I’m always on the lookout for new options to treat pain. This is especially true in geriatrics, where opioids and NSAIDs have a bunch of risks. Suzetrigine (Journavx) represents a newer option in pain management in recent years because it introduces an entirely new mechanism of action. Suzetrigine works differently from other analgesics in that it selectively blocks the NaV1.8 sodium channel located on peripheral pain-sensing neurons.
What I Like About Suzetrigine
New Mechanism
Most new pain medications introduced over the past 20 years have simply represented new formulations or combinations of existing drug classes. Suzetrigine provides a different way to treat pain.
No Opioid or NSAID Adverse Effects
Patients can potentially achieve meaningful pain relief without opioid concerns regarding:
- Respiratory depression
- Addiction
- Misuse
- Euphoria
- Withdrawal
NSAIDs are often contraindicated in many patients who have kidney disease, peptic ulcer disease, CHF and bleeding risks (excellent board exam nuggets to remember on NSAIDs). Suzetrigine avoids all of these issues.
Better Cognitive Profile
Because the drug primarily acts in peripheral nerves, patients generally avoid significant sedation unless a drug interaction is encountered (more on that later). For older adults or patients who need to remain mentally sharp, this represents an attractive characteristic compared to opioids, gabapentinoids, and other analgesic agents that can cause sedation and impact cognition.
What I Don’t Like About Suzetrigine
Cost
This is probably my biggest concern. As with many first-in-class medications, suzetrigine is expensive. For hospitals and insurance companies, cost-effectiveness will be an important consideration, especially when inexpensive generic NSAIDs and opioids remain available.
Limited Long-Term Experience
We simply do not have years of post-marketing experience. Whenever a medication introduces an entirely new mechanism, unexpected adverse effects occasionally emerge after widespread use. Time will provide a much clearer safety picture.
Acute Pain Only
Current approval is limited to acute pain. Many clinicians are far more interested in finding better treatments for chronic pain, where long-term opioid therapy remains problematic. Time will tell if future studies may eventually expand its use.
Drug Interactions
In our geriatric, polypharmacy patients, CYP3A4 interactions still complicate prescribing. CYP3A4 inhibitors will increase concentrations of suzetrigine while inducers will lower concentrations. Patients taking medications such as certain antifungals, macrolide antibiotics, or enzyme-inducing antiseizure medications may require alternative therapies or dose adjustments may be necessary.
Effectiveness May Not Match Opioids for Severe Pain
This is an important practical limitation. While suzetrigine reduces pain, patients experiencing extremely severe postoperative pain may still require opioid therapy, particularly during the first 24 to 48 hours after surgery. Rather than replacing opioids entirely, I see suzetrigine becoming another component of multimodal pain management.
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