Dihydromorphine

Last updated
Dihydromorphine
Dihydromorphine2DCSD.svg
Dihydromorphine 3D ball.png
Clinical data
Other namesDihydromorphine, Paramorphan
Routes of
administration 		Oral, Intravenous, Intranasally, Sublingually
ATC code
  • none
Legal status
Legal status
Identifiers
  • 3,6-dihydroxy-(5α,6α)-4,5-epoxy-17-methylmorphinan
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard 100.007.365 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C17H21NO3
Molar mass 287.359 g·mol−1
3D model (JSmol)
  • O[C@@H]4[C@@H]5Oc1c2c(ccc1O)C[C@H]3N(CC[C@]25[C@H]3CC4)C
  • InChI=1S/C17H21NO3/c1-18-7-6-17-10-3-5-13(20)16(17)21-15-12(19)4-2-9(14(15)17)8-11(10)18/h2,4,10-11,13,16,19-20H,3,5-8H2,1H3/t10-,11+,13-,16-,17-/m0/s1 Yes check.svgY
  • Key:IJVCSMSMFSCRME-KBQPJGBKSA-N Yes check.svgY
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Dihydromorphine (Paramorfan, Paramorphan) is a semi-synthetic opioid structurally related to and derived from morphine. The 7,8-double bond in morphine is reduced to a single bond to get dihydromorphine. [2] Dihydromorphine is a moderately strong analgesic and is used clinically in the treatment of pain and also is an active metabolite of the analgesic opioid drug dihydrocodeine. [3] [4] [5] Dihydromorphine occurs in trace quantities in assays of opium on occasion, as does dihydrocodeine, dihydrothebaine, tetrahydrothebaine, etc. The process for manufacturing dihydromorphine from morphine for pharmaceutical use was developed in Germany in the late 19th century, with the synthesis being published in 1900 and the drug introduced clinically as Paramorfan shortly thereafter. A high-yield synthesis from tetrahydrothebaine was later developed. [6]

Contents

Uses

Medical

Dihydromorphine is used for the management of moderate to severe pain such as that occurring in cancer; however, it is less effective in treating neuropathic pain and is generally considered inappropriate and ineffective for psychological pain. [3] [7]

Research

Dihydromorphine, often labelled with the isotope tritium in the form of [3H]-dihydromorphine, is used in scientific research to study binding of the opioid receptors in the nervous system. [8] [9]

Strength

Dihydromorphine is slightly stronger than morphine as an analgesic with a similar side effect profile. The relative potency of dihydromorphine is about 1.2 times that of morphine. In comparison, the relative potency of dihydrocodeine is around 1.2 to 1.75 times that of codeine. [10]

Pharmacology

Dihydromorphine acts as an agonist at the μ-opioid with a Ki value of 2.5 nM compared to 4.9 nM of morphine, δ-opioid with a Ki value of 137 nM compared to 273 nM of morphine and κ-opioid with a Ki value of 223 nM compared to 227 nM of morphine. Dihydromorphine is therefore slightly more μ-selective than morphine. [3] [4] Agonism of the μ-opioid and δ-opioid receptors is largely responsible for the clinical effects of opioids like dihydromorphine, with the μ-agonism providing more analgesia than the δ. [11] [12]

Pharmacokinetics

Dihydromorphine's onset of action is more rapid than morphine and it also tends to have a longer duration of action, generally 4–7 hours.[ citation needed ]

Legality

Under the 1961 international Single Convention on Narcotic Drugs treaty dihydromorphine is a Schedule I narcotic subject to control, and other countries' laws may vary. [13]

United States

Under the Controlled Substances Act, dihydromorphine is listed as a Schedule I substance along with heroin. [14] In the United States, its role in the production of dihydrocodeine and other related drugs make it a Schedule I substance with one of the higher annual manufacturing quotas granted by the US Drug Enforcement Administration: 3300 kilograms in 2013. Manufacturers, distributors, and importers with the correct DEA license and state permits related thereto are able to use Schedule I drugs in this fashion when they are transformed into something of a lower schedule. [15] The DEA has assigned dihydromorphine and all of its salts, esters, etc. the ACSCN of 9145. As with nicomorphine, MDMA and heroin, dihydromorphine is also used in research in properly licensed facilities. US DEA Form 225, the most common and least expensive individual researcher's license, does not include Schedule I drugs, and so the lab must have a higher-level DEA registration. [16] As with other licit opioids used for medical purposes in other countries, including even much weaker opioids like nicocodeine, benzylmorphine, and tilidine, the reason for dihydromorphine being in Schedule I is that it was not in medical use in the US at time the Controlled Substances Act of 1970 was drawn up.[ citation needed ]

Europe

Dihydromorphine is regulated in the same fashion as morphine in Germany under the BtMG, [17] Austrian SMG, [18] and Swiss BtMG, where it is still used as an analgesic. [19] The drug was invented in Germany in 1900 and marketed shortly thereafter. It is often used in Patient Controlled Analgesia units. [20] [21]

Japan

Dihydromorphine and morphine are also used alongside each other in clinical use in Japan and is regulated as such [22]

See also

Related Research Articles

<span class="mw-page-title-main">Hydrocodone</span> Opioid drug used in pain relief

Hydrocodone, also known as dihydrocodeinone, is an opioid used to treat pain and as a cough suppressant. It is taken by mouth. Typically it is dispensed as the combination acetaminophen/hydrocodone or ibuprofen/hydrocodone for pain severe enough to require an opioid and in combination with homatropine methylbromide to relieve cough. It is also available by itself in a long-acting form under the brand name Zohydro ER, among others, to treat severe pain of a prolonged duration. Hydrocodone is a controlled drug, in the United States a Schedule II Controlled Substance.

<span class="mw-page-title-main">Morphine</span> Pain medication of the opiate family

Morphine is a strong opiate that is found naturally in opium, a dark brown resin produced by drying the latex of opium poppies. It is mainly used as an analgesic. There are numerous methods used to administer morphine: oral; sublingual; via inhalation; injection into a muscle, injection under the skin, or injection into the spinal cord area; transdermal; or via rectal suppository. It acts directly on the central nervous system (CNS) to induce analgesia and alter perception and emotional response to pain. Physical and psychological dependence and tolerance may develop with repeated administration. It can be taken for both acute pain and chronic pain and is frequently used for pain from myocardial infarction, kidney stones, and during labor. Its maximum effect is reached after about 20 minutes when administered intravenously and 60 minutes when administered by mouth, while the duration of its effect is 3–7 hours. Long-acting formulations of morphine are available as MS-Contin, Kadian, and other brand names as well as generically.

<span class="mw-page-title-main">Hydromorphone</span> Opioid drug used for pain relief

Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid among others, is a morphinan opioid used to treat moderate to severe pain. Typically, long-term use is only recommended for pain due to cancer. It may be used by mouth or by injection into a vein, muscle, or under the skin. Effects generally begin within half an hour and last for up to five hours.

<span class="mw-page-title-main">Opioid</span> Psychoactive chemical

Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, and suppressing cough. Extremely potent opioids such as carfentanil are approved only for veterinary use. Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal. Opioids can cause death and have been used for executions in the United States.

<span class="mw-page-title-main">Oxymorphone</span> Opioid analgesic drug

Oxymorphone is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes, after oral administration it begins after about 30 minutes, and lasts about 3–4 hours for immediate-release tablets and 12 hours for extended-release tablets. The elimination half-life of oxymorphone is much faster intravenously, and as such, the drug is most commonly used orally. Like oxycodone, which metabolizes to oxymorphone, oxymorphone has a high potential to be abused.

<span class="mw-page-title-main">Dihydrocodeine</span> Opioid

Dihydrocodeine is a semi-synthetic opioid analgesic prescribed for pain or severe dyspnea, or as an antitussive, either alone or compounded with paracetamol (acetaminophen) or aspirin. It was developed in Germany in 1908 and first marketed in 1911.

<span class="mw-page-title-main">Remifentanil</span> Synthetic opioid analgesic

Remifentanil, marketed under the brand name Ultiva is a potent, short-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anaesthetic. Remifentanil is used for sedation as well as combined with other medications for use in general anesthesia. The use of remifentanil has made possible the use of high-dose opioid and low-dose hypnotic anesthesia, due to synergism between remifentanil and various hypnotic drugs and volatile anesthetics.

<span class="mw-page-title-main">Nalbuphine</span> Opioid analgesic

Nalbuphine, sold under the brand names Nubain among others, is an opioid analgesic which is used in the treatment of pain. It is given by injection into a vein, muscle, or fat.

<span class="mw-page-title-main">Levorphanol</span> Opioid analgesic drug

Levorphanol is an opioid medication used to treat moderate to severe pain. It is the levorotatory enantiomer of the compound racemorphan. Its dextrorotatory counterpart is dextrorphan.

<span class="mw-page-title-main">Levomethorphan</span> Opioid analgesic

Levomethorphan (LVM) (INN, BAN) is an opioid analgesic of the morphinan family that has never been marketed. It is the L-stereoisomer of racemethorphan (methorphan). The effects of the two isomers of racemethorphan are quite different, with dextromethorphan (DXM) being an antitussive at low doses and a dissociative hallucinogen at much higher doses. Levomethorphan is about five times stronger than morphine.

<span class="mw-page-title-main">Piritramide</span> Synthetic opioid

Piritramide(R-3365, trade names Dipidolor, Piridolan, Pirium and others) is a synthetic opioid analgesic that is marketed in certain European countries including: Austria, Belgium, Czech Republic, Slovenia, Germany and the Netherlands. It comes in free form, is about 0.75x times as potent as morphine and is given parenterally for the treatment of severe pain. Nausea, vomiting, respiratory depression and constipation are believed to be less frequent with piritramide than with morphine, and it produces more rapid-onset analgesia when compared to morphine and pethidine. After intravenous administration the onset of analgesia is as little as 1–2 minutes, which may be related to its great lipophilicity. The analgesic and sedative effects of piritramide are believed to be potentiated with phenothiazines and its emetic (nausea/vomiting-inducing) effects are suppressed. The volume of distribution is 0.7-1 L/kg after a single dose, 4.7-6 L/kg after steady-state concentrations are achieved and up to 11.1 L/kg after prolonged dosing.

