Alfentanil:

Intravenous opioid

ECMO Dose Adjustment:

YES—an increased dose may be warranted in some patients.

Renal Impairment Dose Adjustment:

NONE

CRRT Dose Adjustment:

NONE

Hepatic Impairment Dose Adjustment*:

YES—a decreased dose may be warranted in some patients.

Adult Starting Dose^:

Adult Continuous Infusion: 0.25-0.5 mcg/kg/min

Pediatric Starting Dose^:

Pediatric Continuous Infusion: 0.25-0.5 mcg/kg/min

Neonatal Starting Dose^:

Neonatal Continuous Infusion: 0.25-0.5 mcg/kg/min

*Dose adjustment will be dependent on acuity and severity of impairment.

^Always use the lowest-effect dose to an objective endpoint (e.g., pain).

Intravenous opioid physicochemical and pharmacokinetic characteristics

Drug	Alfentanil


Onset (Min)	1-3
Log P	2.8
Protein Binding (%)	88-92
Metabolism / Elimination	Hepatic
Dose Adjustment on ECMO	++
Dose Range*	Adult: 0.25-2 mcg/kg/min
	Pediatric: 0.25-2 mcg/kg/min
	Neonatal: 0.25-2 mcg/kg/min

- Minimal sequestration; no need for dose adjustment

++ Moderate sequestration; may require dose adjustment

+++ Significant sequestration; need for dose adjustment

*Titrate to patient-specific goals, using the lowest effective dose. Dose ranges represent doses typically used in clinical practice; in some situations, patients may require doses above the usual dose range to achieve patient-specific goals.