Journavx: a non-opioid start to your recovery.

For most of my career, the strongest pain medicine we could send a patient home with after surgery was an opioid. Opioids work. They also bring nausea, constipation, drowsiness, itching, and a risk of dependence that nobody wants attached to an elective procedure. I have spent thirty years in pain medicine looking for ways to use less of them.

In January 2025, the FDA approved Journavx (suzetrigine) for moderate to severe acute pain in adults, including pain after surgery. It is the first new class of acute pain medicine in more than two decades, and it is not an opioid or a narcotic. We now build it into the perioperative routine at NCSS.

How it works.

Pain after surgery travels from the surgical site to your brain along nerves. Those nerves fire using tiny sodium channels. One of them, called NaV1.8, sits mainly in the pain-sensing nerves outside the brain and spinal cord. Journavx blocks NaV1.8, which quiets the pain signal close to where it starts.

Because Journavx works out in those nerves and not on the opioid receptors in your brain and gut, it does not produce a high, and it is not a controlled substance.

Easier on your stomach.

Nausea and constipation are two of the most common reasons patients dislike their recovery. Both are classic opioid side effects.

Journavx was approved on the strength of two large trials. One studied tummy tuck patients, which makes the results unusually relevant to the operations performed here. The other studied bunion surgery. Nausea or vomiting occurred in 20% and 9% of patients taking Journavx, compared with 33% and 16% of patients taking hydrocodone with acetaminophen, the opioid combination many people know as Norco. Patients taking a placebo landed in between, at 25% and 12%. Surgery and anesthesia cause some nausea on their own. Journavx did not add to it.

Opioids cause constipation by acting on opioid receptors in the gut. Journavx does not act on those receptors.

The most common side effects in the trials were itching, muscle spasms, a rise in a muscle enzyme on blood tests, and rash, each in roughly 1 to 2% of patients.

How we time it.

The morning of surgery, before you leave home for the surgery center, take two 50 mg tablets (100 mg total) with a small sip of water.

This first dose works best on an empty stomach, and you will already have one, because you fast before anesthesia. Starting before surgery means the medicine is already working when the local anesthetic wears off. We would rather stay ahead of pain than chase it.

Twelve hours after that first dose, take one 50 mg tablet. Your written instructions will tell you how long to continue. After the first dose, you can take Journavx with or without food.

Paired with celecoxib.

Journavx quiets the pain signal. Celecoxib (Celebrex), an anti-inflammatory, works on the swelling and inflammation that create much of that signal to begin with. Together they treat post-operative pain from two directions.

In our experience, most patients on this combination have very little pain after surgery.

Tell us before you take it if

• You take a medicine that strongly blocks the liver enzyme CYP3A, such as the antifungals ketoconazole or itraconazole, the antibiotic clarithromycin, or certain HIV medicines. These cannot be combined with Journavx.
• You have significant liver or kidney disease.
• You use hormonal birth control. Journavx can make many progestin-containing contraceptives less effective. Unless your method contains only levonorgestrel or norethindrone, use a non-hormonal backup such as condoms while taking Journavx and for 28 days after your last dose.
• You are allergic to sulfa drugs, aspirin, or other anti-inflammatories, or you have had stomach ulcers or bleeding. These matter for celecoxib.

Avoid grapefruit and grapefruit juice while you are taking Journavx.

Part of the Rest-Assure standard.

Every scheduled surgical patient at NCSS has a free pre-operative consultation with me. That is where we confirm Journavx is right for you, check it against everything else you take, and walk through the timing so the morning of surgery is simple.

Your surgeon sets your final pain plan, and some patients will still need something more that first night. Our goal is that most won't.

— H. Rand Scott, MD

This article is general information about a prescription medicine and is not medical advice for your situation. Follow the instructions you receive from your surgeon and the NCSS team. Side-effect figures are from the U.S. FDA prescribing information for Journavx. Journavx is a trademark of Vertex Pharmaceuticals; NCSS has no affiliation with the manufacturer.

Getting ready for surgery at NCSS? See your step-by-step medication plan.

Why the plan is built this way: Staying ahead of pain.

H. Rand Scott, MD is founder and Medical Director of Newport Center for Special Surgery. Board-certified anesthesiologist, subspecialty training in interventional pain management at Penn State Milton S. Hershey Medical Center. He personally offers a free Rest-Assure pre-operative consultation to every scheduled surgical patient at NCSS.

The right starting point is a conversation.

Every scheduled surgical patient is offered a free Rest-Assure pre-operative consultation with Dr. Rand Scott personally — medical history, medication planning, and discharge coordination before the day of surgery.

Monday–Thursday, 8am–3pm · Friday by appointment only.