Alfentanil
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Questions & Answers
Side Effects & Adverse Reactions
ALFENTANIL SHOULD BE ADMINISTERED ONLY BY PERSONS SPECIFICALLY TRAINED IN THE USE OF INTRAVENOUS AND GENERAL ANESTHETIC AGENTS AND IN THE MANAGEMENT OF RESPIRATORY EFFECTS OF POTENT OPIOIDS.
AN OPIOID ANTAGONIST, RESUSCITATIVE AND INTUBATION EQUIPMENT AND OXYGEN SHOULD BE READILY AVAILABLE.
BECAUSE OF THE POSSIBILITY OF DELAYED RESPIRATORY DEPRESSION, MONITORING OF THE PATIENT MUST CONTINUE WELL AFTER SURGERY.
Alfentanil administered in initial dosages up to 20 mcg/kg may cause skeletal muscle rigidity, particularly of the truncal muscles. The incidence and severity of muscle rigidity is usually dose-related. Administration of alfentanil at anesthetic induction dosages (above 130 mcg/kg) will consistently produce muscular rigidity with an immediate onset. The onset of muscular rigidity occurs earlier than with other opioids. Alfentanil may produce muscular rigidity that involves all skeletal muscles, including those of the neck and extremities. The incidence may be reduced by: 1) routine methods of administration of neuromuscular blocking agents for balanced opioid anesthesia; 2) administration of up to 1/4 of the full paralyzing dose of a neuromuscular blocking agent just prior to administration of alfentanil at dosages up to 130 mcg/kg; following loss of consciousness, a full paralyzing dose of a neuromuscular blocking agent should be administered; or 3) simultaneous administration of alfentanil and a full paralyzing dose of a neuromuscular blocking agent when alfentanil is used in rapidly administered anesthetic dosages (above 130 mcg/kg).
The neuromuscular blocking agent used should be appropriate for the patient's cardiovascular status. Adequate facilities should be available for postoperative monitoring and ventilation of patients administered alfentanil. It is essential that these facilities be fully equipped to handle all degrees of respiratory depression.
PATIENTS RECEIVING MONITORED ANESTHESIA CARE (MAC) SHOULD BE CONTINUOUSLY MONITORED BY PERSONS NOT INVOLVED IN THE CONDUCT OF THE SURGICAL OR DIAGNOSTIC PROCEDURE; OXYGEN SUPPLEMENTATION SHOULD BE IMMEDIATELY AVAILABLE AND PROVIDED WHERE CLINICALLY INDICATED; OXYGEN SATURATION SHOULD BE CONTINUOUSLY MONITORED; THE PATIENT SHOULD BE OBSERVED FOR EARLY SIGNS OF HYPOTENSION, APNEA, UPPER AIRWAY OBSTRUCTION AND/OR OXYGEN DESATURATION.
Severe and unpredictable potentiation of monoamine oxidase (MAO) inhibitors has been reported for other opioid analgesics, and rarely with alfentanil. Therefore when alfentanil is administered to patients who have received MAO inhibitors within 14 days, appropriate monitoring and ready availability of vasodilators and betablockers for the treatment of hypertension is recommended.
Legal Issues
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Manufacturer Warnings
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FDA Labeling Changes
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Uses
Alfentanil HCl injection is indicated:
- as an analgesic adjunct given in incremental doses in the maintenance of anesthesia with barbiturate/nitrous oxide/oxygen.
- as an analgesic administered by continuous infusion with nitrous oxide/oxygen in the maintenance of general anesthesia.
- as a primary anesthetic agent for the induction of anesthesia in patients undergoing general surgery in which endotracheal intubation and mechanical ventilation are required.
- as the analgesic component for monitored anesthesia care (MAC).
SEE DOSAGE CHART FOR MORE COMPLETE INFORMATION ON THE USE OF ALFENTANIL HCl INJECTION.
History
There is currently no drug history available for this drug.
Other Information
Alfentanil HCl Injection, USP is an opioid analgesic chemically designated as N-[1-[2-(4-ethyl-4,5-dihydro 5-oxo-1H-tetrazol-1-yl)ethyl]-4-(methoxymethyl)-4- piperidinyl]-N-phenylpropanamide monohydrochloride (1:1) with a molecular weight of 452.98 and an n-octanol:water partition coefficient of 128:1 at pH 7.4. The structural formula of Alfentanil hydrochloride is:
Alfentanil HCl Injection, USP is a sterile, non-pyrogenic, preservative free aqueous solution containing alfentanil hydrochloride equivalent to 500 μg per mL of alfentanil base for intravenous injection. The solution, which contains sodium chloride for isotonicity, has a pH range of 4 to 6. Each mL contains: Active: Alfentanil base 500 mcg. Inactives: Sodium Chloride 9 mg and Water for Injection q.s.
Sources
Alfentanil Manufacturers
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Akorn, Inc.
![Alfentanil (Alfentanil Hydrochloride) Injection [Akorn, Inc.]](/wp-content/themes/bootstrap/assets/img/loading2.gif)
Alfentanil | Akorn, Inc.
The dosage of Alfentanil HCl injection should be individualized and titrated to the desired effect in each patient according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure and anesthesia. In obese patients (more than 20% above ideal total body weight), the dosage of Alfentanil HCl injection should be determined on the basis of lean body weight. The dose of Alfentanil HCl injection should be reduced in elderly or debilitated patients (see PRECAUTIONS).
