sevoflurane (Rx)

Brand and Other Names:Ultane
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

liquid

  • 100%

Anesthesia

12-25 years

  • 2.6% in oxygen or 1.4% with 65% N2O/35% oxygen

25-40 years

  • 2.1% in oxygen or 1.1% with 65% N2O/35% oxygen

40-60 years

  • 1.7% in oxygen or 0.9% with 65% N2O/35% oxygen

60-80 years

  • 1.4% in oxygen or 0.7% with 65% N2O/35% oxygen

Dosage Forms & Strengths

liquid

  • 100%

Anesthesia

0-1 month full term neonate

  • 3.3% in oxygen

1-6 months

  • 3% in oxygen

6 months to <3 years

  • 2.8% in oxygen or 2 % with 65% N2O/35% oxygen

3-12 years

  • 2.5% in oxygen or 2.5 % with 65% N2O/35% oxygen

12-25 years

  • 2.6% in oxygen or 1.4% with 65% N2O/35% oxygen
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Interactions

Interaction Checker

and sevoflurane

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            Contraindicated (2)

            • dronedarone

              sevoflurane and dronedarone both increase QTc interval. Contraindicated.

            • thioridazine

              sevoflurane and thioridazine both increase QTc interval. Contraindicated.

            Serious - Use Alternative (169)

            • alfuzosin

              alfuzosin and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • amiodarone

              sevoflurane and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

            • amisulpride

              amisulpride and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

            • anagrelide

              sevoflurane and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.

            • apomorphine

              apomorphine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

              sevoflurane and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.

            • arsenic trioxide

              sevoflurane and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              artemether/lumefantrine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • asenapine

              sevoflurane and asenapine both increase QTc interval. Avoid or Use Alternate Drug.

            • asenapine transdermal

              asenapine transdermal and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • atomoxetine

              atomoxetine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • azithromycin

              sevoflurane and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • bedaquiline

              bedaquiline and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, sevoflurane. 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).

            • buprenorphine

              sevoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

            • calcium/magnesium/potassium/sodium oxybates

              sevoflurane, calcium/magnesium/potassium/sodium oxybates. Either increases effects 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.

            • ceritinib

              ceritinib and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • chloroquine

              chloroquine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • chlorpromazine

              sevoflurane and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

            • ciprofloxacin

              sevoflurane and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • citalopram

              citalopram and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • clozapine

              clozapine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • crizotinib

              crizotinib and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • dasatinib

              dasatinib and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • degarelix

              degarelix and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • dexfenfluramine

              sevoflurane increases toxicity of dexfenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • dexmethylphenidate

              sevoflurane increases toxicity of dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • dextroamphetamine

              sevoflurane increases toxicity of dextroamphetamine by Mechanism: unknown. Avoid or Use Alternate Drug.

            • diethylpropion

              sevoflurane increases toxicity of diethylpropion by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • disopyramide

              sevoflurane and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

            • dobutamine

              sevoflurane increases toxicity of dobutamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • dofetilide

              sevoflurane and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

            • dolasetron

              dolasetron and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • donepezil

              donepezil and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • dopamine

              sevoflurane increases toxicity of dopamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • doxapram

              doxapram, sevoflurane. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

            • droperidol

              sevoflurane and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • efavirenz

              efavirenz and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • eliglustat

              sevoflurane and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              encorafenib and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              entrectinib and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • ephedrine

              sevoflurane increases toxicity of ephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • epinephrine

              sevoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • epinephrine racemic

              sevoflurane increases levels of epinephrine racemic by unknown mechanism. Avoid or Use Alternate Drug.

            • eribulin

              eribulin and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin base

              sevoflurane and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              sevoflurane and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              sevoflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              sevoflurane and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

            • escitalopram

              sevoflurane and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

            • fenfluramine

              sevoflurane increases toxicity of fenfluramine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • fentanyl

              fentanyl, sevoflurane. 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

              fentanyl intranasal, sevoflurane. 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

              fentanyl transdermal, sevoflurane. 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 transmucosal

              fentanyl transmucosal, sevoflurane. 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 sevoflurane 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 sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • flecainide

              sevoflurane and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

            • fluconazole

              sevoflurane and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • fluoxetine

              sevoflurane and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • fluvoxamine

              sevoflurane and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.

