Products
Nicomorphine was commercially available in the form of tablets, suppositories, and as a solution for injection (Vilan). It had been approved in many countries since 1957. It was discontinued in 2015.
Structure and properties
Nicomorphine (C29H25N3O5, Mr = 495.5 g/mol), like heroin, is an ester as well as a nicotinic acid derivative of morphine (3,6-dinicotinoyl ester). It is present in drugs as nicomorphine hydrochloride. In the liver, it is biotransformed to morphine-6-mononicotinate, morphine and its metabolites, among others. These substances are predominantly active. Nicomorphine can therefore be referred to as a prodrug.
Effects
Nicomorphine (ATC N02AA04) is analgesic. The effects are due to binding to μ-opioid receptors. Nicomorphine has comparable potency to morphine, but the onset of action is more rapid because of its higher lipophilicity.
Indications
For the treatment of moderate to severe, acute, and persistent pain. For premedication and support of anesthesia. For treatment of spasmodic pain of the digestive tract and genitourinary system (e.g., gallstones, kidney stones).
Abuse
Like other opioids, nicomorphine can be abused as a euphoric intoxicant.
Dosage
According to the prescribing information. The drugs are usually administered once or twice daily. The tablets can be taken independently of meals.
Contraindications
Nicomorphine is contraindicated in hypersensitivity, acute liver disease, respiratory depression, obstructive airway disease, intestinal obstruction, acute abdomen, delayed gastric emptying, traumatic brain injury, and increased intracranial pressure. It must not be combined with MAO inhibitors. For complete precautions, see the drug label.
Interactions
Drug-drug interactions have been described with central depressant drugs, alcohol, MAO inhibitors, muscle relaxants, rifampicin, clomipramine, amitriptyline, opioid antagonists, andcimetidine.
Adverse effects
The most common possible adverse effects include drowsiness, mood changes, confusion, hallucinations, sweating, dizziness, headache, respiratory depression, small pupils, nausea, vomiting, constipation, dry mouth, palpitations, and facial skin flushing. As with all opioids, there is a risk for respiratory depression and dependence.
