Formulary
Sufentanil: Indications, Dosing, Side Effects and Interactions
Sufentanil is a potent, highly selective -opioid receptor agonist.
MedNext Academy | 4 min read
Sufentanil: Indications, Dosing, Side Effects and Interactions
Sufentanil is a potent, highly selective -opioid receptor agonist.
Drug action
Sufentanil is a potent, highly selective -opioid receptor agonist.
Cautions
Adrenocortical insufficiency (reduced dose is recommended); asthma (avoid during an acute attack); central sleep apnoea; convulsive disorders; current or history of mental health disorder; current or history of substance use disorder; debilitated patients (reduced dose is recommended); diseases of the biliary tract; elderly (reduced dose is recommended); hypotension; hypothyroidism (reduced dose is recommended); impaired respiratory function (avoid in chronic obstructive pulmonary disease); inflammatory bowel disorders; myasthenia gravis; obstructive bowel disorders; prostatic hypertrophy; shock; urethral stenosis Cautions, further information Dependence and addiction Prolonged use of opioid analgesics may lead to drug dependence and addiction, even at therapeutic doses. There is an increased risk in individuals with current or history of substance use disorder or mental health disorders. See also Important safety information . Central sleep apnoea Opioids cause a dose-dependent increased risk of central sleep apnoea, consider total opioid dose reduction. M Palliative care In the control of pain in terminal illness, the cautions listed should not necessarily be a deterrent to the use of opioid analgesics. M Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: if prescribed a strong , oral , or transdermal opioid (i.e. morphine, oxycodone, fentanyl, buprenorphine, diamorphine, methadone, tramadol, pethidine, pentazocine) as first-line therapy for mild pain (WHO analgesic ladder not observed) if used regularly without concomitant laxative (risk of severe constipation) if prescribed a long-acting (modified-release) opioid without a short-acting (immediate-release) opioid for breakthrough pain (risk of persistence of severe pain) Cautions For sufentanil Acute pancreatitis; brain tumour; history of bradyarrhythmias (increased risk of bradycardia); increased susceptibility to cerebral effects of CO 2 retention (including increased intracranial pressure and impaired consciousness)
Contraindications
Acute respiratory depression; comatose patients; head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment); raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment); risk of paralytic ileus
Side effects
Common or very common Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; hypotension (with high doses); miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; vertigo; visual impairment; vomiting (more common on initiation); withdrawal syndrome Uncommon Drug dependence; dysphoria; seizure Side-effects, further information Respiratory depression Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by naloxone. Dependence, addiction, and withdrawal Long term use of opioids in non-malignant pain (longer than 3 months) carries an increased risk of dependence and addiction, even at therapeutic doses. At the end of treatment the dosage should be tapered slowly to reduce the risk of withdrawal effects; tapering from a high dose may take weeks or months. See also Important safety information . Overdose Opioids (narcotic analgesics) cause coma, respiratory depression, and pinpoint pupils. For details on the management of poisoning, see Opioids, under Emergency treatment of poisoning and consider the specific antidote, naloxone hydrochloride. Side-effects For sufentanil Common or very common Anaemia; anxiety; electrolyte imbalance; fever; gastrointestinal discomfort; gastrointestinal disorders; hypersensitivity; hypertension; hypoproteinaemia; hypoxia; insomnia; laryngeal pain; leucocytosis; muscle complaints; post procedural complications Uncommon Angina pectoris; apathy; apnoea; asthenia; burping; chest discomfort; chills; conjunctivitis; diabetes mellitus; diarrhoea; epistaxis; eye pain; feeling hot; headaches; hiccups; hyperbilirubinaemia; hyperglycaemia; hyperlipidaemia; hypovolaemia; increased risk of infection; lipoma; local swelling; memory impairment; movement disorders; oral hypoaesthesia; pain; procedural complications; psychiatric disorders; pulmonary embolism; pulmonary oedema; reflexes increased; renal impairment; respiratory disorders; sensation abnormal; thrombocytopenia; tremor; urinary hesitation; urinary tract pain Frequency not known Coma
Interactions
**Severe interactions:**
- Concomitant treatment with drugs known to induce bradycardia (e.g.
**Other interactions (2):**
- Opioids such as alfentanil and sufentanil, when combined with sevoflurane, may lead to a synergistic fall in heart rate, blood pressure and respiratory rate.
- Short-acting Opiates [CYP3A4 substrates] Alfentanil (20 g/kg single dose, with concomitant naloxone) Fentanyl (5 g/kg single dose) In an independent published study, Alfentanil AUC 0- 6-fold In...
Pregnancy
Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour. Pregnancy For sufentanil Avoid (toxicity in animal studies). M
Breast feeding
Specialist sources indicate safer alternatives may be preferable if breast-feeding a neonate or preterm infant (no information available).
Hepatic impairment
Caution in moderate to severe impairment (risk of prolonged effects; limited information available). M
Renal impairment
Caution in severe impairment (risk of prolonged effects; limited information available). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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