Levorphanol opinions?

[Ligament]

I recently had the pleasure of getting dinner with Gecko (SDN member), a pain doc up here near me in Seattle. Somehow we got on the topic of levorphanol over a dinner of salt and pepper pork chops, black bean ribs, and spicy chinese long green bean, french toast with spaghetti with meat sauce and sweet corn with Horlick's to drink at a local HK style cafe.

You know, what goes better with this food than a discussion of the morphinan class of opioids? I'm sure all you old timers have been in the same situation....

I've always been curious about this med since it is long acting, has NMDA antagonist activity, has ZERO street "name" hence value, does not have the cardiotoxic issues with methadone (I believe)...seems like a great drug in theory.

Have you used it at all and what are your opinions?

Levorphanol: the forgotten opioid. [Review] [21 refs]
Supportive Care in Cancer. 15(3):259-64, 2007 Mar.

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[lobelsteve]

Levorphanol has been used in both inpatient and outpatient settings, but both physicians and patients must be aware of the risk of orthostatic hypotension, dizziness and syncope in ambulatory patients.

Analgesic half life is less than plasma half life. It is a bid drug that usually needs to be Rx'd q6h to cover the pain (similar to methadone).

It is not widely available, only comes in 2mg tablets, and will require titration at 3 day intervals. This means most chronic pain patients will be taking 2-3 tablets bid #180. I'd rather Rx Avinza 60mg #30 (diffuse pill taking behaviors).

That being said, it is still a widely underused medication. I'd prefer it to methadone (qt prolongation) as a long acting.

 

[ampaphb]

I'd rather Rx Avinza 60mg #30

Remind me again, which company do you shill for at those dinner meetings?

 

[lobelsteve]

Remind me again, which company do you shill for at those dinner meetings?

I am on the speakers bureau for a few of the pharmaceutical companies. I choose King Pharm as my favorite not because of the lectures I provide,but because I believe in the product. I am fortunate that I could name any of the other long acting opioids I speak for, but I choose Avinza because it is my first choice. They chose me because I am fun to listen to, or have you forgotten about the lecture series already?

 

[drusso]

I've used and rotated to levorphanol as a third line opioid. It's more expensive than good old fashioned methadone. Agree with needing to dose it QID. I'm not sure I've really found a specific use for it.

 

[Disciple]

I choose King Pharm as my favorite not because of the lectures I provide,but because I believe in the product. I am fortunate that I could name any of the other long acting opioids I speak for, but I choose Avinza because it is my first choice.

What would you say is the advantage over, say, Kadian? The Q24 with Avinza or the 10% IR componenent.

Kadian has a 10mg capsule now and for certain chronic pain patients I've been skipping over the APAP combo short acting opiates and going right to it.

Both companies are giving out $50 copay coupon cards.

 

[Disciple]

I've used and rotated to levorphanol as a third line opioid. It's more expensive than good old fashioned methadone. Agree with needing to dose it QID. I'm not sure I've really found a specific use for it.

How's the insurance coverage on it. Would you put it equivalent to Opana in that regard?

More expensive than Avinza?

 

[ampaphb]

How's the insurance coverage on it. Would you put it equivalent to Opana in that regard?

More expensive than Avinza?

Levorphanol is generic - the others you mentioned are brand. As a result, Levorphanol will be orders of magnitude less expensive

 

[drusso]

Levorphanol is generic - the others you mentioned are brand. As a result, Levorphanol will be orders of magnitude less expensive

While it is generic, and somewhat "orphaned," not all pharmacies keep it around, thus it is more expensive that methadone but certainly cheaper than medications still on patent.

 

[MN1]

I've used and rotated to levorphanol as a third line opioid. It's more expensive than good old fashioned methadone. Agree with needing to dose it QID. I'm not sure I've really found a specific use for it.

3rd line? Interesting. For most I assume it would be about 5th line.

 

[MN1]

I am on the speakers bureau for a few of the pharmaceutical companies. I choose King Pharm as my favorite not because of the lectures I provide,but because I believe in the product. I am fortunate that I could name any of the other long acting opioids I speak for, but I choose Avinza because it is my first choice. They chose me because I am fun to listen to, or have you forgotten about the lecture series already?

Why do you like Avinza so much? Just curious.

 

[lobelsteve]

Why do you like Avinza so much? Just curious.

Because of my inherent bias as a paid speaker on their bureau.

also because it is the only true once a day opioid.

So there ampaphb!

 

[oreosandsake]

just found this

anyone have updated thoughts? this thread is almost 10 years old. paging Dr Lobel

 

[lobelsteve]

And 10 years ago was the last time I heard about that. But more interested in Ligs dinner.

 

[Ligament]

just found this

anyone have updated thoughts? this thread is almost 10 years old. paging Dr Lobel

Have used it for very resistant neuropathic pain with much better than expected results. I rarely prescribe any opioid in the past many years, and this one is an odd duck so prescribe this even rarer still. That said, I've always been impressed with it for neuropathic pain, specifically. Pain in the ass for patients to get it filled at their pharmacies. I think it still has zero street recognition and hence diversion is probably lower...probably. Can never tell with these junkies...

I can't believe I've been on SDN so long...

 

[ampaphb]

$3k for a month's supply

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[Ligament]

$3k for a month's supply

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That does not sound right. Its a generic medication.

 

[Ducttape]

Limited supply, low demand.

Think skirelli, Turing pharmaceuticals and Daraprim....


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