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Berger B, Brooks S, Zuiker R, Richard M, Muehlan C, Dingemanse J. Pharmacological Interactions between the Dual Orexin Receptor Antagonist Daridorexant and Ethanol in a Double-Blind, Randomized, Placebo-Controlled, Double-Dummy, Four-Way Crossover Phase I Study in Healthy Subjects. CNS Drugs 2020; 34:1253-1266. [PMID: 33205362 DOI: 10.1007/s40263-020-00768-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Daridorexant (ACT-541468) is a potent dual orexin receptor antagonist under development for the treatment of sleep disorders. Concomitant intake of ethanol and hypnotics has been shown to result in additive/supra-additive depression of the central nervous system, resulting in pronounced sedation. OBJECTIVE The aim of this study was to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) interactions between ethanol and daridorexant. METHOD This was a single-center, double-blind, placebo-controlled, randomized, four-way crossover study conducted in 19 healthy male/female subjects. Subjects received the following four treatments: ethanol with daridorexant, daridorexant alone, ethanol alone, and placebo. Daridorexant 50 mg and the matching placebo were administered as single oral tablets. Ethanol was infused intravenously and clamped at a level of 0.6 g/L for 5 h. The PK of ethanol and daridorexant were assessed and a battery of PD tests performed. RESULTS Concomitant administration of ethanol prolonged the time to reach maximum plasma concentrations (tmax) of daridorexant (median difference 1.25 h). No other relevant PK interactions were observed. Coadministration with ethanol produced a numerically greater impairment on saccadic peak velocity, body sway, visual analog scale (VAS) alertness, VAS alcohol intoxication, smooth pursuit, and adaptive tracking compared with daridorexant alone. All treatments were generally well tolerated without serious adverse events (AEs). The most commonly reported treatment-emergent AEs following coadministration of daridorexant and ethanol included somnolence, headache, fatigue, sudden onset of sleep, and dizziness. CONCLUSIONS Apart from a shift in tmax, no relevant changes in PK parameters were observed following coadministration of daridorexant and ethanol. The coadministration led to reinforced drug actions that were, at most, indicative of infra-additive effects on certain PD markers. Patients will be advised not to consume ethanol with daridorexant. CLINICAL TRIALS REGISTRATION NUMBER NCT03609775 (ClinicalTrials.gov Identifier).
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Affiliation(s)
- Benjamin Berger
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland.
| | - Sander Brooks
- Centre for Human Drug Research (CHDR), Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Rob Zuiker
- Centre for Human Drug Research (CHDR), Leiden, The Netherlands
| | - Muriel Richard
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | - Clemens Muehlan
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | - Jasper Dingemanse
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
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Kruithof AC, Watanabe S, Peeters PA, de Kam ML, Zuiker RG, Stevens J, van Gerven JM, Stockis A. Pharmacological interactions between brivaracetam and ethanol in healthy males. J Psychopharmacol 2017; 31:915-926. [PMID: 27649776 DOI: 10.1177/0269881116665326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This double-blind, randomized, three-way crossover study explored the potential pharmacokinetic and pharmacodynamic interactions between ethanol and brivaracetam in 18 healthy males, as required for the development of CNS-active drugs. Subjects received (A) ethanol+brivaracetam, (B) ethanol placebo+brivaracetam and (C) ethanol+brivaracetam placebo. Ethanol was infused as a 5.5-hour intravenous clamp with the first 0.5-hour as loading phase to a target level of 0.6 g/L, and brivaracetam was orally administered as a single 200 mg dose. No relevant pharmacokinetic interactions were observed. Co-administration of brivaracetam and ethanol resulted in decreased saccadic peak velocity, smooth pursuit, adaptive tracking and VAS alertness, and increased body sway, saccadic reaction time and VAS score for ethanol effect compared with brivaracetam alone or ethanol alone. Additionally, the immediate word recall scores were generally lower when brivaracetam was co-administered with ethanol, whereas the delayed word test did not show clear additional effects. A post-hoc exploratory analysis for supra-additivity suggested that most pharmacodynamic effects were likely to be additive in nature, except for adaptive tracking, which appeared to be slightly supra-additive. In conclusion, brivaracetam increased ethanol effects on psychomotor function, attention and memory in healthy males. Intake of brivaracetam with alcohol is not recommended.
