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Isoflurane
Also known as: 26675-46-7, Forane, 1-chloro-2,2,2-trifluoroethyl difluoromethyl ether, 2-chloro-2-(difluoromethoxy)-1,1,1-trifluoroethane, Forene, Aerrane
Molecular Formula
C3H2ClF5O
Molecular Weight
184.49  g/mol
InChI Key
PIWKPBJCKXDKJR-UHFFFAOYSA-N
FDA UNII
CYS9AKD70P

A stable, non-explosive inhalation anesthetic, relatively free from significant side effects.
Isoflurane is a General Anesthetic. The physiologic effect of isoflurane is by means of General Anesthesia.
1 2D Structure

Isoflurane

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
2-chloro-2-(difluoromethoxy)-1,1,1-trifluoroethane
2.1.2 InChI
InChI=1S/C3H2ClF5O/c4-1(3(7,8)9)10-2(5)6/h1-2H
2.1.3 InChI Key
PIWKPBJCKXDKJR-UHFFFAOYSA-N
2.1.4 Canonical SMILES
C(C(F)(F)F)(OC(F)F)Cl
2.2 Other Identifiers
2.2.1 UNII
CYS9AKD70P
2.3 Synonyms
2.3.1 Depositor-Supplied Synonyms

1. 26675-46-7

2. Forane

3. 1-chloro-2,2,2-trifluoroethyl Difluoromethyl Ether

4. 2-chloro-2-(difluoromethoxy)-1,1,1-trifluoroethane

5. Forene

6. Aerrane

7. Isoflurano

8. Compound 469

9. Isoflo

10. Isofluranum

11. Ethane, 2-chloro-2-(difluoromethoxy)-1,1,1-trifluoro-

12. R-e 235dal

13. Terrell

14. Ether, 1-chloro-2,2,2-trifluoroethyl Difluoromethyl

15. Hsdb 8057

16. Cys9akd70p

17. Compound-469

18. Chebi:6015

19. 2-chloro-2-difluoromethoxy-1,1,1-trifluoroethane

20. Isofluranum [inn-latin]

21. Ncgc00181037-01

22. Aerrane (veterinary)

23. Dsstox_cid_752

24. Dsstox_rid_75769

25. Dsstox_gsid_20752

26. Isoba; Isofor; Isoforine; Isorrane; R-e 235da1

27. Isoflurano [inn-spanish]

28. Difluoromethyl 1-chloro-2,2,2-trifluoroethyl Ether (isoflurane)

29. Cas-26675-46-7

30. Forane (tn)

31. Ccris 3043

32. Isoflurane [anaesthetics, Volatile]

33. Einecs 247-897-7

34. Unii-cys9akd70p

35. Mfcd00066609

36. Brn 1852087

37. (+/-)-isoflurane

38. Isoflurane [usan:usp:inn:ban:jan]

39. Terrellhsdb 8057

40. Compd 469

41. Isoflurane, Aldrichcpr

42. Isoflurane [mi]

43. Isoflurane [inn]

44. Isoflurane [jan]

45. Isoflurane [usan]

46. Isoflurane [vandf]

47. Isoflurane [mart.]

48. Schembl1532

49. Chembl1256

50. Isoflurane [usp-rs]

51. Isoflurane [who-dd]

52. Difluoromethyl 1-chloro-2,2,2-trifluoroethyl Ether

53. Gtpl2505

54. Hsdb8057

55. Isoflurane (jp17/usp/inn)

56. Isoflurane [green Book]

57. Dtxsid3020752

58. Isoflurane [orange Book]

59. Hsdb-8057

60. Isoflurane [ep Monograph]

61. Bdbm217353

62. Isoflurane [usp Monograph]

63. Amy33546

64. Tox21_112685

65. Tox21_200831

66. Bbl100111

67. S6917

68. Stl454337

69. Akos006228574

70. Db00753

71. Ks-5166

72. Pb47772

73. Ncgc00181037-02

74. Ncgc00181037-03

75. Ncgc00258385-01

76. Ac-154802

77. Db-046999

78. Cs-0017450

79. Ft-0627416

80. C07518

81. D00545

