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Ultiva Side Effects

Generic Name: remifentanil

Note: This page contains side effects data for the generic drug remifentanil. It is possible that some of the dosage forms included below may not apply to the brand name Ultiva.

In Summary

Common side effects of Ultiva include: nausea. Other side effects include: shivering and diaphoresis. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to remifentanil: intravenous powder for solution, intravenous solution

As well as its needed effects, remifentanil (the active ingredient contained in Ultiva) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking remifentanil, check with your doctor or nurse immediately:

More common:
  • Blurred vision
  • chest pain or discomfort
  • confusion
  • difficult or troubled breathing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • 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
  • sweating
  • unusual tiredness or weakness
Less common:
  • Bluish lips or skin
  • chills
  • decrease in cardiac output
  • fast, pounding, or heartbeat or pulse
  • feeling of warmth
  • fever
  • headache
  • nausea or vomiting
  • nervousness
  • 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
  • shivering
  • 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
  • congestion
  • 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
  • difficulty with swallowing
  • disorientation
  • dry mouth
  • dryness or soreness of the throat
  • dysphoria
  • eye pain
  • flushed, dry skin
  • fruit-like breath odor
  • general feeling of illness
  • hiccups
  • hives, itching, or skin rash
  • 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
  • nervousness
  • noisy breathing
  • nosebleeds
  • numbness or tingling in the hands, feet, or lips
  • painful or difficult urination
  • pale skin
  • paralysis
  • 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
  • seizures
  • shakiness in the legs, arms, hands, or feet
  • 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
  • vomiting
  • weakness and heaviness of the legs
  • weight gain

Minor Side Effects

Some remifentanil side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common:
  • Anxiety
  • blurred or loss of vision
  • difficulty having a bowel movement (stool)
  • disturbed color perception
  • double vision
  • halos around lights
  • hyperventilation
  • night blindness
  • overbright appearance of lights
  • pain at the injection site
  • restlessness
  • trouble with sleeping
  • tunnel vision
  • Burning while urinating
  • heartburn
  • hives or welts
  • loss of bladder control
  • loss of memory
  • nightmares
  • 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, intravenous solution


Respiratory side effects have included respiratory depression, apnea, and hypoxia. These effects have tended to occur most frequently in the immediate postoperative period.[Ref]

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.[Ref]


Gastrointestinal side effects including nausea (22% to 44%) and vomiting (8% to 22%) have been reported to occur most frequently in the postoperative period.[Ref]


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.[Ref]

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.[Ref]


Rigidity may be lessened by concomitant administration of a muscle relaxant.[Ref]

Musculoskeletal side effects have included muscle rigidity (<1% to 11%) which has occurred more frequently during induction and maintenance than postoperatively.[Ref]

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.[Ref]


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%).[Ref]


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.[Ref]


1. 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

2. Koo BN, Choi SH, Chun DH, et al. "Respiratory depression caused by remifentanil infusion for postoperative pain control." Anesth Analg 103 (2006): 1627-8

3. "Product Information. Ultiva (remifentanil)." Glaxo Wellcome, Research Triangle Park, NC.

4. Dershwitz M, Randel GI, Rosow CE, Fragen RJ, Connors PM, Librojo ES, Shaw DL, Peng AW, Jamerson BD "Initial clinical experience with remifentanil, a new opioid metabolized by esterases." Anesth Analg 81 (1995): 619-23

5. Sebel PS, Hoke JF, Westmoreland C, Hug CC Jr, Muir KT, Szlam F "Histamine concentrations and hemodynamic responses after remifentanil." Anesth Analg 80 (1995): 990-3

6. Haber GW, Litman RS "Generalized tonic-clonic activity after remifentanil administration." Anesth Analg 93 (2001): 1532-3

It is possible that some side effects of Ultiva may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.