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alfentanil
generic
Black Box Warnings .
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance with 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 patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
CYP450 3A4 Interaction
concomitant use with CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. opioid concentration which may incr. or prolong adverse effects including potentially fatal respiratory depression; monitor patients 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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated patients
- [maintenance]
- Dose: 0.5-1.5 mcg/kg/min IV; Max: 4 mcg/kg/min; Info: use LBW in obese patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated patients; 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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated patients
- [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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated patients
- [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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated patients; 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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in elderly or debilitated patients
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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated patients
- [maintenance, 12 yo and older]
- Dose: 0.5-1.5 mcg/kg/min IV; Max: 4 mcg/kg/min; Info: use LBW in obese patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated patients; 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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated patients
- [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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated patients
- [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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated patients; 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 patients; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; decr. dose in debilitated patients
renal dosing
- [see below]
- renal impairment: consider decr. usual dose
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised