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ORUCH R, HUNEIF MA, PRYME IF, FASMER OB, LUND A. Drug treatment of insomnia: impact of zopiclone. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.22.04792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hladun O, Papaseit E, Martín S, Barriocanal AM, Poyatos L, Farré M, Pérez-Mañá C. Interaction of Energy Drinks with Prescription Medication and Drugs of Abuse. Pharmaceutics 2021; 13:pharmaceutics13101532. [PMID: 34683828 PMCID: PMC8541613 DOI: 10.3390/pharmaceutics13101532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
In recent years, the consumption of energy drinks (EDs) has become increasingly popular, especially among adolescents. Caffeine, a psychostimulant, is the main compound of EDs which also contain other substances with pharmacological effects. This review aims to compile current evidence concerning the potential interactions between EDs, medicines, and drugs of abuse as they are frequently consumed in combination. The substances involved are mainly substrates, inductors or inhibitors of CYP1A2, psychostimulants, alcohol and other depressant drugs. Furthermore, intoxications reported with EDs and other substances have also been screened to describe acute toxicity. The results of our review show that the consumption of both EDs alone and in combination is not as safe as previously thought. Health professionals and consumers need to be aware of the potential interactions of these drinks as well as the absence of long-term safety data.
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Affiliation(s)
- Olga Hladun
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Esther Papaseit
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
- Correspondence: ; Tel.: +34-934978843
| | - Soraya Martín
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
| | - Ana Maria Barriocanal
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Lourdes Poyatos
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Magí Farré
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
| | - Clara Pérez-Mañá
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (HUGTiP-IGTP), 08916 Badalona, Spain; (O.H.); (S.M.); (A.M.B.); (L.P.); (M.F.); (C.P.-M.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallés, Spain
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Cysneiros RM, Farkas D, Harmatz JS, von Moltke LL, Greenblatt DJ. Pharmacokinetic and Pharmacodynamic Interactions Between Zolpidem and Caffeine. Clin Pharmacol Ther 2007; 82:54-62. [PMID: 17443132 DOI: 10.1038/sj.clpt.6100211] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The kinetic and dynamic interaction of caffeine and zolpidem was evaluated in a double-blind, single-dose, six-way crossover study of 7.5 mg zolpidem (Z) or placebo (P) combined with low-dose caffeine (250 mg), high-dose caffeine (500 mg), or placebo. Caffeine coadministration modestly increased maximum plasma concentration (C(max)) and area under the plasma concentration-time curve of zolpidem by 30-40%, whereas zolpidem did not significantly affect the pharmacokinetics of caffeine or its metabolites. Compared to P+P, Z+P significantly increased sedation, impaired digit-symbol substitution test performance, slowed tapping speed and reaction time, increased EEG relative beta amplitude, and impaired delayed recall. Caffeine partially, but not completely, reversed most pharmacodynamic effects of zolpidem. Thus, caffeine only incompletely reverses zolpidem's sedative and performance-impairing effects, and cannot be considered as an antidote to benzodiazepine agonists.
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Affiliation(s)
- R M Cysneiros
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and Tufts--New England Medical Center, Boston, MA, USA
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Kelly TH, Stoops WW, Perry AS, Prendergast MA, Rush CR. Clinical neuropharmacology of drugs of abuse: a comparison of drug-discrimination and subject-report measures. ACTA ACUST UNITED AC 2004; 2:227-60. [PMID: 15006288 DOI: 10.1177/1534582303262095] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in molecular pharmacology and behavioral science have helped elucidate the structure and function of the central nervous system and its relationship to behavior and has sparked the development of pharmacological agents that have increasingly selective and potent effects with fewer adverse side effects. The sensitivity and predictive validity of the two most commonly used methodologies for assessing the neuropharmacological effects of centrally active drugs, subject report of drug effects and drug discrimination, were examined. The sensitivity of the measures was comparable across stimulant, sedative, and opioid drugs. Results with drug-discrimination methodologies were generally consistent with hypothesized neuropharmacological mechanisms across all drug classes, whereas subject reports conformed under more limited testing conditions. Firm conclusions regarding the relative utility of drug-discrimination and subject-report measures for clinical studies of neuropharmacological mechanisms are limited by the small number of studies in which the two methodologies have been tested using identical pharmacological pretreatment manipulations.
