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Desflurane: Drug information

Desflurane: Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Desflurane: Patient drug information" and "Desflurane: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Suprane
Pharmacologic Category
  • General Anesthetic, Inhalation
Dosing: Adult

Note: Dosage must be individualized based on patient response.

Anesthesia, induction

Anesthesia, induction: Initial: Inhaled concentration of 3%, increased by 0.5% to 1% increments every 2 to 3 breaths (end tidal concentrations 4% to 11%). Inspired concentrations >12% have been safely administered during induction and may require a reduction of nitrous oxide or air.

Anesthesia, maintenance

Anesthesia, maintenance: Inhaled concentrations of 2.5% to 8.5% with or without concomitant nitrous oxide.

Mini mum alveolar concentration values:

The minimum alveolar concentration (MAC), the concentration at which 50% of patients do not respond to surgical incision, varies by age. In adults, the concentration at which amnesia and loss of awareness occur (MAC - awake) is 2.4%. Surgical levels of anesthesia are maintained between 2.5% to 8.5%.

Patient Age and Minimum Alveolar Concentration (MAC)

Age

MAC with 100% Oxygen

MAC with 60% N2O/40% Oxygen

25 y

7.3%

4%

45 y

6%

2.8%

70 y

5.2%

1.7%

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult Drug Interactions database for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment necessary.

Dosing: Hepatic Impairment: Adult

No dosage adjustment necessary.

Dosing: Older Adult

The mean alveolar concentrations decrease with increasing age; adjust dose accordingly. Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Desflurane: Pediatric drug information")

Anesthesia, maintenance

Anesthesia, maintenance: Note: The minimum alveolar concentration (MAC), the concentration at which 50% of patients do not respond to surgical incision, varies by age. Desflurane MAC decreases with increasing age; dosage must be individualized based on patient response; desflurane MAC may also be decreased with concomitant nitrous oxide administration.

Infants, Children, and Adolescents: Inhaled concentrations of ~7% to 10% and lower concentrations with nitrous oxide (4% to 7.5%).

Patient Age and Minimum Alveolar Concentration (MAC)

Age

MAC with 100% Oxygen

MAC with 60% N2O/40% Oxygen

Note: Should only be administered with vaporizer specifically designed for desflurane.

10 weeks

9.4% ± 0.4%

9 months

10% ± 0.7%

7.5% ± 0.8%

2 years

9.1% ± 0.6%

3 years

6.4% ± 0.4%

4 years

8.6% ± 0.6%

7 years

8.1% ± 0.6%

25 years

7.3%

4% ± 0.3%

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

No dosage adjustment necessary.

Dosing: Hepatic Impairment: Pediatric

No dosage adjustment necessary.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Gastrointestinal: Nausea (27%), vomiting (16%)

Respiratory: Apnea (15%), breath-holding (30%), cough (34%)

1% to 10%:

Cardiovascular: Atrioventricular nodal arrhythmia, bradycardia, hypertension (including malignant hypertension), oxygen saturation decreased (3% to 10%), tachycardia

Gastrointestinal: Sialorrhea

Ophthalmic: Conjunctivitis

Nervous system: Headache

Neuromuscular & skeletal: Laryngospasm (3% to 10%)

Respiratory: Increased bronchial secretions (3% to 10%), increased cough (3% to 10%), pharyngitis

<1%, postmarketing, and/or case reports: Abdominal pain, acute myocardial infarction, acute pancreatitis, agitation (children; postoperative), asthenia, asthma, atrial fibrillation, bigeminy, blood coagulation test abnormality, bronchospasm, cardiac arrhythmia, cholestasis, disorder of hemostatic components of blood, dizziness, dyspnea, ECG abnormality, erythema of skin, fever, hemoptysis, hemorrhage, hepatic disease, hepatic failure, hepatic necrosis, hepatitis (including cytolytic hepatitis), hepatotoxicity (Chalasani 2021; Chung 2003; Cote 2007), hyperammonemia, hyperkalemia, hypokalemia, hypotension, hypoxia, increased creatinine phosphokinase in blood specimen, increased serum alanine aminotransferase, increased serum aspartate aminotransferase, increased serum bilirubin, increased serum transaminases, increased ST segment on ECG, inversion T wave on ECG, ischemic heart disease, jaundice, malaise, malignant hyperthermia, metabolic acidosis, myalgia, prolonged QT interval on ECG, pruritus, respiratory distress, respiratory failure, rhabdomyolysis, scleral icterus, seizure, shock, torsades de pointes, urticaria, vasodilation, ventricular conduction abnormalities, ventricular dysfunction

Contraindications

Hypersensitivity to desflurane, other halogenated agents, or any component of the formulation; known or suspected genetic susceptibility to malignant hyperthermia; patients in whom general anesthesia is contraindicated; induction of anesthesia in pediatric patients; history of moderate to severe hepatic impairment following anesthesia with desflurane or other halogenated agents and not otherwise explained.

