End-stage renal failure reduces central clearance and prolongs the elimination half life of remifentanil

Abstract

We have demonstrated a significant reduction in the Cl(c) and a prolongation of t1/2 ss of remifentanil in end-stage renal failure patients. While statistically significant, these variations in the pharmacokinetics of remifentanil were clinically modest and may be explained by a reduced volume of distribution in the period following hemodialysis.

Adverse Events Associated with Sedatives, Analgesics, and Other Drugs That Provide Patient Comfort in the Intensive Care Unit

“…113 Despite the role of nonspecific esterases in the metabolism of remifentanil, patients with renal failure have a reduced clearance and a longer elimination half-life than matched controls with normal renal function, resulting in higher serum concentrations. 125 Remifentanil acid, the major metabolite of remifentanil, is renally cleared and accumulates in intensive care patients with moderate-to-severe renal dysfunction who receive remifentanil for up to 72 hours. 126 Because the opioid activity of remifentanil acid is 1/4600 that of the parent drug, accumulation of this metabolite is of uncertain significance.…”

Remifentanil na prática clínica

“…Cerca de 35% do remifentanil ácido é eliminado após 3 a 5 horas de hemodiálise 71 . No período após a hemodiálise foi observada pequena redução da depuração plasmática e prolongamento da meia-vida de eliminação do remifentanil, provavelmente devido à redução do volume de distribuição, de pouco significado clínico 72 .…”

Remifentanil and Other Opioids

“…Remifentanil clearance is independent of liver function, and thus is not modified by severe chronic liver disease (Dershwitz et al 1996), or even by the anhepatic phase of liver transplant (Navapurkar et al 1998). Similarly, remifentanil PK is unaffected by renal disease (Hoke et al 1997;Dahaba et al 2002). Nevertheless in this situation, the elimination of the active metabolite is markedly reduced (Hoke et al 1997).…”