Opioid Analgesic (Ultra-Potent) Pregnancy: Data in pregnant women insufficient to inform drug-associated risk; extended use in pregnancy may cause neonatal opioid withdrawal syndrome. Embryolethality/maternal toxicity in animals.

Sufentanil

Brand names: Sufenta, Dsuvia (sublingual)

Sufentanil is a potent synthetic opioid used for analgesia during anaesthesia and, in some settings, for neuraxial and acute pain management.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Analgesic adjunct to general anaesthesia: initiate at 1 to 2 mcg/kg IV (slow injection or infusion).

Route: Intravenous (slow injection or infusion); also epidural

Frequency:

Max: As adjunct to general anaesthesia: up to 8 mcg/kg; maintenance total dosage 1 mcg/kg/hr or less of expected surgical time. As primary anaesthetic agent: doses >=8 mcg/kg.

US labelling (Hospira). Individualise dose by age, weight, physical status, other drugs, type of anaesthesia and procedure. Dosage by anaesthesia duration - 1 to 2 hours: 1-2 mcg/kg (~75% or more may be given before intubation); 2 to 8 hours: 2-8 mcg/kg. Incremental supplements 10-25 mcg (1-2 h cases) or 10-50 mcg (2-8 h cases) as needed for surgical stress. Epidural for labour and delivery: 10-15 mcg with 10 mL bupivacaine 0.125% (with or without epinephrine). Elderly: start at low end of range and titrate slowly. Paediatric: IV use documented in a limited number of patients as young as 1 day undergoing cardiovascular surgery; neonatal clearance ~half that of adults and further reduced in cardiovascular disease - no clean per-kg paediatric dose stated; verify against a children's formulary. Schedule II controlled substance.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to sufentanil (e.g. anaphylaxis)

Side effects

Apnoea
Skeletal muscle rigidity
Bradycardia
Respiratory depression
Hypotension

Interactions

CYP3A4 inhibitors (e.g. macrolide antibiotics, azole antifungals, protease inhibitors): increased/prolonged opioid effects - consider dose reduction
Benzodiazepines and other CNS depressants: profound sedation, respiratory depression, coma, death
Serotonergic drugs: risk of serotonin syndrome

Clinical monograph

How it works

It is a highly potent selective mu-opioid receptor agonist, producing profound analgesia and dose-dependent central nervous system depression.

Prescribing in practice

Owing to its high potency it causes profound dose-dependent respiratory depression and must be used only where airway management and ventilatory support are immediately available.
Effects, including respiratory depression, are potentiated by other central nervous system depressants and can outlast a single opioid antagonist dose, requiring continued observation.
It can cause bradycardia, hypotension and muscle rigidity, particularly with rapid administration.

Monitoring

Continuous monitoring of respiration, oxygenation and haemodynamics is required during and after administration.

Counselling the patient

This is a very potent opioid given by trained anaesthetic staff with close monitoring.
Drowsiness and slowed breathing can occur and are watched for closely.

Evidence & guidelines

Its high potency and use as an opioid analgesic in anaesthesia are well established and described in the SPC.

Reference: OAA Guidelines on Labour Analgesia; Miller's Anaesthesia 9th Ed; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways