Nicomorphine (Vilan, Subellan, Gevilan, MorZet) is the 3,6-dinicotinate

ester In chemistry, an ester is a compound derived from an acid (either organic or inorganic) in which the hydrogen atom (H) of at least one acidic hydroxyl group () of that acid is replaced by an organyl group (R). These compounds contain a distin ...

morphine Morphine, formerly also called morphia, is an opiate that is found naturally in opium, a dark brown resin produced by drying the latex of opium poppies (''Papaver somniferum''). It is mainly used as an analgesic (pain medication). There are ...

. It is a strong opioid agonist analgesic two to three times as potent as morphine with a side effect profile similar to that of dihydromorphine, morphine, and

diamorphine Heroin, also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the Opium, dried latex of the Papaver somniferum, opium poppy; it is mainly used as a recreational drug for its eupho ...

. Nicomorphine was first synthesized in 1904 and was patented as Vilan by Lannacher Heilmittel G.m.b.H. of Austria in 1957.

Medical Use

The hydrochloride salt is available as ampoules of 10 mg/ml solution for injection, 5 mg tablets, and 10 mg suppositories. It is possible that other manufacturers distribute 10 mg tablets and other concentrations of injectable nicomorphine in ampoules and multidose vials. It is used, particularly in the German-speaking countries and elsewhere in Central Europe and some other countries in Europe and the former USSR in particular, for post-operative, cancer, chronic non-malignant and other neuropathic pain. It is commonly used in patient-controlled analgesia (PCA) units. The usual starting dose is 5–10 mg given every 3–5 hours.

Side effects

Nicomorphine's

side effects In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually used ...

are similar to those of other

opioids Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...

and include itching,

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

and respiratory depression. It is considered by doctors to be one of the better analgesics for the comprehensive mitigation of suffering, as opposed to purely clouding the noxious pain stimulus, in the alleviation of chronic pain conditions.

Chemistry

The method for synthesis of nicomorphine, which involves treating anhydrous morphine base with nicotinic anhydride at 130 °C, was published by Pongratz and Zirm in ''Monatshefte für Chemie'' in 1957, simultaneously with the two analogues nicocodeine and nicodicodeine in an article about amides and esters of various organic acids.

Legality

Nicomorphine is regulated in much the same fashion as morphine worldwide but is a Schedule I controlled substance in the United States and was never introduced there. Nicomorphine may appear on rare occasions on the European black market and other channels for unsupervised opioid users. It can be produced as part of a mixture of salts and derivatives of morphine by end users by means of treating morphine with nicotinic anhydride or related chemicals in an analogue of the heroin homebake process. CAS number of hydrochloride: 35055-78-8
US DEA ACSCN: 9312
Free base conversion ratios of salts:
''Nicomorphine Hydrochloride: 0.93''

Pharmacology

Pharmacodynamics

The 3,6-diesters of morphine are drugs with more rapid and complete central nervous system penetration due to increased lipid solubility and other structural considerations. The prototype for this subgroup of semi-synthetic opiates is

heroin Heroin, also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the Opium, dried latex of the Papaver somniferum, opium poppy; it is mainly used as a recreational drug for its eupho ...

and the group also includes dipropanoylmorphine, diacetyldihydromorphine, disalicylmorphine and others. Whilst this produces an enhanced "bang", i.e. a faster and more sudden onset of action when the drug is administered intravenously, it cannot be distinguished from morphine via other routes, although the different side effect profile, including lower incidence of nausea, is very apparent.

Pharmacokinetics

Nicomorphine is rapidly metabolized when administered by the I.V. route, having a half-life of 3 minutes, into morphine and 6-nicotinoylmorphine, the secondary active metabolite. Half lives of the metabolites were 3–15 minutes for the nicotinoyl metabolite, and 135–190 minutes for morphine. Via the

epidural Epidural administration (from Ancient Greek ἐπί, "upon" + '' dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians ...

route, a much slower release from epidural space occurs and nicomorphine remains detectable for 1.5 hours or so, and has a longer effect of 18.2 +/- 10.1 hours due to slower release of the active metabolites, morphine and 6-nicotinoylmorphine. Half lives for those compounds is listed in the IV route. Pharmacokinetics via the rectal route differ, and change metabolism. Eight minutes after administration, morphine appeared rapidly, and had a half life of 1.48 +/- 0.48h. This was in turn metabolized to morphine-3- and morphine-6-glucoranides after another 12 minutes, which had similar half-lives to one-another, at about 2.8h. No 6-mononicotinoylmorphine was found, and bioavailability of morphine and metabolic actives was 88%. No remaining nicomorphine was found in urine.

References

{{Opioidergics 4,5-Epoxymorphinans Euphoriants Mu-opioid receptor agonists Nicotinate esters Opioids Semisynthetic opioids