Dipipanone, sold under the brand names of Pipadone and Diconal is a strong

opioid Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...

analgesic An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

drug, used for acute pain by mouth ( PO) for adults. It is often used in instances where

morphine Morphine, formerly also called morphia, is an opiate that is found naturally in opium, a dark brown resin produced by drying the latex of opium poppies (''Papaver somniferum''). It is mainly used as an analgesic (pain medication). There are ...

is indicated but cannot be used due to the patient being allergic to morphine. In analgesic potency 25 mg dipipanone is approximately equivalent to 10 mg morphine.

Dosage forms

The main preparation of the drug commercially available is mixed with cyclizine (Diconal, Wellconal) which has the advantage of reducing nausea, vomiting and histamine release associated with strong opioid therapy. Dipipanone was also available as an oral mixture 10 mg/5 mL without the cyclizine during the 1970s–1980s in the United Kingdom. This form was rare and used normally only in drug trials and in specialist Diconal addiction clinics. Dipipanone is now the only alternative opioid left to use in the UK that is of equal strength to morphine that can be prescribed instead, aside from

oxycodone Oxycodone, sold under the brand name Roxicodone and OxyContin (which is the extended-release form) among others, is a semi-synthetic opioid used medically for the treatment of moderate to severe pain. It is highly addictive and is a commonly ...

and

hydromorphone Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid among others, is a morphinan opioid used to treat moderate to severe pain. Typically, long-term use is only recommended for pain due to cancer. It may b ...

which are typically the second and third-line alternative to pain relief when morphine is indicated but not tolerated. A fentanyl patch may also be used, especially in cases of renal impairment. One of the limitations of using dipipanone is that it is only produced in one dosage form that is mixed with the anti-emetic and anti-histamine cyclizine at a ratio of 25% dipipanone to 75% cyclizine which limits the dose of dipipanone to an absolute maximum of 3 tablets per dose up to 4–6 times a day. This is a 10 mg dipipanone and 30 mg cyclizine formulation. It is made by the following manufacturers: * Dipipanone 10 mg / cyclizine 30 mg tablets (Phoenix Healthcare Distribution Ltd) * Dipipanone 10 mg / cyclizine 30 mg tablets (Alliance Healthcare (Distribution) Ltd) * Dipipanone 10 mg / cyclizine 30 mg tablets (Advanz Pharma) All formulations contain the same dose, and differ only in manufacturer. As of November 2011 Amdipharm stopped making the Diconal brand tablets for the UK due to undisclosed commercial reasons. However the product is listed as available on the manufacturer's website as of July 1, 2014. General practitioners are now advised to prescribe it as generic dipipanone/cyclizine tablets.

Use

Dipipanone is now unavailable in most countries of the world either by laws prohibiting its medicinal use as in the United States or by falling out of production as more modern analgesics took its market share. Great Britain, Northern Ireland and South Africa are known to continue to use the substance but it is infrequently prescribed. Dipipanone is a Schedule I controlled substance in the United States; it has been assigned the ACSCN of 9622 and since 2013 had an annual manufacturing quota of 5 grams.

Chemistry

Chemically, dipipanone belongs to the class of opioids called the 4,4-diphenylheptane-3-ones. It closely resembles

methadone Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid used medically to treat chronic pain and opioid use disorder. Prescribed for daily use, the medicine relieves cravings and opioid withdrawal sym ...

, the only structural difference being the ''N'',''N''-dimethyl moiety of methadone being replaced with a

piperidine Piperidine is an organic compound with the molecular formula (CH2)5NH. This heterocyclic amine consists of a six-membered ring containing five methylene bridges (–CH2–) and one amine bridge (–NH–). It is a colorless liquid with an odor de ...

ring. Other related compounds with equivalent activity where the piperidine ring has been replaced by other groups, include the

morpholine Morpholine is an Organic compound, organic chemical compound having the chemical formula oxygen, O(carbon, Chydrogen, H2CH2)2nitrogen, NH. This heterocycle features both amine and ether functional groups. Because of the amine, morpholine is a bas ...

derivative phenadoxone, as well as the corresponding

pyrrolidine Pyrrolidine, also known as tetrahydropyrrole, is an organic compound with the molecular formula (CH2)4NH. It is a cyclic secondary amine, also classified as a saturated heterocycle. It is a colourless liquid that is miscible with water and most ...

derivative dipyanone. The synthesis is the same as for phenadoxone, with the exception that

is used ''

in lieu Many words in the English vocabulary are of French language, French origin, most coming from the Anglo-Norman language, Anglo-Norman spoken by the upper classes in England for several hundred years after the Norman conquest of England, Norman ...

'' of

. Related compounds with an isoquinuclidine ring such as nufenoxole are also known.

Medical and recreational use

Prescription of dipipanone is discouraged apart from in exceptional circumstances, because of the perceived risk of abuse — the BNF marks the substance as "less suitable for prescribing" along with other older compounds such as

pethidine Pethidine, also known as meperidine and sold under the brand name Demerol among others, is a fully synthetic opioid pain medication of the phenylpiperidine class. Synthesized in 1938 as a potential anticholinergic agent by the German chemist Ot ...

and

pentazocine Pentazocine, sold under the brand name Talwin among others, is an analgesic medication used to treat moderate to severe pain. It is believed to work by activating (agonizing) κ-opioid receptors (KOR) and μ-opioid receptors (MOR). As such it i ...

with unusual abuse patterns. The combination with cyclizine leads to a very strong "rush" if the drug is injected, however the tablets contain insoluble binders which can lead to serious injury or death. During the late 1970s to early 1980s in the UK, many deaths were blamed on misuse of this preparation. As supplies became unavailable, opiate users would mix crushed methadone tablets with crushed cyclizine tablets, in an attempt to replicate the effect of Diconal. When taken orally as indicated for pain, the risk of addiction and euphoric potential is similar to that of morphine, The historical deaths linked to misuse of this drug may make this drug distasteful for prescribing doctors.

References

{{Opioidergics Analgesics Ketones Mu-opioid receptor agonists 1-Piperidinyl compounds Synthetic opioids Benzhydryl compounds Withdrawn drugs