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Sweileh WM. Neuroleptic malignant syndrome and serotonin syndrome: a comparative bibliometric analysis. Orphanet J Rare Dis 2024; 19:221. [PMID: 38825678 PMCID: PMC11145872 DOI: 10.1186/s13023-024-03227-5] [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: 04/20/2023] [Accepted: 05/27/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE This study aimed to analyze and map scientific literature on Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) from prestigious, internationally indexed journals. The objective was to identify key topics, impactful articles, prominent journals, research output, growth patterns, hotspots, and leading countries in the field, providing valuable insights for scholars, medical students, and international funding agencies. METHODS A systematic search strategy was implemented in the PubMed MeSH database using specific keywords for NMS and SS. The search was conducted in the Scopus database, renowned for its extensive coverage of scholarly publications. Inclusion criteria comprised articles published from 1950 to December 31st, 2022, restricted to journal research and review articles written in English. Data were analyzed using Microsoft Excel for descriptive analysis, and VOSviewer was employed for bibliometric mapping. RESULTS The search yielded 1150 articles on NMS and 587 on SS, with the majority being case reports. Growth patterns revealed a surge in NMS research between 1981 and 1991, while SS research increased notably between 1993 and 1997. Active countries and journals differed between NMS and SS, with psychiatry journals predominating for NMS and pharmacology/toxicology journals for SS. Authorship analysis indicated higher multi-authored articles for NMS. Top impactful articles focused on review articles and pathogenic mechanisms. Research hotspots included antipsychotics and catatonia for NMS, while SS highlighted drug interactions and specific medications like linezolid and tramadol. CONCLUSIONS NMS and SS represent rare but life-threatening conditions, requiring detailed clinical and scientific understanding. Differential diagnosis and management necessitate caution in prescribing medications affecting central serotonin or dopamine systems, with awareness of potential drug interactions. International diagnostic tools and genetic screening tests may aid in safe diagnosis and prevention. Reporting rare cases and utilizing bibliometric analysis enhance knowledge dissemination and research exploration in the field of rare drug-induced medical conditions.
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Affiliation(s)
- Waleed M Sweileh
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Pérez-Torre P, López-Sendón JL, Mañanes Barral V, Parees I, Fanjul-Arbós S, Monreal E, Alonso-Canovas A, Martínez Castrillo JC. Concomitant treatment with safinamide and antidepressant drugs: Safety data from real clinical practice. Neurologia 2024; 39:340-344. [PMID: 38616061 DOI: 10.1016/j.nrleng.2021.08.005] [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: 05/18/2021] [Accepted: 08/04/2021] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the possible pharmacological interactions between safinamide and antidepressants, and in particular the appearance of serotonin syndrome with data from real life. METHODS We conducted a retrospective observational study of patients with Parkinson's disease from our Movement Disorders Unit, who were under treatment with any antidepressant drug and safinamide. Specifically, symptoms suggestive of serotonin syndrome were screened for. Also, we collected time of simultaneous use, doses of levodopa and other antiparkinsonian drugs. RESULTS Clinical records were reviewed for the study period of September 2018 to September 2019. Seventy-eight PD patients who were treated with safinamide of which 25 (32.05%) had a concomitant treatment with an antidepressant drug, being sertraline and escitalopram the most frequent. Mean age was 80 years±8.43 and H&Y stage was 3 [2-4]. Mean dose of levodopa used was 703.75mg±233.15. Median duration of concomitant treatment with safinamide and antidepressant drug was 6 months (IQR 20.5), and over eighteen months in 5 cases. No case of serotonin syndrome was recorded, neither was any of its typical manifestations combined or in isolation. CONCLUSIONS Our real clinical practice study suggests that concomitant use of safinamide with antidepressant drugs in PD patients seemed to be safe and well tolerated, even in the long term. However, caution is warranted, individualizing treatment regimens and monitoring the potential appearance of adverse effects.
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Affiliation(s)
- P Pérez-Torre
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain.
| | - J L López-Sendón
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - V Mañanes Barral
- Neuropsychology, Movement Disorders Unit, Neurology Department, IRYCIS, Hospital Ramón y Cajal, Madrid, Spain
| | - I Parees
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - S Fanjul-Arbós
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - E Monreal
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - A Alonso-Canovas
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
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Bansal N, Campbell SM, Lin CY, Ashcroft DM, Chen LC. Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care-a modified e-Delphi study. BMC Med 2024; 22:5. [PMID: 38167142 PMCID: PMC10763174 DOI: 10.1186/s12916-023-03213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicators for preventable opioid-related problems in patients with chronic pain in primary care in the UK. This study aimed to identify opioid prescription scenarios for developing indicators for prescribing opioids to patients with chronic pain in primary care. METHODS Scenarios of opioid prescribing indicators were identified from a literature review, guidelines, and government reports. Twenty-one indicators were identified and presented in various opioid scenarios concerning opioid-related harm and adverse effects, drug-drug interactions, and drug-disease interactions in certain disease conditions. After receiving ethics approval, two rounds of electronic Delphi panel technique surveys were conducted with 24 expert panellists from the UK (clinicians, pharmacists, and independent prescribers) from August 2020 to February 2021. Each indicator was rated on a 1-9 scale from inappropriate to appropriate. The score's median, 30th and 70th percentiles, and disagreement index were calculated. RESULTS The panel unanimously agreed that 15 out of the 21 opioid prescribing scenarios were inappropriate, primarily due to their potential for causing harm to patients. This consensus was reflected in the low appropriateness scores (median ranging from 1 to 3). There were no scenarios with a high consensus that prescribing was appropriate. The indicators were considered inappropriate due to drug-disease interactions (n = 8), drug-drug interactions (n = 2), adverse effects (n = 3), and prescribed dose and duration (n = 2). Examples included prescribing opioids during pregnancy, concurrently with benzodiazepines, long-term without a laxative prescription and prescribing > 120-mg morphine milligram equivalent per day or long-term duration over 3 months after surgery. CONCLUSIONS The high agreement on opioid prescribing indicators indicates that these potentially hazardous consequences are relevant and concerning to healthcare practitioners. Future research is needed to evaluate the feasibility and implementation of these indicators within primary care settings. This research will provide valuable insights and evidence to support opioid prescribing and deprescribing strategies. Moreover, the findings will be crucial in informing primary care practitioners and shaping quality outcome frameworks and other initiatives to enhance the safety and quality of care in primary care settings.
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Affiliation(s)
- Neetu Bansal
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Stephen M Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria, 0208, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Chiu-Yi Lin
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Darren M Ashcroft
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, M13 9PL, UK
| | - Li-Chia Chen
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
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Vocca C, Siniscalchi A, Rania V, Galati C, Marcianò G, Palleria C, Catarisano L, Gareri I, Leuzzi M, Muraca L, Citraro R, Nanci G, Scuteri A, Bianco RC, Fera I, Greco A, Leuzzi G, De Sarro G, D’Agostino B, Gallelli L. The Risk of Drug Interactions in Older Primary Care Patients after Hospital Discharge: The Role of Drug Reconciliation. Geriatrics (Basel) 2023; 8:122. [PMID: 38132493 PMCID: PMC10742527 DOI: 10.3390/geriatrics8060122] [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: 08/22/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Drug-drug interactions (DDIs) represent an important clinical problem, particularly in older patients, due to polytherapy, comorbidity, and physiological changes in pharmacodynamic and pharmacokinetic pathways. In this study, we investigated the association between drugs prescribed after discharge from the hospital or clinic and the risk of DDIs with drugs used daily by each patient. METHODS We performed an observational, retrospective, multicenter study on the medical records of outpatients referred to general practitioners. DDIs were measured using the drug interaction probability scale. Potential drug interactions were evaluated by clinical pharmacologists (physicians) and neurologists. Collected data were analyzed using the Statistical Package for the Social Sciences. RESULTS During the study, we evaluated 1772 medical records. We recorded the development of DDIs in 10.3% of patients; 11.6% of these patients required hospitalization. Logistic regression showed an association among DDIs, sex, and the number of drugs used (p = 0.023). CONCLUSIONS This observational real-life study shows that the risk of DDIs is common in older patients. Physicians must pay more attention after hospital discharge, evaluating the treatment to reduce the risk of DDIs.
