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REMIFENTANIL HYDROCHLORIDE 1 mg/mL Injection, Powder, Lyophilized, For Solution — NDC 00143-9391-10 package photo
Label image from the product's FDA listing (DailyMed) — may show a different pack size or an older label revision.

REMIFENTANIL HYDROCHLORIDE 1 mg/mL Injection, Powder, Lyophilized, For Solution — NDC 0143-9391-10 (Billing 00143-9391-10)

by Hikma Pharmaceuticals USA Inc. · 10 VIAL in 1 CARTON / 3 mL in 1 VIAL

This is a package of REMIFENTANIL HYDROCHLORIDE 1 mg/mL Injection, Powder, Lyophilized, For Solution from Hikma Pharmaceuticals USA Inc., marketed since May 2021 and currently FDA-listed. It is this product's only package size.

NDC 00143-9391-10
🏷️ FDA NDC (as labeled) 0143-9391-10 billing pads the labeler segment with a zero
Rx only Generic On market CII ⚠ On shortage ⇄ Compare with another NDC
🗂️ FDA directory synced Oct 1, 2026 · this listing last changed Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

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Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

NDC database record

One package, one record: these facts belong to NDC 0143-9391-10 alone.

Record
FDA NDC Directory package listing · Human prescription drug
Code segments
0143 labeler · 9391 product · 10 package
Package marketed since
May 15, 2021
Sample package
No — commercial package
Listing certified through
Dec 31, 2026
Barcode (UPC-A, from the NDC)
3 0143939110 4
Medicaid fills, this package
75 prescriptions in the last four reported quarters
FDA record last changed
Jul 24, 2026
⚠️
Active FDA shortage. Remifentanil Hydrochloride Injection is currently reported in shortage by the FDA (Demand increase for the drug). Unavailable Shortage details →

Identity & classification

Regulatory identifiers FDA, NLM and CMS codes for this package

FDA NDC (as labeled) 0143-9391-10
Product NDC 0143-9391
11-digit billing NDC 00143939110
NCPDP billing unit EA — each (per item)
RxCUI 1729578, 1729584, 1729710
UNII 5V444H5WIC
Application # ANDA210594
SPL Set ID 9d289052-1eb6-4ba2-a3ca-d2e542a052ae
Established class (EPC) Opioid Agonist
Mechanism of action Full Opioid Agonists
DEA schedule CII
Marketing category ANDA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2021-05-15
Route INTRAVENOUS
Dosage form INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION
Substance REMIFENTANIL HYDROCHLORIDE
TE code (Orange Book) AP · RLD · RS

Drug-database identifiers Medi-Span GPI and First Databank GCN / HICL / AHFS classification

GPI-14 65100087102110
GPI class Remifentanil HCl
GCN Seq No 028228
GCN 07213
HICL code 011931
Ingredient (HICL) Remifentanil Hcl
HIC1 code H
Therapeutic class — broad (HIC1) Nervous System (Except Autonomic)
HIC2 code H3
Therapeutic class — intermediate (HIC2) Analgesics
HIC3 code H3H
Therapeutic class — specific (HIC3) Opioid Analgesic, Anesthetic Adjunct Agents
AHFS code 28:08.08.00
AHFS class Opioid Agonists (28:08)
FDB label name REMIFENTANIL 1 MG VIAL
FDB brand name Remifentanil Hcl
Legend status F — Federal legend — prescription drug or device
Quick answers
  • GSN (GCN sequence number): 028228
  • GCN: 07213
  • GPI-14 (Medi-Span): 65100087102110
  • HICL (First Databank): 011931
  • AHFS class code: 28:08.08.00
  • RxCUI (RxNorm): 1729578
Why two NDCs? The FDA registers this code as 0143-9391-10 — a 4-4-2 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the labeler segment → 00143-9391-10. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

RxNorm drug class

This medicine belongs to the Opioid Agonist class.

Pharmacologic class Opioid Agonist
Drug family (ATC) Opioid anesthetics
How it works Full Opioid Agonists
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

Clinical

Label name REMIFENTANIL 1 MG VIAL Ingredient Remifentanil Hcl
📗 Our plain-language guide HelloPharmacist
  • Remifentanil is a specialized opioid used only in surgery and closely monitored settings. It works within seconds and wears off within minutes, which gives your anesthesia team pre...
  • Why am I getting remifentanil instead of a regular pain medicine?
  • Remifentanil controls pain but cannot put you to sleep on its own, so it is always used together with other anesthetics that do cause unconsciousness. Your team combines it with me...
  • Will I be awake or remember anything during surgery if I'm given this?
📖 Read our full Remifentanil guide →

Supplement & herbal interactions

🌿 Drug–supplement interaction checker →
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer mLPer package
Retail pharmacies payNADAC · weekly Not in the retail survey — common for institutional, discontinued, or low-volume packs.
Medicaid paysCMS SDUD · 12 mo $17.67 $530.05 / 30 ml
Medicare drug plans payPart D · quarterly No Part D plan price is available for this NDC in our data.
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

Packaging — all sizes for this product

Package NDCDescription Marketing startMarketing endStatus
00143-9391-10 You're viewing this Main listing 10 VIAL in 1 CARTON / 3 mL in 1 VIAL 2021-05-15 — Active

Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Remifentanil Hydrochloride 1 mg/mLthis 00143-9391-10 Hikma 10 vials — AP FDA listed —
Remifentanil Hydrochloride 1 mg/mL 63323-0723-03 Fresenius 10 vials — AP FDA listed —
Ultiva 1 mg/mL 67457-0912-01 Mylan 10 vials — AP FDA listed —
Ultiva 1 mg/mL 72078-0034-01 Mylan 10 vials — AP FDA listed —
Remifentanil Hydrochloride 1 mg/mL 63323-0725-10 Fresenius 10 vials — AP FDA listed —
Ultiva 1 mg/mL 67457-0913-02 Mylan 10 vials — AP FDA listed —
Remifentanil Hydrochloride 1 mg/mL 63323-0724-05 Fresenius 10 vials — AP FDA listed —
Ultiva 1 mg/mL 67457-0914-05 Mylan 10 vials — AP FDA listed —
Ultiva 1 mg/mL 72078-0035-02 Mylan 10 vials — AP FDA listed —
Ultiva 1 mg/mL 72078-0036-05 Mylan 10 vials — AP FDA listed —
About this product: this is a generic version of the medicine. FDA equivalence ratings are shown when available, and other versions are listed above, least expensive first.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & generic status

🏛️
2021
On the market since
May 2021
📍
2026
Currently FDA-listed
5 years listed
🔓
·
Generic on the market
this product is a generic
✅This is a generic drug

This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.

Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.

  • 3 mg / 1 mL UNII TE7660XO1C
    Glycine is an amino acid used in medicines as a buffer to help stabilize pH and improve taste. It may also serve as a filler or binder to give the product proper form and consistency.
  • UNII QTT17582CB
    A strong acid used to adjust and maintain the proper pH level in liquid medicines, ensuring stability and preventing breakdown of active ingredients.

2 inactive ingredients listed in the exact product block matched to this NDC.

Where does this data come from?
Data sourced from official FDA Structured Product Labeling (SPL) via DailyMed — ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

Manufacturer & labeler

LabelerHikma Pharmaceuticals USA Inc.
Application holderHIKMA PHARMACEUTICALS USA INC
FDA applicationANDA210594 (ANDA)
Labeler code00143
First marketedMay 2021
DEA scheduleCII
Product typeHuman Prescription Drug
Portfolio726 products on file

More NDCs from Hikma Pharmaceuticals USA Inc. labeler code 00143

The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

Full prescribing information FDA SPL

The complete FDA label for this product — the official prescribing information, verbatim, section by section. Very long sections are excerpted here and marked; the full text is on DailyMed (linked in the sources below). Jump with a chip, search within the label, or expand everything.
🚨 Boxed Warning 🎯 Indications and Usage ⏱️ Dosage and Administration 💊 Dosage Forms and Strengths ⛔ Contraindications ⚠️ Warnings and Cautions 🤒 Adverse Reactions 🔄 Drug Interactions 👥 Use in Specific Populations 🤰 Pregnancy 🧒 Pediatric Use 🧓 Geriatric Use 🆘 Overdosage 🧬 Clinical Pharmacology 🧬 Mechanism of Action 📦 How Supplied / Storage and Handling 📋 Description 💬 Information for Patients 🧬 Pharmacokinetics 🧬 Pharmacodynamics 🔬 Clinical Studies 🔒 Drug Abuse and Dependence 🔒 Controlled Substance 🧪 Nonclinical Toxicology 📄 Carcinogenesis, Mutagenesis, Impairment of Fertility 📄 Recent Major Changes 📄 Package Label / Principal Display Panel
🚨 Boxed Warning ~2 min read ▾

WARNING: ADDICTION, ABUSE, AND MISUSE WARNING: SERIOUS AND LIFE-THREATENING RISKS FROM USE OF REMIFENTANIL HYDROCHLORIDE FOR INJECTION Addiction, Abuse, and Misuse Because the use of Remifentanil Hydrochloride for injection exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death, assess each patient’s risk prior to prescribing and reassess all patients regularly for the development of these behaviors and conditions [see Warnings and Precautions ( 5.1 )] .

