nitazene

Nitazenes are a chemically defined class of substances derived from the parent compound nitazene. Nitazenes were developed in the second half of the 1950s by the Swiss company Ciba AG as pain-relieving agents. They are important as centrally active, selective μ-opioid receptor agonists. The high potency of fentanyl (in humans) is matched by only a few nitazenes and surpassed by etonitazene and isotonitazene. Due to unacceptable side effects, nitazenes were never included in the pharmacopoeia of human or veterinary medicine. Since 2019, highly potent nitazenes have proliferated as ″new synthetic opioids″ in the North American and European narcotics markets and as such have become a formative component of the opioid epidemic in the United States. Overdoses of nitazene opioids have led to several hundred documented fatalities.

== History == In the mid-1950s, the pharmaceutical research department of Ciba AG discovered the (low) analgesic effect of 1-(β-diethylaminoethyl)-2-benzylbenzimidazole (desnitazene). Systematic derivatization of this parent compound in the course of structure-activity relationship investigations revealed an enhancement of activity by nitration of the 5-position. 4'-Methoxylated and ethoxylated compounds achieved potencies in the hot plate test that were previously unattained. The thus discovered etonitazene is the most potent nitazene opioid known to date. The morphine-like mechanism of action was elucidated from the antagonizability of analgesia with allylnormorphine. In a human clinical trial two nitazenes (etonitazene and clonitazene) were investigated in 363 patients and the results were published in 1958. The nitazenes were notable for their low therapeutic index, which precludes their marketability as pharmaceutical drugs.