Taking Remifentanil While Pregnant: What You Need to Know

Is Remifentanil Safe to Take While Pregnant?

Remifentanil is an opioid pain reliever, also called a narcotic or an analgesic. Remifentanil is short-acting, synthetically manufactured and powerful. It’s used primarily for sedation and is part of a combination of medications used for general anesthesia. There are certain surgeries that it’s used for. For example, it’s used during certain spinal surgeries, cardiac surgery and also gastric bypass surgery. One brand-name of remifentanil is called Ultiva. Remifentanil is given as an intravenous infusion. The side effects of remifentanil are similar to other opioids. For example, respiratory depression is a primary effect of the drug. Also possible are dizziness and extreme itching. Sometimes the itching is so bad that an antihistamine is given at the same time as the remifentanil. Remifentanil should only be given in hospital settings, by trained medical professionals who can monitor effects like respiratory depression. However, that’s not always the case, and sometimes opioid anesthetics like remifentanil are diverted from medical use and sold on the streets. Remifentanil is estimated to be twice as strong as fentanyl and anywhere from 100 to 200 times stronger than morphine. This drug, when not used properly, has the potential to be very dangerous and deadly. There are reports, although minimal, of remifentanil being misused. Remifentanil is a schedule II-controlled substance in the U.S.

Is remifentanil safe to take while pregnant? The answer to this is that it depends. Remifentanil is a category C pregnancy drug, as are most other opioids. Category C drugs fall into a gray area regarding safety during pregnancy. The FDA differentiates categories of risk during pregnancy for different drugs. These categories are based on currently available research, which can include animal studies as well as observational studies done on humans. A category C drug doesn’t have enough evidence to show that it’s safe during pregnancy. With category C drugs, a healthcare professional should evaluate whether or not the risks of the drug are greater than the possible benefits it could bring.

There’s another scenario to be aware of with remifentanil and other opioids. If a woman is using opioids recreationally and she becomes pregnant, she shouldn’t stop using suddenly. It’s important to speak with a medical professional or participate in a medical detox. Symptoms of opioid withdrawal can cause pregnancy complications and can be harmful to a woman and her unborn baby. A doctor will typically recommend that a woman either gradually taper her dosage of opioids to mitigate withdrawal or participate in a medically-assisted detox program.

Taking Remifentanil While Pregnant: What You Need to Know

Taking remifentanil may increase the possibility of certain birth defects. This is true of opioids in general. However, the risk of these defects occurring remains small. Opioids, particularly during the early months of pregnancy, may increase the risk of congenital heart defects. Spina bifida, which is a serious neural tube defect that affects the spine and brain, may also be more likely to occur in an infant exposed to opioids in the womb. Hydrocephaly, which is a buildup of fluid in the brain, is potentially more likely in babies exposed to opioids during pregnancy, as is glaucoma. Another birth defect risk raised with the use of opioids is gastroschisis, which is an abdominal wall defect. These defects were all highlighted in relatively new research released by the CDC. According to the CDC, some of the reasons pregnant women cited for using opioids during pregnancy included during surgery, for chronic diseases and because of injuries.

Along with a slightly higher risk of birth defects, there is also a risk of babies being born to remifentanil when exposed to it in the womb. In this case, the baby will likely go through withdrawal after delivery. This is neonatal abstinence syndrome or NAS. During NAS, a baby may be born experiencing problems with breathing, feeding and sleeping. A baby with NAS symptoms may experience irritability, excessive crying, muscle rigidity, tremors and convulsions. Other symptoms of NAS can include vomiting, diarrhea, fever and sweating. When a baby is born and NAS is suspected, specialized treatment, typically the NICU is required.

If a woman is in a medical situation where remifentanil may be used, her doctor has likely weighed the possible risks and benefits. If a woman is, on the other hand, recreationally using remifentanil, she should speak with her healthcare provider. It’s important to stop using opioids safely while pregnant. A medically-assisted detox is one of the safest, most effective ways for a pregnant woman to go through withdrawal. During a medical detox, a pregnant patient can be monitored, and the safety of her and her baby can be ensured. Following medical detox, a woman may require professional addiction treatment.

There are options available to you, and you don’t have to feel hopeless. Reach out to The Recovery Village and learn more about our available programs, including options during pregnancy.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.