Remifentanil
Pronunciation:rehm-ih-FEHN-tuh-nill
Chemical Abstracts Service Registry Number:132875-61-7. (Hydrochloride form
132539-07-2)
Formal Names:Ultiva
Type:Depressant (opioid class).Seepage 24
Federal Schedule Listing:Schedule II (DEA no. 9739)
USA Availability:Prescription
Pregnancy Category:C
Uses.This drug is related tofentanyland became available for medical
purposes in the United States during the 1990s. Remifentanil is used for pain
relief and to help induce anesthesia. Depending on the type of measurement
used, studies of the drug’s potency find it to be 15 to 70 times stronger than
alfentanil (described in this book’s fentanyl listing), which means remifentanil
is strong indeed. Remifentanil is fast acting but is generally not considered
long lasting. An experiment, however, challenged standard belief that the
drug’s actions last only a few minutes, with investigators finding that the
substance still impeded physical movement an hour after taking a dose (al-
though volunteers using the drug felt normal at that point). Researchers have
suggested the substance might have a specialized use in treating certain eye
injuries because the drug can reduce pressure that may otherwise build up
inside the eyeball and cause the contents to leak out. Some investigators have
found that women need a larger remifentanil dose than men for an equivalent
relief from pain.
Drawbacks.Unwanted actions from remifentanil can include muscle tense-
ness and trouble with breathing and heartbeat. These conditions can become
so dangerous that the drug is not supposed to be used unless emergency
resuscitation equipment is on hand and the medical practitioner administering
the substance is an expert. Less serious unwanted effects can include perspi-
ration, itching, nausea, vomiting, and lightheadedness.
Abuse factors.An experiment in a medical setting found that remifentanil
appears to create tolerance to other opioids given for pain control, but another
medical study did not find that effect. A group of recreational opioid users
testing remifentanil declared it to have stronger effects than fentanyl, but re-
searchers running the experiment noted that remifentanil’s brief action meant