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Witkin JM, Cerne R, Newman AH, Izenwasser S, Smith JL, Tortella FC. N-Substituted-3-alkoxy-derivatives of dextromethorphan are functional NMDA receptor antagonists in vivo: Evidence from an NMDA-induced seizure model in rats. Pharmacol Biochem Behav 2021; 203:173154. [PMID: 33609599 PMCID: PMC9659398 DOI: 10.1016/j.pbb.2021.173154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/01/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
Interest in developing NMDA receptor antagonists with reduced side-effects for neurological and psychiatric disorders has been re-energized by the recent introduction of esketamine into clinical practice for treatment-resistant depression. Structural analogs of dextromethorphan bind with low affinity to the NMDA receptor ion channel, have functional effects in vivo, and generally display a lower propensity for side-effects than that of ketamine and other higher affinity antagonists. As such, the aim of the present study was to determine whether a series of N-substituted-3-alkoxy-substituted dextromethorphan analogs produce their anticonvulsant effects through NMDA receptor blockade. Compounds were studied against NMDA-induced seizures in rats. Compounds were administered intracerebroventricularly in order to mitigate confounds of drug metabolism that arise from systemic administration. Comparison of the anticonvulsant potencies to their affinities for NMDA, σ1, and σ2 binding sites were made in order to evaluate the contribution of these receptors to anticonvulsant efficacy. The potencies to block convulsions were positively associated with their affinities to bind to the NMDA receptor ion channel ([3H]-TCP binding) (r = 0.71, p < 0.05) but not to σ1 receptors ([3H]-SKF 10047 binding) (r = -0.31, p = 0.46) or to σ2 receptors ([3H]-DTG binding) (p = -0.38, p = 0.36). This is the first report demonstrating that these dextromethorphan analogs are functional NMDA receptor antagonists in vivo. Given their potential therapeutic utility and favorable side-effect profiles, such low affinity NMDA receptor antagonists could be considered for further development in neurological (e.g., anticonvulsant) and psychiatric (e.g., antidepressant) disorders.
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Affiliation(s)
- Jeffrey M Witkin
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN, USA; Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Rok Cerne
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN, USA; Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amy H Newman
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Sari Izenwasser
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jodi L Smith
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN, USA
| | - Frank C Tortella
- Department of Neuropharmacology and Molecular Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Gusella M, Pasini F, Corso B, Bertolaso L, De Rosa G, Falci C, Modena Y, Barile C, Da Corte Z D, Fraccon A, Toso S, Cretella E, Brunello A, Modonesi C, Segati R, Oliani C, Minicuci N, Padrini R. Predicting steady-state endoxifen plasma concentrations in breast cancer patients by CYP2D6 genotyping or phenotyping. Which approach is more reliable? Pharmacol Res Perspect 2020; 8:e00646. [PMID: 32813313 PMCID: PMC7437348 DOI: 10.1002/prp2.646] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 12/24/2022] Open
Abstract
In previous studies, steady-state Z-endoxifen plasma concentrations (ENDOss) correlated with relapse-free survival in women on tamoxifen (TAM) treatment for breast cancer. ENDOss also correlated significantly with CYP2D6 genotype (activity score) and CYP2D6 phenotype (dextromethorphan test). Our aim was to ascertain which method for assessing CYP2D6 activity is more reliable in predicting ENDOss. The study concerned 203 Caucasian women on tamoxifen-adjuvant therapy (20 mg q.d.). Before starting treatment, CYP2D6 was genotyped (and activity scores computed), and the urinary log(dextromethorphan/dextrorphan) ratio [log(DM/DX)] was calculated after 15 mg of oral dextromethorphan. Plasma concentrations of TAM, N-desmethyl-tamoxifen (ND-TAM), Z-4OH-tamoxifen (4OH-TAM) and ENDO were assayed 1, 4, and 8 months after first administering TAM. Multivariable regression analysis was used to identify the clinical and laboratory variables predicting log-transformed ENDOss (log-ENDOss). Genotype-derived CYP2D6 phenotypes (PM, IM, NM, EM) and log(DM/DX) correlated independently with log-ENDOss. Genotype-phenotype concordance was almost complete only for poor metabolizers, whereas it emerged that 34% of intermediate, normal, and ultrarapid metabolizers were classified differently based on log(DM/DX). Multivariable regression analysis selected log(DM/DX) as the best predictor, with patients' age, weak inhibitor use, and CYP2D6 phenotype decreasingly important: log-ENDOss = 0.162 - log(DM/DX) × 0.170 + age × 0.0063 - weak inhibitor use × 0.250 + IM × 0.105 + (NM + UM) × 0.210; (R2 = 0.51). In conclusion, log(DM/DX) seems superior to genotype-derived CYP2D6 phenotype in predicting ENDOss.
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Affiliation(s)
| | - Felice Pasini
- Oncology UnitCasa di Cura PederzoliPeschiera del GardaItaly
| | - Barbara Corso
- National Research CouncilNeuroscience InstitutePadovaItaly
| | | | - Giovanni De Rosa
- Clinical Pharmacology Unit of the Department of Medicine (DIMED)University of PadovaPadovaItaly
| | - Cristina Falci
- Oncology Unit 2Istituto Oncologico Veneto (IOV)IRCCS PadovaPadovaItaly
| | | | | | | | | | | | | | | | | | | | | | - Nadia Minicuci
- National Research CouncilNeuroscience InstitutePadovaItaly
| | - Roberto Padrini
- Clinical Pharmacology Unit of the Department of Medicine (DIMED)University of PadovaPadovaItaly
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Pozzi-Lorenzo VG, Delgado-Martínez FY, Butler-Sánchez M, Melin K, Santiago-Quiñones DI. Physicochemical Evaluation of Compounded Oral Preparations for Respiratory Illnesses, also known as Mezclitas. P R Health Sci J 2020; 39:189-194. [PMID: 32663916] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Compounded oral solutions for respiratory illnesses such as the common cold and cough are commonly prepared and dispensed by licensed pharmacists in the United States and Puerto Rico (PR). Standard protocols for their preparation and quality assessment and for patient counseling are available for most of the prescribed compounded solutions. However, in PR there is a common prescription approach colloquially referred to as "mezclitas": mixtures of antitussives, expectorants, decongestants, and other active ingredients available in commercial solutions for which there are no science-driven compounding guidelines for local pharmacists. METHODS This study evaluated the physicochemical stability of a commonly dispensed compounded preparation (containing guaifenesin, dextromethorphan, and dexamethasone) that is used for the treatment of respiratory illnesses in PR. The stability indicators tested included clarity, odor, pH, and viscosity. Changes in stability indicators were evaluated for different storage conditions (ambient temperature and refrigerated) over a period of 6 months. RESULTS The samples exhibited small changes in color, odor, and viscosity. Although the observed changes were small, they may be indicative of chemical and/or physical transformations that occurred over time. A survey of local pharmacists also evidenced the absence of standardized protocols for the preparation and dispensation of the mezclitas in PR. CONCLUSION In spite of the absence of protocols for compounding oral solutions for respiratory illnesses, our study suggests that the stability of such solutions is not heavily compromised. However further chemical and physical testing is needed and the findings of such testing used to develop standardized protocols for the compounding of oral solutions for respiratory illnesses.
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Affiliation(s)
- Vanesa G Pozzi-Lorenzo
- Department of Pharmacy Practice, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Frances Y Delgado-Martínez
- Department of Pharmacy Practice, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Maralis Butler-Sánchez
- Department of Pharmacy Practice, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Kyle Melin
- Department of Pharmacy Practice, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Darlene I Santiago-Quiñones
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Mohamed MF, Feng T, Enejosa JV, Fisniku O, Othman AA. Effects of Upadacitinib Coadministration on the Pharmacokinetics of Sensitive Cytochrome P450 Probe Substrates: A Study With the Modified Cooperstown 5+1 Cocktail. J Clin Pharmacol 2020; 60:86-95. [PMID: 31378969 PMCID: PMC6972567 DOI: 10.1002/jcph.1496] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/28/2019] [Indexed: 12/15/2022]
Abstract
The aim of this study was to characterize the effects of upadacitinib, a Janus kinase 1 inhibitor, on in vivo activity of different cytochrome P450 (CYP) enzymes using a cocktail approach. Healthy subjects (n = 20) received single oral doses of the modified Cooperstown 5+1 cocktail drugs (midazolam [CYP3A], caffeine [CYP1A2], warfarin + vitamin K [CYP2C9], omeprazole [CYP2C19], and dextromethorphan [CYP2D6]) without upadacitinib and on day 11 (midazolam) or 12 (all other probes) of a 15-day regimen of upadacitinib 30 mg once daily (extended-release formulation). Serial blood samples and 12-hour urine samples were collected for assays of the probe substrates and select metabolites. The ratio (90%CI) of area under the plasma concentration-time curve from time 0 to infinity (AUCinf ) central values when the cocktail drugs were administered with upadacitinib relative to when administered alone were 0.74 (0.68-0.80) for midazolam, 1.22 (1.15-1.29) for caffeine, 1.11 (1.07-1.15) for S-warfarin, 1.07 (0.95-1.22) for dextromethorphan, and 0.82 (0.72-0.94) for omeprazole. The ratio (90%CI) was 1.09 (1.00-1.19) for 5-hydroxy-omeprazole to omeprazole AUCinf ratio and 1.17 (0.97-1.41) for dextromethorphan to dextrorphan 12-hour molar urinary ratio. Upadacitinib 30 mg once daily (a dose that is twice the optimal dose in rheumatoid arthritis based on phase 3 results) has a limited effect on CYP3A activity (26% decrease in exposure of midazolam, a sensitive CYP3A substrate) and no relevant effects on CYP1A2, CYP2C9, CYP2C19, or CYP2D6 activity in vivo. No clinically relevant changes in plasma exposures are expected for drugs that are substrates for the evaluated CYP enzymes when coadministered with upadacitinib.
