PANTOPON

PANTOPON (Pantopon), a preparation proposed by Sahli in 1909; it represents a mixture of all the alkaloids of opium in the form of hydrochloride salts, with all alkaloids contained in P. in approximately the same proportion as in opium, but in increased concentration. Thus, pantopon contains about 50% morphine and 40% other alkaloids; the remaining 10% consists of hydrochloric acid and crystallization water. According to analysis by Paly (I. Paly), P. contains 49.6% morphine, 26% secondary alkaloids (including 14.4% narcotine, 3.6% papaverine), and 0.3% ash. According to Sahli, pantopon has the following advantages: 1) it contains, along with morphine, other opium alkaloids that beneficially modify the therapeutic action of morphine; 2) it contains alkaloids in the form of readily soluble and easily absorbable hydrochloride salts; 3) it does not contain the ballast substances of opium (fats, wax, resins) that hinder the absorption of alkaloids; 4) it gives clear solutions suitable for subcutaneous injections, whereas aqueous extracts from opium are turbid and have irritating properties. The fact that, in addition to morphine, other alkaloids contained in P. have pharmacological significance is proven, on one hand, by the action of these alkaloids taken separately (see Opium), and then by experiments with morphine-free P.-opon. The latter, according to experiments by Hesse and Neukirch in doses of 0.08-0.1, is capable of stopping diarrhea in cats caused by a milk diet, and if, in addition to morphine, the codeine content in P. is also reduced, the delay of diarrhea no longer occurs. Winternitz, when applying opium to rabbits, observed an effect twice as strong as when using ordinary P. In experiments on himself, the same author observed from 0.5-1.0 of P. a clear hypnotic effect, and from 0.3-0.5 a sedative effect. Klausner describes skin exanthemas after P. and opium. However, Trendelenburg, on the isolated and stretched intestine of a guinea pig, obtained no other data from tincture of opium or P. compared with corresponding solutions of morphine. As for the non-alkaloid components of opium, meconic acid is absent in P.; however, for humans even in large doses this acid is inactive. A comparative study of the action of P. on patients, on one hand, and opium on the other, indicates a faster effect of P. compared with opium. In toxicity, P. is twice as weak as morphine. The local anesthetic effect, depending on the influence on peripheral sensory nerves, is more pronounced in P. than in morphine. The action on the central nervous system is similar to the action of opium and differs from the action of morphine by less depression of the respiratory center. The action on the heart, blood vessels, and circulation is similar to the action of opium. Gastric juice secretion under the influence of P. increases, even when all nerves are severed. The motor function of the intestine sharply decreases, and, as with opium, according to experiments by Popper, the circular fibers of the intestine contract, while the longitudinal fibers relax, and according to experiments by Ganter (1924) on humans, P., when administered subcutaneously in very small doses, increases intestinal tone, which remains elevated for more than an hour. The clinical indications for the use of P. are the same as for morphine and opium. P. is specifically indicated when a rapid effect of the entire sum of opium alkaloids on the body is desirable, for example, when prescribing it as an analgesic (or resp. hypnotic) in cases where morphine, due to its depressing effect on the respiratory center, appears undesirable. A special advantage of P. over opium is the possibility of subcutaneous administration of P. The prescription of P. per os for action on the intestine instead of opium is hardly advantageous, since the slow absorption of opium is a favorable factor (see Opium) that promotes the action of alkaloids over a greater length of intestine. Sahli, however, asserts that the more energetic action of the alkaloids in P. compensates in this case for their action over a more limited extent. To obtain an anti-diarrheal effect, P., according to Sahli, should be prescribed on an empty stomach. The preparation m.-Pantopon (Pantopon), or according to the German F VI-Opium concentratum, is used per os in powder in tablets of 0.01 (single highest dose 0.03), and for subcutaneous injections in the form of a 2% solution in a mixture of 75% sterile water and 25% glycerin, usually in a dose of 0.02 P. With subcutaneous administration, local phenomena are usually absent, and only in very sensitive people is a brief burning sensation observed; when prescribing a 2% solution of P. per os, the usual dose is 5-20 drops. For cough, P. is prescribed in powders of 0.005 three times a day or in a mixture of 0.03-0.04: 200.0. P.-opon, deprived of narcotine. Spasmalgin-tablets containing each 0.01 P., 0.02 papaverine, and 0.001 atrinal. (Atrinal is the acid complex ester of sulfuric acid and atropine, similar in action to the latter but somewhat less poisonous.)-Opon consists of the hydrochloride salts of opium alkaloids except morphine. The main component (50%) is hydrochloride narcotine. Hydrochloride codeine is also contained in Opon in considerable quantity. Opon is a brown, loose powder, readily soluble in water.-Instead of the patented (abroad) P., pharmacopoeial preparations of P. have been introduced in a number of countries. These are: Opium concentratum of the German Pharmacopoeia 1926 with 48-50% morphine, Opial of the Dutch Pharmacopoeia 1926 (composition: 50% hydrochloride morphine, 30% hydrochloride narcotine, 4% hydrochloride papaverine, 2.5% hydrochloride codeine, 2% hydrochloride thebaine, 1% hydrochloride narcene, and 10.5% sodium chloride). The content of pure morphine (base) is 38%. In the USSR, pantopon is prepared by the Chimen factory of Gosmedtorgprom.