            • foscarnet

              sevoflurane and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

            • gemifloxacin

              gemifloxacin and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • gemtuzumab

              sevoflurane and gemtuzumab both increase QTc interval. Avoid or Use Alternate Drug.

            • gilteritinib

              gilteritinib and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • glasdegib

              sevoflurane and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.

            • goserelin

              sevoflurane and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • granisetron

              granisetron and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • haloperidol

              sevoflurane and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • histrelin

              sevoflurane and histrelin both increase QTc interval. Avoid or Use Alternate Drug.

            • hydrocodone

              hydrocodone, sevoflurane. 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

              sevoflurane and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxyzine

              hydroxyzine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              sevoflurane and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • iloperidone

              sevoflurane and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              sevoflurane and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.

            • isocarboxazid

              isocarboxazid increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • isoproterenol

              sevoflurane increases toxicity of isoproterenol by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • itraconazole

              sevoflurane and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • ivosidenib

              sevoflurane and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.

            • lapatinib

              sevoflurane and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • lenvatinib

              sevoflurane and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • leuprolide

              sevoflurane and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.

            • levofloxacin

              sevoflurane and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • lisdexamfetamine

              sevoflurane increases toxicity of lisdexamfetamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • lithium

              sevoflurane and lithium both increase QTc interval. Avoid or Use Alternate Drug.

            • lofexidine

              sevoflurane and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.

            • loperamide

              sevoflurane and loperamide both increase QTc interval. Avoid or Use Alternate Drug.

            • lopinavir

              sevoflurane and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              sevoflurane and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.

            • maprotiline

              sevoflurane and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

            • mefloquine

              mefloquine increases toxicity of sevoflurane by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • methadone

              sevoflurane and methadone both increase QTc interval. Avoid or Use Alternate Drug.

            • methamphetamine

              sevoflurane increases toxicity of methamphetamine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • methylphenidate

              sevoflurane increases toxicity of methylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • metoclopramide intranasal

              sevoflurane, 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

              sevoflurane increases toxicity of midodrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • midostaurin

              sevoflurane and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

            • mifepristone

              sevoflurane and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.

            • mirtazapine

              sevoflurane and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.

            • mobocertinib

              sevoflurane and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.

            • moxifloxacin

              sevoflurane and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • nilotinib

              sevoflurane and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • norepinephrine

              sevoflurane increases toxicity of norepinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

              sevoflurane increases levels of norepinephrine by decreasing metabolism. Contraindicated.

            • octreotide

              sevoflurane and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

            • olanzapine

              sevoflurane 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

              sevoflurane 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

              sevoflurane and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.

            • osimertinib

              sevoflurane and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.

            • oxaliplatin

              sevoflurane and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.

            • oxytocin

              sevoflurane and oxytocin both increase QTc interval. Avoid or Use Alternate Drug.

            • ozanimod

              sevoflurane and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.

            • paliperidone

              sevoflurane and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • panobinostat

              sevoflurane and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

            • pasireotide

              sevoflurane and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.

            • pazopanib

              sevoflurane and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • pentamidine

              sevoflurane and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • phenelzine

              phenelzine increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • phentermine

              sevoflurane increases toxicity of phentermine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • phenylephrine

              sevoflurane increases toxicity of phenylephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

              sevoflurane increases levels of phenylephrine by decreasing metabolism. Contraindicated.

            • phenylephrine PO

              sevoflurane increases levels of phenylephrine PO by decreasing metabolism. Contraindicated.

              sevoflurane increases toxicity of phenylephrine PO by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • pimavanserin

              sevoflurane and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

            • pimozide

              sevoflurane and pimozide both increase QTc interval. Contraindicated.

            • pitolisant

              sevoflurane and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • ponesimod

              sevoflurane and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

            • posaconazole

              sevoflurane and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • primaquine

              sevoflurane and primaquine both increase QTc interval. Avoid or Use Alternate Drug.