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Affiliation(s)
- Thomas H Kelly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington 40536-0086, USA.
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Rivera JO, Hughes HW, Stuart AG. Herbals and asthma: usage patterns among a border population. Ann Pharmacother 2003; 38:220-5. [PMID: 14742754 DOI: 10.1345/aph.1d319] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The use of herbal products (HP) is rising in the US. Higher rates of HP use have been documented in the US/Mexico border population, as well as increasing concerns about herbal-related adverse events. OBJECTIVE To evaluate the prevalence of HP use in adult asthmatic patients requiring hospitalization and the frequency of HP documentation in medical records. METHODS We conducted a retrospective chart review of admissions for asthma to determine the frequency of HP documentation. Additionally, during a 12-month period, a bilingual interviewer conducted prospective, semistructured interviews with patients with asthma exacerbations to record data on HPs used specifically for the treatment of asthma. RESULTS A total of 67 cases were chart-reviewed retrospectively; 60 patients were interviewed prospectively. We found no documentation of HP use by chart review, while prospective interviews showed that 42% of patients reported using HPs for the treatment of asthma. The most common HPs used were oregano 28%, chamomile 20%, garlic 16%, eucalyptus 12%, and lime 12%. Ten patients reported taking an HP that could potentially exacerbate their asthma and 18 patients reported using an HP that could interact with other medications or cause other types of adverse events. CONCLUSIONS An obvious lack of documentation for HP use was observed in the medical records reviewed. Because a number of HPs that are commonly used by residents along the border can interact with antiasthmatic agents and/or result in compromised asthma control, questions about HP use should be included in routine history taking.
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Affiliation(s)
- José O Rivera
- University of Texas at El Paso/University of Texas (UTEP/UT)-Austin Cooperative Pharmacy Program, El Paso, TX 79902-4153, USA.
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Abstract
Insomnia, an inability to initiate or maintain sleep, affects approximately one-third of the American population. Conventional benzodiazepines, such as triazolam and midazolam, were the treatment of choice for short-term insomnia for many years but are associated with adverse effects such as rebound insomnia, withdrawal and dependency. The newer hypnosedatives include zolpidem, zaleplon and zopiclone. These agents may be preferred over conventional benzodiazepines to treat short-term insomnia because they may be less likely to cause significant rebound insomnia or tolerance and are as efficacious as the conventional benzodiazepines. This review aims to summarise the published clinical drug interaction studies involving zolpidem, zaleplon and zopiclone. The pharmacokinetic and pharmacodynamic interactions that may be clinically important are highlighted. Clinical trials have studied potential interactions of zaleplon, zolpidem and zopiclone with the following types of drugs: cytochrome P450 (CYP) inducers (rifampicin), CYP inhibitors (azoles, ritonavir and erythromycin), histamine H(2) receptor antagonists (cimetidine and ranitidine), antidepressants, antipsychotics, antagonists of benzodiazepines and drugs causing sedation. Rifampicin significantly induced the metabolism of the newer hypnosedatives and decreased their sedative effects, indicating that a dose increase of these agents may be necessary when they are administered with rifampicin. Ketoconazole, erythromycin and cimetidine inhibited the metabolism of the newer hypnosedatives and enhanced their sedative effects, suggesting that a dose reduction may be required. Addition of ethanol to treatment with the newer hypnosedatives resulted in additive sedative effects without altering the pharmacokinetic parameters of the drugs. Compared with some of the conventional benzodiazepines, fewer clinically important interactions appear to have been reported in the literature with zaleplon, zolpidem and zopiclone. The fact that these drugs are newer to the market and have not been as extensively studied as the conventional benzodiazepines may be the reason for this. Another explanation may be a difference in CYP metabolism. While triazolam and midazolam are biotransformed almost entirely via CYP3A4, the newer hypnosedatives are biotransformed by several CYP isozymes in addition to CYP3A4, resulting in CYP3A4 inhibitors and inducers having a lesser effect on their biotransformation.
