Cebranopadol dosage and evidence
Written by Aaron CuhaReviewed Sep 2026
The short answer
Cebranopadol is not a peptide. It is a lab made opioid painkiller that also switches on the nociceptin receptor, whose natural key is a peptide. In two studies in healthy volunteers, it slowed breathing less than oxycodone at doses that eased pain equally. In mid-stage trials it matched or beat morphine and
Evidence grade for Cebranopadol: Moderate. The rule: at least one finished study in people, and at least 100 people who took it. The sum on this page: 5 completed trials, 300 people given it. A grade counts how much has been done to people, not whether it works.
- People given it
- 300
- Human studies
- 5
- Found nothing
- 2
Dose
No human dose established
Amounts that were given in studies sit in Human evidence on this page. None of them is a personal dose.
5 completed trials, 300 people given it
No first-hand reports gathered yet. That is a gap in what we have collected, not a finding that nothing has been reported.
Goal pages: Injury, healing and recovery, Bone and joints
In plain English
In plain English, from Aaron
This is how I would explain it to a friend. The evidence, with the numbers, is further down the page.
Cebranopadol is an opioid painkiller pill. It is not a peptide. It also works on a second pain switch, called NOP, whose natural key is a peptide. The hope is pain relief like an opioid with less risk of breathing stopping. It is not approved anywhere.
What people take it for
- Strong pain relief with less risk of slowed breathing.
- Pain after surgery, back pain and cancer pain.
What studies in people showed
Of the published studies, the largest was 258 people after bunion surgery. Two higher doses eased pain better than a dummy pill and better than morphine. In long term low back pain, all doses beat a dummy pill over 14 weeks. In 30 healthy people, blood oxygen dropped in 25 percent after the top dose. After a strong dose of oxycodone, it dropped in 65 percent. Two final-stage trials in pain after surgery ended in 2025 and have not reported. At a high dose, people who use drugs for fun liked it as much as hydromorphone.
What people report
Reports, not study results
The good
- In healthy volunteers, it slowed breathing less than oxycodone at doses that eased pain equally.
The bad
- It is still an opioid. At a high dose, drug users liked it as much as hydromorphone.
- More people quit the higher doses in the back pain trial because of side effects.
- The breathing floor has not been tested in patients, with alcohol or sleeping pills, or at overdose levels.
Where these come from: From the trials on this page. We have not collected user reports on this one yet.
My bottom line
My opinion: interesting science, still an opioid. Any powder sold under this name is a very strong unapproved opioid, dosed in millionths of a gram. Do not touch it.
An opinion, not a finding. I am a coach, not a doctor.
What it has been measured to do
Measured in people
Goals Cebranopadol has been tested for in people, biggest studies first. We count only what the studies on this page say, so the real numbers may be higher.
- Pain258 people · 2 studies · 1 found nothing
35 of the 36 indexed goals have no study of any kind behind Cebranopadol
No study in people, animals or cells on this page reports a result for these. That does not prove Cebranopadol does nothing for them. It does mean anything you have heard about Cebranopadol and one of these did not come from a study cited here.
Show full evidence
What is Cebranopadol?
Cebranopadol is not a peptide. It is a lab made opioid painkiller that also switches on the nociceptin receptor, whose natural key is a peptide. In two studies in healthy volunteers, it slowed breathing less than oxycodone at doses that eased pain equally. In mid-stage trials it matched or beat morphine and tapentadol. Two final-stage trials in pain after surgery finished in 2025 and have not been published. It is not approved.
Cebranopadol shows up in peptide catalogues by mistake, or by association. It is a small lab made molecule, not a peptide. The mix-up comes from its target. Besides the usual opioid receptor, called mu, it switches on the nociceptin receptor, called NOP. The body's own key for NOP is a peptide of 17 amino acids. Switching on both at once is the whole idea. Switching on NOP seems to limit the slowed breathing that opioids cause. So a drug that does both might ease pain like an opioid with less risk of breathing stopping. Grunenthal developed it as GRT-6005. Tris Pharma now owns it.
