Levomethorphan

Levomethorphan is the l-stereoisomer of methorphan. The effects of the two isomers are quite different. Dextromethorphan is an antitussive on low doses and a dissociative on much higher doses, whereas levomethorphan is an opioid analgesic. Levomethorphan has effects similar to levorphanol but is less potent as it must be demethylated to the active form by liver enzymes before becoming active.

In the Kay Scarpetta crime novel Body of Evidence, levomethorphan is used by a terminal cancer patient for relief of chronic pain. Eventually, she takes a fatal overdose (while Dr Scarpetta, coincidentally, is a guest in her house). Scarpetta, who is unfamiliar with this rarely-used drug, consults the decedent’s doctors at the Johns Hopkins University oncology clinic and learns that it is regularly used for a few long-term, trusted patients.

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