Intranasal Oxytocin Blocks Alcohol Withdrawal in Human Subjects.

Department of Psychiatry , The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Alcoholism Clinical and Experimental Research (Impact Factor: 3.31). 10/2012; DOI: 10.1111/j.1530-0277.2012.01958.x
Source: PubMed

ABSTRACT BACKGROUND: The neuropeptide, oxytocin (OT), has been reported to block tolerance formation to alcohol and decrease withdrawal symptoms in alcohol-dependent rodents. Numerous recent studies in human subjects indicate that OT administered by the intranasal route penetrates into and exerts effects within the brain. METHODS: In a randomized, double-blind clinical trial, intranasal OT (24 IU/dose, N = 7) or placebo (N = 4) was given twice daily for 3 days in alcohol-dependent subjects admitted to a research unit for medical detoxification using Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score-driven PRN administration of lorazepam. Subjects rated themselves on the Alcohol Withdrawal Symptom Checklist (AWSC) each time CIWA scores were obtained. Subjects also completed the Penn Alcohol Craving Scale, an Alcohol Craving Visual Analog Scale (ACVAS) and the Profile of Mood States (POMS) on inpatient days 2 and 3. RESULTS: All subjects had drunk heavily each day for at least 2 weeks prior to study and had previously experienced withdrawal upon stopping/decreasing alcohol consumption. OT was superior to placebo in reducing alcohol withdrawal as evidenced by: less total lorazepam required to complete detoxification (3.4 mg [4.7, SD] vs. 16.5 [4.4], p = 0.0015), lower mean CIWA scores on admission day 1 (4.3 [2.3] vs. 11.8 [0.4], p < 0.0001) and day 2 (3.4 [2.2] vs. 11.1 [3.6], p < 0.002), lower AWSC scores on days 1 and 2 (p < 0.02; p = 0.07), and lower ACVAS ratings (p = 0.01) and lower POMS Tension/Anxiety subscale scores on day 2 (p < 0.01). CONCLUSIONS: This is the first demonstration that OT treatment may block alcohol withdrawal in human subjects. Our results are consistent with previous findings in rodents that OT inhibits neuroadaptation to and withdrawal from alcohol. OT could have advantages over benzodiazepines in managing alcohol withdrawal because it may reverse rather than maintain sedative-hypnotic tolerance. It will be important to test whether OT treatment is effective in reducing drinking in alcohol-dependent outpatients.

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Available from: James C Garbutt, Jul 21, 2014
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    • "Oxytocin has also been implicated in modulating the reactivity of the hypothalamicpituitary-adrenal axis (Buisman-Pijlman et al., 2014b), thus in part determining the extent of psychological and physiological response to stress (Feldman, 2012). This expanding knowledge base has underpinned adult human and animal studies administrating intranasal oxytocin as a modulator of behaviors, for example, those associated with substance abuse (McGregor and Bowen, 2012; Pedersen et al., 2013). "
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    • "The authors concluded that lithium reduces withdrawal by stimulating oxytocin release. Since this study, there has been expanding interest in the utility of oxytocin in ameliorating drug and alcohol withdrawal symptoms and promoting longterm abstinence (McGregor and Bowen 2012; McGregor et al. 2008; Pedersen et al. 2013). "
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    • "OT also influences motivated behaviors. For example, intranasal OT improves libido in men (MacDonald and Feifel, 2012), and there is evidence that OT may block withdrawal symptoms in alcohol-dependent patients (Pedersen et al., 2012). Thus, OTappears to play similar roles in humans and in rodents, which strongly supports the use of animal models in the study of central OT regulation of behavior. "
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    ABSTRACT: Oxytocin (OT) promotes social and reproductive behaviors in mammals, and OT deficits may be linked to disordered social behaviors like autism and severe anxiety. Male rat sexual behavior is an excellent model for OT regulation of behavior, as its pattern and neural substrates are well characterized. We previously reported that OT microinjected into the medial preoptic area (MPOA), a major integrative site for male sexual behavior, facilitates copulation in sexually experienced male rats, whereas intra-MPOA injection of an OT antagonist (OTA) inhibits copulation. In the present studies, copulation on the day of sacrifice stimulated OTR mRNA expression in the MPOA, irrespective of previous sexual experience, with the highest levels observed in first-time copulators. In addition, sexually experienced males had higher levels of OTR protein in the MPOA than sexually naïve males and first-time copulators. Finally, intra-MPOA injection of OT facilitated mating in sexually naive males. Others have reported a positive correlation between OT mRNA levels and male sexual behavior. Our studies show that OT in the MPOA facilitates mating in both sexually naive and experienced males, some of the behavioral effects of OT are mediated by the OTR, and sexual experience is associated with increased OTR expression in the MPOA. Taken together, these data suggest a reciprocal interaction between central OT and behavior, in which OT facilitates copulation and copulation stimulates the OT/OTR system in the brain.
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