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Affiliation(s)
| | | | | | | | - Rob Gja Zuiker
- 1 Centre for Human Drug Research, Leiden, the Netherlands
| | - Jasper Stevens
- 1 Centre for Human Drug Research, Leiden, the Netherlands
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Paterson LM, Flechais RSA, Murphy A, Reed LJ, Abbott S, Boyapati V, Elliott R, Erritzoe D, Ersche KD, Faluyi Y, Faravelli L, Fernandez-Egea E, Kalk NJ, Kuchibatla SS, McGonigle J, Metastasio A, Mick I, Nestor L, Orban C, Passetti F, Rabiner EA, Smith DG, Suckling J, Tait R, Taylor EM, Waldman AD, Robbins TW, Deakin JFW, Nutt DJ, Lingford-Hughes AR. The Imperial College Cambridge Manchester (ICCAM) platform study: An experimental medicine platform for evaluating new drugs for relapse prevention in addiction. Part A: Study description. J Psychopharmacol 2015; 29:943-60. [PMID: 26246443 DOI: 10.1177/0269881115596155] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Drug and alcohol dependence are global problems with substantial societal costs. There are few treatments for relapse prevention and therefore a pressing need for further study of brain mechanisms underpinning relapse circuitry. The Imperial College Cambridge Manchester (ICCAM) platform study is an experimental medicine approach to this problem: using functional magnetic resonance imaging (fMRI) techniques and selective pharmacological tools, it aims to explore the neuropharmacology of putative relapse pathways in cocaine, alcohol, opiate dependent, and healthy individuals to inform future drug development. Addiction studies typically involve small samples because of recruitment difficulties and attrition. We established the platform in three centres to assess the feasibility of a multisite approach to address these issues. Pharmacological modulation of reward, impulsivity and emotional reactivity were investigated in a monetary incentive delay task, an inhibitory control task, and an evocative images task, using selective antagonists for µ-opioid, dopamine D3 receptor (DRD3) and neurokinin 1 (NK1) receptors (naltrexone, GSK598809, vofopitant/aprepitant), in a placebo-controlled, randomised, crossover design. In two years, 609 scans were performed, with 155 individuals scanned at baseline. Attrition was low and the majority of individuals were sufficiently motivated to complete all five sessions (n=87). We describe herein the study design, main aims, recruitment numbers, sample characteristics, and explain the test hypotheses and anticipated study outputs.
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Affiliation(s)
- Louise M Paterson
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Remy S A Flechais
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Anna Murphy
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - Laurence J Reed
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Sanja Abbott
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | | | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - David Erritzoe
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Karen D Ersche
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Yetunde Faluyi
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Luca Faravelli
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Emilio Fernandez-Egea
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Nicola J Kalk
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | | | - John McGonigle
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Antonio Metastasio
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK 5 Boroughs Partnership NHS Foundation Trust, Warrington, UK
| | - Inge Mick
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Liam Nestor
- Centre for Neuropsychopharmacology, Imperial College London, London, UK Clinical Research Unit, GlaxoSmithKline, Cambridge, UK
| | - Csaba Orban
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Filippo Passetti
- Centre for Neuropsychopharmacology, Imperial College London, London, UK Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Dana G Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychology, University of Cambridge, Cambridge, UK
| | - John Suckling
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Roger Tait
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Eleanor M Taylor
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - Adam D Waldman
- Centre for Neuroinflammation and Neurodegeneration, Imperial College London, London, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychology, University of Cambridge, Cambridge, UK
| | - J F William Deakin
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - David J Nutt
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
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Pich EM, Collo G. Pharmacological targeting of dopamine D3 receptors: Possible clinical applications of selective drugs. Eur Neuropsychopharmacol 2015; 25:1437-47. [PMID: 26298833 DOI: 10.1016/j.euroneuro.2015.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 06/26/2015] [Accepted: 07/14/2015] [Indexed: 12/26/2022]
Abstract
Dopamine D3 receptors have been pharmacologically engaged in humans since the development of the first antipsychotics and ergot-derivative dopamine (DA) agonists, even without knowing it. These agents were generally non-selective, developed primarily to target D2 receptors. In the last 10 years the understanding of the clinical implication of D3 receptors has been progressing also due to the identification of D3 gene polymorphisms, the use of more selective PET ligands such as [(11)C]-(+)-PHNO and the learning regarding the clinical use of the D3-preferential D2/D3 agonists ropinirole and pramipexole. A new specific neuroplasticity role of D3 receptor regarding dendrite arborisation outgrowth in dopaminergic neurons was also proposed to support, at least in part, the slowing of disease observed in subjects with Parkinson׳s Disease treated with DA agonists. Similar mechanisms could be at the basis of the antidepressant-like effects observed with DA agonists when co-administered with standard of care. Severe adverse event occurring with the use of anti-parkinsonian DA agonists in predisposed subjects, i.e., impulse control disorders, are now suggested to be putatively related to overactive D3 receptors. Not surprisingly, blockade of D3 receptors was proposed as treatment for addictive disorders, a goal that could be potentially achieved by repositioning buspirone, an anxiolytic drug with D3-preferential antagonistic features, or with novel selective D3 antagonists or partial agonists currently in development for schizophrenia. At the moment ABT-925 is the only selective D3 antagonist tested in schizophrenic patients in Phase II, showing an intriguing cognitive enhancing effects supported by preclinical data. Finally, exploratory pharmacogenetic analysis suggested that ABT-925 could be effective in a subpopulation of patients with a polymorphism on the D3 receptor, opening to a possible personalised medicine approach.
