Remifentanil

Remifentanil

[2mg vial $20.30]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Ultiva

ICU INDICATIONS:

  1. Opioid analgesia

PRESENTATION AND ADMINISTRATION:

  • IV: Administer by intravenous infusion. Dilute 2mg in 40ml of compatible IV fluid to make a concentration of 50mcg/ml
    Compatible with the following IV fluids: Water for Injection. 5% Dextrose 0.9% Sodium Chloride

DOSAGE:

  • IV: Initially, 0.1-0.15mcg/kg/min; may titrate by 0.025mcg/kg/min at intervals of at least 5 minutes to desired level of analgesia or sedation; consider initiation of another sedative if desired level of sedation is not achieved with 0.2mcg/kg/min

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV: 0.05-0.2mcg/kg/min.
    Ventilated: usually 0.5-1mcg/kg/min; occasionally up to 8mcg/min

CLINICAL PHARMACOLOGY:

  • Remifentanil is an opioid agonist

CONTRAINDICATIONS:

  1. hypersensitivity to remifentanil

WARNINGS

  • Muscle Rigidity: At the doses recommended muscle rigidity may occur. As with other opioids, the incidence of muscle rigidity is related to the dose and rate of administration

PRECAUTIONS

  • General: As with all potent opioids, profound analgesia is accompanied by marked respiratory depression. Due to the very rapid offset of action of remifentanil, no residual opioid activity will be present within 5-10 minutes after the discontinuation of remifentanil
    Symptoms including tachycardia, hypertension and agitation have been reported upon abrupt cessation, particularly after prolonged administration of remifentanil.
  • Laboratory Tests: No tests in addition to routine ICU tests are required.
    Drug/Laboratory Test Interactions:
    None known.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The concomitant administration with other cardiovascular depressant drugs leads to an increased risk of hypotension; concomitant administration with other CNS depressant drugs also increases the risk of CNS depression.

ADVERSE REACTIONS:

  • Body as a Whole: Anaphylaxis
  • Central nervous system: Skeletal muscle rigidity, Sedation.
  • Cardiovascular system: Asystole, bradycardia, hypotension.
  • Gastrointestinal system: Constipation, nausea/ vomiting.
  • Respiratory system: Apnoea
  • Dermatological system: Pruritis

Critical Care Drug Manual

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