alfentanil (Alfenta, ALF)
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Introduction
Tradename: Alfenta. DEA-controlled substance: class 2.
Indications
- analgesia, treatment of pain
- anesthesia
- sedation
- endotracheal intubation
Contraindications
Dosage
- 8-20 ug/kg IV bolus
- then 3-5 ug/kg/dose or infusion 1.5 ug/kg/min
- total dose 8-40 ug/kg
- higher doses used by longer procedures requiring endotracheal intubation
Injection: 500 ug/mL (2, 5, 10, 20 mL)
Pharmacokinetics
- onset of action: within 5 minutes
- duration of action:
- single dose up to 500 ug: 5-10 minutes
- time to awakenening: 10 minutes following end of surgery
- metabolized in the liver by cyt P450 3A4
elimination via liver
Adverse effects
- common (> 10%)
- bradycardia
- peripheral vasodilation
- drowsiness
- sedation
- increased intracranial pressure
- nausea/vomiting
- constipation
- release of antidiuretic hormone (ADH, vasopressin)
- miosis
- less common (1-10%)
- uncommon (< 1%)
- convulsions, mental depression, paradoxical CNS excitement or delirium, dizziness, dysesthesia, rash, hives, itching, biliary tract spasm, urinary tract spasm, respiratory depression, bronchospasm, laryngospasm, physical & psychological dependence with prolonged use, cold & clammy skin
Toxicity: reversal of toxicity:
- drug adverse effects of opiates
- drug adverse effects of psychotropic agents
- drug adverse effects of sedatives
Drug interactions
- CNS depressants
- phenothiazines
- tricyclic antidepressants (TCA) may potentiate adverse effects of opiate agonists
- any drug that inhibits cyt P450 3A4 may increase levels of alfentanil
- any drug that induces cyt P450 3A4 may diminish levels of alfentanil
- drug interaction(s) of benzodiazepine with opiates
- drug interaction(s) of Z-drugs with opiates
- drug interaction(s) of alcoholic beverage with opiates
- drug interaction(s) of pregabalin with opiates
- drug interaction(s) of gabapentin with opiates
More general terms
Additional terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Deprecated Reference
- ↑ Department of Veterans Affairs, VA National Formulary