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Affiliation(s)
- Emilio Merlo Pich
- Experimental Medicine CNS, Takeda Development Centre Europe, London, UK.
| | - Ginetta Collo
- Department of Molecular and Translational Medicine, University of Brescia, Italy
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Appel NM, Li SH, Holmes TH, Acri JB. Dopamine D3 Receptor Antagonist (GSK598809) Potentiates the Hypertensive Effects of Cocaine in Conscious, Freely-Moving Dogs. J Pharmacol Exp Ther 2015; 354:484-92. [PMID: 26177654 DOI: 10.1124/jpet.115.224121] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/14/2015] [Indexed: 12/12/2022] Open
Abstract
The chronic and relapsing nature of addiction presents unique challenges for ensuring the safety of a potential medication. A patient may use cocaine, for example, while taking the medication or take more medication than prescribed. Thus, a potential medication must be safe and not exacerbate the effects of cocaine. Multiple published studies support antagonism of brain dopamine D3 receptor function as a potential mechanism of action for an anti-addiction medication. Dopamine D3 receptors are widely distributed outside the central nervous system, however; for example, dopamine D3 receptors in the kidneys are implicated in regulating blood pressure. The selective dopamine D3 receptor antagonist GSK598809 [1-(2-fluoro-4-trifluoromethyl-phenyl)-3-{3-[4-methyl-5-(4-methyl-oxazol-5-yl)-4H-[1,2,4]triazol-3-ylsulfanyl]-propyl}-3-aza-bicyclo[3.1.0]hexane] has been proposed as a medication to treat cocaine and other substance use disorders. The US Food and Drug Administration has established guidelines recommending safety studies to investigate potential undesirable pharmacodynamic effects of a substance in relation to exposure in the therapeutic range and above. Hence, we assessed the interaction between this selective dopamine D3 receptor antagonist and cocaine on hemodynamics and cardiac function in freely-moving, telemetered dogs before conducting a clinical trial. GSK598809 increased the hemodynamic effect of cocaine in this model. Thus, the increase in blood pressure after intravenous cocaine was greater in animals that had been pretreated with GSK598809 compared with vehicle. This finding suggests that GSK598809 in particular, and perhaps dopamine D3 receptor antagonists as a class, may produce unacceptable cardiovascular risks as medications to treat cocaine use disorder.
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Affiliation(s)
- Nathan M Appel
- Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland (N.M.A., S.-H.L., J.B.A.); and Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (T.H.H.)
| | - Shou-Hua Li
- Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland (N.M.A., S.-H.L., J.B.A.); and Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (T.H.H.)
| | - Tyson H Holmes
- Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland (N.M.A., S.-H.L., J.B.A.); and Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (T.H.H.)
| | - Jane B Acri
- Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland (N.M.A., S.-H.L., J.B.A.); and Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (T.H.H.)
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Keck TM, John WS, Czoty PW, Nader MA, Newman AH. Identifying Medication Targets for Psychostimulant Addiction: Unraveling the Dopamine D3 Receptor Hypothesis. J Med Chem 2015; 58:5361-80. [PMID: 25826710 PMCID: PMC4516313 DOI: 10.1021/jm501512b] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The dopamine D3 receptor (D3R) is a target for developing medications to treat substance use disorders. D3R-selective compounds with high affinity and varying efficacies have been discovered, providing critical research tools for cell-based studies that have been translated to in vivo models of drug abuse. D3R antagonists and partial agonists have shown especially promising results in rodent models of relapse-like behavior, including stress-, drug-, and cue-induced reinstatement of drug seeking. However, to date, translation to human studies has been limited. Herein, we present an overview and illustrate some of the pitfalls and challenges of developing novel D3R-selective compounds toward clinical utility, especially for treatment of cocaine abuse. Future research and development of D3R-selective antagonists and partial agonists for substance abuse remains critically important but will also require further evaluation and development of translational animal models to determine the best time in the addiction cycle to target D3Rs for optimal therapeutic efficacy.
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Affiliation(s)
- Thomas M Keck
- †Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
| | - William S John
- §Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1083, United States
| | - Paul W Czoty
- §Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1083, United States
| | - Michael A Nader
- §Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1083, United States
| | - Amy Hauck Newman
- †Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, 333 Cassell Drive, Baltimore, Maryland 21224, United States
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