Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Fentanyl Sublimaze	Remifentanil Ultiva
Class	Synthetic phenylpiperidine opioid agonist (μ)	Ultra-short-acting μ-opioid agonist
Mechanism	μ-opioid receptor agonist. ~100× potency of morphine.	μ-opioid agonist. Ester linkage hydrolyzed by nonspecific tissue + plasma esterases — no organ-dependent clearance.
Indications	· Intraop analgesia · Pre-induction blunting of laryngoscopy response · Postop pain · Patches for chronic pain	· TIVA component · Cardiac surgery analgesia · Awake fiberoptic intubation · OB GA cesarean (sometimes)
Dosing	Induction adjunct: 1–3 mcg/kg IV · peds 1–3 mcg/kg IV (full-term + older) Intraop bolus: 0.5–1 mcg/kg IV q30 min · peds 0.5–1 mcg/kg IV q30 min Cardiac induction: 5–25 mcg/kg IV · peds 5–25 mcg/kg IV (peds cardiac) PCA: 10–25 mcg q5–10 min · peds 0.25–0.5 mcg/kg q10–15 min (age-appropriate)	Bolus: 0.5–1 mcg/kg IV (slow over 30 sec) Infusion: 0.05–0.5 mcg/kg/min MAC sedation: 0.025–0.1 mcg/kg/min
PK (onset / duration)	Onset 1–2 min. Duration 30–60 min (bolus). Context-sensitive half-time ↑ with prolonged infusion.	Onset 1 min. Context-sensitive half-time 3–4 min regardless of duration.
Hemodynamics	Minimal at typical doses. Bradycardia at high doses.	↓HR + ↓BP at high infusion rates.
Respiratory	Dose-dependent respiratory depression. Chest wall rigidity at rapid high doses (treat with NMBA).	Profound respiratory depression — must be paired with controlled ventilation or vigilant MAC.
Side effects	· Respiratory depression · Pruritus · Nausea · Constipation · Tolerance + opioid-induced hyperalgesia at high cumulative doses	· Acute opioid tolerance + post-infusion hyperalgesia (dose-dependent) · Bradycardia, hypotension · Chest wall rigidity (most reported of all opioids) · No residual postop analgesia → plan transition opioid before stopping
Contraindications	· MAOI use within 14 days (relative)	· No known absolute
Reversal	—	—
Pearls	· Multimodal analgesia (acetaminophen, NSAID, regional, ketamine) reduces fentanyl needs and OIH. · Watch for 'fentanyl chest wall' rigidity — usually with ≥ 5 mcg/kg push.	· Bridge to long-acting analgesic (morphine 0.1–0.15 mg/kg or hydromorphone 10–20 mcg/kg) ~30 min before stop. · Useful in hepatic + renal failure (organ-independent clearance). · Co-infuse with propofol for TIVA — avoid oversedation by titrating each separately.

Common compares

Propofol vs Etomidate vs Ketamine Sux vs Roc vs Cis Fentanyl vs Remi Phenylephrine vs Norepi Volatiles

Cells showing "—" indicate the drug doesn't have a detail entry for that field yet (most drugs do; some legacy class members haven't been fully populated). Education only — verify dosing against package insert + institutional protocol before bedside use.

Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Fentanyl Sublimaze	Remifentanil Ultiva
Class	Synthetic phenylpiperidine opioid agonist (μ)	Ultra-short-acting μ-opioid agonist
Mechanism	μ-opioid receptor agonist. ~100× potency of morphine.	μ-opioid agonist. Ester linkage hydrolyzed by nonspecific tissue + plasma esterases — no organ-dependent clearance.
Indications	· Intraop analgesia · Pre-induction blunting of laryngoscopy response · Postop pain · Patches for chronic pain	· TIVA component · Cardiac surgery analgesia · Awake fiberoptic intubation · OB GA cesarean (sometimes)
Dosing	Induction adjunct: 1–3 mcg/kg IV · peds 1–3 mcg/kg IV (full-term + older) Intraop bolus: 0.5–1 mcg/kg IV q30 min · peds 0.5–1 mcg/kg IV q30 min Cardiac induction: 5–25 mcg/kg IV · peds 5–25 mcg/kg IV (peds cardiac) PCA: 10–25 mcg q5–10 min · peds 0.25–0.5 mcg/kg q10–15 min (age-appropriate)	Bolus: 0.5–1 mcg/kg IV (slow over 30 sec) Infusion: 0.05–0.5 mcg/kg/min MAC sedation: 0.025–0.1 mcg/kg/min
PK (onset / duration)	Onset 1–2 min. Duration 30–60 min (bolus). Context-sensitive half-time ↑ with prolonged infusion.	Onset 1 min. Context-sensitive half-time 3–4 min regardless of duration.
Hemodynamics	Minimal at typical doses. Bradycardia at high doses.	↓HR + ↓BP at high infusion rates.
Respiratory	Dose-dependent respiratory depression. Chest wall rigidity at rapid high doses (treat with NMBA).	Profound respiratory depression — must be paired with controlled ventilation or vigilant MAC.
Side effects	· Respiratory depression · Pruritus · Nausea · Constipation · Tolerance + opioid-induced hyperalgesia at high cumulative doses	· Acute opioid tolerance + post-infusion hyperalgesia (dose-dependent) · Bradycardia, hypotension · Chest wall rigidity (most reported of all opioids) · No residual postop analgesia → plan transition opioid before stopping
Contraindications	· MAOI use within 14 days (relative)	· No known absolute
Reversal	—	—
Pearls	· Multimodal analgesia (acetaminophen, NSAID, regional, ketamine) reduces fentanyl needs and OIH. · Watch for 'fentanyl chest wall' rigidity — usually with ≥ 5 mcg/kg push.	· Bridge to long-acting analgesic (morphine 0.1–0.15 mg/kg or hydromorphone 10–20 mcg/kg) ~30 min before stop. · Useful in hepatic + renal failure (organ-independent clearance). · Co-infuse with propofol for TIVA — avoid oversedation by titrating each separately.