remifentanil (Rx)

Brand and Other Names:Ultiva
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & 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  

Dosage Forms & 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

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

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Interactions

Interaction Checker

and remifentanil

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (1)

            • alvimopan

              alvimopan, remifentanil. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

            Serious - Use Alternative (25)

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • citalopram

              remifentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • clonidine

              clonidine, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

            • desvenlafaxine

              desvenlafaxine and remifentanil both decrease serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome

            • diazepam intranasal

              diazepam intranasal, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • eluxadoline

              remifentanil, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

            • escitalopram

              remifentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • fentanyl

              fentanyl, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl intranasal

              fentanyl intranasal, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transdermal

              fentanyl transdermal, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transmucosal

              fentanyl transmucosal, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fluvoxamine

              fluvoxamine and remifentanil both increase serotonin levels. Avoid or Use Alternate Drug.

            • hydrocodone

              hydrocodone, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • linezolid

              remifentanil, linezolid. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • methylene blue

              methylene blue and remifentanil both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

            • metoclopramide intranasal

              remifentanil, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • ozanimod

              ozanimod and remifentanil both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • paroxetine

              remifentanil, paroxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • ponesimod

              ponesimod, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

            • selinexor

              selinexor, remifentanil. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sertraline

              remifentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • sufentanil SL

              sufentanil SL, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • valerian

              valerian and remifentanil both increase sedation. Avoid or Use Alternate Drug.

            • venlafaxine

              venlafaxine and remifentanil both decrease serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome

            • vortioxetine

              remifentanil, vortioxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            Monitor Closely (45)

            • almotriptan

              remifentanil increases toxicity of almotriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • amitriptyline

              amitriptyline, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

            • brexanolone

              brexanolone, remifentanil. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              remifentanil increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • captopril

              remifentanil, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • cenobamate

              cenobamate, remifentanil. Either increases effects of the other by sedation. Use Caution/Monitor.

            • clobazam

              remifentanil, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              clomipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

            • cyclobenzaprine

              cyclobenzaprine increases effects of remifentanil by pharmacodynamic synergism. Modify Therapy/Monitor Closely. CNS depressant effect increased.

            • deutetrabenazine

              remifentanil and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • doxepin

              doxepin, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

            • duloxetine

              remifentanil increases toxicity of duloxetine by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • eletriptan

              remifentanil increases toxicity of eletriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • esketamine intranasal

              esketamine intranasal, remifentanil. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • flibanserin

              remifentanil and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

            • fluoxetine

              remifentanil, fluoxetine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

            • frovatriptan

              remifentanil increases toxicity of frovatriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • gabapentin

              gabapentin, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • imipramine

              imipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

            • isocarboxazid

              remifentanil increases toxicity of isocarboxazid by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • lasmiditan

              lasmiditan, remifentanil. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, remifentanil. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levomilnacipran

              remifentanil increases toxicity of levomilnacipran by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • lurasidone

              lurasidone, remifentanil. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • metaxalone

              metaxalone increases effects of remifentanil by pharmacodynamic synergism. Modify Therapy/Monitor Closely. CNS depressant effect increased.

            • midazolam intranasal

              midazolam intranasal, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of benzodiazepines and opioids increases risk of respiratory depression. Use only in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required.

              midazolam intranasal, remifentanil. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • milnacipran

              remifentanil increases toxicity of milnacipran by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • mirtazapine

              mirtazapine, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • naratriptan

              remifentanil increases toxicity of naratriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • oliceridine

              oliceridine, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • phenelzine

              remifentanil increases toxicity of phenelzine by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • pregabalin

              pregabalin, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • remimazolam

              remimazolam, remifentanil. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. aCoadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • rizatriptan

              remifentanil increases toxicity of rizatriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • selegiline

              remifentanil increases toxicity of selegiline by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • selegiline transdermal

              remifentanil increases toxicity of selegiline transdermal by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • stiripentol

              stiripentol, remifentanil. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sumatriptan

              remifentanil increases toxicity of sumatriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • sumatriptan intranasal

              remifentanil increases toxicity of sumatriptan intranasal by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • suvorexant

              suvorexant and remifentanil both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

            • tramadol

              tramadol, remifentanil. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • tranylcypromine

              remifentanil increases toxicity of tranylcypromine by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            • trimipramine

              trimipramine, remifentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. May also increase risk of serotonin syndrome.

            • zolmitriptan

              remifentanil increases toxicity of zolmitriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.

            Minor (1)

            • benazepril

              remifentanil, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

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            Adverse 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

            Biliary tract disease

            Postmarketing Reports

            Serotonin syndrome

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            Warnings

            Black Box Warnings

            Addiction, abuse, and misuse

            • Therapy 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 therapy, and monitor all patients regularly for the development of these behaviors and conditions

            Contraindications

            Epidural or intrathecal administration

            Known hypersensitivity to fentanyl analogs

            Cautions

            In patients who may be susceptible to intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), therapy may reduce respiratory drive, and resultant CO2 retention can further increase intracranial pressure; monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy; opioids may obscure clinical course in a patient with a head injury; avoid the use in patients with impaired consciousness or coma

            Profound sedation, respiratory depression, coma, and death may result from concomitant administration with benzodiazepines or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol); because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate

            Cases of serotonin syndrome, a potentially life-threatening condition, reported with concomitant use of serotonergic drugs; this may occur within the recommended dosage range; the onset of symptoms generally occur within several hours to a few days of concomitant use, but may occur later than that; discontinue therapy immediately if serotonin syndrome is suspected

            Muscle rigidity occurring during induction of can be treated by decreasing rate or discontinuing infusion of drug or by administering a neuromuscular blocking agent; neuromuscular blocking agents used should be compatible with patient's cardiovascular status

            Bradycardia may occur; monitor heart rate during dosage initiation and titration; responsive to ephedrine or anticholinergic drugs

            Therapy may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients; there is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics); monitor patients for signs of hypotension after initiating or titrating dosage; in patients with circulatory shock, therapy may cause vasodilation that can further reduce cardiac output and blood pressure; avoid therapy in patients with circulatory shock

            Not to be administered into same IV tubing with blood due to potential inactivation by nonspecific esterases in blood products

            Therapy may increase frequency of seizures in patients with seizure disorders and in other clinical settings associated with seizures; monitor patients for worsened seizure control during therapy

            May cause spasm of sphincter of Oddi; opioids may cause increases in serum amylase; monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms

            Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients; monitor closely

            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

            Intraoperative awareness in some pts under 55 yo when admin. with propofol infusion < 75 mcg/kg/min

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            Pregnancy & Lactation

            Pregnancy

            Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome; available data in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage

            Labor or delivery

            • Opioids cross placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid induced respiratory depression in neonate; drug is not recommended for use in women during and immediately prior to labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate; opioid analgesics can prolong labor through actions that temporarily reduce strength, duration, and frequency of uterine contractions; however, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor; monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression

            Lactation

            The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy; capsules and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition

            Monitor infants exposed to drug through breast milk for excess sedation and respiratory depression; withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast- feeding is stopped

            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.

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            Pharmacology

            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

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            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

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Ultiva intravenous
            -
            1 mg vial
            Ultiva intravenous
            -
            5 mg vial
            Ultiva intravenous
            -
            2 mg vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            remifentanil intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.