Remifentanil Side Effects

Medically reviewed by Drugs.com. Last updated on Jan 13, 2025.

Applies to remifentanil: intravenous powder for solution, intravenous solution.

Precautions

Your doctor will check your progress closely while you or your child are receiving this medicine . This will allow your doctor to see if the medicine is working properly and to decide if you should continue to receive it.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with remifentanil may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. .

This medicine may make you dizzy, drowsy, or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully.

Tell your doctor if you or your child have stiffness in the muscles of your neck, chest, hands, or legs after receiving this medicine.

Check with your doctor right away if you or your child have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn baby. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Serious side effects of remifentanil

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:

Other side effects of remifentanil

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:

For healthcare professionals

Applies to remifentanil: intravenous powder for injection, intravenous solution.

General adverse events

The most commonly reported adverse reactions have included respiratory depression, bradycardia, hypotension, and skeletal muscle rigidity. In pediatric patients, the most commonly reported events were nausea, vomiting, and shivering.^[Ref]

Respiratory

• Common (1% to 10%): Respiratory depression
• Uncommon (0.1% to 1%): Apnea, hypoxia
• Frequency not reported: Cough, dyspnea, bronchospasm, laryngospasm, rhonchi, stridor, nasal congestion, pharyngitis, pleural effusion, hiccups, pulmonary edema, rales, bronchitis, rhinorrhea

Opioids:

• Frequency not reported: Serious respiratory depression

Cough, dyspnea, bronchospasm, laryngospasm, rhonchi, stridor, nasal congestion, pharyngitis, pleural effusion, hiccups, pulmonary edema, rales, bronchitis, and rhinorrhea have been reported in less than 1% of patients.

Cardiovascular

• Very common (10% or more): Hypotension (up to 19%)
• Common (1% to 10%): Bradycardia, atrial fibrillation, atrial flutter, myocardial ischemia, edema, flushing
• Uncommon (0.1% to 1%): Decreased cardiac output
• Rare (0.01% to 0.1%): Tachycardia, hypertension
• Frequency not reported: Various atrial and ventricular arrhythmias, heart block, ECG change consistent with myocardial ischemia, elevated CPK-MB level, syncope, premature ventricular beats, atrioventricular block
• Postmarketing reports: Asystole

Cardiovascular side effects such as hypotension and bradycardia have been reported to occur most frequently during the induction and maintenance period. 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.

In male patients and in those patient older 65 years, the incidence of hypotension is higher. Various atrial and ventricular arrhythmias, heart block, ECG change consistent with myocardial ischemia, elevated CPK-MB level, and syncope have been reported in less than 1% of patients.

Gastrointestinal

• Very common (10% or more): Nausea (up to 44%), vomiting (up to 22%)
• Common (1% to 10%): Constipation, heartburn
• Frequency not reported: Abdominal discomfort, xerostomia, gastro-esophageal reflux, dysphagia, diarrhea, ileus

Musculoskeletal

• Common (1% to 10%): Skeletal muscle rigidity
• Frequency not reported: Muscle stiffness, musculoskeletal chest pain

Gastrointestinal

Nausea has been reported to occur in very commonly, especially when used as a postoperative analgesic and upon discontinuation. Abdominal discomfort, xerostomia, gastro-esophageal reflux, dysphagia, diarrhea, and ileus have been reported in less than 1% of patients.

Musculoskeletal

Rigidity may be lessened by concomitant administration of a muscle relaxant. Muscle stiffness and musculoskeletal chest pain have been reported in less than 1% of patients.

Nervous system

• Common (1% to 10%): Dizziness, headache
• Frequency not reported: Serotonin syndrome, involuntary movement, prolonged emergence from anesthesia, awareness under anesthesia without pain, rapid awakening from anesthesia, tremors, paresthesia, nystagmus, twitch, seizure

Involuntary movement, prolonged emergence from anesthesia, awareness under anesthesia without pain, rapid awakening from anesthesia, tremors, paresthesia, nystagmus, twitch, and seizure have been reported in less than 1% of patients.

Hypersensitivity

• Frequency not reported: Anaphylactic reaction

Anaphylactic reaction was reported in less than 1% of patients.

Psychiatric

• Common (1% to 10%): Agitation
• Frequency not reported: Anxiety, confusion, disorientation, dysphoria, nightmares, hallucinations, amnesia

Anxiety, confusion, disorientation, dysphoria, nightmares, hallucinations, amnesia have been reported in less than 1% of patients.

Local

• Common (1% to 10%): Pain at IV site
• Frequency not reported: Erythema, pruritus, rash

Erythema, pruritus, and rash at the infusion site was reported in less than 1% of patients.

Dermatologic

• Common (1% to 10%): Pruritus, sweating

Rash and urticaria have been reported in less than 1% of patients.

Other

• Common (1% to 10%): Shivering, fever, chills, sensation of warmth
• Frequency not reported: Decreased body temperature

Hematologic

• Common (1% to 10%): Coagulation disorder
• Frequency not reported: Anemia, lymphopenia, leukocytosis, thrombocytopenia

Anemia, lymphopenia, leukocytosis, and thrombocytopenia have been reported in less than 1% of patients.

Ocular

• Common (1% to 10%): Visual disturbances

Metabolic

• Frequency not reported: Hyperglycemia, electrolyte disorders, increased CPK level

Genitourinary

• Frequency not reported: Urine retention, oliguria, dysuria, urine incontinence

Urine retention, oliguria, dysuria, and urine incontinence have been reported in less than 1% of patients.

Hepatic

• Frequency not reported: Abnormal liver function

See also:

Further information

Remifentanil side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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