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Mellar P. Davis

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date: 18 October 2021

Chapter 15 discusses Levorphanol, a (-)-3-hydroxy-n-methyl morphinan and addresses the dextrorotatory enantiomer of levorphanol, dextrorphan, which for all practical purposes is devoid of opioid receptor activity and is a selective N-methyl-D-aspartate (NMDA) receptor inhibitor. Dextromethorphan is a 3-methylether derivative of dextrorphan through metabolism by CYP2D6. Levorphanol is a multiple receptor binding opioid, an NMDA receptor antagonist, and a monoamine-reuptake inhibitor. Recent experience suggests that it is non-cross-analgesic tolerant to other opioids. Unfortunately, it is both difficult to obtain commercially and little published clinical experience in cancer pain is available

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