In our world of sedation, anesthesia, and pain management, some drugs have a long and complicated legacy, while others offer a glimpse into the future. This month's spotlight features two agents worth your attention: meperidine, a familiar name with evolving relevance, and suzetrigine, a novel non-opioid analgesic that could change the game.
Meperidine: Old Friend, Narrow Path
Drug Class:
Opioid analgesic (phenylpiperidine derivative)
Mechanism:
Mu-opioid receptor agonist
Classic Uses:
- Procedural sedation
- Pre-op medication
- Post-op shivering control
Why It's Still Around:
- Its potent antishivering effects
- Useful for short procedures when other agents are unavailable
- Familiarity for seasoned clinicians
Historical Context:
First synthesized in 1939 as a potential anticholinergic, meperidine unexpectedly emerged as a pain reliever. It gained massive popularity in the 1950s, believed to be safer and less addictive than morphine—a concept now thoroughly disproven.
The Normeperidine Concern:
Metabolism of meperidine produces normeperidine, a neurotoxic compound that can lead to seizures, especially in patients with renal impairment. Critical Note: Narcan (naloxone) reverses meperidine's opioid effects—but not normeperidine's.
Best Use Guidelines:
- Short-term use only
- Dosing: 25-50 mg IV/IM, single dose
- Avoid in elderly, seizure-prone, or renally impaired patients
- Avoid use with MAO inhibitors
Suzetrigine: A New Chapter in Pain Relief
Drug Class:
Selective Nav1.7 sodium channel blocker
Mechanism:
Blocks peripheral pain signal transmission without opioid pathways
Indication:
Investigational drug for acute pain (oral formulation)
What Makes It Unique:
Suzetrigine targets the Nav1.7 sodium channel, known to play a pivotal role in pain signaling. People with congenital mutations in Nav1.7 can't feel pain—but otherwise function normally. This insight sparked the development of suzetrigine, aimed at non-opioid pain relief without the risk of sedation or addiction.
Clinical Potential:
- Provide potent analgesia for acute pain (e.g., surgical, dental)
- Reduce or eliminate the need for opioids post-operatively
- Be ideal for opioid-sparing protocols
Why It Matters in Sedation:
- Enhancing postoperative pain control
- Supporting opioid-sparing strategies
- Reducing risk in opioid-naive or high-risk patients
Final Take:
Meperidine and suzetrigine may sit on opposite ends of the pharmacological timeline, but they share a common thread: the need for clinical judgment, contextual use, and a clear understanding of mechanism, metabolism, and patient safety.
I personally have not had any experience directly with suzetrigine. I would love to hear from any of you that have and how it worked for you and your patients!
Understanding both the legacy drugs we still occasionally use and the innovative therapies on the horizon helps ensure that our treatment plans are always informed, intentional, and patient-centered.
Conclusion:
As always, we value your input. If you have any questions or feedback, please reach out—whether about meperidine, suzetrigine, or any of the other clinical aspects we explore together. Let’s continue to elevate the care we provide by staying informed and intentional with our choices.
Stay safe and keep improving care!
Dr. Travis V. Coulter
Co-Founder, Xchart