For a drug that is not approved, a lot has been measured in people. The biggest trials are the least reported. Two mid-stage trials, in 699 people with diabetic nerve pain and 619 with knee arthritis, finished without a paper. Two final-stage trials in pain after tummy tuck surgery (279 people) and bunion surgery (240) finished in December 2024 and January 2025. No results are posted and no paper could be found. Among published studies, the largest was 258 patients after bunion surgery. 400 and 600 mcg eased pain better than both a dummy pill and morphine 60 mg. In chronic low back pain, 200 to 600 mcg a day for 14 weeks eased pain at every dose, as did tapentadol, compared with a dummy pill. More people quit the higher doses while the dose was being raised. A cancer pain study planned for 524 people only got 126, because too few signed up. People on cebranopadol needed less emergency morphine than people on slow release morphine. The main cancer pain trial (CORAL, NCT01964378) was stopped because too few people joined. The company recorded that this had nothing to do with safety or results.
On breathing, a 2026 study had 30 healthy volunteers each try several doses on different days, with a dummy for comparison. After oxycodone 60 mg, 65 percent had blood oxygen drop to about 80 percent. After cebranopadol 1,000 mcg, 25 percent did. Modelling put slowed breathing about 25 percent lower than oxycodone at doses that eased pain equally. An earlier study gave 12 healthy men one 600 mcg dose. Their breathing slowed but seemed to level off at 4.9 L/min instead of dropping toward zero. Full opioids do not show that floor. The authors warned it was one dose and needed testing higher. In people who use opioids for fun, 200 and 400 mcg felt no better than a dummy. 800 mcg felt like hydromorphone 8 mg.
Cebranopadol is an opioid and carries the usual opioid risks of dependence and overdose. It is not approved anywhere, and openFDA, the FDA's public database, shows no application.
How does Cebranopadol work?
In people, here is what is known. Cebranopadol shrinks pupils, eases pain and slows breathing, like an opioid. In 12 men, slowed breathing leveled off above zero at 600 mcg. In 30 volunteers, it slowed breathing about 25 percent less than oxycodone at doses that eased pain equally. By weight it is far stronger than oxycodone. The blood level that slows breathing is 0.20 ng/mL for cebranopadol against 36 ng/mL for oxycodone. People who use opioids for fun liked it less than hydromorphone at doses up to 400 mcg. Its pain effect builds slowly, over around 8 hours in the 2017 study. That is why mid-stage trials raised the dose over weeks. In a dish, and in a 2026 study of its shape, cebranopadol fully switches on both the NOP receptor and the mu opioid receptor. The leading idea for the breathing floor is that NOP offsets the way mu slows the brain's breathing centres. The human dose results back that idea. So does work in rodents. In rats, cebranopadol also cut cocaine taking, through both receptors.
What have studies in people found about Cebranopadol?
Several thousand people, in studies from early safety tests to final-stage trials. The two breathing studies against oxycodone and the mid-stage pain trials are published. The two recent final-stage trials in pain after surgery are not. Neither are the two largest mid-stage trials, in diabetic nerve pain (699 people) and knee arthritis (619).
- Unpublished mid-stage trials: NCT01939366 (699 people, diabetic nerve pain, results posted 2019) and NCT01709214 (619 people, knee arthritis, no results posted).
- Final-stage trials in pain after surgery: NCT06545097 (279, tummy tuck) and NCT06423703 (240, bunion surgery) finished 2024 to 2025. No results posted.
- Bunion surgery (2018): 258 patients. 400 and 600 mcg eased pain better than a dummy pill and morphine 60 mg.
- Cancer pain (2019): 126 of a planned 524 joined. People on cebranopadol needed less emergency morphine than people on slow release morphine. It was not shown to match morphine on pain itself. The main cancer pain trial (CORAL, NCT01964378) was stopped because too few joined, not for safety or results.
- Chronic low back pain (2017): 14 weeks. All three doses and tapentadol beat a dummy pill. More people quit at higher doses while the dose was being raised.
- Abuse test (2019): 42 people who use opioids for fun. 200 and 400 mcg felt like a dummy, 800 mcg felt like hydromorphone 8 mg. Two more abuse tests (NCT05256108, 38 people; NCT06453265, 48 people, as a nose spray) finished without a paper.
- Head to head with oxycodone (2026): 30 volunteers who each tried several options. Blood oxygen dropped in 25 percent after cebranopadol 1,000 mcg and 65 percent after oxycodone 60 mg. About 25 percent less slowed breathing at doses that eased pain equally.
- Breathing study (2017): 12 healthy men, 600 mcg. Breathing leveled off at 4.9 L/min. The authors warn the floor was shown at one dose only.
What this does not tell you: The breathing floor has been shown in 42 healthy volunteers, at doses up to 1,000 mcg, once, in a lab. It has not been shown in patients. It has not been shown with sleeping pills or alcohol, or at overdose levels, where it would matter most. The 2017 authors warned it might not hold at higher doses, and that still stands. Cebranopadol is a full opioid. At 800 mcg, drug users liked it as much as hydromorphone. Less abuse risk is not no abuse risk. The pain trials mostly ran 12 to 14 weeks or were a single dose. The chronic pain final-stage trial never finished. The two finished final-stage trials that would decide approval have not reported. There is no data on long term use, needing more over time, or withdrawal.
The state of the research
Cebranopadol has been tested in people since at least 2012, under two owners. Its record shows what happens to a big opioid programme when the owner changes and the mood around new opioids changes too. Grunenthal ran the mid-stage trials, most of which are published. It started the chronic cancer pain final-stage trial, which could not sign up enough people. The registry lists the reason as feasibility, not safety or results. The cut short trial that was published favoured cebranopadol. Tris Pharma took over and switched to pain after surgery, the path most new painkillers have used. It finished two final-stage trials in early 2025. Eighteen months later neither has posted results. That is within normal for a company getting ready to file. It is also the gap in which readers should not assume an outcome.
The breathing data are the interesting science. They come from a university anaesthesia group with a long record studying how opioids slow breathing. In the 2026 study they worked with Tris Pharma co-authors. The breathing floor is real in healthy volunteers. It would matter hugely if it held in the situations where people die of opioids. That has not been tested, and it cannot ethically be tested the same way. As for peptide catalogues, cebranopadol does not belong there. It is a small lab made molecule that happens to act on a peptide receptor. Any powder sold under the name is an unapproved, very strong opioid measured in millionths of a gram, which is its own danger.
The evidence, in charts
Fig. 1a · how many people
300people, across 3 studies in people cited here
| Study | People | Share |
|---|---|---|
| Pain Physician 2018 | 258 | 86% |
| Anesthesiology 2026 | 30 | 10% |
| Anesthesiology 2017 | 12 | 4% |
One study holds 86% of these people, so the total rests more on one study than its size suggests. Counts are the number of people each study on this page says it signed up. That includes studies that only watched people and gave nobody the compound. 4 more studies in people give no headcount and are not counted here. Studies still signing people up are left out, and only studies cited on this page are counted.
Fig. 1b · evidence mix
All 7 sources here are studies in people.
- Study in people · done in people7100%
Counted from the list of sources on this page. It counts only what we cite, so there may be more studies out there. A review counts once, however many studies it sums up.
Fig. 2 · evidence over time
The studies cover 5 different years, 2017 to 2026, counted from the list of sources on this page.
Fig. 3 · legal status at a glance
US
Not approved
UK
Not approved
AU
Not approved
CA
Not approved
Not approved in any of the four countries shown. This is what the law says, not a verdict on the science. See Legal status below for the full text and any notes.
Fig. 4 · how much does what
Nobody has tested different amounts in people
This chart would show how the effect changes as the amount goes up. For this compound, nobody has measured that in people. So we leave it empty. We will not borrow an animal chart and pretend it works the same in people.
Fig. 5 · what the molecule is
- Kind of compound
- Small molecule
- Molecule weight
- Not on file
- Half-life
- None on file
- Chain length
- None on file
No amino acid sequence is on file for Cebranopadol, which is expected: a small molecule is not built from amino acids.
The studies we cite
- Study in people2026Respiratory and Antinociceptive Effects of Nociceptin Receptor-mu-Opioid Receptor Agonist Cebranopadol versus Full Opioid Receptor Agonist Oxycodone: A Comparison in Healthy Volunteers
Cebranopadol slowed breathing less than a standard strong opioid did. Thirty healthy volunteers each tried several options on separate days, and nobody involved knew which they were getting. After the higher oxycodone dose, two thirds of them dropped to dangerously low blood oxygen. After the highest cebranopadol dose, a quarter did. At doses that killed pain equally, breathing was less suppressed on cebranopadol. These were healthy volunteers, not patients in pain. Three authors work for the maker.
Randomised, double blind, placebo controlled partial crossover in 30 healthy volunteers: oral cebranopadol 600, 800 or 1,000 mcg, oxycodone 30 or 60 mg, or placebo. Oxygen desaturation to about 80 percent in 65 percent of participants after oxycodone 60 mg versus 25 percent after cebranopadol 1,000 mcg; cebranopadol 600 mcg produced less respiratory depression than oxycodone 30 mg (p = 0.022); modelled respiratory depression about 25 percent lower at equal analgesia. Three authors work for Tris Pharma, the developer.
- Study in people2017Respiratory Effects of the Nociceptin/Orphanin FQ Peptide and Opioid Receptor Agonist, Cebranopadol, in Healthy Human Volunteers
Breathing slowed but appeared to level off rather than keep falling. Twelve healthy men each took a single dose. Modelling of their breathing suggested it would not stop altogether, which is not true of ordinary strong opioids. Pain relief lasted far longer than the effect on breathing. Twelve men and one dose is a thin basis for a safety claim. The authors say it is unknown whether the ceiling holds at higher doses. The paper does not say who paid.
Phase 1, 12 healthy men, single 600 mcg oral dose. Modelled minimum ventilation stayed above zero at 4.9 L/min (95% CI 3.5 to 6.6), a ceiling not seen with full mu agonists. Effect site half-lives 1.2 hours for respiratory depression and 8.1 hours for analgesia. The authors state that further studies are needed to see whether the ceiling holds at higher doses. Funding not stated in the abstract.
- Study in people2017Cebranopadol, a novel first-in-class analgesic drug candidate: first experience in patients with chronic low back pain in a randomized clinical trial
It worked for chronic back pain, at a cost that rose with the dose. Adults with moderate to severe low back pain took cebranopadol at one of three strengths, an existing opioid painkiller, or a dummy, for fourteen weeks. Nobody involved knew which. Every cebranopadol dose beat the dummy for pain across the day, as did the comparison drug. More people quit the higher doses because of side effects while the dose was being built up. The maker paid.
Phase 2, randomised, double blind, 14 weeks: cebranopadol 200, 400 or 600 mcg once daily, tapentadol 200 mg twice daily, or placebo in moderate to severe chronic low back pain. All cebranopadol doses and tapentadol improved 24 hour pain versus placebo on the primary endpoints; higher doses had more discontinuations for adverse events during titration. Developer funded (Grunenthal).
- Study in people2018Cebranopadol: A Novel, First-in-Class, Strong Analgesic: Results from a Randomized Phase IIa Clinical Trial in Postoperative Acute Pain
One tablet beat both a dummy and morphine for pain after foot surgery. Two hundred and fifty eight patients got cebranopadol at one of three strengths, a slow release morphine tablet, or a dummy. The two higher strengths relieved pain over the first ten hours better than either comparison. Morphine worked, but later. The lowest strength was no better than the dummy. Side effects rose with the dose and were worst on morphine. The maker paid.
258 patients after bunionectomy randomised to a single oral dose of cebranopadol 200, 400 or 600 mcg, morphine controlled release 60 mg, or placebo. On the primary endpoint (summed pain intensity 2 to 10 hours), 400 and 600 mcg beat placebo and beat morphine, whose effect emerged later; 200 mcg did not differ from placebo. Adverse events rose with dose and were highest on morphine. Developer funded.
- Study in people2019Cancer-related chronic pain: Investigation of the novel analgesic drug candidate cebranopadol in a randomized, double-blind, noninferiority trial
This trial never got the people it needed and it did not show what it set out to show. It was built for more than five hundred patients with cancer pain and recruited a quarter of that before stopping. Those who took part got cebranopadol or slow release morphine for up to seven weeks. People on cebranopadol reached for less emergency morphine. On pain relief itself, cebranopadol was not shown to match morphine. Side effects were about equally common on both. The maker paid.
