Opioid Lipid Solubility — FRCA Primary MCQ
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Correct answer: A — Metabolism by non-specific blood and tissue esterases
The best answer is “Metabolism by non-specific blood and tissue esterases”. Remifentanil is rapidly metabolised by non-specific blood and tissue esterases to an essentially inactive metabolite. Its offset is therefore not dependent on hepatic metabolism, renal elimination of unchanged drug, or slow receptor dissociation. Protein binding does not explain the defining rapid offset.
Reference: Remifentanil 1 mg, Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/794/smpc