Dosing & Uses
Dosage Forms & Strengths
injectable solution: Schedule II
- 0.5mg/mL
Dose should be calculated based on ideal body weight
Incremental Injection: Anesthesia <30 Minutes
Maintenance: 3-5 mcg/kg IV increments q5-20min, or 0.5-1 mcg/kg/min IV
Total dose: 8-40 mcg/kg IV
Incremental Injection: Anesthesia 30-60 Minutes
Maintenance: 5-15 mcg/kg IV increments q5-20min
Total dose: Up to 75 mcg/kg IV
Anesthetic Induction: Anesthesia >45 Minutes
Maintenance: 0.5-1.5 mcg/kg/min IV or other general anesthetic
Total dose: depends on duration of operation
Continuous Infusion: For Anesthesia >45 Minutes
Maintenance: 0.5-3 mcg/kg/min IV
Total dose: depends on duration of operation
Postherpetic Neuralgia (Orphan)
Management of postherpetic neuralgia
Orphan indication sponsor
- Cinergen, LLC; 146 Medinah Drive; Blue Bell, PA 19422-3212
HIV-Associated Neuropathy (Orphan)
Treatment of painful HIV-associated neuropathy
Orphan indication sponsor
- Cinergen, LLC; 146 Medinah Drive; Blue Bell, PA 19422-3212
Administration
Total dose: depends on duration of operation
Dosage Forms & Strengths
injectable solution: Schedule II
- 0.5mg/mL
Dose should be calculated based on ideal body weight
<12 years
Anesthesia
- Not recommended
>12 years
Incremental Injection: Anesthesia <30 Minutes
- Induction: 8-20 mcg/kg IV
- Maintenance: 3-5 mcg/kg IV increments q5-20min, or 0.5-1 mcg/kg/min IV
- Total dose: 8-40 mcg/kg IV
Incremental Injection: Anesthesia 30-60 Minutes
- Induction: 20-50 mcg/kg IV
- Maintenance: 5-15 mcg/kg IV increments q5-20min
- Total dose: Up to 75 mcg/kg IV
Anesthetic Induction: Anesthesia >45 Minutes
- Induction: 130-245 mcg/kg IV
- Maintenance: 0.5-1.5 mcg/kg/min IV or other general anesthetic
- Total dose: depends on duration of operation
Continuous Infusion: For Anesthesia >45 Minutes
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- alvimopan
alvimopan, alfentanil. receptor binding competition. Contraindicated. Contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea.
- olanzapine/samidorphan
olanzapine/samidorphan will decrease the level or effect of alfentanil by pharmacodynamic antagonism. Contraindicated. Samidorphan elicits opioid antagonistic effects and increases risk of precipitating acute opioid withdrawal in patients dependent on opioids. Prescribing information recommends at least a 7-day opioid-free interval for short-acting opioids and at least a 14-day opioid-free interval for long-acting opioids before starting olanzapine/samidorphan.
Serious - Use Alternative (74)
- acrivastine
acrivastine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- amisulpride
amisulpride and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- apalutamide
apalutamide will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- asenapine
asenapine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- asenapine transdermal
asenapine transdermal and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- avapritinib
avapritinib and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, alfentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
benzhydrocodone/acetaminophen and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - brexpiprazole
brexpiprazole and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- brigatinib
brigatinib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.
- brimonidine
brimonidine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- brivaracetam
brivaracetam and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine
buprenorphine, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- buprenorphine buccal
buprenorphine buccal, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- buprenorphine subdermal implant
buprenorphine subdermal implant and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine transdermal
buprenorphine transdermal and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- butorphanol
butorphanol, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- calcium/magnesium/potassium/sodium oxybates
alfentanil, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- cariprazine
cariprazine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- citalopram
alfentanil, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- clonidine
clonidine, alfentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.
