Remifentanil Side Effects

Brand Names: Ultiva

Please note - some side effects for Remifentanil may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Side Effects of Remifentanil - for the Consumer

Remifentanil

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Remifentanil:

Changes in vision; chills; dizziness; drowsiness; fever; headache; itching; nausea; shivering; sweating; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); fast or slow heartbeat; interrupted breathing; lightheadedness; muscle tightness; pain, redness, or swelling at the injection site; seizures.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

Side Effects by Body System - for Healthcare Professionals

Respiratory

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

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

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

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

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

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

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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