Alfentanil (United States and Canada: Not available): Drug information

For additional information see "Alfentanil (United States and Canada: Not available): Patient drug information" and "Alfentanil (United States and Canada: Not available): Pediatric drug information"

For abbreviations, symbols, and age group definitions show table

ALERT: US Boxed Warning

Addiction, abuse, and misuse:

Because the use of alfentanil 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 and reassess all patients regularly for the development of these behaviors and conditions.

Life-threatening respiratory depression:

Serious, life-threatening, or fatal respiratory depression may occur with use of alfentanil, especially during initiation or following a dosage increase. To reduce the risk of respiratory depression, proper dosing and titration of alfentanil are essential.

Risks from concomitant use with benzodiazepines or other CNS depressants:

Concomitant use of opioids with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of alfentanil and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.

Cytochrome P450 3A4 interaction:

The concomitant use of alfentanil with all cytochrome P450 3A4 inhibitors may result in an increase in alfentanil plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in alfentanil plasma concentration. Monitor patients receiving alfentanil and any CYP3A4 inhibitor or inducer.

Pharmacologic Category

Analgesic, Opioid;
Anilidopiperidine Opioid

Dosing: Adult

Dosage guidance:

Dosing: Dosing should be individualized based on patient-specific factors (eg, comorbidities, severity of pain, degree of opioid experience/tolerance) and titrated to patient-specific treatment goals (eg, improvement in function and quality of life, decrease in pain using a validated pain rating scale). Use the lowest effective dose for the shortest period of time.

Dosage form information: Alfentanil has been discontinued in the United States for >1 year.

Analgesia or anesthesia

Analgesia or anesthesia: IV:

Weight-based dosing should utilize actual body weight for dosing calculations, unless >20% above ideal body weight, then use lean body weight for dosing calculations. Administer induction doses slowly over 3 minutes; as induction dosing may produce loss of vascular tone and hypotension, consider fluid replacement prior to induction. Refer to institutional protocols.

**Alfentanil Dosage Range for Use During Anesthesia^a**
Indication	Estimated duration of procedure	Induction period (initial dose)	Maintenance period (incremental injection)	Maintenance period (continuous infusion)	Total dose	Comments
^aGropper 2019; manufacturer's labeling.
Analgesia (adjunctive agent)	≤30 minutes	8 to 20 mcg/kg	3 to 5 mcg/kg every 5 to 20 minutes	0.25 to 1 mcg/kg/minute	8 to 40 mcg/kg	Spontaneously breathing or assisted ventilation when required.
Analgesia or anesthesia (adjunctive agent)	30 to 60 minutes	20 to 50 mcg/kg (~10 mcg/kg for laryngeal mask airway when co-administered with propofol)	5 to 15 mcg/kg every 5 to 20 minutes		Up to 75 mcg/kg	May be administered in divided doses. Assisted or controlled ventilation required. Discontinue at least 30 minutes prior to end of surgery.
Anesthesia, induction (adjunctive agent)	>45 minutes	25 to 100 mcg/kg			Up to 245 mcg/kg	May be administered in divided doses. Assisted or controlled ventilation required. Concentration of volatile inhalation anesthetics reduced by 30% to 50% for initial hour. Following an anesthetic induction dose of alfentanil, alfentanil infusion rate requirements are reduced by 30% to 50% for the first hour of maintenance.
Anesthesia, maintenance (adjunctive agent)	>45 minutes			0.5 to 2 mcg/kg/minute or general anesthetic	Dependent on duration of procedure	Assisted or controlled ventilation required. Discontinue at least 30 minutes prior to end of surgery.
Monitored Anesthesia Care (MAC), analgesia		3 to 8 mcg/kg	3 to 5 mcg/kg every 5 to 20 minutes	0.25 to 1 mcg/kg/minute	3 to 40 mcg/kg	Sedation, responsiveness, spontaneously breathing. May continue to the end of procedure.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution. The pharmacokinetics of alfentanil were evaluated in adult patients with chronic renal failure and compared to patients with normal renal function. Although V_dss was increased in patients with renal failure, elimination half-life was similar between the 2 groups (Ref). Therefore, prolongation of alfentanil duration of action is not expected and dosage adjustment is not necessary.

Dosing: Liver Impairment: Adult

There are no specific dosage adjustments provided in the manufacturer's labeling; use with caution and reduce the dose as needed; monitor closely.

Dosing: Obesity: Adult

In patients weighing >20% above ideal body weight, determine dose based on lean body weight.

Dosing: Older Adult

Refer to adult dosing. Reduce the initial dose by up to 40%; consider the effect of the initial dose in determining supplemental doses.

Dosing: Pediatric

(For additional information see "Alfentanil (United States and Canada: Not available): Pediatric drug information")

Dosage guidance:

Safety: Doses should be titrated to appropriate effects; wide range of doses is dependent upon desired degree of analgesia/anesthesia. Alfentanil should only be used by clinicians trained in the provision of anesthesia to pediatric patients.

Anesthesia

Anesthesia:

Children <12 years:

Pre-induction, emergence agitation prevention, analgesia in tonsillectomy, or dental procedure patients undergoing general anesthesia: Limited data available: IV: 10 to 20 mcg/kg/dose (Ref).

Procedural analgesia for lumbar puncture or bone marrow aspiration (in addition to propofol): Limited data available: Intermittent IV: 2 to 3 mcg/kg/dose (total dose: mean: 1.4 mcg/kg ± 2.4; range: 1.8 to 9.6 mcg/kg) administered to 20 patients ages 2 to 16 years (Ref).

Children ≥12 years and Adolescents: IV: See table; Note: Base dose on actual body weight unless >20% above ideal body weight, then base dose on lean body weight.

**Alfentanil Dosing in Pediatric Patients ≥12 Years**
Indication	Approximate Duration of Anesthesia (minutes)	Induction Period (Initial Dose) (mcg/kg)	Maintenance Period (Increments/ Infusion)	Total Dose (mcg/kg)	Effects
Incremental IV injection	≤30 minutes	8 to 20 mcg/kg	3 to 5 mcg/kg every 5 to 20 minutes or 0.5 to 1 mcg/kg/minute	8 to 40 mcg/kg	Spontaneously breathing or assisted ventilation when required.
Incremental IV injection	30 to 60 minutes	20 to 50 mcg/kg	5 to 15 mcg/kg every 5 to 20 minutes	Up to 75 mcg/kg	Assisted or controlled ventilation required. Attenuation of response to laryngoscopy and intubation. Discontinue at least 30 minutes prior to end of surgery.
Continuous IV infusion	≥45 minutes	50 to 75 mcg/kg	0.5 to 3 mcg/kg/minute; average infusion rate: 1 to 1.5 mcg/kg/minute	Dependent on duration of procedure	Assisted or controlled ventilation required. Some attenuation of response to intubation and incision, with intraoperative stability.
Anesthetic induction	≥45 minutes	130 to 245 mcg/kg	0.5 to 1.5 mcg/kg/minute or general anesthetic	Dependent on duration of procedure	Assisted or controlled ventilation required. Administer induction dose slowly (over 3 minutes). Concentration of volatile inhalation anesthetics reduced by 30% to 50% for initial hour. Following an anesthetic induction dose of alfentanil, alfentanil IV infusion rate requirements are reduced by 30% to 50% for the first hour of maintenance.
Monitored anesthesia care (MAC)		3 to 8 mcg/kg	3 to 5 mcg/kg every 5 to 20 minutes or 0.25 to 1 mcg/kg/minute	3 to 40 mcg/kg	Sedation, responsiveness, spontaneously breathing. May be continued to the end of the procedure.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. The pharmacokinetics of alfentanil were evaluated in adult patients with chronic renal failure and compared to patients with normal renal function. Although V_dss was increased in patients with renal failure, elimination half-life was similar between the 2 groups (Ref). Therefore, prolongation of alfentanil duration of action is not expected and dosage adjustment is not necessary.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; use with caution and reduce the dose as needed; monitor closely.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Cardiovascular: Bradycardia (14%), chest wall rigidity (17%), hypertension (18%), tachycardia (12%)

Gastrointestinal: Nausea (28%), vomiting (18%)

1% to 10%:

Cardiovascular: Cardiac arrhythmia (1% to 3%), hypotension (10%)

Dermatologic: Pruritus (≤1%), urticaria (≤1%)

Local: Pain at injection site (≤1%)

Nervous system: Confusion (postoperative; ≤1%), dizziness (3% to 9%), drowsiness (≤3%), euphoria (postoperative; ≤1%), headache (≤1%), sedated state (≤3%; postoperative), shivering (≤1%)

Neuromuscular & skeletal: Laryngospasm (≤1%), muscle movements (3% to 9%; skeletal)

Ophthalmic: Blurred vision (1% to 3%)

Respiratory: Apnea (3% to 9%), hypercapnia (≤1%), respiratory depression (1% to 3%; postoperative)

<1%: Respiratory: Bronchospasm

Frequency not defined: Nervous system: Drug abuse, opioid dependence

Postmarketing:

Hypersensitivity: Anaphylaxis (Pepys 1994)

Nervous system: Agitation, allodynia (opioid-induced hyperalgesia) (FDA Safety Communication 2023), epileptiform seizure (Ross 2001), myoclonus

Neuromuscular & skeletal: Muscle rigidity (Benthuysen 1986)

Ophthalmic: Miosis (Black 1999)

Respiratory: Bradypnea, hypoxia

Contraindications

Hypersensitivity (eg, anaphylaxis) to alfentanil or any component of the formulation.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Hyperalgesia: Opioid-induced hyperalgesia (OIH) has occurred with short-term and prolonged use of opioid analgesics. Symptoms may include increased levels of pain upon opioid dosage increase, decreased levels of pain upon opioid dosage decrease, or pain from ordinarily nonpainful stimuli; symptoms may be suggestive of OIH if there is no evidence of underlying disease progression, opioid tolerance, opioid withdrawal, or addictive behavior. Consider decreasing the current opioid dose or opioid rotation in patients who experience OIH.

• Hypotension: May cause hypotension; use with caution in patients with hypovolemia, cardiovascular disease (including acute MI), or drugs which may exaggerate hypotensive effects (including phenothiazines or general anesthetics). Monitor for symptoms of hypotension following initiation or dose titration.

• Hypersensitivity: Anaphylaxis reactions may occur.

• Respiratory depression: Fatal respiratory depression may occur. Carbon dioxide retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids.

• Serotonin syndrome: Potentially life-threatening serotonin syndrome (SS) has occurred with concomitant use of alfentanil and serotonergic agents (eg, SSRIs, SNRIs, triptans, TCAs, 5-HT₃ receptor antagonists, mirtazapine, trazodone, tramadol) and agents that impair metabolism of serotonin (eg, MAO inhibitors). Monitor patients closely for signs of SS such as mental status changes (eg, agitation, hallucinations, delirium, coma); autonomic instability (eg, tachycardia, labile blood pressure, diaphoresis); neuromuscular changes (eg, tremor, rigidity, myoclonus); GI symptoms (eg, nausea, vomiting, diarrhea); and/or seizures. Discontinue alfentanil if serotonin syndrome is suspected.

• Opioid agonist toxicities: Shares the toxic potentials of opioid agonists, and precautions of opioid agonist therapy should be observed.

Disease-related concerns:

• Abdominal conditions: May obscure diagnosis or clinical course of patients with acute abdominal conditions.

• Biliary tract impairment: Use with caution in patients with biliary tract dysfunction, including acute pancreatitis; opioids may cause constriction of sphincter of Oddi.

• Bradyarrhythmias: Bradycardia may occur; use with caution when administering to patients with bradyarrhythmias. Degree of bradycardia may be more pronounced when administered with non-vagolytic skeletal muscle relaxants (eg, vecuronium, cisatracurium) or when anticholinergic agents (eg, atropine) are not used.

• Delirium tremens: Use with caution in patients with delirium tremens.

• Head trauma: Use with extreme caution in patients with head injury, intracranial lesions, or elevated intracranial pressure (ICP); exaggerated elevation of ICP may occur.

• Hepatic impairment: Use with caution in patients with hepatic impairment; reduce the dose as needed; monitor closely.

• Obesity: Use with caution in patients who are morbidly obese. Reduce dose; use lean body weight for dosing in patients >20% over ideal body weight.

• Prostatic hyperplasia/urinary stricture: Use with caution in patients with prostatic hyperplasia and/or urinary stricture.

• Psychosis: Use with caution in patients with toxic psychosis.

• Renal impairment: Use with caution in patients with renal impairment.

• Respiratory disease: Use with caution and monitor for respiratory depression in patients with significant chronic obstructive pulmonary disease or cor pulmonale, and those with a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression, particularly when initiating and titrating therapy; critical respiratory depression may occur, even at therapeutic dosages.

• Seizures: Use with caution in patients with a history of seizure disorders; may increase risk or exacerbate preexisting seizure disorders.

• Skeletal muscle rigidity: May produce muscular rigidity that involves all skeletal muscles, including those of the neck and extremities; incidence is dose-related. Initial doses up to 20 mcg/kg may cause skeletal muscle rigidity, particularly of the truncal muscles. Doses >130 mcg/kg will consistently cause muscle rigidity with an immediate onset. Consider the concomitant use of a nondepolarizing skeletal muscle relaxant to decrease the incidence.

• Sleep-related disorders: Opioid use increases the risk for sleep-related disorders (eg, central sleep apnea, hypoxemia) in a dose-dependent fashion; use with caution.

• Thyroid dysfunction: Use with caution in patients with thyroid dysfunction.

Special populations:

• Cachectic or debilitated patients: Use with caution in cachectic or debilitated patients; there is a greater potential for critical respiratory depression, even at therapeutic dosages. Appropriately reduce the initial dose; consider the effect of the initial dose in determining supplemental doses.

• Older adult: Use with caution in older adults; may be more sensitive to adverse effects. Appropriately reduce the initial dose; consider the effect of the initial dose in determining supplemental doses. Plasma clearance of alfentanil may be reduced and postoperative recovery may be prolonged.

Other warnings/precautions:

• Discontinuation of therapy: Discontinue infusion at least 30 minutes prior to the end of surgery during general anesthesia; during administration for Monitored Anesthesia Care (MAC), infusions may be continued to the end of the procedure.

• Trained individuals: Alfentanil should be administered health care providers specifically trained in the use of anesthetic agents and should not be used in diagnostic or therapeutic procedures outside the monitored anesthesia setting; opioid antagonist, resuscitative and intubation equipment should be readily available.

Product Availability

Alfentanil has been discontinued in the United States for >1 year.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous [preservative free]:

Generic: 1000 mcg/2 mL (2 mL [DSC]); 2500 mcg/5 mL (5 mL [DSC])

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Alfentanil HCl Intravenous)

1000 mcg/2 mL (per mL): $5.26

2500 mcg/5 mL (per mL): $3.77

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Controlled Substance

C-II

Administration: Adult

IV: Administer IV slowly over 3 minutes or by IV continuous infusion.

Administration: Pediatric

Parenteral: IV: Inject slowly over 3 to 5 minutes or by continuous IV infusion; in neonates, monitor closely for chest wall rigidity.

Usual Infusion Concentrations: Adult

IV infusion: 10 mg in 250 mL (total volume) (concentration: 40 mcg/mL) of D₅W or NS

Use: Labeled Indications

Analgesia: Analgesic adjunct for the maintenance of anesthesia with barbiturate/nitrous oxide/oxygen; analgesic with nitrous oxide/oxygen in the maintenance of general anesthesia; analgesic component for monitored anesthesia care.

Anesthetic: Primary anesthetic for induction of anesthesia in general surgery when endotracheal intubation and mechanical ventilation are required.

Medication Safety Issues

Sound-alike/look-alike issues:

ALfentanil may be confused with Anafranil, fentaNYL, remifentanil, SUFentanil

Alfenta may be confused with Sufenta

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (opioids, all formulations and routes of administration) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care, Community/Ambulatory Care, and Long-Term Care Settings).

Metabolism/Transport Effects

Substrate of CYP3A4 (Major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Clinically Relevant Anticholinergic Effects: May increase adverse/toxic effects of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Alvimopan: Opioid Agonists may increase adverse/toxic effects of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation. Risk D: Consider Therapy Modification

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amphetamines: May increase analgesic effects of Opioid Agonists. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Bradycardia-Causing Agents: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

Buprenorphine: May decrease therapeutic effects of Opioid Agonists. Management: Seek alternatives to buprenorphine in patients receiving pure opioid agonists. If combined in certain pain management situations (eg, surgery), monitor for symptoms of therapeutic failure/high dose requirements or opioid withdrawal symptoms. Risk D: Consider Therapy Modification

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Ceritinib: ALfentanil may increase bradycardic effects of Ceritinib. Ceritinib may increase serum concentration of ALfentanil. Management: If use of alfentanil and ceritinib is necessary, consider dosage reduction of alfentanil until stable drug effects are achieved. Frequently monitor patients for respiratory depression, sedation, and bradycardia when these agents are combined. Risk D: Consider Therapy Modification

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Cimetidine: May increase serum concentration of ALfentanil. Risk C: Monitor

Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor

CNS Depressants: May increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

CYP3A4 Inducers (Moderate): May decrease serum concentration of ALfentanil. Management: If concomitant use of alfentanil and moderate CYP3A4 inducers is necessary, consider dosage increase of alfentanil until stable drug effects are achieved. Monitor patients for signs of opioid withdrawal. Risk D: Consider Therapy Modification

CYP3A4 Inducers (Strong): May decrease serum concentration of ALfentanil. Management: If concomitant use of alfentanil and strong CYP3A4 inducers is necessary, consider dosage increase of alfentanil until stable drug effects are achieved. Monitor patients for signs of opioid withdrawal. Risk D: Consider Therapy Modification

CYP3A4 Inhibitors (Moderate): May increase serum concentration of ALfentanil. Management: If use of alfentanil and moderate CYP3A4 inhibitors is necessary, consider dosage reduction of alfentanil until stable drug effects are achieved. Frequently monitor patients for respiratory depression and sedation when these agents are combined. Risk D: Consider Therapy Modification

CYP3A4 Inhibitors (Strong): May increase serum concentration of ALfentanil. Management: If use of alfentanil and strong CYP3A4 inhibitors is necessary, consider dosage reduction of alfentanil until stable drug effects are achieved. Frequently monitor patients for respiratory depression and sedation when these agents are combined. Risk D: Consider Therapy Modification

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Desmopressin: Opioid Agonists may increase hyponatremic effects of Desmopressin. Risk C: Monitor

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Diuretics: Opioid Agonists may increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Eluxadoline: Opioid Agonists may increase constipating effects of Eluxadoline. Risk X: Avoid

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Etrasimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Fexinidazole: Bradycardia-Causing Agents may increase arrhythmogenic effects of Fexinidazole. Risk X: Avoid

Fingolimod: Bradycardia-Causing Agents may increase bradycardic effects of Fingolimod. Management: Consult with the prescriber of any bradycardia-causing agent to see if the agent could be switched to an agent that does not cause bradycardia prior to initiating fingolimod. If combined, perform continuous ECG monitoring after the first fingolimod dose. Risk D: Consider Therapy Modification

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

Gastrointestinal Agents (Prokinetic): Opioid Agonists may decrease therapeutic effects of Gastrointestinal Agents (Prokinetic). Risk C: Monitor

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): May decrease therapeutic effects of Opioid Agonists. Opioid Agonists may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor

Ivabradine: Bradycardia-Causing Agents may increase bradycardic effects of Ivabradine. Risk C: Monitor

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Landiolol: Bradycardia-Causing Agents may increase bradycardic effects of Landiolol. Risk X: Avoid

Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Midodrine: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Monoamine Oxidase Inhibitors: Opioid Agonists may increase serotonergic effects of Monoamine Oxidase Inhibitors. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nalfurafine: Opioid Agonists may increase adverse/toxic effects of Nalfurafine. Opioid Agonists may decrease therapeutic effects of Nalfurafine. Risk C: Monitor

Nalmefene: May decrease therapeutic effects of Opioid Agonists. Management: Avoid the concomitant use of oral nalmefene and opioid agonists. Discontinue oral nalmefene 1 week prior to any anticipated use of opioid agonists. If combined, larger doses of opioid agonists will likely be required. Risk D: Consider Therapy Modification

Naltrexone: May decrease therapeutic effects of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations. Risk X: Avoid

Nefazodone: Opioid Agonists (metabolized by CYP3A4) may increase serotonergic effects of Nefazodone. This could result in serotonin syndrome. Nefazodone may increase serum concentration of Opioid Agonists (metabolized by CYP3A4). Management: If concomitant use of opioid agonists that are metabolized by CYP3A4 and nefazodone is necessary, consider dose reduction of the opioid until stable drug effects are achieved. Monitor for increased opioid effects and serotonin syndrome/serotonin toxicity. Risk D: Consider Therapy Modification

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opioids (Mixed Agonist / Antagonist): May decrease analgesic effects of Opioid Agonists. Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations. Risk X: Avoid

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Ozanimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Pegvisomant: Opioid Agonists may decrease therapeutic effects of Pegvisomant. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Ponesimod: Bradycardia-Causing Agents may increase bradycardic effects of Ponesimod. Management: Avoid coadministration of ponesimod with drugs that may cause bradycardia when possible. If combined, monitor heart rate closely and consider obtaining a cardiology consult. Do not initiate ponesimod in patients on beta-blockers if HR is less than 55 bpm. Risk D: Consider Therapy Modification

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Propofol: ALfentanil may increase adverse/toxic effects of Propofol. Specifically the development of opisthotonus (severe hyperextension and spasticity resulting in arching or bridging position) and/or tonic clonic seizures. Risk C: Monitor

Ramosetron: Opioid Agonists may increase constipating effects of Ramosetron. Risk C: Monitor

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Samidorphan: May decrease therapeutic effects of Opioid Agonists. Risk X: Avoid

Serotonergic Agents (High Risk): Opioid Agonists (metabolized by CYP3A4) may increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification

Siponimod: Bradycardia-Causing Agents may increase bradycardic effects of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. If combined, consider obtaining a cardiology consult regarding patient monitoring. Risk D: Consider Therapy Modification

Somatostatin Analogs: Opioid Agonists may decrease analgesic effects of Somatostatin Analogs. Opioid Agonists may increase analgesic effects of Somatostatin Analogs. Risk C: Monitor

Succinylcholine: May increase bradycardic effects of Opioid Agonists. Risk C: Monitor

Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

Tilidine: May increase therapeutic effects of Opioid Agonists. Risk X: Avoid

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Reproductive Considerations

Long-term opioid use may cause secondary hypogonadism, which may lead to sexual dysfunction or infertility (Brennan 2013).

Pregnancy Considerations

Alfentanil crosses the placenta (Cartwright 1989; Gepts 1986).

Prolonged use of opioids during pregnancy can cause neonatal withdrawal syndrome, which may be life-threatening if not recognized and treated according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available. Opioids may cause respiratory depression and psychophysiologic effects in the neonate; newborns of mothers receiving opioids during labor should be monitored.

The pharmacokinetic properties of alfentanil are not influenced by pregnancy when administered prior to delivery (Gepts 1986). Alfentanil has been evaluated for use in obstetrical analgesia (Mattingly 2003); other agents are more commonly used (ACOG 209 2019).

The ACOG recommends that pregnant women should not be denied medically necessary surgery, regardless of trimester. If the procedure is elective, it should be delayed until after delivery (ACOG 775 2019).

Breastfeeding Considerations

Alfentanil is present in breast milk (Giesecke 1985).

Breast milk was sampled in nine nonbreastfeeding women undergoing tubal ligation. Alfentanil 50 mcg/kg IV was administered following intubation and additional doses given as needed during the procedure. Alfentanil was present in breast milk 4 hours after the surgery and no longer present in breast milk 28 hours after surgery (Giesecke 1985).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother; monitor infants for excess sedation and respiratory depression. The Academy of Breast Feeding Medicine recommends postponing elective surgery until milk supply and breastfeeding are established. Milk should be expressed ahead of surgery when possible. In general, when the child is healthy and full term, breastfeeding may resume, or milk may be expressed once the mother is awake and in recovery. For children who are at risk for apnea, hypotension, or hypotonia, milk may be saved for later use when the child is at lower risk (ABM [Reece-Stremtan 2017]).

Monitoring Parameters

Respiratory and cardiovascular status, blood pressure, heart rate; continue to monitor well after surgery because of the risk for delayed effects

Mechanism of Action

Binds with stereospecific receptors at many sites within the CNS, increases pain threshold, alters pain perception, inhibits ascending pain pathways; is an ultra short-acting opioid

Pharmacokinetics (Adult Data Unless Noted)

Note: An early study of continuous infusion suggested nonlinear pharmacokinetics in neonates (Wiest 1991).

Onset of action: Rapid, within 5 minutes

Duration (dose dependent): 30 to 60 minutes

Distribution: V_d:

Newborns (premature): 0.5 to 0.6 L/kg (Davis 1988; Marlow 1990)

Children: 0.163 to 0.4 L/kg (Davis 1989; Meistelman 1987)

Adults: 0.4 to 1 L/kg

Protein binding:

Neonates: 67%

Adults: 88% to 92%

Bound to alpha₁-acid glycoprotein

Metabolism: Hepatic

Half-life elimination:

Newborns (premature): 5.33 to 9 hours (Davis 1988; Marlow 1990)

Children: 40 to 63 minutes (Davis 1988; Meistelman 1987; Roure 1987)

Adults: 90 to 111 minutes

Excretion: Only 1% of dose is excreted unchanged; urine (major route of elimination of metabolites)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: Reduced plasma clearance and extended terminal elimination may develop.

Older adult: Reduced plasma clearance and extended terminal elimination may develop.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Rapifen;
(AT) Austria: Alfentanil hameln | Rapifen;
(BE) Belgium: Rapifen;
(BR) Brazil: Alfenta | Rapifen;
(CO) Colombia: Alfentanyl;
(CZ) Czech Republic: Rapifen;
(DE) Germany: Alfentanil hameln | Rapifen;
(EE) Estonia: Rapifen;
(ES) Spain: Fanaxal | Limifen;
(FI) Finland: Alfentanil hameln | Alfentanil kalceks | Rapifen | Rapifen orion;
(FR) France: Alfentanil kalceks | Rapifen;
(GB) United Kingdom: Alfentanil | Rapifen;
(GR) Greece: Rapifen;
(IE) Ireland: Rapifen;
(IT) Italy: Fentalim;
(KR) Korea, Republic of: Alfenil | Alfentanil | Hana alfentanil | Spenal;
(KW) Kuwait: Rapifen;
(LB) Lebanon: Rapifen;
(LT) Lithuania: Rapifen;
(LU) Luxembourg: Rapifen;
(LV) Latvia: Alfentanil kalceks | Rapifen;
(MA) Morocco: Rapifen;
(MY) Malaysia: Rapifen;
(NL) Netherlands: Alfentanil hameln;
(NO) Norway: Alfentanil hameln | Alfentanil kalceks | Rapifen;
(NZ) New Zealand: Alfentanil | Rapifen;
(PL) Poland: Rapifen;
(PT) Portugal: Alfentanil | Rapifen;
(PY) Paraguay: Rapifen;
(SA) Saudi Arabia: Rapifen;
(SE) Sweden: Alfentanil hameln | Alfentanil kalceks | Rapifen;
(SI) Slovenia: Alfentanil hameln;
(SK) Slovakia: Rapifen;
(TN) Tunisia: Rapifen;
(TR) Turkey: Rapifen;
(TW) Taiwan: Alfentanil hameln | Rapifen;
(VE) Venezuela, Bolivarian Republic of: Rapifen;
(ZA) South Africa: Rapifen