- desvenlafaxine
desvenlafaxine and alfentanil both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome
- diazepam intranasal
diazepam intranasal, alfentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- escitalopram
alfentanil, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- fentanyl
fentanyl and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl intranasal
fentanyl intranasal and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl iontophoretic transdermal system
fentanyl iontophoretic transdermal system and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transdermal
fentanyl transdermal and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transmucosal
fentanyl transmucosal and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fexinidazole
fexinidazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- fluoxetine
alfentanil, fluoxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and alfentanil both increase serotonin levels. Avoid or Use Alternate Drug.
- hydrocodone
hydrocodone, alfentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- idelalisib
idelalisib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- isocarboxazid
isocarboxazid increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- isoniazid
isoniazid will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor for excessive CNS and respiratory depression
- ivosidenib
ivosidenib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- levetiracetam
levetiracetam and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- linezolid
linezolid increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
alfentanil, linezolid. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. - lonafarnib
lonafarnib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
- lopinavir
lopinavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- lorlatinib
lorlatinib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of lorlatinib with CYP3A substrates, where minimal concentration changes may lead to serious therapeutic failures of the substrate. If concomitant use is unavoidable, increase CYP3A substrate dosage in accordance with approved product labeling.
- lumacaftor/ivacaftor
lumacaftor/ivacaftor will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.
- methohexital
methohexital and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- methylene blue
methylene blue and alfentanil both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities
- metoclopramide intranasal
alfentanil, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- mifepristone
mifepristone will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
- nalbuphine
nalbuphine, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- nefazodone
nefazodone will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- olopatadine intranasal
alfentanil and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- olutasidenib
olutasidenib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.
- ozanimod
ozanimod and alfentanil both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- pacritinib
pacritinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- paroxetine
alfentanil, paroxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- pentazocine
pentazocine, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- pexidartinib
pexidartinib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.
- phenelzine
phenelzine increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- procarbazine
procarbazine increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .
- rasagiline
rasagiline increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. May cause additive CNS depression, drowsiness, dizziness or hypotension, so use with MAOIs should be cautious; lower initial dosages of the analgesic are recommended followed by careful titration. Avoid combination within 14 days of MAOI use.
- repotrectinib
repotrectinib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Repotrectinib is a CYP3A4 inducer. Avoid coadministration with CYP3A substrates where minimal concentration changes can cause reduced efficacy, unless otherwise recommended their prescribing information.
- selegiline transdermal
selegiline transdermal increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selinexor
selinexor, alfentanil. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sertraline
alfentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- sodium oxybate
alfentanil, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sotorasib
sotorasib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications
- sufentanil SL
sufentanil SL, alfentanil. Either increases toxicity of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
sufentanil SL, alfentanil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. - tramadol
tramadol, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.
- tranylcypromine
tranylcypromine increases toxicity of alfentanil by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- valerian
valerian and alfentanil both increase sedation. Avoid or Use Alternate Drug.
- venlafaxine
venlafaxine and alfentanil both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome
- vortioxetine
alfentanil, vortioxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
- zuranolone
alfentanil, zuranolone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of zuranolone with other CNS depressants may increase impairment of psychomotor performance or CNS depressant effects. If unavoidable, consider dose reduction. .
Monitor Closely (255)
- albuterol
alfentanil increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alprazolam
alprazolam and alfentanil both increase sedation. Use Caution/Monitor.
- amifostine
amifostine, alfentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
- amitriptyline
alfentanil and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and alfentanil both increase sedation. Use Caution/Monitor.
- amoxapine
alfentanil and amoxapine both increase sedation. Use Caution/Monitor.
- amphetamine
alfentanil increases and amphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- apomorphine
alfentanil and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
alfentanil increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
alfentanil and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
alfentanil increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- azelastine
azelastine and alfentanil both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and alfentanil both increase sedation. Use Caution/Monitor.
- belladonna and opium
alfentanil and belladonna and opium both increase sedation. Use Caution/Monitor.
- belzutifan
belzutifan will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- benperidol
alfentanil and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
alfentanil increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- berotralstat
berotralstat will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.
- brexanolone
brexanolone, alfentanil. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and alfentanil both increase sedation. Use Caution/Monitor.
- buprenorphine
alfentanil and buprenorphine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
alfentanil and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
alfentanil increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and alfentanil both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and alfentanil both increase sedation. Use Caution/Monitor.
