Clinical attributes help achieve the analgesia outcomes you want

  • Predictable control of depth and duration of analgesia1
  • Rapid onset in 1 to 2 minutes1
  • Rapid response to dose adjustment within 5 to 10 minutes1
  • Rapid offset within 5 to 10 minutes and rapid recovery1
  • No accumulation regardless of infusion duration1

ULTIVA is contraindicated for epidural or intrathecal administration due to the presence of glycine in the formulation and in patients with hypersensitivity to remifentanil (eg, anaphylaxis).1

Interruption of ULTIVA infusion will result in rapid offset and dissipation of analgesic effect within 5-10 minutes after discontinuation.1

Unlike other fentanyl analogs, the duration of action of ULTIVA at a given dose does not increase with increasing duration of administration, due to lack of drug accumulation. When ULTIVA and alfentanil were dosed to equal levels of respiratory depression, recovery of respiratory drive after 3-hour infusions was more rapid and less variable with ULTIVA.1

ULTIVA gives you predictable control of depth and duration of analgesia.1

  • Rapid onset in 1 to 2 minutes1
  • Rapid response to dose adjustment to help manage intraoperative pain1
  • Rapid offset and rapid recovery to have patients awake fast after surgery1-3*
  • No accumulation regardless of infusion duration1

Continuous infusions of ULTIVA should be administered only by an infusion device. Interruption of an infusion of ULTIVA will result in rapid offset of effect. Discontinuation of ULTIVA should be preceded by the establishment of adequate postoperative analgesia.

*

Normal recovery score at 30 minutes was achieved by 81% of ULTIVA patients versus 61% of fentanyl patients. Recovery rates were similar at 45 minutes.3

ULTIVA is a potent ultra–short-acting IV opioid.1

  • Rapid onset in 1 to 2 minutes1
  • Rapid response with 5 to 10 minutes of dose adjustment for flexible analgesic coverage1
  • Rapid offset in 5 to 10 minutes1

Continuous infusions of ULTIVA should be administered only by an infusion device. Interruption of an infusion of ULTIVA will result in rapid offset of effect. Discontinuation of ULTIVA should be preceded by the establishment of adequate postoperative analgesia.1

ULTIVA gives you rapid, predictable recovery to have your patients alert early regardless of infusion duration.1,3,4

In a study by Twersky et al

  • ULTIVA was associated with a somewhat faster emergence than fentanyl4
  • Faster emergence was accompanied by4
    Earlier response to verbal command
    Earlier discharge from the operating room for outpatients
    Earlier eligibility for discharge home for outpatients
  • There was a higher degree of satisfaction expressed by anesthesiologists4
  • Frequencies of postoperative nausea and vomiting were similar4

In a separate study by Guy et al (see graph)

  • Quality of emergence ratings by anesthesiologists were not different between ULTIVA and fentanyl groups, although there was a trend favoring ULTIVA in the overall quality of emergence (P=0.08)3
  • Neurosurgeons rated fentanyl-treated patients as better for patient comfort (P=0.04), level of consciousness (P=0.02), and overall quality of emergence (P=0.01)3
  • Emergence hypertension and surgical pain were more frequently observed in the ULTIVA group3

Unlike other fentanyl analogs, the duration of action of ULTIVA at a given dose does not increase with increasing duration of administration, due to lack of drug accumulation.1

ULTIVA provides rapid elimination with no accumulation.1

  • Rapidly metabolized by nonspecific blood and tissue esterases1
  • Can be used in patients with renal or hepatic impairment1
  • Offset independent of infusion duration to have patients alert quickly even after long procedures1,2
  • No accumulation regardless of infusion duration1

ULTIVA should be used with caution in pediatric, geriatric, and obese patients. 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.1

 

ULTIVA resulted in quicker recovery and earlier neurological examination compared with fentanyl.*2

*

Due to the rapid offset of action of ULTIVA, no residual analgesic activity will be present within 5 to 10 minutes after discontinuation. For patients undergoing surgical procedures where postoperative pain is generally anticipated, alternative analgesics should be administered prior to discontinuation of ULTIVA. The choice of analgesic should be appropriate for the patient's surgical procedure and the level of follow-up care.1


 

ULTIVA has a well-established hemodynamic profile.*1,4

  • Effects on blood pressure and heart rate have been well established in clinical studies4
  • Peak hemodynamic effects occur within 3 to 5 minutes of a single dose or infusion rate increase1
*

In premedicated patients undergoing anesthesia, 1-minute infusions of <2 mcg/kg of ULTIVA cause dose-dependent hypotension and bradycardia.  When appropriate, bradycardia and hypotension can be reversed by reduction of the rate of infusion of ULTIVA or the dose of concurrent anesthetics, or by the administration of fluids or vasopressors. Tachycardia and hypertension have also been reported.1

 

ULTIVA can attenuate the response to intraoperative stressful stimuli.5,6

  • At skin incision and maximal sternal spread, significantly more (P<0.05) patients in the sufentanil group experienced a hemodynamic, somatic, or autonomic response compared with ULTIVA*5
*

No differences between groups were found at intubation, sternotomy, or sternal wire placement. The ULTIVA group exhibited significantly higher maximum and average pain scores during the first hour of weaning and extubation, and the ULTIVA group had more patients complain of nausea, wound pain, and suboptimum pain therapy.5

ULTIVA contains remifentanil, a Schedule II controlled substance. Because opioids are sought by drug abusers and people with addiction disorders, employ strategies to reduce the risks such as proper storage and control practices.1

 

  1. ULTIVA [package insert]. Rockford, IL: Mylan Institutional LLC; 2016.
  2. Wilhelm W, Schlaich N, Harrer J, Kleinschmidt S, Muller M, Larsen R. Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery. Br J Anaesth. 2001;86(1):44-49.
  3. Guy J, Hindman BJ, Baker KZ, et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology. 1997;86(3):514-524.
  4. Twersky RS, Jamerson B, Warner OS, Fleisher LA, Hogue S. Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. J Clin Anesth. 2001;13(6):407-416. Sponsored by GlaxoWellcome Inc.
  5. Lison S, Schill M, Conzen P. Fast-track cardiac anesthesia: efficacy and safety of remifentanil versus sufentanil. J Cardiothorac Vasc Anesth. 2007;21(1):35-40. Supported by a grant from GlaxoSmithKline.
  6. Winterhalter M, Brandl K, Rahe-Meyer N, et al. Endocrine stress response and inflammatory activation during CABG surgery: a randomized trial comparing remifentanil infusion to intermittent fentanyl. Eur J Anaesthesiol. 2008;25(4):326-335.