remifentanil hydrochloride at a glance
Medicine class
Short-acting opioid anaesthetic and analgesic
Administration
Intravenous injection or calibrated infusion after reconstitution and dilution
Clinical setting
Given by trained professionals where breathing and cardiovascular support are immediately available
Offset
Its analgesic effect wears off rapidly after administration stops
What is remifentanil hydrochloride used for?
Licensed uses for the selected product are:
Analgesia during induction or maintenance of general anaesthesia.
Analgesia in mechanically ventilated intensive-care patients aged 18 years and over.
In some UK maternity units, intravenous patient-controlled remifentanil is used for labour analgesia when neuraxial analgesia cannot be used or is declined. This is outside the selected product’s licence and requires a local protocol, trained staff and continuous respiratory monitoring.
How does remifentanil hydrochloride work?
Remifentanil selectively activates mu-opioid receptors, reducing pain signalling and responses to surgical stimulation. Blood and tissue esterases break it down rapidly, so its effects begin and end quickly and it provides little continuing pain relief once stopped.
remifentanil hydrochloride preparations and strengths
Injection
Route: Parenteral
Strengths: 1 mg, 2 mg, 5 mg
How to take remifentanil hydrochloride
Remifentanil is not taken by mouth or used at home. A trained professional reconstitutes and dilutes the powder, then gives it intravenously using suitable equipment while breathing, oxygenation, circulation and sedation are monitored.
It must not be injected into the epidural or intrathecal space.
Infusion lines must be managed carefully to prevent disconnection, obstruction or accidental delivery of residual medicine.
The prepared solution should be clear and free from visible particles.
remifentanil hydrochloride side effects
Common or expected effects
- Low blood pressure
- Nausea or vomiting
- Muscle rigidity
- Slow heart rate
- Slow or temporarily stopped breathing
- Cough
- Itching
- Shivering after an operation
Get urgent medical advice
- Severe respiratory depression, apnoea or low oxygen levels
- Severe muscle or chest-wall rigidity affecting ventilation
- Marked bradycardia, very low blood pressure, abnormal rhythm or cardiac arrest
- Serious allergic reaction, including anaphylaxis
- Seizures
- Possible serotonin syndrome, including agitation, fever, sweating, tremor or muscle stiffness when combined with serotonergic medicines
remifentanil hydrochloride in pregnancy
Evidence in pregnancy is limited, so use requires specialist assessment of maternal benefit and fetal risk. Remifentanil crosses the placenta and may cause neonatal sedation or respiratory depression; if used around delivery, both mother and baby require appropriate monitoring. Patient-controlled use for labour analgesia is outside the selected product’s licence.
remifentanil hydrochloride while breastfeeding
It is unknown whether remifentanil passes into human milk. The selected product advises interrupting breastfeeding for 24 hours after administration; feeding and expressing arrangements should be discussed with the maternity, anaesthetic or specialist medicines team.
remifentanil hydrochloride interactions
The anaesthetic team should review all medicines because several combinations can intensify remifentanil’s effects.
Other opioids, anaesthetics, sedatives and benzodiazepines
Additive sedation, respiratory depression and cardiovascular effects may occur, and requirements for other anaesthetic medicines may be reduced.
Gabapentin or pregabalin
Combined use increases the risk of profound sedation, respiratory depression and opioid overdose.
Beta-blockers and calcium-channel blockers
Slow heart rate and low blood pressure may be more pronounced.
Common questions about remifentanil hydrochloride
Answers are fully visible for fast scanning and source review.
What is remifentanil hydrochloride used for?
It is licensed to provide analgesia during general anaesthesia and in mechanically ventilated adults receiving intensive care.
Is remifentanil hydrochloride an opioid?
Yes. It is a potent, selective mu-opioid receptor agonist used mainly in anaesthesia and critical care.
How is remifentanil hydrochloride given?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.