Levorphanol: Revisiting an Underutilized Analgesic. (January 2014)

• Record Type: Journal Article
• Authors: Prommer, Eric
• Is Part Of: Palliative care. Volume 8(2014)
• Publication Date: 2014-01
• Subjects: opioid -- NMDA -- pain -- neuropathic pain; Palliative treatment -- Periodicals; Terminal care -- Periodicals; Palliative Care; Terminal Care; Palliative treatment; Terminal care; Electronic journals; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 616.029
• DOI: 10.4137/PCRT.S13489
• Languages: English
• ISSNs: 1178-2242

Abstract

Levorphanol (levo-3-hydroxy- N -methylmorphinan) is a step 3 opioid first developed in the 1940s as an alternative to morphine. Levorphanol belongs to the morphinan opioid series. Levorphanol has greater potency than morphine and is a potent N -methyl-D aspartate (NMDA) antagonist. Levorphanol interferes with the uptake of norepinephrine and serotonin, which makes it potentially useful for neuropathic pain. Glucuronidation changes Levorphanol to Levorphanol-3-glucuronide with excretion by the kidney. Levorphanol has a long half-life and may accumulate with repeated dosing. Levorphanol can be administered orally, intravenously, and subcutaneously. This article provides an update regarding the pharmacodynamics, pharmacology, and clinical efficacy of this often overlooked step 3 opioid.