            • procainamide

              sevoflurane and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • pseudoephedrine

              sevoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • quetiapine

              sevoflurane and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.

            • quinine

              sevoflurane and quinine both increase QTc interval. Avoid or Use Alternate Drug.

            • ranolazine

              sevoflurane and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

            • rasagiline

              rasagiline increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • ribociclib

              sevoflurane and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.

            • rilpivirine

              sevoflurane and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.

            • risperidone

              sevoflurane and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • romidepsin

              sevoflurane and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

            • ropeginterferon alfa 2b

              ropeginterferon alfa 2b and sevoflurane 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

              sevoflurane and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • selegiline

              selegiline increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • selpercatinib

              sevoflurane and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • serdexmethylphenidate/dexmethylphenidate

              sevoflurane increases toxicity of serdexmethylphenidate/dexmethylphenidate by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • sertraline

              sevoflurane and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

            • siponimod

              sevoflurane and siponimod both increase QTc interval. Avoid or Use Alternate Drug.

            • sodium oxybate

              sevoflurane, sodium oxybate. Either increases effects 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.

            • solifenacin

              sevoflurane and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.

            • sorafenib

              sevoflurane and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • sotalol

              sevoflurane and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • sufentanil SL

              sufentanil SL, sevoflurane. 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

              sevoflurane and sunitinib both increase QTc interval. Avoid or Use Alternate Drug.

            • tacrolimus

              sevoflurane and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

            • telavancin

              sevoflurane and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

            • tetrabenazine

              sevoflurane and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • toremifene

              sevoflurane and toremifene both increase QTc interval. Avoid or Use Alternate Drug.

            • tranylcypromine

              tranylcypromine increases levels of sevoflurane by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • trazodone

              sevoflurane and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

            • triclabendazole

              sevoflurane and triclabendazole both increase QTc interval. Avoid or Use Alternate Drug.

            • triptorelin

              sevoflurane and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.

            • vandetanib

              sevoflurane and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.

            • vardenafil

              sevoflurane and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.

            • vemurafenib

              sevoflurane and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • venlafaxine

              sevoflurane and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.

            • voclosporin

              sevoflurane and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.

            • voriconazole

              sevoflurane and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • vorinostat

              sevoflurane and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.

            • xylometazoline

              sevoflurane increases toxicity of xylometazoline by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • ziprasidone

              sevoflurane and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (153)

            • acebutolol

              sevoflurane, acebutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • albuterol

              albuterol and sevoflurane both increase QTc interval. Use Caution/Monitor.

            • alfentanil

              sevoflurane and alfentanil both increase sedation. Use Caution/Monitor.

            • alprazolam

              sevoflurane and alprazolam both increase sedation. Use Caution/Monitor.

            • amitriptyline

              sevoflurane and amitriptyline both increase sedation. Use Caution/Monitor.

              sevoflurane and amitriptyline both increase QTc interval. Use Caution/Monitor.

            • apomorphine

              sevoflurane and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              arformoterol and sevoflurane both increase QTc interval. Use Caution/Monitor.

            • atenolol

              sevoflurane, atenolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • baclofen

              sevoflurane and baclofen both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              sevoflurane and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benazepril

              sevoflurane, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • benperidol

              sevoflurane and benperidol both increase sedation. Use Caution/Monitor.

            • betaxolol

              sevoflurane, betaxolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • bisoprolol

              sevoflurane, bisoprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • brexanolone

              brexanolone, sevoflurane. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              sevoflurane and brompheniramine both increase sedation. Use Caution/Monitor.

            • buprenorphine

              sevoflurane and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              sevoflurane and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              sevoflurane 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.

            • butorphanol

              sevoflurane and butorphanol both increase sedation. Use Caution/Monitor.

            • captopril

              sevoflurane increases effects of captopril by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • carbinoxamine

              sevoflurane and carbinoxamine both increase sedation. Use Caution/Monitor.

