Sevoflurane

Sevoflurane is a prescription medicine used as anesthesia during surgery.

• Sevoflurane is available under the following different brand names: Ultane

Adult and pediatric dosage

Liquid

• 100%

Anesthesia

Adult dosage

• 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

Pediatric dosage

• month full-term neonate
  • 3.3% in oxygen
• 1-6 months
  • 3% in oxygen
• 6 months to below 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

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Sevoflurane include:

• drowsiness, and
• dizziness.
• Serious side effects of Sevoflurane include:
• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• anxiety,
• chills,
• unusual change in the amount of urine,
• seizures,
• muscle stiffness,
• fast or irregular heartbeat,
• stomach pain,
• fatigue,
• yellowing of the eyes or skin (jaundice), and
• dark urine.

Rare side effects of Sevoflurane include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Sevoflurane has severe interactions with no other drugs.
• Sevoflurane has serious interactions with at least 67 other drugs.
• Sevoflurane has moderate interactions with at least 149 other drugs.
• Sevoflurane has minor interactions with the following drugs: 
  • amitriptyline
  • amoxapine
  • atracurium
  • clomipramine
  • desipramine
  • disulfiram
  • dosulepin
  • doxepin
  • imipramine
  • incobotulinumtoxinA
  • lofepramine
  • maprotiline
  • nitrous oxide
  • nortriptyline
  • protriptyline
  • rapacuronium
  • trazodone
  • trimipramine

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Susceptibility to malignant hyperthermia
• Hypersensitivity, lack of ventilatory support

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Sevoflurane?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Sevoflurane?”

Cautions

• Volatile liquid; use an 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
• 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 the 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
• 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 years or pregnant women during their third trimester
    • Assess the risk: benefit ratio in these populations, especially for prolonged procedures (ie, more than 3 hours) or multiple procedures

Pregnancy and Lactation

• 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 before 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