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Nicosia N, Kwiecień I, Bednarski M, Głuch-Lutwin M, Mordyl B, Mika K, Hambaryan R, Miller A, Alesci A, Lauriano ER, Zammit P, Ragusa S, Trojan E, Fumia A, Sapa J, Miceli N, Kotańska M. Anti-diabetes and neuroprotection potential and primary safety studies of Isatis tinctoria L. hydroalcoholic leaf extract. Fitoterapia 2024; 177:106138. [PMID: 39053741 DOI: 10.1016/j.fitote.2024.106138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/21/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Natural plant raw materials, previously underestimated in therapeutics, are becoming the subject of research for new applications in medicine. In our research, the hydroalcoholic extract of Isatis tinctoria leaf, rich in flavonoid compounds such as vicenin-2 and quercetin, was examined as a potential antidiabetic and neuroprotective agent. METHODS The effect of the extract and its main flavonoid compounds on protein glycation, alpha-glucosidase activity, and acetylcholinesterase activity was tested. In vitro, in the mouse hippocampal neuronal cell line and in vivo, using a mouse model, the safety of the extract was screened for. RESULTS Our experiments demonstrated significant inhibition of protein glycation, alpha-glucosidase activity, acetylcholinesterase activity, and β-amyloid aggregation by the extract, in a concentration-dependent manner. The extract had a strong reducing effect and did not exhibit cytotoxicity up to a concentration of 25 mg/mL. Intraperitoneal administration of the extract to mice did not have negative effects on body mass, locomotor activity, coordination, and liver cell integrity. CONCLUSIONS Our research sheds new light on this raw material and deepens knowledge of its activity. This may result in the recognition of its therapeutic effects and even in its introduction in the modern treatment of diseases characterized by pathological changes associated with hyperglycemia, oxidation, and inflammation.
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Affiliation(s)
- Noemi Nicosia
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland; PhD Program in Neuroscience, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy; Foundation "Prof. Antonio Imbesi", University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy
| | - Inga Kwiecień
- Department of Medicinal Plant and Mushroom Biotechnology, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland
| | - Marek Bednarski
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland
| | - Monika Głuch-Lutwin
- Department of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Barbara Mordyl
- Department of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Kamil Mika
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland
| | - Rimma Hambaryan
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland
| | - Anthea Miller
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland; Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy
| | - Alessio Alesci
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Eugenia R Lauriano
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Paula Zammit
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland; University of Malta, Msida MSD 2080, Malta
| | - Salvatore Ragusa
- PLANTA/Autonomous Center for Research, Documentation and Training, Via Serraglio Vecchio 28, 90123 Palermo, Italy
| | - Ewa Trojan
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland; Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology Polish Academy of Sciences, 12 Smętna Str., 31-343 Kraków, Poland
| | - Angelo Fumia
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Jacek Sapa
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland
| | - Natalizia Miceli
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Magdalena Kotańska
- Department of Pharmacological Screening, Jagiellonian University, Medical College, Medyczna 9, PL 30-688 Cracow, Poland.
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Elshebiney SA, Elgohary RA, El-Shamarka ME, Mabrouk M, Beheri HH. A novel tramadol-polycaprolactone implant could palliate heroin conditioned place preference and withdrawal in rats: behavioral and neurochemical study. Behav Pharmacol 2024; 35:280-292. [PMID: 38900102 DOI: 10.1097/fbp.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Drug dependence is a chronic brain disease characterized by craving and recurrent episodes of relapse. Tramadol HCl is a promising agent for withdrawal symptoms management, considering its relatively low abuse potential and safety. Oral administration, however, is not preferred in abstinence maintenance programs. Introducing an implantable, long-lasting formula is suggested to help outpatient abstinence programs achieve higher rates of treatment continuation. Tramadol implants (T350 and T650) were prepared on polycaprolactone polymer ribbons by the wet method. Male Wistar rats were adapted to heroin-conditioned place preference (CPP) at escalating doses (3-30 mg/kg, intraperitoneally, for 14 days). Implants were surgically implanted in the back skin of rats. After 14 days, the CPP score was recorded. Naloxone (1 mg/kg, intraperitoneally) was used to induce withdrawal on day 15, and symptoms were scored. Elevated plus maze and open field tests were performed for anxiety-related symptoms. Striata were analyzed for neurochemical changes reflected in dopamine, 3,4-dihydroxyphenyl acetic acid, gamma-aminobutyric acid, and serotonin levels. Brain oxidative changes including glutathione and lipid peroxides were assessed. The tramadol implants (T350 and T650) reduced heroin CPP and limited naloxone-induced withdrawal symptoms. The striata showed increased levels of 3,4-dihydroxyphenyl acetic acid, and serotonin and decreased levels of gamma-aminobutyric acid and dopamine after heroin withdrawal induction, which were reversed after implanting T350 and T650. Implants restore the brain oxidative state. Nonsignificant low naloxone-induced withdrawal score after the implant was used in naive subjects indicating low abuse potential of the implants. The presented tramadol implants were effective at diminishing heroin CPP and withdrawal in rats, suggesting further investigations for application in the management of opioid withdrawal.
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Affiliation(s)
- Shaimaa A Elshebiney
- Narcotics, Ergogenics, and Poisons Department, Medical Research and Clinical Studies Institute, National Research Centre (NRC)
| | - Rania A Elgohary
- Narcotics, Ergogenics, and Poisons Department, Medical Research and Clinical Studies Institute, National Research Centre (NRC)
| | - Marwa E El-Shamarka
- Narcotics, Ergogenics, and Poisons Department, Medical Research and Clinical Studies Institute, National Research Centre (NRC)
| | - Mostafa Mabrouk
- Refractories, Ceramics and Building Materials Department, Advanced Materials, Technology and Mineral Resources Research Institute, National Research Centre (NRC), Giza, Egypt
| | - Hanan H Beheri
- Refractories, Ceramics and Building Materials Department, Advanced Materials, Technology and Mineral Resources Research Institute, National Research Centre (NRC), Giza, Egypt
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Gholami M, Hayes AW, Jamaati H, Sureda A, Motaghinejad M. Role of apoptosis and autophagy in mediating tramadol-induced neurodegeneration in the rat hippocampus. Mol Biol Rep 2023; 50:7393-7404. [PMID: 37453963 DOI: 10.1007/s11033-023-08641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Tramadol (TRA) is an analgesic prescribed for treating mild to moderate pains, the abuse of which has increased in recent years. Chronic tramadol consumption produces neurotoxicity, although the mechanisms are unclear. The present study investigated the involvement of apoptosis and autophagy signaling pathways and the mitochondrial system in TRA-induced neurotoxicity. MATERIALS AND METHODS Sixty adult male Wistar rats were divided into five groups that received standard saline or TRA in doses of 25, 50, 75, 100, or 150 mg/kg intraperitoneally for 21 days. On the 22nd day, the Open Field Test (OFT) was conducted. Jun N-Terminal Kinase (JNK), B-cell lymphoma-2 (Bcl-2), Beclin1, and Bcl-2-like protein 4 (Bax) proteins and tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) were measured in rat hippocampal tissue. RESULTS TRA at doses 75, 100, and 150 mg/kg caused locomotor dysfunction in rats and increased total and phosphorylated forms of JNK and Beclin-1, Bax, and Caspase-3. TRA at the three higher doses also increased the phosphorylated (inactive) form of Bcl-2 level while decreasing the unphosphorylated (active) form of Bcl-2. Similarly, the protein levels of TNF-α and IL-1β were increased dose-dependently. The mitochondrial respiratory chain enzymes were reduced at the three higher doses of TRA. CONCLUSION TRA activated apoptosis and autophagy via modulation of TNF-α or IL-1β/JNK/Bcl-2/Beclin1 and Bcl-2/Bax signaling pathways and dysfunction of mitochondrial respiratory chain enzymes.