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Affiliation(s)
- Leah M Hesse
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, Massachusetts 02111, USA
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Hernández-López C, Farré M, Roset PN, Menoyo E, Pizarro N, Ortuño J, Torrens M, Camí J, de La Torre R. 3,4-Methylenedioxymethamphetamine (ecstasy) and alcohol interactions in humans: psychomotor performance, subjective effects, and pharmacokinetics. J Pharmacol Exp Ther 2002; 300:236-44. [PMID: 11752122 DOI: 10.1124/jpet.300.1.236] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
3,4-Methylenedioxymethamphetamine (MDMA) is frequently consumed in association with alcohol. The effect of this combination in humans has not been previously investigated. Nine male healthy volunteers received single oral doses of 100 mg of MDMA plus 0.8 g/kg ethanol, 100 mg of MDMA, 0.8 g/kg of ethanol, and placebo in a double blind, double dummy, randomized crossover trial. Measurements included psychomotor performance, subjective effects, and pharmacokinetics. Plasma concentrations of MDMA showed a 13% increase after the use of alcohol, whereas plasma concentrations of alcohol showed a 9 to 15% decrease after MDMA administration. The MDMA-alcohol combination induced longer lasting euphoria and well being than MDMA or alcohol alone. MDMA reversed the subjective sedation induced by alcohol but did not reduce drunkenness feelings. MDMA did not reverse the actions of alcohol on psychomotor abilities. Combined use of MDMA and alcohol causes dissociation between subjective and objective sedation. Subjects may feel euphoric and less sedated and might have the feeling of doing better, but actual performance ability continues to be impaired by the effect of alcohol. Confirmation of these findings in further studies will be highly relevant in terms of road safety.
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Affiliation(s)
- Cándido Hernández-López
- Unit of Pharmacology, Institut Municipal d'Investigació Mèdica, Hospital del Mar, Barcelona, Spain
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Hüppe A, Janke W. Experimentelle Untersuchung zur Wirkung von Acetylsalicylsäure kombiniert mit Coffein unter dem Aspekt eines Missbrauchspotentials. Exp Psychol 2001. [DOI: 10.1026//0949-3946.48.3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Coffein als Bestandteil zahlreicher Schmerzmittel soll in Kombination mit einem Analgetikum Wirkungen entfalten, die den Missbrauch begünstigen. Als Beitrag zur Klärung dieses Problemkreises wurde nach einem 2-faktoriellen Plan die Wirkung von Acetylsalicylsäure (500 mg) und Coffein (50 mg und 100 mg) allein und in Kombination auf das psychische Befinden vor, während und nach der Induktion eines Schmerzreizes (Druckschmerz) über mehrdimensionale Selbstbeurteilungsverfahren und Variablen des kardiovaskulären Systems erhoben. Weiterhin wurden Aspekte der subjektiven Bewertung und der Präferenz der Einzelsubstanzen und des Kombinationsanalgetikums über Selbstbeurteilungsmethoden und ein verhaltensbezogenes Präferenzmaß erfasst.Die wichtigsten Ergebnisse sind: (1) Acetylsalicylsäure läßt keine Wirkungen auf die Variablen des psychischen und körperlichen Befindens erkennen. (2) Coffein reduziert negative Befindensaspekte, insbesondere Angst/Traurigkeit, eine Steigerung positiver Befindensaspekte ist nicht beobachtbar. Im Wahlverhalten zeigt sich eine Präferierung von Coffein als Monosubstanz. (3) Das Wirkungsprofil der Kombination ist schwerpunktmäßig durch eine Reduktion der Aspekte Erregtheit und Aktiviertheit geprägt. (4) Die Bewertung der Präparate lässt keine Hinweise auf eine Bevorzugung der Kombination erkennen.Damit stützen die Befunde die Annahme nicht, dass ein peripher wirksames Analgetikum wie ASS mit Coffeinzusatz aufgrund der Wirkungen des Coffeins bevorzugt eingenommen wird.
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Affiliation(s)
- Angelika Hüppe
- Universität Würzburg, Lehrstuhl für Biologische und Klinische Psychologie
| | - Wilhelm Janke
- Universität Würzburg, Lehrstuhl für Biologische und Klinische Psychologie
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Cami J, Farré M, Mas M, Roset PN, Poudevida S, Mas A, San L, de la Torre R. Human pharmacology of 3,4-methylenedioxymethamphetamine ("ecstasy"): psychomotor performance and subjective effects. J Clin Psychopharmacol 2000; 20:455-66. [PMID: 10917407 DOI: 10.1097/00004714-200008000-00010] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") is a recreational drug of increasing use among youth because of its apparent entactogenic properties, such as euphoria, friendliness, closeness, and empathy. However, experimental studies have shown MDMA to be neurotoxic. Data on pharmacologic actions of MDMA in humans are limited. The authors conducted a randomized, double-blind, crossover, controlled trial to assess psychomotor performance and subjective effects in eight healthy male volunteers. MDMA was given in the same range of doses used for recreational purposes (75 and 125 mg). Amphetamine (40 mg) and placebo were used as reference compounds. For the digit-symbol substitution test (DSST), MDMA-125 produced a mild decrease in responses, and amphetamine produced a mild improvement. For the Maddox wing device, MDMA-125 induced esophoria compared with the other drug conditions. MDMA-125 and MDMA-75 produced increases in feelings of euphoria and well-being, as noted by increases in scores on the Addiction Research Center Inventory (ARCI) MBG and A scales, as well as scores of "stimulated," "good effects," "liking," and "high" on the visual analog scales. Amphetamine administration induced similar effects. At the same time, MDMA-125 enhanced sedation- and dysphoria-related effects (ARCI-PCAG and LSD, "confusion," "drunken," and Profile of Mood States Confusion scale). Mild changes in some body perception-related feelings were also reported after MDMA use, but hallucinations or psychoses were not present. In summary, the short-term administration of MDMA produced marked euphoria, a slight impairment in the performance of psychomotor tasks, and mild changes in body perceptions without hallucinations. These data support the abuse liability of MDMA.
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Affiliation(s)
- J Cami
- Pharmacology Unit, Institut Muncipal d'Investigació Mèdica, Barcelona, Spain.
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Farré M, Terán MT, Camí J. A comparison of the acute behavioral effects of flunitrazepam and triazolam in healthy volunteers. Psychopharmacology (Berl) 1996; 125:1-12. [PMID: 8724443 DOI: 10.1007/bf02247387] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Flunitrazepam is an hypnotic benzodiazepine marketed in different European countries. Epidemiological studies have shown that it is frequently abused by opioid addicts. In a survey, "liking" scores for flunitrazepam in methadone maintenance patients were higher than ratings for other benzodiazepines. A double-blind, placebo controlled, crossover clinical trial was conducted to assess the acute behavioral effects of flunitrazepam (0.50 and 2 mg) and triazolam (0.25 and 0.50 mg) in healthy male volunteers. Drug effects on physiological measures, psychomotor performance, and subjective rating scales, including specific questionnaires to evaluate abuse liability (e.g., ARCI or "liking" scores), were assessed before and 6 h after drug administration. Flunitrazepam 2 mg produced the most intense disruptive effects on all the performance tasks, triazolam 0.50 impaired performance except balance. All study drugs at all doses produced sedation symptoms in all or part of the subjective effects questionnaires. Only flunitrazepam 2 mg induced significative increases in some of the scales ("liking", "good effects", "high") that could be related to a possible abuse potential. The results seem to indicate that flunitrazepam, when administered to healthy subjects, produces some pleasurable subjective feelings, that could indicate a higher abuse liability of this drug as compared with other benzodiazepines.
