Dosing, preparation, and administration

Download the Dosing Guide for easy access to ULTIVA dosing guidelines. 

Learn more about how to use ULTIVA. Scroll to see the entire page or click the links to access a specific section.

See how ULTIVA works synergistically with other anesthesia drugs. 

ULTIVA is for IV use only. Continuous infusions of ULTIVA should be administered only by an infusion device. The injection site should be close to the venous cannula and all IV tubing should be cleared at the time of discontinuation of infusion.

Clearance of ULTIVA generally correlates with total body weight and may vary in pediatric, geriatric, and morbidly obese patients due to variation in physiology and pharmacodynamics. Use with caution in such patients.

Adult dosing: general anesthesia

Adult dosing: monitored anesthesia care (MAC)

Pediatric dosing

Reconstitution and dilution

Infusion guidelines

How supplied/storage and handling


Adult dosing guidelines

Adult general anesthesia1
Phase Continuous IV infusion of ULTIVA (mcg/kg/min) Range of infusion dose ULTIVA (mcg/kg/min) Supplemental IV bolus dose of ULTIVA (mcg/kg)
Induction of anesthesia (through intubation) 0.5 – 1*
Maintenance of anesthesia with:
Nitrous oxide (66%) 0.4 0.1 - 2 1
Isoflurane (0.4 to 1.5 MAC) 0.25 0.05 - 2 1
Propofol (100 to 200 mcg/kg/min) 0.25 0.05 - 2 1
Continuation as an analgesic into the immediate postoperative period 0.1 0.025 - 0.2 not recommended

*An initial dose of 1 mcg/kg may be administered over 30 to 60 seconds.

Adult monitored anesthesia care1
Method Timing ULTIVA alone ULTIVA + 2 mg midazolam
Single IV dose Given 90 seconds
before local anesthetic
1 mcg/kg over
30 to 60 seconds
0.5 mcg/kg over
30 to 60 seconds



Continuous IV infusion
Beginning 5
minutes before local
anesthetic
0.1 mcg/kg/min 0.05 mcg/kg/min
After local anesthetic 0.05 mcg/kg/min
(range: 0.025 to
0.2 mcg/kg/min)
0.025 mcg/kg/min
(range: 0.025 to
0.2 mcg/kg/min)

When used alone as an IV analgesic component of monitored anesthesia care, ULTIVA should be initially administered by continuous infusion at a rate of 0.1 mcg/kg/min beginning 5 minutes before placement of the local or regional anesthetic block.

  • Because of the risk for hypoventilation, the infusion rate of ULTIVA should be decreased to 0.05 mcg/kg/min following placement of the block
  • Thereafter, rate adjustments of 0.025 mcg/kg/min at 5-minute intervals may be used to balance the patient's level of analgesia and respiratory rate
  • Rates greater than 0.2 mcg/kg/min are generally associated with respiratory depression (respiratory rates less than 8 breaths/min)
  • Bolus doses of ULTIVA administered simultaneously with a continuous infusion of ULTIVA to spontaneously breathing patients are not recommended

Pediatric dosing guidelines

The table below summarizes the recommended doses in pediatric patients, predominantly ASA physical status I, II, or III. In pediatric patients, remifentanil was administered with nitrous oxide or nitrous oxide in combination with halothane, sevoflurane, or isoflurane. The use of atropine may blunt the potential for bradycardia that can occur upon administration of ULTIVA.

Pediatric general anesthesia1
Phase Continuous IV
infusion of
ULTIVA
(mcg/kg/min)
Range of infusion
dose ULTIVA
(mcg/kg/min)
Supplemental IV
bolus dose of ULTIVA
(mcg/kg)
Maintenance in patients aged 1 to 12 years old with:
Halothane (0.3 to 1.5 MAC) 0.25 0.05-1.3 1
Sevoflurane (0.3 to 1.5 MAC) 0.25 0.05-1.3 1
Isoflurane (0.4 to 1.5 MAC) 0.25 0.05-1.3 1
Maintenance in patients from birth to 2 months of age with:
Nitrous oxide (70%) 0.4 0.4-1.0 1§
An initial dose of 1 mcg/kg may be administered over 30 to 60 seconds. The clearance rate in neonates is highly variable, on average two times higher than in the young healthy adult population. Therefore, an increased infusion rate may be necessary to maintain adequate surgical anesthesia, and additional bolus doses may be required. The use of atropine may blunt the potential for bradycardia that can occur upon administration of ULTIVA. [In the full Prescribing Information, see Clinical Pharmacology: Specific Populations: Pediatric Population (12.3) and Clinical Studies (14.4).] § Boluses of 1 mcg/kg were studied in ASA 1 and 2, full-term patients weighing at least 2500 g, undergoing pyloromyotomy who received pretreatment with atropine. Neonates receiving supplementation with potent inhalation agents or neuraxial anethesia, those with significant comorbidities or undergoing significant fluid shifts, or those who have not been pretreated with atropine, may require smaller bolus doses to avoid hypotension and/or bradycardia.

