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Health Guide

Remifentanil (Intravenous route)

Pronunciation:

rem-i-FEN-ta-nil

Brand Names:

  • Ultiva

Dosage Forms:

  • Powder for Solution
  • Solution

Warnings:

Intravenous route(Powder for Solution)

Remifentanil exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing remifentanil .

Classifications:

Therapeutic—

Analgesic

Chemical—

Opioid

Uses of This Medicine:

Remifentanil injection is used to relieve pain during and after surgery or other medical procedures. It is also used with other medicines (eg, isoflurane, propofol, midazolam, thiopental) 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 injection when given with an anesthetic before or during an operation in children.

Appropriate studies on the relationship of age to the effects of remifentanil injection for the relief of pain after surgery have not been performed in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of remifentanil injection in the elderly. However, elderly patients may be more sensitive to the effects of remifentanil injection than younger adults, which may require caution and 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 not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Nalmefene
  • Naltrexone
  • Safinamide

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.

  • Acepromazine
  • Alfentanil
  • Almotriptan
  • Amineptine
  • Amisulpride
  • Amitriptyline
  • Amitriptylinoxide
  • Amobarbital
  • Amoxapine
  • Amphetamine
  • Anileridine
  • Aripiprazole
  • Asenapine
  • Baclofen
  • Benperidol
  • Benzphetamine
  • Bromazepam
  • Bromopride
  • Brompheniramine
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Carbamazepine
  • Carbinoxamine
  • Cariprazine
  • Carisoprodol
  • Carphenazine
  • Chloral Hydrate
  • Chlorpheniramine
  • Chlorpromazine
  • Chlorzoxazone
  • Citalopram
  • Clomipramine
  • Clozapine
  • Cocaine
  • Codeine
  • Cyclobenzaprine
  • Desipramine
  • Desmopressin
  • Desvenlafaxine
  • Dexmedetomidine
  • Dextroamphetamine
  • Dextromethorphan
  • Dezocine
  • Dibenzepin
  • Dichloralphenazone
  • Difenoxin
  • Dihydrocodeine
  • Diphenhydramine
  • Diphenoxylate
  • Dolasetron
  • Donepezil
  • Doxepin
  • Doxylamine
  • Droperidol
  • Duloxetine
  • Eletriptan
  • Enflurane
  • Escitalopram
  • Eszopiclone
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Fentanyl
  • Flibanserin
  • Fluoxetine
  • Fluphenazine
  • Fluspirilene
  • Fluvoxamine
  • Frovatriptan
  • Furazolidone
  • Granisetron
  • Haloperidol
  • Halothane
  • Hexobarbital
  • Hydrocodone
  • Hydromorphone
  • Hydroxytryptophan
  • Hydroxyzine
  • Iloperidone
  • Imipramine
  • Iproniazid
  • Isocarboxazid
  • Isoflurane
  • Ketamine
  • Ketobemidone
  • Levomilnacipran
  • Levorphanol
  • Linezolid
  • Lisdexamfetamine
  • Lithium
  • Lofepramine
  • Lorcaserin
  • Loxapine
  • Lurasidone
  • Melitracen
  • Melperone
  • Meperidine
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methamphetamine
  • Methdilazine
  • Methocarbamol
  • Methotrimeprazine
  • Methylene Blue
  • Milnacipran
  • Mirtazapine
  • Moclobemide
  • Molindone
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Naratriptan
  • Nefazodone
  • Nialamide
  • Nicomorphine
  • Nitrous Oxide
  • Nortriptyline
  • Olanzapine
  • Ondansetron
  • Opipramol
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Palonosetron
  • Papaveretum
  • Paregoric
  • Paroxetine
  • Pentazocine
  • Pentobarbital
  • Perampanel
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Pimavanserin
  • Pimozide
  • Piperacetazine
  • Pipotiazine
  • Piritramide
  • Primidone
  • Procarbazine
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propofol
  • Protriptyline
  • Quetiapine
  • Ramelteon
  • Rasagiline
  • Remoxipride
  • Risperidone
  • Rizatriptan
  • Secobarbital
  • Selegiline
  • Sertindole
  • Sertraline
  • Sibutramine
  • St John's Wort
  • Sufentanil
  • Sulpiride
  • Sumatriptan
  • Suvorexant
  • Tapentadol
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Thiothixene
  • Tianeptine
  • Tilidine
  • Tizanidine
  • Tolonium Chloride
  • Topiramate
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Trifluoperazine
  • Trifluperidol
  • Triflupromazine
  • Trimeprazine
  • Trimipramine
  • Tryptophan
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Zaleplon
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
  • Zopiclone
  • Zotepine

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. 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 is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

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:

  • Alcohol abuse, or history of or
  • Brain tumor or
  • Breathing or lung problems (eg, apnea, COPD, cor pulmonale, respiratory depression) or
  • Drug dependence, especially with narcotics, or history of or
  • Head injury, history of—May increase risk for more serious side effects.
  • Gallbladder problems or
  • Heart disease or
  • Hypotension (low blood pressure) or
  • Pancreatitis (inflammation of the pancreas) or
  • Seizures, history of or
  • Slow heartbeat—Use with caution. May make these conditions worse.

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:

Your doctor will check your progress closely while you or your child are receiving this medicine . This will allow your doctor to see if the medicine is working properly and to decide if you should continue to receive it.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with remifentanil may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. .

This medicine may make you dizzy, drowsy, or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully.

Tell your doctor if you or your child have stiffness in the muscles of your neck, chest, hands, or legs after receiving this medicine.

Check with your doctor right away if you or your child have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn baby. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

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 suddenly from a lying or sitting position
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 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
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, itching, or skin rash
increased blood pressure
increased hunger
increased menstrual flow or vaginal bleeding
increased sweating
increased thirst
increased urination
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
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: 8/4/2017
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