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Affiliation(s)
- M Farré
- Department of Pharmacology and Toxicology, Universitat Autónoma de Barcelona, Spain
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Mattila MJ, Vanakoski J, Idänpään-Heikkilä JJ. Azithromycin does not alter the effects of oral midazolam on human performance. Eur J Clin Pharmacol 1994; 47:49-52. [PMID: 7988623 DOI: 10.1007/bf00193477] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Since macrolide antibiotics inhibit the oxidative hepatic metabolism of various drugs, including midazolam, the present double blind studies were conducted to find out if azithromycin, a new macrolide of the azalide type, would inhibit the metabolism of midazolam and enhance the effects of midazolam on human performance. In Study I, 64 healthy medical students, divided in four parallel groups received placebo, midazolam (10 mg or 15 mg), and midazolam 10 mg combined with azithromycin (500 mg + 250 mg). In Study II, three males received oral midazolam 10 mg in combination with placebo, azithromycin or erythromycin 750 mg (as a positive control) in a cross-over trial. Objective and subjective tests were done before the intake of midazolam and 30 and 90 min after it, and venous blood was sampled for the assay of midazolam. In the placebo group in Study I, the mean numbers of letters cancelled (LC) at baseline, 30 min and 90 min were 21, 20 and 20, respectively, and the corresponding mean numbers of correct digit symbol substitutions (DSS) were 126, 137 and 140, indicating a practice effect. Midazolam 10 mg impaired these performances (21, 13 and 12 for LC, and 127, 113 and 111 for DSS). Either dose of midazolam produced clumsiness, mental slowness and poor subjective performance, midazolam 15 mg being slightly more active. The corresponding, scores in the azithromycin+midazolam group were 21, 16, 16 for LC, and 132, 121 and 119 for DSS, the only significant difference from placebo being the impairment of DSS at 90 min.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M J Mattila
- Department of Pharmacology and Toxicology, University of Helsinki, Finland
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Mattila MJ, Idänpään-Heikkilä JJ, Törnwall M, Vanakoski J. Oral single doses of erythromycin and roxithromycin may increase the effects of midazolam on human performance. PHARMACOLOGY & TOXICOLOGY 1993; 73:180-5. [PMID: 8265524 DOI: 10.1111/j.1600-0773.1993.tb01560.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Macrolide antibiotics are known to inhibit the metabolism of triazolam and midazolam in vitro and in vivo. To find out if significant interactions take place after single oral doses of these agents to man, 0.25 mg triazolam and 5, 10 and 15 mg of midazolam in capsule from were given with and without 750 mg erythromycin or 300 mg roxithromycin to parallel groups of healthy subjects in four placebo-controlled double-blind studies. Objective tests and subjective assessments were made before the intake of hypnotics and 30 and 90 min after it. In Study I, triazolam impaired letter cancellation, the combination triazolam+erythromycin impaired digit symbol substitution and letter cancellation, and triazolam+roxithromycin impaired digit symbol substitution, all at 90 min. In Study II, midazolam 5 mg and midazolam 10 mg proved quite inert but the combination midazolam 5 mg+erythromycin impaired digit symbol substitution. In Study III, both midazolam 10 mg and midazolam 15 mg impaired digit substitution and letter cancellation, the effects of 15 mg being more prominent. The strongest drug effects were found with midazolam 10 mg+erythromycin which differed from placebo and midazolam (10 mg and 15 mg) in several objective and subjective test variables. In Study IV, the combination midazolam 10 mg+roxithromycin impaired several objective and subjective variables but it was not stronger than midazolam 15 mg. These results were supported by the direct measurements of plasma midazolam in three subjects: erythromycin increased plasma midazolam more than roxithromycin and enhanced midazolam effects following the intake of midazolam 10 mg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M J Mattila
- Department of Pharmacology and Toxicology, University of Helsinki, Finland
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