The pharmacokinetics of alfentanil were studied in 11 patients with alcoholic cirrhosis and 10 control patients during general anesthesia. All patients received 50 μg·kg−1alfentanil as an intravenous bolus injection. Plasma concentrations were measured acintervals up to 10 h, using a specific radioimmunoassay technique. Protein binding was measured by equilibrium dialysis. Patients with cirrhosis had a significantly lower (P< 0.01) plasma clearance of alfentanil of 1.6 ± 1.0 ml·min−1·kg−1(mean ± SD) instead of 3.1 ± 1.6 ml · min−1· kg−1in the controls. The total apparent volume of distribution was similar in the two groups. The elimination half-life was prolonged from 90 ± 18 min in the controls to 219 ± 128 min in the cirrhotics (P< 0.01). Patients with cirrhosis had a higher (P< 0.01) alfentanil plasma-free fraction (18.6 ± 9.4%) compared with the control patients (11.5 ± 3.9%). When kinetic parameters were corrected for protein binding, the unbound volume of distribution and the free drug clearance were decreased significantly in patients with cirrhosis. Since the concentration α1-glycoprotein to which alfentanil mainly is bound in plasma did not differ in the two groups, it is suggested that the increase in the free fraction is caused by an alteration of binding sites of this protein in patients with cirrhosis. Owing to its delayed elimination and increased free fraction, alfentanil will exert a prolonged and pronounced effect in patients with cirrhosis.