Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- dronedarone
sevoflurane and dronedarone both increase QTc interval. Contraindicated.
- thioridazine
sevoflurane and thioridazine both increase QTc interval. Contraindicated.
Serious - Use Alternative (173)
- 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.
- buprenorphine buccal
buprenorphine buccal and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and sevoflurane 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 (157)
- acebutolol
sevoflurane, acebutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- acrivastine
acrivastine and sevoflurane both increase sedation. Use Caution/Monitor.
- 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.
- amisulpride
amisulpride and sevoflurane 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.
- asenapine
asenapine and sevoflurane both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and sevoflurane both increase sedation. 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.
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
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
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.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)
Images
Patient Handout
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) 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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