Opioids Renal Failure — FRCA Primary MCQ
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Correct answer: D — Its metabolite is inactive despite renal excretion
The best answer is “Its metabolite is inactive despite renal excretion”. Remifentanil is metabolised by non-specific blood and tissue esterases, not plasma cholinesterase, and its carboxylic-acid metabolite is essentially inactive. Although that metabolite is excreted in urine, renal impairment does not create the active-metabolite problem seen with some other opioids.
Reference: Remifentanil 1 mg, Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/794/smpc