- butorphanol
alfentanil and butorphanol both increase sedation. Use Caution/Monitor.
- caffeine
alfentanil increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbamazepine
carbamazepine will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and alfentanil both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and alfentanil both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
cenobamate, alfentanil. Either increases effects of the other by sedation. Use Caution/Monitor. - ceritinib
ceritinib increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and alfentanil both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and alfentanil both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and alfentanil both increase sedation. Use Caution/Monitor.
- chlorpromazine
alfentanil and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and alfentanil both increase sedation. Use Caution/Monitor.
- cimetidine
cimetidine will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cinnarizine
cinnarizine and alfentanil both increase sedation. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- clemastine
clemastine and alfentanil both increase sedation. Use Caution/Monitor.
- clobazam
alfentanil, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
alfentanil and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and alfentanil both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and alfentanil both increase sedation. Use Caution/Monitor.
- clozapine
alfentanil and clozapine both increase sedation. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- codeine
alfentanil and codeine both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided.
- cyclizine
cyclizine and alfentanil both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and alfentanil both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and alfentanil both increase sedation. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- danazol
danazol will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dantrolene
dantrolene and alfentanil both increase sedation. Use Caution/Monitor.
- daridorexant
alfentanil and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- deferasirox
deferasirox will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- desflurane
desflurane and alfentanil both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.
- desipramine
alfentanil and desipramine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and alfentanil both increase sedation. Use Caution/Monitor.
- dexfenfluramine
alfentanil increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and alfentanil both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
alfentanil increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
alfentanil increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
alfentanil and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
alfentanil and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and alfentanil both increase sedation. Use Caution/Monitor.
- diethylpropion
alfentanil increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and alfentanil both increase sedation. Use Caution/Monitor.
- difenoxin hcl
alfentanil and difenoxin hcl both increase sedation. Use Caution/Monitor.
- diltiazem
diltiazem will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. In patients receiving both diltiazem and alfentanil, monitor for alfentanil toxicity (sedation, somnolence, confusion, impaired coordination, diminished reflexes, coma). Doses of alfentanil may need to be reduced.
- dimenhydrinate
dimenhydrinate and alfentanil both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and alfentanil both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
alfentanil and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
alfentanil and dipipanone both increase sedation. Use Caution/Monitor.
- dobutamine
alfentanil increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
alfentanil increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
alfentanil increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
alfentanil and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
alfentanil and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and alfentanil both increase sedation. Use Caution/Monitor.
- droperidol
alfentanil and droperidol both increase sedation. Use Caution/Monitor.
- duvelisib
duvelisib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
- efavirenz
efavirenz will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- elagolix
elagolix will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- elranatamab
elranatamab will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Elranatamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of elranatamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.
- eluxadoline
eluxadoline increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- encorafenib
encorafenib, alfentanil. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- enzalutamide
enzalutamide will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- epcoritamab
epcoritamab, alfentanil. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Epcoritamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .
- ephedrine
alfentanil increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
alfentanil increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
alfentanil increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- erythromycin base
erythromycin base will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, alfentanil. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and alfentanil both increase sedation. Use Caution/Monitor.
- ethanol
alfentanil and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and alfentanil both increase sedation. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- fenfluramine
alfentanil increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fluphenazine
alfentanil and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and alfentanil both increase sedation. Use Caution/Monitor.
- fluvoxamine
fluvoxamine will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- formoterol
alfentanil increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ganaxolone
alfentanil and ganaxolone both increase sedation. Use Caution/Monitor.
- givinostat
givinostat will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Givinostat is a weak CYP3A4 inhibitor. Closely monitor if coadministered with orally administered CYP3A4 sensitive substrates for which a small change in substrate plasma concentration may lead to serious toxicities.
- glofitamab
glofitamab, alfentanil. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .
- glycerol phenylbutyrate
glycerol phenylbutyrate will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.
- haloperidol
alfentanil and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
alfentanil and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and alfentanil both increase sedation. Use Caution/Monitor.
- iloperidone
alfentanil and iloperidone both increase sedation. Use Caution/Monitor.
iloperidone increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - iloprost
iloprost, alfentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. When administering iloprost IV, consider temporary discontinuation of concomitant vasodilators or other medications that reduce blood pressure to mitigate potential additive hypotensive effects. If hypotension persists despite discontinuing other antihypertensives and fluid resuscitation, consider iloprost dose reduction or discontinuation.
- imipramine
alfentanil and imipramine both increase sedation. Use Caution/Monitor.
- isavuconazonium sulfate
isavuconazonium sulfate will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isoproterenol
alfentanil increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketamine
ketamine and alfentanil both increase sedation. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketotifen, ophthalmic
alfentanil and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- larotrectinib
larotrectinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lasmiditan
lasmiditan, alfentanil. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, alfentanil. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- lenacapavir
lenacapavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- letermovir
letermovir increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levalbuterol
alfentanil increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levorphanol
alfentanil and levorphanol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
alfentanil increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
alfentanil and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
alfentanil and lofexidine both increase sedation. Use Caution/Monitor.
- lonapegsomatropin
lonapegsomatropin will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- loprazolam
loprazolam and alfentanil both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and alfentanil both increase sedation. Use Caution/Monitor.
- lormetazepam
lormetazepam and alfentanil both increase sedation. Use Caution/Monitor.
- loxapine
alfentanil and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
alfentanil and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone increases effects of alfentanil by Other (see comment). Use Caution/Monitor. Comment: Potential for additive CNS effects .
- maprotiline
alfentanil and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
alfentanil and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
alfentanil and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
alfentanil and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
alfentanil and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
alfentanil increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and alfentanil both increase sedation. Use Caution/Monitor.
- methadone
alfentanil and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
alfentanil increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and alfentanil both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
alfentanil increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and alfentanil both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, alfentanil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
alfentanil increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
alfentanil and mirtazapine both increase sedation. Use Caution/Monitor.
- mitotane
mitotane decreases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- modafinil
alfentanil increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
alfentanil and morphine both increase sedation. Use Caution/Monitor.
- motherwort
alfentanil and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
alfentanil and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
alfentanil and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
alfentanil and nalbuphine both increase sedation. Use Caution/Monitor.
- norepinephrine
alfentanil increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
alfentanil and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
alfentanil and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, alfentanil. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- omaveloxolone
omaveloxolone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.
- opium tincture
alfentanil and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and alfentanil both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and alfentanil both increase sedation. Use Caution/Monitor.
- oxycodone
alfentanil and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
alfentanil and oxymorphone both increase sedation. Use Caution/Monitor.
- palbociclib
palbociclib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib
- paliperidone
alfentanil and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
alfentanil and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
alfentanil and papaverine both increase sedation. Use Caution/Monitor.
- pegvisomant
alfentanil decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.
- pentazocine
alfentanil and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and alfentanil both increase sedation. Use Caution/Monitor.
- perphenazine
alfentanil and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
alfentanil increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and alfentanil both increase sedation. Use Caution/Monitor.
- phentermine
alfentanil increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
alfentanil increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
alfentanil increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
alfentanil and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
alfentanil and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
alfentanil increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pirtobrutinib
pirtobrutinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pirtobrutinib (a CYP3A4 inhibitor) may increase plasma concentrations of sensitive CYP3A4 substrate which may increase the risk of adverse reactions related to these substrates.
- pitolisant
pitolisant will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pitolisant is a borderline/weak inducer of CYP3A4. Monitor sensitive CYP3A4 substrates for reduced effectiveness if coadministered.
- primidone
primidone and alfentanil both increase sedation. Use Caution/Monitor.
- prochlorperazine
alfentanil and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and alfentanil both increase sedation. Use Caution/Monitor.
- propofol
propofol and alfentanil both increase sedation. Use Caution/Monitor.
- propylhexedrine
alfentanil increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
alfentanil and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and alfentanil both increase sedation. Use Caution/Monitor.
- quetiapine
alfentanil and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
alfentanil and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, alfentanil. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. aCoadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- ribociclib
ribociclib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Caution if ribociclib is coadministered with sensitive CYP3A4 substrates that have a narrow therapeutic index. Dose reduction for sensitive CYP3A4 substrates may be needed.
- rifabutin
rifabutin will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
alfentanil and risperidone both increase sedation. Use Caution/Monitor.
- ritlecitinib
ritlecitinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP3A4 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP3A substrates.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b will increase the level or effect of alfentanil by Other (see comment). Use Caution/Monitor. Certain proinflammatory cytokines, including interferons, can suppress CYP450 enzymes resulting in increased exposures of some CYP substrates. Therefore, monitor patients who are receiving concomitant drugs that are CYP450 substrates with a narrow therapeutic index from toxicities to such drugs.
- rucaparib
rucaparib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- salmeterol
alfentanil increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- saquinavir
saquinavir increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- schisandra
schisandra will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- scullcap
alfentanil and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and alfentanil both increase sedation. Use Caution/Monitor.
- selegiline
selegiline increases toxicity of alfentanil by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- sevoflurane
sevoflurane and alfentanil both increase sedation. Use Caution/Monitor.
- shepherd's purse
alfentanil and shepherd's purse both increase sedation. Use Caution/Monitor.
- sofosbuvir/velpatasvir
sofosbuvir/velpatasvir increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Velpatasvir inhibits CYP3A4. Caution if coadministered with drugs with narrow therapeutics indexes.
- somapacitan
somapacitan will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- somatrogon
somatrogon will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- somatropin
somatropin will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates
- St John's Wort
St John's Wort will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- stiripentol
stiripentol, alfentanil. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
- sufentanil
alfentanil and sufentanil both increase sedation. Use Caution/Monitor.
- talquetamab
talquetamab will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Talquetamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of talquetamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.
- tapentadol
alfentanil and tapentadol both increase sedation. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- teclistamab
teclistamab will increase the level or effect of alfentanil by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.
- tecovirimat
tecovirimat will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- telotristat ethyl
telotristat ethyl will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.
- temazepam
temazepam and alfentanil both increase sedation. Use Caution/Monitor.
- terbutaline
alfentanil increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
alfentanil and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
alfentanil and thiothixene both increase sedation. Use Caution/Monitor.
- tipranavir
tipranavir increases levels of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tipranavir is used with ritonavir (boosted therapy) which is a potent CYP3A4 inhibitor.
- topiramate
alfentanil and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
alfentanil and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
alfentanil and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and alfentanil both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and alfentanil both increase sedation. Use Caution/Monitor.
- trifluoperazine
alfentanil and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
alfentanil and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and alfentanil both increase sedation. Use Caution/Monitor.
- trofinetide
trofinetide will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).
- turmeric
turmeric will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ustekinumab
ustekinumab, alfentanil. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- verapamil
verapamil will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. The risk of significant hypotension and/or bradycardia during therapy with alfentanil may be increased in patients receiving calcium-channel blockers.
- vonoprazan
vonoprazan will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Vonoprazan is weak CYP3A inhibitor. Caution with sensitive CYP3A substrates.
- voriconazole
voriconazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Dose reduction of alfentanil may be warranted
- xylometazoline
alfentanil increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
alfentanil increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
alfentanil and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
alfentanil and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
alfentanil and zotepine both increase sedation. Use Caution/Monitor.
Minor (64)
- acetazolamide
acetazolamide will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- amobarbital
amobarbital will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- amphetamine
amphetamine increases effects of alfentanil by unspecified interaction mechanism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- aprepitant
aprepitant will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- armodafinil
armodafinil will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- artemether/lumefantrine
artemether/lumefantrine will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- atazanavir
atazanavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- bosentan
bosentan will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of alfentanil by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- budesonide
budesonide will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butabarbital
butabarbital will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butalbital
butalbital will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- conivaptan
conivaptan will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cortisone
cortisone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclosporine
cyclosporine will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- darifenacin
darifenacin will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- darunavir
darunavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dasatinib
dasatinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dexamethasone
dexamethasone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dextroamphetamine
dextroamphetamine increases effects of alfentanil by unspecified interaction mechanism. Minor/Significance Unknown.
- DHEA, herbal
DHEA, herbal will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dronedarone
dronedarone will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- drospirenone
drospirenone will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- etravirine
etravirine will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eucalyptus
alfentanil and eucalyptus both increase sedation. Minor/Significance Unknown.
- fluconazole
fluconazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fludrocortisone
fludrocortisone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosamprenavir
fosamprenavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosaprepitant
fosaprepitant will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosphenytoin
fosphenytoin will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- grapefruit
grapefruit will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- griseofulvin
griseofulvin will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydrocortisone
hydrocortisone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- indinavir
indinavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- lapatinib
lapatinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- lidocaine
lidocaine increases toxicity of alfentanil by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- lumefantrine
lumefantrine will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- marijuana
marijuana will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- methylprednisolone
methylprednisolone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- metronidazole
metronidazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- miconazole vaginal
miconazole vaginal will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nelfinavir
nelfinavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nevirapine
nevirapine will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nifedipine
nifedipine will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nilotinib
nilotinib will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- pentobarbital
pentobarbital will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- phenobarbital
phenobarbital will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- phenytoin
phenytoin will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- posaconazole
posaconazole will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- prednisone
prednisone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- primidone
primidone will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- quinupristin/dalfopristin
quinupristin/dalfopristin will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- rifapentine
rifapentine will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ritonavir
ritonavir will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- rufinamide
rufinamide will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
alfentanil and sage both increase sedation. Minor/Significance Unknown.
- secobarbital
secobarbital will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- topiramate
topiramate will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zafirlukast
zafirlukast will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ziconotide
ziconotide, alfentanil. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
Adverse Effects
>10%
Arrhythmia (14%)
Bradycardia (14%)
Chest wall rigidity (17%)
Hypertension (18%)
Nausea (28%)
Vomiting (18%)
Tachycardia (12%)
1-10%
Apnea (3-9%)
Blurred vision (1-3%)
Dizziness (3-9%)
Hypotension (10%)
Post-op respiratory depression (1-3%)
Skeletal muscle movements (3-9%)
Postoperative sedation (1-3%)
<1%
Sweating, flushing
Warmness of the face/neck/upper thorax
Pruritus
urticaria
Respiratory (undefined)
Respiratory/circulatory depression
Respiratory arrest
Shock
Cardiac arrest
Nervous System (undefined)
Dizziness
Visual disturbances
Mental clouding/depression
Sedation
Coma
Euphoria
Dysphoria
Weakness
Faintness
Agitation
Restlessness
Nervousness
Seizures
GI (undefined)
Nausea
Vomiting
Constipation
Cardiovascular (undefined)
QT-interval prolongation
Severe cardiac arrhythmias
Cardiac arrest
ST segment elevation
VTach
MI
Angina pectoris
Syncope
Genitourinary (undefined)
Urinary retention
Oliguria
Cholinergic (undefined)
Bradycardia
Dry mouth
Palpitation
Tachycardia
Postmarketing Reports
Hyperalgesia and allodynia
Warnings
Black Box Warnings
Therapy 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 development of these behaviors and conditions
Profound sedation: If decision is made to manage postoperative pain with this drug concomitantly with a benzodiazepine or other CNS depressant, start dosing with the lowest effective dosage and titrate based on clinical response; monitor patients closely for signs and symptoms of respiratory depression, sedation, and hypotension; fluids or other measures to counter hypotension should be available
Life-Threatening Respiratory Depression
- Serious, life-threatening, or fatal respiratory depression may occur with use, especially during initiation or following dosage increase; to reduce risk of respiratory depression, proper dosing and titration are essential
Risks from concomitant use with benzodiazepines or other CNS depressants
- Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant prescribing of this drug and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate
Cytochrome P450 3A4 interaction
- The concomitant use 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 this drug and any CYP3A4 inhibitor or inducer
Contraindications
Hypersensitivity
Increased intracranial pressure
Severe respiratory depresssion
Cautions
Therapy may impair mental or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery after administering drug; warn patients not to drive or operate dangerous machinery unless they are tolerant to effects of the drug and know how they will react to the medication
Use caution in bradycardia, compromised cardiac reserve, head injury, hypothyroidism, increased ICP, intracranial lesions, renal impairment, respiratory impairment, obesicty, history of drug abuse
Concurrent administration of benzodiazepine or neuromuscular blocker will decrease chest wall rigidity
Should be administered by trained individuals
In patients who may be susceptible to intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), therapy may reduce respiratory drive, and resultant CO2 retention can further increase intracranial pressure; monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy; opioids may obscure clinical course in a patient with a head injury; avoid the use in patients with impaired consciousness or coma
May cause spasm of sphincter of Oddi; opioids may cause increases in serum amylase; monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms
Therapy may increase frequency of seizures in patients with seizure disorders and in other clinical settings associated with seizures; monitor patients for worsened seizure control during therapy
Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients; monitor closely
Profound sedation, respiratory depression, coma, and death may result from concomitant administration with benzodiazepines or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol); because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate
Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia; opioid use increases risk of CSA in a dose-dependent fashion; in patients who present with CSA, consider decreasing opioid dosage using best practices for opioid taper
Muscle rigidity occurring during induction of can be treated by decreasing rate or discontinuing infusion of drug or by administering a neuromuscular blocking agent; neuromuscular blocking agents used should be compatible with patient's cardiovascular status
Not to be administered into same IV tubing with blood due to potential inactivation by nonspecific esterases in blood products
Proper placement of needle or catheter in epidural space should be verified before drug is injected to assure that unintentional intravascular or intrathecal administration does not occur; unintentional intravascular injection of sufentanil could result in a potentially serious overdose, including acute truncal muscular rigidity and apnea; unintentional intrathecal injection of sufentanil/bupivacaine epidural doses and volume could produce effects of high spinal anesthesia including prolonged paralysis and delayed recovery; if analgesia is inadequate, placement and integrity of catheter should be verified prior to administration of any additional epidural medications; administer epidurally by slow injection
Bradycardia may occur; monitor heart rate during dosage initiation and titration; responsive to ephedrine or anticholinergic drugs
Therapy may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients; there is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics); monitor patients for signs of hypotension after initiating or titrating dosage; in patients with circulatory shock, therapy may cause vasodilation that can further reduce cardiac output and blood pressure; avoid therapy in patients with circulatory shock
Serotonin syndrome
- Cases of serotonin syndrome, a potentially life-threatening condition, reported with concomitant use of serotonergic drugs; this may occur within the recommended dosage range; the onset of symptoms generally occur within several hours to a few days of concomitant use, but may occur later than that
- Serotonin syndrome symptoms may include mental status changes (eg, agitation, hallucinations, coma), autonomic instability (eg, tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (eg, hyperreflexia, incoordination, rigidity), and/or gastrointestinal symptoms (eg, nausea, vomiting, diarrhea) and can be fatal
- Discontinue therapy immediately if serotonin syndrome is suspected
Addiction, abuse, and misuse
- Opioids are sought for nonmedical use and are subject to diversion from legitimate prescribed use; consider these risks when handling this drug
- Strategies to reduce these risks include proper product storage and control practices for a C-II drug; contact local and state professional licensing board or state-controlled substances authority for information on how to prevent and detect abuse or diversion of this product
Opioid-induce hyperalgesia and allodynia
- Opioid-induced hyperalgesia (OIH) occurs when opioid analgesic paradoxically causes increase in pain, or increase in sensitivity to pain; this condition differs from tolerance, which is the need for increasing doses of opioids to maintain a defined effect