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Affiliation(s)
- Cristina Vocca
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, 87100 Cosenza, Italy;
| | - Vincenzo Rania
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Cecilia Galati
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Gianmarco Marcianò
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Caterina Palleria
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Luca Catarisano
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Ilaria Gareri
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
| | - Marco Leuzzi
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Lucia Muraca
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Rita Citraro
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Giacinto Nanci
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Antonio Scuteri
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Rosa Candida Bianco
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Iolanda Fera
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Antonietta Greco
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Giacomo Leuzzi
- Department of Primary Care, ASP Catanzaro, 88100 Catanzaro, Italy; (M.L.); (L.M.); (G.N.); (A.S.); (R.C.B.); (I.F.); (A.G.); (G.L.)
| | - Giovambattista De Sarro
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Bruno D’Agostino
- Department of Environmental Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Luca Gallelli
- Operative Unit of Clinical Pharmacology and Pharmacovigilance, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy; (C.V.); (V.R.); (G.M.); (C.P.); (L.C.); (I.G.); (G.D.S.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy;
- Medifarmagen SRL, Renato Dulbecco University Hospital, 88100 Catanzaro, Italy
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Manouchehri A, Nekoukar Z, Malakian A, Zakariaei Z. Tramadol poisoning and its management and complications: a scoping review. Ann Med Surg (Lond) 2023; 85:3982-3989. [PMID: 37554850 PMCID: PMC10406095 DOI: 10.1097/ms9.0000000000001075] [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: 01/18/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Tramadol (TR) is an opioid agonist (μ-opioid receptors) that also affects the noradrenergic and serotonergic systems. TR is a synthetic analgesic substance with opioid agonist properties that has been approved for pain management by affecting the central nervous system. OBJECTIVE The primary objective of this scoping review was to determine the poisoning consequences of TR and its associated symptom management techniques, as well as its effect on opioid and non-opioid receptors, metabolism, and complications on various organ systems. DISCUSSION Typically, acute overdose of TR is not considered life threatening, and most fatalities are attributed to polysubstance overdose. TR can cause drowsiness, headaches, seizures, respiratory depression, low heart rate, coma, and even death. Additionally, the prolonged use of TR can lead to addiction, with withdrawal resulting in both common and atypical symptoms. CONCLUSIONS Therefore, it is recommended that patients with TR poisoning receive close monitoring of their cardiovascular system, along with a comprehensive management plan for their levels of consciousness and respiratory function.
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Affiliation(s)
- Aliasghar Manouchehri
- Department of Internal Medicine, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol
| | | | | | - Zakaria Zakariaei
- Toxicology and Forensic Medicine Division, Mazandaran Registry Center for Opioids Poisoning, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
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Chen C, Hennessy S, Brensinger CM, Bilker WB, Dublin S, Chung SP, Horn JR, Bogar KF, Leonard CE. Antidepressant drug-drug-drug interactions associated with unintentional traumatic injury: Screening for signals in real-world data. Clin Transl Sci 2023; 16:326-337. [PMID: 36415144 PMCID: PMC9926061 DOI: 10.1111/cts.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/23/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022] Open
Abstract
Antidepressants are associated with traumatic injury and are widely used with other medications. It remains unknown how drug-drug-drug interactions (3DIs) between antidepressants and two other drugs may impact potential injury risks associated with antidepressants. We aimed to generate hypotheses regarding antidepressant 3DI signals associated with elevated injury rates. Using 2000-2020 Optum's de-identified Clinformatics Data Mart, we performed a self-controlled case series study for each drug triad consisting of an antidepressant + codispensed drug (base-pair) with a candidate interacting medication (precipitant). We included persons aged greater than or equal to 16 years who (1) experienced an injury and (2) used a candidate precipitant, during base-pair therapy. We compared injury rates during observation time exposed to the drug triad versus the base-pair only, adjusting for time-varying covariates. We calculated adjusted rate ratios (RRs) using conditional Poisson regression and accounted for multiple comparisons via semi-Bayes shrinkage. Among 147,747 eligible antidepressant users with an injury, we studied 120,714 antidepressant triads, of which 334 (0.3%) were positively associated with elevated injury rates and thus considered potential 3DI signals. Adjusted RRs for signals ranged from 1.31 (1.04-1.65) for sertraline + levothyroxine with tramadol (vs. without tramadol) to 6.60 (3.23-13.46) for escitalopram + simvastatin with aripiprazole (vs. without aripiprazole). Nearly half of the signals (137, 41.0%) had adjusted RRs greater than or equal to 2, suggesting strong associations with injury. The identified signals may represent antidepressant 3DIs of potential clinical concern and warrant future etiologic studies to test these hypotheses.
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Affiliation(s)
- Cheng Chen
- Center for Real‐World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sean Hennessy
- Center for Real‐World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Colleen M. Brensinger
- Center for Real‐World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Warren B. Bilker
- Center for Real‐World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
- Department of Epidemiology, School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Sophie P. Chung
- Epocrates Medical InformationAthenaHealth, Inc.WatertownMassachusettsUSA
| | - John R. Horn
- Department of Pharmacy, School of PharmacyUniversity of WashingtonSeattleWashingtonUSA
| | - Kacie F. Bogar
- Center for Real‐World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Charles E. Leonard
- Center for Real‐World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Drug Interactions. Forensic Toxicol 2022. [DOI: 10.1016/b978-0-12-819286-3.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pérez-Torre P, López-Sendón JL, Mañanes Barral V, Parees I, Fanjul-Arbós S, Monreal E, Alonso-Canovas A, Martínez Castrillo JC. Concomitant treatment with safinamide and antidepressant drugs: Safety data from real clinical practice. Neurologia 2021:S0213-4853(21)00129-8. [PMID: 34518027 DOI: 10.1016/j.nrl.2021.08.004] [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: 05/18/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the possible pharmacological interactions between safinamide and antidepressants, and in particular the appearance of serotonin syndrome with data from real life. METHODS We conducted a retrospective observational study of patients with Parkinson's disease from our Movement Disorders Unit, who were under treatment with any antidepressant drug and safinamide. Specifically, symptoms suggestive of serotonin syndrome were screened for. Also, we collected time of simultaneous use, doses of levodopa and other antiparkinsonian drugs. RESULTS Clinical records were reviewed for the study period of September 2018 to September 2019. Seventy-eight PD patients who were treated with safinamide of which 25 (32.05%) had a concomitant treatment with an antidepressant drug, being sertraline and escitalopram the most frequent. Mean age was 80 years±8.43 and H&Y stage was 3 [2-4]. Mean dose of levodopa used was 703.75mg±233.15. Median duration of concomitant treatment with safinamide and antidepressant drug was 6 months (IQR 20.5), and over eighteen months in 5 cases. No case of serotonin syndrome was recorded, neither was any of its typical manifestations combined or in isolation. CONCLUSIONS Our real clinical practice study suggests that concomitant use of safinamide with antidepressant drugs in PD patients seemed to be safe and well tolerated, even in the long term. However, caution is warranted, individualizing treatment regimens and monitoring the potential appearance of adverse effects.
