alfentanil (Rx)

Brand and Other Names:Alfenta, Rapifen
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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

            Black Box Warnings

            Therapy exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death; assess each patient’s risk prior to prescribing therapy, and monitor all patients regularly for the development of these behaviors and conditions

            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

            Should be administered by trained individuals

            In patients who may be susceptible to intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), therapy may reduce respiratory drive, and resultant CO2 retention can further increase intracranial pressure; monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy; opioids may obscure clinical course in a patient with a head injury; avoid the use in patients with impaired consciousness or coma

            May cause spasm of sphincter of Oddi; opioids may cause increases in serum amylase; monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms

            Therapy may increase frequency of seizures in patients with seizure disorders and in other clinical settings associated with seizures; monitor patients for worsened seizure control during therapy

            Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients; monitor closely

            Profound sedation, respiratory depression, coma, and death may result from concomitant administration with benzodiazepines or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol); because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate

            Cases of serotonin syndrome, a potentially life-threatening condition, reported with concomitant use of serotonergic drugs; this may occur within the recommended dosage range; the onset of symptoms generally occur within several hours to a few days of concomitant use, but may occur later than that; discontinue therapy immediately if serotonin syndrome is suspected

            Muscle rigidity occurring during induction of can be treated by decreasing rate or discontinuing infusion of drug or by administering a neuromuscular blocking agent; neuromuscular blocking agents used should be compatible with patient's cardiovascular status

            Not to be administered into same IV tubing with blood due to potential inactivation by nonspecific esterases in blood products

            Proper placement of needle or catheter in epidural space should be verified before drug is injected to assure that unintentional intravascular or intrathecal administration does not occur; unintentional intravascular injection of sufentanil could result in a potentially serious overdose, including acute truncal muscular rigidity and apnea; unintentional intrathecal injection of sufentanil/bupivacaine epidural doses and volume could produce effects of high spinal anesthesia including prolonged paralysis and delayed recovery; if analgesia is inadequate, placement and integrity of catheter should be verified prior to administration of any additional epidural medications; administer epidurally by slow injection

            Bradycardia may occur; monitor heart rate during dosage initiation and titration; responsive to ephedrine or anticholinergic drugs

            Therapy may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients; there is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics); monitor patients for signs of hypotension after initiating or titrating dosage; in patients with circulatory shock, therapy may cause vasodilation that can further reduce cardiac output and blood pressure; avoid therapy in patients with circulatory shock

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            Pregnancy & Lactation

            Pregnancy

            Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome; available data in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage

            Labor or delivery

            • Opioids cross placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid induced respiratory depression in neonate; drug is not recommended for use in women during and immediately prior to labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate; opioid analgesics can prolong labor through actions that temporarily reduce strength, duration, and frequency of uterine contractions; however, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor; monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression

            Lactation

            The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy; capsules and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition

            Monitor infants exposed to drug through breast milk for excess sedation and respiratory depression; withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast- feeding is stopped

            Withdrawal signs can occur in breast-fed infants when maternal administration of an opioid analgesic is stopped or when breastfeeding is stopped; naloxone may precipitate opioid withdrawal in a breast-fed infant whose mother received opioid analgesics

            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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