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Is levorphanol a better option than methadone?

Thien C Pham1, Jeffrey Fudin2,3,4, Robert B Raffa5

  • 1PGY2 Pain and Palliative Care Pharmacy Residency, Stratton VA Medical Center, Albany, New York, USA.

Pain Medicine (Malden, Mass.)
|August 27, 2015
PubMed
Summary

Levorphanol may be a safer alternative to methadone for opioid dependence and pain management. It offers improved efficacy and reduced risks, including fewer drug interactions and a lower risk of emergency department visits.

Keywords:
AnalgesiaBenefit/Risk RatioDrug-DependenceLevorphanolMethadoneOpioid

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Area of Science:

  • Pharmacology
  • Pain Management
  • Addiction Treatment

Background:

  • Methadone is a widely used medication for opioid dependence and chronic pain.
  • While effective, methadone has safety concerns and pharmacokinetic/pharmacodynamic properties not unique to the drug.
  • An alternative with a better benefit/risk profile is needed.

Purpose of the Study:

  • To review the pharmacology of methadone.
  • To propose levorphanol as a potential alternative for opioid dependence and pain management.

Main Methods:

  • Review of basic and clinical pharmacology literature for methadone and levorphanol.
  • Comparative analysis of pharmacokinetic and pharmacodynamic properties.
  • Assessment of safety profiles and clinical applications.

Main Results:

  • Levorphanol exhibits greater NMDA antagonism and higher affinity for DOR and KOR compared to methadone.
  • Levorphanol has a shorter plasma half-life but a longer duration of action.
  • Levorphanol presents no CYP450 interactions or QTc prolongation risks.

Conclusions:

  • Levorphanol offers a potentially improved safety profile over methadone.
  • Levorphanol is suitable for specific populations including the elderly, palliative care, and SCI patients.
  • Levorphanol may reduce the need for adjuvant analgesics and lower the risk of emergency department visits.