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Affiliation(s)
- P Pérez-Torre
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain.
| | - J L López-Sendón
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - V Mañanes Barral
- Neuropsychology, Movement Disorders Unit, Neurology Department, IRYCIS, Hospital Ramón y Cajal, Madrid, Spain
| | - I Parees
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - S Fanjul-Arbós
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - E Monreal
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - A Alonso-Canovas
- Movement Disorders Unit, Neurology Department, Ramón y Cajal Hospital, Madrid, Spain
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Chow R, Kozhevnikov D, Prsic EH. Serotonin Syndrome in Palliative Care #403. J Palliat Med 2020; 23:1678-1680. [PMID: 33306009 DOI: 10.1089/jpm.2020.0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Management of Acute Pain Due to Traumatic Injury in Patients with Chronic Pain and Pre-injury Opioid Use. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Influence of combinations of drugs that act on the CYP2D6 metabolic pathway in the treatment of major depressive disorder: A population-based study. Eur Psychiatry 2020; 29:331-7. [DOI: 10.1016/j.eurpsy.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/30/2013] [Accepted: 10/07/2013] [Indexed: 01/08/2023] Open
Abstract
AbstractObjectiveTo describe the frequency of drug combinations (substrate-substrate or substrate-inhibitor) with the potential to interfere with the CYP2D6 metabolic pathway in patients receiving antidepressant medication for major depressive disorder.MethodsWe carried out an observational study using outpatient medical records. We included adult subjects who initiated antidepressant medication during 2008–2010. Patients were assigned to three study groups: no combination, substrate-substrate, and substrate-inhibitor. Follow-up period was 12 months. Main measures: demographics, comorbidity and medication persistence. Statistical analysis included a logistic regression model, P < 0.05.ResultsFive thousand six hundred and thirty patients were recruited (61.9 years, 76.9% female), 24.4% (CI: 23.8 – 26.0%) received some kind of drug combination (substrate-substrate: 15.4%, substrate-inhibitor: 9.0%). Variables significantly associated with drugs combinations that may act on the CYP2D6 metabolic pathway were: dementia (OR = 4.2), neuropathy (OR = 4.2) and stroke (OR = 1.9), P < 0.001. Medication persistence at 12 months was longer in patients with no combination (55.3%) than in patients receiving substrate-substrate (50.5%) or substrate-inhibitor (45.0%) combinations, P < 0.001.ConclusionsTwenty-five percent of major depressive disorder patients received a combination of drugs with the potential to interfere with CYP2D6 metabolic pathway. These combinations increased with comorbidity and resulted in shorter medication persistence of antidepressant treatment.
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Zhang J, Xue R, Li YF, Zhang YZ, Wei HW. Anxiolytic-like effects of treadmill exercise on an animal model of post-traumatic stress disorder and its mechanism. J Sports Med Phys Fitness 2020; 60:172-179. [DOI: 10.23736/s0022-4707.20.10120-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cacabelos R, Cacabelos N, Carril JC. The role of pharmacogenomics in adverse drug reactions. Expert Rev Clin Pharmacol 2019; 12:407-442. [DOI: 10.1080/17512433.2019.1597706] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ramón Cacabelos
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, Corunna, Spain
| | - Natalia Cacabelos
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, Corunna, Spain
| | - Juan C. Carril
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, Corunna, Spain
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Hassamal S, Miotto K, Dale W, Danovitch I. Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures. Am J Med 2018; 131:1382.e1-1382.e6. [PMID: 29752906 DOI: 10.1016/j.amjmed.2018.04.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Abstract
Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol's serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is modest in the general population, but if left untreated, the morbidity and mortality can be high; therefore, prompt recognition and management is essential. Various risk factors such as medical comorbidities, use or abuse of supratherapeutic doses of tramadol, and concomitant administration of proconvulsant serotonergic cytochrome P-450 inhibitors will help clinicians identify individuals at an elevated risk for serotonin toxicity and seizures. Serotonin syndrome and seizures can be effectively treated by administering benzodiazepines, providing supportive care, and discontinuing tramadol and other contributing agents. Cyproheptadine should be administered in moderate to severe cases of serotonin syndrome. Our objective is to summarize the literature on the pharmacology, epidemiology, risk factors, clinical presentations, and evidence-based management of tramadol-related seizures and serotonin syndrome.
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Affiliation(s)
- Sameer Hassamal
- Department of Supportive Care Medicine, City of Hope, Duarte, Calif.
| | - Karen Miotto
- David Geffen School of Medicine at UCLA, Semel Institute of Neuroscience and Human Behavior, Los Angeles, Calif
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, Calif
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, Calif
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15
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Zin CS, Nazar NI, Rahman NS, Alias NE, Ahmad WR, Rani NS, Cardosa MS, Ng KS, Ye FL. Trends and patterns of analgesic prescribing in Malaysian public hospitals from 2010 to 2016: tramadol predominately used. J Pain Res 2018; 11:1959-1966. [PMID: 30288090 PMCID: PMC6160284 DOI: 10.2147/jpr.s164774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose To examine the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioid patients. Patients and methods This cross-sectional study was conducted from 2010 to 2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid, and naproxen), tramadol, and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Annual number of patients and prescriptions were measured in repeat cross-sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata version 13. Results A total of 192,747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were given for 97,227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n=72,999) was the most frequently prescribed analgesic, followed by ketoprofen (17.5%, n=33,793), diclofenac (16.2%, n=31,180), celecoxib (12.2%, n=23,487), and other NSAIDs (<4.5%). All the analgesics were increased over time except meloxicam, indomethacin, and mefenamic acid. Opioids, primarily morphine (2.2%, n=4,021) and oxycodone (0.5%, n=1,049), were prescribed the least, but the rate of increase was the highest. Conclusion Tramadol was the most frequently prescribed analgesic in hospital outpatient settings in Malaysia. Opioids were prescribed the least, but noted the highest increase in utilization.
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Affiliation(s)
- Che Suraya Zin
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Nor Ilyani Nazar
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Norny Syafinaz Rahman
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Nor Elina Alias
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Wan Rohaidah Ahmad
- Department of Anaesthesiology and Intensive Care, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Nurul Sahida Rani
- Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Mary Suma Cardosa
- Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia
| | - Kim Swan Ng
- Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia
| | - Felicia Loh Ye
- Department of Pharmacy, Hospital Selayang, Batu Caves, Malaysia
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Role of dopamine D3 receptor in alleviating behavioural deficits in animal models of post-traumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84:190-200. [PMID: 29510167 DOI: 10.1016/j.pnpbp.2018.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 01/06/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complicated psychiatric disorder, which occurs after exposure to a traumatic event. The main clinical manifestation of PTSD includes fear and stress dysregulation. In both animals and humans, dysregulation of dopamine function appears to be related to conditioned fear responses. Previous studies show that the dopamine D3 receptor (D3R) is involved in schizophrenia, autism, and substance use disorders and is related to emotional disorders. However, few studies have investigated the role of the D3R in the pathogenesis and aetiology of PTSD. In the current study, we have reported that D3R knockout (D3R-/-) mice displayed decreased freezing time of contextual fearing and anxiolytic effects following training sessions consisting of exposure to inescapable electric foot-shocks. Similarly, highly selective blockade of D3Rs by YQA14, a novel D3R antagonist, significantly ameliorated freezing and anxiogenic-like behaviours in the single-prolonged stress (SPS) model of PTSD in rats. And more, YQA14 selectively alleviated the symptoms of PTSD in WT mice but not in D3R-/- mice. In summary, this study demonstrates the anti-PTSD effects of blockade or knockout of the D3R, suggesting that the D3R might play an important role in the pathogenesis and aetiology of PTSD, and might be a potential target for the clinical management of PTSD.
