In this episode, TRC Healthcare editor, Vickie Danaher, PharmD, digs into Suzetrigine—brand name Journavx—the first non-opioid analgesic approved in over two decades.
You’ll hear how it works, how it compares to hydrocodone/acetaminophen, and why it might be a game-changer for patients at risk of opioid misuse. We’ll also unpack limitations in the clinical trials, cost concerns, dosing nuances, and key drug interactions to watch for. Plus, we’ll share tips for counseling patients and navigating formulary decisions, especially if your site participates in the manufacturer’s pilot program.
Don’t miss our quick skim graphic and comparison resource to help you make informed decisions.
This is an excerpt from our April 2025 Pharmacy Essential Updates continuing education webinar series.
The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Explain How Suzetrigine Stacks Up for Acute Pain
- Graphic: New Drug: Suzetrigine (Journavx)
- Resource: Analgesics for Acute Pain in Adults
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Transcript:
This transcript is automatically generated.
00:00:04 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your go-to podcast for fast, evidence-based insights.
00:00:11 Narrator
On this episode, Associate Editor and Clinical Pharmacist Vickie Danaher spotlights Suzetrigine—Journavx—the first in a new class of non-opioid analgesics and breaks down what you need to know before recommending it for acute pain, in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:31 Narrator
TRC has been a trusted resource for healthcare professionals for over 40 years—and now we’re bringing that expertise straight to your ears every 2nd and 4th Tuesday, in bite-sized, actionable episodes…right here on Clinical Capsules.
00:00:45 Narrator
Let’s take a closer look…
00:00:52 Vickie Danaher
And our article says the spotlight is on Suzetrigine, or Journavx as the first met in a new class of non-opioid analgesics approved in over 2 decades.
00:01:03 Vickie Danaher
And given all the ongoing concerns with opioids, such as the risk of misuse or developing opioid use disorder, it can make sense that Suzetrigine is getting a lot of attention as a potential alternative for managing pain.
00:01:17 Vickie Danaher
So today we’re going to talk about the efficacy and safety of Suzetrigine, its role in therapy, and what we need to watch out for if patients get this medication.
00:01:28 Vickie Danaher
So like I mentioned, Suzetrigine has a different mechanism of action than opioids, which we know block pain by binding to opioid receptors mainly in the brain and spinal cord and also by releasing dopamine which leads to feelings of euphoria.
00:01:43 Vickie Danaher
Suzetrigine, now on the other hand, is a selective sodium channel blocker and it works by inhibiting a specific sodium channel in the body called Nav1.8, which is involved in transmitting pain signals from the site of injury or inflammation to the brain.
00:02:01 Vickie Danaher
So by blocking the Nav1.8 sodium channel, Suzetrigine prevents pain signals in the peripheral nervous system from reaching the brain in the first place.
00:02:12 Vickie Danaher
And because Suzetrigine acts outside of the central nervous system and it doesn’t affect the brain directly, it doesn’t have the risks and side effects associated with opioids such as drowsiness, respiratory depression or the potential for abuse or misuse.
00:02:28 Vickie Danaher
And Suzetrigine is also not a controlled substance.
00:02:33 Vickie Danaher
But how well does Suzetrigine work? Based on clinical studies, you’ll hear that Suzetrigine reduces moderate to severe acute pain better and faster than placebo.
00:02:45 Vickie Danaher
And it also works similar to hydrocodone/acetaminophen.
00:02:51 Vickie Danaher
But keep in mind that these data are mainly in about 900 patients receiving Suzetrigine after a tummy tuck or bunion removal.
00:02:59 Vickie Danaher
And about 85% or more of the participants in these studies were white women with an average age in their 40s.
00:03:07 Vickie Danaher
So this is a pretty specific group of patients. Explain it’s too soon to say how well Suzetrigine works in a broader, more diverse patient population.
00:03:17 Vickie Danaher
It’s also too soon to say if Suzetrigine works for other types of pain, such as chronic pain or nerve pain. Although trials are investigating its use for these conditions.
00:03:30 Vickie Danaher
There’s also some other limitations and downsides to be aware of.
00:03:34 Vickie Danaher
For example, these trials of Suzetrigine allowed taking ibuprofen as needed as a rescue medication.
00:03:41 Vickie Danaher
The data on how many participants took ibuprofen are not yet reported.
00:03:45 Vickie Danaher
So that makes it difficult to determine how much of the effect may be due to the rescue treatment versus Suzetrigine itself.
00:03:53 Vickie Danaher
The trials also aren’t formally published in a peer review journal yet, so for now, we’re relying on the information from product labeling and the manufacturer website.
00:04:03 Vickie Danaher
In addition, the studies used doses of hydrocodone/acetaminophen that are lower than what’s often given post op.
00:04:10 Vickie Danaher
And it was dosed every six hours, which is less frequent than the Q4 to 6h interval that many patients would take after surgery.
00:04:19 Vickie Danaher
Plus another potential big limitation is cost. Since Suzetrigine costs about $15 per tablet.
00:04:28 Vickie Danaher
So anticipate payer rejects or prior auths, and overall don’t jump to Suzetrigine for moderate to severe acute pain.
00:04:38 Vickie Danaher
Instead, continued to reassure patients that oral acetaminophen or an NSAID, such as ibuprofen, is usually effective for acute pain.
00:04:48 Vickie Danaher
And recommend either one of these medications first, or the combination of acetaminophen and an NSAID if needed.
