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Tilidine
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Tilidine
Tilidine, sold under the brand name Valoron among others, is a synthetic opioid analgesic, used mainly in Belgium, Bulgaria, Germany, Albania, Luxembourg, and South Africa for the treatment of moderate to severe pain, both acute and chronic. Its onset of pain relief after oral administration is about 10-15 minutes and peak relief from pain occurs about 25-50 minutes after administration.
Tilidine is used in the form of hydrochloride or phosphate salt. In Germany, tilidine is available in a fixed combination with naloxone for oral administration (Valoron N and generics); the mixture of naloxone is claimed to lower the abuse liability of the opioid analgesic. This is so that if people take the medication orally (which is the way they are meant to) the opioid blocker, naloxone, has minimal effects on them but if they inject it the naloxone becomes bioavailable and hence antagonizes the effects of the tilidine producing withdrawal effects. In Switzerland the original Valoron brand with only tilidine and no naloxone is also available.
As well as its use as an analgesic, tilidine is also commonly used in Germany for treatment of restless legs syndrome. The reverse ester[failed verification] is also known and is also a prodrug.
Tilidine explicitly without Naloxone is a controlled substance in most countries, listed in the German BtMG, Austrian SMG, and in the USA under the Controlled Substances Act as ACSCN 9750 as a Narcotic under Schedule I, with an annual aggregate manufacturing quota of 10 grams in 2014. It is used as the hydrochloride (free base conversion ratio 0.882) and HCl hemihydrate (0.858).
Its most common adverse effects are transient nausea and vomiting, dizziness, drowsiness, fatigue, headache, and nervousness; less commonly, nausea and vomiting (after repeated dosing), hallucinations, confusion, euphoria, tremor, hyperreflexia, clonus, and increased sweating. Uncommonly, somnolence; rarely, diarrhoea and abdominal pain.
It usually comes in its hydrochloride hemihydrate salt form; in this form it is highly soluble in water, ethanol and dichloromethane and appears as a white/almost white crystalline powder. Its storage is restricted by its sensitivity to degradation by light and oxygen, hence necessitating its storage in amber bottles and at temperatures below 30 degrees Celsius, respectively.
Considered a low-to-medium-potency opioid, tilidine has the oral potency of about 0.2, that is, a dose of 100mg p.o. is equianalgesic to approximately 20mg morphine sulfate orally. It is administered orally (by mouth), rectally (by a suppository), or by injection (SC, IM, or slowly IV).
Tilidine itself is only a weak opioid, but is rapidly metabolized in the liver and gut to its active metabolite nortilidine and then to bisnortilidine. It is the (1S,2R)-isomer (dextilidine) that is responsible for its analgesic activity. Nortilidine binds to opiate receptors in the central and peripheral nervous systems and suppresses pain perception and transmission.
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Tilidine
Tilidine, sold under the brand name Valoron among others, is a synthetic opioid analgesic, used mainly in Belgium, Bulgaria, Germany, Albania, Luxembourg, and South Africa for the treatment of moderate to severe pain, both acute and chronic. Its onset of pain relief after oral administration is about 10-15 minutes and peak relief from pain occurs about 25-50 minutes after administration.
Tilidine is used in the form of hydrochloride or phosphate salt. In Germany, tilidine is available in a fixed combination with naloxone for oral administration (Valoron N and generics); the mixture of naloxone is claimed to lower the abuse liability of the opioid analgesic. This is so that if people take the medication orally (which is the way they are meant to) the opioid blocker, naloxone, has minimal effects on them but if they inject it the naloxone becomes bioavailable and hence antagonizes the effects of the tilidine producing withdrawal effects. In Switzerland the original Valoron brand with only tilidine and no naloxone is also available.
As well as its use as an analgesic, tilidine is also commonly used in Germany for treatment of restless legs syndrome. The reverse ester[failed verification] is also known and is also a prodrug.
Tilidine explicitly without Naloxone is a controlled substance in most countries, listed in the German BtMG, Austrian SMG, and in the USA under the Controlled Substances Act as ACSCN 9750 as a Narcotic under Schedule I, with an annual aggregate manufacturing quota of 10 grams in 2014. It is used as the hydrochloride (free base conversion ratio 0.882) and HCl hemihydrate (0.858).
Its most common adverse effects are transient nausea and vomiting, dizziness, drowsiness, fatigue, headache, and nervousness; less commonly, nausea and vomiting (after repeated dosing), hallucinations, confusion, euphoria, tremor, hyperreflexia, clonus, and increased sweating. Uncommonly, somnolence; rarely, diarrhoea and abdominal pain.
It usually comes in its hydrochloride hemihydrate salt form; in this form it is highly soluble in water, ethanol and dichloromethane and appears as a white/almost white crystalline powder. Its storage is restricted by its sensitivity to degradation by light and oxygen, hence necessitating its storage in amber bottles and at temperatures below 30 degrees Celsius, respectively.
Considered a low-to-medium-potency opioid, tilidine has the oral potency of about 0.2, that is, a dose of 100mg p.o. is equianalgesic to approximately 20mg morphine sulfate orally. It is administered orally (by mouth), rectally (by a suppository), or by injection (SC, IM, or slowly IV).
Tilidine itself is only a weak opioid, but is rapidly metabolized in the liver and gut to its active metabolite nortilidine and then to bisnortilidine. It is the (1S,2R)-isomer (dextilidine) that is responsible for its analgesic activity. Nortilidine binds to opiate receptors in the central and peripheral nervous systems and suppresses pain perception and transmission.
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