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Ryan NM, Vertigan AE, Birring SS. An update and systematic review on drug therapies for the treatment of refractory chronic cough. Expert Opin Pharmacother 2018; 19:687-711. [PMID: 29658795 PMCID: PMC5935050 DOI: 10.1080/14656566.2018.1462795] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/05/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic Cough (CC) is common and often associated with significant comorbidity and decreased quality of life. In up to 50% of cases, the cough is refractory despite extensive investigation and treatment trials. It is likely that the key abnormality in refractory CC is dysfunctional, hypersensitive sensory nerves, similar to conditions such as laryngeal hypersensitivity and neuropathic pain. AREAS COVERED The aim of this systematic review is to assess drug therapies for refractory CC. The authors review the current management of CC and provide discussion of the similarities between neuropathic pain and refractory CC. They review repurposed and new pharmacological treatments. Several meta-analyses were performed to compare the efficacy of treatments where possible. EXPERT OPINION Repurposed pain medications such as gabapentin and pregabalin reduce the frequency of cough and improve quality of life. Along with speech pathology, they are important and alternate treatments for refractory CC. However, more treatments are needed and the P2X3 ion channel receptor antagonists show the most promise. With a better understanding of neuronal activation and sensitisation and their signal processing in the brain, improved animal models of cough, and the use of validated cough measurement tools, more effective treatments will develop.
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Affiliation(s)
- Nicole M. Ryan
- Clinical Toxicology Research Group, School of Medicine and Public Health, The University of Newcastle, Calvary Mater Hospital, Newcastle, Australia
| | - Anne E. Vertigan
- Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
- Department of Speech Pathology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Surinder S. Birring
- Division of Asthma, Allergy & Lung Biology, School of Transplantation, Immunology, Infection & Inflammation Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
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Maritaz C, Lemare F, Laplanche A, Demirdjian S, Valteau-Couanet D, Dufour C. High-dose thiotepa-related neurotoxicity and the role of tramadol in children. BMC Cancer 2018; 18:177. [PMID: 29433564 PMCID: PMC5809829 DOI: 10.1186/s12885-018-4090-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Serious neurological adverse events (NAE) have occurred during treatment with high-dose thiotepa regimens of children with high-risk solid tumours. The objective was to assess the incidence of NAE related to high-dose thiotepa and to identify potential contributing factors that could exacerbate the occurrence of this neurotoxicity. Methods From May 1987 to March 2011, children with solid tumours treated with high-dose thiotepa were retrospectively identified. Each NAE detected led to an independent case analysis. Potential contributing factors were pre-specified and univariate/multivariable analyses were performed. Results Three hundred seven courses of thiotepa (251 patients) were identified. The total dose per treatment ranged from 600 to 900 mg/m2. 81 NAE (26%) were identified. 46 NAE were related to high-dose thiotepa during the first course (18.3%) and 11 during the second course (19.6%). The symptoms appeared in a median time of 2 days after the introduction of thiotepa. Central and peripheral symptoms were headaches, tremors, confusion, seizures, cerebellar syndrome, and coma. High-dose thiotepa was reintroduced in 18 cases and symptoms reappeared in 5 children. For 3 patients who had seizures during the first course, premedication with clonazepam for the second course has prevented recurrence of NAE. As contributing factors, brain tumour and tramadol treatment increased the risk of thiotepa-related neurotoxicity by 2 to 6 times respectively. Conclusions The incidence of neurotoxicity was 18.3%. Brain tumours and tramadol treatment are risk factors to consider when using high-dose thiotepa. The outcome of patients was favourable without sequelae in all cases and rechallenge with thiotepa was possible.
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Affiliation(s)
- Christophe Maritaz
- Department of Clinical Pharmacy, Gustave-Roussy cancer campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Francois Lemare
- Department of Clinical Pharmacy, Gustave-Roussy cancer campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France.,Faculty of Pharmacy of Paris, Sorbonne-Paris University, 75 006, Paris, France.,EA 7348 MOS, Ecole des Hautes Etudes en Santé Publique, 35000, Rennes, France
| | - Agnes Laplanche
- Department of Biostatistics and Epidemiology, Gustave-Roussy, Villejuif, France
| | - Sylvie Demirdjian
- Department of Clinical Pharmacy, Gustave-Roussy cancer campus, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | | | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Villejuif, France
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19
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Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics. Scand J Pain 2017; 17:193-200. [DOI: 10.1016/j.sjpain.2017.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022]
Abstract
Abstract
Background
As pain is often a comorbid condition, many patients use opioid analgesics in combination with several other drugs. This implies a generally increased risk of drug interactions, which along with inherent pharmacogenetic variability and other factors may cause differences in therapeutic response of opioids.
Aim
To provide an overview of interactions and pharmacogenetic variability of relevance for individual differences in effect and tolerability of opioid analgesics, which physicians and other healthcare professionals should be aware of in clinical practice.
Methods
The article was based on unsystematic searches in PubMed to identify literature highlighting the clinical impact of drug interactions and pharmacogenetics as sources of variable response of opioid analgesics.
Results
Cytochrome P450 (CYP)-mediated metabolism is an important process for both clinically relevant interactions and pharmacogenetic variability of several opioids. Concomitant use of CYP inhibitors (e.g. paroxetine, fluoxetine and bupropion) or inducers (e.g. carbamazepine, phenobarbital and phenytoin) could counteract the clinical effect or trigger side effects of analgesics in the same manner as genetically determined differences in CYP2D6-mediated metabolism of many opioids. Moreover, combination treatment with drugs that inhibit or induce P-glycoprotein (ABCB1), a blood-brain barrier efflux transporter, may alter the amount (‘dose’) of opioids distributed to the brain. At the pharmacodynamic level, it is crucial to be aware of the potential risk of interaction causing serotonergic syndrome when combining opioids and serotonergic drugs, in particular antidepressants inhibiting serotonin reuptake (SSRIs and SNRIs). Regarding pharmacogenetics at the receptor level of pain treatment, the knowledge is currently scarce, but an allelic variant of the μ1 opioid receptor (OPRM1) gene has been associated with higher dosage requirement to achieve analgesia.
Conclusions and implications
Drug interactions and pharmacogenetic differences may lead to therapeutic failure or serious side effects of opioid analgesics. Many interactions involve combinations with antidepressants and antiepileptics, which are highly relevant drugs in patients suffering from pain. To prevent unfavourable drug interactions it is important that clinicians pay close attention and use electronic drug interaction checkers when treatments are initiated or discontinued. For the management of issues related to pharmacogenetic differences, blood-based CYP genotyping is available as routine test at many laboratories, and provide a valuable tool for proper choice of drugs and doses for treatment of pain and other diseases.
