious - Use Alternative (171)
- alfuzosin
alfuzosin and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- amiodarone
isoflurane and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and isoflurane both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
isoflurane and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- apomorphine
isoflurane and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
isoflurane and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
isoflurane and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- atomoxetine
atomoxetine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- azithromycin
isoflurane and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
bedaquiline and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, isoflurane. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).
benzhydrocodone/acetaminophen and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine
isoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine subdermal implant and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine transdermal
buprenorphine transdermal and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine transdermal and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine, long-acting injection
buprenorphine, long-acting injection and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine, long-acting injection and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - ceritinib
ceritinib and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
chloroquine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
isoflurane and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- ciprofloxacin
isoflurane and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
citalopram and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- crizotinib
crizotinib and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- dasatinib
dasatinib and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
degarelix and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- dexfenfluramine
isoflurane increases toxicity of dexfenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- dexmethylphenidate
isoflurane increases toxicity of dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- dextroamphetamine
isoflurane increases toxicity of dextroamphetamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- diethylpropion
isoflurane increases toxicity of diethylpropion by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- disopyramide
isoflurane and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dobutamine
isoflurane increases toxicity of dobutamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- dofetilide
isoflurane and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dolasetron
dolasetron and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- dopamine
isoflurane increases toxicity of dopamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- droperidol
isoflurane and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- efavirenz
efavirenz and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
isoflurane and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
entrectinib and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- ephedrine
isoflurane increases toxicity of ephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- epinephrine
isoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- eribulin
eribulin and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
isoflurane and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
isoflurane and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
isoflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
isoflurane and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- escitalopram
isoflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.
- fenfluramine
isoflurane increases toxicity of fenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- fentanyl
fentanyl, isoflurane. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
fentanyl and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - fentanyl intranasal
fentanyl intranasal, isoflurane. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
fentanyl intranasal and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - fentanyl iontophoretic transdermal system
fentanyl iontophoretic transdermal system and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transdermal
fentanyl transdermal, isoflurane. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
fentanyl transdermal and isoflurane both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - fentanyl transmucosal
fentanyl transmucosal, isoflurane. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fexinidazole
fexinidazole and isoflurane both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
- fingolimod
fingolimod and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- flecainide
isoflurane and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- fluconazole
isoflurane and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
isoflurane and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
isoflurane and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
isoflurane and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- gemifloxacin
gemifloxacin and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- gemtuzumab
isoflurane and gemtuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
gilteritinib and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
isoflurane and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.
- goserelin
isoflurane and goserelin both increase QTc interval. Avoid or Use Alternate Drug.
- granisetron
granisetron and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- haloperidol
isoflurane and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- histrelin
isoflurane and histrelin both increase QTc interval. Avoid or Use Alternate Drug.
- hydrocodone
hydrocodone, isoflurane. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).
- hydroxychloroquine sulfate
isoflurane and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxyzine
hydroxyzine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
isoflurane and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- iloperidone
isoflurane and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
isoflurane and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- isoproterenol
isoflurane increases toxicity of isoproterenol by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- itraconazole
isoflurane and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
isoflurane and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.
- lapatinib
isoflurane and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- lenvatinib
isoflurane and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.
- leuprolide
isoflurane and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.
- levofloxacin
isoflurane and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- lisdexamfetamine
isoflurane increases toxicity of lisdexamfetamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- lithium
isoflurane and lithium both increase QTc interval. Avoid or Use Alternate Drug.
- lofexidine
isoflurane and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.
- loperamide
isoflurane and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
isoflurane and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
isoflurane and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.
- maprotiline
isoflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
- mefloquine
mefloquine increases toxicity of isoflurane by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- methadone
isoflurane and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- methamphetamine
isoflurane increases toxicity of methamphetamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- methylphenidate
isoflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.
- metoclopramide intranasal
isoflurane, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- midodrine
isoflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- midostaurin
isoflurane and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
isoflurane and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- mirtazapine
isoflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
isoflurane and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.
- moxifloxacin
isoflurane and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nilotinib
isoflurane and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- norepinephrine
isoflurane increases toxicity of norepinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- octreotide
isoflurane and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- ofloxacin
isoflurane and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- olanzapine
isoflurane and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances
- olopatadine intranasal
isoflurane and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ondansetron
isoflurane and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.
- osimertinib
isoflurane and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
isoflurane and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.
- oxytocin
isoflurane and oxytocin both increase QTc interval. Avoid or Use Alternate Drug.
- ozanimod
isoflurane and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
isoflurane and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
isoflurane and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.
- pasireotide
isoflurane and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.
