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5 languages العربية تۆرکجه cymraeg deutsch español euskara فارسی suomi français עברית hrvatski bahasa indonesia italiano 日本語 nederlands ଓଡ଼ିଆ polski português română русский srpskohrvatski српскохрватски српски srpski ไทย українська 中文 edit links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikimedia commons wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia synthetic opioid analgesic pharmaceutical compound remifentanil clinical data trade names ultiva other names methyl 1 2 methoxycarbonylethyl 4 phenyl propanoyl amino piperidine 4 carboxylate ahfs drugs com monograph pregnancy category au c routes of administration intravenous drug class opioid atc code n01ah06 who legal status legal status au s8 controlled drug br class a1 narcotic drugs 1 ca schedule i de anlage iii special prescription form required uk class a us schedule ii se förteckning ii 2 pharmacokinetic data bioavailability iv im 100 protein binding 70 bound to plasma proteins metabolism cleaved by non specific plasma and tissue esterases elimination half life 1 20 minutes identifiers iupac name methyl 1 3 methoxy 3 oxopropyl 4 n phenylpropanamido piperidine 4 carboxylate cas number 132875 61 7 y pubchem cid 60815 iuphar bps 7292 drugbank db00899 y chemspider 54803 y unii p10582jyyk kegg d08473 y as hcl d01177 y chebi chebi 8802 y chembl chembl1005 y comptox dashboard epa dtxsid00157826 echa infocard 100 211 201 chemical and physical data formula c 20 h 28 n 2 o 5 molar mass 376 453 g mol 1 3d model jsmol interactive image melting point 5 c 41 f smiles o c oc c2 n c1ccccc1 c o cc ccn ccc o oc cc2 inchi inchi 1s c20h28n2o5 c1 4 17 23 22 16 8 6 5 7 9 16 20 19 25 27 3 11 14 21 15 12 20 13 10 18 24 26 2 h5 9h 4 10 15h2 1 3h3 y key ztvqqqvzcwltdf uhfffaoysa n y verify remifentanil marketed under the brand name ultiva is a potent short acting synthetic opioid analgesic drug it is given to patients during surgery to relieve pain and as an adjunct to an anesthetic remifentanil is used for sedation as well as combined with other medications for use in general anesthesia the use of remifentanil has made possible the use of high dose opioid and low dose hypnotic anesthesia due to synergism between remifentanil and various hypnotic drugs and volatile anesthetics medical uses edit remifentanil is used as an opioid analgesic that has a rapid onset and rapid recovery time 3 it has been used effectively during craniotomies 4 spinal surgery 5 cardiac surgery 6 and gastric bypass surgery 7 while opioids function similarly with respect to analgesia the pharmacokinetics of remifentanil 8 allows for quicker post operative recovery 9 remifentanil can be administered as part of an anesthesia technique called tiva total intravenous anesthesia using computer controlled infusion pumps in a process called tci target controlled infusion a target plasma concentration is entered as ng ml into the pump which calculates its infusion rate according to patient factors like age and weight induction levels of 40 ng ml are commonly used but it generally varies between 3 8 ng ml for certain surgical procedures that produce particularly strong stimuli a level of up to 15 ng ml might be needed the relatively short context sensitive half life of remifentanil allows the desired blood plasma level to be achieved quickly and also for the same reason recovery occurs quickly this allows remifentanil to be used in unique circumstances such as cesarean section 10 remifentanil s short context sensitive half life makes it ideal for intense pain of short duration as such it has been used for analgesia in labor successfully however it is not as effective as epidural analgesia 11 in combination with propofol remifentanil is used for anesthesia of patients undergoing electroconvulsive therapy 12 available forms edit it is administered in the form remifentanil hydrochloride and in adults is given as an intravenous infusion in doses ranging from 0 1 microgram per kilogram per minute to 0 5 μg kg min children may require higher infusion rates up to 1 0 μg kg min 13 the clinically useful infusion rates are 0 025 0 1 μg kg min for sedation rates adjusted to age of patient severity of their illness and invasiveness of surgical procedure small amounts of other sedative medications are usually co administered with remifentanil to produce sedation clinically useful infusion rates in general anesthesia vary but are usually 0 1 1 μg kg min 14 pharmacology edit pharmacokinetics edit remifentanil is considered a metabolic soft drug 15 one that is rapidly metabolized to an inactive form unlike other synthetic opioids which are hepatically metabolized remifentanil has an ester linkage which undergoes rapid hydrolysis by non specific tissue and plasma esterases this means that accumulation does not occur with remifentanil and its