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Affiliation(s)
- Mina Gholami
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Wallace Hayes
- University of South Florida College of Public Health, Tampa, FL, USA
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA
| | - Hamidreza Jamaati
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Antoni Sureda
- Research Group in Community Nutrition and Oxidative Stress (NUCOX), University of Balearic Islands and, Health Research Institute of Balearic Islands (IdISBa), Palma de Mallorca, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Majid Motaghinejad
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Huyghe E, Cuzin B, Grellet L, Faix A, Almont T, Burte C. [Recommendations for the treatment of premature ejaculation]. Prog Urol 2023; 33:237-246. [PMID: 36868935 DOI: 10.1016/j.purol.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES The Post-University Interdisciplinary Association of Sexology (AIUS) has brought together a panel of experts to develop French recommendations for the management of premature ejaculation. METHODS Systematic review of the literature between 01/1995 and 02/2022. Use of the clinical practice guidelines (CPR) method. RESULTS We recommend giving all patients with PE psychosexological counseling, and whenever possible combining pharmacotherapies and sexually-focused cognitive-behavioral therapies, involving the partner in the treatment process. Other sexological approaches could be useful. We recommend the use of dapoxetine as first-line, on-demand oral therapy for primary and acquired PE. We recommend the use of lidocaine 150mg/mL/prilocaine 50mg/mL spray as local treatment for primary PE. We suggest the combination of dapoxetine and lidocaine/prilocaine in patients insufficiently improved by monotherapy. In patients who have not responded to treatments with marketing authorisation, we suggest using an off-label SSRI, preferably paroxetine, in the absence of a contraindication. We recommend treating ED before PE in patients with both symptoms. We do not recommend using α-1 blockers or tramadol in patients with PE. We do not recommend routine posthectomy or penile frenulum surgery for PE. CONCLUSION These recommendations should contribute to improving the management of PE.
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Affiliation(s)
- E Huyghe
- Médecine de la reproduction, CHU de Toulouse, site de Paule-de-Viguier, Toulouse, France; Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, hôpital Rangueil, Toulouse, France; UMR DEFE Inserm 1203, université de Toulouse III, université de Montpellier, Montpellier, France.
| | - B Cuzin
- Service d'urologie, chirurgie de la transplantation, CHU de Lyon, hôpital Édouard-Herriot, Lyon, France; Service de médecine de la reproduction, hôpital Femme-Mère-Enfant, HCL, Bron, France
| | - L Grellet
- Cabinet de sexologie, 19, bis rue Magnol, 34000 Montpellier, France
| | - A Faix
- Cabinet d'urologie, 265, avenue des États du Languedoc, Montpellier, France
| | - T Almont
- Service d'oncologie, CHU de Martinique, Fort-de-France, France
| | - C Burte
- Cabinet de médecine sexuelle, 4, rue des États-Unis, Cannes, France
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5
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Deebel NA, Scarberry K, O’Connor CA, Dutta R, Matz E, Hanlon CA, Terlecki RP. Investigating the Impact of Kratom ( Mitragyna speciosa) Use Upon Male Sexual Health. Res Rep Urol 2023; 15:69-76. [PMID: 36798621 PMCID: PMC9926986 DOI: 10.2147/rru.s390094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose Kratom (Mitragyna speciosa) exhibits μ-receptor agonism and is used as an opioid substitute. While opioids are known to inhibit sexual behavior, less is known regarding kratom. We conducted a pilot study to assess the subjective impact of kratom upon male sexual health including erectile and ejaculatory function. Patients and Methods Twitter and Reddit (r/Kratom) were accessed to disseminate our survey featuring validated instruments (the International Index of Erectile Function, IIEF, and the premature ejaculation diagnostic tool, PEDT). Sexual health prior to and after 4 weeks of kratom use was assessed. Results Most males surveyed (n = 165) were 18-40 years old (84.9%), with 95.8% of respondents using it at least weekly and 82.4% using kratom for ≥1 year. Reasons for use included treating pain (39.4%), and mental health conditions (63.6%). Kratom was associated with a positive (37.7%) and negative (20.5%) impact on sexual health. Kratom subjectively increased time to ejaculation in 104 (66.6%) patients, perceived as positive by 62 (59.6%). Seventy-eight patients answered questions about premature ejaculation. The median (with interquartile range, IQR, following;) pre-kratom and kratom use scores were 13.0; 8.0 and 6.5; 5.0, respectively (p < 0.001). Ejaculation before 5 minutes improved after kratom (51.3% vs 12.8%) (p < 0.0001). Following kratom use, patients reported lack of frustration with ejaculation prior to desire (21.8% vs 61.5%) (p < 0.001). The erectile function domain of the IIEF was statistically significantly different however - clinically similar pre-kratom use (29.0; 5.75) versus 27.0; 6.75 during kratom use (p = 0.037). Conclusion Clinicians treating male sexual health should be aware of kratom and its potential effect on ejaculatory and erectile function.
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Affiliation(s)
- Nicholas A Deebel
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kyle Scarberry
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Collette A O’Connor
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rahul Dutta
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ethan Matz
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ryan P Terlecki
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA,Correspondence: Ryan P Terlecki, Department of Urology, Atrium Health Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, Tel +1 336 716 4131, Fax +1 336 716 9042, Email
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Antipsychotic- and Anxiolytic-like Properties of a Multimodal Compound JJGW08 in Rodents. Int J Mol Sci 2022; 23:ijms232415929. [PMID: 36555568 PMCID: PMC9781916 DOI: 10.3390/ijms232415929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Schizophrenia is a chronic mental illness, which remains difficult to treat. A high resistance to the available therapies, their insufficient efficacy, and numerous side effects are the reasons why there is an urgent need to develop new antipsychotics. This study aimed to assess the antipsychotic-like effects of JJGW08, a novel arylpiperazine alkyl derivative of salicylamide, in rodents. First, considering the JJGW08 receptor profile, we investigated the compound's intrinsic activity towards dopamine D2 and serotonin 5-HT1A, 5-HT2A, and 5-HT7 receptors using functional assays. Next, we assessed the effect of JJGW08 on MK-801- and amphetamine-induced hyperlocomotion, its risk of inducing catalepsy and impairing motor coordination, as well as the anxiolytic-like effects in the four-plate and marble burying tests in mice. Finally, we investigated the antipsychotic-like properties of JJGW08 in rats using MK-801-induced hyperlocomotion and prepulse inhibition tests. We found that JJGW08 showed antagonistic properties at dopamine D2 and serotonin 5-HT1A, 5-HT2A, and 5-HT7 receptors. However, the effect on the 5-HT2A and 5-HT7 receptors was very weak. Moreover, the tested compound showed an antipsychotic-like effect in MK-801- and amphetamine-induced hyperlocomotion but not in a prepulse inhibition test in rats. Notably, JJGW08 demonstrated anxiolytic-like properties in both behavioral tests. Importantly, the compound did not induce catalepsy or motor coordination impairment in mice at antipsychotic-like doses. Our study suggests it is worth searching for new potential antipsychotics among arylpiperazine alkyl derivatives of salicylamide.
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Elsukary AE, Helaly AMNZ, El Bakary AA, Moustafa ME, El-Kattan MA. Comparative Study of the Neurotoxic Effects of Pregabalin Versus Tramadol in Rats. Neurotox Res 2022; 40:1427-1439. [PMID: 35976555 PMCID: PMC9515019 DOI: 10.1007/s12640-022-00557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/22/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
In Egypt, both pregabalin and tramadol misuse increased in the last decade. Although many studies have confirmed the neurotoxic effects of tramadol, those of pregabalin are understudied. The aim of the study is to evaluate the neurotoxic effects of pregabalin compared with tramadol. Thirty male albino rats were included in this experimental study, and they were randomly allocated into three equal groups: group I (normal saline), group II (tramadol misuse), and group III (pregabalin misuse). All rats received the commenced drugs for 1 month. Open field tests were performed on the day of scarification, and after that, cortical samples were taken for immunohistochemical analysis and quantification of dopamine receptors' gene expression. The drug misuse groups showed a significant decrease in weight gain at the end of the study. Open field testing showed the upper hand of controls regarding all of the tested parameters. Tramadol has a more negative impact on the locomotor parameters compared with pregabalin. Both drugs induced relatively low dopamine-1 receptor (D1Rs) expression to dopamine-2 receptors (D2Rs), mimicking the schizophrenia model. Both tramadol and pregabalin were associated with neurotoxic effects in male albino rats. These effects were less noticed with pregabalin. It is suggested that long-term abuse may end in psychosis.
