Effects of cocaine alone and in combination with bromocriptine in human cocaine abusers

This study was conducted to determine whether the acute administration of bromocriptine, a dopamine agonist, modulates the acute pharmacologic effects of i.v. cocaine in humans. Eight current users of i.v. cocaine who were not seeking treatment for their cocaine abuse completed the study while they were inpatients on a research unit. Twelve drug conditions were tested in all subjects in randomized order under double-blind, double-dummy conditions and included cocaine (0, 12.5, 25 and 50 mg, i.v.) in combination with bromocriptine (0, 1.2 and 2.5 mg given orally 2 hr before the cocaine injection). Physiologic and subject- and observer-rated responses were measured. Cocaine alone significantly increased pupil diameter, heart rate and blood pressure, and ratings of drug effect, good effects, liking and rush. Bromocriptine alone significantly increased pupil diameter and heart rate, decreased blood pressure and had only minor effects on subjective measures. There were significant cocaine/bromocriptine interactions on diastolic and mean arterial blood pressure, with combinations producing significantly smaller increases compared to cocaine alone, and on heart rate, with combinations producing significantly larger increases compared to cocaine alone. The physiologic and subjective effects of cocaine were not modified by pretreatment with bromocriptine in any other way that might indicate either a therapeutic benefit or a safety concern. However, bromocriptine alone produced undesirable effects (fainting) that should be considered before administration to outpatient cocaine abusers. Any possible therapeutic benefits of acute administration of bromocriptine in cocaine abuse are not likely to be due directly to modulation of the acute effects of cocaine.

Detoxification for triazolam physical dependence

The clinical characteristics of a series of patients who developed physical dependence to triazolam has not previously been described. We report five cases of high-dose triazolam abuse in which the daily dosage ranged from 5 to 15 mg (100-300 mg diazepam equivalent) and the duration of use ranged from 3 months to 5 years. Physical dependence usually occurs in the context of a history of alcohol or other drug abuse, a history of panic attacks or anxiety disorder, substitution of triazolam for a longer-acting benzodiazepine, or inappropriate use of triazolam as an anxiolytic agent given as multiple daily doses. A rational approach to the pharmacotherapy of triazolam withdrawal is described. Treatment to replace the triazolam with a long half-life CNS depressant and strategies for this pharmacologic therapy are discussed. The abuse liability of triazolam may be no greater and is most likely less than that of some other benzodiazepines.

Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using a standardized withdrawal scale

An accurate characterization of the severity of the alcohol withdrawal syndrome is likely to provide clear guidelines for drug therapy in this disorder. We studied (retrospectively) the usefulness of a standardized withdrawal scale on benzodiazepine drug requirements for patients undergoing alcohol detoxification in a general hospital. One hundred thirty-three patients received the revised Clinical Institute withdrawal Assessment Scale for Alcohol and were medicated only if the score was greater than 10. A comparison group of 117 patients was treated without reference to the scale. The groups were evenly matched with respect to age, sex, concurrent drug use, and laboratory abnormalities. Subjects treated according to the scale required less benzodiazepine (median dose, 50 mg diazepam equivalent compared with 75 mg) (p = 0.04). Rates of complications, discharge against medical advice, and length of stay did not differ between the groups. Rank correlation coefficients revealed a closer relationship between the degree of alcohol exposure (as determined by admitting blood alcohol levels, creatine phosphokinase, and SGOT) and benzodiazepine requirements during withdrawal for the group treated with the scale. Findings suggest that when the scale is used, patients with a greater degree of physical dependence receive (appropriately) a higher dose of benzodiazepine and those with a lesser degree of dependence receive (appropriately) a lower dose of benzodiazepine. Use of the scale appears to minimize both under- and overdosing with benzodiazepine for alcohol withdrawal syndrome.

Characterization of DSM-III-R criteria for uncomplicated alcohol withdrawal provides an empirical basis for DSM-IV

The DSM-III-R criteria for uncomplicated alcohol withdrawal require the presence of coarse tremor of the hands, tongue, or eyelids plus one of a number of other clinical features. We examined the validity and other characteristics of these items in 137 patients in pure alcohol withdrawal using the reliable and valid Clinical Institute Withdrawal Assessment for Alcohol. The DSM-III-R items of hand tremor amplitude, nausea or vomiting, headache, transient hallucinations, autonomic hyperactivity (increased pulse or sweating), and anxiety correlated significantly with total score and significantly indicated clinical severity. Addition of an "agitation" item improved the correlation. The diagnostic accuracy is greater than 95% if any two or more items are present. The number of positive items, of which tremor can be one, to grade clinical severity shows that a score of 2 indicates "very mild"; 3, "mild"; 4, "moderate"; and 5, "severe.". We propose that an Alcohol Withdrawal Diagnostic Inventory and a DSM-III-R-compatible brief Clinical Institute Withdrawal Assessment for Alcohol are useful for clinical research, where graded symptom characterization is needed. Our data may be helpful in the development of criteria for DSM-IV.

Effect of cimetidine and ranitidine on the hepatic and renal elimination of nicotine in humans

In a randomized, double-blind, cross-over experiment, 6 healthy consenting male subjects were administered cimetidine 600 mg or ranitidine 300 mg or placebo p.o. q12h x 2 days. Nicotine bitartrate was administered i.v. on day 2 (1 microgram/kg/min) x 30 min. After cimetidine mean nicotine total and metabolic clearances were decreased by 30% and 27% while after ranitidine the clearances were decreased by 10% and 7% respectively. Since smokers regulate their smoke intake based in large part on their nicotine blood levels these results suggest that the diminished nicotine total clearance in the presence of cimetidine could be important in assisting smoking reduction or cessation.

Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar)

A shortened 10-item scale for clinical quantitation of the severity of the alcohol withdrawal syndrome has been developed. This scale offers an increase in efficiency while at the same time retaining clinical usefulness, validity and reliability. It can be incorporated into the usual clinical care of patients undergoing alcohol withdrawal and into clinical drug trials of alcohol withdrawal.

Differential effects of viqualine on alcohol intake and other consummatory behaviors

Viqualine, a serotonin releaser and uptake inhibitor, was studied for its effects on consummatory behaviors (intake of ethanol and nonalcoholic beverages, cigarette smoking, and changes in body weight) in 29 men who were early-stage problem drinkers between 21 to 55 years of age. Subjects were randomly assigned to receive a placebo and either 100 mg/day viqualine (n = 15) or 200 mg/day viqualine (n = 14) orally in a double-blind crossover study. Viqualine administration and ethanol intake were assessed by self-reports and by measurement of drug and ethanol concentrations in body fluids. Compared with placebo, 100 mg/day viqualine did not decrease ethanol intake. However, 200 mg/day viqualine significantly decreased the total number of drinks consumed in a 14-day period (F1,12 = 5.3; p less than 0.05). An increase in the number of abstinent days was significant only for those subjects who received the placebo first (F1,6 = 11.3, p less than 0.02). Subjects reported a decreased interest in and decreased desire for alcohol during viqualine treatment. Patterns of response varied, but 64% of the subjects decreased the number of alcoholic drinks consumed and/or increased the number of days of abstinence by at least 25% during treatment with 200 mg/day viqualine compared with placebo treatment. Neither dose of viqualine had an effect on cigarette smoking or on consumption of nonalcoholic beverages, but subjects showed significant decreases in body weight with both doses. These findings indicate that viqualine both attenuates ethanol intake and reduces body weight in human beings.

Kinetic and dynamic interactions of oral viqualine and ethanol in man

We have studied the interaction of viqualine, a 5-hydroxytryptamine (5-HT) uptake inhibitor, with ethanol in 16 healthy men aged 20 to 34 years. The subjects were randomly assigned to receive ethanol dosed to maintain blood alcohol concentrations of 17-22 mmol.l-1 (n = 8) or orange juice (n = 8) on each of two test days one week apart and preceded, in random order, by 3 days of viqualine 75 mg bd or placebo. Ethanol had no effect on steady-state viqualine concentrations or the inhibition of 5-HT uptake. Viqualine did not affect acetaldehyde concentrations or cause an aversive alcohol-sensitizing reaction. The deleterious effects of ethanol on word recall, manual tracking, body sway, and self-ratings of intoxication, sedation, and performance were not modified by the presence of viqualine. Within each beverage group performances and self-ratings on viqualine and placebo days were not different. The first dose of viqualine was associated with transient nausea. Viqualine and ethanol do not interact kinetically or dynamically on the variables examined in this study.

Comparative neurologic effects of diazepam and suriclone, a cyclopyrrolone anxiolytic

Suriclone selectively displaces benzodiazepines from their binding sites but is structurally unrelated to benzodiazepines. Neurologic effects of suriclone were compared to those of diazepam in 54 subjects in a sequential, double-blind, single dose, randomized study (placebo; diazepam 10 mg; suriclone 0.2, 0.4, 0.6, or 0.8 mg). Data were collected on-line by microcomputer. Suriclone 0.2 mg did not differ from placebo. Suriclone 0.4 mg and 0.6 mg did not differ from diazepam 10 mg. Suriclone 0.8 mg caused significantly more decrement than diazepam 10 mg (p less than 0.05) in manual tracking, force platform stability, and Heath rail walking and in total severity of symptoms. Suriclone 0.8 mg caused nausea (p = 0.02), clumsiness (p = 0.02), and loss of balance (p = 0.01) more frequently than diazepam 10 mg. Suriclone 0.8 mg produced symptoms and signs qualitatively and quantitatively different from diazepam 10 mg, such as vomiting, unusual ocular movement effects, and difficulty walking. Possibly the differences in CNS drug binding for anxiolytics are associated with clinical differences in toxicity.

