Drug interactions
Esketamine + Sevoflurane
Severity: Major
Esketamine and Sevoflurane: major interaction.
Last updated Sources: UK SmPC
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
Sevoflurane is a general anesthetic and with esketamine produces additive anesthetic and respiratory depressant effects. Anesthetic requirements may be reduced and blood pressure can fall or fluctuate.
What this interaction means in plain words
Esketamine and Sevoflurane 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.
Esketamine belongs to Central Nervous System; Sevoflurane belongs to Central Nervous System.
Why it happens
Additive CNS depression through GABA-A and other ion channel effects of sevoflurane plus NMDA antagonism.
What to do
Use only under anesthetic supervision with continuous monitoring, titrating the anesthetic to clinical effect and reduced requirements.
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
- Esketamine 25 mg/ml solution for injection/infusion - SmPC sections 4.3/4.5 (names the partner; "ments may therefore be needed also for esketamine. The anaesthetic effect of halogenated hydrocarbons (for example halothane, isoflurane, desflurane, sevofluran") — electronic medicines compendium (UK SmPC)
Other interactions of Esketamine
Other interactions of Sevoflurane
Frequently asked questions
Can I take Esketamine with Sevoflurane?
MediHelp rates the interaction as major. Esketamine and Sevoflurane 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. Sevoflurane is a general anesthetic and with esketamine produces additive anesthetic and respiratory depressant effects. Anesthetic requirements may be reduced and blood pressure can fall or fluctuate.
How serious is the interaction between Esketamine and Sevoflurane?
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 only under anesthetic supervision with continuous monitoring, titrating the anesthetic to clinical effect and reduced requirements.
What other medicines interact with Esketamine?
MediHelp also lists interactions of Esketamine with, for example, Alfentanil, Amobarbital, Belladonna and opium. The full list is on the Esketamine page.
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