Nortilidine[1] is the major active metabolite of tilidine. It is formed from tilidine by demethylation in the liver. The racemate has opioid analgesic effects roughly equivalent in potency to that of morphine[2] but virtually all of the opioid activity resides in the (1S,2R) isomer.[3] The (1R,2S) isomer has NMDA antagonist activity. The drug also acts as a dopamine reuptake inhibitor.[4] The reversed-ester of nortilidine is also known[5] which has almost identical properties to nortilidine.[6]
See also
O-Desmethyltramadol, another opioid metabolite with additional (non-opioid) mechanisms of analgesia
^J Clin Pharmacol. 2002 Nov ;42 (11):1257-61 - Sequential first-pass metabolism of nortilidine: the active metabolite of the synthetic opioid drug tilidine
^Opiates: George R. Lenz page 439, Table 9-30 (78)