            • carvedilol

              sevoflurane, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • celiprolol

              sevoflurane, celiprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • cenobamate

              cenobamate, sevoflurane. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              sevoflurane and chloral hydrate both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              sevoflurane and chlordiazepoxide both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              sevoflurane and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              sevoflurane and chlorpromazine both increase sedation. Use Caution/Monitor.

            • cinnarizine

              sevoflurane and cinnarizine both increase sedation. Use Caution/Monitor.

            • cisatracurium

              sevoflurane increases levels of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor.

            • clemastine

              sevoflurane and clemastine both increase sedation. Use Caution/Monitor.

            • clomipramine

              sevoflurane and clomipramine both increase sedation. Use Caution/Monitor.

              sevoflurane and clomipramine both increase QTc interval. Use Caution/Monitor.

            • clonazepam

              sevoflurane and clonazepam both increase sedation. Use Caution/Monitor.

            • clorazepate

              sevoflurane and clorazepate both increase sedation. Use Caution/Monitor.

            • clozapine

              sevoflurane and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              sevoflurane and codeine both increase sedation. Use Caution/Monitor.

            • cyclizine

              sevoflurane and cyclizine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              sevoflurane and cyproheptadine both increase sedation. Use Caution/Monitor.

            • daridorexant

              sevoflurane 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.

            • desflurane

              desflurane and sevoflurane both increase sedation. Use Caution/Monitor.

            • desipramine

              sevoflurane and desipramine both increase sedation. Use Caution/Monitor.

              sevoflurane and desipramine both increase QTc interval. Use Caution/Monitor.

            • deutetrabenazine

              deutetrabenazine and sevoflurane 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).

            • dexchlorpheniramine

              sevoflurane and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              sevoflurane increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              sevoflurane and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • dextromoramide

              sevoflurane and dextromoramide both increase sedation. Use Caution/Monitor.

            • diamorphine

              sevoflurane and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              sevoflurane and diazepam both increase sedation. Use Caution/Monitor.

            • difelikefalin

              difelikefalin and sevoflurane both increase sedation. Use Caution/Monitor.

            • difenoxin hcl

              sevoflurane and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              sevoflurane and dimenhydrinate both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              sevoflurane and diphenhydramine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              sevoflurane and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              sevoflurane and dipipanone both increase sedation. Use Caution/Monitor.

            • dopexamine

              sevoflurane increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              sevoflurane and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              sevoflurane and doxepin both increase sedation. Use Caution/Monitor.

              doxepin and sevoflurane both increase QTc interval. Use Caution/Monitor.

            • doxylamine

              sevoflurane and doxylamine both increase sedation. Use Caution/Monitor.

            • droperidol

              sevoflurane and droperidol both increase sedation. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, sevoflurane. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • esmolol

              sevoflurane, esmolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • estazolam

              sevoflurane and estazolam both increase sedation. Use Caution/Monitor.

            • fenfluramine

              sevoflurane increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fluphenazine

              sevoflurane and fluphenazine both increase sedation. Use Caution/Monitor.

              sevoflurane and fluphenazine both increase QTc interval. Use Caution/Monitor.

            • flurazepam

              sevoflurane and flurazepam both increase sedation. Use Caution/Monitor.

            • fostemsavir

              sevoflurane and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • ganaxolone

              sevoflurane and ganaxolone both increase sedation. Use Caution/Monitor.

            • haloperidol

              sevoflurane and haloperidol both increase sedation. Use Caution/Monitor.

            • hydromorphone

              sevoflurane and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              sevoflurane and hydroxyzine both increase sedation. Use Caution/Monitor.

            • iloperidone

              sevoflurane and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              sevoflurane and imipramine both increase sedation. Use Caution/Monitor.

              sevoflurane and imipramine both increase QTc interval. Use Caution/Monitor.

            • isoniazid

              isoniazid will increase the level or effect of sevoflurane by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.

            • ketamine

              ketamine and sevoflurane both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              sevoflurane and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • labetalol

              sevoflurane, labetalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • lasmiditan

              lasmiditan, sevoflurane. 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 will increase the level or effect of sevoflurane by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levorphanol

              sevoflurane and levorphanol both increase sedation. Use Caution/Monitor.