Planned for 524, enrolled 126 because of low accrual; up to 7 weeks of cebranopadol (200 to 1,000 mcg) versus prolonged release morphine. On the primary endpoint, daily rescue morphine use, cebranopadol was non-inferior and superior (difference -7.48 mg, 95% CI -12.05 to -2.92). Non-inferiority on pain reduction itself was not shown. Adverse events in 83 versus 82 percent. Developer funded; corresponds to the terminated CORAL trial NCT01964378.
- Study in people2019Assessment of the Abuse Potential of Cebranopadol in Nondependent Recreational Opioid Users: A Phase 1 Randomized Controlled Study
At low doses recreational drug users did not like it. At a high dose they did. Forty two people who use opioids for pleasure but are not dependent tried each option in turn, without knowing which was which. The two lower doses felt no better than a dummy. The highest dose felt about as good as a moderate dose of a strong opioid, though the pleasant effect took three hours to arrive. Slower is not the same as safer. The maker paid.
Double blind crossover, 42 completers. Cebranopadol 200 and 400 mcg did not differ from placebo on peak drug liking and scored below hydromorphone; 800 mcg was similar to hydromorphone 8 mg and below 16 mg, with peak liking delayed to 3 hours. Developer funded.
- Study in people2024A Study of Cebranopadol for the Treatment of Acute Pain After Abdominoplasty (NCT06545097)
Two large trials in surgical pain have finished and neither has reported anything. Together they enrolled more than five hundred patients, one group after tummy tuck surgery and one after foot surgery. Both completed around the turn of 2025. As of September 2026 no results have been posted and no paper has been found. The record shows completed trials and empty results sections. The maker paid for both.
Phase 3, 279 participants, completed December 2024. No results posted and no publication located as of September 2026. A companion phase 3 after bunionectomy (NCT06423703, 240 participants) completed January 2025 and is in the same position. Sponsor funded.
Common questions
Has Cebranopadol been tested in people?
Yes. 300 people given it across 5 completed trials cited here, 2 of which found nothing. Cebranopadol is not a peptide. It is a lab made opioid painkiller that also switches on the nociceptin receptor, whose natural key is a peptide. In two studies in healthy volunteers, it slowed breathing less than oxycodone at doses that eased pain equally. In mid-stage trials it matched or beat morphine and
What is the Cebranopadol dosage?
No human dose established. Amounts that were given in studies sit in Human evidence on this page. None of them is a personal dose. 5 completed trials, 300 people given it
Is Cebranopadol FDA-approved?
Not FDA approved. Two final-stage studies in short-term pain finished in 2024 to 2025, with no posted results. A final-stage study in long-term cancer pain was stopped because too few people signed up. No application in openFDA as of September 2026.
Is cebranopadol a peptide?
No. It is a small lab made molecule. It shows up in peptide catalogues because one of its two targets is the nociceptin receptor, and that receptor's natural key is a peptide. The drug itself is not a peptide.
Is it safer than other opioids?
On slowed breathing, in healthy volunteers, the data say yes so far. In 12 men at 600 mcg, breathing leveled off above zero. In 30 volunteers, it slowed breathing about 25 percent less than oxycodone at doses that eased pain equally. At the top doses, blood oxygen dropped in 25 percent on cebranopadol against 65 percent on oxycodone. That has not been shown in patients, with other sedating drugs, or at overdose levels. It is a full opioid, and at 800 mcg drug users liked it as much as hydromorphone.
Does it relieve pain?
In mid-stage trials, yes. 14 weeks of 200 to 600 mcg a day beat a dummy pill for chronic low back pain. Single doses of 400 and 600 mcg beat a dummy pill and morphine 60 mg after bunion surgery. In cancer pain, people on it needed less emergency morphine than people on slow release morphine. Two final-stage trials in pain after surgery finished in 2025 and have not reported.
Why is it not approved?
The chronic cancer pain final-stage trial could not sign up enough patients and was stopped. The company recorded that the reason had nothing to do with safety or results. The two final-stage trials in pain after surgery that could support a filing finished in December 2024 and January 2025. As of September 2026 they have no posted results. openFDA shows no application.