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Affiliation(s)
| | - Tian Feng
- Department of StatisticsAbbVie Inc.North ChicagoIllinoisUSA
| | | | - Ogert Fisniku
- Regulated BioanalysisAbbVie Inc.North ChicagoIllinoisUSA
| | - Ahmed A. Othman
- Clinical Pharmacology and PharmacometricsAbbVie Inc.North ChicagoIllinoisUSA
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Song IH, Ilic K, Murphy J, Lasseter K, Martin P. Effects of Maribavir on P-Glycoprotein and CYP2D6 in Healthy Volunteers. J Clin Pharmacol 2020; 60:96-106. [PMID: 31385617 PMCID: PMC6972521 DOI: 10.1002/jcph.1504] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/15/2019] [Indexed: 12/26/2022]
Abstract
Maribavir is an investigational drug being evaluated in transplant recipients with cytomegalovirus infection. To understand potential drug-drug interactions, we examined the effects of multiple doses of maribavir on cytochrome P450 (CYP) 2D6 and P-glycoprotein (P-gp) activity using probe substrates in healthy volunteers. During this phase 1 open-label study (NCT02775240), participants received the probe substrates digoxin (0.5 mg) and dextromethorphan (30 mg) before and after maribavir (400 mg twice daily for 8 days). Serial plasma samples were analyzed for digoxin, dextromethorpha, dextrorphan, and maribavir concentrations. Pharmacokinetic parameters were calculated (noncompartmental analysis) and analyzed with a linear mixed-effects model for treatment comparison to estimate geometric mean ratios (GMRs) and 90% confidence intervals (CIs). CYP2D6 polymorphisms were genotyped using polymerase chain reaction. Overall, 17 of 18 participants (94.4%) completed the study. All participants were genotyped as CYP2D6 intermediate/extensive metabolizers. GMR (90%CI) of digoxin Cmax , AUClast , and AUC0-∞ with and without maribavir was 1.257 (1.139-1.387), 1.187 (1.088-1.296), and 1.217 (1.110-1.335), respectively, outside the "no-effect" window (0.8-1.25). GMR (90%CI) of dextromethorphan AUClast and AUClast ratio of dextromethorphan/dextrorphan were 0.877 (0.692-1.112) and 0.901 (0.717-1.133), respectively, marginally outside the no-effect window, although large variability was observed in these pharmacokinetic parameters. Pharmacokinetic parameters of dextrorphan were unaffected. Maribavir inhibited P-gp activity but did not affect CYP2D6 activity. Maribavir's effect on the pharmacokinetics of P-gp substrates should be evaluated individually, and caution should be exercised with P-gp substrates with narrow therapeutic windows.
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Affiliation(s)
- Ivy H. Song
- Shire, a Takeda companyLexingtonMassachusettsUSA
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Sikimic J, Hoffmeister T, Gresch A, Kaiser J, Barthlen W, Wolke C, Wieland I, Lendeckel U, Krippeit-Drews P, Düfer M, Drews G. Possible New Strategies for the Treatment of Congenital Hyperinsulinism. Front Endocrinol (Lausanne) 2020; 11:545638. [PMID: 33193079 PMCID: PMC7653201 DOI: 10.3389/fendo.2020.545638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/02/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Congenital hyperinsulinism (CHI) is a rare disease characterized by persistent hypoglycemia as a result of inappropriate insulin secretion, which can lead to irreversible neurological defects in infants. Poor efficacy and strong adverse effects of the current medications impede successful treatment. The aim of the study was to investigate new approaches to silence β-cells and thus attenuate insulin secretion. RESEARCH DESIGN AND METHODS In the scope of our research, we tested substances more selective and more potent than the gold standard diazoxide that also interact with neuroendocrine ATP-sensitive K+ (KATP) channels. Additionally, KATP channel-independent targets as Ca2+-activated K+ channels of intermediate conductance (KCa3.1) and L-type Ca2+ channels were investigated. Experiments were performed using human islet cell clusters isolated from tissue of CHI patients (histologically classified as pathological) and islet cell clusters obtained from C57BL/6N (WT) or SUR1 knockout (SUR1-/-) mice. The cytosolic Ca2+ concentration ([Ca2+]c) was used as a parameter for the pathway regulated by electrical activity and was determined by fura-2 fluorescence. The mitochondrial membrane potential (ΔΨ) was determined by rhodamine 123 fluorescence and single channel currents were measured by the patch-clamp technique. RESULTS The selective KATP channel opener NN414 (5 µM) diminished [Ca2+]c in isolated human CHI islet cell clusters and WT mouse islet cell clusters stimulated with 10 mM glucose. In islet cell clusters lacking functional KATP channels (SUR1-/-) the drug was without effect. VU0071063 (30 µM), another KATP channel opener considered to be selective, lowered [Ca2+]c in human CHI islet cell clusters. The compound was also effective in islet cell clusters from SUR1-/- mice, showing that [Ca2+]c is influenced by additional effects besides KATP channels. Contrasting to NN414, the drug depolarized ΔΨ in murine islet cell clusters pointing to severe interference with mitochondrial metabolism. An opener of KCa3.1 channels, DCEBIO (100 µM), significantly decreased [Ca2+]c in SUR1-/- and human CHI islet cell clusters. To target L-type Ca2+ channels we tested two already approved drugs, dextromethorphan (DXM) and simvastatin. DXM (100 µM) efficiently diminished [Ca2+]c in stimulated human CHI islet cell clusters as well as in stimulated SUR1-/- islet cell clusters. Similar effects on [Ca2+]c were observed in experiments with simvastatin (7.2 µM). CONCLUSIONS NN414 seems to provide a good alternative to the currently used KATP channel opener diazoxide. Targeting KCa3.1 channels by channel openers or L-type Ca2+ channels by DXM or simvastatin might be valuable approaches for treatment of CHI caused by mutations of KATP channels not sensitive to KATP channel openers.
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Affiliation(s)
- Jelena Sikimic
- Department of Pharmacology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
| | - Theresa Hoffmeister
- Department of Pharmacology, Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Münster, Germany
| | - Anne Gresch
- Department of Pharmacology, Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Münster, Germany
| | - Julia Kaiser
- Department of Pharmacology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
| | - Winfried Barthlen
- Department of Pediatric Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Carmen Wolke
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany
| | - Ilse Wieland
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Uwe Lendeckel
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany
| | - Peter Krippeit-Drews
- Department of Pharmacology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
- *Correspondence: Peter Krippeit-Drews,
| | - Martina Düfer
- Department of Pharmacology, Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Münster, Germany
| | - Gisela Drews
- Department of Pharmacology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
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Yao HT, Lin JH, Liu YT, Li ML, Chiang W. Food-Drug Interaction between the Adlay Bran Oil and Drugs in Rats. Nutrients 2019; 11:nu11102473. [PMID: 31618937 PMCID: PMC6835337 DOI: 10.3390/nu11102473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/08/2019] [Revised: 09/29/2019] [Accepted: 10/14/2019] [Indexed: 01/24/2023] Open
Abstract
Adlay (Coix lachryma-jobi L. var. ma-yuen Stapf) contains various phytonutrients for treating many diseases in Asia. To investigate whether orally administered adlay bran oil (ABO) can cause drug interactions, the effects of ABO on the pharmacokinetics of five cytochrome P450 (CYP) probe drugs were evaluated. Rats were given a single oral dose (2.5 mL/kg BW) of ABO 1 h before administration of a drug cocktail either orally or intravenously, and blood was collected at various time points. A single oral dose of ABO administration did not affect the pharmacokinetics of five probe drugs when given as a drug cocktail intravenously. However, ABO increased plasma theophylline (+28.4%), dextromethorphan (+48.7%), and diltiazem (+46.7%) when co-administered an oral drug cocktail. After 7 days of feeding with an ABO-containing diet, plasma concentrations of theophylline (+45.4%) and chlorzoxazone (+53.6%) were increased after the oral administration of the drug cocktail. The major CYP enzyme activities in the liver and intestinal tract were not affected by ABO treatment. Results from this study indicate that a single oral dose or short-term administration of ABO may increase plasma drug concentrations when ABO is given concomitantly with drugs. ABO is likely to enhance intestinal drug absorption. Therefore, caution is needed to avoid food–drug interactions between ABO and co-administered drugs.
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Affiliation(s)
- Hsien-Tsung Yao
- Department of Nutrition, China Medical University, 91 Hsueh-shih Road, Taichung 404, Taiwan.
| | - Jia-Hsuan Lin
- Department of Nutrition, China Medical University, 91 Hsueh-shih Road, Taichung 404, Taiwan.
| | - Yun-Ta Liu
- Department of Nutrition, China Medical University, 91 Hsueh-shih Road, Taichung 404, Taiwan.
| | - Mei-Ling Li
- Department of Nutrition, China Medical University, 91 Hsueh-shih Road, Taichung 404, Taiwan.
| | - Wenchang Chiang
- Graduate Institute of Food Science and Technology, Center for Food and Biomolecules, College of Bioresources and Agriculture, National Taiwan University, 1 Roosevelt Road, Sec. 4, Taipei 106, Taiwan.
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Drugs for cough. Med Lett Drugs Ther 2018; 60:206-8. [PMID: 30625123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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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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Martinak B, Bolis RA, Black JR, Fargason RE, Birur B. Dextromethorphan in Cough Syrup: The Poor Man's Psychosis. Psychopharmacol Bull 2017; 47:59-63. [PMID: 28936010 PMCID: PMC5601090] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dextromethorphan (3-methoxy-N-methylmorphinan), also known as "DXM" and "the poor man's PCP," is a synthetically produced drug that is available in more than 140 over-the-counter cough and cold preparations. Dextromethorphan (DXM) has overtaken codeine as the most widely used cough suppressant due to its availability, efficacy, and safety profile at directed doses. However, DXM is subject to abuse. When consumed at inappropriately high doses (over 1500 mg/day), DXM can induce a state of psychosis characterized by Phencyclidine (PCP)-like psychological symptoms, including delusions, hallucinations, and paranoia. We report a noteworthy case of severe dextromethorphan use disorder with dextromethorphan-induced psychotic disorder in a 40-year-old Caucasian female, whose symptoms remitted only following treatment with a combination of an antipsychotic and mood stabilizer. While some states have begun to limit the quantity of DXM sold or restrict sales to individuals over 18-years of age, there is currently no federal ban or restriction on DXM. Abuse of DXM, a readily available and typically inexpensive agent that is not detected on a standard urine drug screen, may be an under-recognized cause of substance-induced psychosis. It is imperative that clinicians are aware of the potential psychiatric sequelae of recreational DXM use.
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Affiliation(s)
- Bridgette Martinak
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Ramy A Bolis
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Jeffrey Ryne Black
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Rachel E Fargason
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
| | - Badari Birur
- Dr. Martinak, MD, PGY3 Psychiatry Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Mr. Bolis, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Mr. Black, MS-4, Medical Student-4, University of Alabama at Birmingham, Birmingham. Dr. Fargason, MD, Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham. Dr. Birur, MD, Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham
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Kuo HI, Paulus W, Batsikadze G, Jamil A, Kuo MF, Nitsche MA. Chronic Enhancement of Serotonin Facilitates Excitatory Transcranial Direct Current Stimulation-Induced Neuroplasticity. Neuropsychopharmacology 2016; 41:1223-30. [PMID: 26329381 PMCID: PMC4793106 DOI: 10.1038/npp.2015.270] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/12/2015] [Accepted: 08/17/2015] [Indexed: 11/09/2022]
Abstract
Serotonin affects memory formation via modulating long-term potentiation (LTP) and depression (LTD). Accordingly, acute selective serotonin reuptake inhibitor (SSRI) administration enhanced LTP-like plasticity induced by transcranial direct current stimulation (tDCS) in humans. However, it usually takes some time for SSRI to reduce clinical symptoms such as anxiety, negative mood, and related symptoms of depression and anxiety disorders. This might be related to an at least partially different effect of chronic serotonergic enhancement on plasticity, as compared with single-dose medication. Here we explored the impact of chronic application of the SSRI citalopram (CIT) on plasticity induced by tDCS in healthy humans in a partially double-blinded, placebo (PLC)-controlled, randomized crossover study. Furthermore, we explored the dependency of plasticity induction from the glutamatergic system via N-methyl-D-aspartate receptor antagonism. Twelve healthy subjects received PLC medication, combined with anodal or cathodal tDCS of the primary motor cortex. Afterwards, the same subjects took CIT (20 mg/day) consecutively for 35 days. During this period, four additional interventions were performed (CIT and PLC medication with anodal/cathodal tDCS, CIT and dextromethorphan (150 mg) with anodal/cathodal tDCS). Plasticity was monitored by motor-evoked potential amplitudes elicited by transcranial magnetic stimulation. Chronic application of CIT increased and prolonged the LTP-like plasticity induced by anodal tDCS for over 24 h, and converted cathodal tDCS-induced LTD-like plasticity into facilitation. These effects were abolished by dextromethorphan. Chronic serotonergic enhancement results in a strengthening of LTP-like glutamatergic plasticity, which might partially explain the therapeutic impact of SSRIs in depression and other neuropsychiatric diseases.
