Names and pronunciation
(rem-ih-fin′ta-nill) Ultiva
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Drug reference
(rem-ih-fin′ta-nill) Ultiva
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Func. class.: Opiate agonist analgesic
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Chem. class.: μ-Opioid agonist Controlled Substance Schedule II
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ACTION: Inhibits ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus
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USES: In combination with other products for general anesthesia to provide analgesia
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CONTRAINDICATIONS: Hyper sensitivity Precautions: Pregnancy, breastfeeding, children <12 yr, geriatric patients, increased intracranial pressure, acute MI, severe heart disease, GI/renal/hepatic disease, asthma, respiratory conditions, seizure disorders, bradyarrhythmias
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Black Box Warning: Potential for over- dose or poisoning, substance abuse Black Box Warning: Potential for over- dose or poisoning: there is a significant potential; proper patient selection and counseling are needed; keep out of reach of children, pets; accidental overdose and death may occur • Respiratory dysfunction: respiratory depression, character, rate, rhythm; notify prescriber if respirations <12/ min; CV status; bradycardia, syncope • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; avoid use in breastfeeding, excretion unknown
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SIDE EFFECTS CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria, delirium, agitation, anxiety CV: Palpitations, bradycardia, change in B/P, facial flushing, syncope, asystole EENT: Tinnitus, blurred vision, miosis, diplopia GI: Nausea, vomiting, anorexia, consti- pation, cramps, dry mouth GU: Urinary retention, dysuria INTEG: Rash, urticaria, bruising, flush- ing, diaphoresis, pruritus MS: Rigidity RESP: Respiratory depression, apnea
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INTERACTIONS Increase: respiratory depression, hypo- tension, profound sedation: alcohol, seda- tives, hypnotics, other CNS depressants; antihistamines, phenothiazines, MAOIs Drug/Herb Increase: CNS depression—kava
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DOSAGE AND ROUTES • Adult: IV induction 0.5-1 mcg/kg/ min with hypnotic or volatile agent; maintenance with isoflurane or pro- pofol 0.25 mcg/kg/min (range 0.05-2 mcg/kg/min); CONT INFUSION 0.025- 0.2 mcg/kg/min • Child 1-12 yr: CONT IV INFUSION 0.25 mcg/kg/min with isoflurane • Full-term neonate and infant up to 2 mo: CONT IV INFUSION 0.4 mcg/kg/ min with nitrous oxide
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Available forms: Powder for inj lyophi- lized 1, 2, 5 mg
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Administer: • Add 1 mL diluent per mg remifentanil • Shake well; further dilute to a final con- centration of 20, 25, 50, or 250 mcg/mL • Store in light-resistant area at room temperature • Interruption of infusion results in rapid reversal (no residual opioid effect within 5-10 min) Direct IV route • To be used only during maintenance of general anesthesia; inject into tubing close to venous cannula; give to nonintu- bated patients over 30-60 sec Continuous IV INFUSION route R • Use infusion device, max 16 hr; do not use same tubing as blood, do not admix Y-site compatibilities: Acyclovir, alfentanil, amikacin, aminophylline, ampicillin, ampi- cillin/sulbactam, aztreonam, bumetanide, buprenorphine, butorphanol, calcium glu- conate, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizox- ime, cefTRIAXone, cefuroxime, cimetidine, ciprofloxacin, cisatracurium, clindamycin, dexamethasone, digoxin, diltiazem, diphen- hydrAMINE, DOBUTamine, DOPamine, doxacurium, doxycycline, droperidol, enal- aprilat, EPINEPHrine, esmolol, famotidine, fentaNYL, fluconazole, furosemide, ganci- clovir, gatifloxacin, gentamicin, haloperidol, heparin, hydrocortisone sodium succinate, HYDROmorphone, hydrOXYzine, imipenem-cilastatin, inamrinone, isopro- terenol, ketorolac, lidocaine, LORazepam, magnesium sulfate, mannitol, meperidine, methylPREDNISolone sodium succinate, metoclopramide, metroNIDAZOLE, mid- azolam, morphine, nalbuphine, nitroglyc- erin, norepinephrine, ondansetron, phenyl- ephrine, piperacillin, potassium chloride, procainamide, prochlorperazine, prometh- azine, raNITIdine, SUFentanil, theophylline, thiopental, ticarcillin/clavulanate, tobramy- cin, vancomycin, zidovudine Solution compatibilities: D5W, 0.45% NaCl, LR, D5LR, 0.9% NaCl
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Assess: • I&O ratio; check for decreasing out- put; may indicate urinary retention, espe- cially in geriatric patients • CNS changes; dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction • GI status: nausea, vomiting, anorexia, constipation • Allergic reactions: rash, urticaria Black Box Warning: Substance abuse: assess for risks of addiction, abuse, or misuse before drug initiation, and monitor those who receive opioids; assess for depression or other mental illness in the patient or family members
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Evaluate: • Therapeutic response: maintenance of anesthesia
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Reason for product, expected results
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PHARMACOKINETICS 70% protein binding, terminal half-life 3-10 min, excreted in urine; onset: 1-3 min
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• Full-term neonate and infant up to 2 mo: CONT IV INFUSION 0.4 mcg/kg/ min with nitrous oxide
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