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Affiliation(s)
- Ahmed E Elsukary
- Forensic Medicine & Clinical Toxicology Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
| | - Ahmed M N Z Helaly
- Forensic Medicine & Clinical Toxicology Department, Mansoura Faculty of Medicine, Mansoura, Egypt.,Clinical Science Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Amal A El Bakary
- Forensic Medicine & Clinical Toxicology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Maha E Moustafa
- Forensic Medicine & Clinical Toxicology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mohammad A El-Kattan
- Forensic Medicine & Clinical Toxicology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
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Khatmi A, Eskandarian Boroujeni M, Ezi S, Hamidreza Mirbehbahani S, Aghajanpour F, Soltani R, Hossein Meftahi G, Abdollahifar MA, Hassani Moghaddam M, Toreyhi H, Khodagholi F, Aliaghaei A. Combined molecular, structural and memory data unravel the destructive effect of tramadol on hippocampus. Neurosci Lett 2021; 771:136418. [PMID: 34954113 DOI: 10.1016/j.neulet.2021.136418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
Tramadol is a synthetic analogue of codeine and stimulates neurodegeneration in several parts of the brain that leads to various behavioral impairments. Despite the leading role of hippocampus in learning and memory as well as decreased function of them under influence of tramadol, there are few studies analyzing the effect of tramadol administration on gene expression profiling and structural consequences in hippocampus region. Thus, we sought to determine the effect of tramadol on both PC12 cell line and hippocampal tissue, from gene expression changes to structural alterations. In this respect, we investigated genome-wide mRNA expression using high throughput RNA-seq technology and confirmatory quantitative real-time PCR, accompanied by stereological analysis of hippocampus and behavioral assessment following tramadol exposure. At the cellular level, PC12 cells were exposed to 600μM tramadol for 48 hrs, followed by the assessments of ROS amount and gene expression levels of neurotoxicity associated with neurodegenerative pathways such as apoptosis and autophagy. Moreover, the structural and functional alteration of the hippocampus under chronic exposure to tramadol was also evaluated. In this regard, rats were treated with tramadol at doses of 50 mg/kg for three consecutive weeks. In vitro data revealed that tramadol provoked ROS production and caused the increase in the expression of autophagic and apoptotic genes in PC12 cells. Furthermore, in-vivo results demonstrated that tramadol not only did induce hippocampal atrophy, but it also triggered microgliosis and microglial activation, causing upregulation of apoptotic and inflammatory markers as well as over-activation of neurodegeneration. Tramadol also interrupted spatial learning and memory function along with long-term potentiation (LTP). Taken all together, our data disclosed the neurotoxic effects of tramadol on both in vitro and in-vivo. Moreover, we proposed a potential correlation between disrupted biochemical cascades and memory deficit under tramadol administration.
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Affiliation(s)
- Aysan Khatmi
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Cell Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Eskandarian Boroujeni
- Department of Human Molecular Genetics, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Adam Mickiewicz University, Poznan, Poland
| | - Samira Ezi
- Department of Anatomy, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | | | - Fakhroddin Aghajanpour
- Department of Cell Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Soltani
- Department of Cell Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad-Amin Abdollahifar
- Department of Cell Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meysam Hassani Moghaddam
- Department of Anatomical Sciences, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Department of Cell Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Khodagholi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Aliaghaei
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Cell Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lu Y, Zhou Z, Zhang X, Cui Y, Zhang Y, Wang Y. The Influence of Tramadol on Intravaginal Ejaculatory Latency Time and Sexual Satisfaction Score in Treating Patients With Premature Ejaculation: A Network Meta-Analysis. Am J Mens Health 2021; 15:15579883211057713. [PMID: 34911381 PMCID: PMC8721723 DOI: 10.1177/15579883211057713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This network meta-analysis aimed at assessing the influence of tramadol on the intravaginal ejaculatory latency time (IELT) and sexual satisfaction score (SSS) in treating patients with premature ejaculation (PE). The PubMed, Embase, Cochrane Library databases (until July 2021), and original references of the included articles was systematically retrieved. The PRISMA checklist was followed. Finally, 14 articles including 1971 patients were included in this analysis. The results indicated that patients who were treated with tramadol (50 mg, 62 mg, 89 mg, and 100 mg) were superior to those treated with placebo in terms of IELT (p = .003, p < .00001, p < .00001, and p < .00001, respectively), but 25 mg tramadol did not show a significant advantage (p = .06). Patients who were treated with tramadol (50 mg and 100 mg) had a better efficacy than who were treated with 25 mg tramadol in the IELT (p < .00001 and p < .00001), but the effect of 50 mg tramadol and 100 mg tramadol were not significantly different (p = .17). The tramadol group had the better effect than the placebo group in the SSS (p < .0001). And 50 mg tramadol showed a significant improvement compared with 20 mg paroxetine, as assessed by the IELT (p = .03) and SSS (p = .03). Safety assessments including adverse events suggested that tramadol was well tolerated. Tramadol showed a better improvement of IELT and SSS than placebo or paroxetine, and 50 mg tramadol may be a more reasonable therapeutic dose for patients with PE.
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Affiliation(s)
- Youyi Lu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Fengtai District, Beijing, China
| | - Xiaoyi Zhang
- Department of Urology, PLA Rocket Force Characteristic Medical Center, Xicheng District, Beijing, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.,Department of Urology, Beijing TianTan Hospital, Capital Medical University, Fengtai District, Beijing, China
| | - Yong Zhang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Fengtai District, Beijing, China
| | - Yongqiang Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Sałaciak K, Malikowska-Racia N, Lustyk K, Siwek A, Głuch-Lutwin M, Kazek G, Popiół J, Sapa J, Marona H, Żelaszczyk D, Pytka K. Synthesis and Evaluation of the Antidepressant-like Properties of HBK-10, a Novel 2-Methoxyphenylpiperazine Derivative Targeting the 5-HT 1A and D 2 Receptors. Pharmaceuticals (Basel) 2021; 14:ph14080744. [PMID: 34451841 PMCID: PMC8400343 DOI: 10.3390/ph14080744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022] Open
Abstract
The increasing number of patients reporting depressive symptoms requires the design of new antidepressants with higher efficacy and limited side effects. As our previous research showed, 2-methoxyphenylpiperazine derivatives are promising candidates to fulfill these criteria. In this study, we aimed to synthesize a novel 2-methoxyphenylpiperazine derivative, HBK-10, and investigate its in vitro and in vivo pharmacological profile. After assessing the affinity for serotonergic and dopaminergic receptors, and serotonin transporter, we determined intrinsic activity of the compound at the 5-HT1A and D2 receptors. Next, we performed behavioral experiments (forced swim test, tail suspension test) to evaluate the antidepressant-like activity of HBK-10 in naïve and corticosterone-treated mice. We also assessed the safety profile of the compound. We showed that HBK-10 bound strongly to 5-HT1A and D2 receptors and presented antagonistic properties at these receptors in the functional assays. HBK-10 displayed the antidepressant-like effect not only in naïve animals, but also in the corticosterone-induced mouse depression model, i.e., chronic administration of HBK-10 reversed corticosterone-induced changes in behavior. Moreover, the compound’s sedative effect was observed at around 26-fold higher doses than the antidepressant-like ones. Our study showed that HBK-10 displayed a favorable pharmacological profile and may represent an attractive putative treatment candidate for depression.
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Affiliation(s)
- Kinga Sałaciak
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (K.S.); (N.M.-R.); (K.L.); (G.K.); (J.S.)
| | - Natalia Malikowska-Racia
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (K.S.); (N.M.-R.); (K.L.); (G.K.); (J.S.)
- Department of Behavioral Neuroscience and Drug Development, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Klaudia Lustyk
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (K.S.); (N.M.-R.); (K.L.); (G.K.); (J.S.)
| | - Agata Siwek
- Department of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (A.S.); (M.G.-L.)
| | - Monika Głuch-Lutwin
- Department of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (A.S.); (M.G.-L.)
| | - Grzegorz Kazek
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (K.S.); (N.M.-R.); (K.L.); (G.K.); (J.S.)
| | - Justyna Popiół
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland;
| | - Jacek Sapa
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (K.S.); (N.M.-R.); (K.L.); (G.K.); (J.S.)
| | - Henryk Marona
- Department of Bioorganic Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland;
| | - Dorota Żelaszczyk
- Department of Bioorganic Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland;
- Correspondence: (D.Ż.); (K.P.)
| | - Karolina Pytka
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; (K.S.); (N.M.-R.); (K.L.); (G.K.); (J.S.)
- Correspondence: (D.Ż.); (K.P.)
