Brorphine

COPD, Obstructive sleep apnea, Acute asthma, Respiratory insufficiency

Brorphine produces pronounced respiratory depression confirmed in CD-1 mice plethysmography. Naloxone pretreatment at 6 mg/kg IP failed to fully reverse respiratory depression for some compounds in this class. Any pre-existing respiratory compromise is an absolute contraindication.

Traumatic brain injury, Elevated intracranial pressure, Intracranial mass lesion

MOR agonists mask neurological signs and may worsen intracranial hypertension through CO2 retention secondary to respiratory depression. No brorphine-specific data; class inference from MOR agonist pharmacology.

Severe hepatic insufficiency, Decompensated cirrhosis

No specific CYP isoform data published for brorphine. Extensive hepatic metabolism is confirmed (14 metabolites identified in vivo). Impaired hepatic function may prolong drug exposure and increase respiratory depression risk.

Pregnancy, Breastfeeding

All MOR agonists carry risk of neonatal abstinence syndrome when used during pregnancy. Brorphine's high efficacy and unknown pharmacokinetics make gestational exposure particularly hazardous. No brorphine-specific reproductive data exist.

Benzodiazepines, Other opioids, Alcohol, Barbiturates, GABAergic sedatives

Co-administration with other CNS depressants produces additive or synergistic respiratory depression. Forensic case series (Krotulski et al. 2021) document universal polydrug co-detection in brorphine fatalities — 100% with fentanyl, 80% with flualprazolam. This is the most evidence-supported contraindication.

MAO inhibitors (irreversible), MAO inhibitors (reversible)

No published interaction data exist for brorphine with MAOIs. By opioid class precedent, hemodynamic instability is the primary risk. Serotonin syndrome risk is uncertain — brorphine's serotonergic profile has not been tested.