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remifentanil

Generic Name: remifentanil (rem i FEN ta nil)
Brand Name: Ultiva

What is remifentanil?

Remifentanil is an opioid medication. An opioid is sometimes called a narcotic.

Remifentanil is used to treat or prevent pain after surgery or other medical procedure.

Remifentanil may also be used for purposes not listed in this medication guide.

What is the most important information I should know about remifentanil?

You should not receive this medication if you are allergic to fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Subsys, and others).

What should I discuss with my health care provider before I receive remifentanil?

You should not receive this medication if you are allergic to remifentanil or fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Subsys, and others).

To make sure remifentanil is safe for you, tell your doctor:

  • if you have any type of breathing problem or lung disease; or

  • if you use a sedative like Valium (diazepam, alprazolam, lorazepam, Ativan, Klonopin, Restoril, Tranxene, Versed, Xanax, and others).

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether remifentanil passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How is remifentanil given?

Remifentanil is injected into a vein through an IV. A healthcare provider will give you this injection as part of the anesthesia given for your surgery or medical procedure.

Remifentanil is usually given slowly through an IV infusion connected to pump that will release the correct dose of the medication to provide continuous pain relief during and after your surgery.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving remifentanil.

You may be given other pain medications to use after your remifentanil treatment is discontinued.

What happens if I miss a dose?

Since remifentanil is given as needed by a healthcare professional for only a short time, you are not likely to be on a dosing schedule.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving remifentanil?

Remifentanil can cause side effects that may impair your thinking or reactions. You should not plan on driving or doing anything that requires you to be awake and alert right after you are treated with this medication. Dizziness or severe drowsiness can cause falls or other accidents.

Follow your doctor's instructions about any other restrictions on food, beverages, or activity.

Remifentanil side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Your caregivers will watch for any side effects you have, which may clear up within minutes after stopping the remifentanil infusion or decreasing the dose:

  • weak or shallow breathing;

  • fast or slow heart rate;

  • stiff muscles; or

  • severe weakness, feeling light-headed or fainting.

Common side effects may include:

  • nausea, vomiting;

  • shivering;

  • dizziness, vision problems;

  • itching, sweating; or

  • fever.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Remifentanil dosing information

Usual Adult Dose for Anesthesia:

INDUCTION of Anesthesia (through intubation): 0.5 to 1 mcg/kg/min via continuous IV infusion; an initial dose of 1 mcg/kg over 30 to 60 seconds may be administered
-If endotracheal intubation is to occur less than 8 minutes after start of the induction infusion, an initial IV dose should be given
MAINTENANCE of Anesthesia:
-With Nitrous Oxide at 66%: Continuous IV infusion at 0.4 mcg/kg/min (range 0.1 to 2 mcg/kg/min)
-With Isoflurane at 0.4 to 1.5 MAC or Propofol at 100 to 200 mcg/kg/min: Continuous IV infusion at 0.25 mcg/kg/min (range 0.05 to 2 mcg/kg/min)
-An IV bolus of 1 mcg/kg over 30 to 60 seconds may be used every 2 to 5 minutes as needed in response to light anesthesia or transient episodes of intense surgical stress
POSTOPERATIVE: Bolus IV injections are not recommended
-Use continuous IV infusion at 0.1 mcg/kg/min; adjust infusion rate every 5 minutes in 0.025 mcg/kg/min increments to balance level of analgesia and respiratory rate
Maximum rate: 0.2 mcg/kg/min

MONITORED ANESTHESIA CARE (MAC): Supplemental oxygen should be supplied
IV BOLUS Doses: Give 90 seconds before local anesthetic
-With midazolam 2 mg: Administer 0.5 mcg/kg IV over 30 to 60 seconds
-Without midazolam: Administer 1 mcg/kg IV over 30 to 60 seconds
CONTINUOUS IV Infusion: Start infusion 5 minutes before local anesthetic
-With midazolam 2 mg: Initiate at 0.05 mcg/kg/min, then after local anesthetic decrease to 0.025 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min)
-Without midazolam: Initiate IV infusion at 0.1 mcg/kg/min, then after local anesthetic decrease to 0.05 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min)

Comments:
-Dosing should be individualized based on response.
-Monitor patients closely for respiratory depression, especially with initiation and following all dose increases; adjust dose accordingly
-Continuous IV infusions should be administered by a calibrated infusion device.
-Due to rapid offset of action, no residual analgesic activity will be present 5 to 10 minutes after discontinuation; if pain is expected, alternative analgesics should be administered prior to discontinuing.

Uses: As an analgesic during induction and maintenance of general anesthesia; for continuation of analgesia into the immediate postoperative period; and as an analgesic component of monitored anesthesia.

Usual Adult Dose for Pain:

INDUCTION of Anesthesia (through intubation): 0.5 to 1 mcg/kg/min via continuous IV infusion; an initial dose of 1 mcg/kg over 30 to 60 seconds may be administered
-If endotracheal intubation is to occur less than 8 minutes after start of the induction infusion, an initial IV dose should be given
MAINTENANCE of Anesthesia:
-With Nitrous Oxide at 66%: Continuous IV infusion at 0.4 mcg/kg/min (range 0.1 to 2 mcg/kg/min)
-With Isoflurane at 0.4 to 1.5 MAC or Propofol at 100 to 200 mcg/kg/min: Continuous IV infusion at 0.25 mcg/kg/min (range 0.05 to 2 mcg/kg/min)
-An IV bolus of 1 mcg/kg over 30 to 60 seconds may be used every 2 to 5 minutes as needed in response to light anesthesia or transient episodes of intense surgical stress
POSTOPERATIVE: Bolus IV injections are not recommended
-Use continuous IV infusion at 0.1 mcg/kg/min; adjust infusion rate every 5 minutes in 0.025 mcg/kg/min increments to balance level of analgesia and respiratory rate
Maximum rate: 0.2 mcg/kg/min

MONITORED ANESTHESIA CARE (MAC): Supplemental oxygen should be supplied
IV BOLUS Doses: Give 90 seconds before local anesthetic
-With midazolam 2 mg: Administer 0.5 mcg/kg IV over 30 to 60 seconds
-Without midazolam: Administer 1 mcg/kg IV over 30 to 60 seconds
CONTINUOUS IV Infusion: Start infusion 5 minutes before local anesthetic
-With midazolam 2 mg: Initiate at 0.05 mcg/kg/min, then after local anesthetic decrease to 0.025 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min)
-Without midazolam: Initiate IV infusion at 0.1 mcg/kg/min, then after local anesthetic decrease to 0.05 mcg/kg/min (range 0.025 to 0.2 mcg/kg/min)

Comments:
-Dosing should be individualized based on response.
-Monitor patients closely for respiratory depression, especially with initiation and following all dose increases; adjust dose accordingly
-Continuous IV infusions should be administered by a calibrated infusion device.
-Due to rapid offset of action, no residual analgesic activity will be present 5 to 10 minutes after discontinuation; if pain is expected, alternative analgesics should be administered prior to discontinuing.

Uses: As an analgesic during induction and maintenance of general anesthesia; for continuation of analgesia into the immediate postoperative period; and as an analgesic component of monitored anesthesia.

Usual Geriatric Dose for Anesthesia:

Reduce initial adult dose by 50%
-Titrate dose cautiously to effect

Usual Geriatric Dose for Pain:

Reduce initial adult dose by 50%
-Titrate dose cautiously to effect

Usual Pediatric Dose for Anesthesia:

Birth to 2 months old:
-Continuous IV Infusion (with 70% nitrous oxide): 0.4 mcg/kg/min (range 0.4 to 1 mcg/kg/min)
-Supplemental IV bolus of 1 mcg/kg every 2 to 5 minutes may be given in response to light anesthesia or transient episodes of intense surgical stress

1 to 12 years:
MAINTENANCE of Anesthesia:
-IV Bolus: Initial dose of 1 mcg/kg may be administered over 30 to 60 seconds
-Continuous IV Infusion (concomitant administration with Halothane [0.3 to 1.5 MAC], Sevoflurane [0.3 to 1.5 MAC], or Isoflurane [0.4 to 1.5 MAC]): 0.25 mcg/kg/min (range 0.05 to 1.3 mcg/kg/min)
-Supplemental IV bolus of 1 mcg/kg every 2 to 5 minutes may be given in response to light anesthesia or transient episodes of intense surgical stress

Comments:
-Drug clearance in neonates is highly variable (on average 2 times higher than young, healthy adults, therefore, increased infusion rates or supplemental IV bolus doses may be needed in these patients.
-In neonates with significant co-morbidities, those undoing significant fluid shifts, those who have not been pretreated with atropine, or those receiving potent inhalation agents or neuraxial anesthesia, smaller IV bolus doses should be considered to avoid hypotension and/or bradycardia.
-Due to rapid offset of action, no residual analgesic activity will be present 5 to 10 minutes after discontinuation; if pain is expected, alternative analgesics should be administered prior to discontinuation.
-This drug has not been studied in patients under 12 years of age for use in the immediate postoperative period or for use as a component of monitored anesthesia care.

Use: As an analgesic agent during maintenance of general anesthesia.

What other drugs will affect remifentanil?

Other drugs may interact with remifentanil, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all medicines you have recently used.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about remifentanil.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.04.

Date modified: July 02, 2017
Last reviewed: October 03, 2016

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