Remifentanil
ULTIVA
What it isEsterase-cleared mu-opioid agonist; tightly titratable analgesia during anesthesia.
Why this oneRecovery remains rapid after prolonged infusion and does not depend on hepatic or renal clearance.
What limits it⚑ Analgesia ends abruptly, so longer coverage must precede discontinuation; hyperalgesia, respiratory depression, and chest rigidity can occur.
FDA-approved for
- anesthesia (1996)
FDA label
Read the full label on DailyMed ↗
BOXED WARNING Addiction, abuse, and misuse; life-threatening respiratory depression; profound sedation/respiratory depression/death with concomitant benzodiazepines or other CNS depressants
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Analgesic during induction/maintenance of general anesthesia | Adults | Continuous IV infusion, titrated to effect (see full PI tables) | Titrate to effect | Per PI |
| Analgesic component of anesthesia | Geriatric >65 y | Decrease starting dose by 50% | Titrate to effect | Per PI |
| Analgesic component of anesthesia | Pediatric | Weight-based (see PI) | Titrate to effect | Per PI |
Renal No specific adjustment; titrate to effect (caution in renal impairment)
Hepatic Undefined
Instructions
- IV use only; must be diluted before use
- Continuous infusions via infusion device only
- IV bolus only during maintenance of general anesthesia
- Reduce starting dose by 50% in patients >65 y
- Not for epidural or intrathecal use
Contraindications
- Epidural or intrathecal administration (glycine in formulation)
Cautions
- Life-threatening respiratory depression
- Hypotension/sedation/death with concomitant benzodiazepines or CNS depressants
- Opioid-induced hyperalgesia and allodynia
- MAOIs due to risk of serotonin syndrome
- Skeletal muscle rigidity
- Bradycardia
- Hypotension
- Biliary tract disease
- Seizures
Adverse reactions
- Respiratory depression
- Bradycardia
- Hypotension
- Skeletal muscle rigidity
Pregnancy Insufficient human data; prolonged use may cause neonatal opioid withdrawal
Lactation Unknown if excreted in human milk; monitor breastfed infant for sedation/respiratory depression
⚠ BOXED WARNINGS
- Addiction, abuse and misuse
- Life-threatening respiratory depression
Classes and tags
Clinical profile
Mechanism of action: Remifentanil ballicule
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