82. P15338

83. A818554

84. Q413918

85. Sr-01000944965

86. Sr-01000944965-1

87. W-107162

88. 1-chloro-1-(difluoromethoxy)-2,2,2-trifluoroethane

89. 2-chloro-2-(difluoromethoxy)-1,1,1-trifluoro-ethane

90. 1-chloro-2,2,2-trifluroethyl Difluromethyl Ether

91. Ethane, 1-chloro-1-(difluoromethoxy)-2,2,2-trifluoro-

92. 2-[bis(fluoranyl)methoxy]-2-chloranyl-1,1,1-tris(fluoranyl)ethane

2.4 Create Date
2005-03-25
3 Chemical and Physical Properties
Molecular Weight 184.49 g/mol
Molecular Formula C3H2ClF5O
XLogP32.1
Hydrogen Bond Donor Count0
Hydrogen Bond Acceptor Count6
Rotatable Bond Count2
Exact Mass183.9714332 g/mol
Monoisotopic Mass183.9714332 g/mol
Topological Polar Surface Area9.2 Ų
Heavy Atom Count10
Formal Charge0
Complexity102
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count1
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 4  
Drug NameForane
Drug LabelFORANE (isoflurane, USP), a nonflammable liquid administered by vaporizing, is a general inhalation anesthetic drug. It is 1-chloro-2, 2,2-trifluoroethyl difluoromethyl ether, and its structural formula is:Some physical constants are:Molecular weight...
Active IngredientIsoflurane
Dosage FormLiquid
RouteInhalation
Strength99.9%
Market StatusPrescription
CompanyBaxter Hlthcare

2 of 4  
Drug NameIsoflurane
Drug LabelIsoflurane, USP, is a nonflammable, nonexplosive general inhalation anesthetic agent. Its chemical name is 1-chloro-2,2,2-trifluoroethyl difluoromethyl ether, and its structural formula is:Each mL contains 99.9% Isoflurane.Some physical const...
Active IngredientIsoflurane
Dosage FormLiquid
RouteInhalation
Strength99.9%
Market StatusPrescription
CompanyHospira; Halocarbon Prods; Piramal Critical; Piramal Ent

3 of 4  
Drug NameForane
Drug LabelFORANE (isoflurane, USP), a nonflammable liquid administered by vaporizing, is a general inhalation anesthetic drug. It is 1-chloro-2, 2,2-trifluoroethyl difluoromethyl ether, and its structural formula is:Some physical constants are:Molecular weight...
Active IngredientIsoflurane
Dosage FormLiquid
RouteInhalation
Strength99.9%
Market StatusPrescription
CompanyBaxter Hlthcare

4 of 4  
Drug NameIsoflurane
Drug LabelIsoflurane, USP, is a nonflammable, nonexplosive general inhalation anesthetic agent. Its chemical name is 1-chloro-2,2,2-trifluoroethyl difluoromethyl ether, and its structural formula is:Each mL contains 99.9% Isoflurane.Some physical const...
Active IngredientIsoflurane
Dosage FormLiquid
RouteInhalation
Strength99.9%
Market StatusPrescription
CompanyHospira; Halocarbon Prods; Piramal Critical; Piramal Ent

4.2 Therapeutic Uses

FORANE (isoflurane, USP) may be used for induction and maintenance of general anesthesia. Adequate data have not been developed to establish its application in obstetrical anesthesia.