Vital signs should be monitored routinely.
See Dosage Guidelines for the use of Alfentanil HCl injection: 1) by incremental injection as an analgesic adjunct to anesthesia with barbiturate/nitrous oxide/oxygen for short surgical procedures (expected duration of less than one hour); 2) by continuous infusion as a maintenance analgesic with nitrous oxide/oxygen for general surgical procedures; and 3) by intravenous injection in anesthetic doses for the induction of anesthesia for general surgical procedures with a minimum expected duration of 45 minutes; and 4) by intravenous injection as the analgesic component for monitored anesthesia care (MAC).
DOSAGE GUIDELINES
FOR USE DURING GENERAL ANESTHESIA SPONTANEOUSLY BREATHING/
DOSAGE SHOULD BE INDIVIDUALIZED AND TITRATED
ASSISTED VENTILATION Induction of Analgesia: 8 to 20 mcg/kg
Maintenance of Analgesia: 3 to 5 mcg/kg q 5 to 20 min or 0.5 to 1 mcg/kg/min
Total dose: 8 to 40 mcg/kg ASSISTED OR CONTROLLED
VENTILATION
Induction of Analgesia: 20 to 50 mcg/kg
Maintenance of Analgesia: 5 to 15 mcg/kg q 5 to 20 min
Total dose: Up to 75 mcg/kg Incremental Injection
(To attenuate response to laryngoscopy
and intubation) Continuous Infusion
(To provide attenuation of response to
intubation and incision) Infusion rates are variable and should be titrated to the desired clinical effect.
SEE INFUSION DOSAGE GUIDELINES BELOW.
Induction of Analgesia: 50 to 75 mcg/kg
Maintenance of Analgesia: 0.5 to 3 mcg/kg/min (Average rate 1 to 1.5 mcg/kg/min)
Total dose: Dependent on duration of procedure Anesthetic Induction Induction of Anesthesia: 130 to 245 mcg/kg
Maintenance of Anesthesia: 0.5 to 1.5 mcg/kg/min or general anesthetic
Total dose: Dependent on duration of procedure
At these doses, truncal rigidity should be expected and a muscle relaxant should be utilized.
Administer slowly (over 3 minutes).
Concentration of inhalation agents reduced by 30 to 50% for initial hour. MONITORED ANESTHESIA CARE
(MAC)
(For sedated and responsive
spontaneously breathing patients) Induction of MAC: 3 to 8 mcg/kg
Maintenance of MAC: 3 to 5 mcg/kg q 5 to 20 min or 0.25 to 1 mcg/kg/min
Total dose: 3 to 40 mcg/kg INFUSION DOSAGE Continuous Infusion: 0.5 to 3 mcg/kg/min administered with nitrous oxide/oxygen in patients undergoing general surgery. Following an anesthetic induction dose of Alfentanil HCl injection, infusion rate requirements are reduced by 30 to 50% for the first hour of maintenance.
Changes in vital signs that indicate a response to surgical stress or lightening of anesthesia may be controlled by increasing the alfentanil to a maximum of 4 mcg/kg/min and/or administration of bolus doses of 7 mcg/kg. If changes are not controlled after three bolus doses given over a five minute period, a barbiturate, vasodilator, and/or inhalation agent should be used. Infusion rates should always be adjusted downward in the absence of these signs until there is some response to surgical stimulation.
Rather than an increase in infusion rate, 7 mcg/kg bolus doses of Alfentanil HCl injection or a potent inhalation agent should be administered in response to signs of lightening of anesthesia within the last 15 minutes of surgery. Alfentanil HCl injection infusion should be discontinued at least 10 to 15 minutes prior to the end of surgery.Usage in Children: Clinical data to support the use of Alfentanil HCl injection in patients under 12 years of age are not presently available. Therefore, such use is not recommended.
Premedication: The selection of preanesthetic medications should be based upon the needs of the individual patient.
Neuromuscular Blocking Agents: The neuromuscular blocking agent selected should be compatible with the patient's condition, taking into account the hemodynamic effects of a particular muscle relaxant and the degree of skeletal muscle relaxation required (see CLINICAL PHARMACOLOGY, WARNINGS and PRECAUTIONS sections).
In patients administered anesthetic (induction) dosages of Alfentanil HCl injection, it is essential that qualified personnel and adequate facilities are available for the management of intraoperative and postoperative respiratory depression.
Also see WARNINGS and PRECAUTIONS sections.
For purposes of administering small volumes of Alfentanil HCl injection accurately, the use of a tuberculin syringe or equivalent is recommended.
The physical and chemical compatibility of Alfentanil HCl injection have been demonstrated in solution with normal saline, 5% dextrose in normal saline, 5% dextrose in water and Lactated Ringers. Clinical studies of Alfentanil HCl injection infusion have been conducted with Alfentanil HCl injection diluted to a concentration range of 25 mcg/mL to 80 mcg/mL.
As an example of the preparation of Alfentanil HCl injection for infusion, 20 mL of Alfentanil HCl injection added to 230 mL of diluent provides 40 mcg/mL solution of Alfentanil HCl injection.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
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