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Remifentanil Disease Interactions

There are 10 disease interactions with remifentanil:

Major

Narcotic Analgesics (Includes Remifentanil) ↔ Prematurity

Severe Potential Hazard, High plausibility

Applies to: Prematurity/Underweight in Infancy

The use of narcotic (opioid) analgesic agents is contraindicated in premature infants. These agents may cross the immature blood-brain barrier to a greater extent than in adults, resulting in disproportionate respiratory depression.

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Multum Information Services, Inc. Expert Review Panel"
Major

Opiate Agonists (Includes Remifentanil) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication

The use of opiate agonists is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of opiate agonists may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with opiate agonists should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  3. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  7. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  8. "Multum Information Services, Inc. Expert Review Panel"
  9. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  10. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  11. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  13. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  14. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
View all 15 references
Major

Opiate Agonists (Includes Remifentanil) ↔ Hypotension

Severe Potential Hazard, High plausibility

Applies to: Hypotension, Shock, Dehydration

Opiate agonists can induce vasodilation and significant hypotension, particularly when given in high dosages and/or by rapid intravenous administration. Shock and cardiac arrest have occurred. At therapeutic analgesic dosages, ambulatory patients are more likely to experience dizziness and hypotension than patients who are confined to bed. However, orthostatic hypotension may occur in supine patients upon rising. Therapy with opiate agonists should be administered cautiously and initiated at reduced dosages in patients with circulatory shock, hypovolemia, or a predisposition to hypotension. When given by intramuscular or subcutaneous administration, clinicians should also be aware that impaired perfusion in these patients may prevent complete absorption of the drug. With repeated injections, an excessive amount may be absorbed suddenly if normal circulation is reestablished.

References

  1. Cox RG "Hypoxaemia and hypotension after intravenous codeine phosphate." Can J Anaesth 41 (1994): 1211-3
  2. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  3. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
  4. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  6. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  9. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  10. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  14. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  15. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  16. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  17. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  18. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  21. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  22. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  23. Parke TJ, Nandi PR, Bird KJ, Jewkes DA "Profound hypotension following intravenous codeine phosphate: three case reports and some recommendations." Anaesthesia 47 (1992): 852-4
View all 23 references
Major

Opiate Agonists (Includes Remifentanil) ↔ Intracranial Pressure

Severe Potential Hazard, High plausibility

Applies to: Brain/Intracranial Tumor, Head Injury, Cerebral Vascular Disorder

The hypoventilation associated with administration of opiate agonists, particularly by the intravenous route, can induce cerebral hypoxia and vasodilatation with resultant increase in intracranial pressure. Unless mechanical ventilation is provided, extreme caution is advised when opiate agonists are given to patients with head injury, intracranial lesions, or a preexisting elevated CSF pressure. Also, clinicians treating such patients should be aware that opiate agonists may interfere with the evaluation of CNS function, especially with respect to consciousness levels, respiratory status, and pupillary changes.

References

  1. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  2. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  6. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  7. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  8. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  10. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  11. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  14. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  15. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  17. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  18. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  19. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  20. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
View all 20 references
Major

Opiate Agonists (Includes Remifentanil) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Pulmonary Impairment, Altered Consciousness, Asphyxia, Brain/Intracranial Tumor, Head Injury, Cerebral Vascular Disorder, Respiratory Arrest

Opiate agonists may produce significant central nervous system and respiratory depression of varying duration, particularly when given in high dosages and/or by rapid intravenous administration. Apnea may result from decreased respiratory drive as well as increased airway resistance, and rigidity of respiratory muscles may occur during rapid IV administration or when these agents are used in the induction of anesthesia. At therapeutic analgesic dosages, the respiratory effects are usually not clinically important except in patients with preexisting pulmonary impairment. Therapy with opiate agonists should be avoided or administered with extreme caution and initiated at reduced dosages in patients with severe CNS depression; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. In the presence of excessive respiratory secretions, the use of opiate agonists may also be problematic because they decrease ciliary activity and reduce the cough reflex. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. Clinical monitoring of pulmonary function is recommended, and equipment for resuscitation should be immediately available if parenteral or neuraxial routes are used. Naloxone may be administered to reverse clinically significant respiratory depression, which may be prolonged depending on the opioid agent, cumulative dose, and route of administration.

References

  1. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  2. Redpath JB, Pleuvry BJ "Double-blind comparison of the respiratory and sedative effects of codeine phosphate and (+/-)-glaucine phosphate in human volunteers." Br J Clin Pharmacol 14 (1982): 555-8
  3. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  4. Hudson RJ "Apnoea and unconsciousness after apparent recovery from alfentanil- supplemented anaesthesia." Can J Anaesth 37 (1990): 255-7
  5. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  6. Amin HM, Sopchak AM, Esposito BF, Henson LG, Batenhorst RL, Fox AW, Camporesi EM "Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil." J Pharmacol Exp Ther 274 (1995): 34-9
  7. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  8. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  9. Brockway MS, Noble DW, Sharwood-Smith GH, McClure JH "Profound respiratory depression after extradural fentanyl." Br J Anaesth 64 (1990): 243-5
  10. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. Jackson FW "Fentanyl and the wooden chest." Gastroenterology 106 (1994): 820-1
  12. Elloway R, Sherman S, Maas L, et al "Meperidine-induced bronchospasm." Gastrointest Endosc 38 (1992): 93
  13. Morley AD "Profound respiratory depression with morphine patient-controlled analgesia in an elderly patient." Anaesth Intensive Care 24 (1996): 287
  14. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  15. Sackner MA "Effects of hydrocodone bitartrate on breathing pattern of patients with chronic obstructive pulmonary disease and restrictive lung disease." Mt Sinai J Med 51 (1984): 222-6
  16. Comstock MK, Carter JG, Moyers JR, Stevens WC "Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia." Anesth Analg 60 (1981): 362-3
  17. Varrassi G, Celleno D, Capogna G, et al. "Ventilatory effects of subarachnoid fentanyl in the elderly." Anaesthesia 47 (1992): 558-62
  18. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  19. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  21. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  22. Palmer CM "Early respiratory depression following intrathecal fentanyl-morphine combination." Anesthesiology 74 (1991): 1153-5
  23. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  24. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  25. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  26. Bigler D, Eriksen J, Christensen CB "Prolonged respiratory depression caused by slow release morphine." Lancet 06/30/84 (1984): 1477
  27. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  28. Harper MH, Hickey RF, Cromwell TH, Linwood S "The magnitude and duration of respiratory depression produced by fentanyl and fentanyl plus droperidol in man." J Pharmacol Exp Ther 199 (1976): 464-8
  29. Rigg JR, Ilsley AH, Vedig AE "Relationship of ventilatory depression to steady-state blood pethidine concentrations." Br J Anaesth 53 (1981): 613-9
  30. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  31. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  32. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  33. Noble DW, Morrison LM, Brockway MS, Mcclure JH "Respiratory depression after extradural fentanyl." Br J Anaesth 72 (1994): 251
  34. Sandler AN, Baxter AD, Katz J, Samson B, Friedlander M, Norman P, Koren G, Roger S, Hull K, Klein J "A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy: analgesic, respiratory, and pharmacokinetic effects." Anesthesiology 81 (1994): 1169-80
  35. Samuels SI, Rabinov W "Difficulty reversing drug-induced coma in a patient with sleep apnea." Anesth Analg 65 (1986): 1222-4
  36. Etches RC "Respiratory depression associated with patient-controlled analgesia - a review of eight cases." Can J Anaesth 41 (1994): 125-32
  37. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  38. Houghton IT, Aun CST, Wong YC, Chan K, Lau JTF, Oh TE "The respiratory depressant effect of morphine - a comparative study in three ethnic groups." Anaesthesia 49 (1994): 197-201
  39. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  40. Ogawa K, Iranami H, Yoshiyama T, Maeda H, Hatano Y "Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy." Can J Anaesth 40 (1993): 968-70
  41. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  42. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  43. Eisenach JC "Respiratory depression following intrathecal opioids." Anesthesiology 75 (1991): 712
  44. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
View all 44 references
Moderate

Narcotic Analgesics (Includes Remifentanil) ↔ Adrenal Insufficiency

Moderate Potential Hazard, Moderate plausibility

Applies to: Adrenal Insufficiency

Patients with Addison's disease may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. Conversely, these agents may cause or potentiate adrenal insufficiency. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with adrenocortical insufficiency. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  2. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  4. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  11. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  14. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  15. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  16. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  17. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  18. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  19. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  20. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  21. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  22. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  23. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  25. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  26. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
View all 26 references
Moderate

Narcotic Analgesics (Includes Remifentanil) ↔ Hypothyroidism

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypothyroidism, Panhypopituitarism

Patients with hypothyroidism may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. These agents may also exacerbate the effects of hypothyroidism such as lethargy, impaired mentation, depression, and constipation. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with uncontrolled hypothyroidism or myxedema. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  5. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  8. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  9. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  10. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  11. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  12. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  13. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  14. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  15. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  16. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  17. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  18. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  20. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  21. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  22. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  23. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  24. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  25. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
View all 25 references
Moderate

Narcotic Analgesics (Includes Remifentanil) ↔ Seizure Disorders

Moderate Potential Hazard, Low plausibility

Applies to: Seizures

Narcotic (opioid) analgesic agents may exacerbate seizures in patients with seizure disorders and, at higher dosages, have been reported to induce seizures in patients without previous history of seizures. The proconvulsant activity may be the greatest with meperidine, the active metabolite of which is thought to be responsible. Therapy with opioids should be administered cautiously in patients with or predisposed to seizures.