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11
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EEG and Sleep Effects of Tramadol Suggest Potential Antidepressant Effects with Different Mechanisms of Action. Pharmaceuticals (Basel) 2021; 14:ph14050431. [PMID: 34064349 PMCID: PMC8147808 DOI: 10.3390/ph14050431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 01/18/2023] Open
Abstract
Tramadol is a widely used, centrally acting, opioid analgesic compound, with additional inhibitory effects on the synaptic reuptake of serotonin and noradrenaline, as well as on the 5-HT2 and NMDA receptors. Preclinical and clinical evidence also suggests its therapeutic potential in the treatment of depression and anxiety. The effects of most widely used antidepressants on sleep and quantitative electroencephalogram (qEEG) are well characterized; however, such studies of tramadol are scarce. Our aim was to characterize the effects of tramadol on sleep architecture and qEEG in different sleep–wake stages. EEG-equipped Wistar rats were treated with tramadol (0, 5, 15 and 45 mg/kg) at the beginning of the passive phase, and EEG, electromyogram and motor activity were recorded. Tramadol dose-dependently reduced the time spent in rapid eye movement (REM) sleep and increased the REM onset latency. Lower doses of tramadol had wake-promoting effects in the first hours, while 45 mg/kg of tramadol promoted sleep first, but induced wakefulness thereafter. During non-REM sleep, tramadol (15 and 45 mg/kg) increased delta and decreased alpha power, while all doses increased gamma power. In conclusion, the sleep-related and qEEG effects of tramadol suggest antidepressant-like properties, including specific beneficial effects in selected patient groups, and raise the possibility of a faster acting antidepressant action.
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Bumpus JA. Low-Dose Tramadol as an Off-Label Antidepressant: A Data Mining Analysis from the Patients' Perspective. ACS Pharmacol Transl Sci 2020; 3:1293-1303. [PMID: 33344902 PMCID: PMC7737323 DOI: 10.1021/acsptsci.0c00132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Indexed: 01/09/2023]
Abstract
Objectives: The purpose of this analysis was to assess, from the patients' perspective, the effectiveness and relative safety of tramadol as an off-label antidepressant and to determine if patients' views and experiences are consistent with the biomedical literature. Method: A data mining approach was used to analyze databases available at drugs.com. Results: Tramadol was reported to be an effective or very effective antidepressant by 94.6% of patients (123/130) who provided ratings submitted to User Reviews for Tramadol to Treat Depression (https://www.drugs.com/comments/tramadol/for-depression.html). When compared to 34 other antidepressants in the database titled Drugs Used to treat Depression (https://www.drugs.com/condition/depression.html), for which there were ≥100 individual reviews for each drug, tramadol was rated as being the most effective (effectiveness rating = 9.1/10). Phenelzine (effectiveness rating = 8.7/10) was the only other antidepressant having ≥100 individual reviews coupled with a very high (8.0-10.0) effectiveness rating. Eleven patients reported significant symptoms of withdrawal upon cessation of tramadol, and five patients reported loss or reduction of libido as a side effect. Most (57/72, 79.2%) patients who reported a dose consumed experienced relief from depression at low therapeutic doses (25-150 mg/day). Fourteen patients reported taking this antidepressant for 5-10 years, and four patients reported taking tramadol for 10 or more years. Results demonstrated that most patients' comments and beliefs are consistent with the biomedical literature. Conclusions: Patients' reviews coupled with a survey of the biomedical literature indicate that at low therapeutic doses in the absence of interactions with other drugs, adult patients found tramadol to be a generally safe, effective, and fast-acting medication for relief from depression.
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Affiliation(s)
- John A. Bumpus
- Department of Chemistry and Biochemistry, University of Northern Iowa, Cedar Falls, Iowa 50614, United States
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13
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Sałaciak K, Głuch-Lutwin M, Siwek A, Szafarz M, Kazek G, Bednarski M, Nowiński L, Mitchell E, Jastrzębska-Więsek M, Partyka A, Wesołowska A, Kołaczkowski M, Szkaradek N, Marona H, Sapa J, Pytka K. The antidepressant-like activity of chiral xanthone derivatives may be mediated by 5-HT1A receptor and β-arrestin signalling. J Psychopharmacol 2020; 34:1431-1442. [PMID: 33103555 DOI: 10.1177/0269881120959605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Our previous studies showed that xanthone derivatives with N-(2-methoxyphenyl)piperazine fragment have an affinity to the 5-HT1A receptor and show antidepressant-like properties in rodents. In this study, we tested three xanthone derivatives, HBK-1 (R, S) and its enantiomers, in which we increased the distance between the piperazine and xanthone fragments by using a hydroxypropoxy linker. We hypothesized that this would increase the binding to the 5-HT1A receptor and consequently, pharmacological activity. AIMS We aimed to assess the in vitro and in vivo pharmacological activity of the xanthone derivatives. METHODS We evaluated the in vitro affinity for serotonin 5-HT1A and 5-HT2A receptors and serotonin transporter. We also determined the intrinsic activity at the 5-HT1A receptor. We investigated the antidepressant-like properties and safety after acute administration (dose range: 1.25-20 mg/kg) using the forced swim, tail suspension, locomotor activity, rotarod and chimney tests in mice. We also evaluated the basic pharmacokinetic parameters. RESULTS Our results indicated that the compounds showed a high affinity for the 5-HT1A receptor but very weak antagonistic properties in the Ca2+ mobilization assay; however, they showed significant agonistic properties in the β-arrestin recruitment assay. In both behavioural tests the studied xanthone derivatives showed antidepressant-like activity. Pre-treatment with p-chlorophenylalanine or WAY-100635 abolished their antidepressant-like activity. None of the compounds caused motor impairments at antidepressant-like doses. The racemate penetrated the blood-brain barrier and had a relatively high bioavailability after intraperitoneal administration. CONCLUSIONS Xanthone derivatives with N-(2-methoxyphenyl)piperazine fragment and hydroxypropoxy linker show increased binding to the 5-HT1A receptor and may represent an attractive putative treatment candidate for depression.
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Affiliation(s)
- Kinga Sałaciak
- Department of Pharmacodynamics, Jagiellonian University Medical College, Kraków, Poland
| | - Monika Głuch-Lutwin
- Department of Pharmacobiology, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Siwek
- Department of Pharmacobiology, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata Szafarz
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kazek
- Department of Pharmacodynamics, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Bednarski
- Department of Pharmacodynamics, Jagiellonian University Medical College, Kraków, Poland
| | - Leszek Nowiński
- Department of Pharmacodynamics, Jagiellonian University Medical College, Kraków, Poland
| | - Emma Mitchell
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | | | - Anna Partyka
- Department of Clinical Pharmacy, Jagiellonian University Medical College Kraków, Kraków, Poland
| | - Anna Wesołowska
- Department of Clinical Pharmacy, Jagiellonian University Medical College Kraków, Kraków, Poland
| | - Marcin Kołaczkowski
- Department of Medicinal Chemistry, Jagiellonian University Medical College Kraków, Kraków, Poland
| | - Natalia Szkaradek
- Department of Bioorganic Chemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Henryk Marona
- Department of Bioorganic Chemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Sapa
- Department of Pharmacodynamics, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Pytka
- Department of Pharmacodynamics, Jagiellonian University Medical College, Kraków, Poland
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14
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Altarifi AA, Moerke MJ, Alsalem MI, Negus SS. Preclinical assessment of tramadol abuse potential: Effects of acute and repeated tramadol on intracranial self-stimulation in rats. J Psychopharmacol 2020; 34:269881120944153. [PMID: 32842842 DOI: 10.1177/0269881120944153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tramadol is a widely used analgesic that activates mu-opioid receptors (MOR) and inhibits serotonin and norepinephrine transporters. This mixed pharmacology may limit both its own abuse potential and its modulation of abuse potential of other MOR agonists. AIMS This study used an intracranial self-stimulation (ICSS) procedure to compare abuse-related effects produced by acute or repeated treatment with tramadol or morphine in rats. Abuse potential in ICSS procedures is indicated by a drug-induced increase (or 'facilitation') of ICSS responding. METHODS Adult male Sprague-Dawley rats were implanted with electrodes targeting the medial forebrain bundle and trained to respond on a lever for pulses of electrical brain stimulation. Tramadol effects were evaluated after acute administration (3.2-32 mg/kg) in the absence or presence of the opioid antagonist naltrexone, the CYP2D6 hepatic-enzyme inhibitor quinine or a combination of both. Additionally, both tramadol and morphine were also tested before and after repeated tramadol (32 mg/kg/day for six days) or repeated morphine (3.2 mg/kg/day for six days). RESULTS Acute tramadol produced primarily ICSS rate-decreasing effects that were antagonised by naltrexone but not by quinine or naltrexone + quinine. Tramadol also produced little or no ICSS facilitation after repeated tramadol or repeated morphine, and repeated tramadol did not enhance ICSS facilitation by morphine. By contrast, morphine-induced ICSS facilitation was enhanced by repeated morphine treatment. CONCLUSIONS These results suggest that tramadol has lower abuse potential than other abused MOR agonists and that repeated tramadol exposure produces relatively little enhancement of abuse potential of other MOR agonists.