- pazopanib
isoflurane and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
isoflurane and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- phendimetrazine
isoflurane increases toxicity of phendimetrazine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- phentermine
isoflurane increases toxicity of phentermine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- phenylephrine
isoflurane increases toxicity of phenylephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- phenylephrine PO
isoflurane increases toxicity of phenylephrine PO by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- pimavanserin
isoflurane and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
isoflurane and pimozide both increase QTc interval. Contraindicated.
- pitolisant
isoflurane and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- ponesimod
isoflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- posaconazole
isoflurane and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.
- primaquine
isoflurane and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
isoflurane and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- propafenone
isoflurane and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- propylhexedrine
isoflurane increases toxicity of propylhexedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- pseudoephedrine
isoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- quetiapine
isoflurane and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.
- quinine
isoflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.
- ranolazine
isoflurane and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
isoflurane and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.
- rilpivirine
isoflurane and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.
- risperidone
isoflurane and risperidone both increase QTc interval. Avoid or Use Alternate Drug.
- romidepsin
isoflurane and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b and isoflurane both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.
- saquinavir
isoflurane and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.
- selpercatinib
isoflurane and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.
- serdexmethylphenidate/dexmethylphenidate
isoflurane increases toxicity of serdexmethylphenidate/dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- sertraline
isoflurane and sertraline both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
isoflurane and siponimod both increase QTc interval. Avoid or Use Alternate Drug.
- solifenacin
isoflurane and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.
- sorafenib
isoflurane and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
isoflurane and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- sufentanil SL
sufentanil SL, isoflurane. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sunitinib
isoflurane and sunitinib both increase QTc interval. Avoid or Use Alternate Drug.
- tacrolimus
isoflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.
- telavancin
isoflurane and telavancin both increase QTc interval. Avoid or Use Alternate Drug.
- tetrabenazine
isoflurane and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
isoflurane and toremifene both increase QTc interval. Avoid or Use Alternate Drug.
- trazodone
isoflurane and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- triclabendazole
isoflurane and triclabendazole both increase QTc interval. Avoid or Use Alternate Drug.
- triptorelin
isoflurane and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.
- vandetanib
isoflurane and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vardenafil
isoflurane and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.
- vemurafenib
isoflurane and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
- venlafaxine
isoflurane and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.
- voclosporin
isoflurane and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.
- voriconazole
isoflurane and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.
- vorinostat
isoflurane and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.
- xylometazoline
isoflurane increases toxicity of xylometazoline by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- yohimbine
isoflurane increases toxicity of yohimbine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- ziprasidone
isoflurane and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (41)
- acrivastine
acrivastine and isoflurane both increase sedation. Use Caution/Monitor.
- albuterol
albuterol and isoflurane both increase QTc interval. Use Caution/Monitor.
- amisulpride
amisulpride and isoflurane both increase sedation. Use Caution/Monitor.
- amitriptyline
isoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.
- arformoterol
arformoterol and isoflurane both increase QTc interval. Use Caution/Monitor.
- asenapine
asenapine and isoflurane both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and isoflurane both increase sedation. Use Caution/Monitor.
- avapritinib
avapritinib and isoflurane both increase sedation. Use Caution/Monitor.
- benazepril
isoflurane, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.
- brexanolone
brexanolone, isoflurane. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and isoflurane both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and isoflurane both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and isoflurane both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
isoflurane increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- captopril
isoflurane, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.
- clomipramine
isoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.
- daridorexant
isoflurane and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desipramine
isoflurane and desipramine both increase QTc interval. Use Caution/Monitor.
- deutetrabenazine
deutetrabenazine and isoflurane both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- difelikefalin
difelikefalin and isoflurane both increase sedation. Use Caution/Monitor.
- doxepin
doxepin and isoflurane both increase QTc interval. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, isoflurane. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- fluphenazine
isoflurane and fluphenazine both increase QTc interval. Use Caution/Monitor.
- fostemsavir
isoflurane and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- ganaxolone
isoflurane and ganaxolone both increase sedation. Use Caution/Monitor.
- imipramine
isoflurane and imipramine both increase QTc interval. Use Caution/Monitor.
- lasmiditan
lasmiditan, isoflurane. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, isoflurane. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- midazolam intranasal
midazolam intranasal, isoflurane. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- nortriptyline
isoflurane and nortriptyline both increase QTc interval. Use Caution/Monitor.
- oliceridine
oliceridine, isoflurane. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).
- osilodrostat
osilodrostat and isoflurane both increase QTc interval. Use Caution/Monitor.
- perphenazine
isoflurane and perphenazine both increase QTc interval. Use Caution/Monitor.
- prochlorperazine
isoflurane and prochlorperazine both decrease QTc interval. Use Caution/Monitor.
