Alfentanil Dosage

Usual Adult Dose for Anesthesia

Doses should be individualized and titrated to the desired effect according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure, and anesthesia:

• SPONTANEOUSLY Breathing/Assisted Ventilation:

Induction of Analgesia: 8 to 20 mcg/kg IV
Maintenance of Analgesia: 3 to 5 mcg/kg IV every 5 to 20 minutes or 0.5 to 1 mcg/kg/min IV
Total dose: 8 to 40 mcg/kg

• ASSISTED OR CONTROLLED Ventilation
• Incremental Injection (to attenuate response to laryngoscopy and intubation):

Induction of analgesia: 20 to 50 mcg/kg IV
Maintenance of analgesia: 5 to 15 mcg/kg IV every 5 to 20 minutes
Total dose: Up to 75 mcg/kg

• Continuous Infusion (to provide attenuation of response to intubation and incision):

Induction of analgesia: 50 to 75 mcg/kg IV
Maintenance of analgesia: 0.5 to 3 mcg/kg/min IV (average rate 1 to 1.5 mcg/kg/min); infusion rates are variable and should be titrated to the desired clinical effect
Total dose: Dependent on duration of procedure

• Anesthetic Induction:

Induction of analgesia: 130 to 245 mcg/kg IV slowly over 3 minutes
Maintenance of analgesia: 0.5 to 1.5 mcg/kg/min or general anesthetic

• At these doses, truncal rigidity should be expected and a muscle relaxant should be utilized

Total dose: Dependent on duration of procedure

• Monitored Anesthesia Care (MAC):

Induction of MAC: 3 to 8 mcg/kg
Maintenance of MAC 3 to 5 mcg/kg every OR 0.25 to 1 mcg/kg/min
Total dose: 3 to 40 mcg/kg

CONTINUOUS INFUSIONS:
Infusion Rate: 0.5 to 3 mcg/min

• Infusion rates are variable and should be titrated to the desired clinical effect
• Administer with nitrous oxide/oxygen in patients undergoing general surgery
• See dose adjustments section for dose modifications and discontinuation.

Comments:

• Induction doses should be administered slowly over 3 minutes.
• Fluid replacement should be considered prior to induction as induction doses may produce loss of vascular tone and hypotension.
• Patients receiving MAC should be continuously monitored by persons not involved in the surgical or diagnostic procedure.

Uses:

• As an analgesic adjunct given in incremental doses in the maintenance of anesthesia with barbiturates/nitrous oxide/oxygen (generally for surgeries with an expected duration of less than 1 hour).
• As an analgesic administered by continuous infusion with nitrous oxide/oxygen in the maintenance of general anesthesia.
• As a primary anesthetic agent for the induction of anesthesia in patients undergoing general surgery in which endotracheal intubation and mechanical ventilation are required.
• As the analgesic component for MAC.

Usual Adult Dose for Pain

Doses should be individualized and titrated to the desired effect according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure, and anesthesia:

• SPONTANEOUSLY Breathing/Assisted Ventilation:

Induction of Analgesia: 8 to 20 mcg/kg IV
Maintenance of Analgesia: 3 to 5 mcg/kg IV every 5 to 20 minutes or 0.5 to 1 mcg/kg/min IV
Total dose: 8 to 40 mcg/kg

• ASSISTED OR CONTROLLED Ventilation
• Incremental Injection (to attenuate response to laryngoscopy and intubation):

Induction of analgesia: 20 to 50 mcg/kg IV
Maintenance of analgesia: 5 to 15 mcg/kg IV every 5 to 20 minutes
Total dose: Up to 75 mcg/kg

• Continuous Infusion (to provide attenuation of response to intubation and incision):

Induction of analgesia: 50 to 75 mcg/kg IV
Maintenance of analgesia: 0.5 to 3 mcg/kg/min IV (average rate 1 to 1.5 mcg/kg/min); infusion rates are variable and should be titrated to the desired clinical effect
Total dose: Dependent on duration of procedure

• Anesthetic Induction:

Induction of analgesia: 130 to 245 mcg/kg IV slowly over 3 minutes
Maintenance of analgesia: 0.5 to 1.5 mcg/kg/min or general anesthetic

• At these doses, truncal rigidity should be expected and a muscle relaxant should be utilized

Total dose: Dependent on duration of procedure

• Monitored Anesthesia Care (MAC):

Induction of MAC: 3 to 8 mcg/kg
Maintenance of MAC 3 to 5 mcg/kg every OR 0.25 to 1 mcg/kg/min
Total dose: 3 to 40 mcg/kg

CONTINUOUS INFUSIONS:
Infusion Rate: 0.5 to 3 mcg/min

• Infusion rates are variable and should be titrated to the desired clinical effect
• Administer with nitrous oxide/oxygen in patients undergoing general surgery
• See dose adjustments section for dose modifications and discontinuation.

Comments:

• Induction doses should be administered slowly over 3 minutes.
• Fluid replacement should be considered prior to induction as induction doses may produce loss of vascular tone and hypotension.
• Patients receiving MAC should be continuously monitored by persons not involved in the surgical or diagnostic procedure.

