Clinical medicine profile
Alfentanyl
Opioid analgesic
- Route
- ORAL / IV / IM / SC / TD / RECTAL
- Schedule
- POM
- ATC
- Not assigned
- PPB status
- registered
Safety essentials
The information most likely to change a prescribing or dispensing decision.
Contraindications
- Acute respiratory depression, severe asthma/COPD without monitoring, paralytic ileus, acute alcoholism, raised intracranial pressure in unstable settings, MAOI interactions for some agents.
Precautions
- HIGH-ALERT.
- Monitor sedation/RR.
- Start low in elderly/renal/hepatic impairment.
- Constipation prophylaxis.
- Dependence/misuse risk.
- Avoid concurrent sedatives when possible (benzodiazepines — black box risk).
Dosing matrix
Population and organ-function guidance, shown together for faster comparison.
I.V dose: 50-200mcg as required. Chil- dren; 3-5mcg, then I mcg/kg as required. With assisted ventilation, 0.3-3.5mg then 100-200mcg as required. Child 15mcg/kg, then 1-3mcg/kg as required.
See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.
Prefer fentanyl/methadone expert use over morphine in advanced CKD; reduce doses.
- CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Reduce dose/frequency; avoid long-acting in decompensated disease.
Use, effects & interactions
Indications
- Relief of pain especially during operation, enhancement of anaesthesia.
- Clinical selection for Alfentanyl should follow culture results where relevant, Kenya STG/EML recommendations, and the current product SmPC.
- Class context: Opioid analgesic.
- Confirm site-specific dose, duration and monitoring before prescribing.
Adverse effects
- Nausea, constipation, sedation, pruritus, urinary retention.
- Serious: respiratory depression, coma, death in overdose, serotonin syndrome (tramadol), seizures (tramadol/pethidine).
Drug interactions
Open multi-drug checker ↗- WHO ladder still useful framework.
- For cancer pain use around-the-clock + breakthrough.
- Naloxone for overdose.
- Document functional goals
- review long-term opioid benefit regularly.
Mechanism & disposition
It is a short-acting mu-opioid receptor agonist.
Read complete mechanism
It is a short-acting mu-opioid receptor agonist. Opioids agonise CNS mu (primarily), kappa and delta receptors, inhibiting ascending pain pathways and altering pain perception/response. Also cause respiratory depression, miosis, cough suppression and reduced GI motility.
Minutes (IV) to hour (oral)
Hours (agent-dependent)
ORAL / IV / IM / SC / TD / RECTAL
(CYP2D6 critical for codeine/tramadol activation — ultrarapid metabolisers risk toxicity; poor metabolisers lack efficacy). Renal
of active metabolites (morphine-6-glucuronide accumulates in CKD).
Pregnancy, lactation & diet
Use only if necessary; neonatal withdrawal with chronic maternal use. Prefer specialist obstetric advice.
Codeine generally avoided (CYP2D6). Short-term morphine sometimes used with monitoring — check guidance.
Brands & loaded prices
| Brand | Manufacturer | Pack | Observed price |
|---|---|---|---|
| No reviewed brand listings are linked yet. | |||
Sources & review state
Decision support only. Confirm patient-specific decisions against the current product SmPC, Kenya STG/EML, and professional judgement.