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remifentanil (Rx)Brand and Other Names:Ultiva

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection: Schedule II

  • 1mg/vial
  • 2mg/vial
  • 5mg/vial
more...

Anesthesia, Induction

0.5-1 mcg/kg/min IV until after intubation; may give initial dose of 1 mcg/kg if intubation to occur less than 8 min after start of infusion 

Anesthesia, Maintenance

0.25-0.5 mcg/kg/min IV; may bolus with 0.5-1 mcg/kg q2-5min in response to light anesthesia or transient episodes of intense surgical stress 

Conscious Analgesia

1 mcg/kg IV bolus, followed by 0.05-0.2 mcg/kg/min IV 

Analgesia, Immediate Post-Op Period

0.025-0.2 mcg/kg/min IV 

Dosage Forms & Strengths

powder for injection: Schedule II

  • 1mg/vial
  • 2mg/vial
  • 5mg/vial
more...

Anesthesia, Maintenance

Birth-2 months

  • With Nitrous Oxide: 0.4 mcg/kg/min IV 
  • Range: 0.4-1 mcg/kg/min, may give supplemental dose 1 mcg/kg IV

1-12 years old

  • With Halothane, sevoflurane, isoflurane: 0.25 mcg/kg/min IV
  • Range: 0.05-1.3 mcg/kg/min IV, may give supplemental dose 1 mcg/kg over 30-60 sec IV

Decrease dose by 50%; titrate as in adults

Anesthesia, induction

0.25-1 mcg/kg/min IV until after intubation; may give initial dose of 1 mcg/kg if intubation to occur less than 8 min after start of infusion 

Anesthesia, maintenance

0.12.5-0.5 mcg/kg/min IV; may bolus with 0.5-1 mcg/kg q2-5min in response to light anesthesia or transient episodes of intense surgical stress

Conscious analgesia

0.5 mcg/kg IV bolus, followed by 0.05-0.2 mcg/kg/min

Analgesia, immediate post-op period

0.012.5-0.2 mcg/kg/min IV

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Interactions

Interaction Checker

remifentanil and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Nausea

            Vomiting

            1-10%

            Respiratory depression

            Bradycardia (dose dependent)

            Hypertension

            Hypotension (dose dependent)

            Tachycardia

            Skeletal muscle rigidity (dose dependent)

            Postoperative pain

            Shivering

            Apnea

            Hypoxia

            Respiratory depression

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            Warnings

            Contraindications

            Epidural or intrathecal administration

            Known hypersensitivity to fentanyl analogs

            Cautions

            Continuous infusions should be administered only by an infusion device

            Clear IV tubing after discontinuation of remifentanil

            May be associated with apnea and respiratory depression, skeletal muscle rigidity

            Should not be administered in same IV tubing as blood

            May cause bradycardia, hypotension

            Intraoperative awareness in some pts under 55 yo when admin. with propofol infusion < 75 mcg/kg/min

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: unknown; use 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.

            more...
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            Pharmacology

            Mechanism of Action

            Opioid agonist; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation, increases pain threshold  

            Pharmacokinetics

            Half-Life: 3-10 min

            Onset: 1-3 min (IV)

            Protein Bound: 70%

            Vd: 100 mL/kg

            Clearance: 40 mL/min/kg

            Excretion: Urine

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            Administration

            IV Incompatibilities

            Y-site: amphotericin B(?), ampho B cholesteryl SO4, cefoperazone(?), chlorpromazine(?), diazepam(?)

            IV Compatibilities

            Solution: D5/LR, D5/NS, D5W, NS, ½NS, SWI

            Y-site: (partial list) acyclovir, aminophylline, ampicillin, ampicillin/sulbactam, Ca gluconate, ceftazidime, ceftriaxone, cimetidine, cistracurium, clindamycin, dexamethasone, digoxin, diphenhydramine, dobutamine, dopamine, epinephrine, famotidine, fentanyl, furosemide, heparin, hydrocortisone, hydromorphone, imepenem/cilastatin, inamrinone, lidocaine, linezolid, lorazepam, magnesium sulphate, meperidine, methylprednisolone, metoclopramide, metronidazole, midazolam, morphine, nitroglycerin, norepinephrine, ondansetron, KCl, procainamide, prochlorperazine, promethazine, propofol (do not administer in same tubing with blood), sodium bicarbonate, thiopental, sufentanil, trimethoprim/sulfamethoxazole, vancomycin, zidovudine

            IV Preparation

            Reconstitute solution with 1 mL of diluent per mg of remifentanil; shake well to dissolve; should be diluted to final concentration of 25, 50 or 250 mcg/mL prior to administration

            IV Administration

            IV injection over 30-60 sec

            May also do IV infusion

            Storage

            Store intact vials at 2-25°C

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            Images

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            Formulary

            FormularyPatient Discounts

            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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            Select a class to view formulary status for similar drugs

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