Canadian labeling: Additional contraindications (not in US labeling): History of hepatitis due to a halogenated inhalational anesthetic or in whom hepatic dysfunction, jaundice or unexplained fever, leukocytosis, or eosinophilia has occurred after previous halogenated anesthetic administration.

Warnings/Precautions

Concerns related to adverse effects:

• Decreased blood flow: May cause decrease in hepatic and/or renal blood flow.

• Hepatitis: May cause sensitivity hepatitis in patients who have been sensitized by previous exposure to halogenated anesthetics.

• Hyperkalemia: Use of inhaled anesthetics has been associated with rare cases of perioperative hyperkalemia (including fatalities) in pediatric patients; concomitant use of succinylcholine was associated with many of the reported cases, but not all. Risk of hyperkalemia is increased in patients with underlying neuromuscular disease (eg, Duchenne muscular dystrophy). Other abnormalities may include elevation in CK and myoglobinuria. Monitor closely for arrhythmias. Aggressively identify and treat hyperkalemia.

• Increased intracranial pressure: May dilate the cerebral vasculature and may, in certain conditions, increase intracranial pressure. In patients with intracranial space-occupying lesions, administer at ≤0.8 MAC in conjunction with a barbiturate induction and hyperventilation in the period before cranial decompression; maintain cerebral perfusion pressure.

• Malignant hyperthermia: May trigger malignant hyperthermia; some reported cases have been fatal. Risk may be increased with concomitant administration of succinylcholine and volatile anesthetic agents and patients with genetic factors or family history of malignant hyperthermia, including ryanodine receptor or dihydropyridine receptor inherited variants. Signs of malignant hyperthermia may include arrhythmias, cyanosis, hemodynamic instability, hypercapnia, hyperthermia, hypovolemia, hypoxia, muscle rigidity, tachycardia, and tachypnea; coagulopathies, renal failure, and skin mottling may also occur. If malignant hyperthermia is suspected, discontinue triggering agents and institute appropriate therapy (eg, dantrolene) and other supportive measures.

• QT prolongation: Cases of QT prolongation in association with torsade de pointes (some fatal) have been reported with inhaled anesthetic agents; use caution when administering to patients at risk of QT prolongation (eg, concurrent use of drugs that can prolong the QT interval, such as class Ia and III antiarrhythmic drugs, elderly patients, congenital QT prolongation) (Han 2010; Kang 2006; Nakao 2010).

• Respiratory depression: Causes dose-dependent respiratory depression and blunted ventilatory response to hypoxia and hypercapnia. Hypoxic pulmonary vasoconstriction is blunted which may lead to increased pulmonary shunt. May produce elevated carbon monoxide levels and carboxyhemoglobin in the presence of a desiccated dry carbon dioxide absorbent within the circle breathing system of an anesthetic machine; barium hydroxide and soda lime desiccation have been reported when fresh gasses are passed over a carbon dioxide canister at high flow rates over many hours or days. Maintain fresh absorbent as per manufacturer guidelines regardless of state of colorimetric indicator.

Disease-related concerns:

• Cardiovascular disease: Do not use as a single agent to induce anesthesia in patients with CAD or in whom an increase in heart rate or blood pressure should be avoided. Abrupt increases in inspired concentrations >1 MAC can produce a transient increase in blood pressure and heart rate due to increased plasma catecholamine levels. Acute, rapid increases in desflurane concentration can produce increased sympathetic cardiovascular stimulation which lasts for 2 to 4 minutes; can be blunted by concurrent use of nitrous oxide, opioids, beta-blockers, and alpha-2 agonists (Weiskopf 1994). Hypotensive effect due to peripheral vasodilation is dose dependent and increases as anesthesia is deepened. In a scientific statement from the American Heart Association, desflurane has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: major) (AHA [Page 2016]).

• Hepatic disease: Due to the risk of hepatitis with halogenated anesthetics, use in patients with cirrhosis, viral hepatitis, or other preexisting hepatic disease should be approached with caution; disruption of hepatic function, icterus, and fatal liver necrosis have been reported and may indicate hypersensitivity. Consider the use of an anesthetic other than a halogenated anesthetic.

Special populations:

• Pediatric: Postoperative agitation may occur in children while emerging from anesthesia. Contraindicated for induction of general anesthesia in pediatric patients due to the higher incidence of moderate to severe upper airway adverse events (eg, laryngospasm, coughing, breath-holding, increased secretions). Do not use to maintain anesthesia in nonintubated pediatric patients due to a high incidence of moderate to severe upper airway adverse events. Use with caution when used to maintain anesthesia in children ≤6 years when a laryngeal mask airway (LMA) is in place due to the increased potential for adverse respiratory effects especially with removal of the LMA under deep anesthesia. Use with caution in children with asthma or recent upper respiratory infection; increased risk for airway narrowing and increased airway resistance.

• Pediatric neurotoxicity: In pediatric and neonatal patients <3 years and patients in third trimester of pregnancy (ie, times of rapid brain growth and synaptogenesis), the repeated or lengthy exposure to sedatives or anesthetics during surgery/procedures may have detrimental effects on child or fetal brain development and may contribute to various cognitive and behavioral problems. Epidemiological studies in humans have reported various cognitive and behavioral problems including neurodevelopmental delay (and related diagnoses), learning disabilities, and ADHD. Human clinical data suggest that single, relatively short exposures are not likely to have similar negative effects. No specific anesthetic/sedative has been found to be safer. For elective procedures, risk vs benefits should be evaluated and discussed with parents/caregivers/patients; critical surgeries should not be delayed (FDA 2016).

Special handling:

• Occupational caution: Although there are no documented adverse effects of chronic occupational exposure to halogenated anesthetic vapors, like desflurane, some epidemiological studies suggest a link between these anesthetics and increased health problems (particularly spontaneous abortion). There is no specific work exposure limit established for desflurane. However, the National Institute for Occupational Safety and Health (NIOSH) has recommended that workers should not be exposed to ceiling concentrations greater than 2 ppm of any halogenated anesthetic agent over a period ≤1 hour. The predicted effects of acute overexposure by inhalation of desflurane include headache, dizziness, or (in extreme cases) unconsciousness. Precautions (eg, adequate ventilation, scavenging-systems, minimizing leaks/spills) can help to lessen any potential risk.

Other warnings/precautions:

• Monitoring: Transient elevations in white blood cell count and glucose may occur.

• Vaporizer use: Yellow discoloration of desflurane has been observed through the vaporizer sight glass or after draining the vaporizer; quality or efficacy of desflurane is not altered in these situations. Refer to the vaporizer Instructions For Use or contact manufacturer for recommended actions.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Inhalation:

Suprane: (240 mL); 100% (240 mL)

Generic: (240 mL)

Generic Equivalent Available: US

Yes

Administration: Adult

Inhalation: Via desflurane-specific calibrated heated vaporizer

Administration: Pediatric

Inhalation: Administer via desflurane-specific calibrated heated vaporizer.

Use: Labeled Indications

Anesthesia: For induction of anesthesia for inpatient and outpatient surgery and maintenance of anesthesia in adults. For maintenance of anesthesia for inpatient and outpatient surgery in pediatric patients following induction with other agents and tracheal intubation. Note: Use of desflurane for induction of general anesthesia in adult patients may not be suitable due to its irritant properties and unpleasant odor which may cause coughing, breath-holding, laryngospasm, oxygen desaturation, increased secretions, hypertension, and tachycardia.

Medication Safety Issues
Sound-alike/look-alike issues:

Desflurane may be confused with Desferal

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (anesthetic agent, general, inhaled and IV) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Amisulpride (Oral): May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk). Risk C: Monitor therapy

Amisulpride (Oral): May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Bambuterol: May enhance the arrhythmogenic effect of Inhalational Anesthetics. Management: Some labels recommend specifically avoiding halothane; others recommend separating administration by at least 6 hours; other bambuterol labels do not mention this possible interaction. Monitor for increased sensitivity to arrhythmias if coadministered. Risk D: Consider therapy modification

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification

Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification

Calcium Channel Blockers: Inhalational Anesthetics may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy

Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy

Dabrafenib: QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of Dabrafenib. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Daridorexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

DexmedeTOMIDine: CNS Depressants may enhance the CNS depressant effect of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider therapy modification

Dexmethylphenidate-Methylphenidate: May enhance the hypertensive effect of Inhalational Anesthetics. Risk X: Avoid combination

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Difelikefalin: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Domperidone: QT-prolonging Agents (Moderate Risk) may enhance the QTc-prolonging effect of Domperidone. Risk X: Avoid combination

DOPamine: Inhalational Anesthetics may enhance the arrhythmogenic effect of DOPamine. Risk C: Monitor therapy

Doxylamine: CNS Depressants may enhance the CNS depressant effect of Doxylamine. Risk C: Monitor therapy

DroPERidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider therapy modification

DroPERidol: May enhance the CNS depressant effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). DroPERidol may enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Consider dose reductions and monitor for QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider therapy modification

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Ephedra: May enhance the arrhythmogenic effect of Inhalational Anesthetics. Risk X: Avoid combination

EPHEDrine (Nasal): May enhance the arrhythmogenic effect of Inhalational Anesthetics. Risk X: Avoid combination

EPHEDrine (Systemic): May enhance the arrhythmogenic effect of Inhalational Anesthetics. Risk X: Avoid combination

EPINEPHrine (Nasal): Inhalational Anesthetics may enhance the arrhythmogenic effect of EPINEPHrine (Nasal). Risk C: Monitor therapy

EPINEPHrine (Oral Inhalation): Inhalational Anesthetics may enhance the arrhythmogenic effect of EPINEPHrine (Oral Inhalation). Risk C: Monitor therapy

EPINEPHrine (Systemic): Inhalational Anesthetics may enhance the arrhythmogenic effect of EPINEPHrine (Systemic). Management: Administer epinephrine with added caution in patients receiving, or who have recently received, inhalational anesthetics. Use lower than normal doses of epinephrine and monitor for the development of cardiac arrhythmias. Risk D: Consider therapy modification

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Fenoterol: Inhalational Anesthetics may enhance the arrhythmogenic effect of Fenoterol. Risk C: Monitor therapy

Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider therapy modification

Fluorouracil Products: QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of Fluorouracil Products. Management: Monitor for QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Haloperidol: May enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider therapy modification

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Iloperidone: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Isocarboxazid: May enhance the hypotensive effect of Inhalational Anesthetics. Risk X: Avoid combination

Isoproterenol: Inhalational Anesthetics may enhance the arrhythmogenic effect of Isoproterenol. Risk X: Avoid combination

Ixabepilone: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider therapy modification

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Levoketoconazole: QT-prolonging Agents (Moderate Risk) may enhance the QTc-prolonging effect of Levoketoconazole. Risk X: Avoid combination

Lisuride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Loxapine: CNS Depressants may enhance the CNS depressant effect of Loxapine. Risk D: Consider therapy modification

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Metaraminol: Inhalational Anesthetics may enhance the arrhythmogenic effect of Metaraminol. Risk X: Avoid combination

Methadone: QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the CNS depressant effect of Methadone. Methadone may enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation, ventricular arrhythmias, sedation, and respiratory depression. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider therapy modification

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider therapy modification

Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Neuromuscular-Blocking Agents (Nondepolarizing): Inhalational Anesthetics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Management: When initiating a non-depolarizing neuromuscular blocking agent (NMBA) in a patient receiving an inhalational anesthetic, initial NMBA doses should be reduced 15% to 25% and doses of continuous infusions should be reduced 30% to 60%. Risk D: Consider therapy modification

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Norepinephrine: Inhalational Anesthetics may enhance the arrhythmogenic effect of Norepinephrine. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Ondansetron: May enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider therapy modification

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination

Pentamidine (Systemic): May enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Phenylephrine (Ophthalmic): May enhance the adverse/toxic effect of Inhalational Anesthetics. Specifically, the cardiovascular depressant effects of inhalational anesthetics may be increased. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pimozide: May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk). Risk X: Avoid combination

Piperaquine: QT-prolonging Agents (Moderate Risk) may enhance the QTc-prolonging effect of Piperaquine. Risk X: Avoid combination

Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Risk C: Monitor therapy

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy

Procarbazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

QT-prolonging Agents (Highest Risk): QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider therapy modification