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Affiliation(s)
- Hsiao-I Kuo
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Giorgi Batsikadze
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Asif Jamil
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Min-Fang Kuo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A Nitsche
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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12
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Yin WH, Chen P, Yeh HI, Wang KY, Hung YJ, Tseng WK, Wen MS, Wu TC, Wu CC, Cheng SM, Chen JW. Combination With Low-dose Dextromethorphan Improves the Effect of Amlodipine Monotherapy in Clinical Hypertension: A First-in-human, Concept-proven, Prospective, Dose-escalation, Multicenter Study. Medicine (Baltimore) 2016; 95:e3234. [PMID: 27015224 PMCID: PMC4998419 DOI: 10.1097/md.0000000000003234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The combination of low rather than high dose of dextromethorphan (DXM) with amlodipine (AM) could improve blood pressure (BP) reduction in hypertensive animals. The study aimed to evaluate the feasibility of different doses of DXM combined with standard AM treatment in clinical hypertension.This was a prospective, 14-week, dose-escalation, multicenter study. After 2-week run-in period with AM 5 mg/day, hypertensive patients who got the BP goal of 140/90 mmHg kept receiving AM monotherapy for another 12 weeks. The nonresponders, while kept on AM 5 mg/day, received additional DXM treatment for 3 sequential dose-titrated periods with initially 2.5 mg/day, followed by 7.5 mg/day, and finally 30 mg/day. Each period was for 4 weeks. The patients at BP goal after each treatment period were defined as the responders and kept on the same combination till the end of the study. The responder rate of each treatment period was recorded. The changes of BP and serum antioxidant/endothelial markers between week 14 and week 2 were evaluated.Of the 103 patients initially enrolled, 89 entered the treatment period. In the 78 patients completing the study, 31 (40%) at BP goal after 2-week AM run-in kept on AM monotherapy (DXM0). The addition of 2.5 (DXM2.5) and 7.5 mg/day (DXM7.5) of DXM enabled BP goal achievement in 22 (47%) nonresponders to AM monotherapy including 16 (29%) with DXM2.5 and 6 (18%) with DXM7.5. Only 4 patients (16%) reached BP goal with the combination of DXM 30 mg/day (DXM30). Overall, 73% of the 78 patients reached BP goal at the end of the 14-week study. Mean systolic BP was reduced by 7.9% ± 7.0% with DXM2.5 (P < 0.001) and by 5.4% ± 2.4% with DXM7.5 (P = 0.003) respectively at week 14 from that at week 2, which was unchanged in either DXM0 or DXM30 group. Besides, the effects of combination treatment were particularly significant in the patients with impaired endothelial function suggested by reduced serum NOx level at baseline.Accordingly, the combination with low dose of DXM was feasible to improve BP control in patients who failed to achieve the BP goal by standard AM monotherapy. The benefit effects might be significant especially in patients with impaired endothelial function.
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Affiliation(s)
- Wei-Hsian Yin
- From the Heart Center, Cheng-Hsin General Hospital (W-HY); Faculty of Medicine, National Yang-Ming University (W-HY); Institute of Pharmacology, National Yang-Ming University (J-WC); TSH Biopharm Corporation Ltd (PC); Department of Medicine, Mackay Memorial Hospital, Taipei (H-IY); Division of Cardiology, Taichung Veterans General Hospital (K-YW); Department of Internal Medicine, Chung San Medical University, Taichung (K-YW); Division of Endocrinology and Metabolism (Y-JH); Division of Cardiology, Tri-Service General Hospital, Taipei (S-MC); Department of Cardiology, E-DA Medical University Hospital, Kaohsiung (W-KT); Department of Cardiology, Chang Gung Memorial Hospital Linkou, Taoyuan (M-SW); Division of Cardiology, Taipei Veterans General Hospital (T-CW, J-WC); Department of Internal Medicine, National Taiwan University Hospital (C-CW); and Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC (J-WC)
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Marquard J, Stirban A, Schliess F, Sievers F, Welters A, Otter S, Fischer A, Wnendt S, Meissner T, Heise T, Lammert E. Effects of dextromethorphan as add-on to sitagliptin on blood glucose and serum insulin concentrations in individuals with type 2 diabetes mellitus: a randomized, placebo-controlled, double-blinded, multiple crossover, single-dose clinical trial. Diabetes Obes Metab 2016; 18:100-3. [PMID: 26362564 PMCID: PMC5057326 DOI: 10.1111/dom.12576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/23/2015] [Accepted: 09/09/2015] [Indexed: 02/01/2023]
Abstract
In this clinical trial, we investigated the blood glucose (BG)-lowering effects of 30, 60 and 90 mg dextromethorphan (DXM) as well as 100 mg sitagliptin alone versus combinations of DXM and sitagliptin during an oral glucose tolerance test (OGTT) in 20 men with T2DM. The combination of 60 mg DXM plus 100 mg sitagliptin was observed to have the strongest effect in the OGTT. It lowered maximum BG concentrations and increased the baseline-adjusted area under the curve for serum insulin concentrations in the first 30 min of the OGTT (mean ± standard deviation 240 ± 47 mg/dl and 8.1 ± 6.1 mU/l/h, respectively) to a significantly larger extent than did 100 mg sitagliptin alone (254 ± 50 mg/dl and 5.8 ± 2.5 mU/l/h, respectively; p < 0.05) and placebo (272 ± 49 mg/dl and 3.9 ± 3.0 mU/l/h, respectively; p < 0.001). All study drugs were well tolerated, alone and in combination, without serious adverse events or hypoglycaemia. Long-term clinical trials are now warranted to investigate the potential of the combination of 30 or 60 mg DXM and dipeptidyl peptidase-4 inhibitors in the treatment of individuals with T2DM, in particular as preclinical studies have identified the β-cell protective properties of DXM.
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Affiliation(s)
- J Marquard
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | | | - A Welters
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Beta Cell Biology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Düsseldorf, Germany
- German Centre for Diabetes Research, Partner Institution Düsseldorf, Düsseldorf, Germany
| | - S Otter
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Institute for Beta Cell Biology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Düsseldorf, Germany
- German Centre for Diabetes Research, Partner Institution Düsseldorf, Düsseldorf, Germany
| | | | - S Wnendt
- MLM Medical Labs GmbH, Mönchengladbach, Germany
| | - T Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | | | - E Lammert
- Institute of Metabolic Physiology, Department of Biology, Heinrich Heine University, Düsseldorf, Germany
- Institute for Beta Cell Biology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Düsseldorf, Germany
- German Centre for Diabetes Research, Partner Institution Düsseldorf, Düsseldorf, Germany
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Abstract
PURPOSE Morphine is an effective analgesic, but adverse effects limit its clinical use in higher doses. The non-opioid antitussive, dextromethorphan (DM), can potentiate the analgesic effect of morphine and decrease the dose of morphine in acute postoperative pain, but the underlying mechanism remains unclear. We previously observed that DM increases the serum concentration of morphine in rats. Therefore, we investigated the effects of drugs administered at the spinal level to exclude possible pharmacokinetic interactions. As DM has widespread binding sites in the central nervous system [such as N-methyl-D-aspartate (NMDA) receptors, sigma receptors and alpha(3)ss(4) nicotinic receptors], we investigated whether the potentiation of morphine antinociception by DM at the spinal level is related to NMDA receptors. METHODS We used MK-801 as a tool to block the NMDA channel first, and then studied the interaction between intrathecal (i.t.) morphine and DM. The tail-flick test was used to examine the antinociceptive effects of different combinations of morphine and other drugs in rats. RESULTS DM (2-20 microg) or MK-801 (5-15 microg) showed no significant antinociceptive effect by themselves. The antinociceptive effect of morphine (0.5 microg, i.t.) was significantly enhanced by DM and reached the maximal potentiation (43.7%-50.4%) at doses of 2 to 10 microg. Pretreatment with MK-801 (5 or 10 microg, i.t.) significantly potentiated morphine antinociception by 49.9% or 38.7%, respectively. When rats were pretreated with MK-801, DM could not further enhance morphine antinociception (45.7% vs 50.5% and 43.3%). CONCLUSION Our results suggest that spinal NMDA receptors play an important role in the effect of DM to potentiate morphine antinociception.
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Affiliation(s)
- Lok-Hi Chow
- Graduate Institute of Medical Science, Department of Pharmacology, National Defense Medical Center, Tapei, Taiwan
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15
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Abstract
OBJECTIVE To evaluate the role of dextromethorphan/quinidine (DM/Q; Nuedexta™) in the treatment of pseudobulbar affect (PBA). DATA SOURCES A literature search of MEDLINE/PubMed (January 1966-June 2013) was conducted using search terms pseudobulbar affect, pathological laughing and/or crying, emotional lability, dextromethorphan, and quinidine. STUDY SELECTION AND DATA EXTRACTION English language clinical trials and case reports evaluating the safety and efficacy of DM/Q in PBA were included for review. Bibliographies of all relevant articles were reviewed for additional citations. DATA SYNTHESIS PBA, a poorly understood disorder, is characterized by involuntary crying and/or laughing. In the past, antidepressants and antiepileptics have been used off-label with mixed results. Four clinical trials have evaluated the use of DM/Q for the treatment of PBA. Although the therapeutic outcomes with DM/Q have been positive, interpretation of the published evidence is limited by small sample size and short treatment duration. CONCLUSIONS Based on the data available, DM/Q may be a viable, short-term treatment alternative for PBA. Long-term safety and efficacy data are lacking.
