Alfentanil

Alfentanil Brand Name– Alfenta

What is Alfentanil

Alfentanil is a synthetic opiate agonist that is used primarily in anesthesia. Alfentanil is a member of the phenylpiperidine class of opiate agonists and is a derivative of fentanyl.

Alfentanil has significantly different pharmacokinetics and pharmacodynamics than fentanyl or sufentanil. Fentanyl is 5—8 times more potent than alfentanil. Alfentanil has a faster onset and shorter duration of action than fentanyl.

In addition, alfentanil is less lipophilic than fentanyl but is still substantially more lipophilic than morphine.

Alfentanil is widely used as an anesthetic or adjuvant to anesthesia, especially in settings where hemodynamic stability is critical (e.g., cardiovascular surgery).

Alfentanil is useful in attenuating the hemodynamic response to intubation and is useful in anesthesia because it helps maintain cardiovascular stability.

Alfentanil alone does not provide reliable amnestic effects or adequate anesthetic depth for general surgery. The use of inhaled anesthetics and/or hypnotics may be required.

The respiratory depressant effects of alfentanil must be taken into consideration when alfentanil is given to critically ill patients. However, the duration of sedation and respiratory depression is shorter than that seen with fentanyl or sufentanil.

Alfentanil has analgesic effects and may be used in pain management of intensive care and postoperative patients; although, it is rarely given for extended periods.

Only personnel specifically trained in the use of intravenous and general anesthetics should administer alfentanil. The FDA approved alfentanil in 1986.

Indications

1. general anesthesia induction
2. general anesthesia maintenance
3. monitored anesthesia care sedation
4. procedural sedation
5. severe pain

Side Effects

1. adrenocortical insufficiency
2. amenorrhea
3. anaphylactoid reactions
4. apnea
5. arrhythmia exacerbation
6. asystole
7. blurred vision
8. bradycardia
9. bronchospasm
10. chest wall rigidity
11. confusion
12. dizziness
13. drowsiness
14. euphoria
15. gonadal suppression
16. headache
17. hypertension
18. hyponatremia
19. hypotension
20. hypoventilation
21. impotence (erectile dysfunction)
22. infertility
23. injection site reaction
24. laryngospasm
25. libido decrease
26. myoclonia
27. nausea
28. neonatal opioid withdrawal syndrome
29. nystagmus
30. physiological dependence
31. pruritus
32. psychological dependence
33. respiratory arrest
34. respiratory depression
35. seizures
36. serotonin syndrome
37. shivering
38. SIADH
39. sinus tachycardia
40. tolerance
41. urinary retention
42. urticaria
43. vomiting
44. withdrawal

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• accidental exposure
• adrenal insufficiency
• alcoholism
• angina
• biliary tract disease
• bladder obstruction
• breast-feeding
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• coadministration with other CNS depressants
• constipation
• cor pulmonale
• depression
• driving or operating machinery
• epidural administration
• females
• geriatric
• GI disease
• GI obstruction
• head trauma
• heart failure
• hepatic disease
• hypotension
• hypothyroidism
• hypovolemia
• ileus
• increased intracranial pressure
• infants
• inflammatory bowel disease
• labor
• MAOI therapy
• myxedema
• neonates
• obstetric delivery
• oliguria
• opiate agonist hypersensitivity
• potential for overdose or poisoning
• pregnancy
• prostatic hypertrophy
• pulmonary disease
• renal disease
• renal impairment
• requires a specialized care setting
• requires an experienced clinician
• respiratory depression
• respiratory insufficiency
• seizure disorder
• seizures
• substance abuse
• ulcerative colitis
• urethral stricture
• urinary retention