Life-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression may occur with use of Remifentanil Hydrochloride for injection, especially during initiation or following a dosage increase. To reduce the risk of respiratory depression, proper dosing and titration of Remifentanil Hydrochloride for injection are essential [see Warnings and Precautions ( 5.2 )] . Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

Reserve concomitant prescribing of Remifentanil Hydrochloride for injection and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate [see Warnings and Precautions ( 5.3 ), Drug Interactions ( 7 )] . WARNING: SERIOUS AND LIFE-THREATENING RISKS FROM USE OF REMIFENTANIL HYDROCHLORIDE FOR INJECTION See full prescribing information for complete boxed warning. Remifentanil Hydrochloride for injection exposes users to the risks of addiction, abuse, and misuse.

Assess patient’s risk before prescribing and reassess regularly for the development of these behaviors and conditions. ( 5.1 ) Serious, life-threatening, or fatal respiratory depression may occur with use of Remifentanil Hydrochloride for injection, especially during initiation or following a dosage increase. To reduce the risk of respiratory depression, proper dosing and titration of Remifentanil Hydrochloride for injection are essential.

( 5.2 ) Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate. ( 5.3 , 7 )

🎯 Indications and Usage 157 words ▾

1 INDICATIONS AND USAGE Remifentanil Hydrochloride for injection is indicated for intravenous (IV) administration: As an analgesic agent for use during the induction and maintenance of general anesthesia for inpatient and outpatient procedures. For continuation as an analgesic into the immediate postoperative period in adult patients under the direct supervision of an anesthesia practitioner in a postoperative anesthesia care unit or intensive care setting. As an analgesic component of monitored anesthesia care in adult patients.

Remifentanil Hydrochloride for injection is an opioid agonist indicated for intravenous administration: As an analgesic agent for use during the induction and maintenance of general anesthesia for inpatient and outpatient procedures. ( 1 ) For continuation as an analgesic into the immediate postoperative period in adult patients under the direct supervision of an anesthesia practitioner in a postoperative anesthesia care unit or intensive care setting. ( 1 ) As an analgesic component of monitored anesthesia care in adult patients.

( 1 )

⏱️ Dosage and Administration ~3 min read ▾

2 DOSAGE AND ADMINISTRATION Monitor patients closely for respiratory depression when initiating therapy and following dosage increases and adjust the dosage accordingly. ( 2.1 ) Initial Dosage in Adults : See full prescribing information for recommended doses in adult patients. ( 2.2 , 2.3 ) Initial Dosage in Pediatric Patients : See full prescribing information for recommended doses in pediatric patients.

( 2.2 ) Geriatric Patients : The starting doses should be decreased by 50% in elderly patients (> 65 years). ( 2.6 )

2.1Important Dosage and Administration Instructions Monitor patients closely for respiratory depression when initiating therapy and following dosage increases with Remifentanil Hydrochloride for injection and adjust the dosage accordingly [see Warnings and Precautions (5.2) ]. Remifentanil Hydrochloride for injection is for IV use only. Continuous infusions of Remifentanil Hydrochloride for injection 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. Remifentanil Hydrochloride for injection should not be administered without dilution. Consider an alternative to Remifentanil Hydrochloride for injection for patients taking mixed agonist/antagonist and partial agonist opioid analgesics due to reduced analgesic effect or potential withdrawal symptoms.

If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. Discontinue Remifentanil Hydrochloride for injection if patient is not responding appropriately to treatment. Discard unused portion.

2.2General Anesthesia Remifentanil Hydrochloride for injection is not recommended as the sole agent in general anesthesia because loss of consciousness cannot be assured and because of a high incidence of apnea, muscle rigidity, and tachycardia. Remifentanil Hydrochloride for injection is synergistic with other anesthetics; therefore, clinicians may need to reduce doses of thiopental, propofol, isoflurane, and midazolam by up to 75% with the coadministration of Remifentanil Hydrochloride for injection. The administration of Remifentanil Hydrochloride for injection must be individualized based on the patient's response.

Induction of Anesthesia Remifentanil Hydrochloride for injection should be administered at an infusion rate of 0.5 to 1 mcg/kg/min with a hypnotic or volatile agent for the induction of anesthesia. If endotracheal intubation is to occur less than 8 minutes after the start of the infusion of Remifentanil Hydrochloride for injection, then an initial dose of 1 mcg/kg may be administered over 30 to 60 seconds. Remifentanil Hydrochloride for injection should not be used as a sole agent for induction of anesthesia because loss of consciousness cannot be assured and because of a high incidence of apnea, muscle rigidity, and tachycardia.

Maintenance of Anesthesia After endotracheal intubation, the infusion rate of Remifentanil Hydrochloride for injection should be decreased in accordance with the dosing guidelines in Tables 1 (adults, predominately ASA physical status I, II, or III) and 2 (pediatric patients). Due to the fast onset and short duration of action of Remifentanil Hydrochloride for injection, the rate of administration during anesthesia can be titrated upward in 25% to 100% increments in adult patients or up to 50% increments in pediatric patients, or downward in 25% to 50% decrements every 2 to 5 minutes to attain the desired level of μ-opioid effect.

In response to light anesthesia or transient episodes of intense surgical stress, supplemental bolus doses of 1 mcg/kg may be administered every 2 to 5 minutes. At infusion rates > 1 mcg/kg/min, increases in the concomitant anesthetic agents should be considered to increase the depth of anesthesia. [See Clinical Pharmacology: Specific Populations: Pediatric Population (12.3) and Dosage and Administration, Tab… [Excerpted — this section continues on DailyMed.]

💊 Dosage Forms and Strengths 54 words ▾

3 DOSAGE FORMS AND STRENGTHS For injection: 1 mg, 2 mg, and 5 mg: 3 mL Vial 1 mg lyophilized powder 5 mL Vial 2 mg lyophilized powder 10 mL Vial 5 mg lyophilized powder For injection: 1 mg, 2 mg, and 5 mg for intravenous administration after reconstitution and dilution ( 3 )

⛔ Contraindications 76 words ▾

4 CONTRAINDICATIONS Remifentanil Hydrochloride for injection is contraindicated: For epidural or intrathecal administration due to the presence of glycine in the formulation [see Nonclinical Toxicology (13) ] . In patients with hypersensitivity to remifentanil (e.g., anaphylaxis) [see Adverse Reactions (6.2 )] . Remifentanil Hydrochloride for injection is contraindicated: For epidural or intrathecal administration due to the presence of glycine in the formulation.

( 4 ) In patients with hypersensitivity to remifentanil (e.g., anaphylaxis). ( 4 )

⚠️ Warnings and Cautions ~3 min read ▾

5 WARNINGS AND PRECAUTIONS Life-Threatening Respiratory Depression : Monitor closely, particularly during initiation and titration. ( 5.2 ) Risks from Use as Postoperative Analgesia with Concomitant Benzodiazepines or other CNS Depressants : Hypotension, profound sedation, respiratory depression, coma, and death may result from the concomitant use of Remifentanil Hydrochloride for injection with benzodiazepines or other CNS depressants ( 5.3 ) Opioid-Induced Hyperalgesia and Allodynia: Opioid-Induced Hyperalgesia (OIH) occurs when an opioid analgesic paradoxically causes an increase in pain, or an increase in sensitivity to pain.

If OIH is suspected, carefully consider appropriately decreasing the dose of the current opioid analgesic or opioid rotation. ( 5.4 ) Serotonin Syndrome : Potentially life-threatening condition could result from concomitant serotonergic drug administration. Discontinue Remifentanil Hydrochloride for injection if serotonin syndrome is suspected.

