Remifentanil
Pronunciation: reh-mi-FEN-ta-nil.
- Generic name
- remifentanil
- Brand names
- Remiwin, Remifin, Ultiva, Remitex
- Drug class
- Opioid Analgesic (Anesthetic adjunct)
Availability and supply rules vary by country
Trade names by country: United States
Australia: · Full directory
What remifentanil is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how remifentanil works
Mechanism-of-action detail beyond the recorded indications and dosing above was not captured as a separate field in the clinician-authored database record for this medicine; see how_to_take and professional_information.regional_dosing for the recorded clinical detail. (2)
What remifentanil is used for
Analgesia during induction and maintenance of general anesthesia
Analgesia during induction and maintenance of general anesthesia (2) (1)
Analgesia immediately postoperative
Analgesia immediately postoperative (1)
Analgesia during monitored anesthesia care (MAC) procedures
Analgesia during monitored anesthesia care (MAC) procedures (1)
Analgesia in mechanically ventilated patients in the intensive care unit
Analgesia in mechanically ventilated patients in the intensive care unit (1)
Before taking remifentanil
Do not take / not appropriate for
- Remifentanil must never be given into the epidural or intrathecal space (into or around the spinal cord). The formulation contains glycine, which makes these routes unsafe. It is for intravenous use only. (all countries)
- Remifentanil must not be used in anyone who has had a hypersensitivity reaction to remifentanil, such as anaphylaxis. (all countries)
Tell your clinician about
- Any previous reaction to remifentanil, to fentanyl or other opioids, or to any ingredient in the product.
- Any breathing problems, including asthma, sleep apnoea, or chronic lung disease.
- Any liver or kidney problems.
- How much alcohol you drink, and any use of opioids, benzodiazepines, or other sedating medicines.
- Whether you are, could be, or are planning to become pregnant, or are breastfeeding.
- All other medicines you take, including over-the-counter and herbal products.
How to take remifentanil
- Remifentanil is administered intravenously by a healthcare professional in a controlled medical setting. It is not for self-administration. Given as a slow intravenous injection or continuous infusion, usually in combination with other anesthetic agents. Adult dosing (as recorded in the clinician-authored database; verify against a primary source): Typical adult dosing for anesthesia induction: 1 microgram/kg IV over 30–60 seconds, followed by maintenance infusion of 0.1–2 micrograms/kg/min, titrated to effect. Dosing may vary based on procedure and patient factors.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
Remifentanil is administered in a hospital setting by professionals, so missed doses are unlikely. If a dose is missed during a procedure, the healthcare team will adjust as needed.
Overdose
Overdose can cause severe respiratory depression, muscle rigidity, unconsciousness, or death. Warning signs include extreme drowsiness or weakness, irregular/very slow/shallow breathing, pale or blue lips/fingernails/skin, pinpoint pupils, and seizures. Emergency management is performed by the treating medical team and includes stopping the infusion, supporting breathing and circulation, and administering an opioid antagonist such as naloxone (or nalmefene) if needed. (1)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Bradycardia
Incidence: Reported in the clinician-authored database; frequency not established
Hypotension
Incidence: Reported in the clinician-authored database; frequency not established
Muscle rigidity
Incidence: Reported in the clinician-authored database; frequency not established
Nausea
Incidence: Reported in the clinician-authored database; frequency not established
Vomiting
Incidence: Reported in the clinician-authored database; frequency not established
Respiratory depression
Incidence: Reported in the clinician-authored database; frequency not established
Apnea
Incidence: Reported in the clinician-authored database; frequency not established
Chest wall rigidity
Incidence: Reported in the clinician-authored database; frequency not established
Severe or persistent muscle stiffness
What to do: Contact a healthcare professional promptly if this develops. (2)
Difficulty breathing or shortness of breath
What to do: Contact a healthcare professional promptly if this develops. (2)
Sudden drop in blood pressure (dizziness, fainting)
What to do: Contact a healthcare professional promptly if this develops. (2)
Slow or irregular heartbeat
What to do: Contact a healthcare professional promptly if this develops. (2)
Allergic reactions (rash, swelling, itching)
What to do: Contact a healthcare professional promptly if this develops. (2)
Serious warnings
Tell your anesthesia or treating team before your procedure if you have a known allergy to remifentanil, other fentanyl analogs, or any component of the formulation, or if you have acute or severe bronchial asthma — serious
Symptoms: Tell your anesthesia or treating team before your procedure if you have a known allergy to remifentanil, other fentanyl analogs, or any component of the formulation, or if you have acute or severe bronchial asthma. The clinical team will determine whether remifentanil is appropriate for you and will only give it in a monitored setting with resuscitative equipment available.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Seek immediate medical attention if you experience severe breathing problems, loss of consciousness, chest pain, severe allergic reactions (anaphylaxis), or signs of opioid overdose such as pinpoint pupils, extreme drowsiness, or inability to wake up — serious
Symptoms: Seek immediate medical attention if you experience severe breathing problems, loss of consciousness, chest pain, severe allergic reactions (anaphylaxis), or signs of opioid overdose such as pinpoint pupils, extreme drowsiness, or inability to wake up.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Remifentanil can cause life-threatening respiratory depression, especially if not closely monitored — serious
Symptoms: Remifentanil can cause life-threatening respiratory depression, especially if not closely monitored
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
May cause muscle rigidity, particularly in the chest and abdomen — serious
Symptoms: May cause muscle rigidity, particularly in the chest and abdomen
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Rapid offset may result in acute pain if not managed with other analgesics — serious
Symptoms: Rapid offset may result in acute pain if not managed with other analgesics
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Risk of opioid withdrawal symptoms if stopped abruptly in opioid-dependent patients — serious
Symptoms: Risk of opioid withdrawal symptoms if stopped abruptly in opioid-dependent patients