            • linezolid

              linezolid increases levels of sevoflurane by pharmacodynamic synergism. Use Caution/Monitor.

            • lofepramine

              sevoflurane and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              sevoflurane and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              sevoflurane and loprazolam both increase sedation. Use Caution/Monitor.

            • lorazepam

              sevoflurane and lorazepam both increase sedation. Use Caution/Monitor.

            • lormetazepam

              sevoflurane and lormetazepam both increase sedation. Use Caution/Monitor.

            • loxapine

              sevoflurane and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              sevoflurane and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • maprotiline

              sevoflurane and maprotiline both increase sedation. Use Caution/Monitor.

            • meperidine

              sevoflurane and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              sevoflurane and meprobamate both increase sedation. Use Caution/Monitor.

            • methadone

              sevoflurane and methadone both increase sedation. Use Caution/Monitor.

            • metoprolol

              sevoflurane, metoprolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • midazolam

              sevoflurane and midazolam both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, sevoflurane. 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.

            • mirtazapine

              sevoflurane and mirtazapine both increase sedation. Use Caution/Monitor.

            • morphine

              sevoflurane and morphine both increase sedation. Use Caution/Monitor.

            • moxonidine

              sevoflurane and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              sevoflurane and nabilone both increase sedation. Use Caution/Monitor.

            • nadolol

              sevoflurane, nadolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • nalbuphine

              sevoflurane and nalbuphine both increase sedation. Use Caution/Monitor.

            • nebivolol

              sevoflurane, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • nortriptyline

              sevoflurane and nortriptyline both increase sedation. Use Caution/Monitor.

              sevoflurane and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • oliceridine

              oliceridine, sevoflurane. 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).

            • opium tincture

              sevoflurane and opium tincture both increase sedation. Use Caution/Monitor.

            • oxazepam

              sevoflurane and oxazepam both increase sedation. Use Caution/Monitor.

            • oxycodone

              sevoflurane and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              sevoflurane and oxymorphone both increase sedation. Use Caution/Monitor.

            • pancuronium

              sevoflurane increases levels of pancuronium by pharmacodynamic synergism. Use Caution/Monitor.

            • papaveretum

              sevoflurane and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              sevoflurane and papaverine both increase sedation. Use Caution/Monitor.

            • penbutolol

              sevoflurane, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • pentazocine

              sevoflurane and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              sevoflurane and pentobarbital both increase sedation. Use Caution/Monitor.

            • perphenazine

              sevoflurane and perphenazine both increase sedation. Use Caution/Monitor.

              sevoflurane and perphenazine both increase QTc interval. Use Caution/Monitor.

            • phenobarbital

              sevoflurane and phenobarbital both increase sedation. Use Caution/Monitor.

            • phenylephrine PO

              sevoflurane increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              sevoflurane and pholcodine both increase sedation. Use Caution/Monitor.

            • pindolol

              sevoflurane, pindolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • primidone

              sevoflurane and primidone both increase sedation. Use Caution/Monitor.

            • procarbazine

              procarbazine increases levels of sevoflurane by pharmacodynamic synergism. Use Caution/Monitor.

            • prochlorperazine

              sevoflurane and prochlorperazine both increase sedation. Use Caution/Monitor.

              sevoflurane and prochlorperazine both decrease QTc interval. Use Caution/Monitor.

            • promethazine

              sevoflurane and promethazine both increase sedation. Use Caution/Monitor.

              sevoflurane and promethazine both decrease QTc interval. Use Caution/Monitor.

            • propafenone

              sevoflurane and propafenone both increase QTc interval. Use Caution/Monitor.

            • propofol

              propofol and sevoflurane both increase sedation. Use Caution/Monitor.

            • propranolol

              sevoflurane, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • protriptyline

              sevoflurane and protriptyline both increase sedation. Use Caution/Monitor.

              sevoflurane and protriptyline both increase QTc interval. Use Caution/Monitor.