- Symptoms include (but may not be limited to) increased levels of pain upon opioid dosage increase, decreased levels of pain upon opioid dosage decrease, or pain from ordinarily non-painful stimuli (allodynia); these symptoms may suggest OIH only if there is no evidence of underlying disease progression, opioid tolerance, opioid withdrawal, or addictive behavior
- Cases of OIH reported, both with short-term and longer-term use of opioid analgesics; though the mechanism of OIH is not fully understood, multiple biochemical pathways have been implicated; medical literature suggests a strong biologic plausibility between opioid analgesics and OIH and allodynia; if a patient is suspected to be experiencing OIH, carefully consider appropriately decreasing dose of current opioid analgesic or opioid rotation (safely switching the patient to a different opioid moiety)
FDA-approved safety considerations for immediate-release (IR) and extended-release/long-acting (ER/LA) opioid analgesics addressing opioid crisis
- The risk of overdose increases as the dosage increases for all opioid pain medicines
- IR opioids should not be used for an extended period of time unless a patient’s pain remains severe enough to require them and alternative treatment options continue to be inadequate
- Numerous acute pain conditions treated in the outpatient setting require no more than a few days of an opioid pain medicine
- It is recommended to reserve ER/LA opioid pain medicines for severe and persistent pain that requires an extended treatment period with a daily opioid pain medicine and for which alternative treatment options are inadequate
Concomitant use with CYP450 inducers or discontinuation of CYP450 inhibitors
- Concomitant use with CYP3A4 inducers or discontinuation of an CYP3A4 inhibitor could result in lower than expected alfentanil plasma concentrations, decrease efficacy, or, possibly, lead to a withdrawal syndrome in a patient who had developed physical dependence to alfentanil
- When using with CYP3A4 inducers or discontinuing CYP3A4 inhibitors, monitor patients closely at frequent intervals and consider increasing drug dosage
Pregnancy & Lactation
Pregnancy
Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome; available data in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage
Labor or delivery
- Opioids cross placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid induced respiratory depression in neonate; drug is not recommended for use in women during and immediately prior to labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate; opioid analgesics can prolong labor through actions that temporarily reduce strength, duration, and frequency of uterine contractions; however, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor; monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression
Lactation
The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy; capsules and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition
Monitor infants exposed to drug through breast milk for excess sedation and respiratory depression; withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast- feeding is stopped
Withdrawal signs can occur in breast-fed infants when maternal administration of an opioid analgesic is stopped or when breastfeeding is stopped; naloxone may precipitate opioid withdrawal in a breast-fed infant whose mother received opioid analgesics
Lactation: use with caution
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Narcotic agonist analgesic; increases pain threshold, inhibits ascending pain pathways, alters pain perception
Pharmacokinetics
Half-life: 5.33-8.75 hr (prematures, newborns); 40-60 min (children); 83-97 min (adults)
Onset: Immediate
Duration: 30-60 min
Vd: 1 L/kg (premature, newborns); 0.163-0.48 L/kg (children); 0.46 L/kg (adults)
Peak Plasma: distributed in decreasing order of concentration into skeletal muscle, kidneys, liver, intestinal tract, lungs, spleen, and brain
Bioavailability: Varies
Metabolism: liver (hepatic P450 enzyme CYP3A4), CNS, kidneys, lungs, and placenta (conjugation with glucuronic acid, hydrolysis, oxidation, N-dealkylation)
Excretion: urine, feces
Administration
IV Compatibilities
Solution: D5W
Syringe: atracurium, midazolam, ondansetron
Y-site: bivalirudin, cisatracurium, dexmedetomidine, etomidate, fenoldopam, gatifloxacin, Hextend, linezolid, propofol, remifentanil
IV Incompatibilities
Y-site: amphotericin B cholSO4, thiopental
IV Preparation
Add 20 mL to 230 mL of diluent for a final concentration of 40 mg/mL
IV Administration
Keep Naloxone and resuscitation equip available
By incremental injection as analgesic adjunct to anesthesia with barbiturate/nitrous oxide/oxygen for short surgical procedures (expected duration <1 hr)
By continuous infusion as a maintenance analgesic with nitrous oxide/oxygen for general surgical procedures
By IV injection in aesthetic doses for anesthesia induction for general surgical procedures with a minimum expected duration of 45 min
By IV inj as the analgesic component for monitored anesthesia care (MAC)
Storage
Protect from light
Store at controlled room temp
Images
Formulary
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