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Affiliation(s)
- Ahmad A Altarifi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Megan J Moerke
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, USA
| | - Mohammad I Alsalem
- Department of Anatomy and Histology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, USA
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15
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Alsalem M, Altarifi A, Haddad M, Azab B, Kalbouneh H, Imraish A, Saleh T, El-Salem K. Analgesic Effects and Impairment in Locomotor Activity Induced by Cannabinoid/Opioid Combinations in Rat Models of Chronic Pain. Brain Sci 2020; 10:brainsci10080523. [PMID: 32781705 PMCID: PMC7547378 DOI: 10.3390/brainsci10080523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/20/2022] Open
Abstract
Both opioids and cannabinoids have well-known antinociceptive effects in different animal models of chronic pain. However, unwanted side effects limit their use. The aim of this study is to evaluate the antinociceptive effect of combining synthetic cannabinoids with subtherapeutic doses of opioids, and to evaluate the effects of these drugs/combinations on rat’s locomotor activity. Intra-plantar injection of Complete Freund’s Adjuvant (CFA) into the left hindpaw and intraperitoneal injection of streptozotocin (STZ) were used to induce inflammatory and diabetic neuropathic pain in adult male Sprague-Dawley rats, respectively. Von Frey filaments were used to assess the antinociceptive effects of opioids (morphine and tramadol) and the synthetic cannabinoids (HU210 and WIN55212) or their combinations on CFA and STZ-induced mechanical allodynia. Open field test was used to evaluate the effect of these drugs or their combinations on locomotion. HU210 and WIN55212 did not produce significant antinociceptive effect on inflammatory pain while only the maximal dose of HU210 (1 mg/kg) was effective in neuropathic pain. Only the maximal doses of morphine (3.2 mg/kg) and tramadol (10 mg/kg) had significant anti-allodynic effects in both models. Tramadol (1 mg/kg) enhanced the antinociceptive effects of WIN55212 but not HU210 in neuropathic pain with no effect on inflammatory pain. However, in open field test, the aforementioned combination did not change tramadol-induced depression of locomotion. Tramadol and WIN55212 combination produces antinociceptive effects in neuropathic but not inflammatory pain at low doses with no additional risk of locomotor impairment, which may be useful in clinical practice.
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Affiliation(s)
- Mohammad Alsalem
- Faculty of Medicine, The University of Jordan, Amman 11942, Jordan; (B.A.); (H.K.)
- Correspondence:
| | - Ahmad Altarifi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.A.); (K.E.-S.)
| | - Mansour Haddad
- Faculty of Pharmacy, Philadelphia University, Amman 19392, Jordan;
| | - Belal Azab
- Faculty of Medicine, The University of Jordan, Amman 11942, Jordan; (B.A.); (H.K.)
| | - Heba Kalbouneh
- Faculty of Medicine, The University of Jordan, Amman 11942, Jordan; (B.A.); (H.K.)
| | - Amer Imraish
- Faculty of Science, The University of Jordan, Amman 11942, Jordan;
| | - Tareq Saleh
- Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan;
| | - Khalid El-Salem
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (A.A.); (K.E.-S.)
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Tramadol: a Potential Neurotoxic Agent Affecting Prefrontal Cortices in Adult Male Rats and PC-12 Cell Line. Neurotox Res 2020; 38:385-397. [PMID: 32378056 DOI: 10.1007/s12640-020-00214-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/25/2022]
Abstract
Tramadol is a synthetic analogue of codeine that is often prescribed for the treatment of mild to moderate pains. It has a number of side effects including emotional instability and anxiety. In this study, we focus on the structural and functional changes of prefrontal cortex under chronic exposure to tramadol. At the cellular level, the amounts of ROS and annexin V in PC12 cells were evidently increased upon exposure to tramadol (at a concentration of 600 μM for 48 h). To this end, the rats were daily treated with tramadol at doses of 50 mg/kg for 3 weeks. Our findings reveal that tramadol provokes atrophy and apoptosis by the induction of apoptotic markers such as Caspase 3 and 8, pro-inflammatory markers, and downregulation of GDNF. Moreover, it triggers microgliosis and astrogliosis along with neuronal death in the prefrontal cortex. Behavioral disturbance and cognitive impairment are other side effects of tramadol. Overall, our results indicate tramadol-induced neurodegeneration in the prefrontal cortex mainly through activation of neuroinflammatory response.
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17
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Zhang XH, Gao XX, Wu WW, Yu JA. Impact of orally administered tramadol combined with self-selected music on adult outpatients with burns undergoing dressing change: A randomized controlled trial. Burns 2019; 46:850-859. [PMID: 31672469 DOI: 10.1016/j.burns.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effects of music and/or tramadol on pain and anxiety in burn outpatients undergoing dressing changes. DESIGN Randomized controlled trial. SETTING Burns and Plastic Reconstruction Unit. PARTICIPANTS Patients (N=180) with burns on up to 10%-30% of the total body surface area (TBSA). INTERVENTIONS The patients were randomly allocated to 4 equal-sized groups as follows: (1) tramadol group (TG), patients received 100mg of tramadol orally 20min before the dressing change; (2) music group (MG), patients listened to self-selected music during the dressing change; (3) music-plus-tramadol group (MTG), patients received tramadol and listened to self-selected music; and (4) control group (CG), patients received a routine dressing change only. All patients underwent the interventions once per day for 2days. MAIN OUTCOME MEASURES McGill Pain Questionnaire Short Form (MPQ-SF) (primary outcome), McGill Pain Persian version of Burn Specific Pain Anxiety Scale (BSPAS) (primary outcome), and heart rate (HR) and overall patient satisfaction (secondary outcomes). RESULTS The results showed that music-plus-tramadol group (MTG) had better outcomes with respect to pain and anxiety management during dressing changes. CONCLUSIONS In comparison with music or tramadol alone, the integration of music and tramadol offers a secure and favorable treatment choice to relieve pain and anxiety, ultimately improving the satisfaction levels of burn outpatients during dressing changes.
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Affiliation(s)
- Xiu-Hang Zhang
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
| | - Xin-Xin Gao
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
| | - Wei-Wei Wu
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
| | - Jia-Ao Yu
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun 130021, China.
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Liu D, Hu XY, Xia HJ, Wang LJ, Shi P, Chen XP, Zhou QX. Antidepressant effect of venlafaxine in chronic unpredictable stress: Evidence of the involvement of key enzymes responsible for monoamine neurotransmitter synthesis and metabolism. Mol Med Rep 2019; 20:2954-2962. [PMID: 31322231 DOI: 10.3892/mmr.2019.10489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 06/12/2019] [Indexed: 11/06/2022] Open
Abstract
A number of studies have linked abnormalities in the function of the serotonergic and noradrenergic systems to the pathophysiology of depression. It has been reported that selective serotonin reuptake inhibitors promote the expression of tryptophan hydroxylase (TPH), which is involved in the synthesis of serotonin. However, limited evidence of TPH alteration has been found in selective serotonin and noradrenaline reuptake inhibitors (SNRIs), and more key enzymes need to be investigated. The aim of the present study was to determine whether venlafaxine (VLX; a classical SNRI) regulates TPH and other key enzymes responsible for the synthesis and metabolism of monoaminergic transmitters in rats with chronic unpredictable stress (CUS). The present results suggested that CUS‑exposed rats exhibited decreased locomotor activity in the open‑field test and increased immobility time in the forced swim test, as compared with the controls. Pretreatment with VLX (20 mg/kg) significantly increased locomotor activity and reduced immobility time in the CUS‑exposed rats. In addition, VLX (20 mg/kg) treatment prevented the CUS‑induced reduction in tyrosine hydroxylase and TPH expression in the cortex and hippocampus. Furthermore, VLX alleviated the CUS‑induced oxidative stress in the serum, cortex and hippocampus. However, VLX administration did not have an effect on indoleamine‑2,3‑dioxygenase overexpression in the hippocampus. It was therefore concluded that the regulation of abnormalities in the synthesis and metabolism of monoaminergic transmitters may be associated with the antidepressant effects of VLX, suggesting that multimodal pharmacological treatments can efficiently treat depression.