( 5.5 ) Administration : Continuous infusions of Remifentanil Hydrochloride for injection should be administered only by an infusion device. ( 5.6 ) Skeletal Muscle Rigidity : is related to the dose and speed of administration. Muscle rigidity induced by Remifentanil Hydrochloride for injection should be managed in the context of the patient's clinical condition.

( 5.7 ) Potential Inactivation by Nonspecific Esterases in Blood Products : Remifentanil Hydrochloride for injection should not be administered into the same IV tubing with blood due to potential inactivation by nonspecific esterases in blood products. ( 5.8 ) Bradycardia : Monitor heart rate during dosage initiation and titration. It is responsive to ephedrine or anticholinergic drugs ( 5.9 ) Hypotension : Monitor blood pressure during dosage initiation and titration.

It is responsive to decreases in the administration of Remifentanil Hydrochloride for injection or to IV fluids or catecholamine administration ( 5.10 ) Intraoperative Awareness : Inoperative awareness has been reported in patients under 55 years of age when Remifentanil Hydrochloride for injection has been administered with propofol infusion rates of ≤ 75 mcg/kg/min ( 5.11 ) Risks of Use in Spontaneously Breathing Patients with Increased Intracranial Pressure, Brain Tumors, Head Injury, or Impaired Consciousness : Monitor for sedation and respiratory depression.

( 5.12 ) Risks of Use in Patients with Biliary Tract Disease : Monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms. ( 5.13 ) Increased Risk of Seizures in Patients with Seizure Disorders : Monitor patients with a history of seizure disorders for worsened seizure control during Remifentanil Hydrochloride for injection therapy. ( 5.14 ) Rapid Offset of Action : Standard monitoring should be maintained in the postoperative period to ensure adequate recovery without stimulation.

( 5.15 )

5.1Addiction, Abuse, and Misuse Remifentanil Hydrochloride for injection contains remifentanil, a Schedule II controlled substance. As an opioid, Remifentanil Hydrochloride for injection exposes users to the risks of addiction, abuse, and misuse [see Drug Abuse and Dependence (9) ]. Opioids are sought for nonmedical use and are subject to diversion from legitimate prescribed use.

Consider these risks when handling Remifentanil Hydrochloride for injection. Strategies to reduce these risks include proper product storage and control practices for a C-II drug. Contact local state professional licensing board or state controlled substances authority for information on how to prevent and detect abuse or diversion of this product.

5.2Life-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended. Respiratory depression, if not immediately recognized and treated, may lead to respiratory arrest and death. Remifentanil Hydrochloride for injection should b… [Excerpted — this section continues on DailyMed.]

🤒 Adverse Reactions ~3 min read ▾

6 ADVERSE REACTIONS The following serious adverse reactions are described, or described in greater detail, in other sections: Addiction, Abuse, and Misuse [see Warnings and Precautions (5.1) ] Respiratory Depression in Spontaneously Breathing Patients [see Warnings and Precautions (5.2) ] Interactions with Benzodiazepines or other CNS Depressants [see Warnings and Precautions (5.3) ] Opioid-Induced Hyperalgesia and Allodynia [see Warnings and Precautions (5.4) ] Serotonin Syndrome [see Warnings and Precautions (5.5) ] Skeletal Muscle Rigidity [see Warnings and Precautions (5.7) ] Bradycardia [see Warnings and Precautions (5.9) ] Hypotension [see Warnings and Precautions (5.10) ] Biliary Tract Disease [see Warnings and Precautions (5.13) ] Seizures [see Warnings and Precautions (5.14) ] Most common adverse reactions (incidence ≥ 1%) were respiratory depression, bradycardia, hypotension, and skeletal muscle rigidity.

( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Hikma Pharmaceuticals USA Inc. at 1-877-845-0689, or at 1-800-FDA-1088 or www.fda.gov/medwatch.

6.1Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Adverse event information is derived from controlled clinical studies that were conducted in a variety of surgical procedures of varying duration, using a variety of premedications and other anesthetics, and in patient populations with diverse characteristics including underlying disease.

Adults Approximately 2,770 adult patients were exposed to Remifentanil Hydrochloride for injection in controlled clinical studies. The frequencies of adverse events during general anesthesia with the recommended doses of Remifentanil Hydrochloride for injection are given in Table 11. Each patient was counted once for each type of adverse event.

Table 11: Adverse Events Reported in ≥ 1% of Adult Patients in General Anesthesia Studies Does not include adverse events from cardiac studies or the neonatal study. See Tables 14, 15, and 16 for cardiac information. at the Recommended Doses See Table 1 for recommended doses. Not all doses of Remifentanil Hydrochloride for injection were equipotent to the comparator opioid. of Remifentanil Hydrochloride for injection Adverse Event Induction/Maintenance Postoperative Analgesia After Discontinuation Remifentanil Hydrochloride for injection (n = 921) Alfentanil/ Fentanyl (n = 466) Remifentanil Hydrochloride for injection (n = 281) Morphine (n = 98) Remifentanil Hydrochloride for injection (n = 929) Alfentanil /Fentanyl (n = 466) Nausea 8 (<1%) 0 61 (22%) 15 (15%) 339 (36%) 202 (43%) Hypotension 178 (19%) 30 (6%) 0 0 16 (2%) 9 (2%) Vomiting 4 (<1%) 1 (<1%) 22 (8%) 5 (5%) 150 (16%) 91 (20%) Muscle rigidity 98 (11%) ‡ 37 (8%) 7 (2%) 0 2 (<1%) 1 (<1%) Bradycardia 62 (7%) 24 (5%) 3 (1%) 3 (3%) 11 (1%) 6 (1%) Shivering 3 (<1%) 0 15 (5%) 9 (9%) 49 (5%) 10 (2%) Fever 1 (<1%) 0 2 (<1%) 0 44 (5%) 9 (2%) Dizziness 0 0 1 (<1%) 0 27 (3%) 9 (2%) Visual disturbance 0 0 0 0 24 (3%) 14 (3%) Headache 0 0 1 (<1%) 1 (1%) 21 (2%) 8 (2%) Respiratory depression 1 (<1%) 0 19 (7%) 4 (4%) 17 (2%) 20 (4%) Apnea 0 1 (<1%) 9 (3%) 2 (2%) 2 (<1%) 1 (<1%) Pruritus 2 (<1%) 0 7 (2%) 1 (1%) 22 (2%) 7 (2%) Tachycardia 6 (<1%) 7 (2%) 0 0 10 (1%) 8 (2%) Postoperative pain 0 0 7 (2%) 0 4 (<1%) 5 (1%) Hypertension 10 (1%) 7 (2%) 5 (2%) 3 (3%) 12 (1%) 8 (2%) Agitation 2 (<1%) 0 3 (1%) 1 (1%) 6 (<1%) 1 (<1%) Hypoxia 0 0 1 (<1%) 0 10 (1%) 7 (2%) In the elderly population (> 65 years), the incidence of hypotension is higher, whereas the incidence of nausea and vomiting is lower.

Table 12: Incidence (%) of Most Common Adverse Events by Gender in General Anesthesia Studies Does not include adverse events from cardiac studies or the neonatal study. at the Recommended Doses See Table 1 for recommended dose… [Excerpted — this section continues on DailyMed.]

🔄 Drug Interactions ~2 min read ▾

7 DRUG INTERACTIONS Table 18 includes clinically significant drug interactions with remifentanil Hydrochloride for injection. Table 18: Clinically Significant Drug Interactions with Remifentanil Hydrochloride for Injection Benzodiazepines and other Central Nervous System (CNS) Depressants Clinical Impact: Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants including alcohol, increases the risk of hypotension, respiratory depression, profound sedation, coma, and death.

Intervention: Limit dosages and durations to the minimum required. Follow patients closely for signs of respiratory depression and sedation. Patients should be advised to avoid alcohol for 24 hours after surgery [see Warnings and Precautions (5.3) ] .

Examples: Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol. Serotonergic Drugs Clinical Impact: The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome [see Warnings and Precautions (5.5) ] . Intervention: If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

Discontinue Remifentanil Hydrochloride for injection if serotonin syndrome is suspected. Examples: Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that effect the serotonin neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), certain muscle relaxants (i.e., cyclobenzaprine, metaxalone), monoamine oxidase (MAO) inhibitors (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue).

Monoamine Oxidase Inhibitors (MAOIs) Clinical Impact: MAOI interactions with opioids may manifest as serotonin syndrome [see Warnings and Precautions (5.5) ] or opioid toxicity (e.g., respiratory depression, coma) [see Warnings and Precautions (5.2) ]. If urgent use of Remifentanil Hydrochloride for injection is necessary, use test doses and frequent titration of small doses while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression. Intervention: The use of Remifentanil Hydrochloride for injection is not recommended for patients taking MAOIs or within 14 days of stopping such treatment.

Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics Clinical Impact: May reduce the analgesic effect of Remifentanil Hydrochloride for injection and/or precipitate withdrawal symptoms. Intervention: If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. Consider discontinuing Remifentanil Hydrochloride for injection if patient is not responding appropriately to treatment and institute alternative analgesic treatment.

Examples: butorphanol, nalbuphine, pentazocine, buprenorphine Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics: May reduce the analgesic effect of Remifentanil Hydrochloride for injection and/or precipitate withdrawal symptoms. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. ( 7 )

Drug Interactions In animals the duration of muscle paralysis from succinylcholine is not prolonged by remifentanil.

👥 Use in Specific Populations ~3 min read ▾

8 USE IN SPECIFIC POPULATIONS Pregnancy: May cause fetal harm. ( 8.1 ) Labor or Delivery: Respiratory depression and other opioid effects may occur in newborns whose mothers are given Remifentanil Hydrochloride for injection, shortly before delivery. ( 8.1 ) Lactation: Infants exposed to Remifentanil Hydrochloride for injection through breast milk should be monitored for excess sedation and respiratory depression.

( 8.2 ) Pediatric Use: Remifentanil Hydrochloride for injection has not been studied in pediatric patients for use as a postoperative analgesic or as an analgesic component of monitored anesthesia care. ( 8.4 )

8.1Pregnancy Risk Summary Use of opioid analgesics for an extended period of time during pregnancy may cause neonatal opioid withdrawal syndrome. Available data with remifentanil hydrochloride in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage. In animal reproduction studies, reduced fetal rat body weight and pup weights were reported at 2.2 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min for a surgical procedure lasting 3 hours.

There were no malformations noted when remifentanil was administered via bolus injection to pregnant rats or rabbits during organogenesis at doses approximately 5 times and approximately equal, respectively, to a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min for a surgical procedure lasting 3 hours [ see Data ]. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Clinical Considerations Labor or Delivery Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. An opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate.

Remifentanil Hydrochloride for injection, is not recommended for use in pregnant women during or immediately prior to labor, when other analgesic techniques are more appropriate. Opioid analgesics, including Remifentanil Hydrochloride for injection can prolong labor through actions which temporarily reduce the strength, duration, and frequency of uterine contractions. However, this effect is not consistent and may be offset by an increased rate of cervical dilation, which tends to shorten labor.

Monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression. Data Human Data In a human clinical trial, the average maternal remifentanil concentrations were approximately twice those seen in the fetus. In some cases, however, fetal concentrations were similar to those in the mother.

The umbilical arteriovenous ratio of remifentanil concentrations was approximately 30% suggesting metabolism of remifentanil in the neonate. Animal Data Pregnant rats were treated from Gestation Day 6 to 15 with intravenous remifentanil doses of 0.5, 1.6, or 5 mg/kg/day (0.2, 0.7, or 2.2 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min based on body surface area for a surgical procedure lasting 3 hours based on body surface area, respectively). Reduced fetal weights were reported in the high dose group; however, no malformations were reported in surviving fetuses despite a non-dose dependent increase in maternal mortality.

Pregnant rabbits were treated from Gestation Day 6 to 18 with intravenous remifentanil doses of 0.1, 0.5, or 0.8 mg/kg/day (0.09, 0.4, or 0.7 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min based on body surfa… [Excerpted — this section continues on DailyMed.]

🤰 Pregnancy ~3 min read ▾

8.1Pregnancy Risk Summary Use of opioid analgesics for an extended period of time during pregnancy may cause neonatal opioid withdrawal syndrome. Available data with remifentanil hydrochloride in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage. In animal reproduction studies, reduced fetal rat body weight and pup weights were reported at 2.2 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min for a surgical procedure lasting 3 hours.

There were no malformations noted when remifentanil was administered via bolus injection to pregnant rats or rabbits during organogenesis at doses approximately 5 times and approximately equal, respectively, to a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min for a surgical procedure lasting 3 hours [ see Data ]. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Clinical Considerations Labor or Delivery Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. An opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate.

Remifentanil Hydrochloride for injection, is not recommended for use in pregnant women during or immediately prior to labor, when other analgesic techniques are more appropriate. Opioid analgesics, including Remifentanil Hydrochloride for injection can prolong labor through actions which temporarily reduce the strength, duration, and frequency of uterine contractions. However, this effect is not consistent and may be offset by an increased rate of cervical dilation, which tends to shorten labor.

Monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression. Data Human Data In a human clinical trial, the average maternal remifentanil concentrations were approximately twice those seen in the fetus. In some cases, however, fetal concentrations were similar to those in the mother.

The umbilical arteriovenous ratio of remifentanil concentrations was approximately 30% suggesting metabolism of remifentanil in the neonate. Animal Data Pregnant rats were treated from Gestation Day 6 to 15 with intravenous remifentanil doses of 0.5, 1.6, or 5 mg/kg/day (0.2, 0.7, or 2.2 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min based on body surface area for a surgical procedure lasting 3 hours based on body surface area, respectively). Reduced fetal weights were reported in the high dose group; however, no malformations were reported in surviving fetuses despite a non-dose dependent increase in maternal mortality.

Pregnant rabbits were treated from Gestation Day 6 to 18 with intravenous remifentanil doses of 0.1, 0.5, or 0.8 mg/kg/day (0.09, 0.4, or 0.7 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min based on body surface area for a surgical procedure lasting 3 hours based on body surface area, respectively). No malformations were reported in surviving fetuses despite clear maternal toxicity (decreased food consumption and body weights and increased mortality in all treatment groups).

Pregnant rats were treated from Gestation Day 6 to Lactation Day 21 with intravenous boluses of remifentanil 0.5, 1.6, or 5 mg/kg/day (0.2, 0.7, or 2.2 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min based on body surface area for a surgical procedure lasting 3 hours based on body surface area, re… [Excerpted — this section continues on DailyMed.]

🧒 Pediatric Use 198 words ▾

8.4Pediatric Use The efficacy and safety of Remifentanil Hydrochloride for injection as an analgesic agent for use in the maintenance of general anesthesia in outpatient and inpatient pediatric surgery have been established in controlled clinical studies in pediatric patients from birth to 12 years [see Clinical Studies (14.4) ] . The initial maintenance infusion regimen of Remifentanil Hydrochloride for injection evaluated in pediatric patients from birth to 2 months of age was 0.4 mcg/kg/min, the approved adult regimen for use with N 2 O.

The clearance rate observed in neonates was highly variable and on average was 2 times higher than in the young healthy adult population. Therefore, while a starting infusion rate of 0.4 mcg/kg/min may be appropriate for some neonates, an increased infusion rate may be necessary to maintain adequate surgical anesthesia, and additional bolus doses may be required. The individual dose for each patient should be carefully titrated. [See Clinical Pharmacology: Specific Populations: Pediatric Population (12.3) and Dosage and Administration, Table 2 and Maintenance of Anesthesia (2.2). ] Remifentanil Hydrochloride for injection has not been studied in pediatric patients for use as a postoperative analgesic or as an analgesic component of monitored anesthesia care.

🧓 Geriatric Use ~1 min read ▾

8.5Geriatric Use Respiratory depression is the chief risk for elderly patients treated with opioids and has occurred after large initial doses were administered to patients who were not opioid-tolerant or when opioids were co-administered with other agents that depress respiration. Titrate the dosage of Remifentanil Hydrochloride for injection slowly in geriatric patients and frequently reevaluate the patient for signs of central nervous system and respiratory depression [see Warnings and Precautions (5.2) ]. Of the total number of subjects in clinical studies of Remifentanil Hydrochloride for injection, 486 were 65 and over (age range 66 to 90 years).

While the effective biological half-life of remifentanil is unchanged, elderly patients have been shown to be twice as sensitive as the younger population to the pharmacodynamic effects of remifentanil. The recommended starting dose of Remifentanil Hydrochloride for injection should be decreased by 50% in patients over 65 years of age [see Clinical Pharmacology (12.3) and Dosage and Administration (2.2) ] . Titrate the dosage of Remifentanil Hydrochloride for injection slowly in geriatric patients. [See Warnings and Precautions (5.5) .] The clearance of remifentanil is reduced (approximately 25%) in the elderly (> 65 years of age) compared to young adults (average 25 years of age).

However, remifentanil blood concentrations fall as rapidly after termination of administration in the elderly as in young adults. This drug is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

🆘 Overdosage ~1 min read ▾

10 OVERDOSAGE Clinical Presentation Acute overdose with Remifentanil Hydrochloride for injection can be manifested by respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, and, in some cases, pulmonary edema, bradycardia, hypotension, partial or complete airway obstruction, atypical snoring, and death. Marked mydriasis rather than miosis may be seen with hypoxia in overdose situations [see Clinical Pharmacology (12.2) ] . Treatment of Overdose In case of overdose, priorities are the reestablishment of a patent and protected airway and institution of assisted or controlled ventilation, if needed.

Employ other supportive measures (including oxygen and vasopressors) in the management of circulatory shock and pulmonary edema as indicated. Cardiac arrest or arrhythmias will require advanced life-support measures. The opioid antagonists, naloxone or nalmefene, are specific antidotes to respiratory depression resulting from opioid overdose.

For clinically significant respiratory or circulatory depression secondary to remifentanil overdose, stop the infusion or administer an opioid antagonist. Opioid antagonists should not be administered in the absence of clinically significant respiratory or circulatory depression secondary to remifentanil overdose. In an individual physically dependent on opioids, administration of the recommended usual dosage of the antagonist will precipitate an acute withdrawal syndrome.

The severity of the withdrawal symptoms experienced will depend on the degree of physical dependence and the dose of the antagonist administered. If a decision is made to treat serious respiratory depression in the physically dependent patient, administration of the antagonist should be begun with care and by titration with smaller than usual doses of the antagonist.

🧬 Clinical Pharmacology ~3 min read ▾

12 CLINICAL PHARMACOLOGY

12.1Mechanism of Action Remifentanil Hydrochloride for injection is a μ-opioid agonist with rapid onset and peak effect, and short duration of action. The μ- opioid activity of Remifentanil Hydrochloride for injection is antagonized by opioid antagonists such as naloxone. Unlike other opioids, Remifentanil Hydrochloride for injection is rapidly metabolized by hydrolysis of the propanoic acid-methyl ester linkage by nonspecific blood and tissue esterases.

Remifentanil Hydrochloride for injection is not a substrate for plasma cholinesterase (pseudocholinesterase) and, therefore, patients with atypical cholinesterase are expected to have a normal duration of action.

12.2Pharmacodynamics The analgesic effects of Remifentanil Hydrochloride for injection are rapid in onset and offset. Its effects and side effects are dose dependent and similar to other μ-opioids. Remifentanil Hydrochloride for injection in humans has a rapid blood-brain equilibration halftime of 1 ± 1 minutes (mean ± SD) and a rapid onset of action.

The pharmacodynamic effects of Remifentanil Hydrochloride for injection closely follow the measured blood concentrations, allowing direct correlation between dose, blood levels, and response. Blood concentration decreases 50% in 3 to 6 minutes after a 1-minute infusion or after prolonged continuous infusion due to rapid distribution and elimination processes and is independent of duration of drug administration. Recovery from the effects of Remifentanil Hydrochloride for injection occurs rapidly (within 5 to 10 minutes).

New steady-state concentrations occur within 5 to 10 minutes after changes in infusion rate. When used as a component of an anesthetic technique, Remifentanil Hydrochloride for injection can be rapidly titrated to the desired depth of anesthesia/analgesia (e.g., as required by varying levels of intraoperative stress) by changing the continuous infusion rate or by administering an IV bolus injection. Effects on the Central Nervous System Remifentanil produces respiratory depression by direct action on brain stem respiratory centers.

The respiratory depression involves both a reduction in the responsiveness of the brain stem respiratory centers to increases in carbon dioxide tension and to electrical stimulation. Remifentanil causes miosis, even in total darkness. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origins may produce similar findings).

Marked mydriasis rather than miosis may be seen due to hypoxia in overdose situations. Effects on the Gastrointestinal Tract and Other Smooth Muscle Remifentanil causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum. Digestion of food in the small intestine is delayed and propulsive contractions are decreased.

Propulsive peristaltic waves in the colon are decreased, while tone may be increased to the point of spasm resulting in constipation. Other opioid-induced effects may include a reduction in biliary and pancreatic secretions, spasm of sphincter of Oddi, and transient elevations in serum amylase. Effects on the Cardiovascular System Remifentanil produces peripheral vasodilation which may result in orthostatic hypotension or syncope.

Manifestations of histamine release and/or peripheral vasodilation may include pruritus, flushing, red eyes and sweating and/or orthostatic hypotension. Caution must be used in hypovolemic patients, such as those suffering acute myocardial infarction, because remifentanil may cause or further aggravate their hypotension. Caution must also be used in patients with cor pulmonale who have received therapeutic doses of opioids.

Effects on the Endocrine System Opioids inhibit the secretion of adrenocorticotropic hormone (ACTH), cortisol, and luteinizing hormone (LH) in humans. They also stimulate prolactin, growth hormone (GH) secretion, and pancreatic secretion of i… [Excerpted — this section continues on DailyMed.]

🧬 Mechanism of Action 91 words ▾

12.1Mechanism of Action Remifentanil Hydrochloride for injection is a μ-opioid agonist with rapid onset and peak effect, and short duration of action. The μ- opioid activity of Remifentanil Hydrochloride for injection is antagonized by opioid antagonists such as naloxone. Unlike other opioids, Remifentanil Hydrochloride for injection is rapidly metabolized by hydrolysis of the propanoic acid-methyl ester linkage by nonspecific blood and tissue esterases.

Remifentanil Hydrochloride for injection is not a substrate for plasma cholinesterase (pseudocholinesterase) and, therefore, patients with atypical cholinesterase are expected to have a normal duration of action.

📦 How Supplied / Storage and Handling 99 words ▾

16 HOW SUPPLIED/STORAGE AND HANDLING Remifentanil Hydrochloride for injection is a sterile, nonpyrogenic, preservative-free, white to off-white lyophilized powder for intravenous (IV) administration after reconstitution and dilution. Remifentanil Hydrochloride for injection, for intravenous use, is supplied as follows: NDC Number Strength Container Quantity 0143-9391-10 1 mg per vial 3 mL Vial Packaged in cartons of 10 0143-9392-10 2 mg per vial 5 mL Vial Packaged in cartons of 10 0143-9393-10 5 mg per vial 10 mL Vial Packaged in cartons of 10 Remifentanil Hydrochloride for injection should be stored at 2° to 25°C (36° to 77°F).

Discard unused portion.

📋 Description 178 words ▾

11 DESCRIPTION Remifentanil Hydrochloride for injection is an opioid agonist. The chemical name is 3-[4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidine]propanoic acid methyl ester, hydrochloride salt. The molecular weight is 412.91.

Its molecular formula is C 20 H 28 N 2 O 5 •HCl, and it has the following chemical structure. Remifentanil Hydrochloride for injection is a sterile, nonpyrogenic, preservative-free, white to off-white lyophilized powder for intravenous (IV) administration after reconstitution and dilution. Each vial contains 1 mg of remifentanil base and 3 mg of glycine, 2 mg of remifentanil base and 6 mg of glycine or 5 mg of remifentanil base and 15 mg of glycine; and hydrochloric acid to buffer the solutions to a nominal pH of 3 after reconstitution.

When reconstituted as directed, solutions of Remifentanil Hydrochloride for injection are clear and colorless and contain remifentanil hydrochloride (HCl) equivalent to 1 mg/mL of remifentanil base. The pH of reconstituted solutions of Remifentanil Hydrochloride for injection ranges from 2.5 to 3.5. Remifentanil hydrochloride has a pKa of 7.07.

Remifentanil hydrochloride has an n-octanol: water partition coefficient of 17.9 at pH 7.3. Image

💬 Information for Patients ~1 min read ▾

17 PATIENT COUNSELING INFORMATION Addiction, Abuse, and Misuse Inform patients that the use of Remifentanil Hydrochloride for injection, even when taken as recommended, can result in addiction, abuse, and misuse, which can lead to overdose and death [see Warnings and Precautions (5.1) ] . Life-Threatening Respiratory Depression Inform patients of the risk of life-threatening respiratory depression, including information that the risk is greatest when starting Remifentanil Hydrochloride for injection or when the dosage is increased, and that it can occur even at recommended dosages.

Hyperalgesia and Allodynia Advise patients to inform their healthcare provider if they experience symptoms of hyperalgesia, including worsening pain, increased sensitivity to pain, or new pain [see Warnings and Precautions (5.4) , Adverse Reactions (6) ] . Serotonin Syndrome Inform patients that opioids could cause a rare but potentially life-threatening condition called serotonin syndrome resulting from concomitant administration of serotonergic drugs. Warn patients of the symptoms of serotonin syndrome and to seek medical attention right away if symptoms develop after discharge from the hospital.

Instruct patients to inform their healthcare provider if they are taking, or plan to take serotonergic medications [see Warnings and Precautions (5.5) , Drug Interactions (7) ] . Constipation Advise patients of the potential for severe constipation, including management instructions and when to seek medical attention [see Adverse Reactions (6) , Clinical Pharmacology (12.2) ] . Diprivan® is a registered trademark of Fresenius Kabi USA, LLC.

Distributed by: Hikma Pharmaceuticals USA Inc. Berkeley Heights, NJ 07922 Revised:1/2024 462-901-01

🧬 Pharmacokinetics ~3 min read ▾

12.3Pharmacokinetics After IV doses administered over 60 seconds, the pharmacokinetics of remifentanil fit a three compartment model with a rapid distribution half-life of one minute, a slower distribution half-life of 6 minutes, and a terminal elimination half-life of 10 to 20 minutes. Since the terminal elimination component contributes less than 10% of the overall area under the concentration versus time curve (AUC), the effective biological half-life of Remifentanil Hydrochloride for injection is 3 to 10 minutes.

This is similar to the 3- to 10- minute half-life measured after termination of prolonged infusions (up to 4 hours; see Figure 2) and correlates with recovery times observed in the clinical setting after infusions up to 12 hours. Concentrations of remifentanil are proportional to the dose administered throughout the recommended dose range. The pharmacokinetics of remifentanil are unaffected by the presence of renal or hepatic impairment.

Distribution The initial volume of distribution (V d ) of remifentanil is approximately 100 mL/kg and represents distribution throughout the blood and rapidly perfused tissues. Remifentanil subsequently distributes into peripheral tissues with a steady-state volume of distribution of approximately 350 mL/kg. These two distribution volumes generally correlate with total body weight (except in severely obese patients when they correlate better with ideal body weight [IBW]).

Remifentanil is approximately 70% bound to plasma proteins of which two-thirds is binding to alpha-1-acid-glycoprotein. Elimination The clearance of remifentanil in young, healthy adults is approximately 40 mL/min/kg. Clearance generally correlates with total body weight (except in severely obese patients when it correlates better with IBW).

The high clearance of remifentanil combined with a relatively small volume of distribution produces a short elimination half-life of approximately 3 to 10 minutes (see Figure 2). This value is consistent with the time taken for blood or effect site concentrations to fall by 50% (context-sensitive half-times) which is approximately 3 to 6 minutes. Unlike other fentanyl analogs, the duration of action does not increase with prolonged administration.

Figure 2: Mean Concentration (sd) versus Time Titration to Effect The rapid elimination of remifentanil permits the titration of infusion rate without concern for prolonged duration. In general, every 0.1 mcg/kg/min change in the IV infusion rate will lead to a corresponding 2.5 ng/mL change in blood remifentanil concentration within 5 to 10 minutes. In intubated patients only, a more rapid increase (within 3 to 5 minutes) to a new steady state can be achieved with a 1.0 mcg/kg bolus dose in conjunction with an infusion rate increase.

Metabolism Remifentanil is an esterase-metabolized opioid. A labile ester linkage renders this compound susceptible to hydrolysis by nonspecific esterases in blood and tissues. This hydrolysis results in the production of the carboxylic acid metabolite (3-[4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1- piperidine]propanoic acid), and represents the principal metabolic pathway for remifentanil (> 95%).

The carboxylic acid metabolite is essentially inactive (1/4600 as potent as remifentanil in dogs). Remifentanil is not metabolized by plasma cholinesterase (pseudocholinesterase) and is not appreciably metabolized by the liver or lung. Excretion The carboxylic acid metabolite is excreted by the kidneys with an elimination half-life of approximately 90 minutes.

Image Specific Populations Age: Geriatric Population The clearance of remifentanil is reduced (approximately 25%) in the elderly (> 65 years of age) compared to young adults (average 25 years of age). However, remifentanil blood concentrations fall as rapidly after termination of administration in the elderly as in young adults. Age: Pediatric Population In pediatric patients, 5 days to 17 years of age (n = 47), the clearance and volume of distr… [Excerpted — this section continues on DailyMed.]

🧬 Pharmacodynamics ~3 min read ▾

12.2Pharmacodynamics The analgesic effects of Remifentanil Hydrochloride for injection are rapid in onset and offset. Its effects and side effects are dose dependent and similar to other μ-opioids. Remifentanil Hydrochloride for injection in humans has a rapid blood-brain equilibration halftime of 1 ± 1 minutes (mean ± SD) and a rapid onset of action.

The pharmacodynamic effects of Remifentanil Hydrochloride for injection closely follow the measured blood concentrations, allowing direct correlation between dose, blood levels, and response. Blood concentration decreases 50% in 3 to 6 minutes after a 1-minute infusion or after prolonged continuous infusion due to rapid distribution and elimination processes and is independent of duration of drug administration. Recovery from the effects of Remifentanil Hydrochloride for injection occurs rapidly (within 5 to 10 minutes).

New steady-state concentrations occur within 5 to 10 minutes after changes in infusion rate. When used as a component of an anesthetic technique, Remifentanil Hydrochloride for injection can be rapidly titrated to the desired depth of anesthesia/analgesia (e.g., as required by varying levels of intraoperative stress) by changing the continuous infusion rate or by administering an IV bolus injection. Effects on the Central Nervous System Remifentanil produces respiratory depression by direct action on brain stem respiratory centers.

The respiratory depression involves both a reduction in the responsiveness of the brain stem respiratory centers to increases in carbon dioxide tension and to electrical stimulation. Remifentanil causes miosis, even in total darkness. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origins may produce similar findings).

Marked mydriasis rather than miosis may be seen due to hypoxia in overdose situations. Effects on the Gastrointestinal Tract and Other Smooth Muscle Remifentanil causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum. Digestion of food in the small intestine is delayed and propulsive contractions are decreased.

Propulsive peristaltic waves in the colon are decreased, while tone may be increased to the point of spasm resulting in constipation. Other opioid-induced effects may include a reduction in biliary and pancreatic secretions, spasm of sphincter of Oddi, and transient elevations in serum amylase. Effects on the Cardiovascular System Remifentanil produces peripheral vasodilation which may result in orthostatic hypotension or syncope.

Manifestations of histamine release and/or peripheral vasodilation may include pruritus, flushing, red eyes and sweating and/or orthostatic hypotension. Caution must be used in hypovolemic patients, such as those suffering acute myocardial infarction, because remifentanil may cause or further aggravate their hypotension. Caution must also be used in patients with cor pulmonale who have received therapeutic doses of opioids.

Effects on the Endocrine System Opioids inhibit the secretion of adrenocorticotropic hormone (ACTH), cortisol, and luteinizing hormone (LH) in humans. They also stimulate prolactin, growth hormone (GH) secretion, and pancreatic secretion of insulin and glucagon. Effects on the Immune System Opioids have been shown to have a variety of effects on components of the immune system in in vitro and animal models.

The clinical significance of these findings is unknown. Overall, the effects of opioids appear to be modestly immunosuppressive. Concentration-Efficacy Relationships The minimum effective analgesic concentration will vary widely among patients, especially among patients who have been previously treated with potent agonist opioids [see Dosage and Administration ( 2.1 , 2.2 )] .

The minimum effective analgesic concentration of remifentanil for any individual patient may increase over time due to an increase in pain, the devel… [Excerpted — this section continues on DailyMed.]

🔬 Clinical Studies ~3 min read ▾

14 CLINICAL STUDIES Remifentanil Hydrochloride for injection was evaluated in 3,341 patients undergoing general anesthesia (n = 2,706) and monitored anesthesia care (n = 639). These patients were evaluated in the following settings: inpatient (n = 2,079) which included cardiovascular (n = 426), and neurosurgical (n = 61), and outpatient (n = 1,349). Four-hundred and eighty-six (486) elderly patients (age range 66 to 90 years) and 410 pediatric patients (age range birth to 12 years) received Remifentanil Hydrochloride for injection.

