remifentanil (Rx)

Brand and Other Names:Ultiva
  • Print

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection: Schedule II

  • 1mg/vial
  • 2mg/vial
  • 5mg/vial

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

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

Next:

Interactions

Interaction Checker

and remifentanil

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            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

            Biliary tract disease

            Postmarketing Reports

            Serotonin syndrome

            Previous
            Next:

            Warnings

            Black Box Warnings

            Addiction, abuse, and misuse

            • 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

            Epidural or intrathecal administration

            Known hypersensitivity to fentanyl analogs

            Cautions

            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

            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

            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

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

            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

            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

            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

            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

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

            Previous
            Next:

            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

            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.

            Previous
            Next:

            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

            Previous
            Next:

            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

            Previous
            Next:

            Images

            Previous
            Next:

            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.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.