sufentanil citrate: clinical use

Prescribing considerations

• Restrict use to clinicians experienced with opioids and settings equipped to detect and manage hypoventilation, with access to oxygen, assisted ventilation and naloxone.
• Assess respiratory reserve, consciousness, cardiovascular status, hepatic and renal function, concurrent sedatives and opioid-use-disorder risk.
• Use particular caution with older or frail patients, raised intracranial pressure, head injury, bradyarrhythmia, hypovolaemia, ileus risk, biliary disease or acute pancreatitis.
• Consider opioid-induced hyperalgesia if pain paradoxically worsens despite increasing opioid exposure.

Contraindications and cautions

• Hypersensitivity to sufentanil or any excipient.
• Significant respiratory depression or pulmonary compromise.

Monitoring

• Respiratory rate, oxygen saturation, sedation and level of consciousness.
• Pain response and signs of opioid toxicity or hyperalgesia.
• Blood pressure and heart rate, particularly with cardiovascular medicines or hypovolaemia.
• Urinary retention, gastrointestinal motility and signs of misuse, dependence or withdrawal.
• Features of serotonin syndrome when serotonergic medicines are involved.

Clinical pharmacology

Sufentanil is a lipophilic, potent, selective full mu-opioid receptor agonist. Sublingual absorption avoids much intestinal and first-pass CYP3A4 metabolism; swallowing the tablet produces substantially lower bioavailability. It is metabolised mainly by CYP3A4 to inactive metabolites.

Formulation and product differences

• The selected product is a sublingual tablet in a disposable single-dose applicator for healthcare-professional administration.
• Correct placement under the tongue is important; it is not interchangeable in use with swallowed oral formulations.

Sublingual tablet

Route: Sublingual

Strengths: 30 micrograms