US Natl Inst Health; DailyMed. Current Medication Information for Forane (isoflurane) inhalant (December 2011). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3d30eb8d-a62e-475f-926b-78ba63bee9c8


In cases of life-threatening status asthmaticus which are refractory to drug therapy, the administration of inhalation anesthetics can be life-saving as they help alleviate bronchial spasm. We had an 11-year-old female patient suffering from status asthmaticus who was moribund from severe CO2 narcosis and was not responding to any of the conventional therapies. She finally fell into ventricular fibrillation. After cardiopulmonary resuscitation, we administered 2.0% isoflurane in oxygen. Within half an hour, her high inspiratory pressure was dramatically decreased, and then the isoflurane concentration was maintained at 1.0%. After 14 hours of isoflurane anesthesia, PaCO2 decreased to the normal level and the isoflurane treatment was discontinued. The endotracheal tube was removed 4 hours later. She had an uneventful recovery and was discharged from the hospital 11 days later. With its low metabolic rate and therefore low organ toxicity, as well as its low arrhythmogenicity with remarkable bronchodilating activity, we feel isoflurane may well be superior to other inhalation anesthetics in the treatment of status asthmaticus.

PMID:8433481 Shibata Y et al; Masui 42 (1): 116-9 (1993)


Vet: Isoflurane, USP is used for induction and maintenance of general anesthesia in horses and dogs.

US Natl Inst Health; DailyMed. Current Medication Information for Isoflurane USP (isoflurane) inhalant (August 2009). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=b0c8964f-24a8-4bab-ae8d-1536737e43ec


4.3 Drug Warning

Anesthetics, Inhalation

National Library of Medicine's Medical Subject Headings online file (MeSH, 2009) https://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?mode=&term=Isoflurane


In susceptible individuals, isoflurane anesthesia may trigger a skeletal muscle hypermetabolic state leading to high oxygen demand and the clinical syndrome known as malignant hyperthermia. The syndrome includes nonspecific features such as muscle rigidity, tachycardia, tachypnea, cyanosis, arrhythmias, and unstable blood pressure. (It should also be noted that many of these nonspecific signs may appear with light anesthesia, acute hypoxia, etc.) An increase in overall metabolism may be reflected in an elevated temperature, (which may rise rapidly early or late in the case, but usually is not the first sign of augmented metabolism) and an increased usage of the CO2 absorption system (hot canister). PaO2 and pH may decrease, and hyperkalemia and a base deficit may appear.

US Natl Inst Health; DailyMed. Current Medication Information for Forane (isoflurane) inhalant (December 2011). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3d30eb8d-a62e-475f-926b-78ba63bee9c8


Since levels of anesthesia may be altered easily and rapidly, only vaporizers producing predictable concentrations should be used. Hypotension and respiratory depression increase as anesthesia is deepened.

US Natl Inst Health; DailyMed. Current Medication Information for Forane (isoflurane) inhalant (December 2011). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3d30eb8d-a62e-475f-926b-78ba63bee9c8


Increased blood loss comparable to that seen with halothane has been observed in patients undergoing abortions.

US Natl Inst Health; DailyMed. Current Medication Information for Forane (isoflurane) inhalant (December 2011). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3d30eb8d-a62e-475f-926b-78ba63bee9c8


For more Drug Warnings (Complete) data for Isoflurane (24 total), please visit the HSDB record page.


4.4 Drug Indication

For induction and maintenance of general anesthesia.


FDA Label


Sedation of mechanically ventilated patients


5 Pharmacology and Biochemistry
5.1 Pharmacology

Isoflurane is a general inhalation anesthetic used for induction and maintenance of general anesthesia. It induces muscle relaxation and reduces pains sensitivity by altering tissue excitability. It does so by decreasing the extent of gap junction mediated cell-cell coupling and altering the activity of the channels that underlie the action potential.


5.2 MeSH Pharmacological Classification

Anesthetics, Inhalation

Gases or volatile liquids that vary in the rate at which they induce anesthesia; potency; the degree of circulation, respiratory, or neuromuscular depression they produce; and analgesic effects. Inhalation anesthetics have advantages over intravenous agents in that the depth of anesthesia can be changed rapidly by altering the inhaled concentration. Because of their rapid elimination, any postoperative respiratory depression is of relatively short duration. (From AMA Drug Evaluations Annual, 1994, p173) (See all compounds classified as Anesthetics, Inhalation.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
ISOFLURANE
5.3.2 FDA UNII
CYS9AKD70P
5.3.3 Pharmacological Classes
General Anesthetic [EPC]; General Anesthesia [PE]
5.4 ATC Code

N - Nervous system

N01 - Anesthetics

N01A - Anesthetics, general

N01AB - Halogenated hydrocarbons

N01AB06 - Isoflurane


5.5 Absorption, Distribution and Excretion

In the postanesthesia period, only 0.17% of the isoflurane taken up can be recovered as urinary metabolites.