- promethazine
isoflurane and promethazine both decrease QTc interval. Use Caution/Monitor.
- protriptyline
isoflurane and protriptyline both increase QTc interval. Use Caution/Monitor.
- quinidine
isoflurane and quinidine both increase QTc interval. Use Caution/Monitor.
- stiripentol
stiripentol, isoflurane. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
- trifluoperazine
isoflurane and trifluoperazine both decrease QTc interval. Use Caution/Monitor.
- trimipramine
isoflurane and trimipramine both increase QTc interval. Use Caution/Monitor.
- valbenazine
valbenazine and isoflurane both increase QTc interval. Use Caution/Monitor.
Minor (0)
Adverse Effects
1-10%
Nausea
Vomiting
Shivering
<1%
Dose-dependent hypotension
Arrhythmias
Malignant hyperthermia (rare)
Elevations in white blood count
May decrease creatinine and increase BUN
Ileus, severe (fatal)
Hepatic dysfunction (postoperative period) (rare)
Respiratory depression may occur (rare)
Warnings
Contraindications
Hypersensitivity to isoflurane & halogenated agents
Genetic susceptibility to malignant hyperthermia
Patients in whom general anesthesia contraindicated
History of confirmed hepatitis due to a halogenated inhalational anesthetic or a history of unexplained moderate to severe hepatic dysfunction (eg, jaundice associated with fever and/or eosinophilia) after anesthesia with isoflurane or other halogenated inhalational anesthetics
Cautions
Caution in coronary heart disease
May decrease renal and hepatic blood flow
Postoperative hepatic dysfunction and hepatitis reported
Adequate data have not been developed to establish its application in obstetrical anesthesia
Should not be used as a sole agent of induction in patients with ventricular dysfunction
Therapy should only be administered in an adequately equipped anesthetizing environment by those who are familiar with the pharmacology of the drug and qualified by training and experience to manage the anesthetized patient
All patients receiving the drug should be continually monitored (eg, monitoring of the electrocardiogram, blood pressure, oxygen saturation, and end tidal CO2)
The drug is a profound respiratory depressant; excessive respiratory depression may be related to depth of anesthesia and respond to decreasing the inspired concentration of isoflurane
The depressant effect is accentuated by concurrent use of opioids and other respiratory depressants; respiration should be closely monitored and assisted or controlled ventilation employed when necessary
With the exception of neonates, isoflurane MAC decreases with increasing age
QTc prolongation, with rare instances of torsade de pointes, reported; monitor QT interval when administering the drug to susceptible patients
Regardless of the anesthetics employed, maintenance of normal hemodynamics is important to the avoidance of myocardial ischemia in patients with coronary artery disease
Isoflurane can cause dose-dependent coronary vasodilation and has been shown to divert blood from collateral-dependent myocardium to normally perfused areas in an animal model (“coronary steal”); monitor for signs of inadequate myocardial perfusion via hemodynamic monitors (eg, ECG, blood pressure) during administration; consider additional cardiac monitoring in patients with known coronary artery disease, as clinically necessary
Isoflurane causes a dose-dependent reduction in systemic vascular resistance and blood pressure; particular care must be taken when selecting the dosage for patients who are hypovolemic, hypotensive, or otherwise hemodynamically compromised, eg, due to concomitant medications
Increased blood loss comparable to that seen with halothane observed in patients undergoing abortions
Allergic-type hypersensitivity reactions, including anaphylaxis, reported with therapy; manifestations of such reactions have included hypotension, rash, difficulty breathing and cardiovascular collapse
The drug markedly increases cerebral blood flow at deeper levels of anesthesia to produce a transient increase in intracranial pressure; in patients with or at risk for elevations of intracranial pressure (ICP), administer isoflurane in conjunction with ICP- reducing strategies, as clinically appropriate
The color indicator of most CO2 absorbents does not necessarily change as a result of desiccation; therefore, the lack of significant color change should not be taken as assurance of adequate hydration of the CO2 absorbent material; CO2 absorbents should be replaced routinely regardless of the state of color indicator following current manufacturer’s guidelines for use of anesthesiology equipment
Reactions reported following occupational exposure to the drug include dyspnea, bronchospasm, stridor, cough, dizziness, paresthesia, hepatic reactions, flushing rash, contact dermatitis, erythema, periorbital edema, eye irritation, conjunctival hyperemia, and headache
Hepatic reactions
- Cases of mild, moderate and severe postoperative hepatic dysfunction or hepatitis with or without jaundice, including fatal hepatic necrosis and hepatic failure, reported
- Such reactions can represent hypersensitivity hepatitis, a known risk of exposure to halogenated anesthetics, including isoflurane
- As with other halogenated anesthetic agents, the drug may cause sensitivity hepatitis in patients sensitized by previous exposure to halogenated anesthetics
- Clinical judgment should be exercised when isoflurane the drug is used in patients with underlying hepatic conditions or under treatment with drugs known to cause hepatic dysfunction
