Levomethadone Hydrochloride Molteni is indicated for use in substitution therapy for opioid dependence in adults, in combination with appropriate medical, social, and psychosocial support.

The drug is available as an oral syrup in concentrations of 2.5 mg/ml and 5 mg/ml.

Levomethadone is the R(-) enantiomer of methadone. The S(+) enantiomer is responsible for only 1/50th of the analgesic effect of the R(-) enantiomer.

The clinical action of levomethadone in treating opioid and/or opioid analgesic dependence is based on two mechanisms: on the one hand, levomethadone, as a synthetic opioid receptor agonist, produces an effect similar to morphine, which inhibits withdrawal symptoms in individuals dependent on opioids and/or opioid analgesic drugs. On the other hand, depending on the dose and duration of substitution therapy, prolonged oral use of levomethadone can lead to the development of tolerance, which blocks the effects of opioids administered parenterally, subjectively perceived as euphoric.

Levomethadone is the pharmacologically active isomer of methadone, and its effectiveness is comparable to half the dose of methadone racemate. Compared to the racemate, levomethadone blocks hERG potassium channels 3.5 times less, thus reducing QT interval prolongation on the ECG, which gives levomethadone a better cardiovascular safety profile.

Levomethadone is not contraindicated in patients with:

• organic heart disease,
• uncontrolled diabetes,
• severe liver and kidney function disorders,
• pregnant and breastfeeding women.