The ‘green whistle‘ offers effective analgesia for up to one hour in patients suffering from trauma, or during planned procedures such as dressing changes and even childbirth. It is available under the PBS for doctors’ bag emergency supplies, and offered by paramedics in ambulances or by certified lifesavers.

Patients must be conscious to self-administer the smallest effective dose from the 3ml inhaler, haemodynamically stable, and monitored. No more than 2 vials (6ml) should be used per day, or 15ml per week; and preferably not on consecutive days to prevent accumulation in fatty tissues.

Methoxyflurane should not be used as an anaesthetic because of dose related renal failure, which may be exacerbated by other nephrotoxic drugs including some antibiotics (gentamicin, kanamycin, colistin, polymyxin b, cephaloridine and amphotericin b).

Adverse reactions have not been quantified, and are generally minor, but included the possibility of malignant hyperthermia in susceptible patients. Of 25 adverse events reported in 10 patients since 2000, 6 were hepatic, and 3 gastrointestinal. Elevation of liver enzymes, blood urea nitrogen and serum uric acid have also been reported by exposed health workers, who should apply Work Health and Safety Guidelines to reduce occupational exposure to methoxyflurane.

Before prescribing please review the full Product Information.

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