Table of Contents

VANCOUVER HOSPITAL & HEALTH SCIENCES CENTRE PHARMACEUTICAL SCIENCES CSU

DRUG DATA SHEET FOR SUBLINGUAL SUFENTANIL

Indications

• sufentanil may be used as a short duration analgesic for incident pain where a procedure such as moving a patient onto a stretcher, dressing changes, debridement, disimpaction, etc. is known to cause pain but needs to be repeated on several occasions as part of normal care

Pharmacology

• sufentanil is a very potent narcotic analgesic - about 5-10 times the potency of fentanyl. It is highly lipid-soluble and rapidly absorbed from mucosal membranes, with analgesic onset of action evident within 3-5 minutes. Effective duration of action is approximately 10-25 minutes.

Dosage and Administration

• because of incomplete and variable cross-tolerance along with significant individual variation, there is no known consistent equivalent dose ratio to calculate when using sufentanil for incident pain. Therefore, incremental titration is required for each patient.

• the usual dose range is 5 - 25 mcg (0.1-0.5 mL) sublingual pre-procedure; maximum dose is 50 mcg (1 mL) per episode. Wait at least 30 minutes before giving sufentanil for the next procedure.

• instruct patient not to swallow for 2 minutes. Wait 3-5 minutes before attempting the procedure.

Side Effects *

• drowsiness hypotension, dizziness, hypertension, chest wall rigidity, bradycardia

• < 1% incidence : tachycardia, chills, pruritus, nausea, respiratory depression, bronchospasm

• OVERDOSAGE: respiratory depression but highly unlikely in doses used sublingually; if serious respiratory depression occurs (less than 6/min or 8-10/min and patient not able to be roused):
  

  1. STAT call to MD

  2. O2 at 4 L/minute

  3. give naloxone (Narcan) 0.1-0.2 mg IV/SC STAT, then 0.1-0.2 mg increments every 10 minutes until respirations > 10/minute

   * primarily from parenteral use

Monitoring

• sedation scale and respiratory rate every 5-10 minutes for 25 minutes after each dose

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Rev Feb 2003