Drug Information for Sevoflurane (Halocarbon Products Corporation): ADVERSE REACTIONS

Adverse events are derived from controlled clinical trials conducted in the United States, Canada, and Europe. The reference drugs were isoflurane, enflurane, and propofol in adults and halothane in pediatric patients. The studies were conducted using a variety of premedications, other anesthetics, and surgical procedures of varying length. Most adverse events reported were mild and transient, and may reflect the surgical procedures, patient characteristics (including disease) and/or medications administered.

Of the 5182 patients enrolled in the clinical trials, 2906 were exposed to sevoflurane, including 118 adults and 507 pediatric patients who underwent mask induction. Each patient was counted once for each type of adverse event. Adverse events reported in patients in clinical trials and considered to be possibly or probably related to sevoflurane are presented within each body system in order of decreasing frequency in the following listings. One case of malignant hyperthermia was reported in pre-registration clinical trials.

Adult Patients (N=118)

• CardiovascularBradycardia 5%, Hypotension 4%, Tachycardia 2%
• Nervous SystemAgitation 7%
• Respiratory SystemLaryngospasm 8%, Airway obstruction 8%, Breathholding 5%, Cough Increased 5%

Pediatric Patients (N=507)

• CardiovascularTachycardia 6%, Hypotension 4%
• Nervous SystemAgitation 15%
• Respiratory SystemBreathholding 5%, Cough Increased 5%, Larynogospasm 3%, Apnea 2%
• Digestive SystemIncreased salivation 2%

• Body as a wholeFever 1%, Shivering 6%, Hypothermia 1%, Movement 1%, Headache 1%
• CardiovascularHypotension 11%, Hypertension 2%, Bradycardia 5%, Tachycardia 2%
• Nervous SystemSomnolence 9%, Agitation 9%, Dizziness 4%, Increased salivation 4%
• Digestive SystemNausea 25%, Vomiting 18%
• Respiratory SystemCough increased 11%, Breathholding 2%, Laryngospasm 2%

• Body as a wholeAsthenia, Pain
• CardiovascularArrhythmia, Ventricular Extrasystoles, Supraventricular Extrasystoles, Complete AV Block, Bigeminy, Hemorrhage, Inverted T Wave, Atrial Fibrillation, Atrial Arrhythmia, Second Degree AV Block, Syncope, S-T Depressed
• Nervous SystemCrying, Nervousness, Confusion, Hypertonia, Dry Mouth, Insomnia
• Respiratory SystemSputum Increased, Apnea, Hypoxia, Wheezing, Bronchospasm, Hyperventilation, Pharyngitis, Hiccup, Hypoventilation, Dyspnea, Stridor
• Metabolism and NutritionIncreases in LDH, AST, ALT, BUN, Alkaline Phosphatase, Creatinine, Bilirubinemia, Glycosuria, Fluorosis, Albuminuria, Hypophosphatemia, Acidosis, Hyperglycemia
• Hemic and Lymphatic SystemLeucocytosis, Thrombocytopenia
• Skin and Special SensesAmblyopia, Pruritus, Taste Perversion, Rash, Conjunctivitis
• UrogenitalUrination Impaired, Urine Abnormality, Urinary Retention, Oliguria

See WARNINGS for information regarding malignant hyperthermia.

Post-marketing reports indicate that sevoflurane use has been associated with seizures. The majority of cases were in children and young adults, most of whom had no medical history of seizures. Several cases reported no concomitant medications, and at least one case was confirmed by EEG. Although many cases were single seizures that resolved spontaneously or after treatment, cases of multiple seizures have also been reported. Seizures have occurred during, or soon after sevoflurane induction, during emergence, and during post-operative recovery up to a day following anesthesia.

Rare cases of malignant hyperthermia (see CONTRAINDICTIONS and WARNINGS) and allergic reactions, such as rash, urticaria, pruritis, bronchospasm, anaphylactic or anaphylactoid reactions (see CONTRAINDICTIONS) have been reported.

Very rare cases of mild, moderate and severe post-operative hepatic dysfunction or hepatitis with or without jaundice have been reported. Histological evidence was not provided for any of the reported hepatitis cases. In most of these cases, patients had underlying hepatic conditions or were under treatment with drugs known to cause hepatic dysfunction. Most of the reported events were transient and resolved spontaneously (see PRECAUTIONS). In addition, there have been rare post-marketing reports of hepatic failure and hepatic necrosis associated with the use of potent volatile anesthetic agents, including sevoflurane. However, the actual incidence and relationship of sevoflurane to these events cannot be established with certainty.

Transient elevations in glucose, liver function tests, and white blood cell count may occur as with use of other anesthetic agents.