Uses:

• As an analgesic adjunct given in incremental doses in the maintenance of anesthesia with barbiturates/nitrous oxide/oxygen (generally for surgeries with an expected duration of less than 1 hour).
• As an analgesic administered by continuous infusion with nitrous oxide/oxygen in the maintenance of general anesthesia.
• As a primary anesthetic agent for the induction of anesthesia in patients undergoing general surgery in which endotracheal intubation and mechanical ventilation are required.
• As the analgesic component for MAC.

Usual Geriatric Dose for Anesthesia

Initial dose: Reduce usual adult dose by up to 40% to account for reduced clearance and increased sensitivity

• Subsequent doses should be based on the effect of the initial dose

Usual Geriatric Dose for Pain

Initial dose: Reduce usual adult dose by up to 40% to account for reduced clearance and increased sensitivity

• Subsequent doses should be based on the effect of the initial dose

Usual Pediatric Dose for Anesthesia

Doses should be individualized and titrated to the desired effect according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure, and anesthesia:

12 years or older:

• SPONTANEOUSLY Breathing/Assisted Ventilation:

Induction of Analgesia: 8 to 20 mcg/kg IV
Maintenance of Analgesia: 3 to 5 mcg/kg IV every 5 to 20 minutes or 0.5 to 1 mcg/kg/min IV
Total dose: 8 to 40 mcg/kg

• ASSISTED OR CONTROLLED Ventilation
• Incremental Injection (to attenuate response to laryngoscopy and intubation):

Induction of analgesia: 20 to 50 mcg/kg IV
Maintenance of analgesia: 5 to 15 mcg/kg IV every 5 to 20 minutes
Total dose: Up to 75 mcg/kg

• Continuous Infusion (to provide attenuation of response to intubation and incision):

Induction of analgesia: 50 to 75 mcg/kg IV
Maintenance of analgesia: 0.5 to 3 mcg/kg/min IV (average rate 1 to 1.5 mcg/kg/min); infusion rates are variable and should be titrated to the desired clinical effect
Total dose: Dependent on duration of procedure

• Anesthetic Induction:

Induction of analgesia: 130 to 245 mcg/kg IV slowly over 3 minutes
Maintenance of analgesia: 0.5 to 1.5 mcg/kg/min or general anesthetic

• At these doses, truncal rigidity should be expected and a muscle relaxant should be utilized

Total dose: Dependent on duration of procedure

• Monitored Anesthesia Care (MAC):

Induction of MAC: 3 to 8 mcg/kg
Maintenance of MAC 3 to 5 mcg/kg every OR 0.25 to 1 mcg/kg/min
Total dose: 3 to 40 mcg/kg

CONTINUOUS INFUSIONS:
Infusion Rate: 0.5 to 3 mcg/min

• Infusion rates are variable and should be titrated to the desired clinical effect
• Administer with nitrous oxide/oxygen in patients undergoing general surgery
• See dose adjustments section for dose modifications and discontinuation.

Comments:

• Induction doses should be administered slowly over 3 minutes.
• Fluid replacement should be considered prior to induction as induction doses may produce loss of vascular tone and hypotension.
• Patients receiving MAC should be continuously monitored by persons not involved in the surgical or diagnostic procedure.

Uses:

• As an analgesic adjunct given in incremental doses in the maintenance of anesthesia with barbiturates/nitrous oxide/oxygen (generally for surgeries with an expected duration of less than 1 hour).
• As an analgesic administered by continuous infusion with nitrous oxide/oxygen in the maintenance of general anesthesia.
• As a primary anesthetic agent for the induction of anesthesia in patients undergoing general surgery in which endotracheal intubation and mechanical ventilation are required.
• As the analgesic component for MAC.

Usual Pediatric Dose for Pain

Doses should be individualized and titrated to the desired effect according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure, and anesthesia:

12 years or older:

• SPONTANEOUSLY Breathing/Assisted Ventilation:

Induction of Analgesia: 8 to 20 mcg/kg IV
Maintenance of Analgesia: 3 to 5 mcg/kg IV every 5 to 20 minutes or 0.5 to 1 mcg/kg/min IV
Total dose: 8 to 40 mcg/kg

• ASSISTED OR CONTROLLED Ventilation
• Incremental Injection (to attenuate response to laryngoscopy and intubation):

Induction of analgesia: 20 to 50 mcg/kg IV
Maintenance of analgesia: 5 to 15 mcg/kg IV every 5 to 20 minutes
Total dose: Up to 75 mcg/kg

• Continuous Infusion (to provide attenuation of response to intubation and incision):

Induction of analgesia: 50 to 75 mcg/kg IV
Maintenance of analgesia: 0.5 to 3 mcg/kg/min IV (average rate 1 to 1.5 mcg/kg/min); infusion rates are variable and should be titrated to the desired clinical effect
Total dose: Dependent on duration of procedure

• Anesthetic Induction:

Induction of analgesia: 130 to 245 mcg/kg IV slowly over 3 minutes
Maintenance of analgesia: 0.5 to 1.5 mcg/kg/min or general anesthetic

• At these doses, truncal rigidity should be expected and a muscle relaxant should be utilized

Total dose: Dependent on duration of procedure

• Monitored Anesthesia Care (MAC):

Induction of MAC: 3 to 8 mcg/kg
Maintenance of MAC 3 to 5 mcg/kg every OR 0.25 to 1 mcg/kg/min
Total dose: 3 to 40 mcg/kg

CONTINUOUS INFUSIONS:
Infusion Rate: 0.5 to 3 mcg/min

• Infusion rates are variable and should be titrated to the desired clinical effect
• Administer with nitrous oxide/oxygen in patients undergoing general surgery
• See dose adjustments section for dose modifications and discontinuation.

