• 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.

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.

(Generic available)

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

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.

Sufenta

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

• Supplement in anesthesia.
• Decreased pain.

Therapeutic Classification: opioid analgesics, analgesic adjuncts

Pharmacologic Classification: opioid agonists

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).

Schedule II (C-II)

(analgesia†)

†Respiratory depression may last longer than analgesia.

• 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.

soo-FEN-ta-nil

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)