            • quazepam

              sevoflurane and quazepam both increase sedation. Use Caution/Monitor.

            • quinidine

              sevoflurane and quinidine both increase QTc interval. Use Caution/Monitor.

            • rocuronium

              sevoflurane increases levels of rocuronium by pharmacodynamic synergism. Use Caution/Monitor.

            • secobarbital

              sevoflurane and secobarbital both increase sedation. Use Caution/Monitor.

            • selegiline transdermal

              selegiline transdermal increases levels of sevoflurane by pharmacodynamic synergism. Use Caution/Monitor.

            • sotalol

              sevoflurane, sotalol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • stiripentol

              stiripentol, sevoflurane. Either decreases toxicity 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.

            • succinylcholine

              sevoflurane increases levels of succinylcholine by pharmacodynamic synergism. Use Caution/Monitor.

            • sufentanil

              sevoflurane and sufentanil both increase sedation. Use Caution/Monitor.

            • tapentadol

              sevoflurane and tapentadol both increase sedation. Use Caution/Monitor.

            • temazepam

              sevoflurane and temazepam both increase sedation. Use Caution/Monitor.

            • thioridazine

              sevoflurane and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              sevoflurane and thiothixene both increase sedation. Use Caution/Monitor.

            • timolol

              sevoflurane, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • topiramate

              sevoflurane and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              sevoflurane and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              sevoflurane and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              sevoflurane and triazolam both increase sedation. Use Caution/Monitor.

            • triclofos

              sevoflurane and triclofos both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              sevoflurane and trifluoperazine both increase sedation. Use Caution/Monitor.

              sevoflurane and trifluoperazine both decrease QTc interval. Use Caution/Monitor.

            • trimipramine

              sevoflurane and trimipramine both increase sedation. Use Caution/Monitor.

              sevoflurane and trimipramine both increase QTc interval. Use Caution/Monitor.

            • triprolidine

              sevoflurane and triprolidine both increase sedation. Use Caution/Monitor.

            • valbenazine

              valbenazine and sevoflurane both increase QTc interval. Use Caution/Monitor.

            • vecuronium

              sevoflurane increases levels of vecuronium by pharmacodynamic synergism. Use Caution/Monitor.

            • ziconotide

              sevoflurane and ziconotide both increase sedation. Use Caution/Monitor.

            • zotepine

              sevoflurane and zotepine both increase sedation. Use Caution/Monitor.

            Minor (19)

            • amitriptyline

              sevoflurane, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • amoxapine

              sevoflurane, amoxapine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • atracurium

              sevoflurane increases levels of atracurium by pharmacodynamic synergism. Minor/Significance Unknown.

            • clomipramine

              sevoflurane, clomipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • desipramine

              sevoflurane, desipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • disulfiram

              disulfiram will increase the level or effect of sevoflurane by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

            • dosulepin

              sevoflurane, dosulepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • doxepin

              sevoflurane, doxepin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • imipramine

              sevoflurane, imipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • incobotulinumtoxinA

              sevoflurane increases levels of incobotulinumtoxinA by pharmacodynamic synergism. Minor/Significance Unknown.

            • lofepramine

              sevoflurane, lofepramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • maprotiline

              sevoflurane, maprotiline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • nitrous oxide

              nitrous oxide increases levels of sevoflurane by pharmacodynamic synergism. Minor/Significance Unknown.

            • nortriptyline

              sevoflurane, nortriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • ofloxacin

              sevoflurane and ofloxacin both increase QTc interval. Minor/Significance Unknown.

            • protriptyline

              sevoflurane, protriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • rapacuronium

              sevoflurane increases levels of rapacuronium by pharmacodynamic synergism. Minor/Significance Unknown.

            • trazodone

              sevoflurane, trazodone. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

            • trimipramine

              sevoflurane, trimipramine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Risk of arrhythmias or hypotension.