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Not for use outside of monitored medical settings — serious
Symptoms: Not for use outside of monitored medical settings
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Remifentanil infusion is stopped when the procedure ends or as directed by the anesthesiologist — serious
Symptoms: Remifentanil infusion is stopped when the procedure ends or as directed by the anesthesiologist. Effects wear off quickly after discontinuation.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| See recorded interactions | Remifentanil may interact with other central nervous system depressants, including benzodiazepines, other opioids, anesthetics, and alcohol, increasing the risk of respiratory depression and sedation. Inform your healthcare provider about all medications and supplements you are taking. | (2) (1) |
| MAO inhibitors (MAOIs) — e.g., isocarboxazid, phenelzine, tranylcypromine, safinamide | Remifentanil should not be given to a patient currently using, or who has used within the past 14 days, an MAOI. Your anesthesia team will screen for this before your procedure. | (1) |
| Naltrexone and samidorphan | Flagged as significant interactions requiring caution; tell your care team if you take either of these. | (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
If remifentanil is used during pregnancy or labor, it may cause neonatal opioid withdrawal syndrome in the newborn. Your anesthesia and obstetric team will weigh this risk against the benefits and monitor the baby accordingly. (1)
Breastfeeding
Whether to use remifentanil while breastfeeding is a decision your treating clinician makes by weighing potential benefits against potential risks; no absolute prohibition was found in the sources reviewed. Tell your care team if you are breastfeeding. (1)
Children
Pediatric dosing is weight-based and determined by the anesthesiologist. The clinician-authored database records a usual induction dose of 1–3 micrograms/kg IV, followed by maintenance infusion of 0.05–1.3 micrograms/kg/min; these specific figures were not independently confirmed by the external source reviewed in this pass and are presented as DB-sourced, clinician-facing context. (1)
Renal_impairment
No specific renal- or hepatic-impairment numeric dose adjustment was established in the sources reviewed. Remifentanil is metabolized by nonspecific esterases throughout the blood and tissues, which is generally understood to make its clearance largely independent of kidney or liver function, but individualized dosing and monitoring by the anesthesia team is still required, especially in elderly patients or those with significant organ impairment. (1)
Hepatic_impairment
No specific renal- or hepatic-impairment numeric dose adjustment was established in the sources reviewed. Remifentanil is metabolized by nonspecific esterases throughout the blood and tissues, which is generally understood to make its clearance largely independent of kidney or liver function, but individualized dosing and monitoring by the anesthesia team is still required, especially in elderly patients or those with significant organ impairment. (1)
Monitoring
(1)Storage
The clinician-authored database records storing unopened vials at room temperature (below 25°C/77°F), with reconstituted solutions used promptly or stored per hospital protocol. This is standard institutional-pharmacy practice; it was not independently re-verified against a specific product label in this research pass, and in all cases hospital pharmacy storage protocols take precedence.
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Analgesia during induction and maintenance of general anesthesia
Dose summary: Typical adult dosing for anesthesia induction: 1 microgram/kg IV over 30–60 seconds, followed by maintenance infusion of 0.1–2 micrograms/kg/min, titrated to effect. Dosing may vary based on procedure and patient factors.
Renal context: No specific numeric renal- or hepatic-impairment dose adjustment was established in the sources reviewed. Remifentanil is metabolized by nonspecific blood/tissue esterases, generally understood to make clearance largely independent of renal or hepatic function, but individualized titration and monitoring by the anesthesia team remains required, especially in elderly patients. (2)
Frequently asked questions
What is remifentanil used for?
Remifentanil is used for pain relief and sedation during surgery or other medical procedures. It is not used for chronic pain management.
How quickly does remifentanil work?
Remifentanil acts within 1–2 minutes after intravenous administration, providing rapid pain relief and sedation.
How long do the effects of remifentanil last?
The effects of remifentanil wear off quickly, usually within 5–10 minutes after stopping the infusion.
Can remifentanil be used for chronic pain?
No, remifentanil is not suitable for chronic pain due to its very short duration of action and risk of serious side effects.
Is remifentanil addictive?
Remifentanil has a potential for abuse and dependence like other opioids, but its use is restricted to controlled medical environments, reducing this risk.
What should I tell my doctor before receiving remifentanil?
Inform your doctor about any allergies, breathing problems, history of opioid use, and all medications or supplements you are taking.
What happens if I have a reaction to remifentanil during surgery?
Your healthcare team is trained to manage any adverse reactions, including breathing problems or allergic responses, and will provide immediate treatment if needed.
What is the mechanism of action of remifentanil?
Mechanism-of-action detail beyond the recorded indications and dosing above was not captured as a separate field in the clinician-authored database record for this medicine; see how_to_take and professional_information.regional_dosing for the recorded clinical detail. (2)
What is the generic name of Remifentanil?
The generic name is remifentanil. It is sold under brand names including Remiwin, Remifin, Ultiva, Remitex.
What class of drug is remifentanil?
Remifentanil is classed as: Opioid Analgesic (Anesthetic adjunct).
References
- Remifentanil (Intravenous Route) — Description and Brand NamesMayo Clinic · United States · accessed 2026-08-06 · source 1
- Remifentanil Clinician-Authored Medicine RecordMedGuideGlobal Clinician-Authored Medicine Record · Internal · dated 2026 · accessed 2026-08-06 · source 2
- ULTIVA (REMIFENTANIL HYDROCHLORIDE) INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION [MYLAN INSTITUTIONAL LLC] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 3
- Ultiva — FDA approval record (Drugs@FDA NDA020630)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 4
- remifentanil — RxNorm normalized drug concept (RXCUI 236540)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 5
Brand names by country
Single-ingredient remifentanil names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Ultiva1 mg/mL · mylan institutional llc