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Affiliation(s)
- Edna Patatanian
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, Oklahoma
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Rajan S, Colaco S, Ramesh N, Meyyanathan SN, Elango K. Development and validation of dissolution study of sustained release dextromethorphan hydrobromide tablets. Pak J Biol Sci 2014; 17:429-433. [PMID: 24897800 DOI: 10.3923/pjbs.2014.429.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study describes the development and validation of dissolution tests for sustained release Dextromethorphan hydrobromide tablets using an HPLC method. Chromatographic separation was achieved on a C18 column utilizing 0.5% triethylamine (pH 7.5) and acetonitrile in the ratio of 50:50. The detection wavelength was 280 nm. The method was validated and response was found to be linear in the drug concentration range of 10-80 microg mL(-1). The suitable conditions were clearly decided after testing sink conditions, dissolution medium and agitation intensity. The most excellent dissolution conditions tested, for the Dextromethorphan hydrobromide was applied to appraise the dissolution profiles. The method was validated and response was found to be linear in the drug concentration range of 10-80 microg mL(-1). The method was established to have sufficient intermediate precision as similar separation was achieved on another instrument handled by different operators. Mean Recovery was 101.82%. Intra precisions for three different concentrations were 1.23, 1.10 0.72 and 1.57, 1.69, 0.95 and inter run precisions were % RSD 0.83, 1.36 and 1.57%, respectively. The method was successfully applied for dissolution study of the developed Dextromethorphan hydrobromide tablets.
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Phadtare S, Abali E, Brodsky B. Over the counter drugs (and dietary supplement) exercise: a team-based introduction to biochemistry for health professional students. Biochem Mol Biol Educ 2013; 41:384-387. [PMID: 24214182 DOI: 10.1002/bmb.20738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 08/14/2013] [Accepted: 08/23/2013] [Indexed: 06/02/2023]
Abstract
For successful delivery of basic science topics for health-professional students, it is critical to reduce apprehension and illustrate relevance to clinical settings and everyday life. At the beginning of the Biochemistry course for Physician Assistants, a team-based assignment was designed to develop an understanding of the mechanism of action, effectiveness, and toxicity of five common over the counter (OTC) drugs and dietary supplements, and place these familiar medicines in a political and historical context. The objectives of this exercise were to stimulate interest in biochemistry; to provide basic information on enzymes and enzyme inhibitors related to these drugs to be expanded upon later in the course; and to encourage active and interactive learning. Teams of five students were formed, and each student was given an information sheet on aspirin, alpha-galactosidase, orlistat, dextromethorphan, or simvastatin, a low dose statin, which was previously available without prescription at pharmacies in the UK. After each member of the team acquired information on one OTC drug/dietary supplement by reading an assigned information sheet, the team was asked to go through a series of questions, and then submit answers to a quiz as a group. A high rate of success on the quiz, an overwhelmingly positive response on formal course evaluations, and enthusiastic exchanges during class suggested this team-based session accomplished its goals.
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Affiliation(s)
- Sangita Phadtare
- Department of Biochemistry and Molecular Biology, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey, 08854
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Wu K, Lin TH, Liou HC, Lu DH, Chen YR, Fu WM, Yang RS. Dextromethorphan inhibits osteoclast differentiation by suppressing RANKL-induced nuclear factor-κB activation. Osteoporos Int 2013; 24:2201-14. [PMID: 23400250 DOI: 10.1007/s00198-013-2279-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
UNLABELLED Dextromethorphan (DXM), a commonly used antitussive, is a dextrorotatory morphinan. Here, we report that DXM inhibits the receptor activator of nuclear factor kappa B ligand (RANKL)-induced osteoclastogenesis and bone resorption by abrogating the activation of NF-κB signalling in vitro. Oral administration of DXM ameliorates ovariectomy (OVX)-induced osteoporosis in vivo. INTRODUCTION DXM was reported to possess anti-inflammatory properties through inhibition of the release of pro-inflammatory factors. However, the potential role and action mechanism of DXM on osteoclasts and osteoblasts remain unclear. In this study, in vitro and in vivo studies were performed to investigate the potential effects of DXM on osteoclastogenesis and OVX-induced bone loss. METHODS Osteoclastogenesis was examined by the TRAP staining, pit resorption, TNF-α release, and CCR2 and CALCR gene expression. Osteoblast differentiation was analyzed by calcium deposition. Osteogenic and adipogenic genes were measured by real-time PCR. Signaling pathways were explored using Western blot. ICR mice were used in an OVX-induced osteoporosis model. Tibiae were measured by µCT and serum markers were examined with ELISA kits. RESULTS DXM inhibited RANKL-induced osteoclastogenesis. DXM mainly inhibited osteoclastogenesis via abrogation of IKK-IκBα-NF-κB pathways. However, a higher dosage of DXM antagonized the differentiation of osteoblasts via the inhibition of osteogenic signals and increase of adipogenic signals. Oral administration of DXM (20 mg/kg/day) partially reduced trabecular bone loss in ovariectomized mice. CONCLUSION DXM inhibits osteoclast differentiation and activity by affecting NF-κB signaling. Therefore, DXM at suitable doses may have new therapeutic applications for the treatment of diseases associated with excessive osteoclastic activity.
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Affiliation(s)
- Karl Wu
- Department of Orthopedics, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City 220, Taiwan, Republic of China
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Hendershot PE, Antal EJ, Welshman IR, Batts DH, Hopkins NK. Linezolid: Pharmacokinetic and Pharmacodynamic Evaluation of Coadministration with Pseudoephedrine HCl, Phenylpropanolamine HCl, and Dextromethorphan HBr. J Clin Pharmacol 2013; 41:563-72. [PMID: 11361053 DOI: 10.1177/00912700122010302] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Linezolid is a novel oxazolidinone antibiotic with mild reversible monoamine oxidase inhibitor (MAOI) activity. The potential for interaction with over-the-counter (OTC) medications requires quantification. The authors present data evaluating the pharmacokinetic and pharmacodynamic responses to coadministration of oral linezolid with sympathomimetics (pseudoephedrine and phenylpropanolamine) and a serotonin reuptake inhibitor (dextromethorphan). Following coadministration with linezolid, minimal but statistically significant increases were observed in pseudoephedrine and phenylpropanolamine plasma concentrations; a minimal but statistically significant decrease was observed in dextrorphan (the primary metabolite of dextromethorphan) plasma concentrations. Increased blood pressure (BP) was observed following the coadministration of linezolid with either pseudoephedrine or phenylpropanolamine; no significant effects were observed with dextromethorphan. None of these coadministered drugs had a significant effect on linezolid pharmacokinetics. Minimal numbers of adverse events were reported. Potentiation of sympathomimetic activity by linezolid was judged not to be clinically significant, but patients sensitive to the effects of increased BP due to predisposing factors should be treated cautiously. No restrictions are indicated for the coadministration of dextromethorphan and linezolid.
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Affiliation(s)
- P E Hendershot
- Clinical Pharmacology, Pharmacia & Upjohn, Kalamazoo, Michigan 49007-4940, USA
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Shelepova T, Nafziger AN, Victory J, Kashuba ADM, Rowland E, Zhang Y, Sellers E, Kearns G, Leeder JS, Gaedigk A, Bertino JS. Effect of a Triphasic Oral Contraceptive on Drug-Metabolizing Enzyme Activity as Measured by the Validated Cooperstown 5+1 Cocktail. J Clin Pharmacol 2013; 45:1413-21. [PMID: 16291717 DOI: 10.1177/0091270005280851] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of a common oral contraceptive preparation on the activity of 7 drug-metabolizing enzymes were investigated using the validated Cooperstown 5+1 Cocktail. In a randomized crossover fashion, 10 premenopausal women received caffeine, dextromethorphan, omeprazole, intravenous midazolam, and warfarin + vitamin K with and without a triphasic oral contraceptive (ethinyl estradiol 35 microg) and varying doses of daily norgestimate (0.18, 0.215, and 0.25 mg). Bioequivalence testing showed nonequivalence in drug versus no-drug treatment on the activity of drug-metabolizing enzymes (as reflected by metabolite ratios following probe drug administration); the activity of CYP1A2, CYP2C19, and NAT-2 decreased following the oral contraceptive, whereas the activity of CYP2C9 and CYP2D6 increased. No effects on xanthine oxidase or hepatic CYP3A were seen. Application of a non-parametric statistical testing approach revealed a significant difference only for CYP1A2 and CYP2C19. This triphasic oral contraceptive may have a clinically significant effect on the activity of some drug-metabolizing enzymes.
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Affiliation(s)
- Tatiana Shelepova
- Department of Medicine, Clinical Pharmacology Research Center, Bassett Healthcare, Cooperstown, New York, USA
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Carter LP, Reissig CJ, Johnson MW, Klinedinst MA, Griffiths RR, Mintzer MZ. Acute cognitive effects of high doses of dextromethorphan relative to triazolam in humans. Drug Alcohol Depend 2013; 128:206-13. [PMID: 22989498 PMCID: PMC3562553 DOI: 10.1016/j.drugalcdep.2012.08.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 04/17/2012] [Revised: 08/21/2012] [Accepted: 08/23/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although concerns surrounding high-dose dextromethorphan (DXM) abuse have recently increased, few studies have examined the acute cognitive effects of high doses of DXM. The aim of this study was to compare the cognitive effects of DXM with those of triazolam and placebo. METHODS Single, acute, oral doses of DXM (100, 200, 300, 400, 500, 600, 700, 800 mg/70 kg), triazolam (0.25, 0.5mg/70 kg), and placebo were administered p.o. to twelve healthy volunteers with histories of hallucinogen use, under double-blind conditions, using an ascending dose run-up design. Effects on cognitive performance were examined at baseline and after drug administration for up to 6h. RESULTS Both triazolam and DXM produced acute impairments in attention, working memory, episodic memory, and metacognition. Impairments observed following doses of 100-300 mg/70 kg DXM were generally smaller in magnitude than those observed after 0.5mg/70 kg triazolam. Doses of DXM that impaired performance to the same extent as triazolam were in excess of 10-30 times the therapeutic dose of DXM. CONCLUSION The magnitude of the doses required for these effects and the absence of effects on some tasks within the 100-300 mg/70 kg dose range of DXM, speak to the relatively broad therapeutic window of over-the-counter DXM preparations when used appropriately. However, the administration of supratherapeutic doses of DXM resulted in acute cognitive impairments on all tasks that were examined. These findings are likely relevant to cases of high-dose DXM abuse.
