Remifentanil hydrochloride is available as a lyophilized powder in single-dose (preservative-free) vials containing 1, 2, or 5 mg of remifentanil base present as the hydrochloride.3463 Each vial also contains glycine 15 mg and hydrochloric acid for pH adjustment.3463 The contents of the vials should be reconstituted using 1 mL of a compatible diluent for each milligram of remifentanil base; vials should be shaken well to dissolve the powder, yielding a reconstituted solution with an approximate remifentanil concentration of 1 mg/mL.3463 The reconstituted solution should be further diluted in a compatible diluent to a recommended final remifentanil concentration of 20, 25, 50, or 250 mcg/mL prior to administration.3463 Remifentanil hydrochloride should not be administered without dilution.3463
pH
The reconstituted solution has a pH ranging from 2.5 to 3.5.3463
Trade Name(s)
Ultiva
Remifentanil hydrochloride is administered intravenously only.3463 Administration of the drug by the epidural or intrathecal route is contraindicated due to the presence of glycine in the formulation.3463
Single intravenous doses may be administered over 30 to 60 seconds.3463 Remifentanil hydrochloride also may be administered by continuous intravenous infusion using an infusion device.3463 The manufacturer recommends that injection or infusion of the drug be made at or near the venous cannula and that all tubing be cleared at the time the infusion is discontinued.3463 Bolus doses and continuous infusion should not be administered simultaneously to spontaneously breathing patients.3463
Remifentanil hydrochloride is a white to off-white lyophilized powder that forms a clear, colorless solution upon reconstitution.3463 Intact vials should be stored between 2 and 25°C.3463
The solution should be visually inspected for particulate matter and discoloration prior to administration; if particulate matter is present or discoloration occurs, the solution should not be used.3463 Vials are for single dose and do not contain preservatives; unused portions should be discarded.3463
Syringes
In 2015, reports of decreased potency of certain drugs (e.g., remifentanil hydrochloride) stored in Becton Dickinson syringes for extended periods (i.e., exceeding 24 hours) were confirmed by the manufacturer of these syringes; the cause of this change was later identified to be the inclusion of an alternate rubber stopper in the plunger of certain product lots of syringes.3029; 3036; 3037; 3039; 3041; 3042 Decreased potency was not observed when the syringes were filled and used promptly.3037 Use of the alternate stopper was later discontinued and use of the primary stopper in such syringes was resumed; however, Becton Dickinson states that its general-use syringes are cleared by FDA for immediate use in fluid aspiration and injection and that such syringes, regardless of the stopper material, have not been cleared by FDA for use as a closed-container system.3391
Standardize 4 Safety
One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.
Table 1. Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Remifentanil3635
| Patient Population | Concentration Standards | Dosing Units |
|---|---|---|
| Pediatric patients (50 kg) | 50 mcg/mL 250 mcg/mL | mcg/kg/minute |
Drugs in Syringe Compatibility
Y-Site Injection Compatibility (1:1 Mixture)
Additional Compatibility Information
Other Drugs
The manufacturer states that remifentanil hydrochloride (Ultiva, Mylan) has been shown to be compatible with propofol (Diprivan, Fresenius Kabi) when the 2 drugs are coadministered into a running intravenous administration set.3463
For a list of references cited in the text of this monograph, search the monograph titled References.