soo-FEN-ta-nil

Therapeutic Classification: opioid analgesics, analgesic adjuncts

Pharmacologic Classification: opioid agonists

• IV: Analgesic supplement to general anesthesia; usually with other agents (ultra–short-acting barbiturates, neuromuscular blockers, and inhalation anesthetics) to produce balanced anesthesia in patients who are intubated and ventilated.
• Induction/maintenance of anesthesia (with oxygen or oxygen/nitrous oxide and a neuromuscular blocker).
• Epidural: Obstetrical pain during labor and vaginal delivery (in combination with bupivacaine).

Unlabeled Use:

• Epidural: Postoperative pain.

• Binds to opioid receptors in the CNS, altering the response to and perception of pain.
• Produces CNS depression.

• Supplement in anesthesia.
• Decreased pain.

Absorption: IV administration results in complete bioavailability.

Distribution: Does not readily penetrate adipose tissue; crosses the placenta, enters breast milk.

Metabolism/Excretion: Mostly metabolized by the liver; some metabolism in small intestine; ↓ in neonates, further ↓ in neonates with cardiovascular disease.

Half-life: 2.7 hr (↑ during cardiopulmonary bypass; ↑ in neonates, further ↑ in neonates with cardiovascular disease).

(analgesia†)

†Respiratory depression may last longer than analgesia.

Contraindicated in:

• Hypersensitivity; cross-sensitivity among agents may occur
• Known intolerance.

Use Cautiously in:

• Diabetes
• Severe pulmonary or hepatic disease
• CNS tumors
• ↑intracranial pressure
• Head trauma
• Adrenal insufficiency
• Undiagnosed abdominal pain
• Hypothyroidism
• Alcoholism
• Cardiac disease (arrhythmias)
• Geri: Geriatric, debilitated, or critically ill patients
• OB: Use only if the potential benefit justifies the potential risk to the fetus
• Lactation: Use while breastfeeding only if potential benefit justifies potential risk (monitor infant for ↑ drowsiness and breathing difficulties).

CNS: confusion, paradoxical excitation/delirium, postoperative depression, postoperative drowsiness.

EENT: blurred/double vision.

Resp: APNEA, CARDIAC ARREST, LARYNGOSPASM, allergic bronchospasm, respiratory depression.

CV: arrhythmias, bradycardia, circulatory depression, hypotension.

GI: biliary spasm, nausea/vomiting, constipation.

Derm: facial itching.

MS: skeletal and thoracic muscle rigidity.

Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS.

Drug-Drug:

• Avoid use in patients who have received MAO inhibitors within the previous 14 days (may produce unpredictable, potentially fatal reactions).
• Use with benzodiazepines or other CNS depressants including other opioids, non-benzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
• Concurrent use of CYP3A4 inhibitors including ritonavir, ketoconazole, itraconazole, fluconazole clarithromycin, erythromycin, nefazodone, diltiazem, verapamil, nelfinavir, and fosamprenavir↑ levels and risk of opioid toxicity; careful monitoring during initiation, dose changes, or discontinuation of the inhibitor is recommended.
• Concurrent use with CYP3A4 inducers including barbiturates, carbamazepine, efavirenz, corticosteroids, modafinil, nevirapine, oxcarbazepine, phenobarbital, phenytoin, rifabutin, or rifampin may ↓ fentanyl levels and analgesia; if inducers are discontinued or dosage ↓, patients should be monitored for signs of opioid toxicity and necessary dose adjustments should be made.
• Nalbuphine, buprenorphine, or pentazocine may ↓ analgesia.
• Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SSRIs, SNRIs, MAO inhibitors, TCAs, tramadol, trazodone, mirtazapine, 5–HT₃ receptor antagonists, linezolid, methylene blue, and triptans↑ risk of serotonin syndrome.

Low-Dose Anesthesia Adjunct

• IV (Adults): 0.5–2 mcg/kg initially, supplemental doses of 10–25 mcg may be given as needed (not to exceed 1 mcg/kg/hr when administered with nitrous oxide and oxygen).

Moderate-Dose Anesthesia Adjunct

• IV (Adults): 2–8 mcg/kg initially, supplemental doses of 10–50 mcg may be given as needed (not to exceed 1 mcg/kg/hr when administered with nitrous oxide and oxygen).

Primary Anesthesia (with 100% Oxygen)

• IV (Adults): 8–30 mcg/kg initially, supplemental doses of 25–50 mcg may be given as needed or a continuous infusion may be used.
• IV (Children): Cardiovascular surgery — 10–25 mcg/kg initially, followed by maintenance doses of up to 25–50 mcg; clearance in neonates is ↓ and more ↓ in neonates with cardiovascular disease, adjust dose accordingly.

Obstetrical analgesia

• Epidural (Adults): 10–15 mcg in combination with 10 mL of 0.0125% bupivacaine; may be repeated after one hour for two additional doses.