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            Adverse Effects

            Frequency Not Defined

            Malignant hyperthermia

            Dose-dependent hypotension

            Bradycardia

            Tachycardia

            Hypotension

            Hypertension

            Nausea/vomiting

            Cough

            Agitation

            Increased salivation

            Airway obstruction

            Laryngospasm

            Apnea

            Increased BUN

            Increased ALT

            Respiratory irritation

            Nephrotoxicity

            Glycosuria

            Proteinuria

            Postmarketing Reports

            Seizures (majority of cases in children and young adults, most had no medical history of seizures)

            Cardiac arrest

            Cases of mild, moderate and severe post-operative hepatic dysfunction or hepatitis with or without jaundice

            Malignant hyperthermia

            Allergic reactions (eg, rash, urticaria, pruritus, bronchospasm, anaphylactic or anaphylactoid reactions)

            Transient elevations in glucose, liver function tests, and WBC count

            Bradycardia in patients with Down syndrome

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            Warnings

            Contraindications

            Known or suspected genetic susceptibility to malignant hyperthermia

            Known or suspected sensitivity to sevoflurane or to other halogenated inhalational anesthetics

            Cautions

            Volatile liquid; use appropriate vaporizer for inhalation

            Agitation/delirium may occur

            Postoperative hepatitis reported

            Closely monitor patients with anemia, hepatic impairment, myxedema, renal impairment

            Can induce malignant hyperthermia in genetically susceptible individuals

            Advise patients that performance of activities requiring mental alertness, such as driving or operating machinery, may be impaired after sevoflurane anesthesia

            Reports of QT prolongation, associated with torsade de pointes (in exceptional cases, fatalities reported); exercise caution when administering to susceptible patients (eg, congenital long QT syndrome, coadministration with drugs that prolong QT interval)

            Should not be used as a sole agent of induction in patients with ventricular dysfunction

            Risk of perioperative hyperkalemia in pediatric patients reported (rare); some resulting in cardiac arrhythmia and death

            Bradycardia in Down syndrome

            • Episodes of severe bradycardia and cardiac arrest, not related to underlying congenital heart disease, reported during anesthesia induction with sevoflurane in pediatric patients with Down syndrome
            • In most cases, bradycardia improved with decreasing concentration of sevoflurane, manipulating the airway, or administering an anticholinergic or epinephrine
            • During induction, closely monitor heart rate, and consider incrementally increasing the inspired sevoflurane concentration until a suitable level of anesthesia is achieved
            • Consider having an anticholinergic and epinephrine available when administering sevoflurane for induction in this patient population

            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 recommended

            Malignant hyperthermia

            • In susceptible individuals, volatile anesthetic agents, including sevoflurane, may trigger malignant hyperthermia, a skeletal muscle hypermetabolic state leading to high oxygen demand; fatal outcomes reported
            • The 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
            • Successful treatment of malignant hyperthermia depends on early recognition of clinical signs
            • If malignant hyperthermia is 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

            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
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            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies in pregnant women; in animal reproduction studies, reduced fetal weights were noted following exposure to 1 MAC sevoflurane for three hours a day during organogenesis

            There are no data on pregnancy exposures in primates corresponding to periods prior to the third trimester in humans Sevoflurane has been used as part of general anesthesia for elective cesarean section in women; there were no untoward effects in mother or neonate; the safety of sevoflurane in labor and delivery has not been demonstrated

            Lactation

            The concentrations of sevoflurane in milk are probably of no clinical importance 24 hours after anesthesia; because of rapid washout, sevoflurane concentrations in milk are predicted to be below those found with many other volatile anesthetics

            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.

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            Pharmacology

            Mechanism of Action

            Volatile liquid general anesthetic; may alter activity of neuronal ion channels, especially the fast synaptic neurotransmitter receptors including nicotinic acetylcholine, GABA, and glutamate receptors.

            Pharmacokinetics

            Onset: 2-3 min

            Duration: Depends on blood concentration

            Metabolism: Liver (3-5%); CYP2E1

            Excretion: Respiratory exhaled gases

            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)

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            Images

            Pricing & Images are not currently available for this monograph.
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            Patient Handout

            Patient Education
            sevoflurane 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) 2022 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.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.