Reversal of triazolam- and zolpidem-induced memory impairment by flumazenil.
ABSTRACT The effects of flumazenil, a benzodiazepine receptor antagonist, on triazolam- and zolpidem-induced memory impairment were investigated. Sixty subjects received oral triazolam 0.5 mg, zolpidem 20.0 mg, or placebo at 10 a.m. (n = 20 per drug). Ninety minutes later, half of the subjects (n = 10) in each oral drug group were administered flumazenil 1.0 mg, while the remaining half received placebo (normal saline), through indwelling venous catheters. Learning/memory tests (including Simulated Escape, Restricted Reminding, Paired-Associates, and Repeated Acquisition) were administered at that time, and at 1.5-h intervals over the next 6 h. Triazolam/placebo and zolpidem/placebo drug combinations impaired memory on all tests (all Ps < 0.05). However, the triazolam/flumazenil and zolpidem/flumazenil groups showed no evidence of impairment during any test session. These results demonstrate that flumazenil 1.0 mg rapidly and lastingly reverses memory impairment caused by agonists of the benzodiazepine receptor. Furthermore, nonsignificant trends suggested that performance of the placebo/flumazenil group was consistently better than that of the placebo/placebo group, denoting a possible role of endogenous benzodiazepine agonists in natural sleep/wake processes.
Article: Insomnia in Children[Show abstract] [Hide abstract]
ABSTRACT: Insomnia in children is a nonspecific impairing symptom that may be the result of normal developmental changes, psychosocial duress, a sleep disorder, a psychiatric disorder, other medical disorders, substance misuse, or an adverse effect of medication. Careful clinical assessment of insomnia in children may include the use of symptom rating scales, laboratory testing, or other medical assessment. Short- and long-term treatment of insomnia in children involves management of etiological factors and associated syndromes. Controlled treatment studies of pediatric insomnia are limited to <10 published studies of psychosocial and/or psychopharmacological treatment in young children. Directive parent education and behavior modification techniques have been effective in short-term treatment of insomnia in young children, and may be the preferred treatment of extrinsic insomnia, as well as an important adjunctive treatment of any insomnia symptoms. Two benzodiazepines [flurazepam and delorazepam (chlordesmethyldiazepam)], one antihistamine (niaprazine) and one phenothiazine [alimemazine (trimeprazine)] have been shown to be effective in the short-term treatment of insomnia in young children, although none of these agents have US Food and Drug Administration approval for pediatric insomnia. Short-acting benzodiazepines may have a role in the brief treatment of pediatric insomnia associated with an anxiety or mood disorder, psychosis, aggression, medication-induced activation, or anticipatory anxiety associated with a medical procedure. However, tachyphylaxis and risk of misuse preclude the long-term use of benzodiazepines for the treatment of insomnia in children. Newer hypnotics, which appear better tolerated than the benzodiazepines in studies of adults, may have a role when combined with psychosocial treatments of pediatric insomnia. Treatment of intrinsic pediatric insomnia may additionally involve chronotherapy or medical management.Paediatric Drugs 01/2002; 4(6). DOI:10.2165/00128072-200204060-00006 · 1.72 Impact Factor
Article: Benzodiazepine Receptor Antagonists[Show abstract] [Hide abstract]
ABSTRACT: The receptor to which benzodiazepine hypnosedatives and anticonvulsants bind was discovered and characterized in the late 1970s. Agonists and inverse agonists that act at various sites within the receptor complex have been identified. In addition, antagonists of the benzodiazepine receptor have been synthesised. At present, flumazenil is the only agent of this class that is available clinically. Flumazenil has well documented benefits in the treatment of hepatic encephalopathy and benzodiazepine overdose. The drug has also been studied as a potential treatment for neuropsychiatric illnesses in which dysfunction of the γ-aminobutyric acid (GABA)ergic system is implicated as a causal factor. Potential therapeutic benefits are suggested in benzodiazepine tolerance and withdrawal, benzodiazepine-related amnesia, epilepsy, sleep disorders, cognitive disorders and idiopathic recurrent stupor. In contrast, no clear benefits have been found in alcoholism, anxiety and movement disorders. Flumazenil induces few adverse effects, and so represents a promising tool for pharmacological investigations of the GABAergic system and for imaging of the benzodiazepine receptor. As an imaging agent it has been used for quantification of the receptor, and as a neuronal marker in epilepsy and cerebral ischaemia.CNS Drugs 09/1997; 8(3). DOI:10.2165/00023210-199708030-00007 · 4.38 Impact Factor
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ABSTRACT: Introduction The primary purpose of this study was to determine the extent to which low-dose huperzine A, galantamine, or donepezil selectively inhibited acetylcholinesterase (AChE) versus butyrylcholinesterase (BChE) activity in healthy adults and whether such inhibition impacted neurobehavioral performance. Methods In addition to hourly red blood cell cholinesterase sampling, neurobehavioral function was assessed before and after a single oral dose of huperzine A (100 or 200 μg), galantamine (4 or 8 mg), donepezil (2.5 or 5 mg), or placebo (n = 12 subjects per drug/dose). Results Compared to placebo, both dosages of huperzine A and galantamine inhibited circulating AChE but not BChE. With the exception of huperzine A (200 μg), which maintained declarative recall performance across sessions, compounds did not improve neurobehavioral performance. Some aspects of neurobehavioral performance correlated with AChE activity, although associations may have reflected time of day effects. Discussion Although huperzine A and galantamine significantly inhibited AChE (and likely increased central acetylcholine levels), neither compound improved neurobehavioral performance. The latter was likely due to ceiling effects in this young, healthy test population. Under conditions of reduced cholinergic activity (e.g., Alzheimer's disease), AChE inhibition (and corresponding maintenance of cholinergic tone) could potentially maintain/augment some aspects of neurobehavioral function.Physiology & Behavior 10/2014; DOI:10.1016/j.physbeh.2014.09.010 · 3.03 Impact Factor