Postoperative pain (unlabeled)

• Epidural (Adults): 30–60 mcg in 10 mL of 0.9% sodium chloride; additional doses of 25 mcg may be given hourly if needed.

(Generic available)

• Solution for injection (preservative-free): 50 mcg/mL;

• Monitor respiratory rate and BP frequently throughout therapy. Report significant changes immediately. The respiratory depressant effects of sufentanil may last longer than the analgesic effects. Monitor closely.
• IV, Epidural: Assess type, location, and intensity of pain before and 3–5 min after IV administration when sufentanil is used to treat pain.

• May cause ↑ serum amylase and lipase concentrations.

• Symptoms of toxicity include respiratory depression, hypotension, arrhythmias, bradycardia, and asystole. Atropine may be used to treat bradycardia. If respiratory depression persists after surgery, prolonged mechanical ventilation may be required. If an opioid antagonist is required to reverse respiratory depression or coma, naloxone (Narcan) is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by IV push every 2 min. For children and patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 1–2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. Administration of naloxone in these circumstances, especially in cardiac patients, has resulted in hypertension and tachycardia, occasionally causing left ventricular failure and pulmonary edema.

• High Alert:Accidental overdose of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order, dose calculations, and infusion pump settings.
• Do not confuse sufentanil with fentanyl.
  • Benzodiazepines may be administered before or after administration of sufentanil to reduce the induction dose requirements, decrease the time to loss of consciousness, and produce amnesia. This combination may also increase the risk of hypotension.
  • High Alert:Opioid antagonists, oxygen, and resuscitative equipment should be readily available during the administration of sufentanil. Sufentanil should be administered IV only in monitored anesthesia care settings (operating room, emergency department, ICU) with immediate access to life support equipment and should be administered only by personnel trained in resuscitation and emergency airway management.

IV Administration:

• IV Push:
  Diluent: Administer undiluted.
• Rate: Administer slowly over 1–3 min. Slow IV administration may reduce the incidence and severity of muscle rigidity, bradycardia, or hypotension. Neuromuscular blocking agents may be administered concurrently to decrease muscle rigidity.
• Intermittent Infusion:
  Diluent: May be diluted with D5W or 0.9% NaCl.
• Rate: Adjust rate based upon the induction dose so that total dose does not exceed 1 mcg/kg per hour of expected surgical time.
• Y-Site Compatibility:
  • acetaminophen
  • acyclovir
  • alemtuzumab
  • alfentanil
  • amikacin
  • aminocaproic acid
  • aminophylline
  • amphotericin B lipid complex
  • amphotericin B liposome
  • anidulafungin
  • argatroban
  • ascorbic acid
  • atracurium
  • atropine
  • azathioprine
  • azithromycin
  • aztreonam
  • benztropine
  • bivalirudin
  • buprenorphine
  • butorphanol
  • calcium chloride
  • calcium gluconate
  • cangrelor
  • carboplatin
  • carmustine
  • caspofungin
  • cefazolin
  • cefepime
  • cefotaxime
  • cefotetan
  • cefoxitin
  • ceftazidime
  • ceftriaxone
  • cefuroxime
  • chloramphenicol
  • chlorpromazine
  • cisatracurium
  • cisplatin
  • clindamycin
  • cyanocobalamin
  • cyclophosphamide
  • cyclosporine
  • cytarabine
  • dacarbazine
  • dactinomycin
  • dantrolene
  • deptomycin
  • daunorubicin hydrochloride
  • dexamethasone
  • dexmedetomidine
  • dexrazoxane
  • digoxin
  • diltiazem
  • diphenhydramine
  • dobutamine
  • docetaxel
  • dopamine
  • doxacurium
  • doxorubicin
  • doxycycline
  • enalaprilat
  • ephedrine
  • epinephrine
  • epirubicin
  • epoetin alfa
  • eptifibatide
  • ertapenem
  • erythromycin
  • esmolol
  • etomidate
  • etoposide
  • etoposide phosphate
  • famotidine
  • fenoldopam
  • fentanyl
  • fluconazole
  • fludarabine
  • fluorouracil
  • folic acid
  • foscarnet
  • fosphenytoin
  • furosemide
  • ganciclovir
  • gemcitabine
  • gentamicin
  • glycopyrrolate
  • granisetron
  • heparin
  • hetastarch
  • hydrocortisone
  • idarubicin
  • ifosfamide
  • imipenem/cilastatin
  • insulin
  • irinotecan
  • isoproterenol
  • ketamine
  • ketorolac
  • labetalol
  • leucovorin
  • levofloxacin
  • lidocaine
  • linezolid
  • magnesium sulfate
  • mannitol
  • mechlorethamine
  • meperidine
  • mesna
  • metaraminol
  • methotrexate
  • methylprednisolone
  • metoclopramide
  • metoprolol
  • metronidazole
  • midazolam
  • milrinone
  • minocycline
  • mitomycin
  • mitoxantrone
  • morphine
  • multivitamins
  • mycophenolate
  • nafcillin
  • nalbuphine
  • naloxone
  • nesiritide
  • nicardipine
  • nitroglycerin
  • nitroprusside
  • norepinephrine
  • octreotide
  • ondansetron
  • oxacillin
  • oxaliplatin
  • oxytocin
  • paclitaxel
  • palonosetron
  • pamidronate
  • pancuronium
  • pantoprazole
  • papaverine
  • pemetrexed
  • penicillin G
  • pentamidine
  • pentazocine
  • pentobarbital
  • phenobarbital
  • phentolamine
  • phenylephrine
  • phytonadione
  • piperacillin/tazobactam
  • potassium acetate
  • potassium chloride
  • potassium phosphates
  • procainamide
  • prochlorperazine
  • promethazine
  • propofol
  • propranolol
  • protamine
  • pyridoxime
  • quinupristin/dalfopristin
  • ranitidine
  • remifentanil
  • rocuronium
  • scopolamine
  • sodium acetate
  • sodium bicarbonate
  • streptokinase
  • succinylcholine
  • tacrolimus
  • teniposide
  • theophylline
  • thiamine
  • thiotepa
  • tigecycline
  • tirofiban
  • tobramycin
  • tolazoline
  • topotecan
  • vancomycin
  • vasopressin
  • vecuronium
  • verapamil
  • vincristine
  • vinorelbine
  • voriconazole
  • zoledronic acid
• Y-Site Incompatibility:
  • dantrolene
  • daptomycin
  • diazoxide
  • indomethacin
  • lorazepam
  • phenytoin
  • thiopental
  • trimethoprim/sulfamethoxazole
.

