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analgesic drug (trade name Talwin) that is less addictive than morphine (同)Talwin

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/11/05 21:52:17」(JST)

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Pentazocine is a synthetically-prepared prototypical mixed agonist–antagonist narcotic (opioid analgesic) drug of the benzomorphan class of opioids used to treat moderate to moderately severe pain. Pentazocine is sold under several brand names, such as Fortral, Sosegon, Talwin NX (with the μ-antagonist naloxone, will cause withdrawal in opioid dependent persons on injection), Talwin, Talwin PX (without naloxone), Fortwin (Lactate injectable form) and Talacen (with acetaminophen). This compound may exist as one of two enantiomers, named (+)-pentazocine and (−)-pentazocine. (−)-pentazocine is a κ-opioid receptor agonist, while (+)-pentazocine is not, instead displaying a ten-fold greater affinity for the σ receptor. Usually, in its oral formulations, it is combined with naloxone so as to prevent people from crushing the tablets, dissolving them in a solvent (like water) and injecting them for a high (as naloxone is not orally bioavailable it produces no effect when the formulation is used orally, but it blocks the opioid effects of pentazocine if injected intravenously for a high).^[2] Related drugs include phenazocine, dezocine, cyclazocine and several chemicals used in research on the central nervous system.

Use

Medical

Pentazocine is used primarily to treat pain, although its analgesic effects are subject to a ceiling effect.^[3] It has been discontinued by its corporate sponsor in Australia, although it may be available through the special access scheme.^[2]

Recreational

In the 1970s, recreational drug users discovered that combining pentazocine with tripelennamine (a first-generation ethylenediamine antihistamine most commonly dispensed under the brand names Pelamine and Pyribenzamine) produced a euphoric sensation. Since tripelennamine tablets are typically blue in color and brand-name Pentazocine is known as Talwin (hence "Ts"), the pentazocine/tripelennamine combination acquired the slang name Ts and blues. After health-care professionals and drug-enforcement officials became aware of this scenario, the mu-opioid-antagonist naloxone was added to oral preparations containing pentazocine to prevent injection misuse,^[4] and the reported incidence of its misuse has declined precipitously since.

Research

In an open-label, add-on, single-day, acute-dose small clinical study, pentazocine was found to rapidly and substantially reduce symptoms of mania in individuals with bipolar disorder that were in the manic phase of the condition.^[5] It was postulated that the efficacy observed was due to κ-opioid receptor activation-mediated amelioration of hyperdopaminergia in the reward pathways.^[5] Minimal sedation and no side effects including psychotomimetic effects or worsening of psychosis were observed at the dose administered.^[5]

Adverse effects

Side effects are similar to those of morphine, but pentazocine, due to its action at the kappa opioid receptor is more likely to invoke psychotomimetic effects.^[3] High dose may cause high blood pressure or high heart rate.^[2] It may also increase cardiac work after myocardial infarction when given intravenously and hence this use should be avoided where possible.^[2] Respiratory depression is a common side effect, but is subject to a ceiling effect, such that at a certain dose the degree of respiratory depression will no longer increase with dose increases.^[2] Likewise rarely it has been associated with agranulocytosis, erythema multiforme and toxic epidermal necrolysis.^[2]

Tissue damage at injection sites

Severe injection site necrosis and sepsis has occurred (sometime requiring amputation of limb) with multiple injection of pentazocine lactate. In addition, animal studies have demonstrated that Pentazocine is tolerated less well subcutaneously than intramuscularly.^[6]

History

Pentazocine was developed by the Sterling Drug Company, Sterling-Winthrop Research Institute, of Rensselaer, New York. It was approved by the Food and Drug Administration in June 1967 after being favorably reviewed following testing on 12,000 patients in the United States. The analgesic compound was first made at Sterling in 1958. U.S. testing was conducted between 1961 and 1967. By mid 1967 Pentazocine was already being sold in Mexico, England, and Argentina, under different trade names.^[7]

Legal status

Pentazocine was originally classified in Schedule V under the Controlled Substances Act but a petition was filed with the D.E.A. on October 1, 1971, to shift it to Schedule III. The petition was filed by Joseph L. Fink III, a pharmacist and law student at Georgetown University Law Center as part of the course Lawyering in the Public Interest. That petition was accepted for review on November 10, 1971^[8] D.E.A. published a Final Rule transferring it to schedule IV on January 10, 1979, with an effective date of February 9, 1979^[9] This is understood to be the first instance of a successful petition to reclassify a substance under the relatively recently enacted Controlled Substances Act. Pentazocine is still classified in Schedule IV under the Controlled Substances Act in the United States, even with the addition of Naloxone. although some states classify it in Schedule III. Internationally, pentazocine is a Schedule III drug under the Convention on Psychotropic Substances.^[10] Pentazocine has a DEA ACSCN of 9720; being a Schedule IV substance, the DEA does not assign an annual manufacturing quota for pentazocine for the United States.

References

^ Stitzel, Robert E. (2004). Modern pharmacology with clinical applications (6 ed.). Philadelphia: Lippincott Williams & Wilkins. p. 325. ISBN 9780781737623.
^ ^a ^b ^c ^d ^e ^f Sweetman, S, ed. (13 December 2013). "Pentazocine". Martindale: The Complete Drug Reference. London, UK: Pharmaceutical Press. Retrieved 17 March 2014.
^ ^a ^b Joint Formulary Committee (2013). British National Formulary (BNF) (65 ed.). London, UK: Pharmaceutical Press. ISBN 978-0-85711-084-8.
^ "Pentazocine and Naloxone tablets". DailyMed. National Institute of Health. Retrieved 2011-12-10.
^ ^a ^b ^c Chartoff, Elena H.; Mavrikaki, Maria (2015). "Sex Differences in Kappa Opioid Receptor Function and Their Potential Impact on Addiction". Frontiers in Neuroscience. 9. doi:10.3389/fnins.2015.00466. ISSN 1662-453X.
^ "TALWIN (pentazocine lactate) injection, solution". DailyMed. National Institute of Health. Retrieved 2011-12-10.
^ Pain-Killing Drug Approved By F.D.A., New York Times, June 27, 1967, pg. 41.
^ 36 Fed.Reg. 217
^ 44 Fed. Reg. 2169
^ "List of psychotropic substances under international control" (PDF). Green List - Annex to the annual statistical report on psychotropic substances (form P) (23rd ed.). International Narcotics Control Board. August 2003.