Alfentanil injection [prescribing information]. Gurnee, IL: Akorn Inc; December 2023.
American College of Obstetricians and Gynecologists (ACOG). ACOG committee opinion no. 775: nonobstetric surgery during pregnancy. Obstet Gynecol. 2019;133(4):e285-e286. [PubMed 30913200]
American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 209: obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133(3):e208-e225. [PubMed 30801474]
Annila P, Viitanen H, Reinikainen P, et al, "Induction Characteristics of Thiopentone/Suxamethonium, Propofol/Alfentanil or Halothane Alone in Children Aged 1-3 Years," Eur J Anaesthesiol, 1999, 16(6):359-66. [PubMed 10434162]
Bartkowski RR and McDonnell TE, “Prolonged Alfentanil Effect Following Erythromycin Administration,” Anesthesiology, 1990, 73(3):566-8. [PubMed 2203286]
Bartkowski RR, Goldberg ME, Larijani GE, et al, “Inhibition of Alfentanil Metabolism by Erythromycin,” Clin Pharmacol Ther, 1989, 46(1):99-102. [PubMed 2501060]
Bartolek D, Lajtman Z, Zdravcević-Sakić K, et al, "The Optimal Pediatric Induction Dose of Propofol in Combination With Reduced-Dose Rocuronium and Alfentanil for Day-Case Tonsillectomy in Children," Int J Pediatr Otorhinolaryngol, 2007, 71(12):1873-81. [PubMed 17936918]
Benthuysen JL, Smith NT, Sanford TJ, Head N, Dec-Silver H. Physiology of alfentanil-induced rigidity. Anesthesiology. 1986;64(4):440-446. doi:10.1097/00000542-198604000-00005 [PubMed 3008595]
Black ML, Hill JL, Zacny JP. Behavioral and physiological effects of remifentanil and alfentanil in healthy volunteers. Anesthesiology. 1999;90(3):718-726. doi:10.1097/00000542-199903000-00013 [PubMed 10078672]
Bodenham A and Park GR, “Alfentanil Infusions in Patients Requiring Intensive Care,” Clin Pharmacokinet, 1988, 15(4):216-26. [PubMed 3142717]
Brennan MJ. The effect of opioid therapy on endocrine function. Am J Med. 2013;126(3 Suppl 1):S12-S18. [PubMed 23414717]
Cartwright DP, Dann WL, Hutchinson A. Placental transfer of alfentanil at caesarean section. Eur J Anaesthesiol. 1989;6(2):103-109. [PubMed 2498089]
Chauvin M, Lebrault C, Levron JC, Duvaldestin P. Pharmacokinetics of alfentanil in chronic renal failure. Anesth Analg. 1987;66(1):53-56. [PubMed 3099599]
Davis PJ, Killian A, Stiller RL, et al. Alfentanil pharmacokinetics in premature infants and older children [abstract]. Anesthesiology. 1988;69:579-583.
Davis PJ, Killian A, Stiller RL, et al, “Pharmacokinetics of Alfentanil in Newborn Premature Infants and Older Children,” Dev Pharmacol Ther, 1989, 13(1):21-7. [PubMed 2505988]
Davis PJ, Stiller RL, Cook DR, Brandom BW, Davis JE, Scierka AM. Effects of cholestatic hepatic disease and chronic renal failure on alfentanil pharmacokinetics in children. Anesth Analg. 1989;68(5):579-583. [PubMed 2497657]
Gepts E, Heytens L, Camu F. Pharmacokinetics and placental transfer of intravenous and epidural alfentanil in parturient women. Anesth Analg. 1986;65(11):1155-1160. [PubMed 2876662]
Giesecke AH, Rice LJ, Lipton JM. Abstracts of scientific papers. 1985 annual meeting, American Society of Anesthesiologists. Anesthesiology. 1985;63(3A Suppl):A1-A636. [PubMed 4025907]
Gropper M, Eriksson L, Fleisher L, et al, eds. Miller's Anesthesia, 2-Volume Set. 9th ed. St. Louis, MO: Elsevier; 2019.
Kim JY, Chang YJ, Lee JY, et al, "Post-Induction Alfentanil Reduces Sevoflurane-Associated Emergence Agitation in Children Undergoing an Adenotonsillectomy," Acta Anaesthesiol Scand, 2009, 53(5):678-81. [PubMed 19419364]
Kirkham SR and Pugh R, “Opioid Analgesia in Uraemic Patients,” Lancet, 1995, 345(8958):1185.
Kwak HJ, Kim JY, Min SK, et al, "Optimal Bolus Dose of Alfentanil for Successful Tracheal Intubation During Sevoflurane Induction With and Without Nitrous Oxide in Children," Br J Anaesth, 2010, 104(5):628-32. [PubMed 20335182]
Marlow N, Weindling AM, Van Peer A, et al, “Alfentanil Pharmacokinetics in Preterm Infants,” Arch Dis Child, 1990, 65(4 Spec No):349-51. [PubMed 2337359]
Mattingly JE, D'Alessio J, and Ramanathan J, "Effects of Obstetric Analgesics and Anesthetics on the Neonate: A Review," Paediatr Drugs, 2003, 5(9):615-27. [PubMed 12956618]
Meistelman C, Saint-Maurice C, Lepaul M, et al, “A Comparison of Alfentanil Pharmacokinetics in Children and Adults,” Anesthesiology, 1987, 66(1):13-6. [PubMed 3099603]
Ng KP and Wang CY, "Alfentanil for Intubation Under Halothane Anaesthesia in Children," Paediatr Anaesth, 1999, 9(6):491-4. [PubMed 10597551]
Pepys J, Pepys EO, Baldo BA, Whitwam JG. Anaphylactic/anaphylactoid reactions to anaesthetic and associated agents. Skin prick tests in aetiological diagnosis. Anaesthesia. 1994;49(6):470-475. doi:10.1111/j.1365-2044.1994.tb03515.x [PubMed 8017588]
Pokela ML, Ryhanen PT, Koivisto ME, et al, “Alfentanil-Induced Rigidity in Newborn Infants,” Anesth Analg, 1992, 75(2):252-7. [PubMed 1632539]
Rahman Al-Refai A, Al-Mujadi H, Petrova Ivanova M, et al, "Prevention of Pain on Injection of Propofol: A Comparison of Remifentanil With Alfentanil in Children," Minerva Anestesiol, 2007, 73(4):219-23. [PubMed 17159759]
Reece-Stremtan S, Campos M, Kokajko L; Academy of Breastfeeding Medicine. ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeed Med. 2017;12(9):500-506. [PubMed 29624435]
Ross J, Kearse LA Jr, Barlow MK, Houghton KJ, Cosgrove GR. Alfentanil-induced epileptiform activity: a simultaneous surface and depth electroencephalographic study in complex partial epilepsy. Epilepsia. 2001;42(2):220-225. doi:10.1046/j.1528-1157.2001.18600.x [PubMed 11240593]
Roure P, Jean N, Leclerc AC, Cabanel N, Levron JC, Duvaldestin P. Pharmacokinetics of alfentanil in children undergoing surgery. Br J Anaesth. 1987;59(11):1437-440. [PubMed 3120765]
Saarenmaa E, Huttunen P, Leppäluoto J, et al, "Alfentanil as Procedural Pain Relief in Newborn Infants," Arch Dis Child Fetal Neonatal Ed, 1996, 75(2):F103-7. [PubMed 8949692]
Scholz J, Steinfath M, and Schulz M, “Clinical Pharmacokinetics of Alfentanil, Fentanyl, and Sufentanil. An Update,” Clin Pharmacokinet, 1996, 31(4):275-92. [PubMed 8896944]
US Food and Drug Administration (FDA). FDA drug safety communication: FDA updates prescribing information for all opioid pain medicines to provide additional guidance for safe use. https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-prescribing-information-all-opioid-pain-medicines-provide-additional-guidance-safe-use. Published April 13, 2023. Accessed April 17, 2023.
Von Heijne M, Bredlöv B, Söderhäll S, et al, "Propofol or Propofol - Alfentanil Anesthesia for Painful Procedures in the Pediatric Oncology Ward," Paediatr Anaesth, 2004, 14(8):670-5. [PubMed 15283827]
Wiest DB, Ohning BL, and Garner SS, "The Disposition of Alfentanil in Neonates With Respiratory Distress," Pharmacotherapy, 1991, 11(4):308-311. [PubMed 1923912]

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Alfentanil (United States and Canada: Not available): Drug information