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Koniuszewski F, Vogel FD, Dajić I, Seidel T, Kunze M, Willeit M, Ernst M. Navigating the complex landscape of benzodiazepine- and Z-drug diversity: insights from comprehensive FDA adverse event reporting system analysis and beyond. Front Psychiatry 2023; 14:1188101. [PMID: 37457785 PMCID: PMC10345211 DOI: 10.3389/fpsyt.2023.1188101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Medications which target benzodiazepine (BZD) binding sites of GABAA receptors (GABAARs) have been in widespread use since the nineteen-sixties. They carry labels as anxiolytics, hypnotics or antiepileptics. All benzodiazepines and several nonbenzodiazepine Z-drugs share high affinity binding sites on certain subtypes of GABAA receptors, from which they can be displaced by the clinically used antagonist flumazenil. Additional binding sites exist and overlap in part with sites used by some general anaesthetics and barbiturates. Despite substantial preclinical efforts, it remains unclear which receptor subtypes and ligand features mediate individual drug effects. There is a paucity of literature comparing clinically observed adverse effect liabilities across substances in methodologically coherent ways. Methods In order to examine heterogeneity in clinical outcome, we screened the publicly available U.S. FDA adverse event reporting system (FAERS) database for reports of individual compounds and analyzed them for each sex individually with the use of disproportionality analysis. The complementary use of physico-chemical descriptors provides a molecular basis for the analysis of clinical observations of wanted and unwanted drug effects. Results and Discussion We found a multifaceted FAERS picture, and suggest that more thorough clinical and pharmacoepidemiologic investigations of the heterogenous side effect profiles for benzodiazepines and Z-drugs are needed. This may lead to more differentiated safety profiles and prescription practice for particular compounds, which in turn could potentially ease side effect burden in everyday clinical practice considerably. From both preclinical literature and pharmacovigilance data, there is converging evidence that this very large class of psychoactive molecules displays a broad range of distinctive unwanted effect profiles - too broad to be explained by the four canonical, so-called "diazepam-sensitive high-affinity interaction sites". The substance-specific signatures of compound effects may partly be mediated by phenomena such as occupancy of additional binding sites, and/or synergistic interactions with endogenous substances like steroids and endocannabinoids. These in turn drive the wanted and unwanted effects and sex differences of individual compounds.
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Affiliation(s)
- Filip Koniuszewski
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Florian D. Vogel
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Irena Dajić
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Seidel
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Markus Kunze
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Matthäus Willeit
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Margot Ernst
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University Vienna, Vienna, Austria
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Naidoo P, Chetty M. Progress in the Consideration of Possible Sex Differences in Drug Interaction Studies. Curr Drug Metab 2019; 20:114-123. [DOI: 10.2174/1389200220666181128160813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/29/2022]
Abstract
Background:
Anecdotal evidence suggests that there may be sex differences in Drug-drug Interactions
(DDI) involving specific drugs. Regulators have provided general guidance for the inclusion of females in clinical
studies. Some clinical studies have reported sex differences in the Pharmacokinetics (PK) of CYP3A4 substrates,
suggesting that DDI involving CYP3A4 substrates could potentially show sex differences.
Objective:
The aim of this review was to investigate whether recent prospective DDI studies have included both
sexes and whether there was evidence for the presence or absence of sex differences with the DDIs.
Methods:
The relevant details from 156 drug interaction studies within 124 papers were extracted and evaluated.
Results:
Only eight studies (five papers) compared the outcome of the DDI between males and females. The majority
of the studies had only male volunteers. Five studies had females only while 60 had males only, with 7.7% of the
studies having an equal proportion of both sexes. Surprisingly, four studies did not specify the sex of the subjects.
:
Based on the limited number of studies comparing males and females, no specific trends or conclusions were evident.
Sex differences in the interaction were reported between ketoconazole and midazolam as well as clarithromycin and
midazolam. However, no sex difference was observed with the interaction between clarithromycin and triazolam or
erythromycin and triazolam. No sex-related PK differences were observed with the interaction between ketoconazole
and domperidone, although sex-related differences in QT prolongation were observed.
Conclusion:
This review has shown that only limited progress had been made with the inclusion of both sexes in
DDI studies.
