Thermo-sensitive gels containing lorazepam microspheres for intranasal brain targeting

Thermo-sensitive gels containing lorazepam microspheres were developed and characterized for intranasal brain targeting. Pluronics (PF-127 and PF-68) have been selected since they are thermo-reversible polymers with the property of forming a solution at low temperatures (4-5 °C), and a gel at body temperature (37 °C). This property makes them an interesting material to work with, especially in case of controlled release formulations. The present study focuses on the development of an intranasal formulation for lorazepam, as an alternative route of drug delivery to the brain. Direct transport of drugs to the brain circumventing the brain barrier, following intranasal administration, provides a unique feature and better option to target brain. The presence of mucoadhesive microspheres in the gel vehicle via nasal route can achieve a dual purpose of prolonged drug release and enhanced bioavailability. To optimise the microsphere formulation, Box Behnken design was employed by investigating the effect of three factors, polymer concentration (chitosan), emulsifier concentration (Span 80) and cross-linking agent (glutaraldehyde) on the response variable which is the mean particle size. The concentration of 21% PF-127 and 1% PF-68 were found to be promising gel vehicles. The results showed that the release rate followed a prolonged profile dispersion of the microspheres in the viscous media, in comparison to the microspheres alone. Histopathological studies proved that the optimised formulation does not produce any toxic effect on the microscopic structure of nasal mucosa.

Intoxicating effects of lorazepam and barbital in rat lines selected for differential sensitivity to ethanol

The motor impairing effects and plasma concentrations of barbital and lorazepam were studied in the alcohol tolerant (AT) and alcohol non-tolerant (ANT) rat lines developed for low and high sensitivity to motor impairment from ethanol. The mixed (M) line, from which the AT and ANT rats were derived, was also included in the study. Like ethanol, barbital and lorazepam impaired the performance of the ANT rats more than that of the AT rats. The motor performance of the M rats was relatively more impaired after barbital than after lorazepam administration at the same dose used in the AT and ANT rats. At the two latter time points (2.5 and 3.5 h) the sensitive ANT rats had significantly higher serum barbital concentrations than the AT rats. The serum barbital concentrations of the AT and ANT rats did not differ, however, at the two first time points (0.5 and 1.5 h) of the tilting plane tests, although the ANT rats were significantly more intoxicated. The concentrations of lorazepam in plasma do not explain the differential motor impairment either, since the sensitive ANT rats had lower plasma concentrations than the insensitive AT rats. The results, thus, suggest that the selection involved in the development of the AT and ANT lines has not been specific for ethanol. The results also support the idea that ethanol, barbiturates and benzodiazepines have some modes of action in common.

Sexual assault under benzodiazepine submission in a Paris suburb

Sexual assaults under benzodiazepine submission have been described, since use of benzodiazepine enables non consensual sexual activity but rarely fully reported. An accurate evaluation of the phenomenon has seemed interesting. Files of 23 adult males and females examined at the Emergency Forensic Unit of an University Teaching Hospital near Paris were reviewed. All the victims had complained from sexual assault under drug submission, in the years 1996 and 1997. A complete examination for sexual assault was realised linked to clinical examination of drug intoxication. Every victim of rape under drug submission was sampled for urine screening (mean delay of 17.5 h after sexual assault) and blood alcohol level quantification. Urine was screened for benzodiazepines, cocaine, opiates and cannabinoids with qualitative immunochromatographic test. Traumatic lesions of sexual penetration were retrieved in 10 victims and sperm in 5. Clinical signs of benzodiazepine intoxication were retrieved in 12 out of 23 victims. Urine benzodiazepine screening was positive, over the cut-off values (300 ng/mL)when sampled less than 20 h after the facts. In 6 out of 23 victims, drugs of abuse and alcohol were associated to benzodiazepines. A reinforced attention can be brought to the rape under drug submission including the need of a proper examination and samplings shortly after the alleged facts to ascertain the diagnosis and to help the victim facing the Justice inquiry.

Induction of cognitive impairment by scopolamine and noncholinergic agents in rhesus monkeys

In primates, treatment with scopolamine impairs performance of a spatial delayed response task in a way which mimics deficits seen spontaneously in aged primates and demented patients. Despite their efficacy in reversing scopolamine induced disruption, the effects of cholinergic agonists on cognition in aged primates and dements are unimpressive, suggesting that other neurotransmitter systems are also involved in this type of deficit. We have induced a scopolamine-like impairment of spatial delayed response performance in rhesus monkeys using phencyclidine (0.1-0.2 mg/kg i.m.), lorazepam (0.4-0.6 mg/kg s.c.) or tetrahydrocannabinol (1-4 mg/kg p.o.), but not amphetamine (0.1-0.4 mg/kg i.m.), yohimbine (0.1-1.0 mg/kg i.m.) or morphine (2-4 mg/kg i.m.). Our findings suggest that disruption of specific neurotransmitter systems other than acetylcholine may contribute importantly to cognitive decline in aging and dementia.

