Description and Brand Names

Drug information provided by: Micromedex

US Brand Name

  1. Ultiva

Descriptions


Remifentanil injection is used to relieve pain during and after surgery or other medical procedures. It is also used with other medicines (eg, isoflurane, propofol, midazolam, thiopental) just before or during an operation to help the anesthetic work better.

Remifentanil belongs to the group of medicines known as narcotic analgesics (pain medicines). It works by acting on the central nervous system (CNS) or brain to relieve pain.

Remifentanil is to be administered only by or under the immediate supervision of your doctor.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Solution
  • Powder for Solution

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of remifentanil injection when given with an anesthetic before or during an operation in children.

Appropriate studies on the relationship of age to the effects of remifentanil injection for the relief of pain after surgery have not been performed in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of remifentanil injection in the elderly. However, elderly patients may be more sensitive to the effects of remifentanil injection than younger adults, which may require caution and an adjustment in the dose for patients receiving remifentanil.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Nalmefene
  • Naltrexone
  • Safinamide

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acepromazine
  • Alfentanil
  • Almotriptan
  • Amineptine
  • Amisulpride
  • Amitriptyline
  • Amitriptylinoxide
  • Amobarbital
  • Amoxapine
  • Amphetamine
  • Anileridine
  • Aripiprazole
  • Asenapine
  • Baclofen
  • Benperidol
  • Benzhydrocodone
  • Benzphetamine
  • Bromazepam
  • Bromopride
  • Brompheniramine
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Carbamazepine
  • Carbinoxamine
  • Cariprazine
  • Carisoprodol
  • Carphenazine
  • Chloral Hydrate
  • Chlorpheniramine
  • Chlorpromazine
  • Chlorzoxazone
  • Citalopram
  • Clomipramine
  • Clopidogrel
  • Clozapine
  • Cocaine
  • Codeine
  • Cyclobenzaprine
  • Desipramine
  • Desmopressin
  • Desvenlafaxine
  • Dexmedetomidine
  • Dextroamphetamine
  • Dextromethorphan
  • Dezocine
  • Dibenzepin
  • Dichloralphenazone
  • Difenoxin
  • Dihydrocodeine
  • Diphenhydramine
  • Diphenoxylate
  • Dolasetron
  • Donepezil
  • Doxepin
  • Doxylamine
  • Droperidol
  • Duloxetine
  • Eletriptan
  • Enflurane
  • Escitalopram
  • Eszopiclone
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Fentanyl
  • Flibanserin
  • Fluoxetine
  • Fluphenazine
  • Fluspirilene
  • Fluvoxamine
  • Frovatriptan
  • Furazolidone
  • Granisetron
  • Haloperidol
  • Halothane
  • Hexobarbital
  • Hydrocodone
  • Hydromorphone
  • Hydroxytryptophan
  • Hydroxyzine
  • Iloperidone
  • Imipramine
  • Iproniazid
  • Isocarboxazid
  • Isoflurane
  • Ketamine
  • Ketobemidone
  • Levomilnacipran
  • Levorphanol
  • Linezolid
  • Lisdexamfetamine
  • Lithium
  • Lofepramine
  • Lofexidine
  • Lorcaserin
  • Loxapine
  • Lurasidone
  • Melitracen
  • Melperone
  • Meperidine
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methamphetamine
  • Methdilazine
  • Methocarbamol
  • Methotrimeprazine
  • Methylene Blue
  • Metoclopramide
  • Midazolam
  • Milnacipran
  • Mirtazapine
  • Moclobemide
  • Molindone
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Naratriptan
  • Nefazodone
  • Nialamide
  • Nicomorphine
  • Nitrous Oxide
  • Nortriptyline
  • Olanzapine
  • Ondansetron
  • Opipramol
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Palonosetron
  • Papaveretum
  • Paregoric
  • Paroxetine
  • Pentazocine
  • Pentobarbital
  • Perampanel
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Pimavanserin
  • Pimozide
  • Piperacetazine
  • Pipotiazine
  • Piritramide
  • Primidone
  • Procarbazine
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propofol
  • Protriptyline
  • Quetiapine
  • Ramelteon
  • Rasagiline
  • Remoxipride
  • Risperidone
  • Rizatriptan
  • Secobarbital
  • Selegiline
  • Sertindole
  • Sertraline
  • Sibutramine
  • St John's Wort
  • Sufentanil
  • Sulpiride
  • Sumatriptan
  • Suvorexant
  • Tapentadol
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Thiothixene
  • Tianeptine
  • Tilidine
  • Tizanidine
  • Tolonium Chloride
  • Topiramate
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Trifluoperazine
  • Trifluperidol
  • Triflupromazine
  • Trimeprazine
  • Trimipramine
  • Tryptophan
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Zaleplon
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
  • Zopiclone
  • Zotepine

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, or history of or
  • Brain tumor or
  • Breathing or lung problems (eg, apnea, COPD, cor pulmonale, respiratory depression) or
  • Drug dependence, especially with narcotics, or history of or
  • Head injury, history of—May increase risk for more serious side effects.
  • Gallbladder problems or
  • Heart disease or
  • Hypotension (low blood pressure) or
  • Pancreatitis (inflammation of the pancreas) or
  • Seizures, history of or
  • Slow heartbeat—Use with caution. May make these conditions worse.