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Affiliation(s)
- Panjasaram Naidoo
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu Natal, KwaZulu Natal, South Africa
| | - Manoranjenni Chetty
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu Natal, KwaZulu Natal, South Africa
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Gongora M, Peressuti C, Velasques B, Bittencourt J, Teixeira S, Arias-Carrión O, Cagy M, Ribeiro P. Absolute Theta Power in the Frontal Cortex During a Visuomotor Task: The Effect of Bromazepam on Attention. Clin EEG Neurosci 2015; 46:292-8. [PMID: 25394638 DOI: 10.1177/1550059414535576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/22/2014] [Indexed: 11/15/2022]
Abstract
Bromazepam is a benzodiazepine, which has been widely employed in the treatment of anxiety. We investigated the electrophysiological changes in absolute theta power within the frontal cortex when individuals performed a visuomotor task under bromazepam. The sample of 17 healthy individuals was randomized into 2 experimental conditions, under which bromazepam 6 mg and placebo were administered on different days. All subjects were right -handed, with no mental or physical illness and were not using any psychoactive or psychotropic substance during the entire period of the study. We found an increase in reaction time under bromazepam compared with placebo . With regard to the electrophysiological variable, we found a lower theta power value in the prefrontal cortex prior to task execution, compared with after. We therefore suggested that this could be an increase of neural activity in this region, because of the subjects' readiness to perform the task, that is, because of their higher alertness. The right lateral frontal region showed lower theta power under bromazepam for pre- and post-finger movement. This could have occurred because of more effort to execute the task. In the left frontal region: premovement did not demonstrate any difference between conditions, possibly because the proposed task was simple to execute. In conclusion, theta power plays an important role in the analysis of visuomotor performance, assuming that bromazepam causes impairment on sustained attention and sensory perception.
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Affiliation(s)
- Mariana Gongora
- Brain Mapping and Sensory Motor Integration Laboratory, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Caroline Peressuti
- Brain Mapping and Sensory Motor Integration Laboratory, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Bruna Velasques
- Brain Mapping and Sensory Motor Integration Laboratory, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil Institute of Applied Neuroscience, Rio de Janeiro, Brazil
| | - Juliana Bittencourt
- Brain Mapping and Sensory Motor Integration Laboratory, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Silmar Teixeira
- Brain Mapping and Sensory Motor Integration Laboratory, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil Laboratory of Physical Therapy, Veiga de Almeida University of Rio de Janeiro (UVA/RJ), Rio de Janeiro, Brazil
| | - Oscar Arias-Carrión
- Movement Disorders and Transcranial Magnetic Stimulation Unit, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México DF, México
| | - Mauricio Cagy
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Pedro Ribeiro
- Brain Mapping and Sensory Motor Integration Laboratory, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil Institute of Applied Neuroscience, Rio de Janeiro, Brazil School of Physical Education, Bioscience Department, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Itraconazole and domperidone: a placebo-controlled drug interaction study. Eur J Clin Pharmacol 2012; 68:1287-94. [DOI: 10.1007/s00228-012-1258-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/20/2012] [Indexed: 01/16/2023]
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Araújo F, Machado S, Paes F, Cunha M, Budde H, Cagy M, Basile LF, Arias-Carrión O, Velasques B, Piedade R, Ribeiro P. The effects of bromazepam over the temporo-parietal areas during the performance of a visuomotor task: a qEEG study. Neurosci Lett 2011; 496:116-20. [PMID: 21511002 DOI: 10.1016/j.neulet.2011.03.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 03/28/2011] [Accepted: 03/30/2011] [Indexed: 10/18/2022]
Abstract
This study investigated the effects of bromazepam on qEEG when 14 healthy subjects were asked to perform a visuomotor task (i.e., motor vehicle driving task). The subjects were exposed to two experimental conditions: the placebo (PL) and 6 mg of bromazepam (Br 6 mg), following a randomized, double-blind design on different days. Specifically, we observe absolute power extracted from qEEG data for theta band. We expected to see a decrease in absolute theta power in the temporal and parietal areas due to the influence of bromazepam for the experimental group when compared with the placebo group. We found a main effect for the condition factor for electrodes T3, T4, P3 and P4. We also observed a main effect for the period factor for electrodes P3 and P4. We observed that the ingestion of 6 mg of bromazepam induces different patterns in theta power at the temporal and parietal sites. We concluded that 6 mg of bromazepam was an important factor in the fluctuation of the activities in the temporal and parietal areas. We then hypothesize about the specific role of this drug during the execution of a visuomotor task and within the sensorimotor integration process.