References

  1. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8
  2. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  3. Strong WE, Matson M "Probable seizure after alfentanil." Anesth Analg 68 (1989): 692-3
  4. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  5. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  6. Sebel PS, Bovill JG "Fentanyl and convulsions." Anesth Analg 62 (1983): 858-9
  7. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  10. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  12. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  13. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  14. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1
  15. Smith NT, Benthuysen JL, Bickford RG, Sanford TJ, Blasco T, Duke PC, Head N, Dec-Silver H "Seizures during opioid anesthetic induction--are they opioid-induced rigidity?" Anesthesiology 71 (1989): 852-62
  16. Goroszeniuk T, Albin M, Jones RM "Generalized grand mal seizure after recovery from uncomplicated fentanyl-etomidate anesthesia." Anesth Analg 65 (1986): 979-81
  17. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  19. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  20. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40
  21. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  22. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  23. Safwat AM, Daniel D "Grand mal seizure after fentanyl administration." Anesthesiology 59 (1983): 78
  24. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  25. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  26. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1
  27. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  28. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32
  29. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  30. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  31. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9
  32. Hoien AO "Another case of grand mal seizure after fentanyl administration." Anesthesiology 60 (1984): 387-8
  33. Rao TL, Mummaneni N, El-Etr AA "Convulsions: an unusual response to intravenous fentanyl administration." Anesth Analg 61 (1982): 1020-1
  34. Mauro VF, Bonfiglio MF, Spunt AL "Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia." Clin Pharm 5 (1986): 837-9
  35. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  36. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  37. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  38. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  39. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  40. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  41. Benthuysen JL, Stanley TH "Concerning the possible nature of reported fentanyl seizures." Anesthesiology 62 (1985): 205
  42. Kaiko RF, Foley KM, Grabinski PY, et al "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5
  43. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
View all 43 references
Moderate

Narcotic Analgesics (Includes Remifentanil) ↔ Urinary Retention

Moderate Potential Hazard, Low plausibility

Applies to: Urinary Retention

Narcotic (opioid) analgesic agents may inhibit the urinary voiding reflex and increase the tone of the vesical sphincter in the bladder. Acute urinary retention requiring catheterization may occur, particularly in patients with prostatic hypertrophy or urethral stricture and in elderly patients. These agents may also decrease urine production via direct effects on the kidney and central stimulation of the release of vasopressin. Therapy with opioids should be administered cautiously in patients with or predisposed to urinary retention and/or oliguria. The effects on smooth muscle tone appear to be the most pronounced with morphine.

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  3. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. Petersen TK, Husted SE, Rybro L, et al "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8
  5. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  6. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  7. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  9. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  10. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  11. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  12. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  13. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  14. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  15. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  17. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  18. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  19. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  20. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  21. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  22. Petros JG, Mallen JK, Howe K, Rimm EB, Robillard RJ "Patient-controlled analgesia and postoperative urinary retention after open appendectomy." Surg Gynecol Obstet 177 (1993): 172-5
  23. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  24. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  25. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  26. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  27. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  28. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  29. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
View all 29 references
Moderate

Opiate Agonists (Includes Remifentanil) ↔ Arrhythmias

Moderate Potential Hazard, Moderate plausibility

Applies to: Arrhythmias

Opiate agonists have cholinergic activity. Large doses and/or rapid intravenous administration may produce bradycardia and arrhythmia via stimulation of medullary vagal nuclei. Unlike other agents in the class, meperidine also has anticholinergic activity and may cause either bradycardia or tachycardia. Therapy with opiate agonists should be administered cautiously in patients with a history of arrhythmias. Clinical monitoring of cardiovascular status is recommended during therapy. Bradycardia and other cholinergic effects produced by these agents may be controlled with atropine.

References

  1. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  2. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  4. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  5. Hilgenberg JC, Johantgen WC "Bradycardia after intravenous fentanyl during subarachnoid anesthesia." Anesth Analg 59 (1980): 162-3
  6. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  7. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  8. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  11. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. Blair JR, Pruett JK, Crumrine RS, Balser JJ "Prolongation of QT interval in association with the administration of large doses of opiates." Anesthesiology 67 (1987): 442-3
  13. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  14. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  15. Heaney RM "Left bundle branch block associated with propoxyphene hydrochloride poisoning." Ann Emerg Med 12 (1983): 780-2
  16. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  17. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  18. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  19. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  20. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  21. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
View all 21 references

remifentanil drug Interactions

There are 657 drug interactions with remifentanil

remifentanil alcohol/food Interactions

There is 1 alcohol/food interaction with remifentanil

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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