Remifentanil Side Effects
Some side effects of remifentanil may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to remifentanil: intravenous powder for solution
Along with its needed effects, remifentanil may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking remifentanil:More common
- Blurred vision
- chest pain or discomfort
- difficult or troubled breathing
- dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
- irregular, fast or slow, or shallow breathing
- lightheadedness, dizziness, or fainting
- muscle stiffness or tightness
- pale or blue lips, fingernails, or skin
- shortness of breath
- slow or irregular heartbeat
- unusual tiredness or weakness
- Bluish lips or skin
- decrease in cardiac output
- fast, pounding, or irregular heartbeat or pulse
- feeling of warmth
- nausea or vomiting
- not breathing
- pain after surgery
- pain in the shoulders, arms, jaw, or neck
- pounding in the ears
- problems with bleeding or clotting
- redness of the face, neck, arms, and occasionally, upper chest
- Abdominal or stomach pain
- black, tarry stools
- bleeding gums
- blood in the urine or stools
- body aches or pain
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- cough or hoarseness
- cough producing mucus
- coughing that sometimes produces a pink frothy sputum
- coughing up blood
- decreased frequency or amount of urine
- difficult, fast, or noisy breathing, sometimes with wheezing
- difficulty with swallowing
- dry mouth
- dryness or soreness of the throat
- eye pain
- flushed, dry skin
- fruit-like breath odor
- general feeling of illness
- increased blood pressure
- increased hunger
- increased menstrual flow or vaginal bleeding
- increased sweating
- increased thirst
- increased urination
- loss of appetite
- lower back or side pain
- muscle cramps or pain
- noisy breathing
- numbness or tingling in the hands, feet, or lips
- painful or difficult urination
- pale skin
- pinpoint red spots on the skin
- prolonged bleeding from cuts
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- rapid heartbeat
- red or black, tarry stools
- red or dark brown urine
- runny nose
- shakiness in the legs, arms, hands, or feet
- skin rash
- small clicking, bubbling, or rattling sounds in the lungs when listening with a stethoscope
- stuffy nose
- swelling in the legs and ankles
- swelling of the face, fingers, or lower legs
- tender, swollen glands in the neck
- tightness in the chest
- troubled breathing with exertion
- unexplained weight loss
- unusual bleeding or bruising
- voice changes
- weakness and heaviness of the legs
- weight gain
Some side effects of remifentanil may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Less common
- blurred or loss of vision
- difficulty having a bowel movement (stool)
- disturbed color perception
- double vision
- halos around lights
- night blindness
- overbright appearance of lights
- pain at the injection site
- trouble with sleeping
- tunnel vision
- Burning while urinating
- hives or welts
- loss of bladder control
- loss of memory
- problems with memory
- seeing, hearing, or feeling things that are not there
- severe constipation
- severe vomiting
- trouble with urinating
- uncontrolled eye movements
For Healthcare Professionals
Applies to remifentanil: intravenous powder for injection
Respiratory side effects have included respiratory depression, apnea, and hypoxia. These effects have tended to occur most frequently in the immediate postoperative period.
Extremely small doses of remifentanil can cause serious respiratory depression.
Amin and colleagues have shown that respiratory depression due to remifentanil is reversed within 10 minutes upon withdrawal of the drug. The administration of naloxone has not been shown to be more effective than withdrawal of remifentanil alone.
Gastrointestinal side effects including nausea (22% to 44%) and vomiting (8% to 22%) have been reported to occur most frequently in the postoperative period.
Cardiovascular side effects such as hypotension (4% to 19%) and bradycardia (1% to 7%) have been reported to occur most frequently during the induction and maintenance period. Hypertension and tachycardia have been rare events.
Bradycardia and hypotension are probably due to a centrally mediated increase in vagal nerve activity. Glycopyrrolate, atropine and/or ephedrine may be useful in treating these effects. Unlike morphine, decreases in blood pressure are not due to histamine release.
Dershwitz and colleagues describe a case in which a patient who was taking 100 mg of metoprolol twice a day for hypertension experienced severe bradycardia and hypotension within 2 minutes of receiving remifentanil intravenously at 0.3 mg/kg/min. These symptoms responded to atropine, ephedrine and phenylephrine. Remifentanil was continued without further sequelae.
Musculoskeletal side effects have included muscle rigidity (<1% to 11%) which has occurred more frequently during induction and maintenance than postoperatively.
Rigidity may be lessened by concomitant administration of a muscle relaxant.
Nervous system side effects including dizziness and agitation have been relatively rare (<5%). A case of generalized tonic-clonic activity has also been reported.
Other side effects have included postoperative shivering, chills, and fever (1% to 5%). Headache has been reported to occur more frequently in monitored anesthesia care patients (18%) than in general anesthesia patients (1% to 2%).
Dermatologic side effects have included pruritus (1% to 18%) and sweating (6%). Dermatologic side effects have been more common in patients receiving monitored anesthesia care.
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