Nurses Compass
Drug Guide
Sufentanil citrate
Classification
Therapeutic: Analgesic, Opioid
Pharmacological: μ-Opioid receptor agonist
FDA Approved Indications
- Management of pain severe enough to require opioid analgesia and for which alternative methods are inadequate
Mechanism of Action
Sufentanil is a potent μ-opioid receptor agonist that provides analgesia by binding to opioid receptors in the central nervous system, inhibiting ascending pain pathways and altering the perception of and response to pain.
Dosage and Administration
Adult: Dosing is individualized based on patient needs, typically administered via IV for anesthesia or pain management; for Dsuvia, sublingual tablets are used at doses ranging from 30 to 30 mcg.
Pediatric: Limited data; use in children under 2 years not recommended.
Geriatric: Start at lower doses due to increased sensitivity and risk of respiratory depression.
Renal Impairment: Use with caution; dose adjustments may be necessary.
Hepatic Impairment: Use with caution; may require dose reduction.
Pharmacokinetics
Absorption: Rapid absorption; peak plasma concentrations occur within minutes after IV administration.
Distribution: Widely distributed with a volume of distribution of approximately 130 L.
Metabolism: Hepatically metabolized primarily via CYP3A4 to inactive metabolites.
Excretion: Excreted mainly via bile and urine; metabolites are inactive.
Half Life: Approximately 2-4 hours in healthy adults.
Contraindications
- Known hypersensitivity to sufentanil or other opioids.
- Use with caution in respiratory depression, severe asthma, or increased intracranial pressure.
Precautions
- Monitor for respiratory depression, hypotension, and sedation.
- Use with caution in elderly, debilitated, or patients with hepatic or renal impairment.
Adverse Reactions - Common
- Respiratory depression (Serious)
- Hypotension (Common)
- Nausea and vomiting (Common)
- Sedation (Common)
Adverse Reactions - Serious
- Respiratory arrest (Serious)
- Circulatory depression (Serious)
- Anaphylaxis (Rare)
Drug-Drug Interactions
- CNS depressants (e.g., benzodiazepines, SARIs), other opioids, CYP3A4 inhibitors (e.g., ketoconazole, ritonavir)
Drug-Food Interactions
- Alcohol
Drug-Herb Interactions
N/ANursing Implications
Assessment: Assess pain level, respiratory status, blood pressure, and level of sedation before and periodically during administration.
Diagnoses:
- Ineffective airway clearance related to respiratory depression
- Risk for falls related to sedation and hypotension
Implementation: Administer with appropriate monitoring, especially respiratory and cardiovascular status. Have resuscitation equipment available.
Evaluation: Monitor for adequate pain relief, respiratory stability, and adverse effects.
Patient/Family Teaching
- Instruct patient to report any difficulty breathing, excessive sedation, or unusual sensations.
- Caution against operating machinery or performing hazardous activities.
Special Considerations
Black Box Warnings:
- Respiratory depression, which can be life-threatening.
- Risks associated with misuse, abuse, and addiction.
Genetic Factors: Variation in CYP3A4 activity can affect metabolism and response.
Lab Test Interference: May affect liver function tests due to hepatic metabolism.
Overdose Management
Signs/Symptoms: Respiratory depression, unconsciousness, pinpoint pupils.
Treatment: Administer opioid antagonist (naloxone), support respiration with oxygen and ventilation, monitor in a controlled setting.
Storage and Handling
Storage: Store in a secure, locked cabinet at room temperature away from light and moisture.
Stability: Stable under recommended storage conditions for the duration of the labeled shelf life.