Suzetrigine is a relatively newer analgesic offering a novel approach to treating acute pain without acting as an opioid. By selectively blocking the Nav1.8 sodium channel found in peripheral pain-sensing nerves, suzetrigine helps reduce pain transmission while minimizing many of the risks associated with traditional opioid therapy. In this episode of the Real Life Pharmacology podcast, we’ll review how suzetrigine works, its FDA-approved indication, common adverse effects, and where it may fit into clinical practice. Whether you’re a pharmacist, pharmacy student, nurse, or other healthcare professional, this episode will provide practical insights to help you better understand this analgesic.
Pimavanserin is an atypical antipsychotic approved for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis. Unlike traditional antipsychotics, it does not block dopamine receptors, making it a unique option for patients with Parkinson’s disease who are highly sensitive to dopamine antagonism.
Mechanism of Action
Pimavanserin works primarily as a selective serotonin 5-HT2A inverse agonist and antagonist, with minor activity at 5-HT2C receptors. This dopamine-sparing effect is the key reason it does not worsen motor symptoms in Parkinson’s disease.
Adverse Effects
The most commonly reported side effects include peripheral edema, nausea, confusion, and hallucinations. QT interval prolongation is a clinically important concern, especially in patients with existing cardiac risk factors. Somnolence may occur but is generally less prominent compared with dopamine-blocking antipsychotics.
Warnings and Precautions
Pimavanserin carries a boxed warning for increased mortality in elderly patients with dementia-related psychosis, consistent with other antipsychotics. It should not be used in patients with known QT prolongation, a history of ventricular arrhythmias, or in combination with other QT-prolonging agents when possible.
Drug Interactions
Strong CYP3A4 inhibitors, such as ketoconazole or clarithromycin, can significantly increase pimavanserin concentrations and require dose reduction. Strong CYP3A4 inducers, such as rifampin or carbamazepine, may reduce efficacy and should generally be avoided. Additive QT prolongation may occur when combined with other QT-prolonging medications, including certain antiarrhythmics, fluoroquinolones, and macrolide antibiotics.
On this episode of the podcast, I cover guanfacine pharmacology, adverse effects, drug interactions, and much more.
Guanfacine is a central acting alpha-2 agonist that has the brand names of Tenex and Intuniv.
Because of guanfacine’s mechanism of action, it suppresses the sympathetic response leading to a drop in pulse and blood pressure.
It is important to remind patients that the onset of action is slow in the management of ADHD with guanfacine. I discuss this further in this podcast episode.
Ranolazine is primarily used for chronic angina management. I discuss pharmacology, drug interactions, adverse effects, and more in this podcast episode.
Ranolazine is well known to have drug interactions. CYP3A4 is of major importance but there are other subtle drug interactions that are important.
QTc prolongation has been reported with ranolazine so it is important to recognize risk factors and other medications that may contribute to this concern.
Enzyme inducers like carbamazepine, phenytoin, and St. John’s wort are all associated with reducing the concentrations of ranolazine.
