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Remifentanil

Class
Narcotic analgesics
Subclass
Synthetic opioids
Substance name
Remifentanil hydrochloride
Brand names
Ultiva®
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Symptomatic relief of pain • Moderate-to-severe
•
0.1 mcg/kg/min IV continuous infusion
Indications for use
Labeled indications
Adults
•
Symptomatic relief of pain (moderate-to-severe)
•
Facilitation of general anesthesia
•
Induction of general anesthesia
Safety risks
Boxed warnings
Respiratory depression
•
Use extreme caution with pulmonary disease, including COPD or concurrent use of alcohol or other CNS depressants.
Seizures
•
Use extreme caution with head trauma, increased ICP, or a pre-existing seizure disorder.
Urinary retention
•
Use extreme caution with bladder obstruction, pelvic tumors, prostatic hypertrophy, urethral stricture, or renal disease.
Contraindications
Known remifentanil hypersensitivity or fentanyl-analog hypersensitivity
Warnings and precautions
Exacerbation of constipation
•
Use caution with pre-existing gastrointestinal obstruction.
Intravenous drug abuse
•
Use caution with a personal or family history of substance abuse (including alcoholism) or mental illness (e.g., major depression).
Sinus bradycardia
•
Use caution with a history of cardiac disease (e.g., angina, HF), hypotension, cardiac arrhythmias or hypovolemia.
Sphincter of Oddi dysfunction
•
Use caution with biliary tract disease.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
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 acceptable. No dose adjustment required.
Substantial chronic alcohol consumption
•
Use with caution. Monitor serum concentrations. Monitor for toxicity.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Monitor for neonatal opioid withdrawal syndrome. Monitor neonates for respiratory depression. Neonates exposed to opioid analgesics during labor should be monitored for signs of excess sedation and respiratory depression.
•
Prolonged maternal use of opioids during pregnancy can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Unlikely to cause adverse effects in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Hypotension, muscular rigidity, generalized pruritus, headache, nausea, vomiting
Common 1-10%
•
AF, acne, agitation, apnea, bradycardia, coagulation disorder, ↓ cardiac output, hypertension, bleeding, constipation, dizziness, pain, sweating, respiratory depression, shivering, silent myocardial ischemia, tachycardia, wheezing
Uncommon < 1%
•
AV block, anaphylaxis, cardiac arrhythmias, involuntary movements, premature ventricular complexes, fever, VF
Unknown frequency
•
Asystole, hemodynamic instability, nystagmus, pleural effusion, anxiety, confusion, injection site reactions, low urine output, seizure, skin rash, visual disturbances, serotonin syndrome, sphincter of Oddi dysfunction
Interactions
Drug(s)
Check Interactions
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