Comparative Pharmacology
Head-to-head clinical analysis: ALFENTANIL versus DURAGESIC 37.
Peer-Reviewed Evidence
Head-to-head clinical analysis: ALFENTANIL versus DURAGESIC 37.
ALFENTANIL vs DURAGESIC-37
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Alfentanil is a potent, short-acting synthetic opioid analgesic that primarily acts as a mu-opioid receptor agonist. It binds to mu-opioid receptors in the central nervous system, leading to G-protein coupled activation of inwardly rectifying potassium channels and inhibition of voltage-gated calcium channels, resulting in hyperpolarization and reduced neurotransmitter release. This produces analgesia, sedation, and respiratory depression.
Fentanyl binds to mu-opioid receptors, activating G-protein coupled receptor signaling, leading to inhibition of adenylate cyclase, decreased cAMP production, and modulation of ion channels (increased potassium efflux, decreased calcium influx). This results in reduced neuronal excitability, inhibition of nociceptive transmission, and altered pain perception. Additionally, fentanyl may interact with other opioid receptors (kappa, delta) with lower affinity.
Initial IV bolus of 5-20 mcg/kg; maintenance infusion of 0.5-1.5 mcg/kg/min; incremental boluses of 5-10 mcg/kg as needed. Induction of anesthesia: 50-100 mcg/kg IV.
Initial: 25 mcg/hour transdermal patch applied every 72 hours. Titrate based on opioid tolerance. For opioid-naive patients: 12 mcg/hour patch.
None Documented
Clinical Note
moderateAlfentanil + Torasemide
"The risk or severity of adverse effects can be increased when Alfentanil is combined with Torasemide."
Clinical Note
moderateAlfentanil + Etacrynic acid
"The risk or severity of adverse effects can be increased when Alfentanil is combined with Etacrynic acid."
Clinical Note
moderateAlfentanil + Furosemide
"The risk or severity of adverse effects can be increased when Alfentanil is combined with Furosemide."
Clinical Note
moderateAlfentanil + Bumetanide
None Documented
Terminal elimination half-life: 90–111 minutes (1.5–1.85 hours). Clinically, context-sensitive half-time is short (~40 min after 3-hour infusion) due to rapid redistribution and metabolism.
Terminal elimination half-life 20-27 hours (range 13-42 h) after transdermal removal; due to continuous absorption from skin depot, effective half-life is longer during patch wear.
Primarily hepatic metabolism via CYP3A4; <1% excreted unchanged in urine; metabolites (mainly noralfentanil) excreted renally. Biliary/fecal excretion of metabolites accounts for ~30%.
Primarily renal: 75% as metabolites (mostly norfentanyl) and <10% unchanged drug. Fecal: 9% via biliary elimination.
Category C
Category C
Opioid Analgesic
Opioid Analgesic
"The risk or severity of adverse effects can be increased when Alfentanil is combined with Bumetanide."