Interactions

• Acebutolol
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Tramadol
• Acrivastine; Pseudoephedrine
• Aldesleukin, IL-2
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Almotriptan
• Alosetron
• Alprazolam
• Alvimopan
• Amide local anesthetics
• Amifampridine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amobarbital
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amprenavir
• Anticholinergics
• Apalutamide
• Apomorphine
• Apraclonidine
• Aprepitant, Fosaprepitant
• Aripiprazole
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir
• Atazanavir; Cobicistat
• Atenolol
• Atenolol; Chlorthalidone
• Atracurium
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Baclofen
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzonatate
• Beta-blockers
• Betaxolol
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Boceprevir
• Bosentan
• Brexpiprazole
• Brigatinib
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bumetanide
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Butorphanol
• Cannabidiol
• Capsaicin; Metaxalone
• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Carteolol
• Carvedilol
• Cenobamate
• Ceritinib
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chloral Hydrate
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroprocaine
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Cimetidine
• Ciprofloxacin
• Cisatracurium
• Clarithromycin
• Clemastine
• Clevidipine
• Clobazam
• Clofazimine
• Clomipramine
• Clonazepam
• Clonidine
• Clopidogrel
• Clorazepate
• Clozapine
• Cobicistat
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Conivaptan
• Crizotinib
• Crofelemer
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Dabrafenib
• Dalfopristin; Quinupristin
• Danazol
• Dantrolene
• Darifenacin
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Delavirdine
• Desflurane
• Desipramine
• Desmopressin
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dexpanthenol
• Dextromethorphan
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Diltiazem
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Dorzolamide; Timolol
• Doxacurium
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Dronedarone
• Droperidol
• Duvelisib
• Echinacea
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elagolix
• Elbasvir; Grazoprevir
• Eletriptan
• Elexacaftor; tezacaftor; ivacaftor
• Eltrombopag
• Eluxadoline
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emapalumab
• Enalapril; Felodipine
• Encorafenib
• Enflurane
• Enzalutamide
• Erdafitinib
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Esketamine
• Esmolol
• Estazolam
• Eszopiclone
• Ethacrynic Acid
• Ethanol
• Ethotoin
• Etomidate
• Everolimus
• Fedratinib
• Felodipine
• Fesoterodine
• Flibanserin
• Fluconazole
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluvoxamine
• Fosamprenavir
• Fosphenytoin
• Fostamatinib
• Frovatriptan
• Furosemide
• Gabapentin
• Glycerol Phenylbutyrate
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guanabenz
• Guanfacine
• Haloperidol
• Halothane
• Homatropine; Hydrocodone
• Hydantoins
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxyzine
• Ibuprofen; Oxycodone
• Idelalisib
• Iloperidone
• Imatinib
• Imipramine
• Indapamide
• Indinavir
• Isavuconazonium
• Isocarboxazid
• Isoflurane
• Isoniazid, INH
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Isradipine
• Istradefylline
• Itraconazole
• Ivacaftor
• Ivosidenib
• Ixabepilone
• Ketamine
• Ketoconazole
• Labetalol
• Lanreotide
• Lapatinib
• Larotrectinib
• Lasmiditan
• Lefamulin
• Lemborexant
• Lesinurad
• Lesinurad; Allopurinol
• Letermovir
• Levobetaxolol
• Levobunolol
• Levocetirizine
• Levodopa
• Lincosamides
• Linezolid
• Lofexidine
• Loop diuretics
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorazepam
• Lorlatinib
• Loxapine
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Meperidine; Promethazine
• Mephobarbital
• Meprobamate
• Mesoridazine
• Metaxalone
• Methadone
• Methocarbamol
• Methohexital
• Methyldopa
• Metoclopramide
• Metoprolol
• Metyrapone
• Metyrosine
• Midazolam
• Mifepristone
• Minocycline
• Mirtazapine
• Mitotane
• Mivacurium
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Nabilone
• Nadolol
• Nalbuphine
• Naloxone
• Naltrexone
• Naproxen; Sumatriptan
• Naratriptan
• Nebivolol
• Nebivolol; Valsartan
• Nefazodone
• Nelfinavir
• Nesiritide, BNP
• Neuromuscular blockers
• Nevirapine
• Nicardipine
• Nifedipine
• Nilotinib
• Nimodipine
• Nisoldipine
• Nitroglycerin
• Nortriptyline
• Octreotide
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Oritavancin
• Orphenadrine
• Osilodrostat
• Oxazepam
• Oxcarbazepine
• Oxycodone
• Oxymorphone
• Palbociclib
• Paliperidone
• Pancuronium
• Papaverine
• Pazopanib
• Pegvisomant
• Penbutolol
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Perindopril; Amlodipine
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phenothiazines
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Pindolol
• Posaconazole
• Potassium-sparing diuretics
• Pramipexole
• Pramlintide
• Prasugrel
• Pregabalin
• Primidone
• Procaine
• Procarbazine
• Prochlorperazine
• Promethazine
• Propranolol
• Protease inhibitors
• Protriptyline
• Quazepam
• Quetiapine
• Ramelteon
• Ranolazine
• Rapacuronium
• Rasagiline
• Ribociclib
• Ribociclib; Letrozole
• Rifamycins
• Risperidone
• Ritonavir
• Rizatriptan
• Rocuronium
• Ropinirole
• Rotigotine
• Rucaparib
• Saquinavir
• Sarilumab
• Secobarbital
• Selegiline
• Sevoflurane
• Sildenafil
• Siltuximab
• Simeprevir
• Sodium Oxybate
• Solifenacin
• Sotalol
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Streptogramins
• Succinylcholine
• Sumatriptan
• Suvorexant
• Tapentadol
• Tasimelteon
• Tazemetostat
• Telaprevir
• Telithromycin
• Telotristat Ethyl
• Temazepam
• Tetrabenazine
• Tetracaine
• Tezacaftor; Ivacaftor
• Thalidomide
• Thiazide diuretics
• Thiethylperazine
• Thiopental
• Thioridazine
• Thiothixene
• Ticagrelor
• Timolol
• Tipranavir
• Tizanidine
• Tocilizumab
• Tolterodine
• Torsemide
• Tramadol
• Trandolapril; Verapamil
• Tranylcypromine
• Trazodone
• Triamterene
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trimethobenzamide
• Trimipramine
• Triprolidine
• Trospium
• Tubocurarine
• Tucatinib
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Vancomycin
• Vecuronium
• Vemurafenib
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• Vigabatrin
• Vilazodone
• Voriconazole
• Vortioxetine
• Voxelotor
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• Zolmitriptan
• Zolpidem