{"id":1619,"date":"2023-06-25T17:28:42","date_gmt":"2023-06-25T17:28:42","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/alfentanil\/"},"modified":"2023-06-25T19:58:59","modified_gmt":"2023-06-25T19:58:59","slug":"alfentanil","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/alfentanil\/","title":{"rendered":"Alfentanil"},"content":{"rendered":"

<\/p>\n

Alfentanil<\/h1>\n

CLINICAL USE<\/h3>\n

Opioid analgesic:<\/p>\n

  • Short surgical procedures<\/li>\n
  • Intensive care sedation
    \n

    DOSE IN NORMAL RENAL FUNCTION<\/h3>\n<\/li>\n
  • IV injection:Spontaneous respiration: up to\n

    \u2014
    \n500 micrograms over 30 seconds;
    \nsupplemental dose: 250 micrograms
    \nassisted ventilation: 30\u201350<\/p>\n

    \u2014
    \nmicrograms\/kg; supplemental dose:
    \n15 micrograms\/kg<\/li>\n

  • By IV infusion with assisted ventilation:loading dose 50\u2013100 micrograms\/kg as
    \nbolus or fast infusion over 10 minutes,
    \nfollowed by 0.5\u20131 micrograms\/kg\/minute.
    \nDiscontinue infusion 30 minutes before
    \nanticipated end of surgery<\/li>\n
  • For analgesia and suppression ofrespiratory activity during intensive care
    \nwith assisted ventilation: by IV infusion
    \n2 mg\/hour, adjusted according to response
    \n(usual range 0.5\u201310 mg\/hour)<\/li>\n
  • For more rapid initial control give 5 mgIV in divided portions over 10 minutes
    \n(slower if hypotension or bradycardia
    \ndevelops); additional doses of 0.5\u20131 mg
    \nmay be given by IV injection during short
    \npainful procedures<\/p>\n

    PHARMACOKINETICS<\/h3>\n<\/li>\n
  • Molecular weight                           :
    \n453 (as hydrochloride)<\/li>\n
  • %Protein binding                           :
    \n92<\/li>\n
  • %Excreted unchanged in urine     :
    \n0.4<\/li>\n
  • Volume of distribution (L\/kg)       :
    \n0.4\u20131<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :
    \n1\u20132 (average
    \n90 minutes)\/
    \nUnchanged<\/p>\n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : Dose as in normal renal function<\/li>\n
  • 10 to 20     : Dose as in normal renal function<\/li>\n
  • <10           :
    \nDose as in normal renal function<\/p>\n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HD                     :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HDF\/high flux   :
    \nUnknown dialysability. Dose as in
    \nnormal renal function<\/li>\n
  • CAV\/VVHD      :
    \nNot dialysed. Dose as in normal renal function<\/p>\n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Antidepressants: possible CNS excitationor depression (hypertension or
    \nhypotension) in patients also receiving
    \nMAOIs (including moclobemide) \u2013 avoid
    \nconcomitant use; possibly increased
    \nsedative effects with tricyclics<\/li>\n
  • Antifungals: metabolism inhibited byfluconazole and ketoconazole (risk
    \nof prolonged or delayed respiratory
    \ndepression); metabolism possibly inhibited
    \nby itraconazole<\/li>\n
  • Antivirals: concentration possiblyincreased by ritonavir<\/li>\n
  • Sodium oxybate: enhanced effect ofsodium oxybate \u2013 avoid concomitant use
    \n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n

    \u2013<\/p>\n

    Route<\/h4>\n

    IV bolus,<\/p>\n

    IV infusion<\/h4>\n

    Rate of Administration<\/h4>\n

    See dose<\/p>\n

    Comments<\/h4>\n<\/li>\n
  • Alfentanil can be mixed with sodiumchloride 0.9%, glucose 5%, or compound
    \nsodium lactate injection (Hartmann\u2019s
    \nsolution) at a concentration of 0.5 mg\/
    \nmL, but can be used at 2 mg\/mL or even
    \nundiluted at 5 mg\/mL.<\/p>\n

    OTHER INFORMATION<\/h4>\n<\/li>\n
  • Free fraction of drug is increased in renalfailure, hence dose requirements may be
    \nreduced<\/li>\n
  • IV administration: 500 microgramsalfentanil has peak effect in 90 seconds,
    \nand provides analgesia for 5\u201310 minutes
    \n(in unpremedicated adults)<\/li>\n
  • Transient fall in BP and bradycardia mayoccur on administration<\/li>\n
  • Analgesic potency = \u00bc that of fentanylDuration of action = \u2153 that of an equi-\n

    analgesic dose of fentanyl<\/li>\n

  • Onset of action = 4 times more rapid thanan equi-analgesic dose of fentanyl<\/li>\n","protected":false},"excerpt":{"rendered":"

    Alfentanil CLINICAL USE Opioid analgesic: Short surgical procedures Intensive care<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1619","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1619"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1619\/revisions"}],"predecessor-version":[{"id":2936,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1619\/revisions\/2936"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}