Desomorphine (Krokodil): An overview of its chemistry, pharmacology, metabolism, toxicology and analysis.

BACKGROUND: "Krokodil" or "Crocodile" is an illegal homemade desomorphine drug obtained from chemical reactions of commercial codeine drugs with several other powerful and highly toxic chemical agents increasing its addiction and hallucinogenic effects when compared with other morphine analogues. METHODS: This paper summarizes a complete review about an old drug called desomorphine (Krokodil), presenting its chemistry, pharmacology, metabolism, toxicology and analysis. RESULTS: It is of particular interest and concern because this cheaper injectable semisynthetic opioid drug has been largely used in recent years for recreational purposes in several Eastern European as well as North and South American countries, despite known damage to health that continuous use might induce. These injuries are much stronger and more aggressive than morphine's, infecting and rotting skin and soft tissue to the bone of addicts at the point of injection in less than three years, which, in most cases, evolves to death. On this basis, it is imperative that literature reviews focus on the chemistry, pharmacology, toxicology and analysis of dangerous Krokodil to find strategies for rapid and effective determination to mitigate its adverse effects on addicts and prevent consumption. CONCLUSIONS: It is crucial to know the symptoms and consequences of the use of Krokodil, as well as METHODS: for identification and quantification of desomorphine, contaminants and metabolites, which can help the forensic work of diagnosis and propose actions to control and eradicate this great danger to public health around the world.

The combination of ibuprofen and oxycodone/acetaminophen in the management of chronic cancer pain.

Thirty subjects with chronic moderate to severe pain who were receiving oxycodone/acetaminophen (oxy/APAP) for analgesia were initially evaluated for at least 7 days for oxy/APAP requirements for pain control. Each subject then received, in a randomized double-blind fashion, either 600 mg ibuprofen or placebo for an additional 7 days while hospitalized. Oxy/APAP usage was recorded daily along with efficacy and toxicity parameters. Overall global evaluations were also recorded on completion of the study. Comparison of mean differences before and after treatment with ibuprofen or placebo indicated a marked decrease in oxy/APAP use with ibuprofen (p less than 0.01) and a slight increase in use in the placebo group. Reduction in oxy/APAP usage occurred within 24 hours and maximized at 5 days. Overall global scores showed a marked preference for the ibuprofen combination over placebo (p less than 0.01). Daily pain intensity (p less than 0.05) and pain relief scores (p less than 0.05) also improved with the addition of ibuprofen. This study indicates that ibuprofen is efficacious in the management of chronic cancer pain, resulting in both enhanced analgesia and a reduction in concomitant narcotic use.

[Effect of conorphone on the dimensions of the myocardial infarct and the ultrastructural changes in the adjacent tissue]. / Efecto de la conorfona sobre las dimensiones del infarto del miocardio y las alteraciones ultraestrcuturales del tejido adyacente.

Among contemporary problems of cardiovascular therapy, pain management in the cardiac patient is an important issue. Correct selection of a suitable analgesic drug is important in the acute phase of myocardial infarction because pain relief prevents adrenergic response which aggravates unbalance between myocardial oxygen supply and demands. Until today morphine has been the best choice, nevertheless its side effects and limited availability demands pharmacological alternatives. Meperidine has been used for this purpose although its anticholinergic and narcotic profiles do not fulfill the therapeutic requirements. Conorphone is a codeine derivative which retains analgesic potency without other narcotic side effects and which presents an antagonistic profile for the remainder of opiate effects. Preliminary studies demonstrate that conorphone lacks cardiovascular side effects. Conorphone also shows antiarrhythmic effects in experimental models such as in rat in which arrhythmias were induced by coronary ligation. In this paper a morphologic analysis with electron microscopy was done on adjacent myocardial tissue next to an area of infarct. Experimental myocardial infarction was induced by ligation of descendant branch of left coronary artery, four hours prior to rat sacrifice and suitable samples for ultrastructure study were obtained. The experiments demonstrate that a group of rats that received 3.1 mg/kg of conorphone had less expressions of cellular damage when compared with similar myocardial areas of a control group of rats.