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Affiliation(s)
- Fernanda Araújo
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil
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Sampaio I, Puga F, Veiga H, Cagy M, Piedade R, Ribeiro P. The influence of bromazepam on cortical power distribution. AN ACAD BRAS CIENC 2008; 80:335-40. [DOI: 10.1590/s0001-37652008000200012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 11/05/2007] [Indexed: 11/22/2022] Open
Abstract
The EEG has been widely employed in the assessment of electrophysiological changes induced by distinct medications. Its sensibility in detecting alterations produced by a specific substance may be enhanced by methods of quantitative analyses (qEEG). The present study aimed at investigating the modulatory effects of bromazepam on brain dynamics. The effects of bromazepam (3mg) on EEG power distribution were tested in 10 healthy individuals, in a double-blind experiment. The electrophysiological measure was analyzed across experimental conditions, moments, and electrodes, in the delta, theta, alpha and beta frequency bands separately. A significant decrease of relative power was observed in delta and theta (main effect of condition). No interactions were observed. Although the expected anxiolytic EEG profile was not observed (increased beta and decreased alpha activity), this specific result may be related to other factors such as dosage used and the subjects' general physiological state, and not necessarily to the drug itself.
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Affiliation(s)
| | | | | | | | | | - Pedro Ribeiro
- Universidade Federal do Rio de Janeiro, Brasil; UFRJ, Brasil
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Podilsky G, Berger‐Gryllaki M, Testa B, Pannatier A. Development and Validation of an HPLC Method for the Simultaneous Monitoring of Bromazepam and Omeprazole. J LIQ CHROMATOGR R T 2008. [DOI: 10.1080/10826070801893508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Gregory Podilsky
- a Department of Pharmacy , University Hospital Centre , Lausanne, Switzerland
| | | | - Bernard Testa
- a Department of Pharmacy , University Hospital Centre , Lausanne, Switzerland
| | - André Pannatier
- a Department of Pharmacy , University Hospital Centre , Lausanne, Switzerland
- b School of Pharmaceutical Sciences , EPGL, University of Geneva, University of Lausanne , Switzerland
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Oda M, Kotegawa T, Tsutsumi K, Ohtani Y, Kuwatani K, Nakano S. The effect of itraconazole on the pharmacokinetics and pharmacodynamics of bromazepam in healthy volunteers. Eur J Clin Pharmacol 2003; 59:615-9. [PMID: 14517708 DOI: 10.1007/s00228-003-0681-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 08/15/2003] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVE Bromazepam, an anti-anxiety agent, has been reported to be metabolized by cytochrome P(450) (CYP). However, the enzyme responsible for the metabolism of bromazepam has yet to be determined. The purpose of this study was to examine whether the inhibition of CYP3A4 produced by itraconazole alters the pharmacokinetics and pharmacodynamics of bromazepam. METHODS Eight healthy male volunteers participated in this randomized double-blind crossover study. The subjects received a 6-day treatment of itraconazole (200 mg daily) or its placebo. On day 4 of the treatment, each subject received a single oral dose of bromazepam (3 mg). Blood samplings for drug assay were performed up to 70 h after bromazepam administration. The time course of the pharmacodynamic effects of bromazepam on the central nervous system was assessed using a subjective rating of sedation, continuous number addition test and electroencephalography up to 21.5 h after bromazepam administration. RESULTS Itraconazole caused no significant changes in the pharmacokinetics and pharmacodynamics of bromazepam. The mean (+/-SD) values of area under the plasma concentration-time curve and elimination half-life for placebo versus itraconazole were 1328+/-330 ng h/ml versus 1445+/-419 ng h/ml and 32.1+/-9.3 h versus 31.1+/-8.4 h, respectively. CONCLUSION The pharmacokinetics and pharmacodynamics of bromazepam were not affected by itraconazole, suggesting that CYP3A4 is not involved in the metabolism of bromazepam to a major extent. It is likely that bromazepam can be used in the usual doses for patients receiving itraconazole or other CYP3A4 inhibitors.
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Affiliation(s)
- Manami Oda
- Department of Clinical Pharmacology and Therapeutics, Oita Medical University, Oita, Japan
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