Remifentanil
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Remifentanil: From Anesthesia and Analgesia to Common Cold
One-Sentence Summary
Remifentanil is an ultra-short-acting mu-opioid agonist used for anesthesia and analgesia. The TxGNN model predicts it may be effective for common cold, but no clinical trials and only 2 publications (neither studying the cold) are linked to this prediction. The mechanistic review found no plausible link, and the high score is likely a knowledge-graph artifact.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not stated in the registration data. Based on the drug's known pharmacology, it is used for anesthesia and analgesia |
| Predicted New Indication | Common cold |
| TxGNN Prediction Score | 98.68% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 1 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the data compiled for this report. Remifentanil is known as an ultra-short-acting mu-opioid agonist used for anesthesia and analgesia. It has no antiviral action and no role in relieving symptoms of upper respiratory infection.
The two retrieved papers do not support the prediction. One is a study of remifentanil and cold propofol for reducing propofol injection pain. "Cold" there refers to the temperature of the drug, not the illness. The other is a review of awake craniotomy for glioma surgery. Neither studies the common cold.
The mechanistic review therefore concludes that the prediction is most likely an artifact of the knowledge graph, and that there is no sound repurposing rationale.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 21179290 | 2010 | RCT | Korean J Anesthesiol | Remifentanil pretreatment combined with cold propofol to reduce propofol injection pain. Unrelated to the common cold |
| 25909573 | 2015 | Review | J Neurosurg | A single surgeon's 27-year experience with awake craniotomy for glioma resection. Unrelated to the common cold |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN09542P | ULTIVA FOR INJECTION 1 mg/vial | Powder for solution for injection | Not stated in the registration data |
Safety Considerations
- Disease associations from the knowledge graph (not label text): Contraindication links to hypotensive disorder and respiratory failure.
- Drug Interactions: 96 interacting drugs were identified. Examples of Major interactions include bupropion, lorcaserin, dolasetron, naltrexone and palonosetron. Examples of Moderate interactions include morphine, naloxone, atropine, cimetidine and hyoscyamine.
For other safety information, please refer to the package insert.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction is supported only by a model score. There are no clinical trials, and the two retrieved papers do not study the common cold. Remifentanil has no antiviral or symptom-relieving mechanism for upper respiratory infection. The opioid's respiratory depression and hypotension risks also make it a poor fit for this condition.
To proceed, the following is needed:
- Mechanism of action data and a credible pharmacological rationale linking remifentanil to the common cold
- Package insert warnings and contraindications from the Health Sciences Authority (HSA)
- Any direct clinical or preclinical evidence in the common cold. None currently exists.
Appendix: Other Predicted Indications Reviewed
None of the other nine predictions has therapeutic evidence. All are rated Hold.
| Rank | Predicted Indication | Score | Evidence Level | Assessment |
|---|---|---|---|---|
| 2 | Nephrogenic syndrome of inappropriate antidiuresis | 98.15% | L5 | No studies. The condition is caused by gain-of-function variants in the vasopressin V2 receptor, so there is no rationale for remifentanil |
| 3 | Exercise-induced malignant hyperthermia | 96.92% | L5 | No studies. Remifentanil is a non-triggering agent, not a treatment |
| 4 | Familial periodic paralysis | 94.72% | L4 | Case reports of safe anesthetic use only |
| 5 | Hypokalemic periodic paralysis | 93.09% | L4 | Case reports of safe anesthetic use only |
| 6 | Thyrotoxic periodic paralysis, susceptibility to | 89.42% | L5 | No studies and no mechanistic link |
| 7 | Thyrotoxic periodic paralysis | 88.79% | L5 | No studies and no mechanistic link |
| 8 | Malignant hyperthermia, susceptibility to | 88.52% | L4 | Case reports of trigger-free anesthesia. One report describes delayed malignant hyperthermia after TIVA |
| 9 | Headache disorder | 86.05% | L4 | Papers cover anesthetic adjunct use only. Opioids are generally not recommended for primary headache |
| 10 | King-Denborough syndrome | 84.54% | L5 | No studies. Remifentanil can be a safe anesthetic component but is not disease-modifying |
The pattern across these predictions is that remifentanil is a safe anesthetic choice in patients with these conditions. That is not the same as treating the conditions.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.