Suzetrigine
Journavx
Selective Nav1.8 sodium-channel blocker — non-opioid analgesic
Selectively inhibits the peripheral Nav1.8 voltage-gated sodium channel on pain-sensing neurons → blocks nociceptive signaling WITHOUT CNS/opioid activity (no euphoria, no dependence).
Indications
- •Moderate-to-severe acute pain (non-opioid alternative; FDA approved Jan 2025)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Acute pain | Loading dose then maintenance PO per label (e.g., 100 mg load, 50 mg q12h) | — |
Pharmacokinetics
Oral. Hepatic CYP3A4 metabolism → drug-interaction potential; avoid strong CYP3A inhibitors/inducers.
Side effects
- !Pruritus, muscle spasm, rash
- !No respiratory depression, no dependence/abuse potential
Contraindications
- ×Strong CYP3A4 inhibitors (contraindicated per label)
Clinical pearls
- ★First-in-class non-opioid for acute pain — the differentiator drug: peripheral Nav1.8 selectivity means no addiction/respiratory-depression liability.
- ★Efficacy roughly comparable to a low-dose opioid combo in trials, without opioid harms — a multimodal/ERAS building block.
Other drugs in Narcotics & Analgesics
- Fentanyl
μ-opioid receptor agonist. ~100× potency of morphine.
- Remifentanil
μ-opioid agonist. Ester linkage hydrolyzed by nonspecific tissue + plasma esterases — no organ-dependent clearance.
- Morphine
μ-opioid receptor agonist. Active metabolite morphine-6-glucuronide (M6G) is analgesic and renally cleared — accumulates in renal failure → prolonged sedation/respiratory depression. Causes histamine release.
- Hydromorphone
μ-opioid agonist ~5–7× more potent than morphine. No clinically significant active metabolites → safer than morphine in renal failure. Less histamine release.
- Sufentanil
Most potent opioid in common clinical use — ~1000× morphine, ~10× fentanyl. High lipid solubility.
- Alfentanil
μ-opioid agonist ~1/5–1/10 the potency of fentanyl but FASTEST onset of the family — low pKa means a high non-ionized fraction at physiologic pH.
- Meperidine
μ-opioid agonist ~1/10 morphine, plus κ-agonism (anti-shivering). Active metabolite normeperidine is renally cleared, proconvulsant, and neurotoxic.
Suggested reading
- •Stoelting & Hines, Pharmacology & Physiology in Anesthetic Practice, 6e
- •Miller's Anesthesia, 9e
- •FDA package insert