Reconstitution and dilution prior to administration1
Final concentration
(mcg/mL)
Amount of ULTIVA
in each vial (mg)
Final volume after reconstitution
and dilution (mL)
25 1
2
5
40
80
200
50 1
2
5
20
40
100

ULTIVA is stable for 24 hours at room temperature after reconstitution and further dilution to concentrations of 20 to 250 mcg/mL with the IV fluids listed below.

  • Sterile Water for Injection, USP
  • 5% Dextrose Injection, USP
  • 5% Dextrose and 0.9% Sodium Chloride Injection, USP
  • 0.9% Sodium Chloride Injection, USP
  • 0.45% Sodium Chloride Injection, USP
  • Lactated Ringer’s and 5% Dextrose Injection, USP

ULTIVA is stable for 4 hours at room temperature after reconstitution and further dilution to concentrations of 20 to 250 mcg/mL with Lactated Ringer’s Injection, USP.

ULTIVA has been shown to be compatible with these IV fluids when coadministered into a running IV administration set.

IV infusion rates of ULTIVA (mL/h) for a 50 mcg/mL solution1
Infusion rate
(mcg/kg/min)
Patient weight (kg)
30 40 50 60 70 80 90 100
0.025 2.1 2.4 2.7 3.0
0.05 2.4 3.0 3.6 4.2 4.8 5.4 6.0
0.075 2.7 3.6 4.5 5.4 6.3 7.2 8.1 9.0
0.1 3.6 4.8 6.0 7.2 8.4 9.6 10.8 12.0
0.15 5.4 7.2 9.0 10.8 12.6 14.4 16.2 18.0
0.2 7.2 9.6 12.0 14.4 16.8 19.2 21.6 24.0
0.25 9.0 12.0 15.0 18.0 21.0 24.0 27.0 30.0
0.5 18.0 24.0 30.0 36.0 42.0 48.0 54.0 60.0
0.75 27.0 36.0 45.0 54.0 63.0 72.0 81.0 90.0
1.0 36.0 48.0 60.0 72.0 84.0 96.0 108.0 120.0
1.25 45.0 60.0 75.0 90.0 105.0 120.0 135.0 150.0
1.5 54.0 72.0 90.0 108.0 126.0 144.0 162.0 180.0
1.75 63.0 84.0 105.0 126.0 147.0 168.0 189.0 210.0
2.0 72.0 96.0 120.0 144.0 168.0 192.0 216.0 240.0

Compatibility with other therapeutic agents

ULTIVA has been shown to be compatible with Diprivan® (propofol) Injection when coadministered into a running IV administration set. The compatibility of ULTIVA with other therapeutic agents has not been evaluated.

Incompatibilities

Nonspecific esterases in blood products may lead to the hydrolysis of remifentanil to its carboxylic acid metabolite. Therefore, administration of ULTIVA into the same IV tubing with blood is not recommended.

Please see full Prescribing Information for full dosing and therapeutic recommendations and options.

How supplied/storage and handling

ULTIVA should be stored at 2° to 25°C (36° to 77°F). ULTIVA for IV use is supplied as follows:

NDC Number Container Concentration Quantity
67457-198-03 3 mL vial 1 mg lyophilized powder Box of 10
67457-198-05 5 mL vial 2 mg lyophilized powder Box of 10
67457-198-10 10 mL vial 5 mg lyophilized powder Box of 10

Diprivan is a registered trademark of Fresenius Kabi USA, LLC.

1. ULTIVA [package insert]. Rockford, IL: Mylan Institutional LLC; 2016.