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[Pharmacology](https://durgical.com/en/pharmacology/) · [Opioids and antagonists](https://durgical.com/en/pharmacology/classes/opioids-and-antagonists/)

# Sufentanil

A μ opioid of the fentanyl family and one of the most potent in clinical use. It is used in general anaesthesia and epidurally in labour.

Updated 2026-11-01

- Class: [Opioids and antagonists](https://durgical.com/en/pharmacology/classes/opioids-and-antagonists/)
- Receptor: μ-opioid receptor
- ATC code: N01AH03

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

◎**μ-opioid receptor**Sufentanil

ⓘ The figure shows fentanyl, from the same 4-anilidopiperidine family, in the μ receptor bound to its Gi protein; sufentanil occupies the same site.

**Target in 3D:** μ-opioid receptor. PDB structure 8EF5 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8EF5) · Drag to rotate · pinch to zoom

## Mechanism of action

Sufentanil is a μ agonist of the fentanyl family, far more potent than morphine (on the order of a thousand times). It gives strong analgesia in anaesthesia; epidurally, with a local anaesthetic, it relieves labour pain. Its respiratory depression can outlast the measured pain relief.

- Reaches the μ receptor quickly by the intravenous or epidural route
- Activates the μ receptor with great potency
- Strong pain relief in anaesthesia or epidurally
- Respiratory depression can outlast the pain relief

## Pharmacokinetics

**Metabolism**
Liver; CYP3A4 is key, so its inhibitors and inducers change its effect.

**Onset and duration**
Rapid onset intravenously.

## Indications

- Analgesic adjunct to balanced general anaesthesia in intubated, ventilated patients
- Epidural analgesia for labour and vaginal delivery, with a local anaesthetic

## Adverse effects

### Common

- Itching
- Flushing and sweating
- Orthostatic hypotension

### Serious (rare, important)

- Respiratory depression and apnoea
- Muscle rigidity, above all of the chest wall
- Overdose from accidental intravascular injection during an epidural

## Contraindications

- Hypersensitivity to sufentanil

## Key interactions

**CYP3A4 inhibitors, or stopping inducers**
Can prolong its effect and cause a fatal overdose.

**Benzodiazepines, alcohol and other central nervous system depressants**
Add up to profound sedation, respiratory depression, coma and death.

## What is monitored

- Continuous monitoring of breathing, oxygen saturation, blood pressure and heart rate
- In obstetric epidurals: maternal breathing and fetal heart rate

## Administration and safety

- Given only by staff trained in anaesthesia and airway management, with continuous monitoring and resuscitation equipment.
- It can cause muscle rigidity, above all of the breathing muscles, managed with a neuromuscular blocker.
- Epidurally, check that the catheter is not in a vessel: intravascular injection causes rigidity and apnoea.
- Its potency makes a dilution or unit error very dangerous: independent double check.

## Nursing care

- Watch breathing and sedation even after the pain is controlled.
- Keep naloxone, oxygen and airway equipment at hand.
- In obstetric epidurals, watch the mother and the fetal heart rate.
- Watch for chest-wall rigidity or difficulty ventilating.

## Pregnancy and breastfeeding

It is used epidurally in labour; the newborn is watched for respiratory depression.

## Memory aid

SUFENTanil = «SUPER fentanyl»: far more potent, same family. Chest-wall rigidity and apnoea if it goes straight into the blood.

## Test yourself

Think of the answer, then tap the question to see it.

## What happens if an epidural dose of sufentanil is accidentally injected into a vessel?

It can cause an overdose with muscle rigidity, above all of the chest wall, and apnoea.

## Why is breathing still watched after the pain is controlled?

Because sufentanil's respiratory depression can outlast its pain relief.

## How is sufentanil muscle rigidity managed?

With a neuromuscular blocker and ventilatory support.

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## Related drugs

- [Fentanyl](https://durgical.com/en/pharmacology/fentanyl/)
- [Remifentanil](https://durgical.com/en/pharmacology/remifentanil/)

[← Back to the class: Opioids and antagonists](https://durgical.com/en/pharmacology/classes/opioids-and-antagonists/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [SUFENTANIL CITRATE injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=20293943-46ff-4345-1aa4-929b4e017a25) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 23 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N01AH03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/sufentanil/