Cyclopyrrolones, unlike some benzodiazepines, do not induce physical dependence in mice

In a model of physical dependence in mice, treatment with cyclopyrrolones such as zopiclone and suriclone (from 4 to 400 mg/kg/day), did not modify the sensitivity of the gamma-aminobutyric acid (GABA) receptor complex to the partial inverse agonist FG 7142 following their withdrawal, whereas sensitivity changes were observed after treatment and withdrawal from some benzodiazepines (e.g. lorazepam, diazepam, flunitrazepam and triazolam). These data suggest that, in contrast to some benzodiazepines, zopiclone and suriclone may not produce physical dependence.

The NMDA receptor competitive antagonist CPP modulates benzodiazepine tolerance and discontinuation

Benzodiazepine discontinuation is characterized by a syndrome of increased activity and reduced seizure threshold that is similar to effects mediated by the glutamatergic system. To elucidate the involvement of the glutamatergic system in benzodiazepine tolerance and discontinuation, we administered lorazepam, the NMDA antagonist CPP, and the combination of these compounds either concomitantly or consecutively to mice via osmotic pumps and evaluated pentylenetetrazole-induced seizure threshold, open-field activity, and benzodiazepine receptor binding during and after chronic administration. Animals receiving lorazepam alone developed partial tolerance at 7 days and complete tolerance at 14 days to the anticonvulsant effects of lorazepam. This effect was partly attenuated by CPP coadministration with lorazepam. This combination produced only partial tolerance. A reduction in seizure threshold was observed 4 days after discontinuation of lorazepam alone. This effect was abolished by coadministration of CPP with lorazepam and by CPP administration during the withdrawal period. Benzodiazepine binding in most structures examined was significantly reduced at 14 days during chronic lorazepam administration (versus 1 day), and coadministration of CPP did not alter this decrement. After lorazepam discontinuation, binding was increased at 4 and 7 days versus chronically treated animals and versus vehicle within the cerebral cortex. This effect was abolished by coadministration of CPP as well as by CPP administration during the lorazepam withdrawal period. These data support the involvement of the glutamatergic system in benzodiazepine tolerance and discontinuation.

Cleft palate and open eyelids inducing activity of lorazepam and the effect of flumazenil, the benzodiazepine antagonist

Lorazepam (Ativan, Wyeth) at dosages of 20-36 mg/kg was used to test for developmental toxicity in the mouse embryo/foetus model. Two separate regions were considered: (1) the central nervous system and (2) the roof of the mouth and the eyelids. In the first case a single administration of lorazepam was applied at the very beginning of the 9th gestation day. In the second, it was administered in preliminary tests on two consecutive gestation days between the 11th and 14th days and in later experiments once only on the 13th or 14th gestation day. In the first part of investigations regarding the development of the central nervous system, lorazepam unlike many other neurotropic drugs, was found not to induce any aberrations in the process of the neural tube closure. In the second part, in which palate closure and the temporary closure of eyelids were monitored, it was found that lorazepam does interfere with these processes. In order to test whether lorazepam's neurocristopathic activity can be prevented, suggesting the presence of benzodiazepine receptors in the neural crest cells, we used the benzodiazepine antagonist, flumazenil (Anexate, Roche). The results of these experiments indicated the flumazenil was able to prevent cleft palate and open eyelids cases almost completely if it was administered 3 hr after administration of lorazepam. If the treatments were administered in the reverse order, the frequency of neurocristopathy cases was unaffected, i.e. flumazenil did not influence the teratogenic activity of lorazepam.

Circadian variations of lorazepam-induced neurologic deficits

Circadian variations of lorazepam-induced neurologic deficits were tested in mice. The duration of the impairment after administration of 3 mg/kg lorazepam was considerably shorter at 2100 h compared to other times of the day. No significant variations could be found for brain concentrations of drug at recovery and 15 or 30 min after drug administration. Food intake did not seem to account for the circadian pattern observed. It was therefore concluded that chronergy of lorazepam is a result of altered sensitivity of the animal over time rather than to altered pharmacokinetics.

The effect of chronic lorazepam administration in aging mice

To assess benzodiazepine tolerance in aged animals, lorazepam or vehicle was administered chronically to male Crl: CD-1(ICR)BR mice. Pharmacodynamic and neurochemical endpoints were examined on days 1 and 14 of drug administration. There was no age-related significant difference in plasma lorazepam levels. Young and middle-aged animals demonstrated behavioral tolerance to lorazepam, while the aged animals showed a similar trend which failed to reach significance. In addition, aged animals also showed a trend toward tolerance to the anticonvulsant effects of lorazepam. There were no changes in alpha1 mRNA levels in cortex or hippocampus following administration of lorazepam when compared to vehicle-treated animals in any age group. Aged animals, however, had an initial increase in alpha1 mRNA expression in cortex and hippocampus on day 1 of vehicle treatment followed by decreased expression on day 14. These age-related changes were abolished by lorazepam administration. In summary, age-related sensitivity to the effects of lorazepam was not demonstrated in the present study. However, comparison of these data to other studies indicates that the effect of chronic benzodiazepine treatment may be specific to the benzodiazepine administered, the technique used to quantify mRNA expression changes, the subunits of the GABA(A) receptor investigated and the brain region analyzed. The phenomenon of benzodiazepine sensitivity in the elderly is an area of research which remains controversial and may well be compound specific. Determining benzodiazepines that do not produce pharmacodynamic sensitivity, such as lorazepam, may allow more careful prescribing and dosing of these drugs, and perhaps even the development of specific agents which could avoid this sensitivity.

Prenatal benzodiazepine administration. II. Lorazepam exposure is associated with decreases in [35S]TBPS binding but not benzodiazepine binding

Prenatal benzodiazepine exposure has been associated with neurobehavioral alterations in humans and animals. To determine effects of prenatal benzodiazepine exposure on binding at the benzodiazepine and t-butylbicyclophosphorothionate (TBPS) sites on the GABAA receptor in mature offspring, we treated mice with lorazepam, 2 mg/kg/day, during days 13-20 of gestation. Binding was assessed at 6 weeks of age. There were no differences among controls, vehicle- or lorazepam-exposed mice in benzodiazepine receptor binding determined in vivo or in vitro. However, receptor density for [35S]TBPS binding sites was decreased in lorazepam-exposed offspring compared to the other groups. These data are consistent with prior neurochemical results indicating decreased TBPS binding and GABAA receptor function in several systems.

Effects of repeated dose nitrazepam and lormetazepam on psychomotor performance in the elderly

The daytime psychomotor performance of 12 healthy subjects of mean age 81.4 years was examined in a double-blind crossover study following single and repeated nightly doses of nitrazepam 5 mg, lormetazepam 1 mg, and placebo. Accuracy of performance on the Gibson spiral maze was unaffected by both drugs. On a reciprocal tapping task, speed was similarly unaffected. However, while neither drug significantly impaired accuracy on reciprocal tapping after the first dose, nitrazepam, but not lormetazepam, significantly reduced overall accuracy after seven consecutive doses, an effect consistent with drug accumulation.

Physical dependence after benzodiazepine treatments in rats: Comparison of short and long treatments with diazepam and lorazepam

OBJECTIVE

This study examined the development of physical dependence after different durations of treatments with two benzodiazepines (diazepam and lorazepam).

METHOD

Increased excitation in the central nervous system during a 2-week withdrawal period after 4-day and 4-week treatments with diazepam and lorazepam was examined with an EEG threshold method in male rats. Increased excitation was measured as a decreased sensitivity to hexobarbital (i.e., increased threshold doses). The concentrations of hexobarbital in two different brain regions, serum, fat and muscle tissue after 4-week treatment with diazepam were determined with a high-pressure liquid chromatography method.

RESULTS

The duration of withdrawal was influenced by the duration of treatment but the maximum level of withdrawal excitation was similar for both drugs. Equieffective doses of diazepam (20 mg/kg) and lorazepam (2 mg/kg) induced similar patterns of withdrawal excitability after both treatments. The brain concentrations of hexobarbital were significantly higher on Days 1 and 3 of withdrawal after diazepam treatment. Significant correlations between the threshold doses and brain concentrations were found on Day 1, but these correlations disappeared on day 3. At the same time, a difference between the concentrations of hexobarbital in different brain areas emerged.

