Dosing and uses of Ultiva (remifentanil)
Adult dosage forms and strengths
powder for injection: Schedule II
- 1mg/vial
- 2mg/vial
- 5mg/vial
Anesthesia, Induction
0.5-1 mcg/kg/min IV until after intubation; may give initial dose of 1 mcg/kg if intubation to occur less than 8 min after start of infusion
Anesthesia, Maintenance
0.25-0.5 mcg/kg/min IV; may bolus with 0.5-1 mcg/kg q2-5min in response to light anesthesia or transient episodes of intense surgical stress
Conscious Analgesia
1 mcg/kg IV bolus, followed by 0.05-0.2 mcg/kg/min IV
Analgesia, Immediate Post-Op Period
0.025-0.2 mcg/kg/min IV
Pediatric dosage forms and strengths
powder for injection: Schedule II
- 1mg/vial
- 2mg/vial
- 5mg/vial
Anesthesia, Maintenance
Birth-2 months
- With Nitrous Oxide: 0.4 mcg/kg/min IV
- Range: 0.4-1 mcg/kg/min, may give supplemental dose 1 mcg/kg IV
1-12 years old
- With Halothane, sevoflurane, isoflurane: 0.25 mcg/kg/min IV
- Range: 0.05-1.3 mcg/kg/min IV, may give supplemental dose 1 mcg/kg over 30-60 sec IV
Geriatric dosage forms and strengths
Decrease dose by 50%; titrate as in adults
Anesthesia, induction
0.25-1 mcg/kg/min IV until after intubation; may give initial dose of 1 mcg/kg if intubation to occur less than 8 min after start of infusion
Anesthesia, maintenance
0.12.5-0.5 mcg/kg/min IV; may bolus with 0.5-1 mcg/kg q2-5min in response to light anesthesia or transient episodes of intense surgical stress
Conscious analgesia
0.5 mcg/kg IV bolus, followed by 0.05-0.2 mcg/kg/min
Analgesia, immediate post-op period
0.012.5-0.2 mcg/kg/min IV
Ultiva (remifentanil) adverse (side) effects
>10%
Nausea
Vomiting
1-10%
Respiratory depression
Bradycardia (dose dependent)
Hypertension
Hypotension (dose dependent)
Tachycardia
Skeletal muscle rigidity (dose dependent)
Postoperative pain
Shivering
Apnea
Hypoxia
Respiratory depression
Warnings
Contraindications
Epidural or intrathecal administration
Known hypersensitivity to fentanyl analogs
Cautions
Continuous infusions should be administered only by an infusion device
Clear IV tubing after discontinuation of remifentaniL
May be associated with apnea and respiratory depression, skeletal muscle rigidity
Should not be administered in same IV tubing as blood
May cause bradycardia, hypotension
Intraoperative awareness in some pts under 55 yo when admin. with propofol infusion < 75 mcg/kg/min
Pregnancy and lactation
Pregnancy category: C
Lactation: unknown; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Ultiva (remifentanil)
Mechanism of action
Opioid agonist; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation, increases pain threshold
Pharmacokinetics
Half-Life: 3-10 min
Onset: 1-3 min (IV)
Protein Bound: 70%
Vd: 100 mL/kg
Clearance: 40 mL/min/kg
Excretion: Urine
Administration
IV Incompatibilities
Y-site: amphotericin B(?), ampho B cholesteryl SO4, cefoperazone(?), chlorpromazine(?), diazepam(?)
IV Compatibilities
Solution: D5/LR, D5/NS, D5W, NS, ½NS, SWI
Y-site: (partial list) acyclovir, aminophylline, ampicillin, ampicillin/sulbactam, Ca gluconate, ceftazidime, ceftriaxone, cimetidine, cistracurium, clindamycin, dexamethasone, digoxin, diphenhydramine, dobutamine, dopamine, epinephrine, famotidine, fentanyl, furosemide, heparin, hydrocortisone, hydromorphone, imepenem/cilastatin, inamrinone, lidocaine, linezolid, lorazepam, magnesium sulphate, meperidine, methylprednisolone, metoclopramide, metronidazole, midazolam, morphine, nitroglycerin, norepinephrine, ondansetron, KCl, procainamide, prochlorperazine, promethazine, propofol (do not administer in same tubing with blood), sodium bicarbonate, thiopental, sufentanil, trimethoprim/sulfamethoxazole, vancomycin, zidovudine
IV Preparation
Reconstitute solution with 1 mL of diluent per mg of remifentanil; shake well to dissolve; should be diluted to final concentration of 25, 50 or 250 mcg/mL prior to administration
IV Administration
IV injection over 30-60 sec
May also do IV infusion
Storage
Store intact vials at 2-25°C
