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Levomethadone
Synthetic opioid
Synthetic opioid
| Drugs.com =
(HCl)
| elimination_half-life = ~18 hours
Levomethadone, sold under the brand name L-Polamidon among others, is a synthetic opioid analgesic and antitussive which is marketed in Europe and is used for pain management and in opioid maintenance therapy. In addition to being used as a pharmaceutical drug itself, levomethadone is also the main therapeutic component of methadone, which is a racemic mixture of levomethadone (R-methadone) and dextromethadone (S-methadone).
Levomethadone is used for narcotic maintenance in place of, or in some cases alongside as an alternative, to racemic methadone, owing to concern that the cardiotoxic and QT-prolonging action of racemic methadone might be primarily caused by dextromethadone.
Pharmacology
Pharmacodynamics
Levomethadone has approximately 50x the potency of the S-(+)-enantiomer as well as greater μ-opioid receptor selectivity. Accordingly, it is about twice as potent as methadone by weight and its effects are virtually identical in comparison. In addition to its activity at the opioid receptors, levomethadone has been found to act as a weak competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor complex and as a potent noncompetitive antagonist of the α3β4 nicotinic acetylcholine (nACh) receptor.
Chemistry
The separation of the stereoisomers is one of the easier in organic chemistry and is described in the original patent. It involves "treatment of racemic methadone base with d-(+)-tartaric acid in an acetone/water mixture [which] precipitates almost solely the dextro-methadone levo-tartrate, and the more potent Levomethadone can easily be retrieved from the mother liquor in a high state of optical purity."
There is now an asymmetric synthesis available to prepare both levomethadone (R-(−)-methadone) and dextromethadone (S-(+)-methadone).
Society and culture
Generic names
Levomethadone is the generic name of the drug and its .
Brand names
Levomethadone has been sold under brand names including L-Polaflux, L-Polamidon, L-Polamivet, Levadone, Levo-Methasan, Levothyl, Mevodict, Levopidon and Vistadict, among others.
Legal status
Levomethadone is listed under the Single Convention On Narcotic Drugs 1961 and is a Schedule II Narcotic controlled substance in the US as an isomer of methadone (ACSCN 9250) and is not listed separately, nor is dextromethadone. It is similarly controlled under the German Betäubungsmittelgesetz and similar laws in practically every other country.
References
References
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- (1997). "Dictionary of Pharmacological Agents". CRC Press.
- (2000). "Index Nominum 2000: International Drug Directory". Taylor & Francis US.
- PubChem. "Methadone".
- (October 1976). "Side effects of levomethadone and racemic methadone in a maintenance program". Clinical Pharmacology and Therapeutics.
- (May 2007). "Stereoselective Block of hERG Channel by (S)-Methadone and QT Interval Prolongation in CYP2B6 Slow Metabolizers". Clinical Pharmacology and Therapeutics.
- (11 August 2009). "Surface Design: Applications in Bioscience and Nanotechnology". Wiley-VCH.
- (16 August 2011). "Oxford American Handbook of Hospice and Palliative Medicine". Oxford University Press.
- (November 2005). "The effects of racemic D,L-methadone and L-methadone in substituted patients--a randomized controlled study". Drug and Alcohol Dependence.
- (4 November 2005). "The Treatment of Opioid Dependence". JHU Press.
- (October 2001). "Blockade of rat alpha3beta4 nicotinic receptor function by methadone, its metabolites, and structural analogs". The Journal of Pharmacology and Experimental Therapeutics.
- (2011). "The significance of chirality in drug design and development". Current Topics in Medicinal Chemistry.
- "Synthesis of Methadone". Erowid.
- (March 2003). "Synthesis of optically active methadones, LAAM and bufuralol by lipase-catalysed acylations". Tetrahedron: Asymmetry.
- "Process for the preparation of optically active methadones in high enantiomeric purity".
- "Levomethadone". Drugs.com.
- "Conversion Factors for Controlled Substances". Drug Enforcement Administration, United States Department of Justice.
- (2019-08-28). "Opioid prescription patterns in Germany and the global opioid epidemic: Systematic review of available evidence". PLOS ONE.
- (2000). ["Reviewing Current Practice in Drug-substitution Treatment in the European Union"](https://www.emcdda.europa.eu/system/files/publications/111/Insight3_64348.pdf }}{{pn). European Monitoring Centre for Drugs and Drug Addiction.
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