Sufentanil

Sufentanil
Names
Trade namesDsuvia, Sufenta, Zalviso, others
Other namesR30730
IUPAC name
  • N-[4-(Methoxymethyl)-1-(2-thiofuran-2-ylethyl)-4-piperidyl]-N-phenylpropanamide
Clinical data
Drug classOpioid
Main usesPain, anesthesia[1][2]
Side effectsRespiratory depression (insufficient breathing), stiff muscles, abuse[1]
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Pregnancy
category
  • US: N (Not classified yet)
    Routes of
    use    		Intravenous therapy (IV), intramuscular injection (IM), subcutaneous injection (SQ), epidural, intrathecal
    Duration of actionUp to 4 hr[1]
    External links
    AHFS/Drugs.comMonograph
    Legal
    License data
    Legal status
    • AU: S8 (Controlled drug)
    • CA: Schedule I
    • DE: Anlage III (Special prescription form required)
    • UK: Class A
    • US: Schedule II
    • EU: Rx-only
    • In general: ℞ (Prescription only)
    Pharmacokinetics
    Elimination half-life162 minutes
    Chemical and physical data
    FormulaC22H30N2O2S
    Molar mass386.55 g·mol−1
    3D model (JSmol)
    Melting point97 °C (207 °F)
    SMILES
    • O=C(N(c1ccccc1)C2(COC)CCN(CC2)CCc3sccc3)CC
    InChI
    • InChI=1S/C22H30N2O2S/c1-3-21(25)24(19-8-5-4-6-9-19)22(18-26-2)12-15-23(16-13-22)14-11-20-10-7-17-27-20/h4-10,17H,3,11-16,18H2,1-2H3 checkY
    • Key:GGCSSNBKKAUURC-UHFFFAOYSA-N checkY

    Sufentanil, sold under the brand names Sufenta among others, is an opioid medication used to treat moderate to severe pain and during anesthesia.[1][2] It may be given under the tongue, by injection into a vein, or into epidural space.[1][2] Effects last for up to 4 hours.[1]

    Common side effects include respiratory depression (insufficient breathing) and stiff muscles.[1] Other side effects may include abuse, adrenal insufficiency, low blood pressure, androgen deficiency, and serotonin syndrome.[1] It works by attaching to μ-opioid receptors in the brain.[2]

    Sufentanil was first made in 174 and approved for medical use in the United States in 1984.[3][1] In the United States it costs about 50 USD for 500 ucg as of 2021.[4] In the United States it is classified as a Schedule II controlled substance.[1]

    Medical uses

    The main use of this medication is in operating suites and critical care where pain relief is required for a short period of time. It also offers properties of sedation and this makes it a good analgesic component of anesthetic regimen during an operation.[5]

    Because of its extremely high potency, it is often used in surgery and post-operative pain management for patients that are heavily opioid dependent/opioid tolerant because of long term opiate use for chronic pain or illicit opiate use. Currently sufentanil is the most potent opioid painkiller available for use in humans. Although more potent narcotic pain medications do exist, all medications stronger than sufentanil are approved for veterinary use only. It is also used in surgery and post operative pain control in patients that are taking high dose buprenorphine for chronic pain because it is the only opioid that has a potency and binding affinity strong enough to displace buprenorphine from the opioid receptors in the central nervous system and provide analgesia.[6]

    In 2018 a sublingual tablet form was approved in the US for use in battlefield settings where intravenous (IV) treatments may not be readily available.[7]

    Dosage

    The tablets under the tongue are used at a dose of 15 to 30 ug.[2][8]

    Side effects

    It is essential for the administering medical professional to be trained in airway management with readily available airway equipment because the drug causes significant respiratory depression and may cause respiratory arrest if given too rapidly or in too high a dose. Other opioid side effects such as heart rhythm irregularity, blood pressure changes and nausea/vomiting can also be present in patients given this drug and should be dealt with accordingly.

    Sufentanil has been associated with rare instances of anaphylaxis.

