ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Ultiva
ICU INDICATIONS:
- Opioid analgesia
PRESENTATION AND ADMINISTRATION:
IV:
Administer by intravenous infusion. Dilute 2 mg in 40 mL of compatible IV fluid to make a concentration of 50 mcg/mL
Compatible with the following IV fluids:
Water for Injection, 5% Dextrose, 0.9% Sodium Chloride
Do not co-administer with blood products or propofol into the same IV line.
DOSAGE:
IV:
Start infusion at 0.1 - 0.15 mcg/kg/min
Titrate by 0.025 mcg/kg/min at 5 min intervals to desired level analgesia or sedation
Add another sedative if desired level of sedation is not achieved with 0.2 mcg/kg/min
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
IV:
Not intubated & ventilated:
0.05 - 0.2 mcg/kg/min
Intubated & ventilated:
0.5 - 1 mcg/kg/min
CLINICAL PHARMACOLOGY:
Potent opioid agonist. Remifentanil should only be used as for the induction or maintenance of sedation or anaesthesia with immediate access to appropriate airway expertise. Due to the rapid offset of action (within 5 - 10 mins after discontinuation), longer acting opioids should be administered prior to stopping infusions used for analgesia.
Clearance is reduced during hypothermia with a decrease in elimination clearance by 3% per degree Centigrade. Remifentanil is not removed during renal replacement therpay. Clearance is not changed in severe renal or hepatic failure. Clearance is reduced by up to 25% in patients aged over 65 years when compared with younger patients.
CONTRAINDICATIONS:
- 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 IN 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