context sensitive half life remains at 4 minutes after a 4 hour infusion 16 remifentanil is metabolized to remifentanil acid which has 1 4600th the potency of the parent compound 17 due to its quick metabolism and short effects remifentanil has opened up new possibilities in anesthesia when remifentanil is used together with a hypnotic i e one that produces sleep it can be used in relative high doses this is because remifentanil is rapidly eliminated from the blood plasma on termination of the remifentanil infusion hence the effects of the drug quickly dissipate even after very long infusions owing to synergism between remifentanil and hypnotic drugs such as propofol the dose of the hypnotic can be substantially reduced 18 this leads often to more hemodynamic stability during surgery and a quicker post operative recovery time pharmacodynamics edit comparing its analgesia sedation effect in ventilated patients remifentanil may be superior to morphine 19 but not to fentanyl 20 side effects edit remifentanil is a specific μ receptor agonist 18 hence it causes a reduction in sympathetic nervous system tone respiratory depression and analgesia the drug s effects include a dose dependent decrease in heart rate and arterial pressure and respiratory rate and tidal volume muscle rigidity is sometimes noted the most common side effects reported by patients receiving this medication are a sense of extreme dizziness often short lived a common side effect of other fast acting synthetic phenylpiperidine narcotics such as fentanyl and alfentanil and intense itching pruritus often around the face these side effects are often controlled by either altering the administered dose decreasing or in some cases increasing the dose or by administering other sedatives that allow the patient to tolerate or lose awareness of the side effect because pruritus is partially due to excessive serum histamine levels antihistamines such as diphenhydramine benadryl are often co administered this is done with care however as excessive sedation may occur nausea can occur as a side effect of remifentanil however it is usually transient in nature due to the drug s short half life which rapidly removes it from the patient s circulation once the infusion is terminated abuse potential edit remifentanil being a μ receptor agonist functions like other μ receptor agonists such as morphine and codeine it can cause euphoria and has the potential for abuse 21 22 however due to its rapid metabolism and short acting half life the likelihood of abuse is quite low nevertheless there have been some documentations of remifentanil abuse 23 24 society and culture edit development and marketing edit prior to the development of remifentanil most short acting hypnotics and amnestics faced issues with prolonged use where accumulation would result in unfavorable lingering effects during post operative recovery remifentanil was designed to serve as a strong anesthetic with an ultra short and predictable duration that would not have accumulation issues 25 remifentanil was patented by glaxo wellcome inc 26 and was fda approved on july 12 1996 27 its patent ended on the 10th of september 2017 legal status edit in hong kong remifentanil is regulated under schedule 1 of hong kong s chapter 134 dangerous drugs ordinance it can only be used legally by health professionals and for university research purposes the substance can be given by pharmacists under a prescription anyone who supplies the substance without prescription can be fined hk 10 000 us 1 550 the penalty for trafficking or manufacturing the substance is a hk 5 000 000 us 775 000 fine and life imprisonment possession of the substance for consumption without license from the department of health is illegal with a hk 1 000 000 us 155 000 fine and or 7 years of jail time remifentanil is a schedule ii narcotic controlled substance in the united states with a dea acscn of 9739 and a 2013 annual aggregate manufacturing quota of 3 750 grams unchanged from the prior year tert butyl remifentanil edit chemical structure of tert butyl remifentanil replacing the methyl ester on the long chain with a tert butyl ester makes the remifentanil analogue 150 000 times more potent than morphine and 210 times more potent than remifentanil itself which makes it one of the most potent fentanyl analogues known the tert butyl group also makes it more resistant to hydrolysis and extends its half life in the body 28 veterinary use edit remifentanil has a very short half life and quick onset with recovery occurring in a few minutes regardless of length and dosage provided remifentanil is more effective in dogs than cats although an increase in the dosage in cats can achieve equivalent analgesia and anti nociception the half life is 6 minutes in the dog this half life does not increase with increased dosage or prolonged usage and thus remifentanil recovery is very quick hyperalgesia and tolerance has been demonstrated in rodents and rabbits but not dogs and cats in equines remifentanil can provide long lasting sedation when combined with xylazine and used as constant rate infusion 16 references edit anvisa 2023 03 31 rdc nº 784 listas de substâncias entorpecentes psicotrópicas precursoras e outras sob controle especial collegiate board resolution no 784 lists of narcotic psychotropic precursor and other substances under special control in brazilian portuguese diário oficial da união published 2023 04 04 archived from the original on 2023 08 03 retrieved 2023 08 16 remifentanil hameln pulver till koncentrat till injektions infusionsvätska lösning 1 mg in swedish fass 16 march 2026 retrieved 27 july 2026 remifentanil iv opioid analgesic remi ultiva www ultiva com retrieved 2015 11 30 gesztesi z mootz bl white pf november 1999 the use of a remifentanil infusion for hemodynamic control during intracranial surgery anesthesia and analgesia 89 5 1282 7 doi 10 1213 00000539 199911000 00038 pmid 10553851 grottke o dietrich pj wiegels s wappler f november 2004 intraoperative wake up test and postoperative emergence in patients undergoing spinal surgery a comparison of intravenous and inhaled anesthetic techniques using short acting anesthetics anesthesia and analgesia 99 5 1521 1527 doi 10 1213 01 ane 0000134684 25322 26 pmid 15502058 s2cid 45361690 knapik m knapik p nadziakiewicz p misiołek h saucha w walaszczyk m dyaczyńska herman a august 2006 comparison of remifentanil or fentanyl administration during isoflurane anesthesia for coronary artery bypass surgery medical science monitor 12 8 pi33 8 pmid 16865075 de baerdemaeker le jacobs s pattyn p mortier ep struys mm september 2007 influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding remifentanil tci vs sufentanil tci in morbid obesity british journal of anaesthesia 99 3 404 11 doi 10 1093 bja aem164 pmid 17606479 michelsen lg hug jr cc december 1996 the pharmacokinetics of remifentanil journal of clinical anesthesia 8 8 679 82 doi 10 1016 s0952 8180 96 00179 1 pmid 8982900 guy j hindman bj baker kz borel co maktabi m ostapkovich n et al march 1997 comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space occupying lesions anesthesiology 86 3 514 524 doi 10 1097 00000542 199703000 00002 pmid 9066316 white ld hodsdon a an gh thang c melhuish tm vlok r november 2019 induction opioids for caesarean section under general anaesthesia a systematic review and meta analysis of randomised controlled trials international journal of obstetric anesthesia 40 4 13 doi 10 1016 j ijoa 2019 04 007 hdl 10072 416502 pmid 31230994 stocki d matot i einav s eventov friedman s ginosar y weiniger cf march 2014 a randomized controlled trial of the efficacy and respiratory effects of patient controlled intravenous remifentanil analgesia and patient controlled epidural analgesia in laboring women anesthesia and analgesia 118 3 589 597 doi 10 1213 ane 0b013e3182a7cd1b pmid 24149580 s2cid 4844447 ulusoy h cekic b besir a geze s hocaoglu c akdogan a february 2014 sevoflurane remifentanil versus propofol remifentanil for electroconvulsive therapy comparison of seizure duration and haemodynamic responses the journal of international medical research 42 1 111 119 doi 10 1177 0300060513509036 pmid 24398757 weale nk rogers ca cooper r nolan j wolf ar february 2004 effect of remifentanil infusion rate on stress response to the pre bypass phase of paediatric cardiac surgery british journal of anaesthesia 92 2 187 194 doi 10 1093 bja aeh038 pmid 14722167 remifentanil actavis in swedish retrieved 21 aug 2014 bodor n buchwald p january 2000 soft drug design general principles and recent applications medicinal research reviews 20 1 58 101 doi 10 1002 sici 1098 1128 200001 20 1 58 aid med3 3 0 co 2 x pmid 10608921 s2cid 25119421 1 2 simon bt lizarraga i 11 september 2024 opioids in lamont l grimm k robertson s love l schroeder c eds veterinary anesthesia and analgesia the 6th edition of lumb and jones wiley blackwell p 378 isbn 978 1 119 83027 6 hoke jf cunningham f james mk muir kt hoffman we april 1997 comparative pharmacokinetics and pharmacodynamics of remifentanil its principle metabolite gr90291 and alfentanil in dogs the journal of pharmacology and experimental therapeutics 281 1 226 232 doi 10 1016 s0022 3565 24 36558 9 pmid 9103501 1 2 patel ss spencer cm september 1996 remifentanil drugs 52 3 417 27 discussion 428 doi 10 2165 00003495 199652030 00009 pmid 8875131 s2cid 265900417 dahaba aa grabner t rehak ph list wf metzler h september 2004 remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients a randomized double blind study anesthesiology 101 3 640 646 doi 10 1097 00000542 200409000 00012 pmid 15329588 s2cid 17192694 spies c macguill m heymann a ganea c krahne d assman a e...