Alfentanil

Adjunct in maintenance of general anaesthesia, Induction of anaesthesia, Analgesia in patients with spontaneous respiration

Intravenous Adult: Incremental Injection: Anesthesia <30 Minutes Induction: 8-20 mcg/kg IV Maintenance: 3-5 mcg/kg IV increments q5-20min, or 0.5-1 mcg/kg/min IV Total dose: 8-40 mcg/kg IV Incremental Injection: Anesthesia 30-60 Minutes Induction: 20-50 mcg/kg IV Maintenance: 5-15 mcg/kg IV increments q5-20min Total dose: Up to 75 mcg/kg IV Anesthetic Induction: Anesthesia >45 Minutes Induction: 130-245 mcg/kg IV Maintenance: 0.5-1.5 mcg/kg/min IV or other general anesthetic Total dose: depends on duration of operation Continuous Infusion: For Anesthesia >45 Minutes Induction: 50-75 mcg/kg IV Maintenance: 0.5-3 mcg/kg/min IV Total dose: depends on duration of operation

The dose should be calculated based on the ideal body weight Intravenous Child: <12 years Anesthesia Not recommended >12 years

Avoid use or reduce dose; opioid effects increased and prolonged and increased cerebral sensitivity occurs.

In one clinical trial, the dose of alfentanil required to produce anesthesia, as determined by the appearance of delta waves in EEG, was 40% lower in geriatric patients than that needed in healthy young patients. The initial dose of Alfentanil HCl Injection should be appropriately reduced in the elderly. Patients over the age of 65 have been found to have reduced plasma clearance and extended terminal elimination which may prolong postoperative recovery. Elderly patients (aged 65 years or older) may have increased sensitivity to alfentanil. In general, use caution when selecting a dosage for an elderly patient, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy. Respiratory depression is the chief risk for elderly patients treated with opioids, and has occurred after large initial doses were administered to patients who were not opioid-tolerant or when opioids were co-administered with other agents that depress respiration. Titrate the dosage of Alfentanil HCl Injection slowly in geriatric patients. This drug is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Advises caution. Dose adjustments Advises dose reduction and cautious titration.

IV Preparation Add 20 mL to 230 mL of diluent for a final concentration of 40 mg/mL IV Administration Keep Naloxone and resuscitation equip available By incremental injection as analgesic adjunct to anesthesia with barbiturate/nitrous oxide/oxygen for short surgical procedures (expected duration <1 hr) By continuous infusion as a maintenance analgesic with nitrous oxide/oxygen for general surgical procedures By IV injection in aesthetic doses for anesthesia induction for general surgical procedures with a minimum expected duration of 45 min By IV inj as the analgesic component for monitored anesthesia care (MAC)

Obstructive airway disease, resp depression. Hypersensitivity, Increased intracranial pressure. Admin in labour or before clamping of cord during caesarean section. Concomitant use during or w/in 14 days of MAOI therapy.

Alfentanil HCl Injection exposes users to the risks of addiction, abuse, and misuse. Assess patient’s risk before prescribing and reassess regularly for the development of these behaviors and conditions. Serious, life-threatening, or fatal respiratory depression may occur with the use of Alfentanil HCl Injection, especially during initiation or following a dosage increase. To reduce the risk of respiratory depression, proper dosing and titration of alfentanil are essential. Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate. Concomitant use with CYP3A4 inhibitors (or discontinuation of CYP3A4 inducers) can result in a fatal overdose of alfentanil. Life-Threatening Respiratory Depression: in Patients with Chronic Pulmonary Disease or in Elderly, Cachectic, and Debilitated Patients: Monitor closely, particularly during initiation and titration. Risks of Muscle Rigidity and Skeletal Muscle Movement: Manage with a neuromuscular blocking agent. See full prescribing information for more details on managing these risks. Opioid-Induced Hyperalgesia and Allodynia: Opioid-induced hyperalgesia (OIH) occurs when an opioid analgesic paradoxically causes an increase in pain or an increase in sensitivity to pain. If OIH is suspected, carefully consider appropriately decreasing the dose of the current opioid analgesic, or opioid rotation. Serotonin Syndrome: A potentially life-threatening condition that could result from concomitant serotonergic drug administration. Discontinue Alfentanil HCl Injection if serotonin syndrome is suspected. Risks of Use in Patients with Increased Intracranial Pressure, Brain Tumors, and Head Injury: Monitoring Parameters Continuously monitor vital signs, oxygen saturation, BP, and heart rate. Monit

