Suzetrigine (Journavx) for Acute Dental Pain: First Clinical Case Series of a Selective Naᵥ1.8 Inhibitor in Endodontics.

INTRODUCTION: Emergency dental pain remains a significant clinical challenge, with many patients experiencing moderate-to-severe pain that is inadequately controlled by NSAIDs and acetaminophen. This is compounded by high rates of anesthetic failure in dental practices for cases with symptomatic irreversible pulpitis. Inflammation-driven upregulation of Naᵥ1.8 sodium channels contributes to persistent nociceptive signaling and local anesthetic failure. Suzetrigine (Journavx), a first-in-class selective Naᵥ1.8 inhibitor approved for acute moderate to severe pain, offers a mechanism-based approach by targeting the peripheral sodium channel driving inflammatory dental pain. METHODS: This case series describes four patients treated at endodontic specialty practices who received suzetrigine for distinct acute pain scenarios: (1) augmentation of local anesthesia in a patient with symptomatic irreversible pulpitis and prior anesthetic failure, (2) management of pre-operative emergency dental pain in a patient with symptomatic irreversible pulpitis refractory to conventional analgesics, (3) control of post-treatment inflammatory flare-up pain inadequately managed by NSAIDs and corticosteroids, and (4) management of post-surgical pain in a medically complex patient with Ehlers-Danlos syndrome for whom non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids were contraindicated. Suzetrigine was prescribed as a 100 mg oral loading dose followed by 50 mg every 12 hours as needed. RESULTS: Across all four cases, suzetrigine provided clinically meaningful reductions in pain intensity. In Case 1, a single pre-operative loading dose facilitated profound pulpal anesthesia and successful completion of nonsurgical root canal treatment on two teeth that had previously been refractory to multi-agent local anesthetic protocols. In Case 2, suzetrigine consistently reduced pain from 6-8/10 to ≤2/10, effectively bridging the patient to definitive treatment over six days without opioid use. In Case 3, suzetrigine in combination with ibuprofen and acetaminophen achieved complete symptom resolution of flare-up pain that had been inadequately controlled by high-dose ibuprofen, a corticosteroid dose pack, and antibiotics. In Case 4, a single loading dose provided significant pain relief in a patient with contraindications to NSAIDs and corticosteroids. No adverse effects attributable to suzetrigine were reported in any case. CONCLUSIONS: This case series provides the first clinical evidence for the use of suzetrigine in the management of acute dental pain thereby highlighting the role of Naᵥ1.8 in both pre-operative and post-operative dental pain. Further investigation through randomized controlled trials to establish optimal dosing, combination strategies, and efficacy relative to conventional analgesic regimens are warranted.