US Natl Inst Health; DailyMed. Current Medication Information for Forane (isoflurane) inhalant (December 2011). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3d30eb8d-a62e-475f-926b-78ba63bee9c8


It is not known whether this drug is excreted in human milk.

US Natl Inst Health; DailyMed. Current Medication Information for Forane (isoflurane) inhalant (December 2011). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3d30eb8d-a62e-475f-926b-78ba63bee9c8


5.6 Metabolism/Metabolites

Minimal


Renal and hepatic toxicity of the fluorinated ether volatile anesthetics is caused by biotransformation to toxic metabolites. Metabolism also contributes significantly to the elimination pharmacokinetics of some volatile agents. Although innumerable studies have explored anesthetic metabolism in animals, there is little information on human volatile anesthetic metabolism with respect to comparative rates or the identity of the enzymes responsible for defluorination. The first purpose of this investigation was to compare the metabolism of the fluorinated ether anesthetics by human liver microsomes. The second purpose was to test the hypothesis that cytochrome P450 2E1 is the specific P450 isoform responsible for volatile anesthetic defluorination in humans. Microsomes were prepared from human livers. Anesthetic metabolism in microsomal incubations was measured by fluoride production. The strategy for evaluating the role of P450 2E1 in anesthetic defluorination involved three approaches: for a series of 12 human livers, correlation of microsomal defluorination rate with microsomal P450 2E1 content (measured by Western blot analysis), correlation of defluorination rate with microsomal P450 2E1 catalytic activity using marker substrates (para-nitrophenol hydroxylation and chlorzoxazone 6-hydroxylation), and chemical inhibition by P450 isoform-selective inhibitors. The rank order of anesthetic metabolism, assessed by fluoride production at saturating substrate concentrations, was methoxyflurane > sevoflurane > enflurane > isoflurane > desflurane > 0. There was a significant linear correlation of sevoflurane and methoxyflurane defluorination with antigenic P450 2E1 content (r = 0.98 and r = 0.72, respectively), but not with either P450 1A2 or P450 3A3/4. Comparison of anesthetic defluorination with either para-nitrophenol or chlorzoxazone hydroxylation showed a significant correlation for sevoflurane (r = 0.93, r = 0.95) and methoxyflurane (r = 0.78, r = 0.66). Sevoflurane defluorination was also highly correlated with that of enflurane (r = 0.93), which is known to be metabolized by human P450 2E1. Diethyldithiocarbamate, a selective inhibitor of P450 2E1, produced a concentration-dependent inhibition of sevoflurane, methoxyflurane, and isoflurane defluorination. No other isoform-selective inhibitor diminished the defluorination of sevoflurane, whereas methoxyflurane defluorination was inhibited by the selective P450 inhibitors furafylline (P450 1A2), sulfaphenazole (P450 2C9/10), and quinidine (P450 2D6) but to a much lesser extent than by diethyldithiocarbamate. These results demonstrate that cytochrome P450 2E1 is the principal, if not sole human liver microsomal enzyme catalyzing the defluorination of sevoflurane. P450 2E1 is the principal, but not exclusive enzyme responsible for the metabolism of methoxyflurane, which also appears to be catalyzed by P450s 1A2, 2C9/10, and 2D6. The data also suggest that P450 2E1 is responsible for a significant fraction of isoflurane metabolism. Identification of P450 2E1 as the major anesthetic metabolizing enzyme in humans provides a mechanistic understanding of clinical fluorinated ether anesthetic metabolism and toxicity.

