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Van Hirtum LDFM, Van Damme T, Van Hove JLK, Steyaert JG. The behavioral phenotype of children and adolescents with attenuated non-ketotic hyperglycinemia, intermediate to good subtype. Orphanet J Rare Dis 2024; 19:150. [PMID: 38589924 PMCID: PMC11003182 DOI: 10.1186/s13023-024-03172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
AIM We aim to describe the behavioral phenotype of children and adolescents with the good to intermediate attenuated form of non-ketotic hyperglycinemia (NKH) and to explore associations between the behavioral phenotype and age, sex, plasma glycine levels and drug treatment. METHOD Parents of children with attenuated NKH completed questionnaires assessing maladaptive behavior, adaptive behavior, social communication, speech/language development and motor development in addition to demographic and medical questions. RESULTS AND INTERPRETATION Twelve children, age 6 to 21y, functioned at mild to severe intellectual disability levels. Their speech/language development was in line with their developmental quotient. Relative to their intellectual functioning, their motor development and communication were weaker in comparison to their general development. Their adaptive behavior, however, appeared a relative strength. There was no evidence for autism spectrum disorder occurring more frequently than expected, rather social skills, except for communication, were rated as a relative strength. Maladaptive behaviors with ADHD-like characteristics were present in more than two thirds of children. Maladaptive behaviors were significantly related to female sex and to taking dextromethorphan, but no significant relation between plasma glycine levels and behavior was found. Future studies will need to evaluate causality in the observed relation between dextromethorphan use and maladaptive behaviors. Clinicians should reconsider the benefit of dextromethorphan when presented with disruptive behaviors in children with attenuated NKH.
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Affiliation(s)
- Liesbet D F M Van Hirtum
- Department of Child- and Adolescent Psychiatry, KU Leuven, Leuven, Belgium.
- Ankerpunt vzw, Leuven, Belgium.
| | - Tine Van Damme
- Department of Child Psychiatry, UPC Z.Org, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Johan L K Van Hove
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Jean G Steyaert
- Department of Child- and Adolescent Psychiatry, KU Leuven, Leuven, Belgium
- Leuven Autism Research Consortium, Leuven, Belgium
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2
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Pavelka MM, Kohr R. Potential Dextromethorphan-Induced Serotonin Syndrome Leading to Homicide and Suicide. Acad Forensic Pathol 2024; 14:21-25. [PMID: 38505641 PMCID: PMC10947710 DOI: 10.1177/19253621231224531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/17/2023] [Indexed: 03/21/2024]
Abstract
Limited case reports have been published regarding serotonin syndrome due to the combined effects of supratherapeutic levels of dextromethorphan and selective serotonin reuptake inhibitor. We report a case of an adolescent with postmortem findings suggestive of a diagnosis of serotonin syndrome-induced psychosis associated with a double homicide and suicide. Postmortem toxicology of the suicide victim was remarkable for elevated serotonergic metabolites of fluoxetine and dextromethorphan in a 14-year-old male.
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Affiliation(s)
- Matthew M. Pavelka
- Matthew M. Pavelka, Indiana University School of Medicine-Terre Haute, IN 46202,
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3
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Shiromwar SS, Chidrawar VR, Singh S, Chitme HR, Maheshwari R, Sultana S. Multi-faceted Anti-obesity Effects of N-Methyl-D-Aspartate (NMDA) Receptor Modulators: Central-Peripheral Crosstalk. J Mol Neurosci 2024; 74:13. [PMID: 38240858 DOI: 10.1007/s12031-023-02178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024]
Abstract
Hypothalamus is central to food intake and satiety. Recent data unveiled the expression of N-methyl-D-aspartate receptors (NMDAR) on hypothalamic neurons and their interaction with GABAA and serotoninergic neuronal circuits. However, the precise mechanisms governing energy homeostasis remain elusive. Notably, in females, the consumption of progesterone-containing preparations, such as hormonal replacement therapy and birth control pills, has been associated with hyperphagia and obesity-effects mediated through the hypothalamus. To elucidate this phenomenon, we employed the progesterone-induced obesity model in female Swiss albino mice. Four NMDAR modulators were selected viz. dextromethorphan (Dxt), minocycline, d-aspartate, and cycloserine. Obesity was induced in female mice by progesterone administration for 4 weeks. Mice were allocated into 7 groups, group-1 as vehicle control (arachis oil), group-2 (progesterone + arachis oil), and group-3 as positive-control (progesterone + sibutramine); other groups were treated with test drugs + progesterone. Various parameters were recorded like food intake, thermogenesis, serum lipids, insulin, AST and ALT levels, organ-to-body weight ratio, total body fat, adiposity index, brain serotonin levels, histology of liver, kidney, and sizing of fat cells. Dxt-treated group has shown a significant downturn in body weight (p < 0.05) by a decline in food intake (p < 0.01), organ-to-liver ratio (p < 0.001), adiposity index (p < 0.01), and a rise in body temperature and brain serotonin level (p < 0.001). Dxt demonstrated anti-obesity effects by multiple mechanisms including interaction with hypothalamic GABAA channels and anti-inflammatory and free radical scavenging effects, improving the brain serotonin levels, and increasing insulin release from the pancreatic β-cells.
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Affiliation(s)
- Shruti Subhash Shiromwar
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, Malaysia
| | - Vijay R Chidrawar
- School of Pharmacy and Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, TSIIC Jadcharla, Green Industrial Park, 509301, Hyderabad, India.
| | - Sudarshan Singh
- Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Havagiray R Chitme
- Amity Institute of Pharmacy, Amity University, Noida, 201303, Uttarpradesh, India
| | - Rahul Maheshwari
- School of Pharmacy and Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, TSIIC Jadcharla, Green Industrial Park, 509301, Hyderabad, India
| | - Shabnam Sultana
- Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research, Anantapur, India
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Jorbenadze S, Khatiashvili T, Chelidze A, Lo Faro AF, Farkas T, Tini A, Sprega G, Berardinelli D, Busardò FP, Chankvetadze B. Development of a novel enantioselective high-performance liquid chromatography-mass spectrometry method for the differentiation of dextro- and levo-methorphan and their O-demethylated metabolites in human blood and its application to post-mortem samples. J Pharm Biomed Anal 2024; 237:115769. [PMID: 37864951 DOI: 10.1016/j.jpba.2023.115769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/23/2023]
Abstract
Recently we proposed an isocratic enantioselective high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the separation and quantitative determination of dextro- (DXM) and levo-methorphan (LVM) and their pharmacologically relevant metabolites, dextrorphan and levorphanol, respectively, in human blood samples. This method was based on the polysaccharide-based chiral column Lux AMP, a specialty column characterized with high stability in mobile phases of pH 11.0 and above. The use of a single-source column is a limitation for any analytical method. Therefore, the major goal of the present study was to develop an enantioselective method for the differentiation of dextro- and levo-methorphan, as well as their metabolites dextrorphan and levorphanol, using Lux Cellulose-3 as alternative chiral column with methanol containing 0.1 % diethylamine mobile phase. A newly developed method uses a chiral selector part of HPLC columns available from multiple manufacturers and a fairly common mobile phase. The method was validated and applied to post-mortem blood samples. Out of 50 analyzed new samples, dextromethorphan (DXM) was detected in 17 samples. Of these 17 cases DXM was accompanied with LVM in 7 samples. The proposed analytical method is relatively simple, accurate and fast and can be adopted for routine use in forensic and clinical toxicology laboratories.
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Affiliation(s)
- Saba Jorbenadze
- Tbilisi State University, Institute of Physical and Analytical Chemistry, School of Exact and Natural Sciences, Tbilisi 0179, Georgia
| | - Tamar Khatiashvili
- Tbilisi State University, Institute of Physical and Analytical Chemistry, School of Exact and Natural Sciences, Tbilisi 0179, Georgia; Department of Excellence-Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Aluda Chelidze
- Tbilisi State University, Institute of Physical and Analytical Chemistry, School of Exact and Natural Sciences, Tbilisi 0179, Georgia
| | - Alfredo Fabrizio Lo Faro
- Department of Excellence-Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Tivadar Farkas
- Phenomenex Inc., 411 Madrid Ave., Torrance, CA 90501, USA
| | - Anastasio Tini
- Department of Excellence-Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Giorgia Sprega
- Department of Excellence-Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Diletta Berardinelli
- Department of Excellence-Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Francesco Paolo Busardò
- Department of Excellence-Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60121, Italy.
| | - Bezhan Chankvetadze
- Tbilisi State University, Institute of Physical and Analytical Chemistry, School of Exact and Natural Sciences, Tbilisi 0179, Georgia.
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Yang JJ, Liu YX, Wang YF, Ge BY, Wang Y, Wang QS, Li S, Zhang JJ, Jin LL, Hong JS, Yin SM, Zhao J. Anti-epileptic and Neuroprotective Effects of Ultra-low Dose NADPH Oxidase Inhibitor Dextromethorphan on Kainic Acid-induced Chronic Temporal Lobe Epilepsy in Rats. Neurosci Bull 2023:10.1007/s12264-023-01140-8. [PMID: 37973720 DOI: 10.1007/s12264-023-01140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/24/2023] [Indexed: 11/19/2023] Open
Abstract
Neuroinflammation mediated by microglia and oxidative stress play pivotal roles in the development of chronic temporal lobe epilepsy (TLE). We postulated that kainic acid (KA)-Induced status epilepticus triggers microglia-dependent inflammation, leading to neuronal damage, a lowered seizure threshold, and the emergence of spontaneous recurrent seizures (SRS). Extensive evidence from our laboratory suggests that dextromethorphan (DM), even in ultra-low doses, has anti-inflammatory and neuroprotective effects in many animal models of neurodegenerative disease. Our results showed that administration of DM (10 ng/kg per day; subcutaneously via osmotic minipump for 4 weeks) significantly mitigated the residual effects of KA, including the frequency of SRS and seizure susceptibility. In addition, DM-treated rats showed improved cognitive function and reduced hippocampal neuronal loss. We found suppressed microglial activation-mediated neuroinflammation and decreased expression of hippocampal gp91phox and p47phox proteins in KA-induced chronic TLE rats. Notably, even after discontinuation of DM treatment, ultra-low doses of DM continued to confer long-term anti-seizure and neuroprotective effects, which were attributed to the inhibition of microglial NADPH oxidase 2 as revealed by mechanistic studies.
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Affiliation(s)
- Jing-Jing Yang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Ying-Xin Liu
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Yan-Fang Wang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Bi-Ying Ge
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Ying Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Qing-Shan Wang
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
- School of Public Health, Dalian Medical University, Dalian, 116044, China
| | - Sheng Li
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Jian-Jie Zhang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Ling-Ling Jin
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Jau-Shyong Hong
- Neurobiology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, 27709, USA
| | - Sheng-Ming Yin
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China.
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China.
| | - Jie Zhao
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China.
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China.
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Kim E, Perlmutter M, Zweber H, Resch J. Bilateral nephrolithiasis following ingestion of guaifenesin and dextromethorphan. Urol Case Rep 2023; 50:102481. [PMID: 37455782 PMCID: PMC10344657 DOI: 10.1016/j.eucr.2023.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Both guaifenesin and dextromethorphan are routinely available nonprescription medications that are also common drugs of abuse amongst young adults. We describe a presentation of guaifenesin and dextromethorphan misuse resulting in acute renal failure due to bilateral nephrolithiasis. The patient underwent placement of bilateral ureteral stents but again formed small renal stones bilaterally. While most renal calculi are not drug-induced, this case highlights the potential for nephrolithiasis after guaifenesin and dextromethorphan ingestion. It suggests that in this combination ingestion multiple mechanisms lead to a prolonged period of nephrolith formation.
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Affiliation(s)
- Elizabeth Kim
- Transitional Year Program, Hennepin Healthcare, Minneapolis, MN, USA
| | - Michael Perlmutter
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Haley Zweber
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Resch
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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7
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McClure EW, Daniels RN. Classics in Chemical Neuroscience: Dextromethorphan (DXM). ACS Chem Neurosci 2023. [PMID: 37290117 DOI: 10.1021/acschemneuro.3c00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Dextromethorphan (DXM) was introduced in 1958 as the first non-opioid cough suppressant and is indicated for multiple psychiatric disorders. It has been the most used over-the-counter cough suppressant since its emergence. However, individuals quickly noticed an intoxicating and psychedelic effect if they ingested large doses. DXM's antagonism at N-methyl-d-aspartate receptors (NMDAr) is thought to underly its efficacy in treating acute cough, but supratherapeutic doses mimic the activity of dissociative hallucinogens, such as phencyclidine and ketamine. In this Review we will discuss DXM's synthesis, manufacturing information, drug metabolism, pharmacology, adverse effects, recreational use, abuse potential, and its history and importance in therapy to present DXM as a true classic in chemical neuroscience.
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Affiliation(s)
- Elliot W McClure
- Department of Pharmaceutical Sciences, Lipscomb University College of Pharmacy, Nashville, Tennessee 37204, United States
| | - R Nathan Daniels
- Department of Pharmaceutical Sciences, Union University College of Pharmacy, Jackson, Tennessee 38305, United States
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Bates MLS, Trujillo KA. Repeated dextromethorphan administration in adolescent rats produces long-lasting behavioral alterations. Pharmacol Biochem Behav 2023:173581. [PMID: 37290599 DOI: 10.1016/j.pbb.2023.173581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
Initiation of non-medical dextromethorphan (DXM) use often occurs in adolescence, yet little is known about the consequences when use begins during this developmental period. The current experiments examined the acute response and the effects of repeated exposure to DXM in adolescence on behavior in adulthood. We examined locomotor activity, locomotor sensitization, and cognitive function, in rats that received repeated administration of DXM. Groups of adolescent (PND 30) and adult (PND 60) male rats were treated with DXM (60 mg/kg) once daily for 10 days. Locomotor activity in response to DXM was assessed following the first injection, on the 10th day of injection (adolescent - PND 39; adult - PND 69), and following 20 days of abstinence (adolescent - PND 60; adult - PND 90). Acute locomotor effects and locomotor sensitization were compared in adolescents and adults; cross-sensitization to ketamine, another dissociative with abuse potential, was also examined. In a separate group of rodents cognitive deficits were assessed following a 20 day abstinence period (adolescent - PND 60; adult - PND 90) in spatial learning and novel object recognition tasks. The locomotor stimulant effect of DXM was much greater in adolescents than adults. Also, only adolescent rats that were repeatedly administered DXM demonstrated locomotor sensitization at the end of 10 days of injection. However, sensitization occurred after the abstinence period in all rats regardless of age. Nonetheless, cross-sensitization to ketamine was only evident in adolescent-treated rats. DXM also led to an increase in perseverative errors in reversal learning only in the adolescent-treated group. We conclude that repeated use of DXM produces long-lasting neuroadaptations that may contribute to addiction. Deficits in cognitive flexibility occur in adolescents, although further work is necessary to confirm these findings. The results extend the understanding of potential long-term consequences of DXM use in adolescents and adults.
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Affiliation(s)
- M L Shawn Bates
- Department of Psychology and Office for Training, Research and Education in the Sciences (OTRES), California State University, San Marcos, 333 S. Twin Oaks Valley Rd, San Marcos, CA 92096, USA.
| | - Keith A Trujillo
- Department of Psychology and Office for Training, Research and Education in the Sciences (OTRES), California State University, San Marcos, 333 S. Twin Oaks Valley Rd, San Marcos, CA 92096, USA.
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Shimozawa S, Usuda D, Sasaki T, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Hotchi Y, Tokunaga S, Osugi I, Katou R, Ito S, Asako S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M. High doses of dextromethorphan induced shock and convulsions in a 19-year-old female: A case report. World J Clin Cases 2023; 11:3870-3876. [PMID: 37383112 PMCID: PMC10294160 DOI: 10.12998/wjcc.v11.i16.3870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication. There has been a growing number of reported cases of toxicity in recent years. Generally, there are numerous instances of mild symptoms, with only a limited number of reports of severe cases necessitating intensive care. We presented the case of a female who ingested 111 tablets of dextromethorphan, leading to shock and convulsions and requiring intensive care that ultimately saved her life.
CASE SUMMARY A 19-year-old female was admitted to our hospital via ambulance, having overdosed on 111 tablets of dextromethorphan (15 mg) obtained through an online importer in a suicide attempt. The patient had a history of drug abuse and multiple self-inflicted injuries. At the time of admission, she exhibited symptoms of shock and altered consciousness. However, upon arrival at the hospital, the patient experienced recurrent generalized clonic convulsions and status epilepticus, necessitating tracheal intubation. The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock, and noradrenaline was administered as a vasopressor. Gastric lavage and activated charcoal were also administered after intubation. Through systemic management in the intensive care unit, the patient’s condition stabilized, and the need for vasopressors ceased. The patient regained consciousness and was extubated. The patient was subsequently transferred to a psychiatric facility, as suicidal ideation persisted.
CONCLUSION We report the first case of shock caused by an overdose of dextromethorphan.
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Affiliation(s)
- Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Toru Sasaki
- Clinical Training Center, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Suguru Asako
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo-city 113-8421, Tokyo, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-city 177-8521, Tokyo, Japan
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Lee D, Clark ED, Antonsdottir IM, Porsteinsson AP. A 2023 update on the advancements in the treatment of agitation in Alzheimer's disease. Expert Opin Pharmacother 2023; 24:691-703. [PMID: 36958727 DOI: 10.1080/14656566.2023.2195539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) in Alzheimer's Disease (AD) are associated with negative outcomes for patients and their care partners. Agitation is one of the most common and distressing NPS, yet we lack safe and effective treatment options. While nonpharmacologic interventions are considered first line treatment, these may not be effective or appropriate for every patient. Our current approaches to the pharmacologic treatment of agitation in AD consist of the off-label use of antipsychotics, sedative/hypnotics, anxiolytics, mood-stabilizing anticonvulsants, acetylcholinesterase inhibitors, NMDA receptor antagonists, and antidepressants. Despite their prevalent use, they have questionable efficacy and significant safety concerns. AREAS COVERED Advances in the understanding of neurobiological mechanisms of agitation have fueled recent clinical trials. This article is an update to our 2017 review. A comprehensive search of ClinicalTrials.gov was completed from January 2017 to June 2022 using the search terms "Alzheimer's Disease" and "Agitation". A subsequent scoping review was completed in PubMed and Google Scholar. Several agents were identified for promise in treating agitation, including: brexpiprazole, cannabinoids, dexmedetomidine, dextromethorphan, escitalopram, masupirdine, and prazosin. EXPERT OPINION Clinical trials remain underway utilizing both novel and repurposed agents to address symptoms of agitation in AD. With increasing understanding of the neurobiological mechanisms that fuel the development of agitation in AD, the use of enhanced trial design and conduct, advanced statistical approaches, and accelerated pathways for regulatory approval, we are advancing closer to having safe and efficacious treatment options for agitation in AD.
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Affiliation(s)
- Daniel Lee
- Alzheimer's Disease Care, Research and Education (AD-CARE), Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642
| | - Emily D Clark
- Alzheimer's Disease Care, Research and Education (AD-CARE), Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642
| | - Inga M Antonsdottir
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, 21205, Baltimore, MD, USA
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Anton P Porsteinsson
- Alzheimer's Disease Care, Research and Education (AD-CARE), Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642
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11
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Ferguson GP, Achilles SL, Meyn LA, Krajewski CM, Chappell CA, Vinekar K, Chen BA. Dextromethorphan as a novel nonopioid adjunctive agent for pain control with medication abortion: A randomized controlled trial. Contraception 2023; 118:109908. [PMID: 36332661 DOI: 10.1016/j.contraception.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate efficacy and satisfaction of dextromethorphan as a non-narcotic adjuvant to current analgesic regimens for medication abortion. STUDY DESIGN We conducted a randomized, double-blinded, placebo-controlled trial. We randomized eligible participants (N = 156) 1:1 to adjunctively take dextromethorphan (loading dose 60 mg and two subsequent 30 mg doses at 2 and 5 hours after misoprostol administration) or placebo combined with usual-care nonsteroidal anti-inflammatory medications ± opioids for pain. Participants reported pain scores and satisfaction using a secure texting application at 2, 5, 8, and 24 hours after misoprostol administration. Our primary outcome was worst pain score and total analgesic use. RESULTS Baseline demographics of enrolled participants were similar between randomization arms. Worst pain scores for participants receiving dextromethorphan versus placebo (8.0 vs 7.0, p = 0.06) did not differ. Total milligram usage of ibuprofen (800 mg vs 610 mg, p =.62), acetaminophen (1000 mg vs 1300 mg, p = 0.62), and opioids (10 mg vs 15 mg, p = 0.51) did not differ between the randomization groups. Participants randomized to placebo were significantly more likely to be satisfied with their pain control (91% vs 75%, p = 0.02). CONCLUSION Dextromethorphan used adjunctively with standard analgesics did not reduce pain associated with medication abortion. Participants who received dextromethorphan reported decreased satisfaction with their pain control. IMPLICATIONS Dextromethorphan used adjunctively with commonly used analgesic regimens did not reduce medication abortion associated pain. Many participants did not use analgesics as counseled, and nearly 25% used no analgesia during medication abortion.
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12
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Banaei-Boroujeni G, Rezayof A, Alijanpour S, Nazari-Serenjeh F. Targeting mediodorsal thalamic CB1 receptors to inhibit dextromethorphan-induced anxiety/exploratory-related behaviors in rats: The post-weaning effect of exercise and enriched environment on adulthood anxiety. J Psychiatr Res 2023; 157:212-222. [PMID: 36495603 DOI: 10.1016/j.jpsychires.2022.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Dextromethorphan (DXM) is an effective over-the-counter antitussive with an alarming increase as an abused drug for recreational purposes. Although reports of the association between DXM administration and anxiety, there are few investigations into the underlying DMX mechanisms of anxiogenic action. Thus, the present study aimed to investigate the role of the mediodorsal thalamus (MD) cannabinoid CB1 receptors (CB1Rs) in DXM-induced anxiety/exploratory-related behaviors in adult male Wistar rats. Animals were bilaterally cannulated in the MD regions. After one week, anxiety and exploratory behaviors were measured using an elevated plus-maze task (EPM) and a hole-board apparatus. Results showed that DXM (3-7 mg/kg, i. p.) dose-dependently increased anxiety-like behaviors. Intra-MD administration of ACPA (2.5-10 ng/rat), a selective CB1 receptor agonist, decreased anxiety-like effects of DXM. The blockade of MD CB1 receptors by AM-251 (40-120 ng/rat) did not affect the EPM task. However, it potentiated the anxiogenic response of an ineffective dose of DXM (3 mg/kg) in the animals. Moreover, the effect of post-weaning treadmill exercise (TEX) and enriched environment (EE) were examined in adulthood anxiety under the drug treatments. Juvenile rats were divided into TEX/EE and control groups. The TEX/EE-juvenile rats were placed on a treadmill and then exposed to EE for five weeks. Interestingly, compared to untreated animals, post-weaning TEX/EE inhibited the anxiety induced by DXM or AM-251/DXM. It can be concluded that the MD endocannabinoid system plays an essential role in the anxiogenic effect of dextromethorphan. Moreover, post-weaning exercise alongside an enriched environment may have an inhibitory effect on adulthood anxiety-like behaviors.
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Affiliation(s)
- Golnoush Banaei-Boroujeni
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Ameneh Rezayof
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran.
| | - Sakineh Alijanpour
- Department of Biology, Faculty of Science, Gonbad Kavous University, Gonbad Kavous, Iran
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13
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Ajenikoko MK, Ajagbe AO, Onigbinde OA, Okesina AA, Tijani AA. Review of Alzheimer's disease drugs and their relationship with neuron-glia interaction. IBRO Neurosci Rep 2022; 14:64-76. [PMID: 36593897 PMCID: PMC9803919 DOI: 10.1016/j.ibneur.2022.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022] Open
Abstract
Alzheimer's disease (AD) is the most common cause of dementia worldwide. Because Alzheimer's disease has no known treatment, sufferers and their caregivers must concentrate on symptom management. Astrocytes and microglia are now known to play distinct physiological roles in synaptic function, the blood-brain barrier, and neurovascular coupling. Consequently, the search for drugs that can slow the degenerative process in dementia sufferers continues because existing drugs are designed to alleviate the symptoms of Alzheimer's disease. Drugs that address pathological changes without interfering with the normal function of glia, such as eliminating amyloid-beta deposits, are prospective treatments for neuroinflammatory illnesses. Because neuron-astrocytes-microglia interactions are so complex, developing effective, preventive, and therapeutic medications for AD will necessitate novel methodologies and strategic targets. This review focused on existing medications used in treating AD amongst which include Donepezil, Choline Alphoscerate, Galantamine, Dextromethorphan, palmitoylethanolamide, citalopram, resveratrol, and solanezumab. This review summarizes the effects of these drugs on neurons, astrocytes, and microglia interactions based on their pharmacokinetic properties, mechanism of action, dosing, and clinical presentations.
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Affiliation(s)
- Michael Kunle Ajenikoko
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka, Uganda,Correspondence to: Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Uganda.
| | - Abayomi Oyeyemi Ajagbe
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, P.M.B. 900001 Abuja, Nigeria
| | - Oluwanisola Akanji Onigbinde
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, P.M.B. 900001 Abuja, Nigeria
| | - Akeem Ayodeji Okesina
- Department of Clinical Medicine and Community Health, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Ahmad Adekilekun Tijani
- Department of Anatomy, Faculty of Basic Medical Sciences, Modibbo Adama University, Yola, Nigeria
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14
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Seltzer JA, Sheth SK, Friedland S, Foreman E, Toney C, Raviendran R, McDaniel MA, Lasoff DR. Life-threatening pediatric dextromethorphan polistirex overdose. Am J Emerg Med 2022; 61:233.e1-233.e2. [PMID: 35989201 DOI: 10.1016/j.ajem.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022] Open
Abstract
Dextromethorphan polistirex is an extended-release formulation of dextromethorphan hydrobromide, marketed as Delsym® (Reckitt; Parsippany, NJ), with a duration of action roughly two to three times that of the standard formulation. The polistirex binder is responsible for the prolonged duration of action by slowing the release of active ingredient; the liberated dextromethorphan has unchanged pharmacokinetics and clinical effects. A 23-month-old male presented following a 900 mg (71.4 mg/kg) dextromethorphan polistirex ingestion 90 min prior. On arrival, he was unresponsive, tachycardic, and hypertensive with mydriasis, roving eye movements, rotary nystagmus, and opisthotonos. Approximately 90 min after arrival, he required intubation for airway protection. The blood dextromethorphan concentration from 75 min after arrival was 110 ng/mL (10-40 ng/ml therapeutic). He was extubated approximately 13 h after arrival and discharged that day. Most pediatric dextromethorphan overdoses produce mild symptoms that are not considered to be life-threatening. Life threatening overdoses are rare. The toxic dextromethorphan dose and blood concentration as well as the toxicokinetics of the polistirex formulation are not well defined. Our case suggests that a blood dextromethorphan concentration exceeding 100 ng/mL can be toxic in this age group, however further study is needed.
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Affiliation(s)
- Justin A Seltzer
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA, United States of America; VA San Diego Healthcare System, San Diego, CA, United States of America; Rady Children's Hospital San Diego, San Diego, CA, United States of America.
| | - Sarika K Sheth
- Rady Children's Hospital San Diego, San Diego, CA, United States of America
| | - Sarah Friedland
- Rady Children's Hospital San Diego, San Diego, CA, United States of America
| | - Emily Foreman
- Rady Children's Hospital San Diego, San Diego, CA, United States of America
| | - Caitlin Toney
- Rady Children's Hospital San Diego, San Diego, CA, United States of America
| | - Raveen Raviendran
- Rady Children's Hospital San Diego, San Diego, CA, United States of America
| | - Michele A McDaniel
- Rady Children's Hospital San Diego, San Diego, CA, United States of America
| | - Daniel R Lasoff
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA, United States of America; VA San Diego Healthcare System, San Diego, CA, United States of America; Rady Children's Hospital San Diego, San Diego, CA, United States of America
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15
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Schatzberg AF. Understanding the Efficacy and Mechanism of Action of a Dextromethorphan-Bupropion Combination: Where Does It Fit in the NMDA Versus mu-Opioid Story? Am J Psychiatry 2022; 179:448-450. [PMID: 35775155 DOI: 10.1176/appi.ajp.20220434] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alan F Schatzberg
- Department of Psychiatry, Stanford University School of Medicine, Stanford, Calif
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16
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Tabuteau H, Jones A, Anderson A, Jacobson M, Iosifescu DV. Effect of AXS-05 ( Dextromethorphan-Bupropion) in Major Depressive Disorder: A Randomized Double-Blind Controlled Trial. Am J Psychiatry 2022; 179:490-499. [PMID: 35582785 DOI: 10.1176/appi.ajp.21080800] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Altered glutamatergic neurotransmission is implicated in the pathogenesis of major depressive disorder. AXS-05 (dextromethorphan-bupropion) is an oral NMDA receptor antagonist and sigma-1 receptor agonist, which utilizes inhibition of CYP2D6 to increase its bioavailability. This phase 2 trial assessed the efficacy and safety of dextromethorphan-bupropion in the treatment of major depressive disorder. METHODS This randomized, double-blind, multicenter, parallel-group trial evaluated dextromethorphan-bupropion versus the active comparator sustained-release bupropion in patients 18-65 years old with a diagnosis of major depressive disorder of moderate or greater severity. Patients were randomly assigned to receive either dextromethorphan-bupropion (45 mg/105 mg tablet) or bupropion (105 mg tablet), once daily for the first 3 days and twice daily thereafter, for a total of 6 weeks. The primary endpoint was overall treatment effect on Montgomery-Åsberg Depression Rating Scale (MADRS) score (average of the change from baseline for weeks 1-6), assessed in all randomized patients whose diagnosis and severity were confirmed by an independent assessor and who received at least one dose of study medication and had at least one postbaseline assessment. RESULTS Of 97 patients randomized, 17 did not have a confirmed diagnosis and severity based on the independent assessment, resulting in 80 patients in the efficacy population (dextromethorphan-bupropion, N=43; bupropion, N=37). The mean change from baseline in MADRS score over weeks 1-6 (overall treatment effect) was significantly greater with dextromethorphan-bupropion than with bupropion (-13.7 points vs. -8.8 points; least-squares mean difference=-4.9; 95% CI=-3.1, -6.8). MADRS score change with dextromethorphan-bupropion was significantly greater than with bupropion at week 2 and every time point thereafter (week 6: -17.3 vs. -12.1 points; least-squares mean difference=-5.2, 95% CI=-1.1, -9.3). Remission rates were significantly greater with dextromethorphan-bupropion at week 2 and every time point thereafter (week 6: 46.5% vs. 16.2%; least-squares mean difference=30.3%, 95% CI=11.2, 49.4). Response rates (≥50% decrease in MADRS score from baseline) at week 6 were 60.5% with dextromethorphan-bupropion and 40.5% with bupropion (least-squares mean difference=19.9%, 95% CI=-1.6, 41). Most secondary outcomes favored dextromethorphan-bupropion. The most common adverse events with dextromethorphan-bupropion were dizziness, nausea, dry mouth, decreased appetite, and anxiety. Dextromethorphan-bupropion was not associated with psychotomimetic effects, weight gain, or sexual dysfunction. CONCLUSIONS In patients with major depression, dextromethorphan-bupropion (AXS-05) significantly improved depressive symptoms compared with bupropion and was generally well tolerated.
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Affiliation(s)
- Herriot Tabuteau
- Axsome Therapeutics, Inc., New York (Tabuteau, Jones, Anderson, Jacobson); Nathan Kline Institute and New York University School of Medicine, New York (Iosifescu)
| | - Amanda Jones
- Axsome Therapeutics, Inc., New York (Tabuteau, Jones, Anderson, Jacobson); Nathan Kline Institute and New York University School of Medicine, New York (Iosifescu)
| | - Ashley Anderson
- Axsome Therapeutics, Inc., New York (Tabuteau, Jones, Anderson, Jacobson); Nathan Kline Institute and New York University School of Medicine, New York (Iosifescu)
| | - Mark Jacobson
- Axsome Therapeutics, Inc., New York (Tabuteau, Jones, Anderson, Jacobson); Nathan Kline Institute and New York University School of Medicine, New York (Iosifescu)
| | - Dan V Iosifescu
- Axsome Therapeutics, Inc., New York (Tabuteau, Jones, Anderson, Jacobson); Nathan Kline Institute and New York University School of Medicine, New York (Iosifescu)
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17
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Ji JJ, Zhao J, Xiang P, Yan H, Shen M. Chiral analysis of dextromethorphan and levomethorphan in human hair by liquid chromatography-tandem mass spectrometry. Forensic Toxicol 2022; 40:312-321. [PMID: 36454412 DOI: 10.1007/s11419-022-00620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Methorphan exists in two enantiomeric forms including dextromethorphan and levomethorphan. Dextromethorphan is an over-the-counter antitussive drug, whereas levomethorphan is strictly controlled as a narcotic drug. Chiral analysis of methorphan could, therefore, assist clinicians and forensic experts in differentiating between illicit and therapeutic use and in tracing the source of the drug. METHODS A method for enantiomeric separation and quantification of levomethorphan and dextromethorphan in human hair was developed and validated using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Hair was extracted in hydrochloric acid/methanol (1:20, v/v). The supernatant were separated using a Supelco Astec Chirobiotic™ V2 column (250 × 2.1 mm, i.d., 5 μm particle size) and analyzed on a triple quadrupole linear ion trap mass spectrometer in multiple reaction monitoring mode. RESULTS The limits of detection for dextromethorphan and levomethorphan were 2 and 1 pg/mg, respectively; the lower limit of quantification was 2 pg/mg for both drugs. Good linearity (r > 0.995) was observed for both analytes over the linear range. Precision values were below 10% for both analytes; accuracy values ranged from 87.5 to 101%. The extraction recoveries were 78.3-98.4%, and matrix effects were 70.5-88.6%. This method was applied to human hair samples from 120 people suspected of methorphan use to further distinguish the drug chirality. Dextromethorphan was detected in all 120 samples at a concentration range of 2.7-19,100 pg/mg, whereas levomethorphan was not detected in any sample. CONCLUSIONS A sensitive quantitative method was established for the enantiomeric separation of dextromethorphan and levomethorphan in hair. This is the first study to achieve chiral analysis of methorphan in human hair.
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Affiliation(s)
- Jiao-Jiao Ji
- Department of Forensic Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Junbo Zhao
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Ping Xiang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Hui Yan
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China
| | - Min Shen
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China.
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Ward K, Citrome L. AXS-05: an investigational treatment for Alzheimer's disease-associated agitation. Expert Opin Investig Drugs 2022; 31:773-780. [PMID: 35763451 DOI: 10.1080/13543784.2022.2096006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Agitation is common in patients with Alzheimer's disease (AD). Although nonpharmacologic de-escalation strategies are recommend as first-line treatment, medication is often needed to treat agitation. Currently, there are no FDA-approved medications for this indication. Psychotropics used to treat agitation include antipsychotics, which are notable for their efficacy but also their potential to cause serious side effects. AXS-05, a combination of dextromethorphan and bupropion, is currently being investigated for this indication. AREAS COVERED This review will discuss the pharmacology of AXS-05 and available clinical trial results from completed Phase I and Phase II/III studies assessing the potential for this compound to treat agitation in patients with AD. Ongoing research investigating AXS-05 for this indication will also be highlighted. Resources used for this review include PubMed, Embase, clinicaltrials.gov, and literature available on the manufacturer's website. EXPERT OPINION Early released clinical trial data indicate that AXS-05 may be a useful option to treat agitation in patients with AD, and that it appears to be generally well tolerated. AXS-05 may be especially helpful for patients with comorbid depression, when considering available data from separate phase III studies assessing the efficacy and safety of this compound in the treatment of depression.
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Affiliation(s)
- Kristen Ward
- Clinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Leslie Citrome
- Clinical Professor of Psychiatry & Behavioral Sciences, Department of Psychiatry and Behavioral Science, New York Medical College, Valhalla, NY, USA
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Hotha PP, Gupta R, Narang M. Dextromethorphan-induced altered level of consciousness in children: A case series. Curr Drug Saf 2022; 18:389-392. [PMID: 35670336 DOI: 10.2174/1574886317666220606145809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/24/2022] [Accepted: 03/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dextromethorphan, a N-methyl-d-aspartate receptor antagonist, has been used as cold and cough medication. Serious adverse events with therapeutic doses of dextromethorphan are rarely observed. Here, we report three cases of altered level of consciousness in children with therapeutic dose of dextromethorphan. CASE PRESENTATION In all three cases, children developed altered level of consciousness after taking first dose of syrup dextromethorphan. Children were unresponsive to any verbal command and pain stimuli. Medical history revealed no pre-existing comorbidities. Other systemic, cardiovascular, abdominal, respiratory and nervous system examinations were normal. All patients were hospitalised and managed with symptomatic and supportive care. Dextromethorphan was stopped. After adequate treatment, all of them recovered satisfactorily. The causality assessment was done based on the World Health Organization Uppsala Monitoring Centre causality scale and it was probable/likely in all three cases. CONCLUSION In children, altered level of consciousness could occur with therapeutic doses of dextromethorphan; hence, health care professionals should prescribe dextromethorphan with extreme caution.
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Affiliation(s)
| | - Rachna Gupta
- Department of Pharmacology, University College of Medical Sciences, Delhi
| | - Manish Narang
- Department of Pharmacology, University College of Medical Sciences, Delhi
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Doello K, Mesas C, Quiñonero F, Rama AR, Vélez C, Perazzoli G, Ortiz R. Antitumor Effect of Traditional Drugs for Neurological Disorders: Preliminary Studies in Neural Tumor Cell Lines. Neurotox Res 2022; 40:1645-1652. [PMID: 36447028 PMCID: PMC9797471 DOI: 10.1007/s12640-022-00606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
Glioblastoma multiforme is the most common malignant primary brain tumor in adults. Despite new treatments developed including immunomodulation using vaccines and cell therapies, mortality remains high due to the resistance mechanisms presented by these tumor cells and the function of the blood-brain barrier that prevents the entry of most drugs. In this context of searching for new glioblastoma therapies, the study of the existing drugs to treat neurological disorder is gaining great relevance. The aim of this study was to determine, through a preliminary in vitro study on human glioblastoma (A172, LN229), anaplastic glioma (SF268) and neuroblastoma (SK-N-SH) cell lines, the possible antitumor activity of the active principles of several drugs (levomepromazine, haloperidol, lacosamide, valproic acid, levetiracetam, glatiramer acetate, fingolimod, biperiden and dextromethorphan) with the ability to cross the blood-brain barrier and that are commonly used in neurological disorders. Results showed that levetiracetam, valproic acid, and haloperidol were able to induce a relevant synergistic antitumor effect when associated with the chemotherapy currently used in clinic (temozolomide). Regarding the mechanism of action, haloperidol, valproic acid and levomepromazine caused cell death by apoptosis, while biperiden and dextromethorphan induced autophagy. Fingolimod appeared to have anoikis-related cell death. Thus, the assayed drugs which are able to cross the blood-brain barrier could represent a possibility to improve the treatment of neural tumors, though future in vivo studies and clinical trials will be necessary to validate it.