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Affiliation(s)
- Lawrence P. Carter
- University of Arkansas for Medical Sciences, Department of Pharmacology & Toxicology, 4301 W. Markham Street, Little Rock, AR 72205
| | - Chad J. Reissig
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, USA
| | - Matthew W. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, USA
| | - Margaret A. Klinedinst
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, USA
| | - Roland R. Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, USA
| | - Miriam Z. Mintzer
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 5510 Nathan Shock Drive, Baltimore, MD 21224, , telephone: 410-550-0529, fax: 410-550-0030
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Grigor'eva NI, Kuznetsov AN, Koroleva TV, Koroleva ME. [The combined drug ascoril in the treatment of patients with chronic obstructive pulmonary disease concurrent with coronary heart disease]. TERAPEVT ARKH 2013; 85:91-94. [PMID: 24137971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To evaluate the clinical efficacy of the combined drug ascoril (Glenmark, India) in patients with grade I-Ii chronic obstructive pulmonary disease (COPD) concurrent with coronary heart disease (CHD). SUBJECTS AND METHODS Sixty patients, including 12 (20%) women and 48 (80%) men, aged 43 to 68 years (mean age 55.1 +9.9 years), with COPD were examined. The patients were divided into 2 groups. Group 1 used the combined broncholytic and expectorant drug ascoril and Group 2 took mucolytic agent ambroxol. The follow-up period was 7 days. RESULTS On day 2 of ascoril treatment, all the patients showed a significant reduction in the intensity of cough that was completely relieved in 26 (87%) patients by treatment day 7. Prior to ascoril treatment, heart rate (HR) was 64.4+/-5.5 beats/min. A significant increase in HR to 72.7+/-10.1 beats/min was observed 20 min after the first drug intake (p < 0.05) and a decrease to 68.6+/-10.5 beats/min was seen after 60 min. On treatment day 7, HR was 63.0+/-6.5 beats/min, which was similar to that before ascoril treatment (p = 0.6). CONCLUSION In the patients with COPD concurrent with CHD, the combined drug ascoril exerts broncholytic and expectorant effects, with no pronounced negative action on HR.
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Chen SL, Lee SY, Chang YH, Chen SH, Chu CH, Tzeng NS, Lee IH, Chen PS, Yeh TL, Huang SY, Yang YK, Lu RB, Hong JS. Inflammation in patients with schizophrenia: the therapeutic benefits of risperidone plus add-on dextromethorphan. J Neuroimmune Pharmacol 2012; 7:656-64. [PMID: 22730040 PMCID: PMC3611097 DOI: 10.1007/s11481-012-9382-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 06/11/2012] [Indexed: 12/30/2022]
Abstract
UNLABELLED Increasing evidence suggests that inflammation contributes to the etiology and progression of schizophrenia. Molecules that initiate inflammation, such as virus- and toxin-induced cytokines, are implicated in neuronal degeneration and schizophrenia-like behavior. Using therapeutic agents with anti-inflammatory or neurotrophic effects may be beneficial for treating schizophrenia. One hundred healthy controls and 95 Han Chinese patients with schizophrenia were tested in this double-blind study. Their PANSS scores, plasma interleukin (IL)-1β, tumor necrosis factor-α (TNF-α) and brain-derived neurotrophic factor (BDNF) levels were measured before and after pharmacological treatment. Pretreatment, plasma levels of IL-1β and TNF-α were significantly higher in patients with schizophrenia than in controls, but plasma BDNF levels were significantly lower. Patients were treated with the atypical antipsychotic risperidone (Risp) only or with Risp+ dextromethorphan (DM). PANSS scores and plasma IL-1β levels significantly decreased, but plasma TNF-α and BDNF levels significantly increased after 11 weeks of Risp treatment. Patients in the Risp+ DM group showed a greater and earlier reduction of symptoms than did those in the Risp-only group. Moreover, Risp+ DM treatment attenuated Risp-induced plasma increases in TNF-α. Patients with schizophrenia had a high level of peripheral inflammation and a low level of peripheral BDNF. Long-term Risp treatment attenuated inflammation and potentiated the neurotrophic function but also produced a certain degree of toxicity. Risp+ DM was more beneficial and less toxic than Risp-only treatment. CLINICAL TRIAL REGISTRATION Protocol Record: HR-93-50; TRIAL REGISTRATION NUMBER NCT01189006; URL: http://www.clinicaltrials.gov.
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Affiliation(s)
- Shiou-Lan Chen
- Institute of Behavioral Medicine, University Hospital
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
| | - Sheng-Yu Lee
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
- Department of Psychiatry, Tainan Hospital, Department of Health, Executive Yuan, Tainan
| | - Yun-Hsuan Chang
- Institute of Behavioral Medicine, University Hospital
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University
| | - Shih-Heng Chen
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
| | - Chun-Hsieh Chu
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
| | - Po-See Chen
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
| | - Tzung Lieh Yeh
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital
- Addiction Research Center, National Cheng Kung University
- Department of Psychiatry, Tainan Hospital, Department of Health, Executive Yuan, Tainan
| | - Ru-Band Lu
- Institute of Behavioral Medicine, University Hospital
- Department of Psychiatry, National Cheng Kung University Hospital
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University
- Addiction Research Center, National Cheng Kung University
- Department of Psychiatry, Tainan Hospital, Department of Health, Executive Yuan, Tainan
| | - Jau-Shyong Hong
- Neuropharmacology Section, Laboratory of Pharmacology and Chemistry, National Institute of Environmental Health Sciences/National Institutes of Health, Research Triangle Park, North Carolina, USA
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Abstract
OBJECTIVE Studies have suggested that the N-methyl-D-aspartate antagonist dextromethorphan may be useful in the treatment of opioid dependence. DESIGN This double-blinded, placebo-controlled inpatient study evaluated the effects of 0, 30, and 60 mg of dextromethorphan and quinidine (DMQ) on the reinforcing and subjective effects of heroin in recently detoxified heroin abusers. PARTICIPANTS Nine heroin-dependent participants were admitted and then detoxified from heroin over the course of several days. INTERVENTIONS Participants were subsequently stabilized on 0, 30, or 60 mg of DMQ. Each dose of DMQ was administered for two consecutive weeks, and the effects of heroin (0, 12.5, and 50 mg) were studied under each DMQ maintenance dose condition. DMQ and heroin dose were administered in random order both within and between participants. RESULTS Planned comparisons revealed statistically significant increases in progressive ratio breakpoint values and positive subjective ratings as a function of heroin dose. There were no consistent changes in any of the responses as a function of DMQ maintenance dose, other than a modest reduction in craving. CONCLUSIONS In summary, results from this study suggest that maintenance on dextromethorphan in combination with quinidine has a limited role in the treatment of opioid dependence.
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Affiliation(s)
- Suzanne K Vosburg
- Department of Psychiatry New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, USA
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Chen SL, Hsu KY, Huang EYK, Lu RB, Tao PL. Low doses of dextromethorphan attenuate morphine-induced rewarding via the sigma-1 receptor at ventral tegmental area in rats. Drug Alcohol Depend 2011; 117:164-9. [PMID: 21320758 DOI: 10.1016/j.drugalcdep.2011.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 01/04/2011] [Accepted: 01/16/2011] [Indexed: 10/18/2022]
Abstract
Chronic use of morphine causes rewarding and behavioral sensitization, which may lead to the development of psychological craving. In our previous study, we found that a widely used antitussive dextromethorphan (known as a low affinity NMDA receptor antagonist), at doses of 10-20 mg/kg (i.p.), effectively decreased morphine rewarding in rats. In this study, we further investigated the effects and mechanisms of low doses of DM (μg/kg range) on morphine rewarding and behavioral sensitization. A conditioned place preference test was used to determine the rewarding and a locomotor activity test was used to determine the behavioral sensitization induced by the drug(s) in rats. When a low dose of DM (3 or 10 μg/kg, i.p.) was co-administered with morphine (5 mg/kg, s.c.), the rewarding effect, but not behavioral sensitization, induced by morphine was inhibited. The inhibiting effect of DM could be blocked by systemically administering a sigma-1 receptor antagonist, BD1047 (3 mg/kg, i.p.). When BD1047 (5 nmole/site) was locally given at the VTA, it also blocked the effects of a low dose of DM in inhibiting morphine rewarding. Our findings suggest that the activation of the sigma-1 receptor at the VTA may be involved in the mechanism of low doses of DM in inhibiting the morphine rewarding effect and the possibility of using extremely low doses of DM in treatment of opioid addiction in clinics.
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Affiliation(s)
- Shiou-Lan Chen
- Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
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McLeod RL, Tulshian DB, Sadeh J. Where are the new cough treatments: a debriefing of recent clinical proof-of-concept trials with the NOP agonist SCH 486757. Pharmacology 2011; 88:50-4. [PMID: 21757975 DOI: 10.1159/000328782] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 04/15/2011] [Indexed: 11/19/2022]
Abstract
Cough continues to be one of the top reasons why patients seek medical attention from health care providers. The prescription antitussive market is dominated by opioids, such as codeine that produces inconsistent efficacy and is often accompanied by significant side effect liabilities. Consequently, cough represents an unmet medical need and an underserved market. Yet, against the backdrop of increasing cough research, the development of novel treatments has been exceptionally challenging with dextromethorphan being the last US drug approved for cough almost a half century ago. We support the position that an unambiguous and actionable 'road map' that clearly delineates the pathway forward for new cough suppressants from basic research to and beyond clinical proof-of-concept studies will be an important aspect for future success of this pharmacological class of drug. Pivotal to the establishment of such a road map will be the review of lessons learned from antitussive agents that have been recently progressed to proof-of-concept trials. In the present commentary, we briefly discuss observations and challenges pertaining to SCH 486757, a selective orally active NOP agonist that has recently advanced to human antitussive testing.
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Affiliation(s)
- Robbie L McLeod
- Bone, Respiratory, Immunology and Dermatology, Merck Research Laboratories, Kenilworth, NJ 07033-0539, USA.
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Kinoshita H, Ohkubo T, Yasuda M, Yakushiji F. Serotonin syndrome induced by dextromethorphan (Medicon) administrated at the conventional dose. Geriatr Gerontol Int 2011; 11:121-2. [PMID: 21166968 DOI: 10.1111/j.1447-0594.2010.00652.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu J, Tan QY, Liu BL, Xu ML, Zhao CJ, Zhang JQ. [Pharmacokinetic study of a new chewing gum dextromethorphan delivery system]. Nan Fang Yi Ke Da Xue Xue Bao 2011; 31:103-107. [PMID: 21269969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To establish an high-performance liquid chromatography (HPLC)-based method for analysis of the pharmacokinetics and relative bioavailability of dextromethorphan chewing gum tablets in rabbits. METHODS The pharmacokinetic parameters and the relative bioavailability of dextromethorphan chewing gum preparation in rabbits were compared with those of the commercially available chewing dextromethorphan tablets using 3P97 software. RESULTS Pharmacokinetic analysis of the new dextromethorphan chewing gum tablets showed a AUC of 488.76 ∓ 175.00 ng.ml(-1).h, C(max) of 95.45 ∓ 17.53 ng/ml, and t(max) of 1.83 ∓ 0.57 h as compared with the corresponding parameters of 370.13 ∓ 90.56 ng.ml(-1).h, 174.00 ∓ 47.88 ng.ml, and 1.04 ∓ 0.14 h for the commercially available chewing tablets. The relative bioavailability of the new chewing gum medicine system was (140.73 ∓ 65.91)%. CONCLUSION The new dextromethorphan chewing gum preparation shows an increased AUC((0→)), decreased C(max), and prolonged t(max) in comparison with the commercially available chewing tablets, with also a greatly enhanced relative bioavailability.
