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Levacetylmethadol
Systematic (IUPAC) name
(1S,4S)-(6-dimethylamino-4,4-diphenyl-heptan-3-yl) acetate
Identifiers
CAS number 1477-40-3
43033-72-3 (hydrochloride)
ATC code N07BC03
PubChem 15130
DrugBank APRD00745
Chemical data
Formula C 23H31NO2  
Mol. mass 353.498
Pharmacokinetic data
Bioavailability  ?
Protein binding ~80%
Metabolism CYP3A4
Half life 2.6 days
Excretion  ?
Therapeutic considerations
Pregnancy cat.  ?
Legal status Schedule I (CA) Schedule II (US)
Routes Oral

Levacetylmethadol (INN), levomethadyl acetate (USAN), Orlaam (trade name) or levo-α-acetylmethadol (LAAM) is a synthetic opioid similar in structure to methadone. It has a long duration of action due to its active metabolites. It was approved in 1993 by the U.S. Food and Drug Administration for use in the treatment of opioid dependence. In 2001, Orlaam was removed from the European market due to reports of life threatening ventricular rhythm disorders.[1] In 2003, Roxane Laboratories, Inc. discontinued Orlaam in the US.[2]

Contents

Indications

LAAM is indicated as a second-line treatment for the treatment and management of opioid dependence if patients fail to respond to drugs like methadone or buprenorphine. LAAM is not approved for use in Canada.

Chemistry and pharmacology

Levacetylmethadyl acts as a mu-opioid receptor agonist. It also acts as a potent, noncompetitive α3β4 neuronal nicotinic acetylcholine receptor antagonist. [3]

Levomethadyl acetate is the levo isomer of α-methadyl acetate. The dextro isomer is more potent but shorter acting. The levo isomer is also less toxic with an LD50 in mice of 110mg/kg s.c. and 172.8mg/kg orally as opposed to LD50s of 61mg/kg s.c. and 118.3mg/kg orally for dl-α-methadyl acetate. It has a melting point of 215°C and a molecular weight of 353.50. β-methadyl acetate also exists, however it is more toxic and less active than α-methadyl acetate and has no current medical use.

Levomethadyl acetate undergoes extensive first-pass metabolism to the active demethylated metabolite nor-LAAM, which is further demethylated to a second active metabolite, dinor-LAAM. These metabolites are more potent than the parent drug.

Dosing

LAAM is used as an oral solution of levomethadyl acetate hydrochloride at a concentration of 10mg/mL in bottles of 120 and 500 mL under the brand name Orlaam. The first dose of LAAM for patients who have not started treatment with methadone is 20-40mg. The first dose for patients who have been receiving methadone will be a little higher than the amount of methadone that was being taken every day, but not more than 120 mg. Afterwards, the dosage may be adjusted as needed. Unlike methadone, which requires daily administration, LAAM is administered three times a week.

References

  1. ^ EMEA public statement on levoacethylmethadol
  2. ^ U. S. FDA: Drug Shortages
  3. ^ "Blockade of Rat α3β4 Nicotinic Receptor Function by Methadone, Its Metabolites, and Structural Analogs — JPET". http://jpet.aspetjournals.org/content/299/1/366.abstract.  

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