ALFENTANIL

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Created Feb 2019 | Updated Nov 2020

ALFENTANIL

  • [ALFENTA]
  • [RAPIFEN]

R-39209

DEA CODE 9737: Schedule 2 Narcotic

Alfentanil is an opioid analgesic with a rapid onset of action. In clinical settings, alfentanil exerts its principal pharmacologic effects on the central nervous system. Its primary actions of therapeutic value are analgesia and sedation. Alfentanil may increase the patient's tolerance for pain and decrease the perception of suffering, although the presence of the pain itself may still be recognized. In addition to analgesia, alterations in mood, euphoria and dysphoria, and drowsiness commonly occur. Alfentanil depresses the respiratory centers, depresses the cough reflex, and constricts the pupils. Alfentanil, marketed under the trade name Alfenta, Rapifen in Australia is indicated for the management of postoperative pain and the maintenance of general anesthesia.

Interactions:

Drug Interactions (516) Alcohol/Food Interactions (1) Disease Interactions (13)


What other drugs will affect Alfentanil?

A total of 516 drugs are known to interact with Alfentanil.

  • 162 major drug interactions
  • 345 moderate drug interactions
  • 9 minor drug interactions


Alfentanil injection is given together with other medicines to relieve pain during surgery. It is also used as a primary anesthesia (numbing medicine) for patients undergoing general surgery.

Pediatric:
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of alfentanil injection in children 12 years of age and older.

Safety and efficacy have not been established in children younger than 12 years of age.

Geriatric:
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of alfentanil injection in the elderly. However, elderly patients may be more sensitive to the effects of alfentanil injection than younger adults, and are more likely to have age-related kidney or lung problems, which may require caution and an adjustment in the dose for patients receiving alfentanil injection.

Other Medical Problems:
Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, or history of
  • Brain tumor
  • Breathing or lung problems (eg, apnea, COPD, cor pulmonale, respiratory depression, sleep apnea)
  • Drug dependence, especially with narcotics, or history of
  • Head injury, history of - May increase risk for more serious side effects
  • Gallbladder problems
  • Heart disease
  • Hypotension (low blood pressure)
  • Pancreatitis (inflammation of the pancreas)
  • Seizures, history of
  • Slow heartbeat - Use with caution. May make these conditions worse
  • Kidney disease
  • Liver disease - Use with caution. The effects may be increased because of slower removal of the medicine from the body

Breastfeeding:

Summary of Use During Lactation:
When used epidurally or intravenously during labor or for a short time immediately postpartum, amounts of alfentanil ingested by the neonate are small and would not be expected to cause any adverse effects in breastfed infants.

Alfentanil is highly protein bound which should result in less transfer to breastmilk than other opiates; however, because there is no published experience with repeated doses of intravenous alfentanil during established lactation, other agents may be preferred, especially while nursing a newborn or preterm infant.

Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of alfentanil to a few days with careful monitoring.

If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.

Labor pain medication may delay the onset of lactation.

Effects on Lactation and Breastmilk:
Narcotics can increase serum prolactin.

However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Alternate Drugs to Consider:

Alfentanil is a potent but short-acting synthetic opioid analgesic drug, used for anaesthesia in surgery. It is an analogue of fentanyl with around 1/4 to 1/10 the potency of fentanyl and around 1/3 of the duration of action, but with an onset of effects 4x faster than fentanyl.

Alfentanil was discovered at Janssen Pharmaceutica in 1976.

  
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