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Affiliation(s)
- Juan Liu
- Chongqing Key Laboratory of Biochemical and Molecular Pharmacology, Chongqing Medical University, Chongqing 400016, China
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Gärtner R, Kroman N, Callesen T, Kehlet H. Multimodal prevention of pain, nausea and vomiting after breast cancer surgery. Minerva Anestesiol 2010; 76:805-813. [PMID: 20935616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Despite many one- or two-modal attempts to relieve postoperative nausea and vomiting (PONV) and pain, postoperative issues following breast cancer surgery remain a substantial problem. Therefore, the aim of this explorative, hypothesis-generating study was to evaluate the effect of a multimodal, opiate-sparing, evidence-based regimen for prevention of PONV and pain. METHODS Two hundred consecutive patients scheduled for breast cancer surgery were included. The prevention regimen included a package consisting of preoperative paracetamol, dextromethorphan, celecoxib, gabapentin, dexamethasone, total intravenous anaesthesia and intraoperative ondansetron. The patients were prospectively scored according to PONV, pain during rest and mobilization and major side effects. RESULTS Of 200 consecutive breast cancer patients, 191 received the full package. During the first 36 postoperative hours, 79.1% reported no PONV at all and only 3.7% reported severe PONV. At rest, 69.6% reported no or light pain and 3.1% reported severe pain, with corresponding values of 59.7% and 8.9% during arm mobilization. Mean postoperative morphine consumption was 2.2 mg. The only significant side effect was transient dizziness. CONCLUSION A multimodal, opiate-sparing regimen to prevent pain and PONV seems to be more effective than one- or two-component regimens on PONV and pain after breast cancer surgery, a result which calls for large-scale multi-center or randomized studies.
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Affiliation(s)
- R Gärtner
- Department of Breast Cancer Surgery, Rigshospitalet, Copenhagen University, Denmark.
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Loos WJ, de Graan AJM, de Bruijn P, van Schaik RHN, van Fessem MAC, Lam MH, Mathijssen RHJ, Wiemer EAC. Simultaneous quantification of dextromethorphan and its metabolites dextrorphan, 3-methoxymorphinan and 3-hydroxymorphinan in human plasma by ultra performance liquid chromatography/tandem triple-quadrupole mass spectrometry. J Pharm Biomed Anal 2010; 54:387-94. [PMID: 20926215 DOI: 10.1016/j.jpba.2010.08.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/30/2010] [Accepted: 08/31/2010] [Indexed: 11/18/2022]
Abstract
A rapid and sensitive ultra performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) method has been developed and validated for the simultaneous quantitative determination of dextromethorphan (DM) and its metabolites dextrorphan (DX), 3-methoxymorphinan (3MM) and 3-hydroxymorphinan (3HM), in human lithium heparinized plasma. The extraction involved a simple liquid-liquid extraction with 1 ml n-butylchloride from 200μl aliquots of plasma, after the addition of 20 μl 4% (v/v) ammonium hydroxide and 100 μl stable labeled isotopic internal standards in acetonitrile. Chromatographic separations were achieved on an Aquity UPLC(®) BEH C(18) 1.7 μm 2.1 mm x 100mm column eluted at a flow-rate of 0.250 ml/min on a gradient of acetonitrile. The overall cycle time of the method was 7 min, with elution times of 1.3min for DX and 3HM, 2.8 min for 3MM and 2.9min for DM. The multiple reaction monitoring transitions were set at 272>215 (m/z), at 258>133 (m/z), at 258>213 (m/z) and at 244>157 (m/z) for DM, DX, 3MM and 3HM, respectively. The calibration curves were linear (r²≥0.995) over the range of 0.500-100 nM with the lower limit of quantitation validated at 0.500 nM for all compounds, which is equivalent to 136, 129, 129 and 122 pg/ml for DM, DX, 3MM and 3HM, respectively. Extraction recoveries were constant, but ranged from 39% for DM to 83% for DX. The within-run and between-run precisions were within 11.6%, while the accuracy ranged from 92.7 to 110.6%. The applicability of the bioanalytical method was demonstrated and is currently implemented in a clinical trial to study DM as probe-drug for individualized tamoxifen treatment in breast cancer patients.
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Affiliation(s)
- Walter J Loos
- Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, University Medical Center, Rotterdam, The Netherlands.
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Mahmoodzadeh H, Movafegh A, Beigi NM. Preoperative oral dextromethorphan does not reduce pain or morphine consumption after open cholecystectomy. Middle East J Anaesthesiol 2010; 20:559-563. [PMID: 20394254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Dextromethorphan (DM), the D-isomer of the codeine analogue levorphanol, is a weak, noncompetitive N-Methyl-D-Aspartate (NMDA) receptor antagonist. It has been suggested that NMDA receptor antagonists induce preemptive analgesia when administrated before tissue injury occurs, thus decreasing the subsequent sensation of pain. METHOD The study was conducted in the Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. In this seventy two patients scheduled for elective cholesyctectomy between February 2005 and December 2006 were randomized into three equal groups to receive as premedication either oral dextromethorphan 45 mg (Group D45 = 24), dextromethorphan 90 mg (Group D 90 = 24) or placebo (Group C, n=24), 120 min before surgery. A visual analogue scale (VAS) for pain of each patient measured at arrival in the ward and 6 and 24 hours after surgery, was recorded. RESULTS The demographic characteristics of patients, ASA physical status class, duration of surgery, and the basal VAS pain score were similar in the two groups. There was no significant difference in the mean of the VAS pain scores measured over time or morphine consumption between three groups. CONCLUSION Dextromethorphan, 45 and 90 mg orally administrated 2 h before surgery had no effect on postoperative morphine requirement and pain intensity.
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Affiliation(s)
- Hossein Mahmoodzadeh
- Department of Surgery, Ali Shariati Hospital, Tehran Univ. of Medical Sciences, Tehran, Iran
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Adachi Y, Uchisaki S, Itagaki T, Suzuki K, Obata Y, Doi M, Sato S. [Serotonin syndrome caused by an overdose of dextromethorphan, Medicon]. Masui 2009; 58:1531-1533. [PMID: 20055201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the first case of serotonin syndrome caused by overdose of dextromethorphan in Japan. A 34-year-old woman with schizophrenia received a dextromethorphan (Medicon) for a catarrhal symptom from two individual departments of the university hospital by chance. The daily amount of dextromethorphan was up to 180 mg for several days in addition to other regular antipsychotic drugs including risperidone, amitriptyline and levomepromazine. Finally, she was found in deep comatose state (GCS coma scale: E1V1M1) and the trachea was intubated in the emergency room. After admission to intensive care unit, the consciousness gradually improved; however, she was confused and agitated. The situation was normalized within next 24 hours and she was weaned from the mechanical ventilation next day. Serotonin syndrome demonstrates various signs and might be overlooked in an emergency room. Dextromethorphan is considered as a safe antitussive drug; however, the unexpected interaction should be suspected during chronic medical treatment.
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Affiliation(s)
- Yushi Adachi
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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Shear DA, Williams AJ, Sharrow K, Lu XCM, Tortella FC. Neuroprotective profile of dextromethorphan in an experimental model of penetrating ballistic-like brain injury. Pharmacol Biochem Behav 2009; 94:56-62. [PMID: 19619574 DOI: 10.1016/j.pbb.2009.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/08/2009] [Accepted: 07/13/2009] [Indexed: 11/19/2022]
Abstract
Dextromethorphan (DM) has been well-characterized as a neuroprotective agent in experimental models of CNS injury. The goal of this study was to determine the neuroprotective profile of DM in a military-relevant model of penetrating ballistic-like brain injury (PBBI). In an acute (3 day) dose-response study, anesthetized male Sprague-Dawley rats were exposed to a unilateral frontal PBBI with DM (0.156-10 mg/kg) or vehicle delivered as an i.v. bolus from 30 min to 48 h post-injury. In a follow-up (7 day) experiment, the 10-mg/kg bolus injections of DM were administered in conjunction with a 6-h infusion (5 mg/kg/h). DM bolus injections alone produced a dose-dependent improvement in motor recovery on a balance beam task at 3 days post-injury. However, more rapid recovery (24 h) was observed on this task when the bolus injections were combined with the 6-h infusion. Moreover, the DM bolus/infusion treatment regimen resulted in a significant (76%) improvement in cognitive performance in a novel object recognition (NOR) task at 7 days post-injury. Although post-injury administration of DM (all doses) failed to reduce core lesion size, the maximum dose of DM (10 mg/kg) was effective in reducing silver-stained axonal fiber degeneration in the cortical regions adjacent to the injury.
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Affiliation(s)
- Deborah A Shear
- Walter Reed Army Institute of Research, Department of Applied Neurobiology, Silver Spring, MD 21045, USA.
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Abstract
Effects of repetitive dextromethorphan at adolescence on a spatial learning of rats were investigated. Rats received 10 daily injections of dextromethorphan (40 mg/kg) from postnatal day 28 thru 37, and were then subjected to the Morris water maze task from day 38. Significant impairments were found in the probe trial and the reversal training of the maze learning in the female rats, but not in males, treated with dextromethorphan. This result suggests that repetitive dextromethorphan, that is, abuse of dextromethorphan, at adolescence may induce deficits in the hippocampus-based memory function, perhaps more obviously in females.
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Affiliation(s)
- Hee Jeong Cho
- Department of Pharmacology, BK21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Fierens C, Corthout J. Dextromethorphan hydrobromide preparations on the Belgian market--a comparative study. J Pharm Belg 2009:15-17. [PMID: 19391437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Liquid preparations for oral use containing dextromethorphan hydrobromide were verified on identity, content and microbiological quality. The assay method was previously validated according to international guidelines. All examined products complied with the postulated requirements.
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Affiliation(s)
- C Fierens
- Service de Contrôle des Médicaments APB, rue Stevin 137, B-1000 Bruxelles
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Abu-Samra MM, Ismaeil WA. Pre-emptive oral dextromethorphan reduces both postoperative and packing removal pain in patients undergoing nasal surgery. Saudi Med J 2009; 30:214-218. [PMID: 19198708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To determine whether premedication with 45 mg of oral dextromethorphan (DM) given 90 minutes prior to nasal surgery decreases postoperative pain and consequently reduces opioid administration and also, if it reduces the pain of pack removal. METHODS This was a prospective, double blind, randomized, controlled study carried out from January 2007 to March 2008 at Al-Moosa General Hospital, Al-Ahsa, Saudi Arabia, in which 38 patients received oral DM (age 28 +/- 11 years), and 38 patients received placebos (age 26 +/- 10 years). Postoperative pain was assessed using a visual analog scale, and a pain score of > or -5 was treated by a rescue bolus dose of morphine sulfate 2 mg every 10 minutes in the post-anesthesia care unit (PACU) and by one gm of paracetamol in the surgical ward until the score became <5. Pain was also assessed during pack removal. RESULTS The placebo group had a higher pain score in the PACU, and hence a higher morphine consumption than the DM group (7.3 mg +/- 2.6 versus 4.6 mg +/- 1.2, p=0.03). Pain score in the surgical ward was also higher in the placebo group at 4, 8, 12, and 24 hours, but this was insignificant, and was insignificantly lower only at 18 hours (p=0.26). The placebo group had a higher pain score at pack removal than the DM group (7.8 +/- 11 versus 3.5 +/- 15, p=0.004). CONCLUSION Preemptive medication with DM reduces opioid administration in the early postoperative period and during pack removal.