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Affiliation(s)
- Kevin Doello
- Institute of Biopathology and Regenerative Medicine (IBIMER), Biomedical Research Center (CIBM), 18100 Granada, Spain ,grid.411380.f0000 0000 8771 3783Medical Oncology Service, Virgen de Las Nieves Hospital, 18014 Granada, Spain
| | - Cristina Mesas
- Institute of Biopathology and Regenerative Medicine (IBIMER), Biomedical Research Center (CIBM), 18100 Granada, Spain ,grid.4489.10000000121678994Instituto Biosanitario de Granada (Ibs.Granada), SAS-Universidad de Granada, 18012 Granada, Spain ,grid.4489.10000000121678994Department of Anatomy and Embryology, University of Granada, 18071 Granada, Spain
| | - Francisco Quiñonero
- Institute of Biopathology and Regenerative Medicine (IBIMER), Biomedical Research Center (CIBM), 18100 Granada, Spain ,grid.4489.10000000121678994Instituto Biosanitario de Granada (Ibs.Granada), SAS-Universidad de Granada, 18012 Granada, Spain ,grid.4489.10000000121678994Department of Anatomy and Embryology, University of Granada, 18071 Granada, Spain
| | - Ana R. Rama
- Institute of Biopathology and Regenerative Medicine (IBIMER), Biomedical Research Center (CIBM), 18100 Granada, Spain ,grid.21507.310000 0001 2096 9837Department of Health Sciences, University Jaén, 23071 Jaén, Spain
| | - Celia Vélez
- Institute of Biopathology and Regenerative Medicine (IBIMER), Biomedical Research Center (CIBM), 18100 Granada, Spain ,grid.4489.10000000121678994Instituto Biosanitario de Granada (Ibs.Granada), SAS-Universidad de Granada, 18012 Granada, Spain ,grid.4489.10000000121678994Department of Anatomy and Embryology, University of Granada, 18071 Granada, Spain
| | - Gloria Perazzoli
- Institute of Biopathology and Regenerative Medicine (IBIMER), Biomedical Research Center (CIBM), 18100 Granada, Spain ,grid.28020.380000000101969356Department of Medicine, Physiotherapy and Nursing, University of Almería, 04120 Almería, Spain
| | - Raúl Ortiz
- Institute of Biopathology and Regenerative Medicine (IBIMER), Biomedical Research Center (CIBM), 18100 Granada, Spain ,grid.4489.10000000121678994Instituto Biosanitario de Granada (Ibs.Granada), SAS-Universidad de Granada, 18012 Granada, Spain ,grid.4489.10000000121678994Department of Anatomy and Embryology, University of Granada, 18071 Granada, Spain
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Garg U, Taboada E, Kurzinski KL, Frazee CC, Weidemann DK, Srivastava T. Solving an unusual case of acute kidney injury: Answers. Pediatr Nephrol 2021; 36:4137-4140. [PMID: 34606004 DOI: 10.1007/s00467-021-05263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Eugenio Taboada
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Katherine L Kurzinski
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, MO, Kansas City, USA
| | - Clarence C Frazee
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Darcy K Weidemann
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, MO, Kansas City, USA
| | - Tarak Srivastava
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. .,Department of Pediatrics, Section of Nephrology, Children's Mercy Hospital, MO, Kansas City, USA.
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22
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Ghasemzadeh Z, Seddighfar M, Alijanpour S, Rezayof A. Ventral tegmental area serotonin 5-HT 1A receptors and corticolimbic cFos/BDNF/GFAP signaling pathways mediate dextromethorphan/morphine anti-allodynia. Physiol Behav 2021; 239:113522. [PMID: 34242672 DOI: 10.1016/j.physbeh.2021.113522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 12/30/2022]
Abstract
AIMS The present study examined the role of ventral tegmental area (VTA) serotonergic 5HT1A receptors in dextromethorphan/morphine-induced anti-allodynia and the possible changes of corticolimbic cFos, brain-derived neurotrophic factor (BDNF), and glial fibrillary acidic protein (GFAP) following the treatments. MATERIALS AND METHODS The VTA cannulation and the chronic constriction of the sciatic nerve were performed in male Wistar rats. Flexion withdrawal thresholds to mechanical stimulation in the hind-limb were determined using von Frey hairs. The expressions of cFos, BDNF, and GFAP were evaluated using the Western blotting technique. KEY FINDINGS BDNF (in the hippocampus), and GFAP (in the targeted sites) levels were increased following neuropathic pain. Morphine administration induced an anti-allodynic effect with a decrease in the amygdala BDNF level. Dextromethorphan/morphine-induced anti-allodynia was accompanied by the decrease of hippocampus/amygdala/PFC GFAP and amygdala cFos expressions. The PFC BDNF expression level was increased in dextromethorphan/morphine-treated rats. Intra-VTA microinjection of (S)-WAY100135 (1 µg/rat), a selective 5-HT1A receptor antagonist, inhibited the anti-allodynic effect of dextromethorphan/morphine. This treatment increased the cFos level in the hippocampus and the amygdala while decreased the PFC level of cFos. The hippocampal BDNF expression was significantly increased, while the amygdala and the PFC expressions of BDNF were decreased under treatment. (S)-WAY100135 plus dextromethorphan/morphine increased the hippocampal/amygdala and PFC levels of GFAP. SIGNIFICANCE These findings indicate that dextromethorphan could potentiate the analgesic effect of morphine via the implication of the VTA serotonin 5-HT1A receptors. It seems that the changes in the corticolimbic cFos/BDNF/GFAP signaling pathway may be involved in the observed anti-allodynic effect.
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Affiliation(s)
- Zahra Ghasemzadeh
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Masoud Seddighfar
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Sakineh Alijanpour
- Department of Biology, Faculty of Science, Gonbad Kavous University, Gonbad Kavous, Iran
| | - Ameneh Rezayof
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran.
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23
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Ontiveros S, Cantrell L. Fatal cold medication poisoning in an adolescent. Am J Emerg Med 2021; 52:269.e1-269.e2. [PMID: 34454805 DOI: 10.1016/j.ajem.2021.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Toxicity from the intentional misuse of over-the-counter (OTC) combination cold products has been widely recognized. Adolescents are most frequently involved and dextromethorphan containing products are the most popular. Desired symptoms include stimulatory effects, euphoria, hallucinations, and dissociation. Potential adverse effects include tachycardia, agitation, hyperthermia, acidosis, and coma. However, mortality is rare [ 1-3]. Co-formulated ingredients such as acetaminophen, pseudoephedrine, and antihistamines may also be present and potentiate dangerous effects. We report a case of an adolescent decedent with markedly elevated postmortem chlorpheniramine (CPA) and dextromethorphan (DXM) blood concentrations and no other identifiable cause of death.
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Affiliation(s)
- Sam Ontiveros
- UC San Diego Medical Center, Dept. of Emergency Medicine, 200 W. Arbor Drive, San Diego, CA 92103-8676, USA.
| | - Lee Cantrell
- California Poison Control System, San Diego Division, 200 W. Arbor Dr., San Diego, CA, 92103-8925, USA
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24
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Kayode AA, Kayode OT, Oridota OJ. Alterations in the biochemical indices in Wistar rats exposed to an overdose of codeine and dextromethorphan. J Taibah Univ Med Sci 2021; 16:198-208. [PMID: 33897324 PMCID: PMC8046956 DOI: 10.1016/j.jtumed.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study investigates the impact of repeated oral exposure to two cough syrups containing codeine and dextromethorphan (DXM) on male Wistar rats. METHODS We divided 35 rats into seven groups of five rats each. Group A was given 0.5 mL of distilled water, Groups B, C, and D were given 0.1, 0.2 and 0.4 mL/kg body weight (b. w) of cough syrup containing codeine (CSC), respectively, and Groups E, F, and G were administered 0.1, 0.2 and 0.4 mL/kg b. w of cough syrup containing DXM, respectively. The treatment was continued for 28 days. The rats were euthanised under mild diethyl ether anaesthesia. The kidney, liver, and blood of the rats were examined for further analyses. RESULTS Significant (p < 0.05) alterations were observed in the liver function tests: ALT, AST, ALP, albumin, and total bilirubin. All doses of CSC and DXM significantly increased the ALT levels (p < 0.05). Furthermore, similar significant alterations were observed for the kidney function parameters such as creatinine, urea, and uric acid (p < 0.05). All doses of DXM caused significant elevations in the levels of urea (p < 0.05). The histopathological evaluations also showed slight changes in the architecture of the liver, kidney, and brain tissues. CONCLUSION The findings of this study suggest that overdose of these cough syrups may predispose the consumer to hepatic and renal injuries.
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Affiliation(s)
- Abolanle A. Kayode
- Department of Biochemistry, School of Basic Medical Sciences, Babcock University, Ilishan - Remo, Nigeria
| | - Omowumi T. Kayode
- Biochemistry Unit, Department of Biological Sciences, Mountain Top University, Ogun State, Nigeria
| | - Opemipo J. Oridota
- Department of Chemical and Food Sciences, College of Natural and Applied Sciences, Bells University of Technology, Ota, Ogun State, Nigeria
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25
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Klima S, Brüll M, Spreng AS, Suciu I, Falt T, Schwamborn JC, Waldmann T, Karreman C, Leist M. A human stem cell-derived test system for agents modifying neuronal N-methyl-D-aspartate-type glutamate receptor Ca 2+-signalling. Arch Toxicol 2021; 95:1703-22. [PMID: 33713149 DOI: 10.1007/s00204-021-03024-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
Methods to assess neuronal receptor functions are needed in toxicology and for drug development. Human-based test systems that allow studies on glutamate signalling are still scarce. To address this issue, we developed and characterized pluripotent stem cell (PSC)-based neural cultures capable of forming a functional network. Starting from a stably proliferating neuroepithelial stem cell (NESC) population, we generate “mixed cortical cultures” (MCC) within 24 days. Characterization by immunocytochemistry, gene expression profiling and functional tests (multi-electrode arrays) showed that MCC contain various functional neurotransmitter receptors, and in particular, the N-methyl-d-aspartate subtype of ionotropic glutamate receptors (NMDA-R). As this important receptor is found neither on conventional neural cell lines nor on most stem cell-derived neurons, we focused here on the characterization of rapid glutamate-triggered Ca2+ signalling. Changes of the intracellular free calcium ion concentration ([Ca2+]i) were measured by fluorescent imaging as the main endpoint, and a method to evaluate and quantify signals in hundreds of cells at the same time was developed. We observed responses to glutamate in the low µM range. MCC responded to kainate and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), and a subpopulation of 50% had functional NMDA-R. The receptor was modulated by Mg2+, Zn2+ and Pb2+ in the expected ways, and various toxicologically relevant agonists (quinolinic acid, ibotenic acid, domoic acid) triggered [Ca2+]i responses in MCC. Antagonists, such as phencyclidine, ketamine and dextromethorphan, were also readily identified. Thus, the MCC developed here may fill an important gap in the panel of test systems available to characterize the effects of chemicals on neurotransmitter receptors.
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26
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Majeed A, Xiong J, Teopiz KM, Ng J, Ho R, Rosenblat JD, Phan L, Cao B, McIntyre RS. Efficacy of dextromethorphan for the treatment of depression: a systematic review of preclinical and clinical trials. Expert Opin Emerg Drugs 2021; 26:63-74. [PMID: 33682569 DOI: 10.1080/14728214.2021.1898588] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The large percentage of adults with major depressive disorder (MDD) insufficiently responding and/or tolerating conventional monoamine-based antidepressants invites the need for mechanistically novel treatments. Convergent evidence implicates glutamatergic signaling as a potential therapeutic target in MDD. AREAS COVERED The synthesis herein of preclinical and clinical studies indicates that dextromethorphan (DXM) is well tolerated and exhibits clinically significant antidepressant effects; DXM combined with bupropion has demonstrated replicated and relatively rapid onset efficacy in adults with MDD. DXM efficacy has been preliminarily reported in adults with bipolar depression. The combination of DXM and bupropion represents a pharmacokinetic and pharmacodynamic synergy which may account for the rapidity of action in MDD. EXPERT OPINION The combination of DXM and bupropion is a safe, well tolerated and efficacious treatment option in adults with MDD. Priority questions are whether DXM/bupropion is uniquely effective across discrete domains of psychopathology (e.g. anhedonia, reward processing, general cognitive systems) and/or whether it is able to significantly improve patient-reported outcomes (e.g. quality of life, psychosocial functioning). The availability of ketamine/esketamine and DXM/bupropion instantiates the relevance of glutamate as a treatment target in MDD. Studies in bipolar depression with DXM/bupropion are warranted as well as in MDD with suicidality.
