Historical perspective on the chemistry and development of naltrexone

The first clinically useful narcotic antagonist was nalorphine. This compound was relatively weak, short-acting, and produced a number of side effects, the most prominent of which were psychotomimetic in nature. For these reasons nalorphine did not qualify as a possible modality for the treatment of heroin addiction. Cyclazocine is a totally synthetic narcotic antagonist which is much more potent and longer acting than nalorphine. It was the first compound used by Martin in clinical trials in postaddicts. However, its dysphoric effects necessitated long induction periods and these CNS effects precluded its use in long-acting delivery systems. Naloxone was a "pure" antagonist which did not produce the psychotomimetic effects of either nalorphine or cyclazocine. Although it is a potent antagonist when given parenterally, it is shorter acting than cyclazocine. Replacement of the N-allyl substituent of naloxone with the cyclopropylmethyl radical of cyclazocine led to naltrexone, which is even more potent than either naloxone or cyclazocine and has a longer duration than naloxone. Because of this favorable combination of properties naltrexone proved to be the drug of choice for inclusion in long-acting delivery systems.