Of the general anesthesia patients, 682 also received Remifentanil Hydrochloride for injection as an IV analgesic agent during the immediate postoperative period.

14.1Induction and Maintenance of General Anesthesia - Inpatient/Outpatient The efficacy of Remifentanil Hydrochloride for injection was investigated in 1,562 patients in 15 randomized, controlled trials as the analgesic component for the induction and maintenance of general anesthesia. Eight of these studies compared Remifentanil Hydrochloride for injection to alfentanil and two studies compared Remifentanil Hydrochloride for injection to fentanyl. In these studies, doses of Remifentanil Hydrochloride for injection up to the ED 90 were compared to recommended doses (approximately ED 50 ) of alfentanil or fentanyl.

Induction of Anesthesia Remifentanil Hydrochloride for injection was administered with isoflurane, propofol, or thiopental for the induction of anesthesia (n = 1,562). The majority of patients (80%) received propofol as the concurrent agent. Remifentanil Hydrochloride for injection reduced the propofol and thiopental requirements for loss of consciousness.

Compared to alfentanil and fentanyl, a higher relative dose of Remifentanil Hydrochloride for injection resulted in fewer responses to intubation (see Table 19). Overall, hypotension occurred in 5% of patients receiving Remifentanil Hydrochloride for injection compared to 2% of patients receiving the other opioids. Remifentanil Hydrochloride for injection has been used as a primary agent for the induction of anesthesia; however, it should not be used as a sole agent because loss of consciousness cannot be assured and because of a high incidence of apnea, muscle rigidity, and tachycardia.

The administration of an induction dose of propofol or thiopental or a paralyzing dose of a muscle relaxant prior to or concurrently with Remifentanil Hydrochloride for injection during the induction of anesthesia markedly decreased the incidence of muscle rigidity from 20% to < 1%. Table 19: Response to Intubation (Propofol/Opioid Induction Propofol was titrated to loss of consciousness. Not all doses of Remifentanil Hydrochloride for injection were equipotent to the comparator opioid. ) Opioid Treatment Group/ (No. of Patients) Initial Dose (mcg/kg) Pre-Intubation Infusion Rate (mcg/kg/min) No.

(%) Muscle Rigidity No. (%) Hypotension During Induction No. (%) Response to Intubation Study 1: Remifentanil Hydrochloride for injection (35) 1 0.1 1 (3%) 0 27 (77%) Remifentanil Hydrochloride for injection (35) 1 0.4 3 (9%) 0 11 (31%) Differences were statistically significant (P < 0.02).

Alfentanil (35) 20 1.0 2 (6%) 0 26 (74%) Study 2: Remifentanil Hydrochloride for injection (116) 1 0.5 9 (8%) 5 (4%) 17 (15%) † Alfentanil (118) 25 1.0 6 (5%) 5 (4%) 33 (28%) Study 3: Remifentanil Hydrochloride for injection (134) 1 0.5 2 (1%) 4 (3%) 25 (19%) Alfentanil (66) 20 2.0 0 0 19 (29%) Study 4: Remifentanil Hydrochloride for injection (98) 1 0.2 11 (11%) † 2 (2%) 35 (36%) Remifentanil Hydrochloride for injection (91) 2 Initial doses greater than 1 mcg/kg are not recommended. 0.4 11 (12%) † 2 (2%) 12 (13%) † Fentanyl (97) 3 NA 1 (1%) 1 (1%) 29 (30%) Use During Maintenance of Anesthesia Remifentanil Hydrochloride for injection was investigated in 929 patients in seven well controlled general surgery studies in conjunction with nitrous oxide, isoflurane, or propofol in both inpatient and outpatient settings.… [Excerpted — this section continues on DailyMed.]

🔒 Drug Abuse and Dependence ~3 min read ▾

9 DRUG ABUSE AND DEPENDENCE

9.1Controlled Substance Remifentanil Hydrochloride for injection contains remifentanil, a Schedule II controlled substance.

9.2Abuse Remifentanil Hydrochloride for injection contains remifentanil, a substance with high potential for misuse and abuse, which can lead to the development of substance use disorder, including addiction [see Warnings and Precautions (5.1) ] . Misuse is the intentional use, for therapeutic purposes, of a drug by an individual in a way other than prescribed by a healthcare provider or for whom it was not prescribed. Abuse is the intentional, non-therapeutic use of a drug, even once, for its desirable psychological or physiological effects.

Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use (e.g., continuing drug use despite harmful consequences, giving a higher priority to drug use than other activities and obligations), and possible tolerance or physical dependence. Misuse and abuse of Remifentanil Hydrochloride for injection increases risk of overdosage, which may lead to central nervous system and respiratory depression, hypotension, seizures, and death.

The risk is increased with concurrent abuse of Remifentanil Hydrochloride for injection with alcohol and/or other CNS depressants. Abuse of and addiction to opioids in some individuals may not be accompanied by concurrent tolerance and symptoms of physical dependence. In addition, abuse of opioids can occur in the absence of addiction.

All patients treated with opioids require careful and frequent reevaluation for signs of misuse, abuse, and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use. Patients at high risk of Remifentanil Hydrochloride for injection abuse include those with a history of prolonged use of any opioid, including products containing remifentanil, those with a history of drug or alcohol abuse, or those who use Remifentanil Hydrochloride for injection in combination with other abused drugs. “Drug-seeking” behavior is very common in persons with substance use disorders.

Drug-seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing, or referral, repeated “loss” of prescriptions, tampering with prescriptions, and reluctance to provide prior medical records or contact information for other treating healthcare provider(s). “Doctor shopping” (visiting multiple prescribers to obtain additional prescriptions) is common among people who abuse drugs and people with substance use disorder. Preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with inadequate pain control.

Remifentanil Hydrochloride for injection, like other opioids, can be diverted for nonmedical use into illicit channels of distribution. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests, as required by state and federal law, is strongly advised. Proper assessment of the patient, proper prescribing practices, periodic reevaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs.

Risks Specific to Abuse of Remifentanil Hydrochloride for injection Abuse of Remifentanil Hydrochloride for injection poses a risk of overdose and death. The risk is increased with concurrent use of Remifentanil Hydrochloride for injection with alcohol and/or other CNS depressants. Parenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV.

9.3Dependence Both tolerance and physical dependence can develop during use of opioid therapy. Tolerance is a physiological state characterized by a reduced response to a drug after repeated administration (i.e., a higher dose of a drug is required to produce the same effect t… [Excerpted — this section continues on DailyMed.]

🔒 Controlled Substance 14 words ▾

9.1Controlled Substance Remifentanil Hydrochloride for injection contains remifentanil, a Schedule II controlled substance.

🧪 Nonclinical Toxicology ~1 min read ▾

13 NONCLINICAL TOXICOLOGY

13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis Long-term studies in animals to evaluate the carcinogenic potential of remifentanil have not been conducted. Mutagenesis Mutagenicity was observed with remifentanil in the in vitro mouse lymphoma assay in the presence but not absence of metabolic activation. Remifentanil did not induce gene mutation in the in vitro bacterial reverse mutation assay (Ames test) and was not genotoxic in the in vivo rat hepatocyte unscheduled DNA synthesis assay.

No clastogenic effect was seen in cultured Chinese hamster ovary cells or in the in vivo mouse micronucleus test. Impairment of Fertility Remifentanil has been shown to reduce fertility in male rats when tested after 70+ days of daily IV administration of 0.5 mg/kg, which is approximately 0.2 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min in terms of mg/m 2 of body surface area for a surgical procedure lasting 3 hours or 40 times a single bolus human dose of 2 mcg/kg, in terms of mg/m 2 of body surface area.

The fertility of female rats was not affected at IV doses as high as 1 mg/kg which is 0.4 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min in terms of mg/m 2 of body surface area for a surgical procedure lasting 3 hours or approximately 80 times a single bolus human dose of 2 mcg/kg, in terms of mg/m 2 of body surface area, when administered for at least 15 days before mating.

