Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
SUPRANE vs ENFLURANE
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Suprane (desflurane) is a volatile general anesthetic that potentiates GABA-A receptor activity and inhibits NMDA receptor function, leading to neuronal hyperpolarization and depression of central nervous system activity.
Enflurane is a volatile halogenated ether that potentiates GABA-A receptor activity, inhibits NMDA receptors, and enhances glycine receptor function, leading to generalized central nervous system depression and anesthesia.
Induction and maintenance of general anesthesia for inpatient and outpatient surgery in adults and children,Maintenance of anesthesia in pediatric patients
Induction and maintenance of general anesthesia,Supplement to nitrous oxide and oxygen anesthesia
Induction: 0.5-3% inspired concentration in oxygen or oxygen/nitrous oxide mixture; Maintenance: 0.5-2% inspired concentration. Administered via inhalation using a calibrated vaporizer.
Induction: 0.5-4.5% inspired concentration; Maintenance: 0.5-3% inspired concentration with oxygen/nitrous oxide; via inhalation.
Context-sensitive half-life: 2-5 minutes after brief administration; prolonged to 20-40 minutes after prolonged administration due to slow release from fat stores.
Terminal elimination half-life is approximately 4-8 hours in adults; context: prolonged with obesity due to high lipid solubility and storage in adipose tissue.
Minimal hepatic metabolism (less than 0.02%) via CYP2E1; primarily eliminated unchanged by the lungs.
Primarily hepatic via cytochrome P450 (CYP2E1); approximately 2% undergoes oxidative metabolism to difluoromethoxy-difluoroacetic acid and fluoride ions; rest is excreted unchanged by lungs.
Primarily eliminated by the lungs with minimal metabolism (<5%). Less than 0.2% of the absorbed dose is excreted renally as unchanged drug.
Primarily eliminated by pulmonary excretion as unchanged drug (>90%); less than 5% is metabolized via CYP2E1 to fluoride ions and other metabolites, which are renally excreted.
~60% bound to serum proteins, primarily albumin and lipoproteins.
Approximately 55-75% bound to serum proteins, primarily albumin and alpha-1-acid glycoprotein.
Vd: 0.6-0.8 L/kg at steady state; large distribution into lipid-rich tissues.
Volume of distribution at steady state (Vdss) is approximately 3.5-4.5 L/kg, indicating extensive tissue distribution and lipid solubility.
Inhalation: ~100% due to complete absorption from the lungs; no oral bioavailability is clinically relevant.
Inhalation: Bioavailability is essentially 100% as administered via inhalation, with rapid absorption across the alveolar-capillary barrier.
No dose adjustment required for renal impairment; Suprane is minimally metabolized and renally excreted.
No specific GFR-based dose adjustment required; however, monitor for nephrotoxicity in severe renal impairment (e GFR <30 m L/min) due to potential fluoride ion accumulation.
No specific dose adjustment for Child-Pugh class A or B; caution in severe hepatic impairment (Child-Pugh C) due to potential decreased clearance, consider reduced maintenance concentrations.
Child-Pugh A: no adjustment; Child-Pugh B: use with caution, reduce concentration; Child-Pugh C: avoid due to risk of hepatotoxicity and altered metabolism.
Induction: 3% inspired concentration in oxygen (or oxygen/nitrous oxide) for unpremedicated children, titrated to effect; Maintenance: 1-2% inspired concentration. Adjust based on age and response.
Induction: 1-4% inspired concentration; Maintenance: 0.5-2% inspired concentration; adjust based on age and response.
Elderly patients (≥65 years): Reduce induction and maintenance concentrations by 20-50% due to increased sensitivity and slower recovery; typical maintenance 0.5-1.5% inspired.
Reduce inspired concentration by 25-50% due to decreased minimal alveolar concentration (MAC) and increased sensitivity; monitor hemodynamics closely.
Suprane is contraindicated for induction of anesthesia in pediatric patients due to a high incidence of laryngospasm, coughing, breath-holding, and hypoxia.
None
Risk of malignant hyperthermia,Risk of perioperative hypersensitivity reactions including anaphylaxis,Risk of QT prolongation and torsades de pointes,Risk of hepatotoxicity in patients with previous exposure to halogenated anesthetics,May cause dose-dependent respiratory depression,Use caution in patients with increased intracranial pressure,May cause hypotension and bradycardia
May cause dose-dependent respiratory and cardiovascular depression,Risk of seizures (especially with deep anesthesia or hypocarbia),Potential for hepatotoxicity (rare, but caution in patients with pre-existing liver disease),Malignant hyperthermia risk,Should not be used in patients with known sensitivity to halogenated anesthetics
Known or suspected susceptibility to malignant hyperthermia,Known hypersensitivity to desflurane or other halogenated anesthetics,Induction of anesthesia in pediatric patients,Patients with a history of hepatitis or unexplained jaundice after previous halogenated anesthetic use
Known hypersensitivity to enflurane or other halogenated anesthetics,Known or suspected genetic susceptibility to malignant hyperthermia,Severe hypotension or hypovolemia (relative),Prior history of hepatitis after halothane or other halogenated agents (relative)
No direct food interactions; fasting is required before anesthesia (typically NPO for 6-8 hours for solids, 2 hours for clear liquids) to reduce aspiration risk during induction.
No specific food interactions known for enflurane. Avoid alcohol for at least 24 hours post-anesthesia as it may increase sedation and hepatotoxicity risk.
Sevoflurane (Suprane) is classified as FDA Pregnancy Category B. Animal studies have not demonstrated teratogenic effects, but there are no adequate and well-controlled studies in pregnant women. Use in the first trimester should be avoided unless essential. In the second and third trimesters, it is used for general anesthesia; however, it may produce uterine relaxation and fetal depression. Prolonged or repeated exposure should be avoided due to potential neurotoxicity in the developing fetus.