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Overexpression of the 18 kDa translocator protein (TSPO) in the hippocampal dentate gyrus produced anxiolytic and antidepressant-like behavioural effects. Neuropharmacology 2017; 125:117-128. [PMID: 28655607 DOI: 10.1016/j.neuropharm.2017.06.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/18/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022]
Abstract
The 18 kDa translocator protein (TSPO) is a five transmembrane domain protein that plays a crucial role in neurosteroid (e.g., allopregnanolone) synthesis by promoting the transport of cholesterol to the inner mitochondrial membrane. This protein is predominantly expressed in steroid-synthesizing tissues, including the central and peripheral nervous system, affecting stress-related disorders such as anxiety and depression. Recent studies have focused on the hippocampal dentate gyrus, which is very important for involvement of anxiety and depression. However, the exact role that TSPO plays in the pathophysiology of anxiety and depression and the involvement of the hippocampal dentate gyrus in regulating these behavioural effects remain elusive. This study used the lentiviral vectors mediating TPSO overexpression to assess the effects of TPSO overexpression in the hippocampal dentate gyrus on anxiolytic and antidepressant-like behavioural effects in mice. The expression of TSPO and the concentration of allopregnanolone in hippocampus tissues (3 mm in diameter around the injection site on both sides) were measured by Western blot and ELISA, respectively. The results indicated that microinjection of the LV-TSPO resulted in a significant increase in TSPO expression and allopregnanolone concentration in the hippocampus. Moreover, TSPO overexpression of the mouse hippocampal dentate gyrus generated significant anxiolytic and antidepressant-like behavioural effects in a series of behavioural models. These effects were completely blocked by the TSPO antagonist PK11195 (3 mg/kg, intraperitoneally) and the 5α-reductase inhibitor finasteride (5 mg/kg,intraperitoneally). Meanwhile, the increased allopregnanolone was also reversed by PK11195 and finasteride. In addition, neither PK11195 nor finasteride had an effect on the expression of TSPO. Overall, our results are the first to suggest that the overexpression of TSPO in the hippocampal dentate gyrus produced anxiolytic and antidepressant-like behavioural effects that are partially mediated by downstream allopregnanolone biosynthesis. Our results suggest that TSPO would be a potential anxiolytic and antidepressant therapeutic target.
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21
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Day RO, Snowden L, McLachlan AJ. Life‐threatening drug interactions: what the physician needs to know. Intern Med J 2017; 47:501-512. [DOI: 10.1111/imj.13404] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Richard O. Day
- Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Sydney New South Wales Australia
- School of Medical Sciences, Medicine University of New South Wales Sydney New South Wales Australia
- St Vincent's Clinical School, Medicine University of New South Wales Sydney New South Wales Australia
| | - Leone Snowden
- New South Wales Medicines Information Centre Sydney New South Wales Australia
| | - Andrew J. McLachlan
- Faculty of Pharmacy University of Sydney and Centre for Education and Research on Ageing, Concord Hospital Sydney New South Wales Australia
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22
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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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23
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Safety issues related to the use of prescription drugs in patients with chronic diseases: a bibliographic review. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-016-0371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Rolke R, Rolke S, Hiddemann S, Mücke M, Cuhls H, Radbruch L, Elsner F, Peuckmann-Post V. [Update palliative pain therapy]. Internist (Berl) 2016; 57:959-970. [PMID: 27631529 DOI: 10.1007/s00108-016-0126-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cancer pain and pain associated with non-neoplastic diseases can be associated with pain mechanisms, such as a peripheral or central sensitization or deafferentation. The clarification allows indirect conclusions about the underlying mechanisms based on clinical signs, such as allodynia or hyperalgesia. Non-opioid analgesics are the basis of cancer pain therapy according to the World Health Organization (WHO) pain ladder. In the case of severe cancer pain, treatment can be escalated directly from level 1 to level 3. Opioids are highly effective for the treatment of cancer pain even with a neuropathic component, which can occur in up to 40 % of cases as amixed pain syndrome. Coanalgesics represent a valuable therapeutic adjunct for better pain control and can address treatment of comorbidities, such as anxiety, depression and sleep disorders. When liver and/or renal function is reduced, the dosage of many drugs has to be adapted. Treatment of multimorbid or critically ill patients with opioids and antidepressants/anticonvulsants requires consideration of numerous possible pharmacodynamic and pharmacokinetic interactions.
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Affiliation(s)
- R Rolke
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - S Rolke
- Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Deutschland
| | - S Hiddemann
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Mücke
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.,Institut für Hausarztmedizin, Medizinische Fakultät, Universität Bonn, Bonn, Deutschland.,Zentrum für Seltene Erkrankungen Bonn (ZSEB), Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Cuhls
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - F Elsner
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - V Peuckmann-Post
- Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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26
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Antidepressant-Like and Anxiolytic-Like Effects of ZBD-2, a Novel Ligand for the Translocator Protein (18 kDa). Neuromolecular Med 2016; 19:57-68. [PMID: 27544207 DOI: 10.1007/s12017-016-8425-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 07/02/2016] [Indexed: 12/17/2022]
Abstract
Activation of translocator protein (18 kDa) (TSPO) plays an important role to mediate rapid anxiolytic efficacy in stress response and stress-related disorders by the production of neurosteroids. However, little is known about the ligand of TSPO on the anxiety-like and depressive behaviors and the underlying mechanisms in chronic unpredictable mild stress (UCMS) mice. In the present study, a novel ligand of TSPO, ZBD-2 [N-benzyl-N-ethyl-2-(7,8-dihydro-7-benzyl-8-oxo-2-phenyl-9H-purin-9-yl) acetamide] synthesized by our laboratory, was used to evaluate the anxiolytic and antidepressant efficacy and to elucidate the underlying mechanisms. ZBD-2 (3 mg/kg) significantly attenuated anxiety-like and depressive behaviors in the UCMS mice, which was blocked by TSPO antagonist PK11195 (3 mg/kg). Treatment of ZBD-2 reversed the decrease in biogenic amines (norepinephrine, dopamine, and serotonin) in the brain region of hippocampus in the UCMS mice. The decreases in TSPO, GluN2B-containing N-methyl-D-aspartate (NMDA) receptors, GluA1, p-GluA1-Ser831, p-GluA1-Ser845, PSD-95, and GABAA-a2 were integrated with the increases of CaMKII and iNOS levels in the hippocampus of the UCMS mice. ZBD-2 significantly reversed the changes of above proteins. However, ZBD-2 or PK11195 treatment did not affect the levels of GluN2A-containing NMDA receptors and the total levels of GAD67. Our study provides strong evidences that ZBD-2 has a therapeutic effect on chronic stress-related disorders such as depression and anxiety through regulating the biogenic amine levels and the synaptic proteins in the hippocampus.
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27
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Abdel-Hamid IA, Andersson KE, Waldinger MD, Anis TH. Tramadol Abuse and Sexual Function. Sex Med Rev 2016; 4:235-246. [DOI: 10.1016/j.sxmr.2015.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 11/24/2022]
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28
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Brown EE, Davies S. Potential for Drug-Drug Interactions with Adjunctive Tramadol Use in Treatment of Obsessive-Compulsive Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:308-9. [PMID: 27254806 PMCID: PMC4841283 DOI: 10.1177/0706743716633423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eric E Brown
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Simon Davies
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Zhang LM, Qiu ZK, Chen XF, Zhao N, Chen HX, Xue R, Zhang YZ, Yang RF, Li YF. Involvement of allopregnanolone in the anti-PTSD-like effects of AC-5216. J Psychopharmacol 2016; 30:474-81. [PMID: 26783231 DOI: 10.1177/0269881115625115] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cholesterol import into mitochondria through the translocator protein (18 KDa) (TSPO) is the starting point and an important rate-limiting step in neurosteroidogenesis. For this reason TSPO has received increased attention in the pathophysiology of post-traumatic stress disorder (PTSD). In an effort to explore the role of TSPO in mediating the anti-PTSD effect, we first assessed the effects of the TSPO ligand AC-5216 in alleviating the enhanced anxiety and fear response in a time-dependent sensitization (TDS) procedure, a rat PTSD animal model. In the present study, we showed that chronic treatment with AC-5216 caused significant suppression of the enhanced anxiety and contextual fear induced in post-TDS rats; these effects were blocked by PK11195. Furthermore, AC-5216 treatment increased the levels of allopregnanolone in the serum, prefrontal cortex, and hippocampus of post-TDS rats, and these effects were antagonized by PK11195. These results demonstrate that AC-5216 has a clear anti-PTSD-like effect, which might be partially mediated by binding to TSPO and the subsequent synthesis of allopregnanolone.
