Drug interactions
Epinephrine + Isoflurane
Severity: Major
Epinephrine and Isoflurane: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Halogenated anesthetics sensitize the myocardium to catecholamines, so epinephrine can provoke ventricular arrhythmias and hypertension. Isoflurane sensitizes less than halothane, but the risk persists with systemic or large-dose epinephrine.
What this interaction means in plain words
Epinephrine and Isoflurane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Epinephrine belongs to Endocrine; Isoflurane belongs to Central Nervous System.
Why it happens
Volatile anesthetic sensitization of the myocardium to catecholamine-induced arrhythmias.
What to do
Use the lowest effective epinephrine dose, titrate slowly and monitor the ECG and blood pressure continuously. Limit local infiltration doses.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Isoflurane
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Epinephrine with Isoflurane?
MediHelp rates the interaction as major. Epinephrine and Isoflurane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Halogenated anesthetics sensitize the myocardium to catecholamines, so epinephrine can provoke ventricular arrhythmias and hypertension. Isoflurane sensitizes less than halothane, but the risk persists with systemic or large-dose epinephrine.
How serious is the interaction between Epinephrine and Isoflurane?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective epinephrine dose, titrate slowly and monitor the ECG and blood pressure continuously. Limit local infiltration doses.
What other medicines interact with Isoflurane?
MediHelp also lists interactions of Isoflurane with, for example, Adrenaline-articaine, Amisulpride, Arsenic trioxide. The full list is on the Isoflurane page.
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