The physiological behavior of morphinans (naturally occurring and semi-synthetic derivatives) is thought to be associated with the aromatic
A ring, the nitrogen-containing
D ring and the "bridge" between these two rings formed by carbons 9, 10 and 11 of the core, with the
D ring "above" the core (
levorotatory). Small groups are usually found on morphinan derivatives at carbons 3 and 6. Many such derivatives have an
epoxy group between carbons 4 and 5 (i.e., 4,5α-epoxy), thereby forming an
E ring. The substitution of certain bulky groups on nitrogen 17 converts an opioid agonist into an opioid antagonist, the most important of which is
naloxone, a non-selective opioid
antagonist with no opioid
agonist properties whatsoever (
"silent" antagonist). Additionally, substitution of certain very bulky groups on carbon 6 converts naloxone into a peripherally-selective opioid antagonist with no centrally-selective antagonist properties (
naloxegol). The addition of a two-carbon bridge between carbons 6 and 14 (e.g., 6,14-ethano, or 6,14-etheno), and which significantly distorts the
C ring, may increase potency 1,000 to 10,000 times, or greater, compared to morphine, as in
etorphine, and others. The relative potency is thought to be associated with the degree of distortion of the
C ring, and is perhaps greatest in
diprenorphine, where this group is α,α-dimethyl-6,14-etheno. Diprenorphine (M5050) is the recommended etorphine (M99) antagonist, but it is not a pure opioid antagonist (i.e., it is also a weak opioid agonist), so naloxone remains a significant therapeutic tool in suspected cases of opioid overdose. See also
Bentley compounds. If the
D ring is "below" the core (
dextrorotatory), the analgesic and euphoric properties are eliminated or are dramatically reduced, but the cough-suppressant property is retained, as in
dextromethorphan. == Chemical derivatives ==