External links

Eurekalert report on PNAS article

UpToDate Contents

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1. オピオイド系薬剤を慢性的に使用している患者における急性疼痛マネージメント management of acute pain in the patient chronically using opioids
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English Journal

High-dose pentazocine antagonizes the antinociception induced by high-dose morphine.

Shu H1, Wang Z2, Ye F3, Li Q3, Dou Y3, Lin Y3, Huang W3, Xiao X4.
Life sciences.Life Sci.2015 Jun 1;130:1-6. doi: 10.1016/j.lfs.2015.02.023. Epub 2015 Mar 25.
AIMS: To investigate the effects of high doses of pentazocine on antinociception induced by a high dose of morphine and the role of the kappa-opioid receptors (KORs) in these effects in mice.MAIN METHODS: Sixty-six C57BL/6J mice were pretreated with a KOR antagonist, nor-binaltorphimine (nor-BNI) (1
PMID 25817230

κ Agonists as a novel therapy for menopausal hot flashes.

Oakley AE1, Steiner RA, Chavkin C, Clifton DK, Ferrara LK, Reed SD.
Menopause (New York, N.Y.).Menopause.2015 May 18. [Epub ahead of print]
OBJECTIVE: The etiology of postmenopausal hot flashes is poorly understood, making it difficult to develop and target ideal therapies. A network of hypothalamic estrogen-sensitive neurons producing kisspeptin, neurokinin B and dynorphin-called KNDy neurons-are located adjacent to the thermoregulator
PMID 25988798

Opioids for agitation in dementia.

Brown R1, Howard R, Candy B, Sampson EL.
The Cochrane database of systematic reviews.Cochrane Database Syst Rev.2015 May 14;5:CD009705. [Epub ahead of print]
BACKGROUND: Agitation is a common experience for people living with dementia, particularly as day-to-day function and cognition start to decline more. At the present time there are limited pharmacological options for relieving agitation and little is known about the safety and efficacy of opioid dru
PMID 25972091

Japanese Journal

ドロペリドール，フェンタニル，ケタミンを組み合わせた静脈麻酔によるERCP 鎮静法の安全性評価

日本消化器内視鏡学会雑誌 58(12), 2389-2398, 2016
NAID 130005251275

鎮静下（セデーション）大腸内視鏡検査を受けた患者の実状調査：帰宅判定スケール作成に向けての取り組み

葦 44, 17-20, 2015-03-10
NAID 120005738100

ダブルバルーン内視鏡を用いたERCP検査中の経皮的CO<SUB>2</SUB>分圧モニタリング

日本消化器内視鏡学会雑誌 57(9), 2379-2384, 2015
NAID 130005100934

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★リンクテーブル★

リンク元	「オピオイド」「ペンタゾシン」

「オピオイド」

Pentazocine
Systematic (IUPAC) name
	(2RS,6RS,11RS)-6,11-dimethyl-3-(3-methylbut-2-en-1-yl)-1,2,3,4,5,6-hexahydro-2,6-methano-3-benzazocin-8-ol; or; 2-dimethylallyl-5,9-dimethyl-2'-hydroxybenzomorphan
Clinical data
Pregnancy; category	AU: C; US: C (Risk not ruled out) or D (if used near to term); ;
Routes of; administration	Oral, IV, IM
Legal status
Legal status	AU: S8 (Controlled); CA: Schedule I; DE: Anlage III (Prescription only); US: Schedule IV; Schedule III (international);
Pharmacokinetic data
Bioavailability	~20% orally
Metabolism	Hepatic
Onset of action	15 min
Biological half-life	2 to 3 hours
Excretion	Renal
Identifiers
CAS Number	359-83-1
ATC code	N02AD01 (WHO)
PubChem	CID 441278
IUPHAR/BPS	1606
DrugBank	DB00652
ChemSpider	390041
UNII	RP4A60D26L
KEGG	D00498
ChEMBL	CHEMBL560
Chemical data
Formula	C19H27NO
Molar mass	285.424 g/mol
3D model (Jmol)	Interactive image
	SMILES Oc1ccc3c(c1)[C@]2([C@H]([C@H](N(CC2)C\C=C(/C)C)C3)C)C ;
	InChI InChI=1S/C19H27NO/c1-13(2)7-9-20-10-8-19(4)14(3)18(20)11-15-5-6-16(21)12-17(15)19/h5-7,12,14,18,21H,8-11H2,1-4H3/t14-,18+,19+/m0/s1 ; Key:VOKSWYLNZZRQPF-GDIGMMSISA-N ;
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　　[★]

英: opioid
同: 類麻薬
関: オピオイド受容体

オピオイド受容体に結合するモルフィン様物質のことを指す。

内因性のオピオイドペプチドが発見され、これらは内因性オピオイドペプチドと呼ばれるようになった。

作用

縮瞳

モルフィンと多くのμ,κアゴニストは瞳孔の縮小を引き起こす。これは瞳孔を支配する副交感神経の興奮による。μアゴニストを中毒量投与すると縮瞳し、pinpoints pupupilsはpathognomonicである。(GOO.559)