Remifentanil
Remifentanil is short-acting and a potent synthetic opioid analgesic. It is used in surgeries to
relieve pain and as an adjunct to an Anaesthetic. It is used to sedate and combined with other
medications in inducing general anesthesia. Remifentanil potentiates the use of high-dose
opioids and low-dose hypnotic anesthesia, using the synergy between itself and other hypnotic
drugs and volatile anesthetics. Remifentanil was meant to be a strong anesthetic with the
shortest and predictable duration, without causing accumulation issues. As a specific mu-type-
opioid receptor agonist, it reduces sympathetic nervous system tone and leads to respiratory
depression and analgesia.
Remifentanil is sold under the brand Names Ultiva among others.
Glaxo Wellcome Inc. filed its Remifentanil patent and was FDA approved in 1996.
Dosage and administration
Remifentanil is sold as Injection, powder, lyophilized, for the solution of 1mg, 2mg & 5mg vials.
For inducing Anesthesia, the adult is given a dose of 0.5-1 mcg per kg per minute, through an IV
until after intubation, and could be given an initial dose of 1 mcg per kg if intubation is needed
less than 8 min after the start of infusion. This is followed by a maintenance dose of 0.25-0.5
mcg per kg per minute through an IV and if using bolus with 0.5-1 mcg per kg over 2-5 minutes
for inducing light anesthesia or transient episodes of intense surgical stress. For inducing
Conscious Analgesia, the dose is 1 mcg per kg, through an IV bolus, followed by a maintenance
dose of 0.05-0.2 mcg per kg per min and for Analgesia in the Immediate Post-Op Period, the
dose is 0.025-0.2 mcg per kg per min, through an IV.
The Price of Remifentanil
In the USA, the consumer has to pay around $550 for a supply of 10 powder for injection of 1
mg. the average price of Remifentanil API is around $187,211per kilogram of the powder.
How does it work?
Remifentanil is the fastest acting, rapid onset, and peak effect µ-opioid agonist with a short
duration of action. The µ-opioid activity antagonized by opioid antagonists like naloxone.
However, the analgesic effects, results, and side effects are dependent on the dose and similar
to other opioids. Remifentanil rapid blood-brain equilibration of half-time of 1 ± 1 minutes with a
rapid onset of action.
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