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Remifentanil (Intravenous route)

Pronunciation:

rem-i-FEN-ta-nil

Brand Names:

  • Ultiva

Dosage Forms:

  • Powder for Solution

Classifications:

Therapeutic—

Analgesic

Chemical—

Opioid

Uses of This Medicine:

Remifentanil is used to relieve pain during and after surgery or other medical procedures. It is also used with other medicines (e.g., isoflurane, propofol, midazolam, thiopental, Diprivan®) just before or during an operation to help the anesthetic work better.

Remifentanil belongs to the group of medicines known as narcotic analgesics (pain medicines). It works by acting on the central nervous system (CNS) or brain to relieve pain.

Remifentanil is to be administered only by or under the immediate supervision of your doctor.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of remifentanil in children when given with an anesthetic before or during an operation. However, safety and efficacy have not been established in children for the relief of pain after surgery.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of remifentanil in the elderly. However, elderly patients are more sensitive to the effects of remifentanil, which may require an adjustment in the dose for patients receiving remifentanil.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Adinazolam
  • Alfentanil
  • Alprazolam
  • Anileridine
  • Bromazepam
  • Brotizolam
  • Butalbital
  • Carbinoxamine
  • Carisoprodol
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorzoxazone
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Codeine
  • Dantrolene
  • Diazepam
  • Estazolam
  • Ethchlorvynol
  • Fentanyl
  • Flunitrazepam
  • Flurazepam
  • Fospropofol
  • Halazepam
  • Hydrocodone
  • Hydromorphone
  • Ketazolam
  • Levorphanol
  • Lorazepam
  • Lormetazepam
  • Meclizine
  • Medazepam
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Metaxalone
  • Methocarbamol
  • Methohexital
  • Midazolam
  • Morphine
  • Morphine Sulfate Liposome
  • Nitrazepam
  • Nordazepam
  • Opium
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Prazepam
  • Propoxyphene
  • Quazepam
  • Remifentanil
  • Sodium Oxybate
  • Sufentanil
  • Tapentadol
  • Temazepam
  • Thiopental
  • Triazolam

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Perampanel

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bradycardia (slow heartbeat) or
  • Breathing or lung problems (e.g., apnea, respiratory depression) or
  • Heart rhythm problems or
  • Hypotension (low blood pressure)—Use with caution. May make these conditions worse.
  • Fentanyl allergy (e.g., Actiq®, Duragesic®, Sublimaze®), history of—Should not be used in patients with this condition.

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given through a needle placed in one of your veins.

Precautions While Using This Medicine:

It is very important that your doctor check your progress closely while you are receiving this medicine to see if it is working properly and to allow for a change in the dose.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates or medicine for seizures; muscle relaxants; or other anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you are receiving this medicine.

Check with your doctor right away if you have bluish lips or skin; chest pain; difficulty with breathing; a fast, pounding, or irregular heartbeat or pulse; shortness of breath; or muscle stiffness after receiving this medicine.

Dizziness, lightheadedness, or fainting may occur with this medicine, especially when you get up from a lying or sitting position suddenly. Getting up slowly may help, but if the problem continues or gets worse, check with your doctor.

This medicine may cause constipation. This is more common if you use it for a long time. Ask your doctor if you should also use a laxative to prevent and treat constipation.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common
Blurred vision
chest pain or discomfort
confusion
difficult or troubled breathing
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
irregular, fast or slow, or shallow breathing
lightheadedness, dizziness, or fainting
muscle stiffness or tightness
pale or blue lips, fingernails, or skin
shortness of breath
slow or irregular heartbeat
sweating
unusual tiredness or weakness
Less common
Bluish lips or skin
chills
decrease in cardiac output
fast, pounding, or irregular heartbeat or pulse
feeling of warmth
fever
headache
nausea or vomiting
nervousness
not breathing
pain after surgery
pain in the shoulders, arms, jaw, or neck
pounding in the ears
problems with bleeding or clotting
redness of the face, neck, arms, and occasionally, upper chest
shivering
Rare
Abdominal or stomach pain
black, tarry stools
bleeding gums
blood in the urine or stools
body aches or pain
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
congestion
cough or hoarseness
cough producing mucus
coughing that sometimes produces a pink frothy sputum
coughing up blood
decreased frequency or amount of urine
difficult, fast, or noisy breathing, sometimes with wheezing
difficulty with swallowing
disorientation
dry mouth
dryness or soreness of the throat
dysphoria
eye pain
flushed, dry skin
fruit-like breath odor
general feeling of illness
hiccups
hives
increased blood pressure
increased hunger
increased menstrual flow or vaginal bleeding
increased sweating
increased thirst
increased urination
itching
loss of appetite
lower back or side pain
muscle cramps or pain
nervousness
noisy breathing
nosebleeds
numbness or tingling in the hands, feet, or lips
painful or difficult urination
pale skin
paralysis
pinpoint red spots on the skin
prolonged bleeding from cuts
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rapid heartbeat
red or black, tarry stools
red or dark brown urine
runny nose
seizures
shakiness in the legs, arms, hands, or feet
skin rash
small clicking, bubbling, or rattling sounds in the lungs when listening with a stethoscope
stuffy nose
swelling in the legs and ankles
swelling of the face, fingers, or lower legs
tender, swollen glands in the neck
tightness in the chest
troubled breathing with exertion
unexplained weight loss
unusual bleeding or bruising
voice changes
vomiting
weakness and heaviness of the legs
weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
Anxiety
blurred or loss of vision
difficulty having a bowel movement (stool)
disturbed color perception
double vision
halos around lights
hyperventilation
night blindness
overbright appearance of lights
pain at the injection site
restlessness
trouble with sleeping
tunnel vision
Rare
Burning while urinating
heartburn
hives or welts
loss of bladder control
loss of memory
nightmares
problems with memory
seeing, hearing, or feeling things that are not there
severe constipation
severe vomiting
trouble with urinating
uncontrolled eye movements

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 4/4/2014

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