Dosing, preparation, and administration
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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 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
minutes before local
|0.1 mcg/kg/min||0.05 mcg/kg/min|
|After local anesthetic||0.05 mcg/kg/min
(range: 0.025 to
(range: 0.025 to
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
|Range of infusion
bolus dose of ULTIVA
|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§|
Reconstitution and dilution prior to administration1
|Amount of ULTIVA
in each vial (mg)
|Final volume after reconstitution
and dilution (mL)
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
|Patient weight (kg)|
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.
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:
|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.