PMID:8214760 Kharasch ED, Thummel KE; Anesthesiology 79 (4): 795-807 (1993)


Isoflurane undergoes minimal biotransformation in man.

US Natl Inst Health; DailyMed. Current Medication Information for Forane (isoflurane) inhalant (December 2011). Available from, as of July 23, 2012: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3d30eb8d-a62e-475f-926b-78ba63bee9c8


Renal and hepatic toxicity of the fluorinated ether volatile anesthetics is caused by biotransformation to toxic metabolites. Metabolism also contributes significantly to the elimination pharmacokinetics of some volatile agents. Although innumerable studies have explored anesthetic metabolism in animals, there is little information on human volatile anesthetic metabolism with respect to comparative rates or the identity of the enzymes responsible for defluorination. The first purpose of this investigation was to compare the metabolism of the fluorinated ether anesthetics by human liver microsomes. The second purpose was to test the hypothesis that cytochrome P450 2E1 is the specific P450 isoform responsible for volatile anesthetic defluorination in humans. Microsomes were prepared from human livers. Anesthetic metabolism in microsomal incubations was measured by fluoride production. The strategy for evaluating the role of P450 2E1 in anesthetic defluorination involved three approaches: for a series of 12 human livers, correlation of microsomal defluorination rate with microsomal P450 2E1 content (measured by Western blot analysis), correlation of defluorination rate with microsomal P450 2E1 catalytic activity using marker substrates (para-nitrophenol hydroxylation and chlorzoxazone 6-hydroxylation), and chemical inhibition by P450 isoform-selective inhibitors. The rank order of anesthetic metabolism, assessed by fluoride production at saturating substrate concentrations, was methoxyflurane > sevoflurane > enflurane > isoflurane > desflurane > 0. There was a significant linear correlation of sevoflurane and methoxyflurane defluorination with antigenic P450 2E1 content (r = 0.98 and r = 0.72, respectively), but not with either P450 1A2 or P450 3A3/4. Comparison of anesthetic defluorination with either para-nitrophenol or chlorzoxazone hydroxylation showed a significant correlation for sevoflurane (r = 0.93, r = 0.95) and methoxyflurane (r = 0.78, r = 0.66). Sevoflurane defluorination was also highly correlated with that of enflurane (r = 0.93), which is known to be metabolized by human P450 2E1. Diethyldithiocarbamate, a selective inhibitor of P450 2E1, produced a concentration-dependent inhibition of sevoflurane, methoxyflurane, and isoflurane defluorination. No other isoform-selective inhibitor diminished the defluorination of sevoflurane, whereas methoxyflurane defluorination was inhibited by the selective P450 inhibitors furafylline (P450 1A2), sulfaphenazole (P450 2C9/10), and quinidine (P450 2D6) but to a much lesser extent than by diethyldithiocarbamate. These results demonstrate that cytochrome P450 2E1 is the principal, if not sole human liver microsomal enzyme catalyzing the defluorination of sevoflurane. P450 2E1 is the principal, but not exclusive enzyme responsible for the metabolism of methoxyflurane, which also appears to be catalyzed by P450s 1A2, 2C9/10, and 2D6. The data also suggest that P450 2E1 is responsible for a significant fraction of isoflurane metabolism. Identification of P450 2E1 as the major anesthetic metabolizing enzyme in humans provides a mechanistic understanding of clinical fluorinated ether anesthetic metabolism and toxicity.

PMID:8214760 Kharasch ED, Thummel KE; Anesthesiology 79 (4): 795-807 (1993)


5.7 Mechanism of Action

Isoflurane induces a reduction in junctional conductance by decreasing gap junction channel opening times and increasing gap junction channel closing times. Isoflurane also activates calcium dependent ATPase in the sarcoplasmic reticulum by increasing the fluidity of the lipid membrane. Also appears to bind the D subunit of ATP synthase and NADH dehydogenase. Isoflurane also binds to the GABA receptor, the large conductance Ca2+ activated potassium channel, the glutamate receptor and the glycine receptor.


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