SUZETRIGINE (JOURNAVX®)

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• Voltage-gated sodium channel (NaV) blocker
• Suzetrigine (Journavx®)

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• Suzetrigine is a sodium channel blocker indicated for the treatment of moderate to severe acute pain in adults

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• Suzetrigine is a sodium channel blocker that selectively blocks the NaV1.8 voltage-gated sodium channel, which is expressed in peripheral sensory neurons and is involved in the transmission of pain signals. By selectively inhibiting these channels, suzetrigine inhibits the transmission of pain signals to the spinal cord and brain. A major active metabolite of suzetrigine, M6-SUZ, is a less potent inhibitor of NaV1.8 than suzetrigine by 3.7-fold.

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• Summary
• After bunionectomy, pain control during the first 48 post-op hours was superior with suzetrigine compared to placebo. However, HC/APAP was superior to suzetrigine. After abdominoplasty, suzetrigine was superior to placebo and equivalent to HC/APAP.

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• Concomitant strong CYP3A4 inhibitors

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• Kidney disease
• eGFR > 15 ml/min: No dose adjustment necessary
• eGFR < 15 ml/min: Do not use

• Liver disease
• Child-Pugh A: The recommended dosage is the same as in those with normal hepatic function.
• Child-Pugh B:
• Dose 1: The recommended starting dose of suzetrigine is 100 mg taken orally. Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food. Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).
• Doses 2, 3, and 4: Starting 12 hours after the initial dose, take 50 mg of suzetrigine orally every 12 hours. Take these doses with or without food.
• Dose 5 and Subsequent Doses: Starting 12 hours after Dose 4, take 50 mg of suzetrigine orally every 24 hours. Take these dose(s) with or without food.
• Child-Pugh C: Avoid use

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• NOTE: The drug interactions presented here are NOT all-inclusive. Other interactions may exist. Drug interaction checkers provide the most efficient and practical way to check for interactions among multiple medications. A free interaction checker is available from Drugs.com (see Drugs.com interactions checker).

• Strong CYP3A Inhibitors - Concomitant use of suzetrigine with strong CYP3A inhibitors is contraindicated. Strong CYP3A inhibitors increase suzetrigine and M6-SUZ (active metabolite) exposures, which may cause suzetrigine adverse reactions.
• Moderate CYP3A Inhibitors - Suzetrigine exposure is increased. See moderate CYP3A inhibitor dosing recommendations.
• Strong and Moderate CYP3A Inducers - Avoid concomitant use of suzetrigine with strong and moderate CYP3A inducers. These inducers result in reduced exposures of suzetrigine and M6-SUZ, which may result in reduced suzetrigine efficacy.
• CYP3A Substrates - If suzetrigine is used concomitantly with sensitive CYP3A substrates or CYP3A substrates where minimal concentration changes may lead to loss of efficacy, refer to the Prescribing Information for the CYP3A substrates for dosing instructions. Dosage modification of the concomitant CYP3A substrates may be required when initiating or discontinuing suzetrigine. Suzetrigine is an inducer of CYP3A, and concomitant use with suzetrigine may reduce the exposure of sensitive CYP3A substrates which may decrease the efficacy of these substrates. Discontinuation of suzetrigine may increase exposure to sensitive CYP3A substrates.
• Hormonal Contraceptives - suzetrigine-treated patients using hormonal contraceptives containing progestins other than levonorgestrel and norethindrone should use additional nonhormonal contraceptives (such as condoms), or use alternative contraceptives (such as a combined oral contraceptive containing ethinyl estradiol as the estrogen and levonorgestrel or norethindrone as the progestin, or an intrauterine system) during treatment with suzetrigine and for 28 days after discontinuation of suzetrigine.
• Grapefruit - Avoid food or drink containing grapefruit during treatment with suzetrigine.

• Metabolism and clearance
• Suzetrigine has a major active metabolite called M6-SUZ, which is a less potent inhibitor of NaV1.8 than suzetrigine
• CYP3A4 is the primary pathway for the metabolism of suzetrigine and M6-SUZ. Suzetrigine induces CYP3A and, to a lesser extent, CYP2B6, CYP2C8, CYP2C9, and CYP2C19.
• Suzetrigine inhibits CYP2C8, CYP2C9, and CYP2C19, but is not expected to cause clinically significant drug interactions
• Suzetrigine inhibits OATP1B1, OATP1B3 and OAT3 but is not expected to cause clinically significant drug interactions.
• Suzetrigine is not a P-gp substrate, but M6-SUZ is a P-gp substrate

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• Dosage form
• 50 mg tablet
• No generic. Costs more than $150 for 30 tablets.

• Dosing (moderate to severe acute pain in adults)
• The recommended starting dose is 100 mg orally. Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food to avoid delay in onset of action. Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).
• Starting 12 hours after the initial dose, take 50 mg orally every 12 hours. Take these doses with or without food.
• Use beyond 14 days has not been studied

• Liver disease dosing
• Child-Pugh A: The recommended dosage is the same as in those with normal hepatic function.
• Child-Pugh B:
• Dose 1: The recommended starting dose of suzetrigine is 100 mg taken orally. Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food. Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).
• Doses 2, 3, and 4: Starting 12 hours after the initial dose, take 50 mg of suzetrigine orally every 12 hours. Take these doses with or without food.
• Dose 5 and Subsequent Doses: Starting 12 hours after Dose 4, take 50 mg of suzetrigine orally every 24 hours. Take these dose(s) with or without food.
• Child-Pugh C: Avoid use

• With CYP3A4 inhibitors
• Strong CYP3A4 inhibitors: Do not combine. Contraindicated.
• Moderate CYP3A4 inhibitors:
• Dose 1: The recommended starting dose of suzetrigine is 100 mg orally. Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food. Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).
• Doses 2, 3, and 4: Starting 12 hours after the initial dose, take 50 mg of suzetrigine orally every 12 hours. Take these doses with or without food.
• Dose 5 and Subsequent Doses: Starting 12 hours after Dose 4, take 50 mg of suzetrigine orally every 24 hours. Take these dose(s) with or without food.

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• Suzetrigine was FDA-approved in 2025 and has no long-term safety data

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• Suzetrigine (Journavx®) prescribing information