📄 Carcinogenesis, Mutagenesis, Impairment of Fertility ~1 min read ▾

13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis Long-term studies in animals to evaluate the carcinogenic potential of remifentanil have not been conducted. Mutagenesis Mutagenicity was observed with remifentanil in the in vitro mouse lymphoma assay in the presence but not absence of metabolic activation. Remifentanil did not induce gene mutation in the in vitro bacterial reverse mutation assay (Ames test) and was not genotoxic in the in vivo rat hepatocyte unscheduled DNA synthesis assay.

No clastogenic effect was seen in cultured Chinese hamster ovary cells or in the in vivo mouse micronucleus test. Impairment of Fertility Remifentanil has been shown to reduce fertility in male rats when tested after 70+ days of daily IV administration of 0.5 mg/kg, which is approximately 0.2 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min in terms of mg/m 2 of body surface area for a surgical procedure lasting 3 hours or 40 times a single bolus human dose of 2 mcg/kg, in terms of mg/m 2 of body surface area.

The fertility of female rats was not affected at IV doses as high as 1 mg/kg which is 0.4 times a human intravenous infusion of an induction dose of 1 mcg/kg with a maintenance dose of 2 mcg/kg/min in terms of mg/m 2 of body surface area for a surgical procedure lasting 3 hours or approximately 80 times a single bolus human dose of 2 mcg/kg, in terms of mg/m 2 of body surface area, when administered for at least 15 days before mating.

📄 Recent Major Changes 21 words ▾

Boxed Warning 01/2024 Warnings and Precautions (5.3, 5.4) 01/2024 Boxed Warning 01/2024 Warnings and Precautions ( 5.3 , 5.4 ) 01/2024

📄 Package Label / Principal Display Panel 201 words ▾

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL NDC 0143- 9391 -01 Rx only Remifentanil Hydrochloride for Injection CII 1 mg For Intravenous use ONLY Single Dose Vial Discard Unused Portion NDC 0143- 9392 -01 Rx only Remifentanil Hydrochloride for Injection CII 2 mg For Intravenous use ONLY Single Dose Vial Discard Unused Portion NDC 0143- 9393 -01 Rx only Remifentanil Hydrochloride for Injection CII 5 mg For Intravenous use ONLY Single Dose Vial Discard Unused Portion NDC 0143- 9391 -10 Rx only Remifentanil Hydrochloride for Injection CII 1 mg Equivalent to 1 mg of remifentanil For Intravenous use ONLY Single Dose Vial Discard Unused Portion 10 x 1 mg Single Dose Vials NDC 0143- 9392 -10 Rx only Remifentanil Hydrochloride for Injection CII 2 mg Equivalent to 2 mg of remifentanil For Intravenous use ONLY Single Dose Vial Discard Unused Portion 10 x 2 mg Single Dose Vials NDC 0143- 9393 -10 Rx only Remifentanil Hydrochloride for Injection CII 5 mg Equivalent to 5 mg of remifentanil For Intravenous use ONLY Single Dose Vial Discard Unused Portion 10 x 5 mg Single Dose Vials SERIALIZATION IMAGE 1 mg vial 2mg vial 5mg vial 1 mg carton 2 mg carton 5 mg carton serialization image

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗

Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for this package alone, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q1 2026 · 5 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
75
Units reimbursed last 4 qtrs
95
Gross reimbursed last 4 qtrs
$1.7K
Avg / prescription
$22.38
Avg / unit
$17.6684
Latest quarter Q1 2026
0Rx
Fee-for-service vs managed care ⓘ
33% FFS 67% MCO
Fee-for-service · 25 Rx Managed care · 50 Rx
State Medicaid map
Alaska: no data reported AK Maine: no data reported ME Washington: no data reported WA Idaho: no data reported ID Montana: no data reported MT North Dakota: no data reported ND Minnesota: no data reported MN Wisconsin: no data reported WI Michigan: no data reported MI New York: no data reported NY Vermont: no data reported VT New Hampshire: no data reported NH Oregon: no data reported OR Nevada: no data reported NV Wyoming: no data reported WY South Dakota: no data reported SD Iowa: no data reported IA Illinois: no data reported IL Indiana: no data reported IN Ohio: 22 units · 0.2 per 100k residents OH Pennsylvania: no data reported PA New Jersey: no data reported NJ Massachusetts: 48 units · 0.7 per 100k residents MA California: no data reported CA Utah: no data reported UT Colorado: no data reported CO Nebraska: no data reported NE Missouri: 25 units · 0.4 per 100k residents MO Kentucky: no data reported KY West Virginia: no data reported WV Virginia: no data reported VA Maryland: no data reported MD Connecticut: no data reported CT Rhode Island: no data reported RI Arizona: no data reported AZ New Mexico: no data reported NM Kansas: no data reported KS Arkansas: no data reported AR Tennessee: no data reported TN North Carolina: no data reported NC South Carolina: no data reported SC Delaware: no data reported DE Oklahoma: no data reported OK Louisiana: no data reported LA Mississippi: no data reported MS Alabama: no data reported AL Georgia: no data reported GA D.C.: no data reported DC Hawaii: no data reported HI Texas: no data reported TX Florida: no data reported FL
Units reimbursed · per 100k residents
0.20.7
gray = no data reported ⓘ
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 Massachusetts 0.7 /100k
2 Missouri 0.4 /100k
3 Ohio 0.2 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Remifentanil Hydrochloride — the ingredient across all brands.

Top reported reactions

Anaphylactic Shock357
Hypotension159
Anaphylactic Reaction150
Cardiac Arrest121
Blood Pressure Decreased103
Bradycardia88
Tachycardia87

Reporter sex

2,363 reports

Serious outcomes

Death245
Reports over time (by year) — tap or hover for the count & year
2019 2021 2023 2026 152 69
Most recent year is provisional (FAERS lags ~3 months).
Where does this data come from?
Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.

About this NDC listing & data coverage

Finished prescription product
What data is (and isn’t) available for this NDC — tap to expand
NDC identity (package / product / labeler codes) ✓ Available
Labeler ✓ Available
Product & package description ✓ Available
Marketing category & status ✓ Available
Active ingredient / dosage form / route ✓ Available
FDA label (SPL via DailyMed) ✓ Available
Package photos ✓ Available
Inactive ingredients (structured) ✓ Available
NADAC pharmacy acquisition price (CMS) — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey.
Orange Book / therapeutic-equivalence data ✓ Available
HCPCS J-code billing crosswalk — Not published for this NDC Most self-administered / retail products have no J-code — that is normal.
Medicaid utilization (CMS SDUD) ✓ Available
“Not published” reflects what the public FDA / CMS / NLM sources provide for this exact package code — it is a property of the data feeds, not a judgment about the product.

Questions about this listing

Why is there no price listed?
The pricing shown on our NDC pages comes from CMS NADAC, a voluntary survey of retail community pharmacy invoices. CMS does not publish a NADAC for every NDC — packages outside the retail survey (institutional and hospital products, bulk packages, discontinued items, and many OTC items) may never receive one. A missing price reflects the survey's scope, not this product's actual cost, and does not mean the product is free or unavailable.
Is the NDC printed on the package the same as the 11-digit billing NDC?
Yes, they identify this exact package in different formats. The form printed on the packaging and shown on DailyMed is the one the FDA registered. Insurance claims use a fixed 11-digit 5-4-2 format, so the short segment is padded with a leading zero and the dashes are dropped. The Identity section at the top of this page lists each form of this code.
Is this package still being marketed?
Yes, per the latest FDA NDC Directory data on this page: this package is listed as actively marketed, with no marketing end date reported by Hikma Pharmaceuticals USA Inc.. Listing status can change — the directory data on this page refreshes weekly.
Who lists this product with the FDA?
Hikma Pharmaceuticals USA Inc. is the labeler of record for this NDC — the company under whose FDA-assigned code the package is listed. The labeler may be the manufacturer itself or a distributor marketing the product under its own code.
Do I need a prescription for this product?
This NDC is listed with FDA as a prescription product, so it is dispensed under a prescriber's order. Your pharmacist can tell you whether any over-the-counter forms of the same medication exist.
This page identifies an FDA-listed package (the NDC) and reports public regulatory and pricing data about the listing. It is reference information, not a medical recommendation — talk to your pharmacist or prescriber about your own medication.
Where does this data come from?
Listing facts (marketing category, packager status, marketing dates) from the FDA openFDA NDC Directory; label availability from DailyMed; pricing coverage from CMS NADAC; equivalence scope from the FDA Orange Book.
← 00143-9387-25 · Hikma 00143-9392-10 · Hikma →
For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.