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
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  • Secobarbital
  • Selegiline
  • Sevoflurane
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  • 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
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  • Tocilizumab
  • Tolterodine
  • Torsemide
  • Tramadol
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  • Tranylcypromine
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  • Trimipramine
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  • Trospium
  • Tubocurarine
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  • Valerian, Valeriana officinalis
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  • Vancomycin
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  • Verapamil
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Vortioxetine
  • Voxelotor
  • Zafirlukast
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  • Zanubrutinib
  • Ziconotide
  • Zileuton
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
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