Dosage of Alfentanil GH in details
The dosage of Alfentanil GH should be individualized according to age, body weight, physical status, underlying pathological condition, use of other drugs and type of surgery and anaesthesia.
The initial dose should be reduced in the elderly and in debilitated patients. In children, it should be increased. The effect of the initial dose should be taken into account in determining supplemental doses.
To avoid bradycardia, it is recommended to administer a small IV dose of an anticholinergic agent just before induction. Droperidol may be given to prevent nausea and vomiting.
For Use as an Induction Agent: An IV bolus dose of ≥120 mcg/kg (17 mL/70 kg) Alfentanil GH will induce hypnosis and analgesia while maintaining good cardiovascular stability in patients with adequate muscle relaxation.
For Short Procedures and Use in Outpatients: Small doses of Alfentanil GH are most useful for minor, short but painful surgical procedures and for outpatients, provided good monitoring equipment is available.
An IV bolus dose of 7-15 mcg/kg (1-2 mL/70 kg) will suffice for procedures lasting <10 min. Should the duration of the procedure exceed 10 min, further increments of 7-15 mcg/kg (1-2 mL/70 kg) should be given 10-15 min or as required.
Spontaneous respiration may be maintained in most instances with a dose of 7 mcg/kg (1 mL/70 kg) or less, slowly injected; suggested increments with this technique are 3.5 mcg/kg (0.5 mL/70 kg).
It is preferable not to administer droperidol or benzodiazepines to outpatients as these drugs may lengthen the recovery period. In outpatients, a preferred technique consists of an anticholinergic agent, a short-acting induction hypnotic, Alfentanil GH and N2O/O2.
When postoperative nausea occurs, it is of relatively short duration and easily controlled by conventional measures.
For Procedures of Medium Duration: The dose of initial IV bolus should be adapted to the expected duration of the surgical procedure as follows. See Table 1.
When surgery is more prolonged or more aggressive, analgesia can be maintained by either increments of 15 mcg/kg (2 mL/70 kg) Alfentanil GH when required (to avoid postoperative respiratory depression, no Alfentanil GH should be administered during the last 10 min of surgery; or a Alfentanil GH infusion at a rate of 1 mcg/kg/min (0.14 mL/70 kg/min) until 5-10 min before the completion of surgery.
Periods of very painful stimuli can easily be overcome by a small dose increments or by temporarily increasing the infusion rate. When Alfentanil GH is used without N2O/O2 or another inhalation anaesthetic, a higher maintenance dose of Alfentanil GH is required.
For Long Procedures: Alfentanil GH may be used as the analgesic component of anaesthesia for long lasting surgical procedures especially when rapid extubation is indicated. Optimum analgesia and stable autonomic condition are maintained through an individually adapted initial IV dose and by adjusting the infusion rate to the severity of the surgical stimuli and the reactions of the patients.
Alfentanil GH interactions
Drugs Modifying the Effect of Alfentanil GH: Drugs eg, barbiturates, benzodiazepines, neuroleptics, halogenic gases and other, nonselective CNS depressants (eg, alcohol) may potentiate the respiratory depression of narcotics.
When patients have received such drugs, the dose of Alfentanil GH required will be less than usual. Likewise, following the administration of Alfentanil GH, the dose of other CNS-depressant drugs should be reduced.
Alfentanil GH is metabolized mainly via the human cytochrome P-450 3A4 enzyme. In vitro data suggest that potent cytochrome P-450 3A4 enzyme inhibitors (eg, ketoconazole, itraconazole, ritonavir) may inhibit the metabolism of Alfentanil GH. Available human pharmacokinetic data indicate that the metabolism of Alfentanil GH is inhibited by fluconazole, voriconazole, erythromycin, diltiazem and cimetidine (known cytochrome P-450 3A4 enzyme inhibitors). This could increase the risk of prolonged or delayed respiratory depression. The concomitant use of such drugs requires special patient care and observation; in particular, it may be necessary to lower the dose of Alfentanil GH.
It is usually recommended to discontinue MAO inhibitors 2 weeks prior to any surgical or anaesthetic procedure.
Effect of Alfentanil GH on the Metabolism of Other Drugs: In combination with Alfentanil GH, the blood concentrations of propofol are 17% higher than in the absence of Alfentanil GH. The concomitant use of Alfentanil GH and propofol may require a lower dose of Alfentanil GH.
Incompatibilities: The injectable solution must not be mixed with other products. If desired, Alfentanil GH may be mixed with sodium chloride or glucose IV infusions. Such dilutions are compatible with plastic infusion sets. These should be used within 24 hrs of preparation.
References
- FDA/SPL Indexing Data. "1N74HM2BS7: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
- MeSH. "Anesthetics, Intravenous". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
- PubMed Health. "Alfentanil (By injection) (Alfentanil Novaplus): This section provide the link out information of drugs collectetd in PubMed Health. ". http://www.ncbi.nlm.nih.gov/pubmedhe... (accessed September 17, 2018).
Reviews
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Information checked by Dr. Sachin Kumar, MD Pharmacology
