Why is Levorphanol (Levo-Dromoran) rarely prescribed anymore?

[K'd-OUT-in-AZ]

For those who do not know what it is, Levorphanol is a very potent full agonist opioid that is a member of the Morphinian class, and is similar to Morphine in effect, but is much more potent. Roughly 8 times more potent. (30mg similar to 4mg) Its half-life of 11-16 hours is so much longer compared to Morphine which is only 2-3 hours. The effects last much longer than 4 hours and even up to 15 hours. Much higher oral BA compared to Morphine as well. Levorphanol has effect on the mu, kappa and delta opioid receptors and its NMDA properties make it useful for types of pain that other analgesics may not be as effective against; levorphanol's sigma receptor, SNRI properties make it even more useful particularly for neuropathic pain.

It is available in 2mg and 4mg tablets.

I have to ask, why isn't this used more for chronic and severe pain? Sounds to me to be just as effective, if not more than other immediate release opioids prescribed for severe pain. It has a very long duration, a moderately high oral BA and produces powerful analgesia. Sounds like it would be a great alternative to other opioids and another option for those who don't respond to certain opioids.

If it were prescribed more often it is possible that it would become a popular street drug though. I have tried it twice before; IV and oral and it was very potent and a powerful sedative.

Regardless, why isn't this around much anymore? I've just wondered if others thought the same.

 

[Valley88]

I don't know much about it. It says all of those same things you described about it on wikipedia.

I would have to guess it's not prescribed because it seems (to me at least) that it would be abused beyond the point of control on the street, lol. Not that there aren't always other choices of drugs for people to abuse, but this stuff is 4 to 8x more potent than morphine, that's some strong sh#t. Junkies would be all over that.

It does seem to be very effective for pain though. Maybe they use it in hospitals, seems like they should.

 

[TheLostBoys]

Would be nice if doctors would prescribe it for severe pain patients but I havent heard of anyone getting this stuff.

 

[StaySedated]

they may give it to people with resistant severe chronic pain. from what you describe, it sounds like if it were more common it would be very widely abused.

 

[BIGsherm7272]

seems like potency-wise it is almost on par with hydromorphone compared to morphine......but idk how it feels, like if it has good legs or if it just feels like a beefed-up morphine

 

[NotQuiteAnonymous]

There is only one manufacturer (Roxane) for this drug.

It seems to be used mostly to relieve the pain of terminal cancer.

 

[EPP1961]

Levophanol a Forgotten Retro 70's Opiate

Wow, a truly Retro 70's opiate and what a potent opiate it is. My guess is Levorphanol being around for over 40 years fell into obscurity in the 1990's when big pharma was pushing their new opiates (well old opiates wrapped in new packaging).
Levorphanol would present no more of a problem than other pure mu opiates.
It's much like the 1970's and 1980's when your Doctor treated pain with Tylenol with Codeine #3, and to a lesser extent, Tylenol #4. Back then the only Hydrocodone analgesic was Knoll Pharmaceuticals Vicodin and it was packed with acetaminophen. Back then Hydrocodone was seen only as cough medicine?
Nowadays with hydocodone being the number one most prescribed medicine in the USA very few Doctor's write Tylenol #3 prescriptions anymore. Sadly, many Physicians expose their ignorance beliving Hydrocodone is as effective as Oxycodone.
Back about 8 years ago my Physician would prescribe Tylenol Codeine #4 and everytime I went to the Pharmacy I would be told they no longer stock it.
You can also be assured if Levophanol made a comeback and was found to be most effective in treating chronic pain, the DEA would begin a massive campaign aimed as discouraging and discrediting it.

 

[J. G. Wentworth]

For those of us in chronic pain, something like that would be a godsend. I will ask my PM doc if he knows anything about it.

 

[TheLostBoys]

I was given a Levorphanol shot for outpatient surgery & let me tell you, this stuff has an amazing euphoric high & legs that last over 8 hours. I would take Levorphanol over any other opiate w/o thinking twice!

 

[EPP1961]

If you can talk to him/her about meds that's good. Still, Levorphanol's obscurity probably comes from the lack of clinical studies or physician experience as to the advantages of this med.
From what I have read and what I recall from several experiences in the 1980's when Oxycodone was ineffective in relieveing my cluster headaches, I was prescribed Levo Dromoran. Levorphanol worked, as did Oxymorphone.

 

[Alex000]

Maybe it is just got "forgotten" in the mix of all the other pain meds. Maybe because it sounds like it has very high abuse potential. I'd guess the former though.

 

[NeighborhoodThreat]

Wow, a truly Retro 70's opiate and what a potent opiate it is. My guess is Levorphanol being around for over 40 years fell into obscurity in the 1990's when big pharma was pushing their new opiates (well old opiates wrapped in new packaging).
Levorphanol would present no more of a problem than other pure mu opiates.
It's much like the 1970's and 1980's when your Doctor treated pain with Tylenol with Codeine #3, and to a lesser extent, Tylenol #4. Back then the only Hydrocodone analgesic was Knoll Pharmaceuticals Vicodin and it was packed with acetaminophen. Back then Hydrocodone was seen only as cough medicine?
Nowadays with hydocodone being the number one most prescribed medicine in the USA very few Doctor's write Tylenol #3 prescriptions anymore. Sadly, many Physicians expose their ignorance beliving Hydrocodone is as effective as Oxycodone.
Back about 8 years ago my Physician would prescribe Tylenol Codeine #4 and everytime I went to the Pharmacy I would be told they no longer stock it.
You can also be assured if Levophanol made a comeback and was found to be most effective in treating chronic pain, the DEA would begin a massive campaign aimed as discouraging and discrediting it.

This sort of thing belongs in your blog, it doesn't really follow the updated rules and guidelines of BDD.

Closed.