Proper Use

A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given through a needle placed in one of your veins.

Precautions

Your doctor will check your progress closely while you or your child are receiving this medicine . This will allow your doctor to see if the medicine is working properly and to decide if you should continue to receive it.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with remifentanil may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. .

This medicine may make you dizzy, drowsy, or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully.

Tell your doctor if you or your child have stiffness in the muscles of your neck, chest, hands, or legs after receiving this medicine.

Check with your doctor right away if you or your child have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn baby. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

  1. Blurred vision
  2. chest pain or discomfort
  3. confusion
  4. difficult or troubled breathing
  5. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  6. irregular, fast or slow, or shallow breathing
  7. lightheadedness, dizziness, or fainting
  8. muscle stiffness or tightness
  9. pale or blue lips, fingernails, or skin
  10. shortness of breath
  11. slow or irregular heartbeat
  12. sweating
  13. unusual tiredness or weakness

Less common

  1. Bluish lips or skin
  2. chills
  3. decrease in cardiac output
  4. fast, pounding, or heartbeat or pulse
  5. feeling of warmth
  6. fever
  7. headache
  8. nausea or vomiting
  9. nervousness
  10. not breathing
  11. pain after surgery
  12. pain in the shoulders, arms, jaw, or neck
  13. pounding in the ears
  14. problems with bleeding or clotting
  15. redness of the face, neck, arms, and occasionally, upper chest
  16. shivering

Rare

  1. Abdominal or stomach pain
  2. black, tarry stools
  3. bleeding gums
  4. blood in the urine or stools
  5. body aches or pain
  6. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  7. congestion
  8. cough or hoarseness
  9. cough producing mucus
  10. coughing that sometimes produces a pink frothy sputum
  11. coughing up blood
  12. decreased frequency or amount of urine
  13. difficult, fast, or noisy breathing
  14. difficulty with swallowing
  15. disorientation
  16. dry mouth
  17. dryness or soreness of the throat
  18. dysphoria
  19. eye pain
  20. flushed, dry skin
  21. fruit-like breath odor
  22. general feeling of illness
  23. hiccups
  24. hives, itching, or skin rash
  25. increased blood pressure
  26. increased hunger
  27. increased menstrual flow or vaginal bleeding
  28. increased sweating
  29. increased thirst
  30. increased urination
  31. loss of appetite
  32. lower back or side pain
  33. muscle cramps or pain
  34. nervousness
  35. noisy breathing
  36. nosebleeds
  37. numbness or tingling in the hands, feet, or lips
  38. painful or difficult urination
  39. pale skin
  40. paralysis
  41. pinpoint red spots on the skin
  42. prolonged bleeding from cuts
  43. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  44. rapid heartbeat
  45. red or black, tarry stools
  46. red or dark brown urine
  47. runny nose
  48. seizures
  49. shakiness in the legs, arms, hands, or feet
  50. small clicking, bubbling, or rattling sounds in the lungs when listening with a stethoscope
  51. stuffy nose
  52. swelling in the legs and ankles
  53. swelling of the face, fingers, or lower legs
  54. tender, swollen glands in the neck
  55. tightness in the chest
  56. troubled breathing with exertion
  57. unexplained weight loss
  58. unusual bleeding or bruising
  59. voice changes
  60. vomiting
  61. weakness and heaviness of the legs
  62. weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  1. Anxiety
  2. blurred or loss of vision
  3. difficulty having a bowel movement (stool)
  4. disturbed color perception
  5. double vision
  6. halos around lights
  7. hyperventilation
  8. night blindness
  9. overbright appearance of lights
  10. pain at the injection site
  11. restlessness
  12. trouble with sleeping
  13. tunnel vision

Rare

  1. Burning while urinating
  2. heartburn
  3. hives or welts
  4. loss of bladder control
  5. loss of memory
  6. nightmares
  7. problems with memory
  8. seeing, hearing, or feeling things that are not there
  9. severe constipation
  10. severe vomiting
  11. trouble with urinating
  12. uncontrolled eye movements

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.