alfentanil (Rx)

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Brand and Other Names:Alfenta, Rapifen

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution: Schedule II

  • 0.5mg/mL
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Dose should be calculated based on ideal body weight

Incremental Injection: Anesthesia <30 Minutes

Induction: 8-20 mcg/kg IV 

Maintenance: 3-5 mcg/kg IV increments q5-20min, or 0.5-1 mcg/kg/min IV

Total dose: 8-40 mcg/kg IV

Incremental Injection: Anesthesia 30-60 Minutes

Induction: 20-50 mcg/kg IV 

Maintenance: 5-15 mcg/kg IV increments q5-20min

Total dose: Up to 75 mcg/kg IV

Anesthetic Induction: Anesthesia >45 Minutes

Induction: 130-245 mcg/kg IV 

Maintenance: 0.5-1.5 mcg/kg/min IV or other general anesthetic

Total dose: depends on duration of operation

Continuous Infusion: For Anesthesia >45 Minutes

Induction: 50-75 mcg/kg IV 

Maintenance: 0.5-3 mcg/kg/min IV

Total dose: depends on duration of operation

Postherpetic Neuralgia (Orphan)

Management of postherpetic neuralgia

Orphan indication sponsor

  • Cinergen, LLC; 146 Medinah Drive; Blue Bell, PA 19422-3212

HIV-Associated Neuropathy (Orphan)

Treatment of painful HIV-associated neuropathy

Orphan indication sponsor

  • Cinergen, LLC; 146 Medinah Drive; Blue Bell, PA 19422-3212

Administration

Total dose: depends on duration of operation

Dosage Forms & Strengths

injectable solution: Schedule II

  • 0.5mg/mL

Dose should be calculated based on ideal body weight

<12 years

Anesthesia

  • Not recommended

>12 years

Incremental Injection: Anesthesia <30 Minutes

  • Induction: 8-20 mcg/kg IV
  • Maintenance: 3-5 mcg/kg IV increments q5-20min, or 0.5-1 mcg/kg/min IV
  • Total dose: 8-40 mcg/kg IV  

Incremental Injection: Anesthesia 30-60 Minutes

  • Induction: 20-50 mcg/kg IV 
  • Maintenance: 5-15 mcg/kg IV increments q5-20min
  • Total dose: Up to 75 mcg/kg IV

Anesthetic Induction: Anesthesia >45 Minutes

  • Induction: 130-245 mcg/kg IV 
  • Maintenance: 0.5-1.5 mcg/kg/min IV or other general anesthetic
  • Total dose: depends on duration of operation

Continuous Infusion: For Anesthesia >45 Minutes

  • Induction: 50-75 mcg/kg IV 
  • Maintenance: 0.5-3 mcg/kg/min IV
  • Total dose: depends on duration of operation
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Interactions

Interaction Checker

and alfentanil

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Arrhythmia (14%)

            Bradycardia (14%)

            Chest wall rigidity (17%)

            Hypertension (18%)

            Nausea (28%)

            Vomiting (18%)

            Tachycardia (12%)

            1-10%

            Apnea (3-9%)

            Blurred vision (1-3%)

            Dizziness (3-9%)

            Hypotension (10%)

            Post-op respiratory depression (1-3%)

            Skeletal muscle movements (3-9%)

            Postoperative sedation (1-3%)

            <1%

            Sweating, flushing

            Warmness of the face/neck/upper thorax

            Pruritus

            urticaria

            Respiratory (undefined)

            Respiratory/circulatory depression

            Respiratory arrest

            Shock

            Cardiac arrest

            Nervous System (undefined)

            Dizziness

            Visual disturbances

            Mental clouding/depression

            Sedation

            Coma

            Euphoria

            Dysphoria

            Weakness

            Faintness

            Agitation

            Restlessness

            Nervousness

            Seizures

            GI (undefined)

            Nausea

            Vomiting

            Constipation

            Cardiovascular (undefined)

            QT-interval prolongation

            Severe cardiac arrhythmias

            Cardiac arrest

            ST segment elevation

            VTach

            MI

            Angina pectoris

            Syncope

            Genitourinary (undefined)

            Urinary retention

            Oliguria

            Cholinergic (undefined)

            Bradycardia

            Dry mouth

            Palpitation

            Tachycardia

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            Warnings

            Contraindications

            Hypersensitivity

            Increased intracranial pressure

            Severe respiratory depresssion

            Cautions

            Use caution in bradycardia, compromised cardiac reserve, head injury, hypothyroidism, increased ICP, intracranial lesions, renal impairment, respiratory impairment, obesicty, history of drug abuse

            Concurrent administration of benzodiazepine or neuromuscular blocker will decrease chest wall rigidity

            Skeletal muscle and chest wall rigidity, respiratory distress, or impaired ventilation may occur with rapid infusion (slow injection over 3-5min recommended)

            Should be administered by trained individuals

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Narcotic agonist analgesic; increases pain threshold, inhibits ascending pain pathways, alters pain perception

            Pharmacokinetics

            Half-life: 5.33-8.75 hr (prematures, newborns); 40-60 min (children); 83-97 min (adults)

            Onset: Immediate

            Duration: 30-60 min

            Vd: 1 L/kg (premature, newborns); 0.163-0.48 L/kg (children); 0.46 L/kg (adults)

            Peak Plasma: distributed in decreasing order of concentration into skeletal muscle, kidneys, liver, intestinal tract, lungs, spleen, and brain

            Bioavailability: Varies

            Metabolism: liver (hepatic P450 enzyme CYP3A4), CNS, kidneys, lungs, and placenta (conjugation with glucuronic acid, hydrolysis, oxidation, N-dealkylation)

            Excretion: urine, feces

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            Administration

            IV Compatibilities

            Solution: D5W

            Syringe: atracurium, midazolam, ondansetron

            Y-site: bivalirudin, cisatracurium, dexmedetomidine, etomidate, fenoldopam, gatifloxacin, Hextend, linezolid, propofol, remifentanil

            IV Incompatibilities

            Y-site: amphotericin B cholSO4, thiopental

            IV Preparation

            Add 20 mL to 230 mL of diluent for a final concentration of 40 mg/mL

            IV Administration

            Keep Naloxone and resuscitation equip available

            By incremental injection as analgesic adjunct to anesthesia with barbiturate/nitrous oxide/oxygen for short surgical procedures (expected duration <1 hr)

            By continuous infusion as a maintenance analgesic with nitrous oxide/oxygen for general surgical procedures

            By IV injection in aesthetic doses for anesthesia induction for general surgical procedures with a minimum expected duration of 45 min

            By IV inj as the analgesic component for monitored anesthesia care (MAC)

            Storage

            Protect from light

            Store at controlled room temp

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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