Isoflurane sensitizes the myocardium to arrhythmogenic effects of adrenaline. Doses greater than 5 mcg/kg administered submucosally may produce ventricular arrhythmias.
Source: NLP:isoflurane
Isoflurane Interactions
Brand names: Terrell
General Anesthetic
Route: Respiratory (Inhalation)
Contraindications
4 CONTRAINDICATIONS Terrell is contraindicated in patients: in whom general anesthesia is contraindicated. with known sensitivity to Terrell or to other halogenated agents [see Warnings and Precautions (5.3) ] . with known or suspected genetic susceptibility to malignant hyperthermia [see Warnings and Precautions (5.1) , Clinical Pharmacology (12.5) ]. with a history of confirmed hepatitis due to a halogenated inhalational anesthetic or a historycof unexplained moderate to severe hepatic dysfunction (e.g., jaundice associated with fevercand/or eosinophilia) after anesthesia with isoflurane or other halogenated inhalational anesthetics. Patients in whom general anesthesia is contraindicated ( 4 ) Patients with known sensitivity to Terrell or other halogenated agents ( 4 ) Patients with known or suspected genetic susceptibility to malignant hyperthermia ( 4 ) Patients with a history of confirmed hepatitis due to a halogenated inhalational anesthetic or a history of unexplained moderate to severe hepatic dysfunction (e.g., jaundice associated with feverand/or eosinophilia) after anesthesia with Terrell or other halogenated inhalational anesthetics ( 4 )
Pregnancy & Breastfeeding
8.1 Pregnancy Risk Summary There are no adequate and well-controlled studies in pregnant women. In animal reproduction studies, embryofetal toxicity was noted in pregnant mice exposed to 0.075% (increased post implantation losses) and 0.3% isoflurane (increased post implantation losses and decreased livebirth index) during organogenesis. Published studies in pregnant primates demonstrate that the administration of anesthetic and sedation drugs that block NMDA receptors and/or potentiate GABA activity during the period of peak brain development increases neuronal apoptosis in the developing brain of the offspring when used for longer than 3 hours. There are no data on pregnancy exposures in primates corresponding to periods prior to the third trimester in humans (see Data). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15- 20%, respectively. Data Animal Data Pregnant rats were exposed to isoflurane at concentrations of 0%, 0.1%, or 0.4% for two hours per day during organogenesis (Gestational Days 6-15). Isoflurane did not cause malformations or clear maternal toxicity under these conditions. Pregnant mice exposed to isoflurane at concentrations of 0%, 0.075%, or 0.30% for 2 hours per day during organogenesis (Gestational Days 6-15). Isoflurane increased fetal toxicity (higher post implantation losses at 0.075 and 0.3% groups and significantly lower live-birth index in the 0.3% isoflurane treatment group). Isoflurane did not cause malformations or clear maternal toxicity under these conditions. Pregnant rats were exposed to concentrations of isoflurane at 0%, 0.1%, or 0.4% for 2 hours per day during late gestation (GD 15-20). Animals appeared slightly sedated during expo
24 interactions on record
Isoflurane may lead to marked hypotension in patients treated with calcium antagonists.
Source: NLP:isoflurane
Concomitant use may cause enhanced CNS depressant effects. Dosage reduction of dexmedetomidine or isoflurane may be required.
Source: NLP:dexmedetomidine
Concomitant use may increase risk of sudden blood pressure and heart rate increase during surgery. Avoid use on day of surgery.
Source: NLP:dexmethylphenidate hydrochloride
Concomitant use may increase cardiac autonomic irritability and sensitize the myocardium to dopamine, potentially leading to ventricular arrhythmias and hypertension.
Source: NLP:dopamine hydrochloride
Fentanyl decreases MAC of isoflurane and may cause synergistic fall in blood pressure and respiratory rate when combined.
Source: NLP:isoflurane
MAO inhibitors combined with isoflurane may increase risk of hemodynamic instability during surgery or medical procedures.
Source: NLP:isoflurane
Concomitant use may increase risk of sudden blood pressure and heart rate increase during surgery. Avoid use on day of surgery.
Source: NLP:methylphenidate hydrochloride
Concomitant use may increase risk of sudden blood pressure and heart rate increase during surgery. Avoid on day of surgery.
Source: NLP:methylphenidate hydrochloride extended release
Concomitant use may lead to ventricular tachycardia or ventricular fibrillation. Monitor cardiac rhythm.
Source: NLP:norepinephrine bitartrate
Increases anesthetic/sedative and cardiorespiratory effects of propofol during maintenance anesthesia. Concurrent use is routinely used.
Source: NLP:propofol
Enhances neuromuscular blocking activity and prolongs duration of rocuronium bromide action by 11-50% and decreases infusion requirements by approximately 40%.
Source: NLP:rocuronium bromide
May enhance the neuromuscular blocking action of succinylcholine.
Source: NLP:succinylcholine chloride
Isoflurane enhances vecuronium-induced neuromuscular blockade. Potentiation is most prominent with isoflurane use.
Source: NLP:vecuronium bromide
Isoflurane + AtracuriumModerate
Isoflurane potentiates the muscle relaxant effect of atracurium, reducing required ED95 by approximately 25-40%. Dose adjustment required.
Source: NLP:isoflurane
Isoflurane + Atracurium BesylateModerate
May enhance the neuromuscular blocking action of atracurium.
Source: NLP:atracurium besylate
Co-administration with dexmedetomidine hydrochloride leads to enhancement of pharmacodynamic effects. Dosage reduction may be required.
Source: NLP:dexmedetomidine hydrochloride
Co-administration leads to enhancement of pharmacodynamic effects. Reduction in dosage of dexmedetomidine or isoflurane may be required.
Source: NLP:dexmedetomidine hydrochloride in 0.9% sodium chloride
Isoflurane + Nitrous OxideModerate
Nitrous oxide decreases the minimum alveolar concentration (MAC) of isoflurane. Dose adjustment required.
Source: NLP:isoflurane
Beta blockers may exaggerate cardiovascular effects of isoflurane, including hypotension and negative inotropic effects.
Source: NLP:isoflurane
Isoflurane + PancuroniumModerate
Isoflurane potentiates the muscle relaxant effect of pancuronium, reducing required ED95 by approximately 25-40%. Dose adjustment required.
Source: NLP:isoflurane
Isoflurane + RocuroniumModerate
Isoflurane enhances rocuronium activity, prolonging neuromuscular block duration and decreasing infusion requirements by approximately 40%.
Source: NLP:rocuronium
Isoflurane + SuccinylcholineModerate
Isoflurane potentiates the muscle relaxant effect of succinylcholine, reducing required ED95 by approximately 25-40%. Dose adjustment required.
Source: NLP:isoflurane
Isoflurane + VecuroniumModerate
Isoflurane potentiates the muscle relaxant effect of vecuronium, reducing required ED95 by approximately 25-40%. Dose adjustment required.
Source: NLP:isoflurane