20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           : Dose as in normal renal function
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Dose as in normal renal function
HD                     :Not dialysed. Dose as in normal renal function
HDF/high flux   :Unlikely to be dialysed. Dose as in normal renal function
CAV/VVHD      :Unknown dialysability. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anti-arrhythmics: delayed absorption of mexiletine
Antidepressants: possible CNS excitation or depression (hypertension or hypotension) in patients also receiving MAOIs (including moclobemide) – avoid concomitant use; possibly increased sedative effects with tricyclics
Antipsychotics: enhanced sedative and hypotensive effect
Antivirals: concentration possibly increased by ritonavir (risk of toxicity) – avoidSodium oxybate: enhanced effect of sodium oxybate – avoid concomitant use
ADMINISTRATION
Reconstition
To 1 mg/mL with infusion fluid
Route
IV
Rate of Administration
Dependent on indication
Comments
Dilute to 20–250 mcg/mL with glucose 5%, sodium chloride 0.9% or water for injection; usually 50 micrograms/mL for general anaesthesia
OTHER INFORMATION
Half-life of metabolite is increased to 30 hours in renal failure compared with 90 minutes in patients with normal renal functionMetabolite is essentially inactive Remifentanil would be expected to be metabolised before patient needs to be dialysed25–35% of metabolites are removed by dialysis.