<span class="mw-page-title-main">Nicocodeine</span> Opioid analgesic and antitussive drug

Nicocodeine is an opioid analgesic and cough suppressant, an ester of codeine closely related to dihydrocodeine and the codeine analogue of nicomorphine. It is not commonly used in most countries, but has activity similar to other opiates. Nicocodeine and nicomorphine were introduced in 1957 by Lannacher Heilmittel of Austria. Nicocodeine is metabolised in the liver by demethylation to produce nicomorphine, also known as 6-nicotinoylmorphine, and subsequently further metabolised to morphine. Side effects are similar to those of other opiates and include itching, nausea and respiratory depression. Related opioid analogues such as nicomorphine and nicodicodeine were first synthesized. The definitive synthesis, which involves treating anhydrous codeine base with nicotinic anhydride at 130 °C, was published by Pongratz and Zirm in Monatshefte für Chemie in 1957, simultaneously with the two analogues in an article about amides and esters of various organic acids.

<span class="mw-page-title-main">Codeine</span> Opiate and prodrug of morphine used to treat pain

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<span class="mw-page-title-main">Benzylmorphine</span> Opioid analgesic and cough suppressant drug

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<span class="mw-page-title-main">Tapentadol</span> Opioid analgesic of benzenoid class

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References

  1. ↑ Anvisa (2023-03-31). "RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 2023-04-04). Archived from the original on 2023-08-03. Retrieved 2023-08-16.
  2. ↑ Rama Rao Nadendla. Principles Of Organic Medicinal Chemistry pp. 215
  3. 1 2 3 DrugBank: Dihydromorphine (DB01565)
  4. 1 2 Dihydromorphine - PubChem
  5. ↑ Susanne Ammon; Ute Hofmann; Ernst-Ulrich Griese; Nadja Gugeler & Gerd Mikus (1999). "Pharmacokinetics of dihydrocodeine and its active metabolite after single and multiple oral dosing". British Journal of Clinical Pharmacology. 48 (3): 317–322. doi:10.1046/j.1365-2125.1999.00042.x. PMC   2014322 . PMID   10510141.
  6. ↑ "Dihydromorphine | Thin Layer Chromatography | Chemistry".
  7. ↑ Dureja. Handbook Of Pain Management pp. 67
  8. ↑ Antkiewicz-Michaluk L, Vetulani J, Havemann U, Kuschinsky K (1982). "3H-dihydromorphine binding sites in subcellular fractions of rat striatum". Pol J Pharmacol Pharm. 34 (1–3): 73–78. PMID   6300816.
  9. ↑ Savage DD, Mills SA, Jobe PC, Reigel CE (1988). "Elevation of naloxone-sensitive 3H-dihydromorphine binding in hippocampal formation of genetically epilepsy-prone rats". Life Sci. 43 (3): 239–246. doi:10.1016/0024-3205(88)90313-x. PMID   2840539.
  10. ↑ Rama Rao Nedendla. Principles Of Organic Medicinal Chemistry pp. 216
  11. ↑ Costantino CM, Gomes I, Stockton SD, Lim MP, Devi LA (2012). "Opioid receptor heteromers in analgesia". Expert Rev Mol Med. 14 (9): e9. doi:10.1017/erm.2012.5. PMC   3805500 . PMID   22490239.
  12. ↑ Varga EV, Navratilova E, Stropova D, Jambrosic J, Roeske WR, Yamamura HI (2004). "Agonist-specific regulation of the delta-opioid receptor". Life Sci. 76 (6): 599–612. doi:10.1016/j.lfs.2004.07.020. PMID   15567186.
  13. ↑ Single Convention on Narcotic Drugs, 1961 - Page 40 of 44
  14. ↑ Controlled Substances (in alphabetical order) Archived 2016-04-17 at the Wayback Machine - Page 5 of 12
  15. ↑ DEA Website: Forms, Retrieved 26. April 2014
  16. ↑ DEA Web Site, retrieved 30. April 2014
  17. ↑ Deutsche Betäbungsmittelgesetz, accessed 27. April 2014
  18. ↑ SMG, 30. April 2014
  19. ↑ UNODC Bulletin On Narcotics, 1953, Issue 2
  20. ↑ Opioids for Pain Control (Cambridge Press, 2002)
  21. ↑ Goodman & Gilman's The Pharmacological Basis of Therapeutics, 10th Edition5n
  22. ↑ UNODC Bulletin On Narcotics, 1955
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