Remifentanil Signs, Symptoms, and Side Effects

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Remifentanil is a synthetic opioid that’s administered as a pain reliever during surgical procedures with general anesthesia. Remifentanil is 100 to 200 times more powerful than morphine and is twice as potent as fentanyl.

Remifentanil has unique pharmacological properties that make it difficult to misuse. Unlike most opioids, it is not metabolized by the liver; instead, Remifentanil undergoes rapid hydrolysis in non-specific tissues. This leads to a short half-life of only four minutes, even following continuous administration over the course of several hours.

Patients recover quickly following surgery when Remifentanil is taken as the primary pain reliever. Lower doses of hypnotics like propofol are also needed during Remifentanil treatment. Remifentanil’s unique pharmacology allows it to be administered via computerized infusion in a process called Total Intravenous Anesthesia (TIVA). Its short half-life allows optimal plasma concentrations of the drug to be tightly regulated and monitored.

Remifentanil Signs, Symptoms, and Side Effects
Remifentanil is a powerful central nervous system depressant that’s derived from fentanyl. Remifentanil is an opioid agonist, meaning it binds to specific opioid receptors to reduce the patient’s perception of pain. In doing so, Remifentanil causes respiratory depression and a reduction in sympathetic nervous system tone.

Remifentanil acts directly on the brainstem to inhibit the autonomic urge to breathe. The brainstem regulates autonomic breathing based off carbon dioxide levels in the blood. Remifentanil inhibits the brainstem’s ability to accurately read carbon dioxide levels, leading to carbon dioxide toxicity and oxygen deprivation (hypoxia) in the event of an overdose. The risk of life-threatening respiratory depression is low in a hospital setting due to the drug’s short elimination time.

Remifentanil, as with all synthetic opioids, has a high potential for addiction. Roughly five to six percent of patients who are introduced to opioid narcotics in a medical setting try street heroin at some point. Certain individuals are genetically predisposed to developing a substance misuse disorder, and Remifentanil can act as the trigger that initiates this dormant tendency. However, even patients without a family history of substance misuse are at risk for developing the psychological disease of addiction due to the high influence of potent synthetic opioids, like Remifentanil.

Remifentanil is less-appealing for recreational use due to its short half-life. As such, Remifentanil is rarely targeted by illicit drug dealers for distribution. The fentanyl from which Remifentanil is derived, however, is largely responsible for the current opioid overdose epidemic that has overtaken North America in the last two decades.

The severity of Remifentanil’s effects is dose-dependent. Patients typically experience a decrease in arterial pressure, respiratory rate, heart rate, and tidal volume. Clinically significant respiratory depression is rare due to the drug’s short half-life and gradual route of administration. Muscle rigidity is occasionally noted. The most common side effects are dizziness and intense itching (pruritis). Sedatives and antihistamines may be administered to treat itchiness. When nausea occurs, it tends to pass quickly.

If you or someone you love is struggling with opioid misuse, The Recovery Village is available to answer any questions you may have. Visit us online at or call our toll-free 24-hour hotline at 855-548-9825 to learn more about recovery resources in your area. We can help you to start living a healthy, substance-free life today.

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.