Not Classi Pregnancy Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome; available data in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage Labor or delivery Opioids cross placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid induced respiratory depression in neonate; drug is not recommended for use in women during and immediately prior to labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate; opioid analgesics can prolong labor through actions that temporarily reduce strength, duration, and frequency of uterine contractions; however, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor; monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression Lactation The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy; capsules and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition Monitor infants exposed to drug through breast milk for excess sedation and respiratory depression; withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast- feeding is stopped Withdrawal signs can occur in breastfed infants when maternal administration of an opioid analgesic is stopped or when breastfeeding is stopped; naloxone may precipitate opioid withdrawal in a breast-fed infant whose mother received opioid analgesics Lactation: use with caution

Concomitant Use of CNS Depressants: May decrease pulmonary arterial pressure and may cause hypotension. See FPI for management instructions. For post-operative pain, start with the lowest effective dosage and monitor for potentiation of CNS depressant effects. Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics: Avoid use with Alfentanil HCl Injection because they may reduce analgesic effect of Alfentanil HCl Injection or precipitate withdrawal symptoms. Potentially Fatal: Rarely, may cause severe and unpredictable potentiation of MAOIs. Contraindicated (2) alvimopan olanzapine/samidorphan Serious - Use Alternative (78) acrivastine amisulpride apalutamide asenapine asenapine transdermal avapritinib benzhydrocodone/acetaminophen brexpiprazole brigatinib brimonidine brivaracetam buprenorphine buprenorphine buccal buprenorphine subdermal implant buprenorphine transdermal buprenorphine, long-acting injection butorphanol calcium/magnesium/potassium/sodium oxybates cariprazine citalopram clonidine desloratadine desvenlafaxine diazepam buccal diazepam intranasal escitalopram fentanyl fentanyl intranasal fentanyl iontophoretic transdermal system fentanyl transdermal fentanyl transmucosal fexinidazole fluoxetine fluvoxamine hydrocodone idelalisib isocarboxazid isoniazid ivosidenib levetiracetam levocetirizine linezolid lonafarnib lopinavir loratadine lorlatinib lumacaftor/ivacaftor methohexital methylene blue metoclopramide intranasal mifepristone mobocertinib nalbuphine nefazodone olopatadine intranasal olutasidenib ozanimod pacritinib paroxetine pentazocine pexidartinib phenelzine procarbazine rasagiline repotrectinib selegiline transdermal selinexor sertraline sodium oxybate sotorasib sufentanil SL tramadol tranylcypromine valerian venlafaxine vortioxetine voxelotor zuranolone

>10% Arrhythmia (14%) Bradycardia (14%) Chest wall rigidity (17%) Hypertension (18%) Nausea (28%) Vomiting (18%) Tachycardia (12%) 1-10% Apnea (3-9%) Blurred vision (1-3%) Dizziness (3-9%) Hypotension (10%) Post-op respiratory depression (1-3%) Skeletal muscle movements (3-9%) Postoperative sedation (1-3%) <1% Sweating, flushing Warmness of the face/neck/upper thorax Pruritus Urticaria Respiratory (undefined) Respiratory/circulatory depression Respiratory arrest Shock Cardiac arrest Nervous System (undefined) Dizziness Visual disturbances Mental clouding/depression Sedation Coma Euphoria Dysphoria Weakness Faintness Agitation Restlessness Nervousness Seizures

Alfentanil is a short-acting opioid analgesic related to fentanyl. It binds w/ stereospecific receptors w/in the CNS, thereby altering pain perception, increasing pain threshold, and inhibiting ascending pain pathways.