- As with all halogenated anesthetics, repeated anesthetics within a short period of time may result in increased effects, particularly in patients with underlying hepatic conditions, or additive effects in patients treated with drugs known to cause hepatic dysfunction
- Evaluate the need for repeated exposure in each individual patient and adjust the dose of isoflurane based on signs and symptoms of adequate depth of anesthesia if repeated exposure in a short period of time is clinically indicated
Malignant hyperthermia
- In susceptible individuals, isoflurane anesthesia may trigger a skeletal muscle hypermetabolic state leading to high oxygen demand and the clinical syndrome known as malignant hyperthermia; fatal outcomes of malignant hyperthermia have been reported
- Risk of developing malignant hyperthermia increases with concomitant administration of succinylcholine and volatile anesthetic agents; therapy can induce malignant hyperthermia in patients with known or suspected susceptibility based on genetic factors or family history, including those with certain inherited ryanodine receptor (RYR1) or dihydropyridine receptor (CACNA1S) variants
- Signs consistent with malignant hyperthermia may include hyperthermia, hypoxia, hypercapnia, muscle rigidity (eg, jaw muscle spasm), tachycardia (eg, particularly that unresponsive to deepening anesthesia or analgesic medication administration), tachypnea, cyanosis, arrhythmias, hypovolemia, and hemodynamic instability; skin mottling, coagulopathies, and renal failure may occur later in the course of the hypermetabolic process
- An increase in overall metabolism may be reflected in an elevated temperature, (which may rise rapidly early or late in the case, but usually is not the first sign of augmented metabolism) and increased usage of the CO2 absorption system (hot canister)
- PaO2 and pH may decrease, and hyperkalemia and a base deficit may appear; treatment includes discontinuance of triggering agents (eg, isoflurane), administration of intravenous dantrolene sodium, and application of supportive therapy
- Successful treatment of malignant hyperthermia depends on early recognition of clinical signs; if malignant hyperthermia suspected, discontinue all triggering agents (eg, volatile anesthetic agents and succinylcholine), administer intravenous dantrolene sodium, and initiate supportive therapies
- Consult prescribing information for intravenous dantrolene sodium for additional information on patient management
- Supportive therapies include administration of supplemental oxygen and respiratory support based on clinical need, maintenance of hemodynamic stability and adequate urinary output, management of fluid and electrolyte balance, correction of acid-base derangements, and institution of measures to control rising temperature
- Renal failure may appear later, and urine flow should be sustained if possible; fatal outcome of malignant hyperthermia has been reported with isoflurane
Pediatric use
- During the induction of anesthesia, saliva flow and tracheobronchial secretion can increase and can be the cause of larynogospasm, particularly in children
Perioperative Hyperkalemia
- Inhaled anesthetics associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients postoperatively
- Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable
- Concomitant use of succinylcholine has been associated with most, but not all, of these cases
- Elevated serum creatinine kinase levels and, in some cases, changes in urine consistent with myoglobinuria observed
- Despite similar presentation to malignant hyperthermia, none of affected patients exhibited signs or symptoms of muscle rigidity or hypermetabolic state
- Early and aggressive intervention to treat hyperkalemia and resistant arrhythmias recommended
- Evaluation for latent neuromuscular disease recomended
General anesthetics and sedation drugs in young children and pregnant women
-
Brain development
- Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
- Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
- Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies in pregnant women; in animal reproduction studies, embryofetal toxicity was noted in pregnant mice exposed to 0.075% (increased post implantation losses) and 0.3% isoflurane (increased post implantation losses and decreased live- birth index) during organogenesis
Lactation
Due to insufficient information regarding the excretion of isoflurane in human milk, the potential risks and benefits for each specific patient should be carefully considered before isoflurane is administered to nursing women
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Volatile liquid inhalation anesthetic
Pharmacokinetics
Onset: Rapid (7-10 min)
Duration: Short (depends on blood concentration)
Minimum Alveolar Conc: 1.3%
Metabolism: Liver (0.2%)
Pharmacogenomics
Increased incidence of malignant hyperthermia with use of volatile anesthetics or depolarizing neuromuscular blockers in patients with gene mutations in ryanodine receptor (RYR1) or calcium channel alpha (1S)- subunit gene (CACNA1S)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| isoflurane inhalation - | 99.9 % liquid |  | |
| isoflurane inhalation - | 99.9 % liquid |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
isoflurane inhalation
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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