Lefisyo (Levomethadone Hydrochloride)

Levomethadone Hydrochloride is used in the management of pain and opioid dependence, acting on the mu‑opioid receptor pathway.

• Moderate to severe pain: provides potent analgesia for patients requiring strong opioid relief.
• Opioid dependence management: serves as a substitution therapy to reduce withdrawal symptoms and support maintenance treatment.

• Levomethadone Hydrochloride acts as a full agonist at the mu‑opioid receptors in the central nervous system. By binding to these receptors, it activates intracellular signaling pathways that inhibit nociceptive transmission, producing analgesia, and also mimics the effects of endogenous opioids, thereby reducing cravings and withdrawal in opioid‑dependent individuals.

Levomethadone Hydrochloride may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: feeling of stomach upset or urge to vomit.
• Constipation: reduced bowel movements and hard stools.
• Dizziness: light‑headed sensation, especially when standing quickly.
• Drowsiness: increased sleepiness or fatigue.

Serious or Rare Side Effects

• Respiratory depression: slowed or shallow breathing that can be life‑threatening.
• QT interval prolongation: cardiac rhythm disturbance that may lead to arrhythmia.
• Severe hypotension: marked drop in blood pressure causing faintness or shock.

When prescribing Levomethadone Hydrochloride, clinicians should consider several safety measures.

• Assess respiratory function: monitor for signs of depression, especially after dose changes.
• Evaluate liver function: adjust therapy if hepatic impairment is present.
• Avoid use in acute asthma: risk of bronchospasm and worsening airway obstruction.
• Use caution in elderly patients: increased sensitivity to opioid effects and higher fall risk.
• Store at ambient temperature below 25°C: keep in the original pack, protect from moisture.

Levomethadone Hydrochloride can interact with various medications, requiring careful management.

Major Interactions (Avoid)

• CNS depressants (e.g., benzodiazepines, alcohol): may cause profound sedation and respiratory depression.
• Monoamine oxidase inhibitors (MAOIs): increase risk of serotonin syndrome and hypertensive crisis.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): can raise levomethadone plasma levels, heightening toxicity.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce drug exposure, diminishing efficacy.
• Other opioids: additive opioid effects can increase sedation and respiratory risk.
• QT‑prolonging agents (e.g., certain antiarrhythmics, fluoroquinolones): may exacerbate cardiac rhythm disturbances.