• Discuss the use of anesthetic agents and the sensations to expect with the patient before surgery.
• Explain pain assessment scale to patient.
• Caution patient to change positions slowly to minimize orthostatic hypotension.
• May causes dizziness and drowsiness. Advise patient to call for assistance during ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr after administration during outpatient surgery.
• Instruct patient to avoid alcohol or other CNS depressants for 24 hr after administration for outpatient surgery.

• General quiescence.
  • Reduced motor activity.
• Pronounced analgesia.

Sufenta

Schedule II (C-II)

• Acute pain (Indications).
• Ineffective breathing pattern (Adverse Reactions).
• Risk for injury (Side Effects).

NDC Code^*

• 0409- Hospira, Inc.
  • 0409-3382- Sufentanil Citrate
    • 0409-3382-21- 10 VIAL, SINGLE-USE in 1 CARTON (0409-3382-21) > 1 mL in 1 VIAL, SINGLE-USE (0409-3382-11)

• 0409- Hospira, Inc.
  • 0409-3382- Sufentanil Citrate
    • 0409-3382-22- 10 VIAL, SINGLE-USE in 1 CARTON (0409-3382-22) > 2 mL in 1 VIAL, SINGLE-USE (0409-3382-12)

• 0409- Hospira, Inc.
  • 0409-3382- Sufentanil Citrate
    • 0409-3382-25- 10 VIAL, SINGLE-USE in 1 CARTON (0409-3382-25) > 5 mL in 1 VIAL, SINGLE-USE (0409-3382-15)

• 0641- West-Ward Pharmaceuticals Corp.
  • 0641-6110- Sufentanil Citrate
    • 0641-6110-10- 10 AMPULE in 1 CARTON (0641-6110-10) > 1 mL in 1 AMPULE (0641-6110-01)

• 0641- West-Ward Pharmaceuticals Corp.
  • 0641-6111- Sufentanil Citrate
    • 0641-6111-10- 10 AMPULE in 1 CARTON (0641-6111-10) > 2 mL in 1 AMPULE (0641-6111-01)

• 0641- West-Ward Pharmaceuticals Corp.
  • 0641-6112- Sufentanil Citrate
    • 0641-6112-10- 10 AMPULE in 1 CARTON (0641-6112-10) > 5 mL in 1 AMPULE (0641-6112-01)

• 17478- Akorn, Inc.
  • 17478-050- Sufentanil Citrate
    • 17478-050-01- 10 AMPULE in 1 CARTON (17478-050-01) > 1 mL in 1 AMPULE

• 17478- Akorn, Inc.
  • 17478-050- Sufentanil Citrate
    • 17478-050-02- 10 AMPULE in 1 CARTON (17478-050-02) > 2 mL in 1 AMPULE

• 17478- Akorn, Inc.
  • 17478-050- Sufentanil Citrate
    • 17478-050-05- 10 AMPULE in 1 CARTON (17478-050-05) > 5 mL in 1 AMPULE

• 61621- AcelRx Pharmaceuticals, Inc
  • 61621-430- Dsuvia
    • 61621-430-01- 1 TABLET in 1 POUCH (61621-430-01)

• 61621- AcelRx Pharmaceuticals, Inc
  • 61621-430- Dsuvia
    • 61621-430-11- 10 TABLET in 1 CARTON (61621-430-11)