Drug/Small Molecule:
remifentanil

PharmGKB contains no dosing guidelines for this drug/small molecule. To report known genotype-based dosing guidelines, or if you are interested in developing guidelines, click here.

PharmGKB contains no drug labels with pharmacogenomic information for this drug/small molecule. To report a drug label with PGx, click here.

Disclaimer: The PharmGKB's clinical annotations reflect expert consensus based on clinical evidence and peer-reviewed literature available at the time they are written and are intended only to assist clinicians in decision-making and to identify questions for further research. New evidence may have emerged since the time an annotation was submitted to the PharmGKB. The annotations are limited in scope and are not applicable to interventions or diseases that are not specifically identified.

The annotations do not account for individual variations among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It remains the responsibility of the health-care provider to determine the best course of treatment for a patient. Adherence to any guideline is voluntary, with the ultimate determination regarding its application to be made solely by the clinician and the patient. PharmGKB assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the PharmGKB clinical annotations, or for any errors or omissions.

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This is a non-comprehensive list of genetic tests with pharmacogenetics relevance, typically submitted by the manufacturer and manually curated by PharmGKB. The information listed is provided for educational purposes only and does not constitute an endorsement of any listed test or manufacturer.

A more complete listing of genetic tests is found at the Genetic Testing Registry (GTR).

PGx Test Variants Assayed Gene?
2D structure from PubChem
provided by PubChem

Overview

Generic Names
  • Remifentanyl
Trade Names
  • Ultiva
Brand Mixture Names

PharmGKB Accession Id:
PA451232

Description

Remifentanil (marketed by Abbott as Ultiva) is a potent ultra short-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anaesthetic. Remifentanil is a specific mu-type-opioid receptor agonist. Hence, it causes a reduction in sympathetic nervous system tone, respiratory depression and analgesia.

Source: Drug Bank

Indication

For use during the induction and maintenance of general anesthesia.

Source: Drug Bank

Other Vocabularies

Information pulled from DrugBank has not been reviewed by PharmGKB.

Pharmacology, Interactions, and Contraindications

Mechanism of Action

Remifentanil is a micro-opioid agonist with rapid onset and peak effect, and short duration of action. The micro-opioid activity of remifentanil is antagonized by opioid antagonists such as naloxone.

Source: Drug Bank

Pharmacology

Remifentanil is an opioid agonist with rapid onset and peak effect and ultra-short duration of action. The opioid activity of remifentanil is antagonized by opioid antagonists such as naloxone. The analgesic effects of remifentanil are rapid in onset and offset. Its effects and side effects are dose dependent and similar to other opioids. Remifentanil in humans has a rapid blood-brain equilibration half-time of 1 +/- 1 minutes (mean +/- SD) and a rapid onset of action.

Source: Drug Bank

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

By hydrolysis of the propanoic acid-methyl ester linkage by nonspecific blood and tissue esterases.

Source: Drug Bank

Protein Binding

70% (bound to plasma proteins)

Source: Drug Bank

Half-Life

1-20 minutes

Source: Drug Bank

Clearance

Source: Drug Bank

Route of Elimination

Remifentanil is an esterase-metabolized opioid. The carboxylic acid metabolite is essentially inactive (1/4600 as potent as remifentanil in dogs) and is excreted by the kidneys with an elimination half-life of approximately 90 minutes.

Source: Drug Bank

Volume of Distribution

Source: Drug Bank

Chemical Properties

Chemical Formula

C20H28N2O5

Source: Drug Bank

Isomeric SMILES

CCC(=O)N(c1ccccc1)C2(CCN(CC2)CCC(=O)OC)C(=O)OC

Source: OpenEye

Canonical SMILES

CCC(=O)N(C1=CC=CC=C1)C1(CCN(CCC(=O)OC)CC1)C(=O)OC

Source: Drug Bank

Average Molecular Weight

376.4467

Source: Drug Bank

Monoisotopic Molecular Weight

376.199822016

Source: Drug Bank

Genes that are associated with this drug in PharmGKB's database based on (1) variant annotations, (2) literature review, (3) pathways or (4) information automatically retrieved from DrugBank, depending on the "evidence" and "source" listed below.

Drug Targets

Gene Description
OPRD1 (source: Drug Bank)
OPRK1 (source: Drug Bank)
OPRM1 (source: Drug Bank)

Drug Interactions

Drug Description
remifentanil Possible increased risk of serotonin syndrome. (source: Drug Bank)
remifentanil The CNS depressants, Triprolidine and Remifentanil, may increase adverse/toxic effects due to additivity. Monitor for increased CNS depressant effects during concomitant therapy. (source: Drug Bank)
remifentanil The CNS depressants, Triprolidine and Remifentanil, may increase adverse/toxic effects due to additivity. Monitor for increased CNS depressant effects during concomitant therapy. (source: Drug Bank)

Relationships from National Drug File - Reference Terminology (NDF-RT)

May Treat
Contraindicated With

Publications related to remifentanil: 1

No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Reversal of opioid-induced bladder dysfunction by intravenous naloxone and methylnaltrexone. Clinical pharmacology and therapeutics. 2007. Rosow C E, et al. PubMed

LinkOuts

Web Resource:
Wikipedia
National Drug Code Directory:
67457-198-03
DrugBank:
DB00899
KEGG Compound:
C08021
PubChem Compound:
60815
PubChem Substance:
10221
46504538
Drugs Product Database (DPD):
2230410
BindingDB:
50012491
ChemSpider:
54803
Therapeutic Targets Database:
DAP000264
FDA Drug Label at DailyMed:
dbc63b6e-f8c5-4fd0-8ec3-4f5e19125313

Clinical Trials

These are trials that mention remifentanil and are related to either pharmacogenetics or pharmacogenomics.

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Sources for PharmGKB drug information: DrugBank, Open Eye Scientific Software.