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Affiliation(s)
- Mohamed M Abu-Samra
- Department of Otolaryngology, Al-Moosa General Hospital, Al-Ahsa 31982, Kingdom of Saudi Arabia.
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Liu PY, Lin CC, Tsai WC, Li YH, Lin LJ, Shi GY, Hong JS, Chen JH, Wu HL. Treatment with dextromethorphan improves endothelial function, inflammation and oxidative stress in male heavy smokers. J Thromb Haemost 2008; 6:1685-92. [PMID: 18647232 DOI: 10.1111/j.1538-7836.2008.03082.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dextromethorphan (DM) is reported to reduce the inflammation-mediated degeneration of dopaminergic neurons. OBJECTIVE The goal of this study was to test if DM can improve the endothelial dysfunction and inflammatory markers in heavy smokers. PATIENTS AND METHODS Forty habitual smoking healthy male volunteers (mean age, 31.5 +/- 1.4 years) were randomly given either DM (120 mg day(-1)) or a placebo for 6 months. We determined endothelial function using the brachial artery diameter changes in flow-mediated dilatation (FMD) and measured their inflammatory and oxidative markers. A sex-and-age matched non-smoking group (n = 20) was compared as normal parameters. RESULTS Habitual smokers showed impaired baseline endothelial function in FMD (smoking vs. non-smoking: 6.3 +/- 1.8 vs. 10.2 +/- 2.3% respectively, P < 0.01). Without change in smoking behavior, lipid and metabolic parameters, a significant increase in FMD was found in the DM-treated group (32%), accompanied by a decrease in high-sensitivity C-reactive protein (hs-CRP), phospholipase A(2), matrix metalloproteinase-3, interleukin 6 (IL-6) and tumor necrosis factor-alpha receptor II (TNF-alpha RII) (all P < 0.05), but unchanged in von Willebrand factor (VWF)and plasminogen activator inhibitor-1 (PAI-1). An increase in plasma glutathione peroxidase and a decrease in spot urinary excretion of 8-epi-prostaglandin F(2a) were found in DM-treated smokers. CONCLUSIONS Our study suggests that a 6-month treatment with DM can improve endothelial function and attenuate vascular oxidative stress and inflammation markers in habitual smokers.
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Affiliation(s)
- P-Y Liu
- Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Akkaramongkolporn P, Kulvanich P, Pathipvanich M. Preparation and In Vitro Release of Dual-Drug Resinates Containing Equivalent Content Dextromethorphan and Diphenhydramine. Drug Dev Ind Pharm 2008; 32:483-96. [PMID: 16638687 DOI: 10.1080/03639040500529143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The dual-drug resinate containing equivalent content of dextromethorphan hydrobromide (DTM) and diphenhydramine hydrochloride (DPH) was developed and characterized. To achieve this specific resinate, a procedure of simultaneous dual-drug loading using loading solutions composed of different proportions of DTM and DPH was performed and a dual-drug loading diagram was constructed to determine the equivalent drug loading solution (ELS) and also the estimated equivalent drug content (EQC). The effects of resin crosslinkage, overall drug concentration of the loading solution, and temperature during drug loading on the values of ELS and EQC were assessed. The increased overall drug concentration from 0.25 to 1.0% w/v elevated the EQC values from 18 to 35% w/w for low crosslinked resins (Dowex 50 W x 2 and x 4), and from 18 to 27% w/w for high crosslinked resin (Dowex 50 W x 8). It also changed the values of ELS from 0.50 to 0.48 for the low crosslinked resins, and 0.50 to 0.55 for the high crosslinked resin. For the high crosslinked resin, the applied heat from 35 to 65 degrees C further increased the values of EQC from 27 to 32% w/w, and changed the values of ELS in the reverse direction from 0.55 to 0.48. However, the heat did not exert significant effects on the values of EQC and ELS for the low crosslinked resins. Different batches of dual-drug resinates prepared from the determined ELS provided the resultant resinates with equivalent contents of DTM and DPH which were very close to the estimated EQC. The drug release from the resinates was performed in 0.05, 0.1, 0.2, and 0.4 N of KCl solutions. The increased ionic strength generally accelerated the release of both drugs except for 0.4 N KCl solution in which the drug release from the resinates of high crosslinkage was decreased. The congestion on the outward movement of drugs through the high crosslinked matrix might cause the delay of drug release. In conclusion, the release study demonstrated that the dual-drug resinate using a suitable crosslinked resin could be used for extended delivery of two combined drugs with the equivalent therapeutic dose.
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Affiliation(s)
- Prasert Akkaramongkolporn
- Department of Industrial Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand.
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41
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Abstract
Good evidence exists to suggest that individuals on opioid maintenance for the treatment of addiction (i.e. methadone) are less tolerant of experimental pain than are matched controls or ex-opioid addicts, a phenomenon theorized to reflect opioid-induced hyperalgesia (OIH). Agonist activity at the excitatory ionotropic N-methyl-D-aspartate (NMDA) receptor on dorsal horn neurons has been implicated in the development of both OIH and its putative expression at the clinical level-opioid tolerance. The aim of this study was to evaluate the potential utility of the NMDA-receptor antagonist, dextromethorphan (DEX), to reverse or treat OIH in methadone-maintenance (MM) patients. Utilizing a clinical trial design and double-blind conditions, changes in pain threshold and tolerance [cold pressor (CP) and electrical stimulation (ES)] following a 5-week trial of DEX (titrated to 480 mg/day) in comparison with placebo was evaluated in a well-characterized sample of MM patients. The sample (n = 40) was 53% male and ethnically diverse (53% Latino, 28% African American, 10% White, 9% other), with a mean age of 48.0 years (SD = 6.97). Based on t-test analyses, no difference was found between groups on CP pain threshold, CP pain tolerance, ES pain threshold or ES pain tolerance, both pre- and postmedication. Notably, DEX-related changes significantly differed by gender, with women tending to show diminished tolerance for pain with DEX therapy. These results support that chronic high-dose NMDA antagonism does not improve tolerance for pain in MM patients, although a gender effect on DEX response is suggested.
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Affiliation(s)
- Peggy A Compton
- Acute Care Section, School of Nursing, University of California at Los Angeles, Factor Building 4-246, Box 956918, Los Angeles, CA 90095-6918, USA.
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Gärtner R, Callesen T, Kroman N, Kehlet H. [Postoperative inconveniences after breast cancer surgery]. Ugeskr Laeger 2008; 170:2032-2034. [PMID: 18534168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The most common postoperative inconveniences after breast cancer surgery are pain, nausea and vomiting, which contribute to reduced patient satisfaction, prolonged hospital stays and delayed courses of rehabilitation. This article summarizes the literature regarding available procedure-specific evidence for prophylactic nausea, vomiting and pain treatment supported by transferable evidence from similar types of surgery. We propose a prophylactic combination of Dexametason, Ondansteron, Paracetamol, Celecoxib, Gabapentin and Detromethorphan as future treatment.
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Affiliation(s)
- Rune Gärtner
- Rigshospitalet, Mamma- og Endokrinkirurgisk Klinik, Anaestesi.
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43
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Gärtner R, Kroman N, Callesen T, Kehlet H. [Multimodal treatment of pain and nausea in breast cancer surgery]. Ugeskr Laeger 2008; 170:2035-2038. [PMID: 18534169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV associated with surgery for these patients. MATERIALS AND METHODS 116 consecutive patients scheduled for breast cancer surgery were prospectively scored according to pain, PONV and sedation after being introduced to a combined evidence-based, empiric multimodal opioid-sparing prevention and treatment regime consisting of Paracetamol, Celecoxib, Dextromethorphan, Gabapetin, Dexamethason and Ondansetron. RESULTS In the recovery room, 75% of the patients scored either no or light pain at rest compared to 68% under mobilization. In the department, 94% of the patients scored no or light pain at rest as well as under mobilization on the evening of the operation and the next morning. Morphine consumption in the recovery room was, on average, 2 mg per patient. Only 1.5% of the patients were given morphine in the department. Five patients were troubled by light PONV, one by moderate PONV and another suffered from severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later. CONCLUSION It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain optimal postoperative pain and nausea control without significant problems with respect to sedation.
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Affiliation(s)
- Rune Gärtner
- Rigshospitalet, Mamma- og Endokrinkirurgisk Klinik, HovedOrtoCentret, Anaestesi.
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Chau-In W, Sukmuan B, Ngamsangsirisapt K, Jirarareungsak W. Efficacy of pre- and postoperative oral dextromethorphan for reduction of intra- and 24-hour postoperative morphine consumption for transabdominal hysterectomy. Pain Med 2007; 8:462-7. [PMID: 17661864 DOI: 10.1111/j.1526-4637.2006.00226.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We studied the effect of dextromethorphan (DEX), an N-methyl-D-aspartate receptor antagonist, on analgesic consumption and pain scores after abdominal hysterectomy. We aimed to compare the analgesic effectiveness and incidence of adverse side effects of oral DEX with placebo (P). DESIGN This was a double-blinded, randomized, placebo-controlled study. SETTING AND PATIENTS One hundred patients were randomized to two groups. Group DEX was given 30-mg tablets of oral DEX with their premedication and three more times in the first 24 hours after surgery. Group P received the placebo following the same schedule. Postoperative analgesic requirements were assessed using a patient-controlled analgesia system. Pain was assessed at rest using a visual analogue scale in the post-anesthetic care unit (PACU), 6 and 24 hours after surgery. RESULTS Mean pain scores were significantly lower at the PACU (62.6 vs 75.7) as was the mean sum of all resting pain scores (144.5 vs 173.1). Mean morphine consumption was greatest in the DEX group (35.1 vs 33.0 mg; P < 0.05). The sedation scores, postoperative analgesic requirements, and incidence of side effects were similar between the P and DEX groups as were the mean pain scores. CONCLUSIONS During PACU, however, there were two differences between the DEX and placebo groups: 1) a lower pain score at PACU; and 2) a prolonged time to the first use of morphine at PACU in the DEX group as compared with the placebo group. A low-dose DEX had a weaker though still measurable effect in this clinical trial compared with trials using higher doses.
