SOJOURN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for SOJOURN (SOJOURN).
Selective norepinephrine reuptake inhibitor (NRI) that increases norepinephrine levels in the synaptic cleft, enhancing adrenergic transmission primarily in the descending pain pathways of the spinal cord.
| Metabolism | Metabolized by CYP2D6 and CYP3A4; major metabolites are desmethyl and N-desisopropyl derivatives. Inhibits CYP2D6. |
| Excretion | Renal: 70% unchanged; biliary/fecal: 20% as metabolites; 10% in expired air. |
| Half-life | Terminal half-life 12-15 hours; clinical context: supports twice-daily dosing in most patients. |
| Protein binding | 88% bound to serum albumin; minor binding to alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.8 L/kg; indicates distribution into total body water. |
| Bioavailability | Oral: 65% due to first-pass metabolism; IM: 90%; rectal: 50%. |
| Onset of Action | Oral: 30-60 min; IV: 5-15 min; IM: 15-30 min. |
| Duration of Action | 4-6 hours for analgesic effect; 12-24 hours for anti-inflammatory effect. |
400 mg orally once daily
| Dosage form | LIQUID |
| Renal impairment | GFR ≥60 mL/min: no adjustment; GFR 30-59 mL/min: 200 mg once daily; GFR <30 mL/min: 100 mg once daily; hemodialysis: 100 mg after each dialysis session |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: 200 mg once daily; Child-Pugh C: contraindicated |
| Pediatric use | Weight ≥40 kg: 400 mg once daily; Weight 20-39 kg: 200 mg once daily; Weight <20 kg: 100 mg once daily |
| Geriatric use | Start at 200 mg once daily; titrate based on renal function and tolerability |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for SOJOURN (SOJOURN).
| Breastfeeding | Excreted into breast milk; M/P ratio 0.8. Contraindicated due to potential neonatal toxicity. Avoid breastfeeding during therapy and for 5 half-lives after last dose. |
| Teratogenic Risk | First trimester: Increased risk of major congenital malformations (cardiovascular, neural tube defects) based on animal studies and limited human data. Second and third trimesters: Associated with fetal growth restriction, oligohydramnios, and preterm birth. |
| Fetal Monitoring |
■ FDA Black Box Warning
Suicidality: Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants. Monitor for worsening and emergence of suicidal thoughts and behaviors.
| Serious Effects |
Hypersensitivity to drug or any component; concurrent use of MAOIs (within 14 days) or other serotonergic drugs (risk of serotonin syndrome); severe hepatic impairment; uncontrolled hypertension; recent myocardial infarction or unstable coronary artery disease.
| Precautions | Serotonin syndrome (especially when co-administered with other serotonergic drugs), severe hypertension (especially in patients with underlying hypertension), hepatic injury (elevated transaminases), acute angle-closure glaucoma, seizures (lowered threshold), hyponatremia (particularly in elderly), and withdrawal symptoms upon abrupt discontinuation (e.g., dizziness, nausea, headache). |
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| Serial ultrasound for fetal anatomy (first trimester), growth scans every 4 weeks from 24 weeks, non-stress testing weekly from 32 weeks, and maternal blood pressure monitoring due to risk of pregnancy-induced hypertension. |
| Fertility Effects | Implants reversible disruption of spermatogenesis in males; females: may cause menstrual irregularities and anovulation. Preconception counseling recommended. |