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alfentanil
generic
Black Box Warnings .
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
CYP450 3A4 Interaction
concomitant use w/ CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. opioid conc. which may incr. or prolong adverse effects incl. potentially fatal resp. depression; monitor pts receiving any concomitant CYP450 3A4 inhibitor or inducer
Adult Dosing .
Dosage forms: INJ
general anesthesia
- [induction]
- Dose: 130-245 mcg/kg/dose IV x1; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated pts
- [maintenance]
- Dose: 0.5-1.5 mcg/kg/min IV; Max: 4 mcg/kg/min; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated pts; after induction dose, decr. infusion rate by 30-50% during 1st hour of maintenance; may incr. infusion rate and/or give 7 mcg/kg IV prn if anesthetic lightening or surgical stress; D/C 10-15min before surgery end
general anesthesia adjunct
- [incremental dosing, anesthesia <30min]
- Dose: 3-5 mcg/kg/dose IV q5-20min; Start: 8-20 mcg/kg/dose IV x1; Max: 40 mcg/kg/total dose; Alt: 0.5-1 mcg/kg/min IV, D/C 10-15min before surgery end; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated pts
- [incremental dosing, anesthesia 30-60min]
- Dose: 5-15 mcg/kg/dose IV q5-20min; Start: 20-50 mcg/kg/dose IV x1; Max: 75 mcg/kg/total dose; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated pts
- [continuous infusion, anesthesia >45min]
- Dose: 0.5-3 mcg/kg/min IV; Start: 50-75 mcg/kg/dose IV x1; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated pts; D/C 10-15min before surgery end
monitored anesthesia care adjunct
- [3-5 mcg/kg/dose IV q5-20min]
- Start: 3-8 mcg/kg/dose IV x1; Max: 40 mcg/kg/total dose; Alt: 0.25-1 mcg/kg/min IV; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated pts
renal dosing
- [see below]
- renal impairment: consider decr. usual dose
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ
general anesthesia
- [induction, 12 yo and older]
- Dose: 130-245 mcg/kg/dose IV x1; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated pts
- [maintenance, 12 yo and older]
- Dose: 0.5-1.5 mcg/kg/min IV; Max: 4 mcg/kg/min; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated pts; after induction dose, decr. infusion rate by 30-50% during 1st hour of maintenance; may incr. infusion rate and/or give 7 mcg/kg/dose IV prn if anesthetic lightening or surgical stress; D/C 10-15min before surgery end
general anesthesia adjunct
- [incremental dosing, anesthesia <30min, 12 yo and older]
- Dose: 3-5 mcg/kg/dose IV q5-20min; Start: 8-20 mcg/kg/dose IV x1; Max: 40 mcg/kg/total dose; Alt: 0.5-1 mcg/kg/min IV, D/C 10-15min before surgery end; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated pts
- [incremental dosing, anesthesia 30-60min, 12 yo and older]
- Dose: 5-15 mcg/kg/dose IV q5-20min; Start: 20-50 mcg/kg/dose IV x1; Max: 75 mcg/kg/total dose; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated pts
- [continuous infusion, anesthesia >45min, 12 yo and older]
- Dose: 0.5-3 mcg/kg/min IV; Start: 50-75 mcg/kg/dose IV x1; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated pts; D/C 10-15min before surgery end
monitored anesthesia care adjunct
- [12 yo and older]
- Dose: 3-5 mcg/kg/dose IV q5-20min; Start: 3-8 mcg/kg/dose IV x1; Max: 40 mcg/kg/total dose; Alt: 0.25-1 mcg/kg/min IV; Info: use LBW in obese pts; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated pts
renal dosing
- [see below]
- renal impairment: consider decr. usual dose
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised