Drug: Alfenta

ALFENTA (alfentanil hydrochloride) Injection is an opioid analgesic chemically designated as N-[1-[2-(4-ethyl-4,5-dihydro-5-oxo-1H-tetrazol-1-yl)ethyl]-4- (methoxymethyl)-4-piperidinyl]-N-phenylpropanamide monohydrochloride (1:1) with a molecular weight of 452.98 and an n-octanol:water partition coefficient of 128:1 at pH 7.4. The structural formula of ALFENTA (alfentanil) is: ALFENTA (alfentanil) is a sterile, non-pyrogenic, preservative free aqueous solution containing alfenta (alfentanil) hydrochloride equivalent to 500 μg per mL of alfenta base for intravenous injection. The solution, which contains sodium chloride for isotonicity, has a pH range of 4-6. Each mL contains: Active: (alfentanil) base 500 mcg. Inactive: Sodium Chloride 9 mg and Water for Injection Q.S. Last reviewed on RxList: 8/14/2008
This monograph has been modified to include the generic and brand name in many instances.

Source: http://www.rxlist.com

The most common adverse reactions of opioids are respiratory depression and skeletal muscle rigidity, particularly of the truncal muscles. ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may produce muscular rigidity that involves the skeletal muscles of the neck and extremities. See CLINICAL PHARMACOLOGY, WARNINGS, and PRECAUTIONS on the management of respiratory depression and skeletal muscle rigidity. The adverse experience profile from 696 patients receiving ALFENTA (alfenta (alfenta (alfentanil) nil) nil) for Monitored Anesthesia Care (MAC) is similar to the profile established with ALFENTA (alfenta (alfenta (alfentanil) nil) nil) during general anesthesia. Respiratory events reported during MAC included hypoxia, apnea, and bradypnea. Other adverse events reported by patients receiving ALFENTA (alfenta (alfenta (alfentanil) nil) nil) for MAC, in order of decreasing frequency, were nausea, hypotension, vomiting, pruritus, confusion, somnolence and agitation. The following adverse reaction information is derived from controlled and open clinical trials in 785 patients who received intravenous ALFENTA (alfenta (alfenta (alfentanil) nil) nil) during induction and maintenance of general anesthesia. The controlled trials included treatment comparisons with fentanyl, thiopental sodium, enflurane, saline placebo and halothane. The incidence of certain side effects is influenced by the type of use, e.g., chest wall rigidity has a higher reported incidence in clinical trials of alfenta (alfenta (alfenta (alfentanil) nil) nil) nil induction, and by the type of surgery, e.g., nausea and vomiting have a higher reported incidence in patients undergoing gynecologic surgery. The overall reports of nausea and vomiting with ALFENTA (alfenta (alfenta (alfentanil) nil) nil) were comparable to fentanyl. Incidence Greater than 1% - Probably Causally Related (Derived from clinical trials) Gastrointestinal: nausea (28%), vomiting (18%)
Cardiovascular: arrhythmia, bradycardia (14%), hypertension (18%), hypotension (10%), tachycardia (12%)
Musculoskeletal: chest wall rigidity (17%), skeletal muscle movements*
Respiratory: apnea*, postoperative respiratory depression
Central Nervous System: blurred vision, dizziness*, sleepiness/postoperative sedation *Incidence 3% to 9%
All others 1% to 3% Incidence Less than 1% - Probably Causally Related (Derived from clinical trials) Adverse events reported in post-marketing surveillance, not seen in clinical trials, are italicized. Body as a whole: anaphylaxis
Central Nervous System: headache*, myoclonic movements, postoperative confusion*, postoperative euphoria*, shivering*
Dermatological: itching*, urticaria*
Injection Site: pain*
Musculoskeletal: skeletal muscle rigidity of neck and extremities
Respiratory: bronchospasm, hypercarbia*, laryngospasm* *Incidence 0.3% to 1% Drug Abuse And Dependence ALFENTA (alfenta (alfenta (alfenta (alfentanil) nil) nil) nil hydrochloride) is a Schedule II controlled drug substance that can produce drug dependence of the morphine type and therefore has the potential for being abused. Opioid analgesics have been associated with abuse and dependence in health care providers and others with ready access to such drugs. ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be handled accordingly. Read the Alfenta (alfentanil for injection) Side Effects Center for a complete guide to possible side effectsLearn More »

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The dosage of ALFENTA (alfenta (alfenta (alfenta (alfentanil) nil) nil) nil hydrochloride) should be individualized and titrated to the desired effect in each patient according to body weight, physical status, underlying pathological condition, use of other drugs, and type and duration of surgical procedure and anesthesia. In obese patients (more than 20% above ideal total body weight), the dosage of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be determined on the basis of lean body weight. The dose of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be reduced in elderly or debilitated patients (see PRECAUTIONS). Vital signs should be monitored routinely. See Dosage Guidelines for the use of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) : 1) by incremental injection as an analgesic adjunct to anesthesia with barbiturate/nitrous oxide/oxygen for short surgical procedures (expected duration of less than one hour); 2) by continuous infusion as a maintenance analgesic with nitrous oxide/oxygen for general surgical procedures; and 3) by intravenous injection in anesthetic doses for the induction of anesthesia for general surgical procedures with a minimum expected duration of 45 minutes; and 4) by intravenous injection as the analgesic component for monitored anesthesia care (MAC). DOSAGE GUIDELINES DOSAGE SHOULD BE INDIVIDUALIZED AND TITRATED
FOR USE DURING GENERAL ANESTHESIA SPONTANEOUSLY BREATHING/ ASSISTED VENTILATION Induction of Analgesia: 8-20 mcg/kg
Maintenance of Analgesia: 3-5 mcg/kg q 5-20 min or 0.5 to 1 mcg/kg/min
Total dose: 8-40 mcg/kg ASSISTED OR CONTROLLED VENTILATION Incremental Injection
(To attenuate response to laryngoscopy and intubation) Induction of Analgesia: 20-50 mcg/kg
Maintenance of Analgesia: 5-15 mcg/kg q 5-20 min
Total dose: Up to 75 mcg/kg Continuous Infusion
(To provide attenuation of response to intubation and incision) Infusion rates are variable and should be titrated to the desired clinical effect.
SEE INFUSION DOSAGE GUIDELINES BELOW.
Induction of Analgesia: 50-75 mcg/kg
Maintenance of Analgesia: 0.5 to 3 mcg/kg/min (Average rate 1 to 1.5 mcg/kg/min)
Total dose: Dependent on duration of procedure Anesthetic Induction Induction of Anesthesia: 130-245 mcg/kg
Maintenance of Anesthesia: 0.5 to 1.5 mcg/kg/min or general anesthetic
Total dose: Dependent on duration of procedure
At these doses, truncal rigidity should be expected and a muscle relaxant should be utilized.
Administer slowly (over 3 minutes).
Concentration of inhalation agents reduced by 30-50% for initial hour. MONITORED ANESTHESIA CARE (MAC)
(For sedated and responsive, spontaneously breathing patients) Induction of MAC: 3-8 mcg/kg
Maintenance of MAC: 3-5 mcg/kg q 5-20 min or 0.25 to 1 mcg/kg/min
Total dose: 3-40 mcg/kg INFUSION DOSAGE Continuous Infusion: 0.5-3 mcg/kg/min administered with nitrous oxide/oxygen in patients undergoing general surgery. Following an anesthetic induction dose of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) , infusion rate requirements are reduced by 30-50% for the first hour of maintenance.

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Both the magnitude and duration of central nervous system and cardiovascular effects may be enhanced when ALFENTA (alfenta (alfenta (alfentanil) nil) nil) is administered in combination with other CNS depressants such as barbiturates, tranquilizers, opioids, or inhalation general anesthetics. Postoperative respiratory depression may be enhanced or prolonged by these agents. In such cases of combined treatment, the dose of one or both agents should be reduced. Limited clinical experience indicates that requirements for volatile inhalation anesthetics are reduced by 30 to 50% for the first sixty (60) minutes following ALFENTA (alfenta (alfenta (alfentanil) nil) nil) induction. The concomitant use of erythromycin with ALFENTA (alfentanil) can significantly inhibit ALFENTA (alfenta (alfenta (alfentanil) nil) nil) clearance and may increase the risk of prolonged or delayed respiratory depression. Cimetidine reduces the clearance of ALFENTA (alfentanil) . Therefore smaller ALFENTA (alfenta (alfenta (alfentanil) nil) nil) doses will be required with prolonged administration and the duration of action of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may be extended. Perioperative administration of drugs affecting hepatic blood flow or enzyme function may reduce plasma clearance and prolong recovery. Read the Alfenta Drug Interactions Center for a complete guide to possible interactions Learn More »

Source: http://www.rxlist.com

ALFENTA (alfenta (alfenta (alfenta (alfentanil) nil) nil) nil hydrochloride) is indicated:
  • as an analgesic adjunct given in incremental doses in the maintenance of anesthesia with barbiturate/nitrous oxide/oxygen.
  • 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 monitored anesthesia care (MAC).
SEE DOSAGE CHART FOR MORE COMPLETE INFORMATION ON THE USE OF ALFENTA (alfenta (alfenta (alfentanil) nil) nil) .

Source: http://www.rxlist.com

ALFENTA (alfenta (alfenta (alfenta (alfentanil) nil) nil) nil hydrochloride) is contraindicated in patients with known hypersensitivity to the drug or known intolerance to other opioid agonists.Last reviewed on RxList: 8/14/2008
This monograph has been modified to include the generic and brand name in many instances.

Source: http://www.rxlist.com

Overdosage would be manifested by extension of the pharmacological actions of ALFENTA (alfentanil hydrochloride) (see CLINICAL PHARMACOLOGY) as with other potent opioid analgesics. No experience of overdosage with ALFENTA (alfenta (alfenta (alfentanil) nil) nil) was reported during clinical trials. The intravenous LD50 of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) is 43-51 mg/kg in rats, 72-74 mg/kg in mice, 72-82 mg/kg in guinea pigs and 60-88 mg/kg in dogs. Intravenous administration of an opioid antagonist such as naloxone should be employed as a specific antidote to manage respiratory depression. The duration of respiratory depression following overdosage with ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may be longer than the duration of action of the opioid antagonist. Administration of an opioid antagonist should not preclude immediate establishment of a patent airway, administration of oxygen, and assisted or controlled ventilation as indicated for hypoventilation or apnea. If respiratory depression is associated with muscular rigidity, a neuromuscular blocking agent may be required to facilitate assisted or controlled ventilation. Intravenous fluids and vasoactive agents may be required to manage hemodynamic instability.

Source: http://www.rxlist.com

ALFENTA (alfenta (alfenta (alfenta (alfentanil) nil) nil) nil hydrochloride) Injection for intravenous use. Each mL Contains: Active: Alfenta (alfenta (alfenta (alfentanil) nil) nil) nil base 500 mcg. Inactives: Sodium Chloride 9 mg and WFI Q.S ALFENTA (alfenta (alfenta (alfentanil) nil) nil) Injection is available as: NDC 11098-060-02, 2 mL Ampule in packages of 10
NDC 11098-060-05, 5 mL Ampule in packages of 10
NDC 11098-060-10, 10 mL Ampule in packages of 5
NDC 11098-060-20, 20 mL Ampule in packages of 5 Taylor Pharmaceuticals, Decatur, IL 62522. Rev. 06/05. FDA rev date: 05/25/99Last reviewed on RxList: 8/14/2008
This monograph has been modified to include the generic and brand name in many instances.

Source: http://www.rxlist.com

DELAYED RESPIRATORY DEPRESSION, RESPIRATORY ARREST, BRADYCARDIA, ASYSTOLE, ARRHYTHMIAS AND HYPOTENSION HAVE ALSO BEEN REPORTED. THEREFORE, VITAL SIGNS MUST BE MONITORED CONTINUOUSLY. General: The initial dose of ALFENTA (alfenta (alfenta (alfenta (alfentanil) nil) nil) nil hydrochloride) should be appropriately reduced in elderly and debilitated patients. The effect of the initial dose should be considered in determining supplemental doses. In obese patients (more than 20% above ideal total body weight), the dosage of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be determined on the basis of lean body weight. In one clinical trial, the dose of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) required to produce anesthesia, as determined by appearance of delta waves in EEG, was 40% lower in geriatric patients than that needed in healthy young patients. In patients with compromised liver function and in geriatric patients, the plasma clearance of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may be reduced and postoperative recovery may be prolonged. Induction doses of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be administered slowly (over three minutes). Administration may produce loss of vascular tone and hypotension. Consideration should be given to fluid replacement prior to induction. Diazepam administered immediately prior to or in conjunction with high doses of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may produce vasodilation, hypotension and result in delayed recovery. Bradycardia produced by ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may be treated with atropine. Severe bradycardia and asystole have been successfully treated with atropine and conventional resuscitative methods. The hemodynamic effects of a particular muscle relaxant and the degree of skeletal muscle relaxation required should be considered in the selection of a neuromuscular blocking agent. Following an anesthetic induction dose of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) , requirements for volatile inhalation anesthetics or ALFENTA (alfenta (alfenta (alfentanil) nil) nil) infusion are reduced by 30 to 50% for the first hour of maintenance. ALFENTA (alfenta (alfenta (alfentanil) nil) nil) infusions should be discontinued at least 10-15 minutes prior to the end of surgery during general anesthesia. During administration of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) for Monitored Anesthesia Care (MAC), infusions may be continued to the end of the procedure. Respiratory depression caused by opioid analgesics can be reversed by opioid antagonists such as naloxone. Because the duration of respiratory depression produced by ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may last longer than the duration of the opioid antagonist action, appropriate surveillance should be maintained. As with all potent opioids, profound analgesia is accompanied by respiratory depression and diminished sensitivity to CO2 stimulation which may persist into or recur in the postoperative period. Intraoperative hyperventilation may further alter postoperative response to CO2. Appropriate postoperative monitoring should be employed, particularly after infusions and large doses of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) , to ensure that adequate spontaneous breathing is established and maintained in the absence of stimulation prior to discharging the patient from the recovery area. Head Injuries: ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be used with caution in patients with head injury or increased intracranial pressure, due to the increased risk of respiratory depression. As with all opioids, ALFENTA (alfenta (alfenta (alfentanil) nil) nil) may obscure the clinical course of patients with head injuries and should be used only if clinically indicated. Impaired Respiration: ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be used with caution in patients with pulmonary disease, decreased respiratory reserve or potentially compromised respiration. In such patients, opioids may additionally decrease respiratory drive and increase airway resistance. During anesthesia, this can be managed by assisted or controlled respiration. Impaired Hepatic or Renal Function: In patients with liver or kidney dysfunction, ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be administered with caution due to the importance of these organs in the metabolism and excretion of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) . Carcinogenesis, Mutagenesis and Impairment of Fertility: No long-term animal studies of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) have been performed to evaluate carcinogenic potential. No structural chromosome mutations were produced in the in vivo micronucleus test in female rats at single intravenous doses of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) as high as 20 mg/kg body weight (approximately 40 times the upper human dose), equivalent to a dose of 103 mg/m² body surface area. No dominant lethal mutations were produced in the in vivo dominant lethal test in male and female mice at the maximum intravenous dose of 20 mg/kg (60 mg/m²). No mutagenic activity was revealed in the in vitro Ames Salmonella typhimurium test, with and without metabolic activation. Pregnancy Category C: ALFENTA (alfenta (alfenta (alfentanil) nil) nil) has been shown to have an embryocidal effect in rats and rabbits when given in doses 2.5 times the upper human dose for a period of 10 days to over 30 days. These effects could have been due to maternal toxicity (decreased food consumption with increased mortality) following prolonged administration of the drug. No evidence of teratogenic effects has been observed after administration of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) in rats or rabbits. There are no adequate and well-controlled studies in pregnant women. ALFENTA (alfenta (alfenta (alfentanil) nil) nil) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Labor and Delivery: There are insufficient data to support the use of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) in labor and delivery. Placental transfer of the drug has been reported; therefore, use in labor and delivery is not recommended. Nursing Mothers: In one study of nine women undergoing postpartum tubal ligation, significant levels of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) were detected in colostrum four hours after administration of 60 mcg/kg of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) , with no detectable levels present after 28 hours. Caution should be exercised when ALFENTA (alfenta (alfenta (alfentanil) nil) nil) is administered to a nursing woman. Pediatric Use: Adequate data to support the use of ALFENTA (alfenta (alfenta (alfentanil) nil) nil) in children under 12 years of age are not presently available. Last reviewed on RxList: 8/14/2008
This monograph has been modified to include the generic and brand name in many instances.

Source: http://www.rxlist.com

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