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Affiliation(s)
- Li-Ming Zhang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Zhi-Kun Qiu
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China Department of Pharmacology, the First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiao-Fei Chen
- Department of Pharmacology, the 309 Hospital of PLA, Beijing, China
| | - Nan Zhao
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Hong-Xia Chen
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Rui- Xue
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - You-Zhi Zhang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Ri-Fang Yang
- Department of Medicinal Chemistry, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yun-Feng Li
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, Beijing, China
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Sweileh WM, Shraim NY, Zyoud SH, Al-Jabi SW. Worldwide research productivity on tramadol: a bibliometric analysis. SPRINGERPLUS 2016; 5:1108. [PMID: 27478725 PMCID: PMC4949195 DOI: 10.1186/s40064-016-2801-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 07/08/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pain management and safe use of analgesics is an important medical issue. Tramadol is an old analgesic with controversial properties. Evaluation of worldwide scientific output on tramadol has not been explored. Therefore, the main objective of this study was to give a bibliometric overview of global research productivity on tramadol. METHODS SciVerse Scopus was used to retrieve and quantitatively and qualitatively analyze worldwide publications on tramadol. RESULTS A total of 2059 original and review research articles on tramadol were retrieved from Scopus. Forty-six documents (2.23 %) were published in Anesthesia and Analgesia Journal whereas 30 (1.46 %) were published in Arzneimittel Forschung Drug Research Journal. Retrieved tramadol documents were published from 71 countries and appeared in 160 peer reviewed journals. Although the United States of America (259; 12.86 %) had the largest contribution to tramadol publications; the contribution by other countries like Turkey (232; 11.27) India (189; 8.09 %) and Germany (176; 8.56 % was not far away from that of USA. The most productive institution was Grunenthal, Germany (47; 2.28 %) followed by Tehran University of Medical Sciences, Iran (29; 1.41 %), and, Ortho-McNeil Pharmaceutical Incorporated, USA (25; 1.21 %). Of the 2059 documents, there were 370 documents about dependence. The leading institution in documents pertaining to tramadol dependence was Grunenthal GmbH (18; 4.86 %) followed by Ortho-McNeil Pharmaceutical Incorporated (17; 4.59 %). CONCLUSIONS The current study showed that there is an obvious interest in tramadol research. More efforts are needed to clarify the abuse potential and safety profile of tramadol to help in determining the legal status of tramadol. Collaboration among pharmaceutical industry, clinical researchers and academic institutions can improve research quantity and quality on tramadol.
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Affiliation(s)
- Waleed M. Sweileh
- Department of Pharmacology/Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Naser Y. Shraim
- Department of Pharmaceutical Chemistry and Technology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samah W. Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Lam YWF. Serotonin syndrome associated with morphine-phenelzine interaction. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/pu.30083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ryan NM, Isbister GK. Tramadol overdose causes seizures and respiratory depression but serotonin toxicity appears unlikely. Clin Toxicol (Phila) 2015; 53:545-50. [PMID: 25901965 DOI: 10.3109/15563650.2015.1036279] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Tramadol is a commonly used centrally acting analgesic associated with seizures and suspected to cause serotonin toxicity in overdose. OBJECTIVE This study sought to investigate the effects of tramadol overdose, and included evaluation for serotonin toxicity based on the Hunter Serotonin Toxicity Criteria where the seven clinical features of spontaneous clonus, inducible clonus, ocular clonus, agitation, diaphoresis, tremor and hyperreflexia are examined for in all patients taking serotonergic medications; seizures and central nervous system depression. MATERIALS AND METHODS This was an observational cases series based on a retrospective review of tramadol overdoses (> 400 mg) admitted to a tertiary toxicology unit from November 2000 to June 2013. Demographic details, information on ingestion (dose and co-ingestants), clinical effects, complications (seizures, serotonin toxicity and cardiovascular effects) and intensive care unit (ICU) admission were extracted from a clinical database. RESULTS There were 71 cases of tramadol overdose (median age: 41 years, range: 17-69 years; and median ingested dose: 1000 mg, interquartile range [IQR]: 800-2000 mg). Seizures were dose related and occurred in 8 patients, one of them co-ingested a benzodiazepine compared with 16 patients without seizures. There were no cases of serotonin toxicity meeting the Hunter Serotonin Toxicity Criteria. Tachycardia occurred in 27 and mild hypertension occurred in 32. The Glasgow Coma Score was < 15 in 29 and < 9 in 5 patients; three co-ingested tricyclic antidepressants and two tramadol alone (3000 mg and 900 mg). Respiratory depression occurred in 13, median dose: 2500 (IQR: 1600-3000) mg which was significantly different (p = 0.003) to patients without respiratory depression, median dose: 1000 (IQR: 750-1475) mg. Eight patients were admitted to ICU, five due to co-ingestant toxicity and three for respiratory depression. DISCUSSION Tramadol overdose was associated with a significant risk of seizures and respiratory depression in more severe cases, both which appear to be related to the ingested dose. There were no cases of serotonin toxicity, while opioid-like effects and adrenergic effects were prominent. CONCLUSION Tramadol overdose is associated with seizures and respiratory depression, but is unlikely to cause serotonin toxicity.
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Affiliation(s)
- Nicole M Ryan
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, and School of Medicine and Public Health, The University of Newcastle , Newcastle, NSW , Australia
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Gruen ME, Roe SC, Griffith E, Hamilton A, Sherman BL. Use of trazodone to facilitate postsurgical confinement in dogs. J Am Vet Med Assoc 2015; 245:296-301. [PMID: 25029308 DOI: 10.2460/javma.245.3.296] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of oral administration of the serotonin antagonist and reuptake inhibitor trazodone hydrochloride to facilitate confinement and calming after orthopedic surgery in dogs. DESIGN Prospective open-label clinical trial. ANIMALS 36 client-owned dogs that underwent orthopedic surgery. PROCEDURES Starting the day after surgery, dogs were administered trazodone (approx 3.5 mg/kg [1.6 mg/lb], PO, q 12 h) with tramadol (4 to 6 mg/kg [1.8 to 2.7 mg/lb], PO, q 8 to 12 h) for pain management. After 3 days, administration of tramadol was discontinued, and the trazodone dosage was increased (approx 7 mg/kg [3.2 mg/lb], PO, q 12 h) and maintained for at least 4 weeks. If needed, trazodone dosage was increased (7 to 10 mg/kg [3.2 to 4.5 mg/lb], PO, q 8 h). Owners completed electronic surveys rating their dogs' confinement tolerance, calmness or hyperactivity level, and responses to specific provocative situations prior to surgery and 1, 2, 3, and 4 weeks after surgery and at the postsurgery evaluation (at 8 to 12 weeks). RESULTS Most (32/36 [89%]) of owners reported that their dogs, when given trazodone during the 8 to 12 weeks following orthopedic surgery, improved moderately or extremely with regard to confinement tolerance and calmness. Trazodone was well tolerated, even in combination with NSAIDs, antimicrobials, and other medications; no dogs were withdrawn from the study because of adverse reactions. Owner-reported median onset of action of trazodone was 31 to 45 minutes, and median duration of action was ≥ 4 hours. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that oral administration of trazodone was safe and efficacious and may be used to facilitate confinement and enhance behavioral calmness of dogs during the critical recovery period following orthopedic surgery.
