SUZETRIGINE TAB,ORAL

Clinical Criteria Summary

Patients undergoing surgical procedure with or expected to have moderate-to-severe pain
Patients unable to use or with insufficient response to systemic NSAIDs or acetaminophen as part of Enhanced Recovery After Surgery (ERAS) protocol
Patient not candidate for short-term opioid use, opioid minimization is clinically indicated OR patient declines use of short term opioids as part of shared decision making

Pregnancy must be excluded prior to receiving suzetrigine
If taking contraceptives containing progestins other than levonorgestrel and norethindrone, use additional nonhormonal contraceptives (e.g. condoms) or alternative contraceptives during suzetrigine therapy and for 28 days after the last dose

In patients with moderate hepatic illness (Child-Pugh B) or taking moderate CYP3A4 inhibitors, reduce dose frequency to once every 24 hours after 4 doses (start of day 3)
Avoid use in patients on strong or moderate CYP3A4 inducers

May be considered when post-operative opioids will be used, but opioid minimization is particularly important (e.g., thoracic and abdominal surgery)
Opioids should not be withheld from patients who truly need them for post-operative pain management, even with a history of OUD or dependence; use cautiously with assistance from addiction/pain specialists
Not specifically studied in patients with OUD/opioid dependence or SUD

Tablet for oral use
Loading dose: 100 mg on empty stomach
Maintenance dose: 50 mg every 12 hours, initiated 12 hours after loading dose start

Concomitant use with strong CYP3A4 inhibitors is contraindicated
Patients using contraceptives containing progestins other than levonorgestrel and norethindrone require additional nonhormonal contraception (e.g., condoms) or alternative contraceptives during suzetrigine therapy and for 28 days after the last dose

Currently indicated only as a treatment for acute pain
Demonstrates modest reduction in pain with a small effect size that is numerically better than placebo; clinical significance of this difference is uncertain (e.g., similar request for rescue medication)
Did not perform better than low-dose opioid therapy (e.g., 20 MEDD)
Not studied in context of usual post-operative pain protocols
Studied primarily in middle-aged females; generalizability to how a VHA Veteran population would respond to treatment is unclear
No evidence demonstrates it performs better than treatment options commonly used postoperatively and already on formulary (e.g., NSAIDs, intravenous APAP, opioids, local and regional blocks)