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Affiliation(s)
- Amna Majeed
- Temerty Faculty of Medicine, University of Toronto, Canada
| | - Jiaqi Xiong
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Kayla M Teopiz
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Jason Ng
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Roger Ho
- Institute for Health Innovation and Technology (Ihealthtech), National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joshua D Rosenblat
- Department of Pharmacology, University of Toronto, Toronto, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Lee Phan
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University (SWU), P. R. China
| | - Roger S McIntyre
- Department of Pharmacology, University of Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada.,Brain and Cognition Discovery Foundation, Toronto, Canada
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27
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Sarkar I, Sen A. In silico screening predicts common cold drug Dextromethorphan along with Prednisolone and Dexamethasone can be effective against novel Coronavirus disease (COVID-19). J Biomol Struct Dyn 2020; 40:3706-3710. [PMID: 33225870 PMCID: PMC7754926 DOI: 10.1080/07391102.2020.1850528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The ongoing outbreak of Coronavirus disease 2019 (COVID-19) is a matter of great concern. Although the mortality rate caused by this virus is less than that of SARS and MERS, it is showing higher efficacy in terms of human-to-human transmission. Several strategies have been taken by scientists and researchers worldwide to combat this virus. Numerous phytochemicals and synthesized chemicals are under incessant inspection to obtain a potent anti-covid drug. Since, till now no precise therapy is available for covid patients, researchers are trying to categorize all possible anti-covid substances. Repurposing of drugs and combined drug therapy are becoming popular in treating such viral diseases. In this study, we are proposing the repurposing of three chemicals-Dextromethorphan, Prednisolone and Dexamethasone as anti-covid agents. We have used the tertiary structure of Coronavirus main protease (Mpro) with PDB ID 6LU7 as the target protein in this analysis. Molecular docking and dynamics study further revealed their synergistic effect against the COVID-19 protease protein. Communicated by Ramaswamy H. Sarma
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Affiliation(s)
- Indrani Sarkar
- Bioinformatics Facility, Department of Botany, University of North Bengal, India
| | - Arnab Sen
- Bioinformatics Facility, Department of Botany, University of North Bengal, India
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28
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Mesripour A, Golbidi M, Hajhashemi V. Dextromethorphan improved cyclosporine-induced depression in mice model of despair. Res Pharm Sci 2020; 15:447-453. [PMID: 33628286 PMCID: PMC7879785 DOI: 10.4103/1735-5362.297847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/22/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022] Open
Abstract
Background and purpose: Cyclosporine (Cyc) is a calcineurin inhibitor used in immunosuppressive therapy that may cause psychological problems such as depression. Previous investigations have shown the positive antidepressant effects of dextromethorphan (Dxt). Therefore, the aim of this study was the evaluation of the Dxt effect on Cyc-induced depression in an animal model of despair in two separate cohorts. Experimental approach: Male albino mice were used, first total activity was evaluated by the locomotor test, and then after that, the immobility time during the forced swimming test was measured as an indicator of depression. Cyc, Dxt, and fluoxetine (the reference antidepressant drug) were all administered IP. Tests were performed either 4 h after injection (cohort 4 h) or in separate groups 24 h after injection (cohort 24 h). Findings/Results: Cyc reduced total activity measured after 4 h in the locomotor test and it was normalized after 24 h. Immobility time dose-dependently increased during the forced swimming test and remained so after 24 h (cohort 24 h; Cyc 10, 20, and 40 mg/kg, 157 ± 22, 180 ± 8, and 228 ± 4 s, respectively; Cyc 40 mg/kg P < 0.001 vs control 142 ± 13 s) that indicated Cyc induced depressive-like behavior. Dxt (30 mg/kg) like fluoxetine reduced the immobility time when co-administered with Cyc compared with Cyc and remained effective after 24 h (cohort 24 h; 120 ± 30, P < 0.001 vs Cyc 40 mg/kg alone). Conclusion and implications: Dxt was a useful drug for preventing Cyc-induced depression that remained effective for 24 h in mice. Since interpretation from animal studies to humans must be done with caution further clinical studies on the effect of Dxt in patients suffering from psychological side effects of Cyc may be reasonable.
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Affiliation(s)
- Azadeh Mesripour
- Department of Pharmacology and Toxicology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| | - Mojgan Golbidi
- Department of Pharmacology and Toxicology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| | - Valiollah Hajhashemi
- Department of Pharmacology and Toxicology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran.,Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
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29
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Pandey P, Prasad K, Prakash A, Kumar V. Insights into the biased activity of dextromethorphan and haloperidol towards SARS-CoV-2 NSP6: in silico binding mechanistic analysis. J Mol Med (Berl) 2020; 98:1659-1673. [PMID: 32965508 PMCID: PMC7509052 DOI: 10.1007/s00109-020-01980-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/28/2022]
Abstract
Abstract The outbreak of novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus continually led to infect a large population worldwide. SARS-CoV-2 utilizes its NSP6 and Orf9c proteins to interact with sigma receptors that are implicated in lipid remodeling and ER stress response, to infect cells. The drugs targeting the sigma receptors, sigma-1 and sigma-2, have emerged as effective candidates to reduce viral infectivity, and some of them are in clinical trials against COVID-19. The antipsychotic drug, haloperidol, exerts remarkable antiviral activity, but, at the same time, the sigma-1 benzomorphan agonist, dextromethorphan, showed pro-viral activity. To explore the potential mechanisms of biased binding and activity of the two drugs, haloperidol and dextromethorphan towards NSP6, we herein utilized molecular docking–based molecular dynamics simulation studies. Our extensive analysis of the protein-drug interactions, structural and conformational dynamics, residual frustrations, and molecular switches of NSP6-drug complexes indicates that dextromethorphan binding leads to structural destabilization and increase in conformational dynamics and energetic frustrations. On the other hand, the strong binding of haloperidol leads to minimal structural and dynamical perturbations to NSP6. Thus, the structural insights of stronger binding affinity and favorable molecular interactions of haloperidol towards viral NSP6 suggests that haloperidol can be potentially explored as a candidate drug against COVID-19. Key messages •Inhibitors of sigma receptors are considered as potent drugs against COVID-19. •Antipsychotic drug, haloperidol, binds strongly to NSP6 and induces the minimal changes in structure and dynamics of NSP6. •Dextromethorphan, agonist of sigma receptors, binding leads to overall destabilization of NSP6. •These two drugs bind with NSP6 differently and also induce differences in the structural and conformational changes that explain their different mechanisms of action. •Haloperidol can be explored as a candidate drug against COVID-19. Electronic supplementary material The online version of this article (10.1007/s00109-020-01980-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Preeti Pandey
- Department of Chemistry & Biochemistry, University of Oklahoma, 101 Stephenson Parkway, Norman, OK, 73019-5251, USA
| | - Kartikay Prasad
- Amity Institute of Neuropsychology & Neurosciences (AINN), Amity University, Noida, UP, 201303, India
| | - Amresh Prakash
- Amity Institute of Integrative Sciences and Health (AIISH), Amity University Haryana, Gurgaon, 122413, India.
| | - Vijay Kumar
- Amity Institute of Neuropsychology & Neurosciences (AINN), Amity University, Noida, UP, 201303, India.
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30
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Hu T, Hou Y, Lu J, Wang X, Wei D, Wang C. Dextromethorphan - A widely-used cough suppressant - Induces local anaphylaxis via MRGPRX2 on mast cells. Chem Biol Interact 2020; 330:109248. [PMID: 32871113 DOI: 10.1016/j.cbi.2020.109248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023]
Abstract
Dextromethorphan (DM) is a cough suppressant available in many prescribed and over-the-counter medications. Adverse reactions induced by DM have been regularly reported, including allergic skin reactions in some cases. However, the underlying mechanisms of local anaphylaxis induced by DM have not been elucidated. In this study, we found that DM could activate mast cells to increase calcium mobilization and release β-hexosaminidase, histamine, tumor necrosis factor-α, MCP-1, and IL-8 in a dose-dependent manner. The allergic reactions were confirmed by hind paw swelling and extravasation assay in vivo. Furthermore, DM was revealed to induce local anaphylaxis via MRGPRX2 by the mast cell-deficient kitW-sh/W-sh mice and MRGPRX2 knockdown mast cells. And the MRGPRX2-HEK293/CMC analysis and frontal analysis also showed that DM has a considerable affinity with MRGPRX2. Together, our findings suggest that close monitoring should be drawn on patients with DM for its potential anaphylaxis via MRGPRX2.
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Affiliation(s)
- Tian Hu
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Yajing Hou
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Jiayu Lu
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Xiangjun Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Di Wei
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Cheng Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, PR China.
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31
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Kale SG, Shetty A, Moin A, Archana TS, Kumar P, Bagga V. Comparative Evaluation of Preemptive Analgesia of Dextromethorphan and Ibuprofen in Third Molar Surgeries. Ann Maxillofac Surg 2020; 10:312-319. [PMID: 33708573 PMCID: PMC7944010 DOI: 10.4103/ams.ams_252_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction: Postoperative pain following third molar removal is one of the most common and unpleasant complications encountered in routine surgical practice. Various methods have been advocated to minimize the postoperative pain: preemptive analgesia is one of those found to be effective. Objective: The aim of this study was to compare the preemptive analgesic efficacy of Dextromethorphan (DM) and Ibuprofen in the third molar surgeries. Material and Methods: Thirty-six patients reporting to our institution were included in the study. Patients were randomized into three groups of 12 patients each to receive either DM 30 mg, ibuprofen 100 mg, or placebo in the form of multivitamin syrup, 90 min before the procedure. The difficulty of removal of the teeth was assessed using Campbell difficulty score. The study objectives were to evaluate the time elapsed since surgery after which the patient took their first dose of aceclofenac, to evaluate the postoperative pain using visual analog scale score, and to record the number of aceclofenac tablets consumed postoperatively. Results: The results of the study revealed that preemptive DM was significantly better than ibuprofen and placebo in the duration of time that elapsed before the patients consumed their first analgesic postoperatively. Preemptive DM also reduced the total number of aceclofenac tablets consumed on the day of surgery and on the 1st postoperative day, but the difference was not statistically significant. Between the two drugs, DM is better suited for providing preemptive analgesia. No side effects at a dose of 30 mg of DM were noted in any of the patients. Conclusion: DM premedication is a viable preemptive analgesic in reducing postoperative pain.
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Affiliation(s)
- Saurabh Gajanan Kale
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Ayesha Moin
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - T S Archana
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Praveen Kumar
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Vivek Bagga
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
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Carbonaro TM, Johnson MW, Griffiths RR. Subjective features of the psilocybin experience that may account for its self-administration by humans: a double-blind comparison of psilocybin and dextromethorphan. Psychopharmacology (Berl) 2020; 237:2293-304. [PMID: 32500212 DOI: 10.1007/s00213-020-05533-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
RATIONALE Although both psilocybin and dextromethorphan (DXM) produce psychedelic-like subjective effects, rates of non-medical use of psilocybin are consistently greater than DXM. OBJECTIVE New data are presented from a study of psilocybin and DXM relevant to understanding the features of psilocybin subjective effects that may account for its higher rates of non-medical use. METHODS Single, acute oral doses of psilocybin (10, 20, 30 mg/70 kg), DXM (400 mg/70 kg), and placebo were administered under double-blind conditions to 20 healthy participants with histories of hallucinogen use. RESULTS High doses of both drugs produced similar time courses and increases in participant ratings of peak overall drug effect strength. Nine subjective effect domains are proposed to be related to the reinforcing effects of psilocybin: liking, visual effects, positive mood, insight, positive social effects, increased awareness of beauty (both visual and music), awe/amazement, meaningfulness, and mystical experience. For most ratings, (1) psilocybin and DXM both produced effects significantly greater than placebo; (2) psilocybin showed dose-related increases; 3, DXM was never significantly higher than psilocybin; (4) the two highest psilocybin doses were significantly greater than DXM. These differences were consistent with two measures of desire to take the drug condition again. CONCLUSIONS This analysis provides new information about domains of psilocybin subjective effects proposed to be related to its reinforcing effects (alternatively described as the "motivation" to use). Observed differences on these domains between psilocybin and DXM are consistent with the relative rates of non-medical use of psilocybin and DXM.
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33
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Jamali H, Heydari A. Effect of dextromethorphan/quinidine on pentylenetetrazole- induced clonic and tonic seizure thresholds in mice. Neurosci Lett 2020; 729:134988. [PMID: 32325102 DOI: 10.1016/j.neulet.2020.134988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/07/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study aimed to investigate the effects of dextromethorphan (DM) or dextromethorphan/quinidine (DM/Q) against pentylenetetrazole (PTZ)- induced seizure threshold in mice and the probable involvement of N-methyl d-aspartate (NMDA), sigma-1 and serotonin 1A (5-HT1A) receptors. MATERIAL AND METHODS NMRI male mice (25-30 g) received quinidine (10, 20, and 30 mg/kg), DM (5, 10, 25, and 50 mg/kg) or DM/Q (10/20, 25/20, and 50/20 mg/kg), 30 min before the infusion of PTZ. ketamine (1 and 5 mg/kg), BD-1047 (2.5 and 5 mg/kg) or WAY-100635 (0.5 and 1 mg/kg) were administrated as pre-treatment 30 min before the selected dose of DM/Q. Seizures were induced by intravenous PTZ infusion. All data were presented as means ± S.E.M. One-way ANOVA test was used to determine statistical significance (p < 0.05). RESULTS DM (25 and 50 mg/kg) significantly increased PTZ- induced seizure threshold. DM/Q at doses of 10/20 and 25/20 mg/kg had anticonvulsant effect, while at a dose of 50/20 mg/kg attenuated anticonvulsant effect of DM 50 mg/kg. Ketamine (5 mg/kg) or WAY-100635 (1 mg/kg) potentiated, while BD-1047 (2.5 and 5 mg/kg) attenuated the anticonvulsant effect of DM/Q 10/20 mg/kg. CONCLUSION The results of present study demonstrate that combination with quinidine potentiates the anticonvulsant effect of DM at lower doses, while attenuates it at higher dose. Meanwhile, the effects of DM/Q on seizure activity likely involve an interaction with NMDA, the sigma-1 or the 5-HT1A receptor which may be secondary to the elevation of DM levels.
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Affiliation(s)
- Hassan Jamali
- Physiology Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| | - Azhdar Heydari
- Physiology Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran; Department of Physiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
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Tampi RR, Joshi P, Marpuri P, Tampi DJ. Evidence for using dextromethorphan-quinidine for the treatment of agitation in dementia. World J Psychiatry 2020; 10:29-33. [PMID: 32399396 PMCID: PMC7203083 DOI: 10.5498/wjp.v10.i4.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/03/2020] [Accepted: 03/22/2020] [Indexed: 02/05/2023] Open
Abstract
Behavioral and psychological symptoms including agitation are common in dementia, and are associated with decreased quality of life, increased risk of institutionalization, and greater patient and caregiver distress. Pharmacological agents used for management of behavioral and psychological symptoms of dementia are limited by their tolerability, prompting a need for identifying efficacious and safe pharmacological treatments for managing agitation in dementia. The combination of dextromethorphan and quinidine sulfate is approved for pseudobulbar affect, and may be effective in managing agitation in dementia. A review of literature found only one randomized controlled trial that evaluated the use of dextromethorphan-quinidine for the management of agitation in dementia when compared to placebo. Data from this trial demonstrated that dextromethorphan-quinidine decreased agitation in dementia, and was well tolerated. Although promising, further research is needed before dextromethorphan-quinidine combination can be accepted as a standard treatment for agitation in dementia.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44106, United States
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, United States
| | - Pallavi Joshi
- Department of Psychiatry and Behavioral Sciences, Northwell Health-Staten Island University Hospital, Staten Island, NY 10306, United States
| | - Padmapriya Marpuri
- Department of Psychiatry, Einstein Medical Center, Philadelphia, PA 19141, United States
| | - Deena J Tampi
- Diamond Healthcare, Richmond, VA 23219, United States
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Blair G, Wells C, Ko A, Modarres J, Pace C, Davis JM, Rezvani AH, Rose JE, Levin ED. Dextromethorphan and bupropion reduces high level remifentanil self-administration in rats. Pharmacol Biochem Behav 2020; 193:172919. [PMID: 32246985 DOI: 10.1016/j.pbb.2020.172919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 02/04/2023]
Abstract
Opiate addiction has risen substantially during the past decade. New treatments to combat opiate addiction are sorely needed. The current study was conducted to determine the acute individual and interactive effects of bupropion and dextromethorphan in a rat model of opiate self-administration using the short-acting synthetic opioid remifentanil. Both of these drugs have been found to reduce self-administration of nicotine. Bupropion and dextromethorphan and their combination had differential effects depending on whether the rats showed higher or lower baseline remifentanil self-administration. The rats with higher initial remifentanil self-administration showed a significant decrease in remifentanil self-administration with bupropion or dextromethorphan treatment, compared to the vehicle control condition. This decrease in self-remifentanil administration was most pronounced when combination of the higher doses of bupropion and dextromethorphan were administered. In contrast, the rats with lower baseline remifentanil self-administration showed the opposite effect of drug treatment with an increase in remifentanil self-administration with bupropion treatment compared to the vehicle control condition. Dextromethorphan had no significant effect inthis group. This study shows that combination bupropion and dextromethorphan affects remifentanil self-administration in a complex fashion with differential effects on low and high baseline responders. In subjects with high baseline remifentanil self-administration, bupropion and dextromethorphan treatment significantly reduced self-administration, whereas in subjects with low baseline remifentanil self-administration, bupropion increased remifentanil self-administration and dextromethorphan had no discernible effect. This finding suggests that combination bupropion-dextromethorphan should be tested in humans, with a focus on treating people with high-level opiate use.
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Lee SY, Wang TY, Chen SL, Chang YH, Chen PS, Huang SY, Tzeng NS, Wang LJ, Lee IH, Chen KC, Yang YK, Hong JS, Lu RB. Combination of dextromethorphan and memantine in treating bipolar spectrum disorder: a 12-week double-blind randomized clinical trial. Int J Bipolar Disord 2020; 8:11. [PMID: 32115672 PMCID: PMC7049537 DOI: 10.1186/s40345-019-0174-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/16/2019] [Indexed: 11/12/2022] Open
Abstract
Background The aim of this study is to determine whether adding combination of agents with anti-inflammatory and neurotrophic effects is more efficacious than mood stabilizer alone in improving clinical symptoms, plasma brain-derived neurotrophic factor (BDNF), cytokine levels, and metabolic profiles in patients with bipolar spectrum disorder. Methods In a randomized, double-blind, controlled 12-week clinical trial, patients with moderate mood symptoms (HDRS ≥ 18 or YMRS ≥ 14) were recruited. The patients were randomly assigned to a group while still undergoing regular valproate (VPA) treatments: VPA + dextromethorphan (DM) (30 mg/day) + memantine (MM) (5 mg/day) (DM30 + MM5) (n = 66), VPA + DM (30 mg/day) (DM30) (n = 69), VPA + MM (5 mg/day) (MM5) (n = 66), or VPA + Placebo (Placebo) (n = 69). Symptom severity, immunological parameters [plasma tumor necrosis factor (TNF)-α and C-reactive protein (CRP)] and plasma brain-derived neurotrophic factor (BDNF) were regularly examined. Metabolic profiles [cholesterol, triglycerides, glycosylated hemoglobin (HbA1C), fasting serum glucose, body mass index (BMI)] were measured at baseline and at 2, 8, and 12 weeks. Results Depression scores were significantly (P = 0.03) decreases and BDNF levels significantly (P = 0.04) increased in the DM30 + MM5 group than in the Placebo group. However, neither depressive scores nor BDNF levels were significantly different between the DM30, MM5, and Placebo groups. Changes in certain plasma cytokine and BDNF levels were significantly correlated with metabolic parameters. Conclusion We concluded that add-on DM30 + MM5 was significantly more effective than placebo for clinical symptoms and plasma BDNF levels. Additional studies with larger samples and mechanistic studies are necessary to confirm our findings. Trial registration NCT03039842 (https://register.clinicaltrials.gov/). Trial date was from 1 Jan 2013 to 31 December 2016 in National Cheng Kung University Hospital. Registered 28 February 1 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03039842?term=NCT03039842&rank=1.
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Affiliation(s)
- Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Tzu-Yun Wang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Shiou-Lan Chen
- Department of Neurology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Hsuan Chang
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Po-See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Kao-Ching Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Yen-Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Jau-Shyong Hong
- Laboratory of Toxicology and Pharmacology, NIH/NIEHS, Research Triangle Park, Durham, NC, USA
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan. .,Yanjiao Furen Hospital, Hebei, China. .,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.
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Lu RB, Chang YH, Lee SY, Wang TY, Cheng SL, Chen PS, Yang YK, Hong JS, Chen SL. Dextromethorphan Protect the Valproic Acid Induced Downregulation of Neutrophils in Patients with Bipolar Disorder. Clin Psychopharmacol Neurosci 2020; 18:145-152. [PMID: 31958915 PMCID: PMC7006988 DOI: 10.9758/cpn.2020.18.1.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/30/2019] [Accepted: 10/24/2019] [Indexed: 11/18/2022]
Abstract
Objective Valproic acid (VPA) is an anticonvulsant and commonly long term used as a mood stabilizer for patients with mood disorders. However its chronic effects on the hematological changes were noticed and need to be further evaluated. In this study, we evaluated, in Taiwanese Han Chinese patients with bipolar disorders (BD), the chronic effects of VPA or VPA plus dextromethorphan (DM) on the hematological molecules (white blood cell [WBCs], red blood cells [RBCs], hemoglobin, hematocrit, and platelets). Methods In a 12-week, randomized, double-blind study, we randomly assigned BD patients to one of three groups: VPA plus either placebo (VPA+P, n = 57) or DM (30 mg/day, VPA+DM30, n = 56) or 60 mg/day (VPA+DM60, n = 53). The Young Mania Rating Scale and Hamilton Depression Rating Scale were used to evaluate symptom severity, and the hematological molecules were checked. Results Paired t test showed that the WBC, neutrophils, platelets and RBCs were significantly lowered after 12 weeks of VPA+P or VPA+DM30 treatment. VPA+DM60 represented the protective effects in the WBCs, neutrophils, and RBCs but not in the platelets. We further calculated the changes of each hematological molecules after 12 weeks treatment. We found that combination use of DM60 significantly improved the decline in neutrophils induced by the long-term VPA treatment. Conclusion Hematological molecule levels were lower after long-term treatment with VPA. VPA+DM60, which yielded the protective effect in hematological change, especially in the neutrophil counts. Thus, DM might be adjunct therapy for maintaining hematological molecules in VPA treatment.
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Affiliation(s)
- Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Yun-Hsuan Chang
- Department of Psychology, Asia University, Taichung, Taiwan, ROC.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Tzu-Yun Wang
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Shu-Li Cheng
- Dpartment of Nursing, Mackay Medical College, Taipei, Taiwan, ROC
| | - Po-See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Yen-Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Jau-Shyong Hong
- Neurobiology Laboratory, NIH/NIEHS, Research Triangle Park, NC, USA
| | - Shiou-Lan Chen
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.,Graduate Institute of Medicine & M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan, ROC.,Department of Medical Research, KMU Hospital, Kaohsiung, Taiwan, ROC
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Magwebu ZE, Mazinu M, Abdul-Rasool S, Chauke CG. The effect of hyperglycinemic treatment in captive-bred Vervet monkeys (Chlorocebus aethiops). Metab Brain Dis 2019; 34:1467-1472. [PMID: 31230217 DOI: 10.1007/s11011-019-00449-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/10/2019] [Indexed: 12/24/2022]
Abstract
Nonketotic hyperglycinemia (NKH) is a neuro-metabolic disorder caused by a deficiency in the glycine cleavage system (GCS) and glycine transporter 1 (GlyT1). A case of atypical late onset of NKH has been reported in a colony of captive-bred Vervet monkeys. The purpose of this study was to evaluate the effect of sodium benzoate and dextromethorphan in reducing glycine levels in hyperglycinemic monkeys. Twelve captive-bred Vervet monkeys were assigned into three groups consisting of four animals (control, valproate induced and cataract with spontaneous hyperglycinemia). Valproate was used to elevate glycine levels and the induced group was then treated with sodium benzoate and dextromethorphan together with group three to normalise glycine levels in cerebrospinal fluid (CSF) and plasma. Valproate induction elicited changes in phosphate, alkaline phosphatase and platelet count, however, no significant changes in the glycine levels were observed, and this might be due to the individual variability within the group. The treatment intervention was only obtained in the spontaneous group whereby the glycine levels were normalised in CSF and plasma. Therefore, it can be concluded that sodium benzoate and dextromethorphan treatment was effective and beneficial to the hyperglycinemic group.
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Affiliation(s)
- Zandisiwe E Magwebu
- Primate Unit and Delft Animal Centre, South African Medical Research Council, P.O Box 19070, Tygerberg, Cape Town, 7505, South Africa.
| | - Mikateko Mazinu
- Primate Unit and Delft Animal Centre, South African Medical Research Council, P.O Box 19070, Tygerberg, Cape Town, 7505, South Africa
| | - Sahar Abdul-Rasool
- Medical Bioscience Department, University of the Western Cape, Belville, South Africa
| | - Chesa G Chauke
- Primate Unit and Delft Animal Centre, South African Medical Research Council, P.O Box 19070, Tygerberg, Cape Town, 7505, South Africa
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Su WL, Weng YY, Huang WH, Shui HA, Chou TC. Mechanisms of the antiplatelet and analgesic effects of dextromethorphan and its metabolites. Tzu Chi Med J 2019; 32:154-161. [PMID: 32269947 PMCID: PMC7137376 DOI: 10.4103/tcmj.tcmj_48_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/27/2019] [Accepted: 04/29/2019] [Indexed: 12/04/2022] Open
Abstract
Objective: In the present study, we investigated the effects of dextromethorphan (DM) and its metabolites, including dextrorphan (LK2), 3-methoxymorphinan (LK3), and 3-hydroxymorphinan (LK4), on platelet aggregation in vitro and the inflammatory pain caused by carrageenan in rats, and their underlying mechanisms. Materials and Methods: Rabbit platelets were pretreated with DM or its metabolites to assess their effects on platelet aggregation and related target mediators. In addition, the analgesic activity and the underlying mechanisms of DM and LK3 were investigated in a carrageenan-evoked thermal hyperalgesia rat model. Results: The inhibitory potency of DM and its metabolites on platelet aggregation induced by arachidonic acid or collagen was LK3> DM > LK4>> LK2 as demonstrated by the half-maximal inhibitory concentration values. Moreover, the mechanisms of the antiplatelet effect of DM and LK3 may involve the inhibition of intracellular calcium mobilization, expression of platelet surface glycoprotein IIb/IIIa, the formation of thromboxane B2, and elevation of platelet membrane fluidity. DM and LK3 also exhibited analgesic effects on carrageenan-evoked thermal hyperalgesia by suppressing the production of pro-inflammatory cytokines, nitric oxide, prostaglandin E2, and neutrophil infiltration in inflammatory sites. Conclusion: DM and its metabolites, especially LK3, exhibit both antiplatelet and analgesic effects, and may, therefore, potentially ameliorate platelet hyperactivity and inflammatory-related diseases.
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Affiliation(s)
- Wen-Lin Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Ya Weng
- Graduate Institute of Physiology, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Hsin Huang
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Hao-Ai Shui
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Tz-Chong Chou
- Department of Medical Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
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Liu CT, Huang YS, Chen HC, Ma KH, Wang CH, Chiu CH, Shih JH, Kang HH, Shiue CY, Li IH. Evaluation of brain SERT with 4-[ 18F]-ADAM/micro-PET and hearing protective effects of dextromethorphan in hearing loss rat model. Toxicol Appl Pharmacol 2019; 378:114604. [PMID: 31153898 DOI: 10.1016/j.taap.2019.114604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 01/12/2023]
Abstract
This study investigated the protective effects of dextromethorphan (DXM) on noise-induced hearing loss (NIHL) in rats. This study aimed to improve the auditory threshold and to understand the protective effects of DXM against N-methyl-d-aspartate (NMDA)-induced neurite degeneration of serotonergic neurons. The animals were exposed to 8-kHz narrowband noise at a 118-dB sound pressure level for 3.5 h. The hearing thresholds were determined by measuring the auditory brainstem response to click stimuli. Serotonin transporter (SERT) expression was determined through micro-positron emission tomography (PET) using N,N-dimethyl-2-(2-amino-4-18F-fluorophenylthio)benzylamine (4-[18F]-ADAM). We also investigated the effects of DXM on NMDA-induced morphological changes in the primary cultures of rat serotonergic neurons. NIHL significantly improved after prophylactic treatment with DXM (p < .05). SERT density in DXM-treated rats was significantly higher than that in non-DXM-treated rats. Because prophylactic medication restored the NMDA-inhibited neurite length of serotonergic neurons and presented SERT density, DXM could be a potential agent in alleviating NIHL.
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Affiliation(s)
- Cheng-Tsung Liu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan
| | - Yuahn-Sieh Huang
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Chien Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Kuo-Hsing Ma
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hung Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Otorhinolaryngology, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Chuang-Hsin Chiu
- Department of Nuclear Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Jui-Hu Shih
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | | | - Chyng-Yann Shiue
- Department of Nuclear Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - I-Hsun Li
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
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Nakamura T, Matsuo M. Reply to the Letter, "Methotrexate myelopathy: A mimicker of subacute combined degeneration of the spinal cord". Brain Dev 2019; 41:646. [PMID: 31027652 DOI: 10.1016/j.braindev.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Takuji Nakamura
- Department of Pediatrics, National Hospital Organization Ureshino Medical Center, 2436 Ureshino, Saga 843-0393, Japan.
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
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Olives TD, Boley SP, LeRoy JM, Stellpflug SJ. Ten Years of Robotripping: Evidence of Tolerance to Dextromethorphan Hydrobromide in a Long-Term User. J Med Toxicol 2019; 15:192-197. [PMID: 30903576 DOI: 10.1007/s13181-019-00706-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Dextromethorphan hydrobromide is widely available as an over-the-counter cough suppressant. A semi-synthetic opioid displaying N-methyl-D-aspartate receptor antagonism, it is commonly abused for recreational purposes. Spuriously elevated serum chloride concentrations are a well-described phenomenon in the setting of dextromethorphan hydrobromide toxicity, but evidence to suggest the development of tolerance is limited to case reports. CASE A 32-year-old male known to chronically ingest dextromethorphan hydrobromide for recreational purposes presented to regional hospitals on 179 occasions over 110 months and was treated for dextromethorphan toxicity on 163/174 (93.7%) of these visits. He reported a subjective need to increase his dosing over time to achieve the same degree of intoxication. Measured serum chloride over this period (n = 217) ranged from 98 to 138 mEq/L (median 115 mEq/L, IQR 110-123 mEq/L). Measured concentrations over the 110-month period progressively rose, with a fitted plot of 111.15 + 0.00232x describing the rise in measured chloride. Though not formally assessed, anion gaps tended to become progressively more negative over the observed period. DISCUSSION We report a patient with persistent dextromethorphan hydrobromide abuse at escalating doses whose mean serum chloride concentration increased, on average, by 0.00232 mEq/L every day over a 110-month period. This case demonstrates progressive spurious hyperchloremia secondary to bromide interference in hospital-based chloride assays, supporting the patient's reported need to dose escalate to the same desired effect. Although this artefactual laboratory finding is a well-documented result of bromide ingestion, it may be useful in identifying patterns of dextromethorphan hydrobromide use that suggest tolerance.
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Affiliation(s)
- Travis D Olives
- Hennepin Healthcare - Department of Emergency Medicine, 701 South 8th Street, Minneapolis, MN, 55415, USA. .,Minnesota Poison Control System, Minneapolis, MN, USA.
| | - Sean P Boley
- Minnesota Poison Control System, Minneapolis, MN, USA.,United Hospital, Saint Paul, MN, USA
| | - Jenna M LeRoy
- Minnesota Poison Control System, Minneapolis, MN, USA.,Regions Hospital, Saint Paul, MN, USA
| | - Samuel J Stellpflug
- Minnesota Poison Control System, Minneapolis, MN, USA.,Regions Hospital, Saint Paul, MN, USA
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Zhou R, Chen SH, Li G, Chen HL, Liu Y, Wu HM, Wang Y, Feng J, Hong JS. Ultralow doses of dextromethorphan protect mice from endotoxin-induced sepsis-like hepatotoxicity. Chem Biol Interact 2019; 303:50-6. [PMID: 30822415 DOI: 10.1016/j.cbi.2019.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/23/2022]
Abstract
Dextromethorphan, a wildly used over-the-counter antitussive drug, is reported to have anti-inflammatory effects. Previously, we and others have demonstrated that dextromethorphan at micromolar doses displays potent hepatoprotective effects and enhances mice survival in a sepsis model. Moreover, we also observed potent anti-inflammatory and neuroprotective effects of subpicomolar concentrations of dextromethorphan in rodent primary neuron-glial cultures. The purpose of this study was to provide a proof of principle that ultralow dose dextromethorphan displays anti-inflammatory and cytoprotective effects in animal studies. Here, we report that subpico- and micromolar doses of dextromethorphan showed comparable efficacy in protecting mice from lipopolysaccharide/d-galactosamine (LPS/GalN)-induced hepatotoxicity and mortality. Mice were given injections of dextromethorphan from 30 min before and 2, 4 h after an injection of LPS/GalN (20 μg/600 mg/kg). Our results showed that dextromethorphan at subpicomolar doses promoted survival rate in LPS/GalN-injected mice. Ultralow dose dextromethorphan also significantly reduced serum alanine aminotransferase activity, TNF-α level and liver cell damage of endotoxemia mice. Mechanistic studies using primary liver Kupffer cell cultures revealed that subpicomolar concentrations of dextromethorphan reduced the NADPH oxidase-generated superoxide free radicals from Kupffer cells, which in turn reduced the elevation of its downstream reactive oxygen species (iROS) to relieve the oxidative stress and decreased TNF-α production in Kupffer cells. Taken together, these findings suggest a novel therapeutic concept of using ultralow doses of dextromethorphan for the intervention of sepsis or septic shock.
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Ohi Y, Kodama D, Haji A. Involvement of the cAMP-Dependent Pathway in Dextromethorphan-Induced Inhibition of Spontaneous Glutamate Transmission in the Nucleus Tractus Solitarius Neurons of Guinea Pigs. Pharmacology 2018; 103:76-81. [PMID: 30517935 DOI: 10.1159/000495295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022]
Abstract
Dextromethorphan (DEX) presynaptically decreases glutamatergic transmission in second-order neurons of the nucleus tractus solitarius (TS). To clarify the inhibitory mechanism of DEX, the present study examined the interaction of DEX with cAMP. The effects of DEX on miniature and TS-evoked excitatory postsynaptic currents (mEPSCs and eEPSCs) were recorded under activation of the cAMP-dependent pathway using the brainstem slices. An increase in cAMP by forskolin counteracted the inhibitory effect of DEX on mEPSCs. Eight-Bromo-cAMP and N-ethylmaleimide also attenuated the DEX effect. However, forskolin had negligible effects on the DEX-induced inhibition of eEPSCs. This suggests that DEX decreases spontaneous glutamate release by inhibiting the cAMP-dependent pathway and synchronous release by another unknown mechanism.
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Affiliation(s)
- Yoshiaki Ohi
- Laboratory of Neuropharmacology, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan,
| | - Daisuke Kodama
- Laboratory of Neuropharmacology, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Akira Haji
- Laboratory of Neuropharmacology, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
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45
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Poklis JL, Mulder HA, Peace MR. The unexpected identification of the cannabimimetic, 5F-ADB, and dextromethorphan in commercially available cannabidiol e-liquids. Forensic Sci Int 2018; 294:e25-e27. [PMID: 30442388 DOI: 10.1016/j.forsciint.2018.10.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 01/07/2023]
Abstract
Electronic cigarettes (e-cigarettes) were developed as an alternative method for nicotine delivery and had a significant surge in popularity. E-liquids are formulations used in e-cigarettes, and consist of a ratio of propylene glycol (PG) and vegetable glycerin (VG), a pharmaceutical and/or herbal remedy and, usually, a flavoring agent. Presented is the evaluation of nine cannabidiol (CBD) e-liquids from a single manufacturer for cannabinoids and other psychoactive compounds by Direct Analysis in Real Time Mass Spectrometry (DART-MS) and Gas Chromatography Mass Spectrometry (GC/MS). The analysis of these products resulted in the detection of CBD in all nine produces and the unexpected detections of 5-fluoro MDMB-PINACA (5F-ADB) in four of the products and dextromethorphan (DXM) in one of the products. The analysis of these products illustrates the potential quality control issues that can occur in an unregulated industry. CBD products are believed by many users to offer heath benefits, but the detection of a dangerous cannabimimetic, 5F-ADB, and DXM in these products illustrates the need for oversight.
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Affiliation(s)
- Justin L Poklis
- Virginia Commonwealth University, Department of Pharmacology & Toxicology, 410 North 12th Street, Room 754, Box 980613, Richmond, VA 23298-0613, USA.
| | - Haley A Mulder
- Virginia Commonwealth University, Department of Forensic Science, 1015 Floyd Avenue, Room 2015, Richmond, VA 23284, USA
| | - Michelle R Peace
- Virginia Commonwealth University, Department of Forensic Science, 1015 Floyd Avenue, Room 2015, Richmond, VA 23284, USA
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Barrett FS, Carbonaro TM, Hurwitz E, Johnson MW, Griffiths RR. Double-blind comparison of the two hallucinogens psilocybin and dextromethorphan: effects on cognition. Psychopharmacology (Berl) 2018; 235:2915-2927. [PMID: 30062577 PMCID: PMC6162157 DOI: 10.1007/s00213-018-4981-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/23/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Classic psychedelics (serotonin 2A receptor agonists) and dissociative hallucinogens (NMDA receptor antagonists), though differing in pharmacology, may share neuropsychological effects. These drugs, however, have undergone limited direct comparison. This report presents data from a double-blind, placebo-controlled within-subjects study comparing the neuropsychological effects of multiple doses of the classic psychedelic psilocybin with the effects of a single high dose of the dissociative hallucinogen dextromethorphan (DXM). METHODS Twenty hallucinogen users (11 females) completed neurocognitive assessments during five blinded drug administration sessions (10, 20, and 30 mg/70 kg psilocybin; 400 mg/70 kg DXM; and placebo) in which participants and study staff were informed that a large range of possible drug conditions may have been administered. RESULTS Global cognitive impairment, assessed using the Mini-Mental State Examination during peak drug effects, was not observed with psilocybin or DXM. Orderly and dose-dependent effects of psilocybin were observed on psychomotor performance, working memory, episodic memory, associative learning, and visual perception. Effects of DXM on psychomotor performance, visual perception, and associative learning were in the range of effects of a moderate to high dose (20 to 30 mg/70 kg) of psilocybin. CONCLUSIONS This was the first study of the dose effects of psilocybin on a large battery of neurocognitive assessments. Evidence of delirium or global cognitive impairment was not observed with either psilocybin or DXM. Psilocybin had greater effects than DXM on working memory. DXM had greater effects than all psilocybin doses on balance, episodic memory, response inhibition, and executive control.
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Affiliation(s)
- Frederick S Barrett
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA.
| | - Theresa M Carbonaro
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Ethan Hurwitz
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Matthew W Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
| | - Roland R Griffiths
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD, 21224, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Qiu YW, Lv XF, Jiang GH, Su HH, Ma XF, Tian JZ, Zhuo FZ. Potential gray matter unpruned in adolescents and young adults dependent on dextromethorphan-containing cough syrups: evidence from cortical and subcortical study. Brain Imaging Behav 2018; 11:1470-1478. [PMID: 27738991 DOI: 10.1007/s11682-016-9628-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Adolescence is a unique period in neurodevelopment. Dextromethorphan (DXM)-containing cough syrups are new addictive drugs used by adolescents and young adults. The effects of chronic DXM abuse on neurodevelopment in adolescents and young adults are still unknown. The aim of this study was to investigate the differences in cortical thickness and subcortical gray matter volumes between DXM-dependent adolescents and young adults and healthy controls, and to explore relationships between alternations in cortical thickness/subcortical volume and DXM duration, initial age of DXM use, as well as impulsive behavior in DXM-dependent adolescents and young adults. Thirty-eight DXM-dependent adolescents and young adults and 18 healthy controls underwent magnetic resonance imaging scanning, and cortical thickness across the continuous cortical surface was compared between the groups. Subcortical volumes were compared on a structure-by-structure basis. DXM-dependent adolescents and young adults exhibited significantly increased cortical thickness in the bilateral precuneus (PreC), left dorsal lateral prefrontal cortex (DLPFC. L), left inferior parietal lobe (IPL. L), right precentral gyrus (PreCG. R), right lateral occipital cortex (LOC. R), right inferior temporal cortex (ITC. R), right lateral orbitofrontal cortex (lOFC. R) and right transverse temporal gyrus (TTG. R) (all p < 0.05, multiple comparison corrected) and increased subcortical volumes of the right thalamus and right pallidum. There was a significant correlation between initial age of DXM use and cortical thickness of the DLPFC. L and PreCG. R. A significant correlation was also found between cortical thickness of the DLPFC. L and impulsive behavior in patients. This was the first study to explore relationships between cortical thickness/subcortical volume and impulsive behavior in adolescents dependent on DXM. These structural changes might explain the neurobiological mechanism of impulsive behavior in adolescent DXM users.
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Affiliation(s)
- Ying-Wei Qiu
- Department of Medical Imaging, Zhongshan Ophthalmic Center, SunYat-sen University, Guangzhou, People's Republic of China. .,Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, 510317, People's Republic of China. .,Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
| | - Xiao-Fei Lv
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Gui-Hua Jiang
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, 510317, People's Republic of China
| | - Huan-Huan Su
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, 510317, People's Republic of China
| | - Xiao-Fen Ma
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, 510317, People's Republic of China
| | - Jun-Zhang Tian
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, 510317, People's Republic of China
| | - Fu-Zhen Zhuo
- Addiction Medicine Division, Guangdong No.2 Provincial People's Hospital, Guangzhou, 510317, People's Republic of China
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Levin ED, Wells C, Slade S, Rezvani AH. Mutually augmenting interactions of dextromethorphan and sazetidine-A for reducing nicotine self-administration in rats. Pharmacol Biochem Behav 2018; 166:42-47. [PMID: 29407477 PMCID: PMC5836513 DOI: 10.1016/j.pbb.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 12/27/2022]
Abstract
A variety of nicotinic drug treatments have been found to decrease nicotine self-administration. However, interactions of drugs affecting different nicotinic receptor subtypes have not been much investigated. This study investigated the interactions between dextromethorphan, which blocks nicotinic α3β2 receptors as well as a variety of other receptors with sazetidine-A which is a potent and selective α4β2 nicotinic receptor partial agonist with desensitizing properties. This interaction was compared with dextromethorphan combination treatment with mecamylamine, which is a nonspecific nicotinic channel blocker. Co-administration of dextromethorphan (either 0.5 or 5 mg/kg) and lower dose of sazetidine-A (0.3 mg/kg) caused a significant reduction in nicotine SA. With regard to food-motivated responding, 3 mg/kg of sazetidine-A given alone caused a significant decrease in food intake. However, the lower 0.3 mg/kg sazetidine-A dose did not significantly affect food-motivated responding even when given in combination with the higher 5 mg/kg dextromethorphan dose which itself caused a significant decrease in food motivated responding. Interestingly, this higher dextromethorphan dose significantly attenuated the decrease in food motivated responding caused by 3 mg/kg of sazetidine-A. Locomotor activity was increased by the lower 0.3 mg/kg sazetidine-A dose and decreased by the 5 mg/kg dextromethorphan dose. Mecamylamine at the doses (0.1 and 1 mg/kg) did not affect nicotine SA, but at 1 mg/kg significantly decreased food-motivated responding. None of the mecamylamine doses augmented the effect of dextromethorphan in reducing nicotine self-administration. These studies showed that the combination of dextromethorphan and sazetidine-A had mutually potentiating effects, which could provide a better efficacy for promoting smoking cessation, however the strength of the interactions was fairly modest.
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Affiliation(s)
- Edward D Levin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
| | - Corrine Wells
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Susan Slade
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Amir H Rezvani
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
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Tran HQ, Lee Y, Shin EJ, Jang CG, Jeong JH, Mouri A, Saito K, Nabeshima T, Kim HC. PKCδ Knockout Mice Are Protected from Dextromethorphan-Induced Serotonergic Behaviors in Mice: Involvements of Downregulation of 5-HT 1A Receptor and Upregulation of Nrf2-Dependent GSH Synthesis. Mol Neurobiol 2018; 55:7802-7821. [PMID: 29468562 DOI: 10.1007/s12035-018-0938-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022]
Abstract
We investigated whether a specific serotonin (5-HT) receptor-mediated mechanism was involved in dextromethorphan (DM)-induced serotonergic behaviors. We firstly observed that the activation of 5-HT1A receptor, but not 5-HT2A receptor, contributed to DM-induced serotonergic behaviors in mice. We aimed to determine whether the upregulation of 5-HT1A receptor induced by DM facilitates the specific induction of certain PKC isoform, because previous reports suggested that 5-HT1A receptor activates protein kinase C (PKC). A high dose of DM (80 mg/kg, i.p.) induced a selective induction of PKCδ out of PKCα, PKCβI, PKCβII, PKCξ, and PKCδ in the hypothalamus of wild-type (WT) mice. More importantly, 5-HT1A receptor co-immunoprecipitated PKCδ in the presence of DM. Consistently, rottlerin, a pharmacological inhibitor of PKCδ, or PKCδ knockout significantly protected against increases in 5-HT1A receptor gene expression, 5-HT turnover rate, and serotonergic behaviors induced by DM. Treatment with DM resulted in an initial increase in nuclear factor erythroid-2-related factor 2 (Nrf2) nuclear translocation and DNA-binding activity, γ-glutamylcysteine (GCL) mRNA expression, and glutathione (GSH) level. This compensative induction was further potentiated by rottlerin or PKCδ knockout. However, GCL mRNA and GSH/GSSG levels were decreased 6 and 12 h post-DM. These decreases were attenuated by PKCδ inhibition. Our results suggest that interaction between 5-HT1A receptor and PKCδ is critical for inducing DM-induced serotonergic behaviors and that inhibition of PKCδ attenuates the serotonergic behaviors via downregulation of 5-HT1A receptor and upregulation of Nrf2-dependent GSH synthesis.
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MESH Headings
- Acetophenones/pharmacology
- Animals
- Behavior, Animal
- Benzopyrans/pharmacology
- Cell Nucleus/drug effects
- Cell Nucleus/metabolism
- Dextromethorphan
- Down-Regulation
- Glutamate-Cysteine Ligase/genetics
- Glutamate-Cysteine Ligase/metabolism
- Glutathione/biosynthesis
- Glutathione Disulfide/metabolism
- Hypothalamus/metabolism
- Hypothermia, Induced
- Isoenzymes/metabolism
- Mice, Inbred C57BL
- Mice, Knockout
- NF-E2-Related Factor 2/metabolism
- Neuroprotective Agents/pharmacology
- Phosphorylation/drug effects
- Piperazines/pharmacology
- Protein Kinase C-delta/metabolism
- Pyridines/pharmacology
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptor, Serotonin, 5-HT1A/metabolism
- Receptor, Serotonin, 5-HT2A/metabolism
- Serotonin/metabolism
- Serotonin 5-HT1 Receptor Antagonists/pharmacology
- Time Factors
- Up-Regulation
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Affiliation(s)
- Hai-Quyen Tran
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea
| | - Youngho Lee
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea
| | - Eun-Joo Shin
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea.
| | - Choon-Gon Jang
- Department of Pharmacology, School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Akihiro Mouri
- Advanced Diagnostic System Research Laboratory, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, 470-1192, Japan
| | - Kuniaki Saito
- Advanced Diagnostic System Research Laboratory, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, 470-1192, Japan
| | - Toshitaka Nabeshima
- Advanced Diagnostic System Research Laboratory, Fujita Health University Graduate School of Health Science, Toyoake, Aichi, 470-1192, Japan
- Aino University, Ibaraki, 576-0012, Japan
- Japanese Drug Organization of Appropriate and Research, Nagoya, 468-0069, Japan
| | - Hyoung-Chun Kim
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341, Republic of Korea.
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50
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Carbonaro TM, Johnson MW, Hurwitz E, Griffiths RR. Double-blind comparison of the two hallucinogens psilocybin and dextromethorphan: similarities and differences in subjective experiences. Psychopharmacology (Berl) 2018; 235:521-34. [PMID: 29116367 DOI: 10.1007/s00213-017-4769-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/19/2017] [Indexed: 01/21/2023]
Abstract
RATIONALE Although psilocybin and dextromethorphan (DXM) are hallucinogens, they have different receptor mechanisms of action and have not been directly compared. OBJECTIVE This study compared subjective, behavioral, and physiological effects of psilocybin and dextromethorphan under conditions that minimized expectancy effects. METHODS Single, acute oral doses of psilocybin (10, 20, 30 mg/70 kg), DXM (400 mg/70 kg), and placebo were administered under double-blind conditions to 20 healthy participants with histories of hallucinogen use. Instructions to participants and staff minimized expectancy effects. Various subjective, behavioral, and physiological effects were assessed after drug administration. RESULTS High doses of both drugs produced similar increases in participant ratings of peak overall drug effect strength, with similar times to maximal effect and time-course. Psilocybin produced orderly dose-related increases on most participant-rated subjective measures previously shown sensitive to hallucinogens. DXM produced increases on most of these same measures. However, the high dose of psilocybin produced significantly greater and more diverse visual effects than DXM including greater movement and more frequent, brighter, distinctive, and complex (including textured and kaleidoscopic) images and visions. Compared to DXM, psilocybin also produced significantly greater mystical-type and psychologically insightful experiences and greater absorption in music. In contrast, DXM produced larger effects than psilocybin on measures of disembodiment, nausea/emesis, and light-headedness. Both drugs increased systolic blood pressure, heart rate, and pupil dilation and decreased psychomotor performance and balance. CONCLUSIONS Psilocybin and DXM produced similar profiles of subjective experiences, with psilocybin producing relatively greater visual, mystical-type, insightful, and musical experiences, and DXM producing greater disembodiment.
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