00:04:56 Vickie Danaher
So for example, we can suggest acetaminophen 500 to 1000 milligrams and ibuprofen 200 to 400 milligrams every six hours as needed.
00:05:09 Vickie Danaher
Explain that the combination seems to work better than either med alone, and doses can be taken at the same time.
00:05:17 Vickie Danaher
And then we can consider Suzetrigine as an option for managing acute pain if acetaminophen and an NSAID isn’t enough, or if these meds can’t be used.
00:05:28 Vickie Danaher
As well as if patients can afford Suzetrigine’s cost.
00:05:34 Vickie Danaher
It may also be suitable in patients with risks for abuse or misuse, or patients with opioid use disorder, although it was not specifically studied in these patients.
00:05:45 Vickie Danaher
And then if patients get Suzetrigine, we’ll need to take steps to ensure it’s used appropriately. So watch dosing closely and educate patients about proper administration, since this can be a little confusing.
00:05:59 Vickie Danaher
So most patients getting Suzetrigine should start with two, 50 milligram tablets or 100 milligrams by mouth on an empty stomach first as a loading dose.
00:06:12 Vickie Danaher
And then starting 12 hours later, patients should take one 50 milligram tablet every 12 hours thereafter, and these doses can be taken with or without food.
00:06:23 Vickie Danaher
But again, the loading dose needs to be taken on an empty stomach, so at least one hour before or two hours after food to ensure optimal absorption and to avoid any delay in the onset of action.
00:06:38 Vickie Danaher
Also keep in mind that dose adjustments are needed in moderate liver disease and Suzetrigine should be avoided in severe liver disease.
00:06:48 Vickie Danaher
Also stay alert for interactions. For instance avoids Suzetrigine with strong CYP3A inhibitors such as itraconazole or inducers such as rifampin.
00:07:02 Vickie Danaher
Educate to avoid grapefruit and also ensure that an “Avoid Grapefruit” auxiliary label is included with Suzetrigine prescriptions since grapefruit can increase Suzetrigine levels.
00:07:15 Vickie Danaher
Also check if patients getting Suzetrigine take hormonal contraceptives.
00:07:21 Vickie Danaher
Suzetrigine may decrease the effect of certain progestin hormones, since progestins are CYP3A substrates and Suzetrigine is a CYP3A inducer.
00:07:35 Vickie Danaher
Recommend backup contraception such as condoms while on, Suzetrigine and for 28 days after, and patients who take hormonal contraceptives that contain progestins other than levonorgestrel or norethindrone.
00:07:53 Vickie Danaher
Studies suggest Suzetrigine has a minimal effect on combination ethinyl estradiol with levonorgestrel, but it may affect other combinations.
00:08:05 Vickie Danaher
So this is a good reminder to make sure patient profiles are up to date with current meds when dispensing Suzetrigine to catch potential interactions.
00:08:15 Vickie Danaher
Another thing to stay alert for are look-alike sound-alike errors.
00:08:19 Vickie Danaher
So I know when I first saw the brand name Journavx, the first few letters reminded me of Jornay PM for ADHD, especially if it’s abbreviated as Jornay.
00:08:31 Vickie Danaher
Suzetrigine can also be confused with lamotrigine since they end in the same 7 letters and they both come in a 50 milligram strength.
00:08:41 Vickie Danaher
Let patients know about side effects.
00:08:43 Vickie Danaher
The most common ones with Suzetrigine include itching and muscle spasms. And advise limiting treatment with Suzetrigine to the shortest duration needed.
00:08:53 Vickie Danaher
There are no data for its use in acute pain beyond 14 days.
00:08:58 Vickie Danaher
So watch for Suzetrigine prescriptions with refills or more than a 14 day supply and stay alert for refill requests.
00:09:07 Vickie Danaher
And finally, there’s a couple special considerations relating to Suzetrigine’s use in the hospital that are worth mentioning. In most cases we shouldn’t expect Suzetrigine to be added to formulary… again, mainly due to cost.
00:09:19 Vickie Danaher
It’s about $15 per tablet. So that’s $30 per day.
00:09:25 Vickie Danaher
But you might see some uptake if Suzetrigine gets added to the Non-Opioids Prevent Addiction In the Nation Act, or NOPAIN Act.
00:09:34 Vickie Danaher
This would require Medicare to provide additional reimbursement for Suzetrigine and hospital outpatient departments, and ambulatory care surgery centers.
00:09:45 Vickie Danaher
Also be aware that some inpatient pharmacies may receive an initial supply of brand name Suzetrigine as part of a manufacturer pilot program that provides enough med to treat up to 100 patients for five days.
00:09:58 Vickie Danaher
If your hospital participates in this pilot, make sure that the meds provided are only dispensed to inpatients, not patients being discharged.
00:10:08 Vickie Danaher
So to close out this topic, be sure to get our Suzetrigine quick skim graphic on our website to share fast facts about this new medication.
00:10:18 Vickie Danaher
And also review our resource, Analgesics for Acute Pain in Adults to compare Suzetrigine to other medications.
00:10:30 Narrator
We hope you enjoyed and gained practical insights from listening to this episode!
00:10:34 Narrator
We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights, where you’ll find even more concise, evidence-based tools.
00:10:50 Narrator
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00:11:06 Narrator
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00:11:15 Narrator
Thanks for listening… stay sharp, stay current—and we’ll catch you next time on Clinical Capsules!
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