Compliance among heavy alcohol users in clinical drug trials

A high level of patient compliance is essential in determining the efficacy and safety of treatment with new drugs. Alcohol abusers are generally considered to exhibit a low level of compliance with respect to the taking of medication. This study describes a selection strategy and compares methods of determining compliance in two clinical trials assessing the effects of zimelidine and citalopram on ethanol intake in nondepressed male heavy drinkers (greater than 4 drinks/day). Objective methods included the use of a tracer substance (riboflavin), measurement of neurochemical effects (serotonin uptake inhibition), and measurement of drug and metabolite concentrations in body fluids (blood and urine). Other methods included self-report and pill count. Mean compliance estimates for the taking of medication ranged from 78 to 97% depending on the method used. Methods to determine ethanol use included daily self-monitoring and daily urine alcohol measurement. Alcohol consumption correlated with urine alcohol measurement (r = 0.62, p less than .001). These comprehensive assessments of compliance allowed accurate evaluations of drug efficacy and toxicity. The study demonstrates that with stringent selection and reinforcement procedures, exceptionally high levels of compliance can be attained in this group of subjects. Similar procedures should be included in trials evaluating new drugs.

The serotonin uptake inhibitor citalopram attenuates ethanol intake

No effective drug for decreasing ethanol intake is available for clinical use. Our previous studies showed that zimeldine decreased ethanol intake in rats and nondepressed alcohol abusers. However, zimeldine was withdrawn from the market because of serious toxicity. We tested citalopram, a selective serotonin uptake inhibitor, in 39 male nondepressed early-stage problem drinkers (aged 19 to 61 years). Subjects were randomly allocated to receive either citalopram, 20 (n = 20) or 40 (n = 19) mg/day orally, or placebo in a double-blind, crossover trial. Citalopram administration and ethanol intake were assessed by self-report and objectively. Citalopram, 20 mg/day, did not show an effect. However, citalopram, 40 mg/day, decreased the number of drinks consumed (F1,17 = 5.27; P less than 0.05) and increased the number of abstinent days (F1,17 = 13.18; P less than 0.005). The effect is probably through modulation of the neurobiologic mechanisms regulating ethanol intake. Our results suggest a new pharmacologic approach to decrease ethanol intake.

Treatment of the barbiturate abstinence syndrome

Patients with the barbiturate abstinence syndrome require pharmacotherapy (and hospitalization) when there is a history of the ingestion of greater than 0.4 g of secobarbital or its equivalent for 90 or more days, or of 0.6 g for 30 or more days, or a previous history of barbiturate withdrawal seizures or delirium. The pharmacological management of withdrawal, which is rational, safe, efficacious and relatively simple, is described and recommended. This treatment relies on a phenobarbital loading-dose technique which is titrated to clinical end-points. The prolonged elimination of phenobarbital prevents the reappearance of withdrawal symptoms and, since repeated doses are not required, results in less manipulative drug-seeking behaviour.

Putative immunoglobulin VH genes of the goldfish, Carassius auratus, detected by heterologous cross-hybridization with a murine VH probe

By using a defined cDNA probe for the VH region of a murine phosphocholine-binding myeloma protein (S107) we have defined a family of distinct cross-hybridizing DNA sequences in genomic DNA of the goldfish. The estimated number of the goldfish putative VH family detectable by the S107 probe is about 36. By using two putative goldfish VH probes to analyze, by hybridization, the relationships among seven of the goldfish genomic clones, we have determined that the putative goldfish VH genes recognized by the S107 probe comprise at least several distinct families that are not closely related.

Genetic selection for tolerance to niclosamide and copper in Biomphalara glabrata (Mollusca: Pulmonata)

Successive generations of the PR-79 and M-line laboratory stocks of Biomphalaria glabrata were exposed in the LC90 of niclosamide or copper sulfate. Survivors from each generation produced the succeeding generation by self fertilization. The PR-79 stock showed no evidence of tolerance to either molluscicide following five generations of selection. On the other hand, M-line F5 snails demonstrated approximately two-fold higher tolerance to both molluscicides than did non-selected M-line snails.