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Affiliation(s)
- Dan Liu
- Department of Pharmacy, Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Xiao-Ya Hu
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Hai-Jian Xia
- Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Li-Jia Wang
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Ping Shi
- Department of Pharmacy, Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Xiang-Pan Chen
- Department of Pharmacy, Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Qi-Xin Zhou
- Key Laboratory of Biochemistry and Molecular Pharmacology, Department of Pharmacology, Chongqing Medical University, Chongqing 400016, P.R. China
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19
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Duan G, Bao X, Yang G, Peng J, Wu Z, Zhao P, Zuo Z, Li H. Patient-controlled intravenous tramadol versus patient-controlled intravenous hydromorphone for analgesia after secondary cesarean delivery: a randomized controlled trial to compare analgesic, anti-anxiety and anti-depression effects. J Pain Res 2018; 12:49-59. [PMID: 30588079 PMCID: PMC6302801 DOI: 10.2147/jpr.s184782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction This study aimed to compare the postoperative analgesic effects of tramadol and hydromorphone for secondary cesarean delivery (CD) as well as their anti-anxiety and anti-depression properties. Methods A total of 106 patients receiving secondary CD under spinal anesthesia were randomly allocated to the tramadol group (n=53) and the hydromorphone group (n=53). Each group received patient-controlled intravenous analgesia using flurbiprofen 4 mg/kg combined with tramadol (4 mg/kg) or hydromorphone (0.04 mg/kg) immediately after the surgery. Postoperative pain numerical rating scale (NRS) for incision and visceral pain, hospital anxiety and depression scale (HADS), early walking time and length of hospital stay were assessed. Results Patients in the tramadol and hydromorphone groups exhibited equivalent incision pain NRS at different time points (P>0.05). Visceral pain in the tramadol group was higher than that in the hydromorphone group at postoperative 4 hours (2.9 [1.2] vs 2.3 [1.4], P=0.011) and 8 hours (2.4 [1.1] vs 1.8 [1.1], P=0.028). One week after the surgery, the patients in the tramadol group, as compared to the hydromorphone group, had lower anxiety scores (1.9 [3.5] vs 3.6 [4.1], P=0.033) and depression scores (0.8 [1.3] vs 2.7 [4.1], P=0.023). In addition, early walking time (25.3 [7.0] hours vs 29.3 [9.6] hours, P=0.016) and length of hospital stay (2.9 [0.8] days vs 3.3 [0.8] days, P= 0.008) after the surgery in the tramadol group were less than those in the hydromorphone group. Conclusion Postoperative intravenous analgesia with tramadol or hydromorphone for secondary CD provides comparable analgesic effects on incision pain. Tramadol is less effective in controlling visceral pain compared to hydromorphone. However, tramadol can help to alleviate anxiety and depression in the early postpartum period, improve patients’ early mobilization and shorten their hospital stay. Clinical trial number and registry URL No: ChiCTR-IIR-17011043; URL: www.chictr.org.cn.
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Affiliation(s)
- Guangyou Duan
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
| | - Xiaohang Bao
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
| | - Guiying Yang
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
| | - Jing Peng
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
| | - Zhuoxi Wu
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
| | - Peng Zhao
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China,
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Tramadol-Induced Mood Elevation in a Patient with No Previous Psychiatric History. Case Rep Psychiatry 2018; 2018:9574395. [PMID: 30364082 PMCID: PMC6188767 DOI: 10.1155/2018/9574395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/30/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022] Open
Abstract
Tramadol is a powerful analgesic medication with antidepressant effects like venlafaxine. Hypomanic features were reported in patients with psychiatric history of mood disturbance when tramadol was prescribed for them. However, it is extremely rare to notice such mood-elevating effect in patients who have no previous psychiatric history. We report on the observation of a distressing mood-elevating effect for tramadol in a patient with no previous psychiatric history. We present the case of a 26-year-old female patient who developed accelerated flow of speech, overactivity, and difficulty in sleeping following intake of tramadol 50 mg dose. These symptoms resolved four hours later and recurred as she retook tramadol. The patient has no history of mood disorder or any other psychiatric comorbidity. Clinicians should exercise caution when prescribing tramadol.
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Mehdizadeh H, Pourahmad J, Taghizadeh G, Vousooghi N, Yoonessi A, Naserzadeh P, Behzadfar L, Rouini MR, Sharifzadeh M. Mitochondrial impairments contribute to spatial learning and memory dysfunction induced by chronic tramadol administration in rat: Protective effect of physical exercise. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:426-433. [PMID: 28757160 DOI: 10.1016/j.pnpbp.2017.07.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/06/2017] [Accepted: 07/26/2017] [Indexed: 01/15/2023]
Abstract
Despite the worldwide use of tramadol, few studies have been conducted about its effects on memory and mitochondrial function, and controversial results have been reported. Recently, there has been an increasing interest in physical exercise as a protective approach to neuronal and cognitive impairments. Therefore, the aim of this study was to investigate the effects of physical exercise on spatial learning and memory and brain mitochondrial function in tramadol-treated rats. After completion of 2-week (short-term) and 4-week (long-term) treadmill exercise regimens, male Wistar rats received tramadol (20, 40, 80mg/kg/day) intraperitoneally for 30days. Then spatial learning and memory was assessed by Morris water maze test (MWM). Moreover, brain mitochondrial function was evaluated by determination of mitochondrial reactive oxygen species (ROS) level, mitochondrial membrane potential (MMP), mitochondrial swelling and cytochrome c release from mitochondria. Chronic administration of tramadol impaired spatial learning and memory as well as brain mitochondrial function as indicated by increased ROS level, MMP collapse, increased mitochondrial swelling and cytochrome c release from mitochondria. Conversely, treadmill exercise significantly attenuated the impairments of spatial learning and memory and brain mitochondrial dysfunction induced by tramadol. The results revealed that chronic tramadol treatment caused memory impairments through induction of brain mitochondrial dysfunction. Furthermore, pre-exposure to physical exercise markedly mitigated these impairments through its positive effects on brain mitochondrial function.
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Affiliation(s)
- Hajar Mehdizadeh
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalal Pourahmad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, Faculty of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran; Rehabilitation Research Center, Faculty of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Vousooghi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Genetics Laboratory, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Research Center for Cognitive and Behavioral Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Yoonessi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Naserzadeh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ladan Behzadfar
- Department of Pharmacology and Toxicology, Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Rouini
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sharifzadeh
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Malikowska N, Fijałkowski Ł, Nowaczyk A, Popik P, Sałat K. Antidepressant-like activity of venlafaxine and clonidine in mice exposed to single prolonged stress - A model of post-traumatic stress disorder. Pharmacodynamic and molecular docking studies. Brain Res 2017; 1673:1-10. [PMID: 28797691 DOI: 10.1016/j.brainres.2017.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/14/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a growing issue worldwide characterized by stress and anxiety in response to re-experiencing traumatic events which strongly impair patient's quality of life and social functions. Available antidepressant and anxiolytic drugs are not efficacious in the majority of treated individuals. This necessitates a significant medical demand to develop novel therapeutic strategies for PTSD. EXPERIMENTAL APPROACH Animal model of PTSD was induced using a mouse single prolonged stress protocol (mSPS). To assess the activity of venlafaxine and clonidine, the forced swim test (FST) was used repeatedly 24h, 3days, 8days, 15days and 25days after mSPS. To get insight into a possible mechanism of anti-PTSD action, molecular docking procedure was utilized for the most active drug. This in silico part comprised molecular docking of enantiomers of venlafaxine to human transporters for serotonin (hSERT), norepinephrine (hNET) and dopamine (hDAT). KEY RESULTS In mSPS-subjected mice FST revealed the effectiveness of venlafaxine, however in non SPS-subjected mice both venlafaxine and clonidine were active. Molecular docking studies indicated that the affinity of venlafaxine to monoamine transporters is growing in the following rank order: hDAT<hNET<hSERT. Both venlafaxine enantiomers present different selectivity and binding mode. CONCLUSION AND IMPLICATIONS Venlafaxine but not clonidine was effective in an animal model of PTSD. Its mechanism of action, i.e., SERT, NET and DAT inhibition indicates potential drug targets for PTSD treatment. We expect that these results will contribute to a broader application of VLX in PTSD patients.
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Affiliation(s)
- Natalia Malikowska
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Łukasz Fijałkowski
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 2 dr. A. Jurasza St., 85-094 Bydgoszcz, Poland
| | - Alicja Nowaczyk
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 2 dr. A. Jurasza St., 85-094 Bydgoszcz, Poland
| | - Piotr Popik
- Department of Behavioral Neuroscience and Drug Development, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Kinga Sałat
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland.
