Sevoflurane
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Sevoflurane: From General Anaesthesia to Prinzmetal Angina
One-Sentence Summary
Sevoflurane is an inhaled general anaesthetic used for induction and maintenance of anaesthesia in a controlled perioperative setting. The TxGNN model predicts it may be effective for Prinzmetal angina, but this is a model prediction only, with 0 clinical trials and 0 publications supporting this direction.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | General anaesthesia (inhaled anaesthetic; the registered indication text is not available in the Singapore licence records) |
| Predicted New Indication | Prinzmetal angina |
| TxGNN Prediction Score | 99.78% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 4 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Based on general pharmacology, sevoflurane is a volatile anaesthetic that enhances GABA-A receptor activity and inhibits NMDA and nicotinic receptors. Volatile anaesthetics also have vasodilatory effects on vascular smooth muscle, partly through calcium channel modulation.
Prinzmetal angina is caused by coronary artery vasospasm. A vasodilatory effect could therefore, in theory, relate to this condition. However, no clinical or literature support was found for this link. Sevoflurane is given only in a controlled perioperative setting, so chronic or preventive use for vasospastic angina is not plausible. The prediction should be treated as a hypothesis, not as evidence of benefit.
Other high-scoring predictions, none of which has clinical trial evidence, are:
| Rank | Predicted Indication | Score | Evidence Level | Assessment |
|---|---|---|---|---|
| 2 | Tourette syndrome | 99.50% | L5 | No studies; inhaled anaesthesia is impractical for a chronic condition |
| 3 | Fibromyalgia | 99.42% | L4 | One case report on anaesthetic management only; indirect |
| 4 | Tendinitis | 99.41% | L4 | Anaesthesia studies in tendon surgery; the link is a surgical context, not treatment |
| 5 | Myositis fibrosa | 99.41% | L5 | No studies and no plausible mechanism |
| 6 | Idiopathic granulomatous myositis | 99.41% | L5 | No studies |
| 7 | Nephrogenic syndrome of inappropriate antidiuresis | 99.40% | L5 | No action on the V2 receptor pathway; nephrotoxicity concerns |
| 8 | Trichotillomania | 99.33% | L5 | No studies; nonspecific CNS effects |
| 9 | Migraine disorder | 99.23% | L4 | Only a paediatric MRI anaesthesia cohort; volatile agents can cause headache |
| 10 | Inclusion body myositis | 99.09% | L4 | One case report on perioperative management only |
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature is available for Prinzmetal angina.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN16819P | NOREVELL Inhalation Anaesthetic Liquid 100% | Inhalant | Not stated in the licence record |
| SIN14780P | SOJOURN Inhalation Anaesthetic Liquid 100% | Inhalant | Not stated in the licence record |
| SIN08264P | SEVORANE Inhalation | Solution | Not stated in the licence record |
| SIN13741P | Sevoflurane Inhalation Anaesthetic Liquid 100% | Inhalant | Not stated in the licence record |
Safety Considerations
- Disease associations flagged in the knowledge graph (not label text): the TxGNN knowledge graph lists contraindication links with epilepsy, kidney disease, pyoureter, liver disease, gallbladder disease, hypotensive disorder, malignant hyperthermia of anaesthesia, exercise-induced malignant hyperthermia, pseudotumor cerebri, intracranial hypertension, Duchenne muscular dystrophy, muscular dystrophy, Becker muscular dystrophy and proteinuria. These must be checked against the approved package insert. Hypotension is particularly relevant to a cardiovascular indication.
- Drug Interactions: 100 interactions were recorded; the first 20 retrieved are summarized here.
- Major: epinephrine, dolasetron, cisapride.
- Moderate (examples): morphine, ondansetron, palonosetron, clarithromycin, levofloxacin, famotidine, exenatide, loperamide and several laxatives and bowel-preparation agents.
- Minor: metronidazole.
The package insert warnings and contraindications could not be retrieved and should be reviewed directly.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction rests on model score alone (L5), with no clinical trials or supporting literature for Prinzmetal angina. Sevoflurane is a perioperative inhaled anaesthetic, so chronic or preventive use for vasospastic angina is impractical. Package insert safety data is also missing.
To proceed, the following is needed:
- Package insert warnings and contraindications from the HSA records, which is a blocking gap for safety screening
- Mechanism of action data (for example from DrugBank) to support any analysis of a mechanistic link
- Preclinical or clinical evidence of an effect on coronary vasospasm
- A feasibility assessment of a practical route and setting of use, given that sevoflurane is an inhaled agent used only under controlled anaesthesia
- A review of the knowledge-graph contraindication signals, including hypotension and malignant hyperthermia, against the label
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.