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Affiliation(s)
- Margaret E Gruen
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607
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Zhang LM, Zhou WW, Ji YJ, Li Y, Zhao N, Chen HX, Xue R, Mei XG, Zhang YZ, Wang HL, Li YF. Anxiolytic effects of ketamine in animal models of posttraumatic stress disorder. Psychopharmacology (Berl) 2015; 232:663-72. [PMID: 25231918 DOI: 10.1007/s00213-014-3697-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/28/2014] [Indexed: 01/13/2023]
Abstract
This study investigated the effectiveness of ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, in alleviating the enhanced anxiety and fear response in both a mouse model of PTSD induced by inescapable electric foot shocks and a rat model of PTSD induced by a time-dependent sensitization (TDS) procedure. First, we evaluated the effect of ketamine on behavioral deficits in a mouse model of PTSD that consisted of foot shocks followed by three situational reminders. Our results showed that the aversive procedure induced several behavioral deficiencies, such as increased freezing behavior and anxiety, as well as reduced time spent in an aversive-like context, which were reversed by repeated treatment with ketamine. The effect of ketamine on behavioral changes after exposure to TDS was also investigated, and the levels of brain-derived neurotrophic factor (BDNF) in the hippocampus were measured. The results revealed that after TDS, the rats showed a significant increase in contextual freezing and a decrease in the percentage of time spent in and numbers of entries into open arms in the elevated plus maze test. As a positive control drug, sertraline (Ser, 15 mg/kg, i.g.), a selective serotonin reuptake inhibitor (SSRI) ameliorated these behavioral deficits. These behavioral effects were mimicked by chronic ketamine treatment. Furthermore, ketamine normalized the decreased BDNF level in the hippocampus in post-TDS rats. Taken together, these results suggest that ketamine exerts a therapeutic effect on PTSD that might be at least partially mediated by an influence on BDNF signaling in the hippocampus.
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Affiliation(s)
- Li-Ming Zhang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Haidian, Beijing, 100850, China
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Anxiolytic-like effects of YL-IPA08, a potent ligand for the translocator protein (18 kDa) in animal models of post-traumatic stress disorder. Int J Neuropsychopharmacol 2014; 17:1659-69. [PMID: 24763106 DOI: 10.1017/s1461145714000479] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recently, the translocator protein (18 kDa) (TSPO), previously called peripheral benzodiazepine receptor (PBR) and both the starting point and an important rate-limiting step in neurosteroidogenesis, has received increased attention in the pathophysiology of post-traumatic stress disorder (PTSD) because it affects the production of neurosteroids, reinforcing the hypothesis that selective TSPO ligands could potentially be used as anti-PTSD drugs. As expected, we showed that chronic treatment with YL-IPA08 [N-ethyl-N-(2-pyridinylmethyl)-2-(3,4-ichlorophenyl)-7-methylimidazo [1,2-a] pyridine-3-acetamide hydrochloride], a potent and selective TSPO ligand synthesized by our institute, caused significant suppression of enhanced anxiety and contextual fear induced in the inescapable electric foot-shock-induced mouse model of PTSD and the time-dependent sensitization (TDS) procedure. These effects were completely blocked by the TSPO antagonist PK11195. Furthermore, YL-IPA08 could increase the level of allopregnanolone in the prefrontal cortex and serum of post-TDS rats, and these effects were antagonized by PK11195. In summary, the findings from the current study showed that YL-IPA08, a potent and selective TSPO ligand, had a clear anti-PTSD-like effect, which might be partially mediated by binding to TSPO and the subsequent synthesis of allopregnanolone.
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Möller J, Laflamme L, Söderberg Löfdal K. CYP2D6-Inhibiting Drugs and the Increased Risk of Fall-Related Injuries Due to Newly Initiated Opioid Treatment - A Swedish, Register-Based Case-Crossover Study. Basic Clin Pharmacol Toxicol 2014; 116:134-9. [DOI: 10.1111/bcpt.12289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Jette Möller
- Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
| | - Lucie Laflamme
- Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
| | - Karin Söderberg Löfdal
- Department of Clinical Pharmacology; Karolinska University Hospital Huddinge; Stockholm Sweden
- Division of Clinical Pharmacology; Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
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Changes in intensity of serotonin syndrome caused by adverse interaction between monoamine oxidase inhibitors and serotonin reuptake blockers. Neuropsychopharmacology 2014; 39:1996-2007. [PMID: 24577320 PMCID: PMC4059910 DOI: 10.1038/npp.2014.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/08/2022]
Abstract
Drug interaction between inhibitors of monoamine oxidase (MAOIs) and selective serotonin (5-hydroxytryptamine, 5-HT) reuptake (SSRIs) induces serotonin syndrome, which is usually mild but occasionally severe in intensity. However, little is known about neural mechanisms responsible for the syndrome induction and intensification. In this study, we hypothesized that the syndrome induction and intensity utilize two different but inter-related mechanisms. Serotonin syndrome is elicited by excessive 5-HT in the brain (presynaptic mechanism), whereas syndrome intensity is attributed to neural circuits involving 5-HT2A and NMDA receptors (postsynaptic mechanism). To test this hypothesis, basal 5-HT efflux and postsynaptic circuits were pharmacologically altered in rats by once daily pretreatment of the MAOI clorgyline for 3, 6, or 13 days. Syndrome intensity was estimated by measuring 5-HT efflux, neuromuscular activity, and body-core temperature in response to challenge injection of clorgyline combined with the SSRI paroxetine. Results showed that the onset of serotonin syndrome is caused by 5-HT efflux exceeding 10-fold above baseline, confirming the presynaptic hypothesis. The neuromuscular and body-core temperature abnormalities, which were otherwise mild in drug-naive rats, were significantly intensified to a severe level in rats pretreated with daily clorgyline for 3 and 6 days but not in rats pretreated for 13 days. The intensified effect was blocked by M100907 and MK-801, suggesting that variation in syndrome intensity was mediated through a 5-HT2A and NMDA receptor-engaged circuit. Therefore, we concluded that pretreatments of MAOI pharmacologically alter the activity of postsynaptic circuits, which is responsible for changes in syndrome intensity.
