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
• Anticholinergics
• Apomorphine
• Apraclonidine
• Aripiprazole
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• 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
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benzonatate
• Benzphetamine
• Benztropine
• Beta-blockers
• Betaxolol
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Brexpiprazole
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Butorphanol
• Calcium-channel blockers
• Candesartan; Hydrochlorothiazide, HCTZ
• Cannabidiol
• Capsaicin; Metaxalone
• Captopril; Hydrochlorothiazide, HCTZ
• Carbetapentane; Chlorpheniramine
• 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
• Carisoprodol
• Carteolol
• Carvedilol
• Cenobamate
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chloral Hydrate
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroprocaine
• Chlorothiazide
• 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
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Cisatracurium
• Citalopram
• Clemastine
• Clobazam
• Clomipramine
• Clonazepam
• Clonidine
• Clopidogrel
• Clorazepate
• 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
• Esmolol
• Estazolam
• Eszopiclone
• Ethanol
• Ethotoin
• Etomidate
• Fesoterodine
• Flavoxate
• Flibanserin
• Fluoxetine
• 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
• Indacaterol; Glycopyrrolate
• Isocarboxazid
• Isoflurane
• Ketamine
• Labetalol
• Lasmiditan
• Lemborexant
• Levobetaxolol
• Levobunolol
• Levobupivacaine
• Levocetirizine
• Levomilnacipran
• Lidocaine
• Lincosamides
• Linezolid
• Lisdexamfetamine
• Lofexidine
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorazepam
• Loxapine
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Melatonin
• Mepenzolate
• Meperidine; Promethazine
• Mephobarbital
• Mepivacaine
• Mepivacaine; Levonordefrin
• Meprobamate
• Mesoridazine
• Metaxalone
• Methadone
• Methamphetamine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
• Methohexital
• Methscopolamine
• Methyclothiazide
• Methyldopa
• Methylene Blue
• Methylphenidate
• Metoclopramide
• Metolazone
• Metoprolol
• Metyrapone
• Metyrosine
• Midazolam
• Milnacipran
• Minocycline
• Mirtazapine
• Mivacurium
• Molindone
• Monoamine oxidase inhibitors
• Nabilone
• Nadolol
• Nalbuphine
• Naloxone
• Naltrexone
• Naproxen; Sumatriptan
• Naratriptan
• Nebivolol
• Nebivolol; Valsartan
• Nefazodone
• Nesiritide, BNP
• Neuromuscular blockers
• Nitroglycerin
• Nortriptyline
• Octreotide
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Ondansetron
• Orphenadrine
• Oxazepam
• Oxybutynin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Palonosetron
• Pancuronium
• Papaverine
• Paroxetine
• Pegvisomant
• Penbutolol
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phenothiazines
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Pindolol
• Pramipexole
• Pramlintide
• Prasugrel
• Pregabalin
• Prilocaine
• Prilocaine; Epinephrine
• Primidone
• Procaine
• Procarbazine
• Prochlorperazine
• Promethazine
• Propantheline
• Propranolol
• Protriptyline
• Quazepam
• Quetiapine
• Ramelteon
• Rapacuronium
• Rasagiline
• Risperidone
• Ritonavir
• Rizatriptan
• Rocuronium
• Ropinirole
• Ropivacaine
• Rotigotine
• Scopolamine
• Secobarbital
• Selective serotonin reuptake inhibitors
• Selegiline
• Serotonin norepinephrine reuptake inhibitors
• Serotonin-Receptor Agonists
• Serotonin-Receptor Antagonists
• Sertraline
• Sevoflurane
• Sildenafil
• Sodium Oxybate
• Solifenacin
• Sotalol
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Succinylcholine
• Sumatriptan
• Suvorexant
• Tapentadol
• Tasimelteon
• Temazepam
• Tetrabenazine
• Tetracaine
• Thalidomide
• Thiazide diuretics
• Thiethylperazine
• Thiopental
• Thioridazine
• Thiothixene
• Ticagrelor
• Timolol
• Tizanidine
• Tolterodine
• Tramadol
• Tranylcypromine
• Trazodone
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trihexyphenidyl
• Trimethobenzamide
• Trimipramine
• Triprolidine
• Trospium
• Tubocurarine
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Vancomycin
• Vecuronium
• Venlafaxine
• Vigabatrin
• Vilazodone
• Vortioxetine
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolmitriptan
• Zolpidem