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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              Serious - Use Alternative (61)

              • alfuzosin

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

              • apomorphine

                apomorphine and sevoflurane 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.

              • atomoxetine

                atomoxetine and sevoflurane 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).

              • 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.

              • 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.

              • deutetrabenazine

                deutetrabenazine 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.

              • dobutamine

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

              • 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.

              • efavirenz

                efavirenz and sevoflurane 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.

              • 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.

              • 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).

              • 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.

              • lefamulin

                lefamulin and sevoflurane 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.

              • 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.

              • 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.

              • 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.

              • 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.

              • pseudoephedrine

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

              • rasagiline

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

              • selegiline

                selegiline increases levels of sevoflurane by pharmacodynamic synergism. 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.

              • 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.

              • tranylcypromine

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

              • xylometazoline

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

              Monitor Closely (146)

              • 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.

              • 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.

              • 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.

              • desflurane

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

              • desipramine

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

              • 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.

              • 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.

              • 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.

              • 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.

              • 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.

              • 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.

              • 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.

              • promethazine

                sevoflurane and promethazine both increase sedation. 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.

              • quazepam

                sevoflurane and quazepam both increase sedation. 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.

              • trimipramine

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

              • triprolidine

                sevoflurane and triprolidine both increase sedation. 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 (18)

              • 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.

              • 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

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              Warnings

              Contraindications

              Susceptibility to malignant hyperthermia

              Hypersensitivity, lack of ventilatory support

              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

              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

              Perioperative hyperkalemia

              • Inhaled anesthetics associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients postoperatively
              • Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable
              • Concomitant use of succinylcholine has been associated with most, but not all, of these cases
              • Elevated serum creatinine kinase levels and, in some cases, changes in urine consistent with myoglobinuria observed
              • Despite similar presentation to malignant hyperthermia, none of affected patients exhibited signs or symptoms of muscle rigidity or hypermetabolic state
              • Early and aggressive intervention to treat hyperkalemia and resistant arrhythmias recommended
              • Evaluation for latent neuromuscular disease recomended

              General anesthetics and sedation drugs in young children and pregnant women

              • Brain development
                • Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
                • Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
                • Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
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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) 2021 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.