Remifentanil

What is Remifentanil

Remifentanil is an opiate agonist for use during general anesthesia and monitored anesthesia care.

Remifentanil is a member of the phenylpiperidine class of opiate agonists.

It has a rapid onset and peak effect and an ultra-short duration of action.

The effects subside within 5—10 minutes after discontinuation of therapy.

New steady-state concentrations occur within 5 to 10 minutes after changes in infusion rates.

Remifentanil is useful in attenuating the hemodynamic response to intubation and helps maintain cardiovascular stability during anesthesia. 

Brand Name

Ultiva

Indications & Dosage

  • endotracheal intubation
  • general anesthesia induction
  • general anesthesia maintenance
  • moderate pain
  • procedural sedation
  • rapid-sequence intubation
  • severe pain
  • Remifentanil should be dosed on ideal body weight (IBW) in obese patients (more than 30% over IBW).
  • Individualize remifentanil dosing for each patient; consider physical and medical status of the patient, the degree of anesthesia or analgesia required, the clinical environment, patient response, and opioid-tolerance. Remifentanil is synergistic with other anesthetics; coadministration may require dose reduction of anesthetic agents (i.e., thiopental, propofol, isoflurane, midazolam) by up to 75%.
  • Pretreatment with anticholinergic agents (e.g., atropine) and vagolytic neuromuscular blocking agents (when appropriate) may reduce the occurrence of hypotension and/or bradycardia.
  • Remifentanil has a short duration of action; no residual analgesic activity will be present within 5 to 10 minutes after drug discontinuation. If significant continued pain is anticipated, administer an alternative analgesic prior to remifentanil discontinuation.

Side Effects

  1. abdominal pain
  2. adrenocortical insufficiency
  3. agitation
  4. amenorrhea
  5. amnesia
  6. anaphylactic shock
  7. anaphylactoid reactions
  8. anemia
  9. anxiety
  10. apnea
  11. arrhythmia exacerbation
  12. asystole
  13. atrial fibrillation
  14. atrial flutter
  15. AV block
  16. bleeding
  17. bradycardia
  18. bronchospasm
  19. chest pain (unspecified)
  20. chest wall rigidity
  21. chills
  22. confusion
  23. constipation
  24. cough
  25. diaphoresis
  26. diarrhea
  27. dizziness
  28. dysphagia
  29. dysphoria
  30. dyspnea
  31. dysuria
  32. edema
  33. erythema
  34. fever
  35. flushing
  36. gastroesophageal reflux
  37. gonadal suppression
  38. hallucinations
  39. headache
  40. hiccups
  41. hyperglycemia
  42. hyperkalemia
  43. hypertension
  44. hyponatremia
  45. hypotension
  46. hypoventilation
  47. hypoxia
  48. ileus
  49. impotence (erectile dysfunction)
  50. infection
  51. infertility
  52. injection site reaction
  53. involuntary movements
  54. laryngospasm
  55. leukocytosis
  56. libido decrease
  57. lymphopenia
  58. nasal congestion
  59. nausea
  60. neonatal opioid withdrawal syndrome
  61. nightmares
  62. nystagmus
  63. oliguria
  64. paresthesias
  65. pharyngitis
  66. physiological dependence
  67. pleural effusion
  68. premature ventricular contractions (PVCs)
  69. pruritus
  70. psychological dependence
  71. pulmonary edema
  72. pyrosis (heartburn)
  73. rash
  74. respiratory arrest
  75. respiratory depression
  76. rhinorrhea
  77. seizures
  78. serotonin syndrome
  79. shivering
  80. SIADH
  81. sinus tachycardia
  82. stroke
  83. syncope
  84. thrombocytopenia
  85. tolerance
  86. tremor
  87. urinary incontinence
  88. urinary retention
  89. urticaria
  90. ventricular fibrillation
  91. visual impairment
  92. vomiting
  93. withdrawal
  94. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • accidental exposure
  • acute abdomen
  • adrenal insufficiency
  • alcoholism
  • angina
  • biliary tract disease
  • bladder obstruction
  • bradycardia
  • breast-feeding
  • cardiac disease
  • chronic obstructive pulmonary disease (COPD)
  • coadministration with other CNS depressants
  • constipation
  • cor pulmonale
  • depression
  • diarrhea
  • driving or operating machinery
  • epidural administration
  • ethanol ingestion
  • ethanol intoxication
  • females
  • geriatric
  • GI disease
  • GI obstruction
  • head trauma
  • heart failure
  • hypotension
  • hypothyroidism
  • hypovolemia
  • ileus
  • increased intracranial pressure
  • inflammatory bowel disease
  • intrathecal administration
  • labor
  • myxedema
  • neonatal opioid withdrawal syndrome
  • neonates
  • obesity
  • obstetric delivery
  • oliguria
  • opiate agonist hypersensitivity
  • potential for overdose or poisoning
  • pregnancy
  • prostatic hypertrophy
  • pulmonary disease
  • renal disease
  • 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; Doxylamine
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Tramadol
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Almotriptan
  • Alosetron
  • Alprazolam
  • Alvimopan
  • Amide local anesthetics
  • Amifampridine
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amobarbital
  • Amoxapine
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamines
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  • Articaine; Epinephrine
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  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atenolol
  • Atenolol; Chlorthalidone
  • Atracurium
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine
  • Azelastine; Fluticasone
  • Azilsartan; Chlorthalidone
  • Baclofen
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  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzonatate
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  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
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  • Brompheniramine; Pseudoephedrine
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  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cariprazine
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  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
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  • Chlorpheniramine
  • Chlorpheniramine; Codeine
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  • 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
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Cisatracurium
  • Citalopram
  • Clemastine
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  • Clonazepam
  • Clonidine
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  • Clozapine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Crofelemer
  • Cyclizine
  • Cyclobenzaprine
  • Cyproheptadine
  • Dantrolene
  • Darifenacin
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desflurane
  • Desipramine
  • Desmopressin
  • Desvenlafaxine
  • Deutetrabenazine
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dexmethylphenidate
  • Dexpanthenol
  • Dextroamphetamine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Promethazine
  • Diazepam
  • Dicyclomine
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Dolasetron
  • Dorzolamide; Timolol
  • Doxacurium
  • Doxepin
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Droperidol
  • Duloxetine
  • Eletriptan
  • Eltrombopag
  • Eluxadoline
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enflurane
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Escitalopram
  • Esketamine
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  • Ethanol
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  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
  • Fluvoxamine
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fosphenytoin
  • Frovatriptan
  • Gabapentin
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guanabenz
  • Guanfacine
  • Haloperidol
  • Halothane
  • Homatropine; Hydrocodone
  • Hydantoins
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Iloperidone
  • Imipramine
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  • Ketamine
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  • Methocarbamol
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  • Methylene Blue
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  • Nitroglycerin
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  • Pentazocine
  • Pentazocine; Naloxone
  • Pentobarbital
  • Perampanel
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenelzine
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  • Phenothiazines
  • Phenylephrine; Promethazine
  • Phenytoin
  • Pimozide
  • Pindolol
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