title: Pharmacokinetic properties of single- and repeated-dose sufentanil sublingual tablets in healthy volunteers.
abstract: OBJECTIVE
  Sufentanil is a μ-opioid agonist with a high therapeutic index in preclinical studies and no active metabolites, and it is highly lipophilic, thereby enabling a transmucosal route of administration. Rapid distribution from the plasma after IV sufentanil administration results in a short duration of action requiring excessive repeated dosing if used for postoperative analgesia. The sufentanil sublingual tablet system (SSTS) is a handheld, preprogrammed, patient-controlled analgesia system designed to allow patients to self-administer sufentanil 15-μg tablets under their tongue with a 20-minute lockout. The pharmacokinetic (PK) characteristics of sufentanil, administered by different routes of delivery and after single and repeated sublingual (SL) administration, were examined in 2 studies.
  
  
  METHODS
  A randomized, open-label, crossover study in healthy subjects evaluated the PK profile of sufentanil 15 μg administered by different routes: IV, SL, buccal (BU), and PO. A second open-label, crossover study in healthy subjects evaluated the PK parameters after single and repeated doses (full SSTS drug cartridge of 40 consecutive SL doses administered every 20 minutes) of a sufentanil 15-μg SL tablet. Doses were self-administered using the SSTS.
  
  
  RESULTS
  In the route of administration study (n = 25), mean Cmax values were highest with IV administration, and bioavailability values were: SL, 59%; BU, 78%; and PO, 9%. The absorption across the oral mucosa was associated with a median plasma half-time (time from Cmax to 50% of Cmax) that was 25-fold longer (2.5 hours) with SL versus IV administration (0.1 hours). In the single- and repeated-dose study (n = 38), mean AUC0-∞ was 125.5 h · pg/mL, and Cmax was 35.0 pg/mL, with a median Tmax of 0.8 hours after the administration of a single sufentanil SL tablet. With 40 consecutive doses, Cmax was 8-fold higher compared with that of a single dose, and steady state was achieved after the 13th dose. Median plasma half-time after the 40th dose was not statistically longer than that after a single dose (2.7 vs 2.2 hours, respectively), and the median Tmax was 0.3 hours after the last repeated dose.
  
  
  CONCLUSIONS
  These study results support the viability of the SSTS for use in patient-controlled analgesia. The wide range of mean drug concentrations achieved after repeated dosing at 20-minute intervals compared with those with a single dose suggests the flexibility of patient-controlled dosing to meet individual analgesic requirements. The prolonged plasma half-time with SL administration is expected to provide a more appropriate duration of analgesia compared with that of IV administration, and the PK properties of repeated-dose administration support a 20-minute lockout interval.
authors.affiliation: PRA Health Sciences, Lenexa, Kansas.
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Willsie
authors.affiliation: AcelRx Pharmaceuticals, Inc, Redwood City, California.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Evashenk
authors.affiliation: AcelRx Pharmaceuticals, Inc, Redwood City, California.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Hamel
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Hwang
authors.affiliation: Essence Sciences, San Jose, California.
authors.forename: Yu-Kun
authors.initials: YK
authors.lastname: Chiang
authors.affiliation: AcelRx Pharmaceuticals, Inc, Redwood City, California. Electronic address: ppalmer@acelrx.com.
authors.forename: Pamela P
authors.initials: PP
authors.lastname: Palmer
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D001682:Biological Availability; D018592:Cross-Over Studies; D004334:Drug Administration Schedule; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy; D059408:Pain Management; D017409:Sufentanil / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D017409:Sufentanil
keywords: context-sensitive half-time; patient-controlled analgesia; sublingual; sufentanil