Characteristics of the Association of Brotizolam, a Thieno-Triazolo Diazepine Derivative, with the Benzodiazepine Receptor: A Selective and High Affinity Ligand of the Central Type I Benzodiazepine Receptor

Effects of brotizolam as a co-agent with ketamine for induction of anaesthesia in calves

Anaesthesia in food producing animals in the EU and UK is legally limited to a narrow choice of drugs; the only licensed benzodiazepine being brotizolam. The aim of this study was to investigate the effects of brotizolam as a co-agent with ketamine on the quality of induction, intubation, muscle relaxation and recovery from isoflurane anaesthesia. Seventeen calves were enrolled in this prospective, blinded, randomized experimental study. Calves were sedated with 0.05 mg/kg xylazine and 0.1 mg/kg butorphanol IV. After assessing the quality of sedation, anaesthesia was induced with 2 mg/kg ketamine (group KETA) or 2 mg/kg ketamine with 2 μg/kg brotizolam IV (group BROTI). An additional 1 mg/kg ketamine was administered IV every 2 min until intubation was possible. Anaesthesia was maintained with isoflurane in a mixture of oxygen and air. The amount of ketamine required, quality of induction, intubation, muscle relaxation, and recovery were scored and compared between groups using ordinal regression models (P < 0.05 was considered statistically significant). Sedation scores did not differ significantly between groups but were positively associated with the quality of recovery (P = 0.0098). Group BROTI was associated with a lower quality of induction (P < 0.0001), intubation (P = 0.0203) and muscle relaxation (P = 0.0043). The sedation score and treatment had no effect on the number of attempts of intubation, additional ketamine doses, time to extubation and recovery time. Brotizolam had a negative effect on the quality of induction, intubation, and muscle relaxation compared to ketamine alone. We do not recommend using brotizolam under these circumstances.

Reagent-Based Diversity-Oriented Synthesis of Triazolo[1,5-a][1,4]diazepine Derivatives from Polymer-Supported Homoazidoalanine

Herein, we report the synthesis of skeletally different triazolo[1,5-a][1,4]diazepines starting from immobilized homoazidoalanine. After sulfonylation with 2/4-nitrobenzenesulfonyl chlorides and Mitsunobu alkylation with various alkynols, the corresponding N-substituted nitrobenzenesulfonamides were obtained. Their catalyst-free Huisgen cycloaddition provided immobilized and functionalized triazolo[1,5-a][1,4]diazepines as the key intermediates for further modification. Using the concept of diversity-oriented, reagent-based synthesis, the key intermediates were subsequently converted to heterocycles bearing [5 + 7 + 5], [5 + 7 + 6], and [5 + 7 + 7] scaffolds. Furthermore, the synthesis of spirocyclic triazolodiazepines was developed.

Distinct effects of orexin receptor antagonist and GABAA agonist on sleep and physical/cognitive functions after forced awakening

The majority of patients with insomnia are treated with hypnotic agents. In the present study, we evaluated the side-effect profile of an orexin receptor antagonist and γ-aminobutyric acid A (GABA_A) receptor agonist on physical/cognitive functions upon forced awakening. This double-blind, randomized, placebo-controlled, cross-over study was conducted on 30 healthy male subjects. Fifteen minutes before bedtime, the subjects took a pill of suvorexant (20 mg), brotizolam (0.25 mg), or placebo and were forced awake 90 min thereafter. Physical- and cognitive-function tests were performed before taking the pill, after forced awakening, and the next morning. Polysomnographic recordings revealed that the efficacies of the hypnotic agents in prolonging total sleep time (∼30 min) and increasing sleep efficiency (∼6%) were comparable. When the subjects were allowed to go back to sleep after the forced awakening, the sleep latency was shorter under the influence of hypnotic agents (∼2 min) compared to the placebo trial (24 min), and the rapid eye movement latency was significantly shorter under suvorexant (98.8, 81.7, and 48.8 min for placebo, brotizolam, and suvorexant, respectively). Although brotizolam significantly impaired the overall physical/cognitive performance (sum of z score) compared with placebo upon forced awakening, there was no significant difference in the total z score of performance between suvorexant and placebo. Notably, the score for static balance with the eyes open was higher under suvorexant compared to brotizolam administration. The energy expenditure was lower under suvorexant and brotizolam compared with the placebo. The effect size of brotizolam (d = 0.24) to reduce the energy expenditure was larger than that of suvorexant (d < 0.01).