Comments:

• Induction doses should be administered slowly over 3 minutes.
• Fluid replacement should be considered prior to induction as induction doses may produce loss of vascular tone and hypotension.
• Patients receiving MAC should be continuously monitored by persons not involved in the surgical or diagnostic procedure.

Uses:

• As an analgesic adjunct given in incremental doses in the maintenance of anesthesia with barbiturates/nitrous oxide/oxygen (generally for surgeries with an expected duration of less than 1 hour).
• As an analgesic administered by continuous infusion with nitrous oxide/oxygen in the maintenance of general anesthesia.
• As a primary anesthetic agent for the induction of anesthesia in patients undergoing general surgery in which endotracheal intubation and mechanical ventilation are required.
• As the analgesic component for MAC.

Renal Dose Adjustments

Use with caution, dosage adjustments may be required; however, no specific guidelines have been suggested.

• More frequent monitoring for signs of respiratory depression, sedation, and hypotension are recommended due to due to extensive renal excretion.

Liver Dose Adjustments

Use with caution, dosage adjustments may be required; however, no specific guidelines have been suggested.

• More frequent monitoring for signs of respiratory depression, sedation, and hypotension are recommended due to due to extensive hepatic metabolism

Dose Adjustments

Obese Patients (more than 20% above ideal body weight): Dose on ideal body weight

Concomitant Use of Other CNS Depressants:

• Dose reductions of this drug may be needed
• Following administration of this drug, the dose of other CNS depressant drugs should be reduced

To Reduce Incidence of Skeletal Muscle Rigidity:

• Use neuromuscular blocking agent for balance opioid anesthesia; the neuromuscular blocking agent should be appropriate for patient's cardiovascular status
• For use of this drug at doses up to 130 mcg/kg: Administer up to one-fourth of the full paralyzing dose of a neuromuscular blocking agent just prior and following loss of consciousness, give the full paralyzing dose of the neuromuscular blocking agent, or
• Simultaneously give this drug with a full paralyzing dose of a neuromuscular blocking agent

Continuous Infusion Dose Adjustments:

• Following anesthetic induction dose: Infusion rate should be reduced by 30% to 50% for the first hour of maintenance
• Following anesthetic induction dose: Volatile inhalation anesthetics should be reduced 30% to 50% for the first hour of maintenance.
• For changes in vital signs that indicate a response to surgical stress or lightening of anesthesia: Increase infusion to a maximum of 4 mcg/kg/min and/or give up to 3 IV bolus doses of 7 mcg/kg over 5 minutes
• If still not controlled, a barbiturate, vasodilator, and/or inhalation agent should be used
• Infusion rates should be adjusted downward until there is some response to surgical stimulation
• Within the last 15 minutes of surgery, IV boluses (7 mcg/kg) or a potent inhalation agent should be administered in response to signs of lightening of anesthesia.

Discontinuation:

• During general anesthesia, continuous infusions should be discontinued at least 10 to 15 minutes prior to the end of surgery
• For MAC, infusions may be continued to the end of the procedure

Precautions

US BOXED WARNING: ADDICTION, ABUSE, AND MISUSE:

• This drug exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient's risk prior to prescribing; monitor all patients regularly for the development of these behaviors and conditions.

Safety and efficacy have not been established in patients younger than 12 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule II

Dialysis

Data not available

Other Comments

Administration advice:

• For IV use only
• Induction doses should be administered slowly (over 3 minutes)

Storage requirements:

• Protect from light

Reconstitution/preparation techniques:

• Infusion studies were conducted with concentrations of 25 mcg/mL to 80 mcg/mL

IV compatibility:

• Compatible with Normal Saline, 5% Dextrose in Normal Saline, 5% Dextrose in Water, Lactated Ringers

General:

• Administration of this drug is restricted to those healthcare professionals specifically trained in the use of IV anesthetics and the management of the respiratory effects of potent opioids.
• This drug should be administered in facilities that have qualified personnel and are adequate equipped to handle any degree of respiratory depression; ensure opioid antagonists, resuscitative and intubation equipment, and oxygen are readily available during drug administration.

Monitoring:

• Vital signs should be continuously monitor during and after surgery
• Monitor oxygen saturation and watch for early signs of hypotension, apnea, upper airway obstruction and/or oxygen desaturation
• Elderly: Consider monitoring renal function

Patient Advice:

• Patients should be advised not to drive or operate machinery for 24 hours.
• Breastfeeding should be avoided for 24 hours

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer