alfentanil

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Debilitated or severely ill patients
Diabetes
Severe pulmonary or hepatic disease
CNS tumors
↑intracranial pressure
Head trauma
Adrenal insufficiency
Undiagnosed abdominal pain
Hypothyroidism
Alcoholism
Cardiac arrhythmias
OB: Prolonged use during pregnancy may cause neonatal opioid withdrawal syndrome; not recommended for use during or immediately prior to labor (may cause respiratory depression in the newborn)
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
OB: Lactation: Pedi: Safety not established
Pedi: Children <12 yr (safety and effectiveness not established)
Geri: Older adults may be more susceptible to adverse reactions.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: blurred vision.

CV: bradycardia, hypotension, tachycardia, arrhythmias, hypertension.

GI: nausea, vomiting.

MS: thoracic muscle rigidity, skeletal muscle rigidity.

Neuro: dizziness, sleepiness.

Resp: RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA AND SLEEP-RELATED HYPOXEMIA), apnea.

Interactions ⬆ ⬇

Drug-Drug:

Concurrent use of CYP3A4 inhibitors including ritonavir, ketoconazole, itraconazole, fluconazole clarithromycin, erythromycin, nefazodone, diltiazem, verapamil, nelfinavir, and fosamprenavir↑ levels and risk of opioid toxicity; careful monitoring during initiation, dose changes, or discontinuation of the inhibitor is recommended.
Concurrent use with CYP3A4 inducers including barbiturates, carbamazepine, efavirenz, corticosteroids, modafinil, nevirapine, oxcarbazepine, phenobarbital, phenytoin, rifabutin, or rifampin may ↓ levels and analgesia; if inducers are discontinued or dosage ↓, patients should be monitored for signs of opioid toxicity and necessary dose adjustments should be made.
Use with benzodiazepines or other CNS depressants including other opioids, non-benzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
MAO inhibitors should be avoided for 14 days before use.
Concurrent use with benzodiazepines, antihypertensives, alcohol, or diuretics may ↑ risk of hypotension.
Nalbuphine, buprenorphine, or butorphanol may ↓ analgesia.
Concurrent use of protease inhibitors may ↑ risk of CNS depression.
Naltrexone and naloxone will block all effects of alfentanil.
Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SSRIs, SNRIs, MAO inhibitors, TCAs, tramadol, trazodone, mirtazapine, 5–HT₃ receptor antagonists, linezolid, methylene blue, and triptans↑ risk of serotonin syndrome.

Drug-Natural Products:

Concomitant use of kava or valerian can ↑ CNS depression.

Route/Dosage ⬆ ⬇

Incremental Injection (Duration of Anesthesia <30 min) — Induction Period

IV (Adults): 8–20 mcg/kg.

Incremental Injection (Duration of Anesthesia <30 min) — Maintenance Period

IV (Adults): 3–5 mcg/kg every 5–20 min or 0.5–1 mcg/kg/min (total dose 8–40 mcg/kg).

Incremental Injection (Duration of Anesthesia 30–60 min) — Induction Period

IV (Adults): 20–50 mcg/kg.

Incremental Injection (Duration of Anesthesia 30–60 min) — Maintenance Period

IV (Adults): 5–15 mcg/kg every 5–20 min (up to total dose of 75 mcg/kg).

Continuous Infusion (Duration of Anesthesia >45 min) — Induction

IV (Adults): 50–75 mcg/kg.

Continuous Infusion (Duration of Anesthesia >45 min) — Maintenance

IV (Adults): 0.5–3 mcg/kg/min (average rate 1–1.5 mcg/kg/min). Infusion rate should be ↓ by 30–50% after first hour of maintenance. If lightening occurs, infusion rate may be ↑ up to 4 mcg/kg/min or boluses of 7 mcg/kg may be administered.

Pediatric dose (unlabeled)

IV (Children): Induction — 12.5–50 mcg/kg initially, followed by supplemental doses of 10–15 mcg or infusion at 0.5–1.5 mcg/kg/min.

Anesthetic Induction (Duration of Anesthesia >45 min)

IV (Adults): 130–245 mcg/kg followed by 0.5–1.5 mcg/kg/min or general anesthesia.

Monitored Anesthesia Care — Induction

IV (Adults): 3–8 mcg/kg.

Monitored Anesthesia Care — Maintenance

IV (Adults): 3–5 mcg/kg every 5–20 min or 0.25–1 mcg/kg/min (total dose 3–40 mg/kg).

Implementation ⬆ ⬇

High Alert:Accidental overdose of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order, dose calculations and infusion pump programming.
Alfentanil is a drug with known abuse potential. Follow hospital policies for controlled substances to prevent diversion.
Alfentanil should only be administered by a person specifically trained in use of IV anesthetics and management of opioid-induced respiratory depression. Make sure an opioid antagonist, resuscitative equipment, and oxygen are available.
Benzodiazepines may be administered before alfentanil to reduce induction dose requirements and decrease time to loss of consciousness; may also increase the risk of hypotension.

IV Administration:

IV Push: Administer small volumes undiluted via tuberculin syringe for accuracy.
Rate: Administer slowly over 3 min; may reduce incidence and severity of muscle rigidity, bradycardia, or hypotension. Neuromuscular blocking agents may be administered concurrently to decrease muscle rigidity.
Continuous Infusion:
Rate: See Route and Dosage section.
- Discontinue IV infusion at least 10–15 min before the end of surgery.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- amikacin
- aminophylline
- amiodarone
- anidulafungin
- argatroban
- ascorbic acid
- atropine
- azathioprine
- azithromycin
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- cisatracurium
- cisplatin
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin
- doxorubicin liposomal
- doxycycline
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etomidate
- etoposide
- etoposide phosphate
- famotidine
- fenoldopam
- fentanyl
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gemtuzumab
- gentamicin
- glycopyrrolate
- granisetron
- heparin
- hetastarch
- hydrocortisone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- meperidine
- mesna
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- mitomycin
- mitoxantrone
- morphine
- multivitamins
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxacillin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pancuronium
- papaverine
- pemetrexed
- penicillin G
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- procainamide
- prochloraperazine
- promethazine
- propofol
- propranolol
- protamine
- pyridoxine
- quinupristin/dalfopristin
- remifentanil
- rocuronium
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- teniposide
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- amphotericin B lipid complex
- amphotericin B liposome
- dantrolene
- diazepam
- diazoxide
- pantoprazole
- phenytoin
- thiopental
- trimethoprim/sulfamethoxazole

US Brand Names ⬆ ⬇

Contr. Subst. Schedule ⬆ ⬇

Classifications ⬆ ⬇

Therapeutic Classification: analgesic adjuncts, opioid analgesics

Pharmacologic Classification: opioid agonists

Availability ⬆ ⬇

(Generic available)

Solution for injection: 500 mcg/mL;

Time/Action Profile ⬆ ⬇

(analgesia and respiratory depression)

ROUTE	ONSET	PEAK	DURATION
IV	immediate	1–1.5 min	5–10 min†

†↓ in children.

Assessment ⬆ ⬇

Assess vital signs, especially respiratory status and ECG, frequently during and following administration. Notify health care professional immediately of significant changes. Postoperative pain may require treatment relatively early in recovery period due to short duration of alfentanil.

Lab Test Considerations:

May cause elevated serum amylase and lipase concentrations.

Toxicity and Overdose:

Symptoms of toxicity include respiratory depression, hypotension, arrhythmias, bradycardia, and asystole. Atropine may be used to treat bradycardia. If respiratory depression persists after surgery, prolonged mechanical ventilation may be required. If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by IV push every 2 min. For children and patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 1–2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. Administration of naloxone in these circumstances, especially in cardiac patients, has resulted in hypertension and tachycardia, occasionally causing left ventricular failure and pulmonary edema.

Pot. Nursing Diagnoses ⬆ ⬇

Acute pain (Indications).
Disturbed sensory perception(visual, auditory, Side Effects).
Ineffective breathing pattern (Side Effects).

Patient/Family Teaching ⬆ ⬇

Discuss the use of anesthetic agents and sensations to expect with patient before surgery.
Alfentanil may cause drowsiness and dizziness. Advise patient to call for assistance when ambulating.
Advise patient to change position slowly to minimize orthostatic hypotension.
After outpatient surgery, instruct patients to avoid alcohol or other CNS depressants for 24 hr after the administration of alfentanil.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes ⬆ ⬇

General quiescence.
Reduced motor activity.
Pronounced analgesia.

Code ⬆

NDC Code^*

0409- Hospira, Inc.
0409-2266- Alfentanil Hydrochloride 0409-2266-02- 10 AMPULE in 1 CARTON (0409-2266-02) > 2 mL in 1 AMPULE

0409- Hospira, Inc.
0409-2266- Alfentanil Hydrochloride 0409-2266-05- 10 AMPULE in 1 CARTON (0409-2266-05) > 5 mL in 1 AMPULE

17478- Akorn, Inc.
17478-067- Alfentanil Hydrochloride 17478-067-02- 10 AMPULE in 1 CARTON (17478-067-02) > 2 mL in 1 AMPULE

17478- Akorn, Inc.
17478-067- Alfentanil Hydrochloride 17478-067-05- 10 AMPULE in 1 CARTON (17478-067-05) > 5 mL in 1 AMPULE

17478- Akorn, Inc.
17478-067- Alfentanil Hydrochloride 17478-067-10- 5 AMPULE in 1 CARTON (17478-067-10) > 10 mL in 1 AMPULE

17478- Akorn, Inc.
17478-067- Alfentanil Hydrochloride 17478-067-20- 5 AMPULE in 1 CARTON (17478-067-20) > 20 mL in 1 AMPULE

17478- Akorn, Inc.
17478-841- Alfentanil 17478-841-02- 10 AMPULE in 1 CARTON (17478-841-02) > 2 mL in 1 AMPULE

17478- Akorn, Inc.
17478-841- Alfentanil 17478-841-05- 10 AMPULE in 1 CARTON (17478-841-05) > 5 mL in 1 AMPULE

17478- Akorn, Inc.
17478-841- Alfentanil 17478-841-10- 5 AMPULE in 1 CARTON (17478-841-10) > 10 mL in 1 AMPULE

17478- Akorn, Inc.
17478-841- Alfentanil 17478-841-20- 5 AMPULE in 1 CARTON (17478-841-20) > 20 mL in 1 AMPULE

section name header

Pronunciation ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