Anacardic acid: molluscicide in cashew nut shell liquid

The components of anacardic acid, (a mixture of 6-n-C (15) alkylsalicylic acids whose side chains vary in degrees of unsaturation) have been isolated by high pressure liquid chromatography from a crude extract of cashew nut shell, Anacardium occidentale, and tested for toxicity to fresh water snails, Biomphalaria glabrata. The triene component is the most toxic form (LC (50) 0.35 ppm), the diene and monoene components are less toxic (LC (50) 0.9 and 1.4 ppm), and the saturated component is relatively nontoxic (LC (50) > 5 ppm). Since decarboxylated anacardic acid (cardanol) and salicylic acid do not kill snails at concentrations up to 5 ppm, it appears that both, carboxyl group and unsaturated side chain are absolutely required for molluscicidal activity. The mechanism of toxicity of anacardic acid to snails is unknown.

Schistosoma mansoni, NIH-SM-PR-2 strain, in susceptible and nonsusceptible stocks of Biomphalaria glabrata: comparative histology

Of 10 inbred stocks of Biomphalaria glabrata examined, eight were susceptible to the NIH-Sm-PR-1 strain (PR-1) of Schistosoma mansoni, whereas only three were susceptible to the NIH-Sm-PR-2 strain (PR-2). By employing a histological ranking system based on parasite development and host tissue response, we have observed a range of nonsusceptibility among stocks nonsusceptible to PR-2. In three nonsusceptible stocks, sporocysts were rapidly surrounded by host amebocytes and were destroyed within a few days. However, in four other nonsusceptible stocks, sporocysts were surrounded by only a minimal host reaction and some sporocysts persisted for at least 3 weeks. Nondevelopment of sporocysts in these four stocks may result from biochemical unsuitability or a weak from of resistance in the host. Parasite development and host tissue response also varied among three stocks of snails that were susceptible to PR-2. In two susceptible stocks, most PR-2 sporocysts developed normally, and the small proportion that underwent degeneration elicited no host cellular response within the first week of infection. However, in a third susceptible stock, most sporocysts were surrounded by a minimal host reaction and very few appeared to develop normally.

Castroia kamariae sp. nov. and Limatulum kuziai sp. nov. (Lecithodendriidae) from the free-tailed bat (Tadarida mops de Blainville) from West Malaysia

Thirteen bats, Tadarida mops de Blainville, collected from the Ampang district in Kuala Lumpur, Malaysia, were found positive for the trematodes Castroia kamariae sp. nov. and Limatulum kuziai sp. nov. Two distinct but morphologically similar forms of Castroia kamariae were recovered. The morphological type is apparently determined by its location in the host intestine.

Fibricola ramachandrani (Betterton, 1976) Palmieri, Krishnasamy and Sullivan comb. nov. from Malaysian rodent hosts with a special note on intraspecific morphological variation

Neodiplostomum (Conodiplostomum) ramachandrani Betterton, 1976 has been reported from four species of rodent hosts: Echinosorex gymnurus (Raffles): Rattus whiteheadi (Thos); R. muelleri (Jentink) and Callosciurus notatus (Boddaert). A comparison of trematodes recovered from these hosts revealed patterns of host-induced morphological variation taking place. Because N. (Conodiplostomum) ramachandrani shows little generic difference from Fibricola intermedius (Pearson, 1959) Sudarikov, 1960 it is transferred to the genus Fibricola and is now designated Fibricola ramachandrani (Betterton, 1976) Palmieri, Krishnasamy and Sullivan.

Strigeoid trematodes of Malaysia with descriptions of a new genus and three new species

Six species of strigeoid trematodes are reported from Malaysia. One new genus and 3 new species are described: Apatemon (Apatemon( jamesi sp. n (Strigeidae); cercaria Cotylurus sullivani sp. n. (Strigeidae); Neodiplostomum (Neodiplostomum) sp. (Diplostomatidae); Fibricola ramachandrani (Diplostomatidae); Pseudoscolopacitrema otteri gen. n. et sp. n. (Diplostomatidae); and cercaria Cyathocotyle malayi sp. n. (Cyathocotylidae). The life cycles of A. jamesi and C. malayi have also been investigated.

Effect of duration and intensity of infection with Echinostoma audyi on survival of Lymnaea rubiginosa exposed to copper sulfate

Lymnaea rubiginosa infected with 1 to 5 miracidia of Echinostoma audyi for 1, 2, 3, and 5 weeks, and snails infected with up to 10 or 20 miracidia for 3 weeks, were exposed to copper (Cu) as CuSO4 2 hr and allowed to recover 48 hr. In general, snails ininfected with up to 5 miracidia of E. audyi were no more susceptible to Cu than noninfected snails. Snails infected with up to 10 miracidia for 3 weeks were 1.3 times more susceptible to Cu than noninfected snails. However, snails infected with up to 20 miracidia for 3 weeks were not more susceptible to Cu, possibly because infection with such a large number of parasites eliminated the most susceptible snails from the population prior to exposure to Cu.