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Szkutnik-Fiedler D, Grabowski T, Balcerkiewicz M, Michalak M, Pilipczuk I, Wyrowski Ł, Urjasz H, Grześkowiak E. The influence of a single and chronic administration of venlafaxine on tramadol pharmacokinetics in a rabbit model. Pharmacol Rep 2017; 69:555-559. [PMID: 31994089 DOI: 10.1016/j.pharep.2017.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The combined use of tramadol with selective serotonin and norepinephrine reuptake inhibitors e.g. venlafaxine may be associated with serotonin syndrome. No previous studies exist examining the influence of a weak CYP2D6 inhibitor venlafaxine on the pharmacokinetics of tramadol. Therefore, the aim of this study was to determine the effect of a single and chronic administration of venlafaxine on the pharmacokinetics of tramadol using a rabbit model. METHODS Adult New Zealand white rabbits of both sexes (n = 21) were used. Animals received 100 mg of tramadol per os (one slow release tablet) and 75 mg of venlafaxine (one prolonged release capsule), and were divided into four groups: control group - a single dose of tramadol alone, 1 day group - a single dose of tramadol and venlafaxine, 7 and 14 days groups - seven and fourteen days administration of venlafaxine once daily plus a single dose of tramadol on the last day of the study. RESULTS Venlafaxine administration over a period of 7 and 14 days resulted in faster elimination of tramadol compared to the control group: significantly higher values of kel, and lower values of t1/2kel and MRT for the 7 and 14 days group were observed. Although no differences in bioavailability of tramadol were obtained. CONCLUSION Using a rabbit model, there is no evidence that the combined administration of tramadol and venlafaxine may increase the plasma exposure of tramadol and therefore increase the risk of serotonin syndrome.
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Affiliation(s)
- Danuta Szkutnik-Fiedler
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Poznań, Poland.
| | | | - Monika Balcerkiewicz
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Poznań, Poland
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Irina Pilipczuk
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Poznań, Poland
| | - Łukasz Wyrowski
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Poznań, Poland
| | - Hanna Urjasz
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Poznań, Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Poznań, Poland
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Fiaes GCDS, Roncon CM, Sestile CC, Maraschin JC, Souza RLS, Porcu M, Audi EA. Panicolytic-like effect of tramadol is mediated by opioid receptors in the dorsal periaqueductal grey. Behav Brain Res 2017; 326:52-58. [DOI: 10.1016/j.bbr.2017.02.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 11/15/2022]
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25
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Abstract
Over the past 20−30 years, the premature ejaculation (PE) treatment paradigm, previously limited to behavioural psychotherapy, has expanded to include drug treatment. Pharmacotherapy for PE predominantly targets the multiple neurotransmitters and receptors involved in the control of ejaculation which include serotonin, dopamine, oxytocin, norepinephrine, gamma amino-butyric acid (GABA) and nitric oxide (NO). The objective of this article is to review emerging PE interventions contemporary data on the treatment of PE was reviewed and critiqued using the principles of evidence-based medicine. Multiple well-controlled evidence-based studies have demonstrated the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) in delaying ejaculation, confirming their role as first-line agents for the medical treatment of lifelong and acquired PE. Daily dosing of SSRIs is likely to be associated with superior fold increases in IELT compared to on-demand SSRIs. On-demand SSRIs are less effective but may fulfill the treatment goals of many patients. Integrated pharmacotherapy and CBT may achieve superior treatment outcomes in some patients. PDE-5 inhibitors alone or in combination with SSRIs should be limited to men with acquired PE secondary to co-morbid ED. New on-demand rapid acting SSRIs, oxytocin receptor antagonists, or single agents that target multiple receptors may form the foundation of more effective future on-demand medication. Current evidence confirms the efficacy and safety of dapoxetine, off-label SSRI drugs, tramadol and topical anaesthetics drugs. Treatment with α1-adrenoceptor antagonists cannot be recommended until the results of large well-designed RCTs are published in major international peer-reviewed medical journals. As our understanding of the neurochemical control of ejaculation improves, new therapeutic targets and candidate molecules will be identified which may increase our pharmacotherapeutic armamentarium.
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Affiliation(s)
- Chris G McMahon
- Australian Centre for Sexual Health, Sydney, NSW 2065, Australia
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26
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Abstract
The management recommendation for both acquired premature ejaculation (APE) and lifelong PE (LPE) are similar, such as a behavioral/psychotherapy, a pharmacotherapy and a combination of these treatments. For the drug treatment for PE, gold standard is selective serotonin reuptake inhibitors (SSRIs) including dapoxetine or paroxetine. The drug treatment for PE is still developing and some new promising therapeutic options have been proposed. Topical anesthetics, tramadol, and alpha-1 blockers will be the next strategies of the drug treatment for PE in the future.
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Affiliation(s)
- Shin-Ichi Hisasue
- Department of Urology, Chiba-Nishi General Hospital, Matsudo City, Chiba, Japan
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27
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Contemporary Management of Disorders of Male Orgasm and Ejaculation. Urology 2016; 93:9-21. [DOI: 10.1016/j.urology.2016.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 01/06/2023]
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28
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Gamil NM, Maklad YA, Ahmed MA, Nofal S, Ahmed AA. Modulatory effect of cilostazol on tramadol-induced behavioral and neurochemical alterations in rats challenged across the forced swim despair test. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2016. [DOI: 10.1016/j.bjbas.2016.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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29
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Coadministration of tramadol with aripiprazole and venlafaxine--The effect on spatial memory functions in male rats. Pharmacol Rep 2015; 68:451-6. [PMID: 26922552 DOI: 10.1016/j.pharep.2015.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The impairment of memory functions is very common in patients with chronic pain, particularly in patients with existing cognitive disorders. Results of some studies confirmed that tramadol (TRM), a frequently prescribed analgesic drug, improves memory functions in humans. However, there are no studies on the effect of co-administration of TRM with antidepressants or antipsychotics on memory; therefore, the aim of this study was to evaluate the effect of concomitant use of TRM with a second generation antipsychotic-aripiprazole (ARI) and an antidepressant-venlafaxine (VEN) on memory using an animal model. METHODS The effect of TRM (5mg/kg)+ARI (1.5mg/kg) and TRM (5mg/kg)+VEN (20mg/kg) on memory in Wistar rats was examined using the Morris water maze test after single and chronic administration (7 and 14 days). RESULTS It was observed that a single and chronic administration of TRM, VEN or ARI alone, but not a combination of TRM+VEN or TRM+ARI (except for 14 days of treatment) can improve memory in rats compared to the control group. After 14 days of administration, both combinations achieved improvement similar to each drug individually and improved spatial memory in rats compared to the control animals. CONCLUSION It can be assumed that chronic treatment with combinations of TRM+VEN or TRM+ARI is unlikely to cause memory impairment and interfere with either any antidepressant effect of VEN or any antipsychotic effect of ARI in patients suffering from chronic pain using TRM.
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30
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Abstract
INTRODUCTION Over the past 20-30 years, the premature ejaculation (PE) treatment paradigm, previously limited to behavioral psychotherapy, has expanded to include drug treatment. Pharmacotherapy for PE predominantly targets the multiple neurotransmitters and receptors involved in the control of ejaculation, which include serotonin, dopamine, oxytocin, norepinephrine, gamma amino-butyric acid (GABA) and nitric oxide (NO). AIM The objective of this article is to review current and emerging PE interventions. METHODS Contemporary data on the treatment of PE were reviewed and critiqued using the principles of evidence-based medicine. MAIN OUTCOME MEASURE Integrated pharmacotherapy and cognitive behavioral therapy (CBT) may achieve superior treatment outcomes in some patients. Phosphodiesterase type 5 inhibitors alone or in combination with selective serotonin reuptake inhibitors (SSRIs) should be limited to men with acquired PE secondary to comorbid erectile dysfunction (ED). New on-demand rapid-acting SSRIs, oxytocin receptor antagonists, or single agents that target multiple receptors may form the foundation of more effective future on-demand medication. RESULTS Multiple well-controlled evidence-based studies have demonstrated the efficacy and safety of SSRIs in delaying ejaculation, confirming their role as first-line agents for the medical treatment of lifelong and acquired PE. Daily dosing of SSRIs is likely to be associated with superior fold increases in intravaginal ejaculation latency time compared with on-demand SSRIs. On-demand SSRIs are less effective but may fulfill the treatment goals of many patients. CONCLUSIONS Current evidence suggests that psychosexual CBT has a limited role in the contemporary management of PE and confirms the efficacy and safety of dapoxetine, off-label SSRI drugs, and topical anesthetics drugs. Treatment with tramadol, α1-adrenoceptor antagonists cannot be recommended until the results of large, well-designed randomized controlled trials are published in major international peer-reviewed medical journals. As our understanding of the neurochemical control of ejaculation improves, new therapeutic targets and candidate molecules will be identified, which may increase our pharmacotherepeutic armamentarium. McMahon CG. Current and emerging treatments for premature ejaculation. Sex Med Rev 2015;3:183-202.
