Alfentanil

Registered South African indications:

• Analgesia 
• Induction of anaesthesia 

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients 
• Obstructive airway disease
• Non-ventilated respiratory depression 
• Obstetric labour
• Prior to clamping of the umbilical cord during caesarean section 
• Coadministration with monoamine oxidase inhibitors or within 14 days of their use 

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment 
• Hepatic impairment 
• Elderly 
• Children
• Hypovolaemia
• Large doses
• Hypothyroidism
• Pulmonary disease
• Decreased respiratory reserve 
• Alcoholism
• History of opioid abuse
• Compromised intracerebral compliance
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: inj

Analgesia during general anaesthesia
- Procedures of short duration and use in outpatients

• IV: Initial: 7-15μg/kg, as a slow injection; Titrate by 7-15μg/kg at intervals of 10-15min

An anticholinergic, a short-acting induction agent and nitrous oxide/oxygen mixture are recommended for outpatients 

Analgesia during general anaesthesia
- Procedures of medium duration 

• IV: Titrate by 15μg/kg as required OR 1μg/kg/min as an infusion

The last dose should be given and infusion stopped at least 10min prior to the end of surgery 

The maintenance dose should be increased when administered without other inhalation anaesthetics 

Induction of anaesthesia

• IV: >120μg/kg, as a bolus 

Paed. forms avail. in SA and covered in this monograph: inj

Analgesia during general anaesthesia

• IV: 0.5-2μg/kg/min, as an infusion

Analgesia during general anaesthesia with intravenous anaesthetic agent

• IV: 1μg/kg/min, as an infusion

Induction of anaesthesia

• IV: 10-20μg/kg; Titrate by 5-10μg/kg at appropriate intervals

Pregnancy

• Caution
• Although no teratogenic or acute embryotoxic effects have been observed in animal experiments, insufficient data are available to evaluate any harmful effects in humans. Consequently, it is necessary to consider possible risks and potential advantages before administering this drug to pregnant patients
• Intravenous administration during childbirth (including caesarian section) is not recommended because alfentanil crosses the placenta and because the foetal respiratory centre is particularly sensitive to opioids. If alfentanil is administered nevertheless, assisted ventilation equipment must be immediately available for use if required. An opioid antagonist for the child must always be available. The half-life of the opioid antagonist may be shorter than the half-life of alfentanil, therefore, repeated administration of the opioid antagonist must be considered

Breastfeeding

• Caution; not recommended
• Alfentanil may enter the maternal milk. Therefore, breastfeeding or use of expressed breast milk is not recommended for 24 hours following the administration of alfentanil

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended
  Reduce dose if necessary; Monitor closely

Elderly

• Caution; dose adjustment recommended
  Reduce dose by 40%; Subsequent doses should be guided by effect of initial dose

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Prohibited - In competition

Central Nervous System Disorders

• Movement disorders
• Dizziness
• Sedation 
• Dyskinesia
• Headache 
• Somnolence 
• Unresponsive to stimuli 
• Seizures
• Loss of consciousness
• Euphoria
• Agitation
• Disorientation
• Confusion

Cardiovascular Disorders

• Bradycardia
• Tachycardia
• Arrhythmia
• Cardiac arrest  

Respiratory Disorders

• Apnoea
• Hypercapnia
• Laryngospasm
• Respiratory depression 
• Bronchospasm
• Epistaxis 
• Respiratory arrest 
• Hiccups
• Cough 

Gastrointestinal Disorders

• Nausea and vomiting

Musculoskeletal Disorders

• Muscle rigidity
• Myoclonus

Skin and Subcutaneous Tissue Disorders

• Allergic dermatitis
• Hyperhidrosis
• Pruritus
• Erythema
• Rash 
• Injection site pain 

Immune, Blood and Lymphatic System Disorders

• Hypersensitivity reactions 
• Fever

Sensory Disorders

• Visual disturbances 

• Central nervous system depressants 
• CYP3A4 inhibitors 
• Beta blockers 
• Muscle relaxants 
• Monoamine oxidase inhibitors 
• Serotonergic agents 

None routine 

Alfentanil is a synthetic phenylpiperidine derivative and mu-opioid receptor agonist which binds with stereospecific receptors at many sites within the central nervous system. It is an ultra short-acting opioid and increases the pain threshold, alters pain perception and inhibits ascending pain pathways.

Injection (per ml) 0.5mg

• Rapifen (Piramal Critical) originator