Remifentanil Intravenous for adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

  • Stored in CD press, MDA regulations apply (storage and recording requirements)
  • Remifentanil should only be used by personnel experienced in anaesthesia and airways management or under their direct supervision (ref 1)
  • Administration must be into a fast flowing line or a dedicated line which is removed when remifentanil is discontinued
  • Do not flush as there is sufficient remifentanil in the dead space to cause respiratory depression. After the infusion is discontinued, disconnect the giving set, aspirate the cannula contents and then flush with Sodium chloride 0.9% (ref 1)
  • For Y-site compatibility see below

Available preparations

Remifentanil 2 mg powder for concentrate for solution for injection or infusion

Remifentanil 5 mg powder for concentrate for solution for injection or infusion

Reconstitution

Water for Injection or Sodium chloride 0.9 %

  • Dilute each 2mg vial with 2ml
  • Dilute each 5mg vial with 5ml

Dilute further prior to administration

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Slow intravenous injection

  • Administer over at least 30 seconds (ref 1)

Continuous intravenous infusion (Administer using an electronically controlled infusion device)

  • Dilute to a final concentration of 20 to 250 micrograms per ml

    • Dilute 5mg to 50ml (100 micrograms per ml)
    • Dilute 10mg to 50ml (200 micrograms per ml)
  • Higher concentration may be used if required (unlicensed (ref 2))
    • Dilute 20mg to 50ml (400 micrograms per ml)

Dose in adults

The administration of remifentanil must be individualised based on the patient's response.

General Anaesthesia

  • As per anaesthetics
  • Full information may be obtained from the SPC- available on www.hpra.ie

Intensive Care - used to provide analgesia in mechanically ventilated intensive care patients

  • Usage longer than three days is not recommended
  • Initial Infusion rate 0.1micrograms/kg/min to 0.15micrograms/kg/min
  • Titrate at increments of 0.025micrograms/kg/min
  • Allow a period of at least 5 minutes between dose adjustments
  • The level of sedation and analgesia should be carefully monitored and the remifentanil infusion rate adjusted as required
  • If an infusion rate of 0.2 micrograms /kg/min is reached and the desired level of sedation is not achieved, it is recommended that dosing with an appropriate sedative agent is initiated
  • Further increases to the remifentanil infusion rate in increments of 0.025 micrograms /kg/min may be made if additional analgesia is required
  • Normal ranges are 0.006 to 0.74 micrograms /kg/min: see tables overleaf to find rates of administration
  • Bolus doses of remifentanil are not recommended in the intensive care setting
Rate in ml/HOUR of a solution containing 5mg in 50ml (100 micrograms per ml)
Dose in micrograms/kg/minute 0.006 0.05 0.1 0.125 0.15 0.175 0.2 0.3 0.4 0.5 0.6 0.74
Body weight below
40kg 0.1 1.2 2.4 3 3.6 4.2 4.8 7.2 9.6
45kg 0.2 1.4 2.7 3.4 4.1 4.7 5.4 8.1 ;
50kg 0.2 1.5 3 3.8 4.5 5.3 6 9
55kg 0.2 1.7 3.3 4.1 5 5.8 6.6 9.9
60kg 0.2 1.8 3.6 4.5 5.4 6.3 7.2
65kg 0.2 2 3.9 4.9 5.9 6.8 7.8
70kg 0.3 2.1 4.2 5.3 6.3 7.4 8.4
75kg 0.3 2.3 4.5 5.6 6.8 7.9 9
80kg 0.3 2.4 4.8 6 7.2 8.4 9.6
85kg 0.3 2.6 5.1 6.4 7.7 8.9
90kg 0.3 2.7 5.4 6.8 8.1 9.5
Rate in ml/HOUR of a solution containing 10mg in 50ml (200 micrograms per ml)
Dose in micrograms/kg/minute 0.006 0.05 0.1 0.125 0.15 0.175 0.2 0.3 0.4 0.5 0.6 0.74
Body weight below
50kg 1.5 1.9 2.3 2.6 3 4.5 6 7.5 9
55kg 1.7 2.1 2.5 2.9 3.3 5 6.6 8.3 9.9
60kg 1.8 2.3 2.7 3.2 3.6 5.4 7.2 9
65kg 1 2 2.4 2.9 3.4 3.9 5.9 7.8 9.8
70kg 1.1 2.1 2.6 3.2 3.7 4.2 6.3 8.4
75kg 1.1 2.3 2.8 3.4 3.9 4.5 6.8 9
80kg 1.2 2.4 3 3.6 4.2 4.8 7.2 9.6
85kg 1.3 2.6 3.2 3.8 4.5 5.1 7.7
90kg 1.4 2.7 3.4 4.1 4.7 5.4 8.1
95kg 1.4 2.9 3.6 4.3 5 5.7 8.6
Rate in ml/HOUR of a solution containing 20mg in 50ml (400 micrograms per ml)
Dose in micrograms/kg/minute 0.006 0.05 0.1 0.125 0.15 0.175 0.2 0.3 0.4 0.5 0.6 0.74
Body weight below
60kg 1.1 1.4 1.6 1.8 2.7 3.6 4.5 5.4 6.7
65kg 1 1.2 1.5 1.7 2 2.9 3.9 4.9 5.9 7.2
70kg 1.1 1.3 1.6 1.8 2.1 3.2 4.2 5.3 6.3 7.8
75kg 1.1 1.4 1.7 2 2.3 3.4 4.5 5.6 6.8 8.3
80kg 1.2 1.5 1.8 2.1 2.4 3.6 4.8 6 7.2 8.9
85kg 1.3 1.6 1.9 2.2 2.6 3.8 5.1 6.4 7.7 9.4
90kg 1.4 1.7 2 2.4 2.7 4.1 5.4 6.8 8.1 10
95kg 1.4 1.8 2.1 2.5 2.9 4.3 5.7 7.1 8.6 10.5
100kg 1.5 1.9 2.3 2.6 3 4.5 6 7.5 9 11.1

Dosage tables are provided for the end user to double check flow rates ONLY. They are not intended to guide the user in the rate at which doses are increased or decreased.

If there is no rate marked in above tables - then use a stronger or weaker concentration table instead.

Elderly (>65 years of age)

  • Use during anaesthesia: dose reductions recommended (see SPC)
  • Use in Intensive care: no initial dose reduction required. Titrate dose to patient needs

Establishment of alternative analgesia prior to discontinuation of Remifentanil

  • Due to the very rapid offset of action of remifentanil, no residual opioid activity will be present within 5 to 10 minutes after discontinuation
  • Prior to discontinuation of Remifentanil, patients must be given alternative analgesic and sedative agents at a sufficient time in advance to allow the therapeutic effects of these agents to become established

Monitoring

  • Close monitoring in a critical care ward required

Storage

  • Store below 250C

References

SPC June 2024

1. Injectable Medicines Administration Guide, Medusa, downloaded 19/06/2025

2: Minimum infusion volumes 4th Edition, Dec 2012 UKCPA

Therapeutic classification

Opioid anaesthetics