Enflurane is not recommended during the first and second trimesters due to potential teratogenicity based on animal studies showing fetal malformations. During the third trimester, use is avoided for elective procedures as it may cause uterine relaxation and fetal depression. Risk is dose-dependent and duration-dependent.
Sevoflurane is rapidly eliminated; trace amounts may be excreted into breast milk. The M/P ratio is not established. Due to rapid clearance, the risk to the infant is low. The manufacturer recommends discontinuing breastfeeding for 24 hours after anesthesia to minimize exposure.
Enflurane is excreted into breast milk in low concentrations. The M/P ratio is not well established but estimated around 0.5-1.0. Because of rapid clearance and minimal oral bioavailability, a single exposure is considered compatible with breastfeeding after waiting 24 hours. No adverse effects reported in infants.
No specific dose adjustments are recommended for sevoflurane during pregnancy. Pharmacokinetic changes in pregnancy (e.g., increased volume of distribution, decreased protein binding) may require higher induction doses and more rapid adjustments. Maintenance doses should be titrated to effect with careful monitoring of maternal vital signs and fetal heart rate.
Pregnancy may decrease MAC (minimum alveolar concentration) by up to 40% due to progesterone and endogenous opioids. Dose should be reduced accordingly. No specific dose adjustment based on pharmacokinetic changes, but careful titration to effect is required.
Suprane (desflurane) has a low blood-gas partition coefficient (0.42) enabling rapid induction and emergence. It is a potent bronchodilator but can cause airway irritation and coughing during induction; avoid in pediatric mask inductions. Contraindicated in patients with known or suspected malignant hyperthermia susceptibility. Requires a calibrated vaporizer due to high vapor pressure (near-ambient). Can produce dose-dependent hypotension and respiratory depression.
Enflurane is a potent inhalation anesthetic that can cause dose-dependent myocardial depression and hypotension. It sensitizes the myocardium to catecholamines, increasing arrhythmia risk. Enflurane may provoke seizure activity at high concentrations or with hypocapnia. Malignant hyperthermia trigger. Use caution in patients with hepatic or renal impairment due to fluoride ion release.
You will be given this anesthetic gas through a mask or breathing tube to keep you asleep during surgery.,You may experience a temporary sore throat or cough after waking up.,Common side effects include nausea, vomiting, and shivering as you recover.,You should not drive or operate machinery for at least 24 hours after anesthesia.,Inform your doctor if you have any personal or family history of malignant hyperthermia.
You will be unconscious and feel no pain during surgery.,You may experience nausea or shivering after waking up.,Inform your anesthesiologist if you have a personal or family history of malignant hyperthermia.,Avoid operating machinery or driving for at least 24 hours after anesthesia.,Report any unusual muscle stiffness, fever, or dark urine after surgery.
No interactions on record
"Enflurane, a halogenated volatile anesthetic, and venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), both inhibit neuronal reuptake of monoamines, leading to increased central nervous system (CNS) levels of serotonin and norepinephrine. Concurrent use may potentiate the risk of serotonin syndrome, characterized by agitation, hyperthermia, autonomic instability, and neuromuscular hyperactivity. Additionally, venlafaxine can lower the seizure threshold, while enflurane may produce epileptiform EEG activity, raising the potential for perioperative seizures."
"Enflurane is a halogenated volatile anesthetic that potentiates the effects of gamma-aminobutyric acid (GABA) at GABA-A receptors, leading to central nervous system (CNS) depression. Tiapride, a selective dopamine D2 receptor antagonist, can also cause CNS depression and prolong the QT interval. Combined use may result in additive CNS depression, increasing the risk of excessive sedation, respiratory depression, and hypotension. Additionally, both drugs can lower the seizure threshold, potentially increasing the risk of perioperative seizures."
"The combination of enflurane and levobupivacaine increases the risk of cardiotoxicity and central nervous system (CNS) toxicity. Enflurane sensitizes the myocardium to the arrhythmogenic effects of levobupivacaine, potentially leading to severe ventricular arrhythmias. Additionally, both drugs depress myocardial contractility and conduction, which may result in hypotension, bradycardia, or cardiac arrest."
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about SUPRANE vs ENFLURANE, answered by our medical review team.
SUPRANE is a Inhalational Anesthetic that works by Suprane (desflurane) is a volatile general anesthetic that potentiates GABA-A receptor activity and inhibits NMDA receptor function, leading to neuronal hyperpolarization and depression of central nervous system activity.. ENFLURANE is a Inhalational Anesthetic that works by Enflurane is a volatile halogenated ether that potentiates GABA-A receptor activity, inhibits NMDA receptors, and enhances glycine receptor function, leading to generalized central nervous system depression and anesthesia.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between SUPRANE and ENFLURANE depend on the specific clinical indication. These are both Inhalational Anesthetic agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of SUPRANE is: Induction: 0.5-3% inspired concentration in oxygen or oxygen/nitrous oxide mixture; Maintenance: 0.5-2% inspired concentration. Administered via inhalation using a calibrated vaporizer.. The standard adult dose of ENFLURANE is: Induction: 0.5-4.5% inspired concentration; Maintenance: 0.5-3% inspired concentration with oxygen/nitrous oxide; via inhalation.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between SUPRANE and ENFLURANE in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. SUPRANE is classified as Category C. Sevoflurane (Suprane) is classified as FDA Pregnancy Category B. Animal studies have not demonstrated teratogenic effects, but there are no adequate and well-controlled studies in . ENFLURANE is classified as Category C. Enflurane is not recommended during the first and second trimesters due to potential teratogenicity based on animal studies showing fetal malformations. During the third trimester,. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.