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Kapur BM, Lala PK, Shaw JLV. Pharmacogenetics of chronic pain management. Clin Biochem 2014; 47:1169-87. [PMID: 24912048 DOI: 10.1016/j.clinbiochem.2014.05.065] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/25/2014] [Accepted: 05/27/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The experience of chronic pain is one of the commonest reasons individuals seek medical attention, making the management of chronic pain a major issue in clinical practice. Drug metabolism and responses are affected by many factors, with genetic variations offering only a partial explanation of an individual's response. There is a paucity of evidence for the benefits of pharmacogenetic testing in the context of pain management. DESIGN AND METHODS We reviewed the literature between 2000 and 2013, and references cited therein, using various keywords related to pain management, pharmacology and pharmacogenetics. RESULTS Opioids continue to be the mainstay of chronic pain management. Several non-opioid based therapies, such as treatment with cannabinoids, gene therapy and epigenetic-based approaches are now available for these patients. Adjuvant therapies with antidepressants, benzodiazepines or anticonvulsants can also be useful in managing pain. Currently, laboratory monitoring of pain management patients, if performed, is largely through urine drug measurements. CONCLUSIONS Drug half-life calculations can be used as functional markers of the cumulative effect of pharmacogenetics and drug-drug interactions. Assessment of half-life and therapeutic effects may be more useful than genetic testing in preventing adverse drug reactions to pain medications, while ensuring effective analgesia. Definitive, mass spectrometry-based methods, capable of measuring parent drug and metabolite levels, are the most useful assays for this purpose. Urine drug measurements do not necessarily correlate with serum drug concentrations or therapeutic effects. Therefore, they are limited in their use in monitoring efficacy and toxicity.
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Affiliation(s)
- Bhushan M Kapur
- Department of Clinical Pathology, Sunnybrook Health Sciences Center, Toronto, Canada; Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children University of Toronto, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Canada.
| | - Prateek K Lala
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children University of Toronto, Canada
| | - Julie L V Shaw
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Canada
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Ferrari A, Tiraferri I, Palazzoli F, Licata M. Tramadol abuse in a binge pattern in a young depressed woman. Eur Addict Res 2014; 20:82-6. [PMID: 24080865 DOI: 10.1159/000353971] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tramadol is a central analgesic with a unique pharmacological profile in that it is an opioid agonist and an inhibitor of serotonin and norepinephrine reuptake. We describe a case of abuse of tramadol in a binge pattern in a young woman who had initially received the prescription of tramadol as an analgesic as needed. CASE DESCRIPTION The patient had no history of drug or alcohol abuse, but suffered from depression. Over time, she had increased the doses up to 30 ml of tramadol 100 mg/ml oral solution a week. She took the drug in consecutive 'pinches', from afternoon to evening. Tramadol improved her mood, gave her euphoria, but also caused constipation and urinary retention. Detoxification was carried out by partial replacement with tramadol 100 mg extended release and gradual reduction of the number of pinches. The patient found it hard to follow the program because of withdrawal symptoms of an opioid type and especially because of the worsening of depression. CONCLUSION The action of tramadol on the monoaminergic system is believed to be a factor that limits abuse liability and gives advantageous antidepressant-like properties, but it also involves the risk of inducing abuse of the analgesic to improve mood as if it were a stimulant.
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Affiliation(s)
- Anna Ferrari
- Division of Toxicology and Clinical Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
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Martin DP, Bhalla T, Beltran R, Veneziano G, Tobias JD. The safety of prescribing opioids in pediatrics. Expert Opin Drug Saf 2013; 13:93-101. [PMID: 24073760 DOI: 10.1517/14740338.2013.834045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pain management has become a widely discussed topic throughout all medical subspecialties. Although pediatric pain management has evolved significantly in its recent history, there is continued interest in the adequacy of pain treatment, both in the acute inpatient setting as well as the postoperative and chronic pain management setting. Although health care providers are becoming more aggressive concerning prompt and effective treatment of acute and chronic pain, safety data and adverse effects of narcotic analgesics may be overlooked. AREAS COVERED The authors review the current paradigm of acute pain management with an emphasis on oral narcotic medications, and the safety data available concerning prescribing these medications. EXPERT OPINION Further, the authors present their opinions concerning current and future practices regarding the prescribing practice of opiate analgesics, as well as a step-wise approach for acute oral pain management.
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Affiliation(s)
- David P Martin
- Ohio State University, Nationwide Children's Hospital, Department of Anesthesiology and Pain Medicine , 700 Children's Drive, Columbus, OH 43205 , USA +1 614 722 4200 ; +1 614 722 4203 ;
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Zhang LM, Zhao N, Guo WZ, Jin ZL, Qiu ZK, Chen HX, Xue R, Zhang YZ, Yang RF, Li YF. Antidepressant-like and anxiolytic-like effects of YL-IPA08, a potent ligand for the translocator protein (18 kDa). Neuropharmacology 2013; 81:116-25. [PMID: 24067925 DOI: 10.1016/j.neuropharm.2013.09.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/04/2013] [Accepted: 09/09/2013] [Indexed: 11/16/2022]
Abstract
It has been demonstrated that the translocator protein (18 kDa) (TSPO) plays an important role in stress-response and stress-related disorders, such as anxiety and depression, by affecting the production of neurosteroids, supporting the potential use of selective TSPO ligands as antidepressant or anxiolytic drugs. N-ethyl-N-(2-pyridinylmethyl)- 2-(3,4-ichlorophenyl)- 7-methylimidazo [1,2-a] pyridine-3-acetamide hydrochloride (YL-IPA08), a novel TSPO ligand that has been synthesized at our institute, exerted a high affinity for TSPO in a crude mitochondrial fraction prepared from rat cerebellum but exhibited only a negligible affinity for the central benzodiazepine receptor. As expected, YL-IPA08 incubation with the cultured rat astrocyte cells increased the pregnenolone and progesterone concentration from the cultured medium. Moreover, YL-IPA08 produced significant antidepressant-like and anxiolytic-like effects in a series of mouse and rat behavior models. In addition, the antidepressant-like behavior of YL-IPA08 was totally blocked by the TSPO antagonist PK11195 in a tail suspension test, and the anxiolytic effect was blocked by PK11195 but not by a CBR antagonist in the elevated plus-maze test. Furthermore, compared with the CBR agonist diazepam, YL-IPA08 had no myorelaxant effects and did not affect the motor coordination, memory or hexobarbitone-induced sleep in mice. Overall, these results indicate that YL-IPA08 is a more potent and selective TSPO ligand, which exerts antidepressant-like and anxiolytic-like effects on behaviors that are mediated by TSPO but does not cause the side effects that are typically associated with conventional benzodiazepines.
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Affiliation(s)
- Li-Ming Zhang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China
| | - Nan Zhao
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China
| | - Wen-Zhi Guo
- Department of Anesthesiology, General Hospital of Beijing Military Command, Beijing 100007, China
| | - Zeng-Liang Jin
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China
| | - Zhi-Kun Qiu
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China; Department of Pharmacology, School of Pharmaceutical Sciences, Southern Medical University, 1023 Shatainan Road, Guangzhou, PR China
| | - Hong-Xia Chen
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China
| | - Rui Xue
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China
| | - You-Zhi Zhang
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China
| | - Ri-Fang Yang
- Department of Medicinal Chemistry, Beijing Institute of Pharmacology and Toxicology, Beijing, PR China
| | - Yun-Feng Li
- Department of New Drug Evaluation, Beijing Institute of Pharmacology and Toxicology, 27 Taiping Road, Beijing, PR China.
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Abstract
Palliative care patients do not only suffer from cancer pain but also from painful muscle spasticity due to multiple sclerosis, amyotrophic lateral sclerosis, after stroke or due to dementia if damage of the pyramidal motor system is present. Centrally active muscle relaxants can be helpful also when used as coanalgesics for cancer pain. In addition to opioids other coanalgesics, such as tricyclic antidepressants or serotonin/noradrenalin reuptake inhibitors as well as anticonvulsants (sodium channel and calcium channel blockers) can be helpful if neuropathic cancer pain is present. Idiopathic Parkinsonism or multiple system atrophy leads more to a painful rigor and pain control should be supported here by optimal adjustment of L-DOPA or DOPA agonist therapy. However, pain treatment should always address the psychological, social and spiritual demands of the patient.
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