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Alfentanil

Class
Narcotic analgesics
Subclass
Synthetic opioids
Generic name
Alfentanil hydrochloride
Common formulations
Solution for injection
Dosage and administration
Adults patients
General anesthesia • For mechanical ventilation
•
20-50 mcg/kg IV bolus over 3 minutes, followed by a dose of 5-15 mcg/kg administered every 5-20 minutes for the maintenance of anesthesia
Monitored anesthesia care sedation
•
3-8 mcg/kg IV bolus over 3 minutes, followed by a dose of 0.25-1 mcg/kg/min, for the maintenance of anesthesia
Indications for use
Labeled indications
Adults
•
Treatment of ventilator-associated pneumonia (moderately severe)
•
Facilitation of general anesthesia (for mechanical ventilation)
•
Facilitation of general anesthesia (for patients with assisted ventilation)
•
Facilitation of general anesthesia (patients requiring endotracheal intubation and mechanical ventilation)
•
Facilitation of monitored anesthesia care sedation
Safety risks
Boxed warnings
Seizures
•
Use extreme caution head trauma or with increased ICP.
Warnings and precautions
Bradycardia
•
Use caution with cardiac diseases.
COPD
•
Use caution COPD.
Exacerbation of gastrointestinal disorders
•
Use caution history of or ongoing gastrointestinal disturbances.
Hypothyroidism
•
Use caution with adrenal insufficiency.
Oliguria
•
Use caution bladder obstruction, pelvic tumors, prostatic hypertrophy, urethral stricture, or renal disease.
Sphincter of Oddi dysfunction
•
Use caution biliary tract disease.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Free fraction of drug is increased in renal failure, hence dose requirements may be reduced.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use with caution. Monitor serum concentrations. Titrate slowly. - Decrease the dosage as required and monitor closely for signs of respiratory depression, sedation, and hypotension.
Substantial chronic alcohol consumption
•
Use with caution. Titrate slowly. - Decrease the dosage as required and monitor closely for signs of respiratory depression, sedation, and hypotension.
Unexplained abnormality in LFTs
•
Use with caution. Monitor serum concentrations. Titrate slowly. - Decrease the dosage as required and monitor closely for signs of respiratory depression, sedation, and hypotension.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks.
Breastfeeding
Consider alternative agents that may be safer.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Arrhythmias, bradycardia, chest wall rigidity, nausea, vomiting
Common 1-10%
•
Apnea, hypoventilation
Uncommon < 1%
•
Anaphylaxis, bronchospasm, hypertonia, ↑ blood CO2, laryngospasm, myoclonus, postoperative delirium, headache, itching, shivering, urticaria
Unknown frequency
•
Adrenal insufficiency, klinefelter syndrome, serotonin syndrome
Interactions
Drug(s)
Check Interactions
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