QT-prolonging Antidepressants (Moderate Risk): QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Antidepressants (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Antipsychotics (Moderate Risk): QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Class IC Antiarrhythmics (Moderate Risk): QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Class IC Antiarrhythmics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-Prolonging Inhalational Anesthetics (Moderate Risk): May enhance the hypotensive effect of other QT-Prolonging Inhalational Anesthetics (Moderate Risk). QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of other QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for hypotension and QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Kinase Inhibitors (Moderate Risk): May enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Miscellaneous Agents (Moderate Risk): May enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk): QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Quinolone Antibiotics (Moderate Risk): QT-Prolonging Inhalational Anesthetics (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Quinolone Antibiotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk): May enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Ritodrine: May enhance the adverse/toxic effect of Inhalational Anesthetics. Risk C: Monitor therapy

Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider therapy modification

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy

Sertindole: May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk). Risk X: Avoid combination

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Succinylcholine: Desflurane may enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification

Zuranolone: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider therapy modification

Pregnancy Considerations

Based on animal data, repeated or prolonged use of general anesthetic and sedation medications that block N-methyl-D- aspartate (NMDA) receptors and/or potentiate gamma-aminobutyric acid (GABA) activity, may affect brain development. Evaluate benefits and potential risks of fetal exposure to desflurane when duration of surgery is expected to be >3 hours (Olutoye 2018).

Use of desflurane in obstetric anesthesia has been described (Boat 2010; Karaman 2006; Patel 1995). However, other agents are more commonly used (ACOG 209 2019; Devroe 2015). Maternal exposure should be minimized due to dose dependent uterine relaxation and fetal depression (Devroe 2015).

The ACOG recommends that pregnant women should not be denied medically necessary surgery, regardless of trimester. If the procedure is elective, it should be delayed until after delivery (ACOG 775 2019).

Breastfeeding Considerations

It is not known if desflurane is present in breast milk.

The manufacturer recommends that caution be exercised when administering desflurane to breastfeeding females; however, based on pharmacokinetic properties, use of desflurane for the maintenance of anesthesia in breastfeeding women is acceptable (Dalal 2014). The Academy of Breast Feeding Medicine recommends postponing elective surgery until milk supply and breastfeeding are established. Milk should be expressed ahead of surgery when possible. In general, when the child is healthy and full term, breastfeeding may resume, or milk may be expressed once the mother is awake and in recovery. For children who are at risk for apnea, hypotension, or hypotonia, milk may be saved for later use when the child is at lower risk (ABM [Reece-Stremtan 2017]).

Monitoring Parameters

Blood pressure, heart rate and rhythm, temperature, oxygen saturation, end-tidal CO2 and end-tidal desflurane concentrations should be monitored prior to and throughout anesthesia; adverse respiratory symptoms in pediatric patients (≤6 years); signs and symptoms of airway narrowing in children with asthma or recent upper respiratory infection

Mechanism of Action

Although not completely defined, it is thought that desflurane enhances inhibitory postsynaptic channel activity and inhibits excitatory synaptic activity resulting in general anesthesia.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: 1 to 2 minutes

Duration: Emergence time: Depends on blood concentration when desflurane is discontinued

The rate of change of anesthetic concentration in the lung is more rapid with desflurane because of its low blood/gas solubility (0.42), which is similar to nitrous oxide.

Metabolism: Hepatic (0.02%) to trifluoroacetate (negligible) and inorganic fluoride

