Theophylline antagonizes the effect of diazepam on ventricular automaticity

The influence of diazepam and midazolam on adenosine-induced forearm vasodilation in humans

Adenosine is an endogenous purine with vasodilating and cardioprotective properties. Animal experiments have shown that some benzodiazepine-induced effects can be explained by potentiation of adenosine effects, via inhibition of the nucleoside transport system. The objective of this study was to determine whether the frequently used benzodiazepines diazepam and midazolam increase adenosine-induced vasodilation in the human forearm vascular bed, measured by venous occlusion plethysmography. Adenosine (0.6, 6, 20, and 60 nmol/min/dl ForeArm Volume) was infused into the brachial artery with and without concomitant separate infusion of diazepam (21 nmol/min/dl, n = 9) and midazolam (23 nmol/min/dl, n = 8). Plasma concentrations of diazepam resp. midazolam at the end of the infusion protocol averaged 0.5 +/- 0.2 microg/ml plasma (1.6 microM) for diazepam versus 1.2 +/- 0.4 microg/ml plasma (3 microM) for midazolam. Intra-arterial infusion of the benzodiazepines did not alter baseline vascular tone, and had no significant influence on the forearm vasodilator response to adenosine. The adenosine-induced relative change in Forearm Vascular Resistance (FVR) was -3 +/- 7, -48 +/- 8, -75 +/- 6, and -85 +/- 3% in the absence and 3.5 +/- 11, -54 +/- 5, -74 +/- 5, and -82 +/- 3% resp. in the presence of diazepam (P > 0.1, repeated measures ANOVA, n = 9). Likewise, in the absence resp. presence of midazolam, FVR fell by 1 +/- 6, 55 +/- 5, 74 +/- 3, and 84 +/- 2% resp. 11 +/- 11, 59 +/- 2, 80 +/- 3, and 87 +/- 2% (P > 0.1, n = 7). Intra-brachial infusion of diazepam and midazolam resulting in forearm concentrations in the high therapeutic range does not augment adenosine-induced forearm vasodilation. A possible interaction at supra-therapeutic levels of the benzodiazepines can not be excluded from the present study, but lacks clinical significance.

Effects of allocryptopine, an alkaloid isolated from Glaucium arabicum on rat isolated ileum and urinary bladder

1. The alkaloid, allocryptopine, was isolated from the chloroform extract of Glaucium arabicum. 2. The effect of allocryptopine on urinary bladder and ileal smooth muscles was investigated in this study. 3. Allocryptopine, in concentrations from 1 x 10(-5) to 3 x 10(-3) M caused a concentration-dependent contraction of rat isolated urinary bladder and a concentration-dependent relaxation of rat ileal smooth muscles. 4. Theophylline (10(-5) M) shifted to the left the allocryptopine concentration-effect curve on ileum and increased the maximum inhibitory effect of allocryptopine. 5. Methylene blue (10(-3) M) had no significant effect on the concentration-effect curve of allocryptopine of the ileum. 6. Phentolamine (10(-6) M) shifted to the right the allocryptopine concentration-effect curve of urinary bladder. 7. These observations suggest that allocryptopine induces a relaxing effect on the ileum by inhibiting phosphodiesterase enzyme, and thus elevating cellular cAMP and its contractile effect on the urinary bladder by affecting alpha-adrenergic receptors in this tissue.

Adenosine in the mammalian heart: nothing to get excited about

Until quite recently, the cardiodepressant actions of adenosine were widely accepted. A nucleoside that produces negative chronotropic and ionotropic effects, adenosine, has been used clinically as the drug of choice for terminating supraventricular (atrioventricular node) tachycardia and is likely to play an important part in regulating arrhythmogenic activity as an endogenous antiarrhythmic metabolite. Despite this, recent experimental data, particularly resulting from in vitro studies using animal models, have shown a paradoxical excitable action of adenosine in the heart. In this article, Amir Pelleg and Steven Kutalek present the reasons why they continue to believe that any excitatory actions of adenosine in the heart are clinically irrelevant.

Adenosine and ventricular automaticity

Adenosine is considered a cardiodepressant agent due to its negative chronotropic and inotropic effects. However, the effect of adenosine on ventricular automaticity is less well established since both an increase and a decrease in ventricular automaticity have been reported. The experimental and clinical evidence dealing with the effects of adenosine on ventricular automaticity as well as the possible mechanisms involved, is presented in this review.

Enhancement by benzodiazepines of the inhibitory effect of adenosine on skeletal neuromuscular transmission

1. Interactions of benzodiazepines with adenosine on the neuromuscular transmission were studied in mouse diaphragm preparations. 2. In tubocurarine (0.6-0.8 microM)-partially paralyzed preparations, diazepam (35 microM) and Ro 5-4864 (3-30 microM), a peripheral type benzodiazepine receptor agonist, potentiated the inhibitory effect of adenosine on indirect twitch responses. 3. The central type receptor agonist, clonazepam did not affect the inhibitory effect of adenosine. 4. The peripheral benzodiazepine receptor antagonist, PK11195 (1-10 microM) attenuated the adenosine inhibition and antagonized the potentiation by Ro 5-4864. 5. Ro 5-4864 failed to enhance further the inhibitory effect of adenosine in the presence of dipyridamole, an adenosine uptake inhibitor that also potentiated adenosine inhibition. 6. Neither Ro 5-4864 nor PK 11195 affected the inhibition produced by a stable adenosine analogue, 2-chloroadenosine, which is not a substrate for the adenosine uptake system. 7. Ro 5-4864 did not affect endplate potentials (e.p.ps) in the absence of adenosine, but reduced the amplitude of e.p.ps in the presence of adenosine without affecting miniature e.p.ps. 8. It is suggested that benzodiazepines potentiate the adenosine-effected presynaptic inhibition of neuromuscular transmission by an inhibition of adenosine uptake through activation of peripheral type benzodiazepine receptors.

Diazepam enhances the inhibitory action of adenosine on transmission at the frog neuromuscular junction

The effect of diazepam and its interaction with adenosine on evoked endplate potentials (e.p.p.s) and on twitch tension were investigated in innervated sartorius muscles of the frog. Diazepam (100 microM) reversibly decreased the amplitude of the e.p.p.s and the twitch responses evoked by indirect stimulation, and reversibly increased the resting membrane potential recorded from the endplates. In a concentration (30 microM) virtually devoid of an effect on the e.p.p.s, twitch responses, or resting membrane potential of the muscle fibres, diazepam potentiated the inhibitory action of adenosine on neuromuscular transmission, but not that induced by the stable analogue of adenosine 5'-N-ethylcarboxamide adenosine (NECA), which is not a substrate for the adenosine uptake system. The potentiating effect of diazepam was not observed in the presence of dipyridamole, an adenosine uptake blocker which potentiated the effect of adenosine on neuromuscular transmission. Diazepam shifted to the left the concentration-response curve obtained for adenosine in the presence of the adenosine receptor antagonist 8-phenyltheophylline (8-PT). The results suggest that diazepam acts at the frog neuromuscular junction by increasing the level of adenosine at the junction level; this increase probably results from inhibition in the uptake of the nucleoside.