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Affiliation(s)
- Waraporn Chau-In
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Chen YW, Chen YC, Lin CN, Chu CC, Lin MT, Wang JJ, Kao CH. The spinal anaesthetic effect of dextromethorphan, dextrorphan, and 3-methoxymorphinan. Eur J Pharmacol 2007; 569:188-93. [PMID: 17601557 DOI: 10.1016/j.ejphar.2007.05.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 04/09/2007] [Accepted: 05/15/2007] [Indexed: 10/23/2022]
Abstract
Dextromethorphan, an antitussive, has a complex pharmacologic profile and has not been well studied. Our aim was to evaluate whether dextromethorphan and its metabolites, dextrorphan and 3-methoxymorphinan, have a spinal anaesthetic effect. Using a method of spinal blockade in rats, we evaluated the potencies and durations of the effects of dextromethorphan and its metabolites on spinal blockades of motor function and nociception. Bupivacaine was the active control. We found that dextromethorphan and its metabolites produced a dose-related spinal blockade of motor function and nociception. On an ED(50) basis, the ranks of potencies were bupivacaine>dextrorphan>3-methoxymorphinan>dextromethorphan (p<0.05 for the differences). On an equipotent basis, dextrorphan and bupivacaine produced similarly longer nociceptive blockades than did dextromethorphan and 3-methoxymorphinan (p<0.05 for the differences). Co-administration of dextromethorphan or its metabolites with bupivacaine produced an additive effect. In conclusion, intrathecal injections of dextromethorphan or its metabolites, dextrorphan and 3-methoxymorphinan, produced dose-related spinal blockades of motor function and nociception. The suitability of these drugs as clinical spinal anaesthetics is worth further evaluation.
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Affiliation(s)
- Yu-Wen Chen
- Department of Medical Research, Chi-Mei Medical Centre, Tainan, Taiwan
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Pongjanyakul T, Puttipipatkhachorn S. Modulating drug release and matrix erosion of alginate matrix capsules by microenvironmental interaction with calcium ion. Eur J Pharm Biopharm 2007; 67:187-95. [PMID: 17270407 DOI: 10.1016/j.ejpb.2006.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 12/12/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
Effect of calcium gluconate (CG) content on release of dextromethorphan hydrobromide (DMP), model drug, from capsules containing low and medium viscosity grades of sodium alginate (SA) was investigated in different dissolution media. Matrix erosion of the SA matrix capsules in distilled water and pH 7.4 phosphate buffer was compared. Molecular interaction of SA with calcium ion in surface gel layer of the SA matrix capsules was examined using Fourier transform infrared spectroscopy and differential scanning calorimetry. In distilled water and pH 7.4 phosphate buffer, DMP release rate depended on the viscosity grade of SA, whereas a comparable DMP release rate was found in 0.1N HCl. Incorporation of CG into the SA matrix capsules caused a faster drug release in acidic medium because CG acted as a channeling agent in the hydrated insoluble gel matrix of alginic acid. Interaction of calcium ions with carboxyl groups of SA could be formed in surface gel layer of hydrated matrix capsules in distilled water. This led to a more rigid matrix gel structure that caused a slower drug release and matrix erosion. In contrast, the extent of this interaction in pH 7.4 phosphate buffer was less than that in distilled water because the common ion effect and high concentration of sodium ion retarded the hydration of SA and the binding of calcium ions with carboxyl groups of SA. Thus, a small change in drug release and matrix erosion was observed. This finding suggests that microenvironmental interaction between hydrated SA and calcium ion in distilled water could be created in the formulations prepared using low compression force. Moreover, incorporation of CG could moderate drug release and matrix erosion of the SA matrix capsules.
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Affiliation(s)
- Thaned Pongjanyakul
- Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand.
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Nakashima D, Takama H, Ogasawara Y, Kawakami T, Nishitoba T, Hoshi S, Uchida E, Tanaka H. Effect of cinacalcet hydrochloride, a new calcimimetic agent, on the pharmacokinetics of dextromethorphan: in vitro and clinical studies. J Clin Pharmacol 2007; 47:1311-9. [PMID: 17652181 DOI: 10.1177/0091270007304103] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cinacalcet hydrochloride (cinacalcet) is a positive allosteric modulator of the calcium-sensing receptor indicated for the treatment of secondary hyperparathyroidism in dialysis patients. In vitro study has demonstrated that cinacalcet is a potent inhibitor of cytochrome P450 (CYP) 2D6 with a K(i) value of 0.087 micromol/L, which is comparable to the well-known potent CYP2D6 inhibitor, quinidine (0.064 micromol/L). A clinical study was conducted to assess the inhibitory effect of cinacalcet on CYP2D6 substrates in healthy volunteers. Each subject received 50 mg of cinacalcet or a matched placebo orally once daily for 8 days with 30 mg of dextromethorphan coadministered on day 8. The mean AUC(0-infinity) and C(max) of dextromethorphan increased 11- and 7-fold, respectively, in extensive metabolizers when coadministered with cinacalcet versus placebo. Therefore, during concomitant treatment with cinacalcet, it may be necessary to consider making dose adjustments for drugs with a narrow therapeutic index that are mainly metabolized by CYP2D6.
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Affiliation(s)
- Daisuke Nakashima
- Product Development Department, Pharmaceutical Division, Kirin Brewery Company Ltd, 26-1 Jingumae 6-chome, Shibuya-ku, Tokyo, 150-8011, Japan.
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Honarmand A, Safavi MR. Preoperative oral dextromethorphan vs. clonidine to prevent tourniquet-induced cardiovascular responses in orthopaedic patients under general anaesthesia. Eur J Anaesthesiol 2007; 24:511-5. [PMID: 17202010 DOI: 10.1017/s0265021506002055] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Preoperative oral dextromethorphan and intravenous clonidine attenuate arterial pressure and heart rate increases during tourniquet inflation under general anaesthesia. The effect of preoperative oral clonidine on these variables has not been investigated. METHODS We designed this study to compare the effect of preoperative oral dextromethorphan or clonidine on haemodynamic changes during tourniquet inflation in 75 patients undergoing lower limb surgery under general anaesthesia. Patients were randomly assigned into three groups: dextromethorphan 30 mg (n = 25), clonidine 3 microg kg(-1) (n = 25) and placebo (n = 25). Anaesthesia was maintained with isoflurane 1.2% and N2O 50% in oxygen with endotracheal intubation. Dextromethorphan, clonidine or placebo was given orally in a double-blinded fashion 90 min before induction of anaesthesia. Systolic, diastolic and mean arterial pressure and heart rate were measured at 0, 30, 45, 60 min after the start of tourniquet inflation, before tourniquet release and 20 min after tourniquet deflation. RESULTS Systolic, diastolic and mean arterial pressure were significantly lower in the clonidine group compared with control after 45, 60 min tourniquet inflation and before tourniquet release (P < 0.05). Twenty minutes after deflation, diastolic and mean arterial pressure in the control group were still increased and significantly higher compared with the clonidine group (P < 0.05). Development of more than a 30% increase in systolic arterial pressure during tourniquet inflation was more frequent in the control group than in the other groups. CONCLUSIONS Preoperative oral clonidine 3 microg kg(-1) significantly prevented tourniquet-induced systemic arterial pressure increase in patients under general anaesthesia better than oral dextromethorphan.
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Affiliation(s)
- A Honarmand
- Department of Anesthesiology and Intensive Care, Isfahan University School of Medicine, Isfahan, Iran
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Lee JH, Shin EJ, Jeong SM, Lee BH, Yoon IS, Lee JH, Choi SH, Kim YH, Pyo MK, Lee SM, Chae JS, Rhim H, Oh JW, Kim HC, Nah SY. Effects of dextrorotatory morphinans on brain Na+ channels expressed in Xenopus oocytes. Eur J Pharmacol 2007; 564:7-17. [PMID: 17346698 DOI: 10.1016/j.ejphar.2007.01.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Revised: 01/26/2007] [Accepted: 01/31/2007] [Indexed: 10/23/2022]
Abstract
We previously demonstrated that dextromethorphan (DM; 3-methoxy-17-methylmorphinan) analogs have neuroprotective effects. Here, we investigated the effects of DM, three of its analogs (DF, 3-methyl-17-methylmorphinan; AM, 3-allyloxy-17-methoxymorphian; and CM, 3-cyclopropyl-17-methoxymorphinan) and one of its metabolites (HM; 3-methoxymorphinan), on Na(+) channel activity. We used the two-microelectrode voltage-clamp technique to test the effects of DM, DF, AM, CM and HM on Na(+) currents (I(Na)) in Xenopus oocytes expressing cRNAs encoding rat brain Nav1.2 alpha and beta1 or beta2 subunits. In oocytes expressing Na(+) channels, DM, DF, AM and CM, but not HM, induced tonic and use-dependent inhibitions of peak I(Na) following low- and high-frequency stimulations. The order of potency for the inhibition of peak I(Na) was AM-CM > DM=DF. The DM, DF, AM and CM-induced tonic inhibitions of peak I(Na) were voltage-dependent, dose-dependent and reversible. The IC(50) values for DM, DF, AM and CM were 116.7+/-14.9, 175.8+/-16.9, 38.6+/-15.5, and 42.5+/-8.5 microM, respectively. DM and its analogs did not affect the steady-state activation and inactivation voltages. AM and CM, but not DM and DF, inhibited the plateau I(Na) more effectively than the peak I(Na) in oocytes expressing inactivation-deficient I1485Q-F1486Q-M1487Q (IFMQ3) mutant channels; the IC(50) values for AM and CM in this system were 8.4+/-1.3 and 8.7+/-1.3 microM, respectively, for the plateau I(Na) and 43.7+/-5.9 and 32.6+/-7.8 microM, respectively, for the peak I(Na). These results collectively indicate that DM and its analogs could be novel Na(+) channel blockers acting on the resting and open states of brain Na(+) channels.
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Affiliation(s)
- Jun-Ho Lee
- Department of Physiology, College of Veterinary Medicine, Institute of Biomedical Science and Technology, Bio/Molecular Informatics Center, Konkuk University, Seoul, Republic of Korea 143-701
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Chen YW, Chu KS, Lin CN, Tzeng JI, Chu CC, Lin MT, Wang JJ. Dextromethorphan or dextrorphan have a local anesthetic effect on infiltrative cutaneous analgesia in rats. Anesth Analg 2007; 104:1251-5, tables of contents. [PMID: 17456682 DOI: 10.1213/01.ane.0000260330.18745.a8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Dextromethorphan blocks sodium channels, the site of action of local anesthetics. In this study we evaluated whether dextromethorphan has a local anesthetic effect. METHODS We administered dextromethorphan and its active metabolite--dextrorphan, and lidocaine subcutaneously to rats and tested them for cutaneous anesthesia. Drug-drug interactions and systemic safety indices (LD50s/ED50s) were also evaluated. RESULTS Dextromethorphan and dextrorphan had a local anesthetic effect after cutaneous infiltration. The ranking of potencies was dextromethorphan > dextrorphan > lidocaine (P < 0.01 for each comparison). A combination of dextromethorphan or dextrorphan with lidocaine produced an additive effect. Dextromethorphan and dextrorphan had 2.4- and 1.9-fold higher system safety indices than did lidocaine. CONCLUSION Dextromethorphan and dextrorphan were more potent local anesthetics than lidocaine, but with higher systemic safety indices. Coadministration of dextromethorphan or dextrorphan with lidocaine produced an additive effect.
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Affiliation(s)
- Yu-Wen Chen
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
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