Excretion: Exhaled gases

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Suprane;
  • (AR) Argentina: Suprane;
  • (AT) Austria: Desfluran piramal | Suprane;
  • (AU) Australia: Desflurane Sandoz;
  • (BE) Belgium: Suprane;
  • (BR) Brazil: Desforane;
  • (CN) China: Suprane;
  • (CO) Colombia: Suprane;
  • (CZ) Czech Republic: Suprane;
  • (DE) Germany: Desfluran piramal | Suprane;
  • (EC) Ecuador: Suprane;
  • (EE) Estonia: Suprane;
  • (EG) Egypt: Suprane;
  • (ES) Spain: Suprane;
  • (FI) Finland: Suprane;
  • (FR) France: Suprane;
  • (GB) United Kingdom: Suprane;
  • (GR) Greece: Suprane;
  • (HK) Hong Kong: Suprane;
  • (HU) Hungary: Suprane;
  • (ID) Indonesia: Suprane;
  • (IT) Italy: Desflurano Piramal | Suprane;
  • (JO) Jordan: Suprane;
  • (JP) Japan: Suprane;
  • (KR) Korea, Republic of: Suprane;
  • (KW) Kuwait: Suprane;
  • (LB) Lebanon: Suprane;
  • (LT) Lithuania: Suprane;
  • (LV) Latvia: Suprane;
  • (MX) Mexico: Suprane;
  • (MY) Malaysia: Suprane;
  • (NO) Norway: Suprane;
  • (NZ) New Zealand: Suprane;
  • (PH) Philippines: Suprane;
  • (PL) Poland: Desfluran piramal | Suprane;
  • (PR) Puerto Rico: Suprane;
  • (PT) Portugal: Suprane;
  • (QA) Qatar: Suprane;
  • (RU) Russian Federation: Suprane;
  • (SA) Saudi Arabia: Suprane;
  • (SE) Sweden: Suprane;
  • (SG) Singapore: Suprane;
  • (SK) Slovakia: Suprane;
  • (TH) Thailand: Suprane;
  • (TN) Tunisia: Suprane;
  • (TR) Turkey: Suprane;
  • (TW) Taiwan: Suprane;
  • (UY) Uruguay: Suprane;
  • (VE) Venezuela, Bolivarian Republic of: Suprane;
  • (ZA) South Africa: Suprane | Torrane
  1. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 209: Obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133(3):e208-e225. [PubMed 30801474]
  2. American College of Obstetricians and Gynecologists (ACOG). ACOG committee opinion no. 775: nonobstetric surgery during pregnancy. Obstet Gynecol. 2019;133(4):e285-e286. [PubMed 30913200]
  3. Boat A, Mahmoud M, Michelfelder EC, et al. Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgery. Paediatr Anaesth. 2010;20(8):748-756. doi:10.1111/j.1460-9592.2010.03350.x [PubMed 20670239]
  4. Chalasani NP, Maddur H, Russo MW, Wong RJ, Reddy KR; Practice parameters committee of the American College of Gastroenterology. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2021;116(5):878-898. doi:10.14309/ajg.0000000000001259 [PubMed 33929376]
  5. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014;24(4):359-371. doi:10.1111/pan.12331 [PubMed 24372776]
  6. Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section. Curr Opin Anaesthesiol. 2015;28(3):240-246. doi:10.1097/ACO.0000000000000185 [PubMed 25827280]
  7. Food and Drug Administration. FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women. https://www.fda.gov/Drugs/DrugSafety/ucm53235. Updated April 27, 2017.
  8. Han DW, Park K, Jang SB, Kern SE. Modeling the effect of sevoflurane on corrected QT prolongation: a pharmacodynamic analysis. Anesthesiology. 2010;113(4):806-811. [PubMed 20808206]
  9. Kang J, Reynolds WP, Chen XL, et al. Mechanisms underlying the QT interval-prolonging effects of sevoflurane and its interactions with other QT-prolonging drugs. Anesthesiology. 2006;104(5):1015-1022. [PubMed 16645454]
  10. Karaman S, Akercan F, Aldemir O, Terek MC, Yalaz M, Firat V. The maternal and neonatal effects of the volatile anaesthetic agents desflurane and sevoflurane in caesarean section: a prospective, randomized clinical study. J Int Med Res. 2006;34(2):183-192. [PubMed 16749414]
  11. Nakao S, Hatano K, Sumi C, et al. Sevoflurane causes greater QTc interval prolongation in elderly patients than in younger patients. Anesth Analg. 2010;110(3):775-779. [PubMed 20185656]
  12. Olutoye OA, Baker BW, Belfort MA, Olutoye OO. Food and Drug Administration warning on anesthesia and brain development: implications for obstetric and fetal surgery. Am J Obstet Gynecol. 2018;218(1):98-102. [PubMed 28888583]
  13. Page RL 2nd, O'Bryant CL, Cheng D, et al; American Heart Association Clinical Pharmacology and Heart Failure and Transplantation Committees of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2016;134(6):e32-e69. [PubMed 27400984]
  14. Patel SS, Goa KL. Desflurane. A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia. Drugs. 1995;50(4):742-767. [PubMed 8536556]
  15. Reece-Stremtan S, Campos M, Kokajko L; Academy of Breastfeeding Medicine. ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeed Med. 2017;12(9):500-506. [PubMed 29624435]
  16. Suprane (desflurane) [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; November 2022.
  17. Suprane (desflurane) [product monograph]. Mississauga, Ontario, Canada: Baxter Corporation; July 2023.
  18. Weiskopf RB, Eger EI 2nd, Noorani M, et al. Fentanyl, Esmolol, and Clonidine Blunt the Transient Cardiovascular Stimulation Induced by Desflurane in Humans. Anesthesiology. 1994;81(6):1350-1355. [PubMed 7992902]
Topic 8891 Version 287.0

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