CONCLUSIONS

The duration of treatment had a minor influence on the pattern of withdrawal excitation. Equieffective doses of diazepam and lorazepam induced comparable withdrawal excitability indicating no significant difference in their potential to induce physical dependence. The time-dependent change in the hexobarbital concentrations in the brain suggests that withdrawal excitation after diazepam treatment is a complex phenomenon probably involving several different systems at different times.

Behavioral changes persisting into adulthood after neonatal benzodiazepine administration in the rat

The day after birth male pups of hooded Lister rats were randomly fostered to form experimental litters of eight. Within each litter pups were randomly assigned among the following groups: vehicle control; diazepam (1, 5 or 10 mg/kg); lorazepam (0.25, 0.5, 1 or 2.5 mg/kg). Injections were given daily from day 1 until weaning at day 21. The pups were then tested as adults, from day 65. There were no effects of neonatal treatment when the pups were tested undrugged in 3 animal tests of anxiety, but in the social interaction test the neonatal diazepam treatment significantly reduced the anxiogenic effects of yohimbine. The neonatal diazepam treatment significantly enhanced the sedative effects of a challenge dose of chlordiazepoxide in the holeboard. Passive avoidance acquisition and retention were unaffected by the early treatment. Neonatal treatment with both benzodiazepines reduced the incidence of myoclonic jerks when the pups were challenged with pentylenetetrazole. Both neonatal treatments enhanced aggressive acts displayed when the residents were confronted with an intruder in their home-cages. However, when the rats that had been treated neonatally with lorazepam were themselves intruding into another's territory, they were significantly more submissive.

Chronic benzodiazepine administration. X. Concurrent administration of the peripheral-type benzodiazepine ligand PK11195 attenuates chronic effects of lorazepam

Chronic administration of benzodiazepine active at the tau-aminobutyric acidA receptor ("central" benzodiazepine sites) is associated with behavioral tolerance and receptor downregulation. Recent reports indicate possible interactions between central sites and benzodiazepines active at "peripheral-type" sites located primarily on non-neuronal cells. To evaluate these interactions during chronic administration, we treated mice with lorazepam for 1 to 14 days alone or in combination with the peripheral-type site ligand PK11195 [N-methyl-N-(methyl-1-propyl)chloro-2-phenyl-1-isoquinoline-3-carboxamid e]. Lorazepam was associated with tolerance at 7 days, but tolerance was not observed during concurrent administration of PK11195. Lorazepam was also associated with benzodiazepine receptor down-regulation in cortex and hippocampus at 7 days. With concurrent administration of PK11195, this effect remained in cortex but was absent in hippocampus. tau-Aminobutyric acid-dependent chloride uptake was reduced in both cortex and hippocampus with lorazepam, but not with concurrent lorazepam and PK11195. PK11195 administration alone did not affect behavior or neurochemical parameters, or did it alter brain lorazepam concentrations. These data indicate that concurrent PK11195 administration attenuates behavioral and neurochemical effects of chronic lorazepam administration.

Limited in vivo bioassays on some benzodiazepines: lack of experimental initiating or promoting effect of the benzodiazepine tranquillizers diazepam, clorazepate, oxazepam and lorazepam

Four benzodiazepine tranquillizers were tested for their ability to initiate or promote the development of preneoplastic and neoplastic rat liver lesions. In comparison with the liver carcinogen, N-2-fluorenylacetamide, the benzodiazepines exhibited no initiating activity during a 14-week period of daily administration by gavage. To study the promoting activity, N-2-fluorenylacetamide was used to initiate altered foci and neoplastic nodules in rat liver during 8 weeks and then the benzodiazepines were administered by daily gavage for a period of 12 weeks. The liver tumor promoter phenobarbital had a substantial enhancing effect upon the persistence of nodules but none of the benzodiazepines showed a similar effect. Thus, in the process model systems used, to detect initiating or promoting potential effect, the benzodiazepine tranquillizers failed to exhibit either an initiating or a promoting action.

Differential amnestic properties of short- and long-acting benzodiazepines

It has been demonstrated previously that orally administered lorazepam can cause anterograde amnesia in young adults. In this study, the effects of 7.5 and 15 mg clorazepate and 1 and 2 mg lorazepam on recall were compared in 74 healthy adults. Word list presentation tests were administered to subjects at selected intervals to measure immediate and delayed recall. Statistically significant memory impairment was found with 2 mg lorazepam during both immediate and delayed recall testing. Clorazepate produced no statistically significant amnestic effects. The data suggest that benzodiazepines differ in their potential for causing memory impairment.