remifentanil
CLINICAL USE
Analgesic Induction of anaesthesia
DOSE IN NORMAL RENAL FUNCTION
Induction: 0.5–1 microgram/kg/min Maintenance: Ventilated patients: 0.05–2 mcg/kg/min —Spontaneous respiration: 25–100 —nanograms/kg/minAnalgesia and sedation in ventilated, intensive care patients: 6–740 nanograms/kg/minuteAdditional analgesia during painful procedures in ventilated, intensive care patients: 100–750 nanograms/kg/minute
PHARMACOKINETICS
Molecular weight                           :412.9 (as hydrochloride) %Protein binding                           :70 %Excreted unchanged in urine     : 95 (as metabolites) Volume of distribution (L/kg)       :0.35half-life – normal/ESRD (hrs)      :3–10 minutes (biological activity)/unchangedTerminal elimination 10 to 20     : minutes DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
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 functionHDF/high flux   :Unlikely to be dialysed. Dose as in normal renal functionCAV/VVHD      :Unknown dialysability. Dose as in normal renal function IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsAnti-arrhythmics: delayed absorption of mexiletineAntidepressants: possible CNS excitation or depression (hypertension or hypotension) in patients also receiving MAOIs (including moclobemide) – avoid concomitant use; possibly increased sedative effects with tricyclicsAntipsychotics: enhanced sedative and hypotensive effectAntivirals: 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.
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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