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Affiliation(s)
- Chris G McMahon
- Australian Centre for Sexual Health, Sydney, NSW, Australia.
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31
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Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, Torres LO. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med 2014; 2:60-90. [PMID: 25356302 PMCID: PMC4184677 DOI: 10.1002/sm2.28] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. AIM The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. METHOD A comprehensive literature review was performed. RESULTS This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. CONCLUSION Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60-90.
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Affiliation(s)
- Stanley E Althof
- Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA
| | | | - Marcel D Waldinger
- Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University Utrecht, The Netherlands
| | - Ege Can Serefoglu
- Department of Urology, Bagcilar Training & Research Hospital Istanbul, Merkez Mah, Turkey
| | - Alan W Shindel
- Department of Urology, University of California at Davis CA, USA
| | - P Ganesan Adaikan
- Department of Obstetrics and Gynecology, National University of Singapore Singapore, Singapore
| | - Edgardo Becher
- Division of Urology, University of Buenos Aires Buenos Aires, Argentina
| | - John Dean
- St. Peter's Sexual Medicine, The London Clinic London, UK
| | - Francois Giuliano
- Neuro-Uro-Andrology, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Garches, France
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA
| | - Annamaria Giraldi
- Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark
| | - Sidney Glina
- Department of Urology, Instituto H. Ellis Sao Paulo, Brazil
| | - Luca Incrocci
- Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands
| | - Emmanuele Jannini
- School of Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila L'Aquila, Italy
| | - Marita McCabe
- School of Psychology, Deakin University Burwood, Vic., Australia
| | - Sharon Parish
- Albert Einstein College of Medicine, Department of Medicine, Montefiore Medical Center Bronx, NY, USA
| | - David Rowland
- Graduate School, Valparaiso University Valparaiso, IN, USA
| | - R Taylor Segraves
- Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA
| | - Ira Sharlip
- Department of Urology, University of California San Francisco, CA, USA
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Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med 2014; 11:1392-422. [PMID: 24848686 DOI: 10.1111/jsm.12504] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. AIM The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. METHOD A comprehensive literature review was performed. RESULTS This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. CONCLUSION Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years.
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Affiliation(s)
- Stanley E Althof
- Department of Psychiatry, Case Western Reserve University School of Medicine, West Palm Beach, FL, USA
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Hoffelt C, Zwack A. Assessment and management of chronic pain in patients with depression and anxiety. Ment Health Clin 2014. [DOI: 10.9740/mhc.n198935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article will review the role of the pharmacist in the management of chronic pain in patients with comorbid mood disorders.
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Szałek E, Karbownik A, Murawa D, Połom K, Urbaniak B, Grabowski T, Wolc A, Więckiewicz A, Grześkowiak E, Kokot ZJ, Murawa P, Burchardt P, Cieśla S. The pharmacokinetics of the effervescent vs. conventional tramadol/paracetamol fixed-dose combination tablet in patients after total gastric resection. Pharmacol Rep 2014; 66:159-64. [PMID: 24905322 DOI: 10.1016/j.pharep.2013.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 05/26/2013] [Accepted: 06/13/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tramadol/paracetamol is a fixed-dose combination prescribed for the relief of moderate to severe pain. The combination acts synergistically and guarantees the rapid onset of paracetamol and the prolonged analgesic effect of tramadol with good tolerability. These drugs are often used in various formulations in the treatment of patients with postoperative pain, e.g. after stomach resection. Gastrectomy leads to pathophysiological changes within the alimentary tract, which may affect the process of drug absorption. The aim of the research was an analysis of the pharmacokinetics of tramadol/paracetamol from effervescent and conventional tablets in patients after total gastrectomy. METHODS The research was carried out on patients after gastrectomy with Roux-en-Y reconstruction. The patients received two tramadol/paracetamol fixed-dose combination tablets in a single orally administered dose of 75/650 mg (2 × 37.5/325 mg). The patients were subjected to one of the two study drug group with: I. effervescent tablet (ET) (n = 14; mean [SD] age, 63.4 [10.1] years; weight, 75.5 [15.3]kg; and BMI, 26.0 [4.6]kg/m(2)) and II. conventional tablet (CT) (n = 12; mean [SD] age, 66.8 [7.7] years; weight, 79.8 [17.8]kg; and BMI, 27.4 [5.3]kg/m(2)). Blood samples were collected within 10 h after the drug administration. The plasma concentrations of tramadol and paracetamol were measured with validated HPLC (high-performance liquid chromatography) method with UV detection. RESULTS The comparison of the paracetamol and tramadol C(max) ratio for the ET group with that of the CT group gave ratios of 1.16 [90% confidence interval (CI) 1.06, 1.27] and 0.86 (90% CI 0.72, 1.02), respectively. The comparison of the paracetamol and tramadol AUC(0-t) ratio for the ET group with that of the CT group showed ratios of 0.99 (90% CI 0.88, 1.10) and 1.00 (90% CI 0.82, 1.22), respectively. The comparison of the difference for the effervescent and conventional formulation gave an estimated decrease in t(max) of 0.5 h for paracetamol and 0.13 h for tramadol. CONCLUSIONS In view of the changes in the pharmacokinetics of paracetamol and tramadol in the patients after gastric resection for both formulations compared the conventional tablet seems to be more appropriate due to the comparable rate of absorption of both substances, higher concentrations of tramadol and comparable exposure to paracetamol.
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Affiliation(s)
- Edyta Szałek
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland.
| | - Agnieszka Karbownik
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland
| | - Dawid Murawa
- 1st Department of Surgical Oncology and General Surgery Department, Wielkopolska Cancer Centre, Poznań, Poland
| | - Karol Połom
- 1st Department of Surgical Oncology and General Surgery Department, Wielkopolska Cancer Centre, Poznań, Poland
| | - Bartosz Urbaniak
- Department of Inorganic and Analytical Chemistry, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | | | - Anna Wolc
- Department of Animal Science, Iowa State University, IA, USA
| | - Aleksandra Więckiewicz
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland
| | - Zenon J Kokot
- Department of Inorganic and Analytical Chemistry, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Paweł Murawa
- 1st Department of Surgical Oncology and General Surgery Department, Wielkopolska Cancer Centre, Poznań, Poland; Cancer Pathology Department, Clinic of Oncology, University of Medical Sciences, Poznań, Poland
| | - Paweł Burchardt
- Division of Cardiology-Intensive Care, University of Medical Sciences, Poznań, Poland
| | - Sławomir Cieśla
- Department of General Surgery, Leszno Regional Hospital, Leszno, Poland
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Cojocaru GR, Popa-Wagner A, Stanciulescu EC, Babadan L, Buga AM. Post-stroke depression and the aging brain. J Mol Psychiatry 2013; 1:14. [PMID: 25408907 PMCID: PMC4223891 DOI: 10.1186/2049-9256-1-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/25/2013] [Indexed: 11/12/2022] Open
Abstract
Ageing is associated with changes in the function of various organ systems. Changes in the cardiovascular system affect both directly and indirectly the function in a variety of organs, including the brain, with consequent neurological (motor and sensory performance) and cognitive impairments, as well as leading to the development of various psychiatric diseases. Post-stroke depression (PSD) is among the most frequent neuropsychiatric consequences of cerebral ischemia. This review discusses several animal models used for the study of PSD and summarizes recent findings in the genomic profile of the ageing brain, which are associated with age-related disorders in the elderly. Since stroke and depression are diseases with increased incidence in the elderly, great clinical benefit may especially accrue from deciphering and targeting basic mechanisms underlying PSD. Finally, we discuss the relationship between ageing, circadian rhythmicity and PSD.
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Affiliation(s)
- Gabriel R Cojocaru
- Department of Functional Sciences, Center of Clinical and Experimental Medicine, University of Medicine and Pharmacy of Craiova, Petru Rares str., no 2, Craiova, 200349 Romania
| | - Aurel Popa-Wagner
- Department of Psychiatry, University of Medicine Rostock, Rostock, Germany
| | - Elena C Stanciulescu
- Faculty of Pharmacy, Chair of Biochemistry, University of Medicine and Pharmacy of Craiova, Craiova, 200349 Romania
| | - Loredana Babadan
- Department of Functional Sciences, Center of Clinical and Experimental Medicine, University of Medicine and Pharmacy of Craiova, Petru Rares str., no 2, Craiova, 200349 Romania
| | - Ana-Maria Buga
- Department of Functional Sciences, Center of Clinical and Experimental Medicine, University of Medicine and Pharmacy of Craiova, Petru Rares str., no 2, Craiova, 200349 Romania
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