    Overdose

    Because sufentanil is very potent, practitioners must be prepared to reverse the effects of the drug should the patient exhibit symptoms of overdose such as respiratory depression or respiratory arrest. As for all other opioid-based medications, naloxone (trade name Narcan) is the definitive antidote for overdose. Depending on the amount administered, it can reverse the respiratory depression and, if enough is administered, completely reverse the effects of sufentanil.[9][10]

    Chemistry

    It is a synthetic opioid analgesic drug approximately 5 to 10 times as potent as its parent drug, fentanyl, and 500 times as potent as morphine. Structurally, sufentanil differs from fentanyl through the addition of a methoxymethyl group on the piperidine ring (which increases potency but is believed to reduce duration of action[11]), and the replacement of the phenyl ring by thiophene.

    Society and culture

    Sufentanil with and without lidocaine or mepivacaine is available as a transdermal patch similar to fentanyl in Europe under trade names such as Chronogesic. It is available as a sublingual tablet under the trade name Dsuvia.[12] The decision to approve this new potent synthetic opioid came under criticism from politicians and from the chair of the FDA advisory committee, who fear that the tablets will be easily diverted to the illegal drug market.[13]

    See also

    References

    1. 1 2 3 4 5 6 7 8 9 10 "SUFentanil Monograph for Professionals". Drugs.com. Archived from the original on 21 January 2021. Retrieved 15 October 2021.
    2. 1 2 3 4 5 "Dzuveo". Archived from the original on 23 November 2020. Retrieved 15 October 2021.
    3. ↑ Baheti, Dwarkadas K.; Laheri, Vandana V. (31 March 2018). Understanding Anesthetic Equipment & Procedures: A Practical Approach. JP Medical Ltd. p. 16. ISBN 978-93-5270-316-6. Archived from the original on 17 October 2021. Retrieved 15 October 2021.
    4. ↑ "Sufentanil Prices, Coupons & Patient Assistance Programs". Drugs.com. Archived from the original on 26 October 2020. Retrieved 15 October 2021.
    5. ↑ Savoia G, Loreto M, Gravino E (September 2001). "Sufentanil: an overview of its use for acute pain management". Minerva Anestesiologica. 67 (9 Suppl 1): 206–216. PMID 11778119.
    6. ↑ "Fentanyl Citrate - Drug Summary". pdr.net. Archived from the original on 24 September 2015. Retrieved 23 October 2015.
    7. ↑ Davio, Kelly (November 5, 2018). "FDA Approves Painkiller Dsuvia Amid Criticism". American Journal of Managed Care. Archived from the original on February 20, 2020. Retrieved January 11, 2021.
    8. ↑ "Zalviso". Archived from the original on 28 October 2020. Retrieved 15 October 2021.
    9. ↑ "Sufenta (Sufentanil Citrate Injection) Drug Information: Overdosage and Contraindications - Prescribing Information at RxList". RxList. Archived from the original on 25 September 2015. Retrieved 23 October 2015.
    10. ↑ "The First and Only Naloxone Auto-Injector EVZIO® (naloxone HCl injection)". evzio.com. Archived from the original on 15 February 2016. Retrieved 23 October 2015.
    11. ↑ Vucković S, Prostran M, Ivanović M, Dosen-Mićović Lj, Todorović Z, Nesić Z, Stojanović R, Divac N, Miković Z (2009). "Fentanyl analogs: structure-activity-relationship study". Curr Med Chem. 16 (9): 2468–2474. doi:10.2174/092986709788682074. PMID 19601792.
    12. ↑ Silverman, Ed (November 2, 2018). "Despite criticism and concerns, FDA approves a new opioid 10 times more powerful than fentanyl". Pharmalot. Archived from the original on November 2, 2018. Retrieved November 2, 2018.
    13. ↑ Goodnough, Abby (November 2, 2018). "F.D.A. Approves Powerful New Opioid Despite Warnings of Likely Abuse". The New York Times. Archived from the original on November 2, 2018. Retrieved November 2, 2018.
    External sites:
    Identifiers:
    • "Sufentanil citrate". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 2020-10-22. Retrieved 2021-01-11.
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