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Biomedical subjects

H D Kleber

Publications and source records attributed to H D Kleber.

At least 127 records · Page 7Linked to original sources
PubMed1980

Opiate withdrawal using clonidine. A safe, effective, and rapid nonopiate treatment.

Clonidine hydrochloride was administered to ten patients in an inpatient setting after abrupt discontinuation of chronic methadone hydrochloride administration. Clonidine produced a rapid and statistically significant decrease in opiate withdrawal signs and symptoms. Clonidine administration for 14 days enabled all patients to be successfully detoxified from chronic opiate administration. In all patients studied, clonidine was a safe and effective nonopiate treatment of opiate withdrawal that suppressed the affect, signs, and symptoms of opiate withdrawal. These data support the hypothesis that the alpha 2-adrenergic agonist, clonidine, has substantial antiwithdrawal effect by replacing opiate-mediated inhibition with alpha 2-mediated inhibition of brain noradrenergic activity.

Brain↗
PubMed1980

Clonidine suppresses the opioid abstinence syndrome without clonidine-withdrawal symptoms: a blind inpatient study.

Nine hospitalized opioid-addicted patients were blindly given clonidine within 36 hours of the abrupt and blind discontinuation of methadone. All nine patients were successfully withdrawn from methadone and were asymptomatic upon discharge. Clonidine-treated patients had significantly fewer symptoms than a comparable group of opioid addicts abruptly withdrawn from methadone. No exacerbation of symptomatology developed after the cessation of clonidine. The clinical implications of clonidine's suppression of opioid withdrawal and the alpha-2 adrenergic mediation of the abstinence syndrome are discussed.

Adult↗
PubMed1980

Serum prolactin and opiate withdrawal.

To evaluate the dopamine hyperactivity hypothesis for opiate withdrawal, we measured serum prolactin (PRL) in 21 male methadone addicts during significant opiate withdrawal and after clonidine suppression of opiate withdrawal signs and symptoms. We also measured serum PRL in these addicts 4 weeks after they were free of clonidine and opiates. Serum PRL was significantly decreased during opiate withdrawal and after clonidine reversal of withdrawal symptoms when compared to serum PRL measured in the drug-free baseline samples. These data suggest that dopaminergic hyperactivity is present in opiate withdrawal, but may not be related to the signs and symptoms of withdrawal. A noradrenergic hyperactivity hypothesis is proposed to explain the neurobiological system that becomes activated in withdrawal, generates symptoms, and is inhibited after clonidine administration.

Clonidine↗
PubMed1980

Efficacy of clonidine in opiate withdrawal: a study of thirty patients.

In a placebo-controlled, double-blind crossover trial, clonidine caused a marked and significant reduction of objective signs and subjective symptoms of opiate withdrawal in thirty hospitalized opiate addicts. In an open trial of clonidine in opiate withdrawal, clonidine was found to suppress opiate withdrawal signs and symptoms, allowing all of the patients to detoxify successfully from chronic opiate addiction. Clonidine was demonstrated to reverse and suppress the signs, symptoms, and effects associated with opiate withdrawal. These data support a release from chronic opiate-induced noradrenergic inhibition producing noradrenergic hyperactivity as the pathophysiological substrate for opiate withdrawal. Clonidine replaces opiate-mediated inhibition with alpha-2 mediated inhibition of noradrenergic nuclei.

Brain↗
PubMed1980

The use of clonidine in detoxification from opiates.

Use of clonidine hydrochloride in detoxification from opiates has demonstrated that this substance can rapidly suppress the signs and symptoms associated with opiate withdrawal. Clonidine hydrochloride, an alpha-adrenergic agonist, is a non-opiate substance. Studies to date indicate that clonidine is useful for withdrawal from methadone maintenance, where it can help in detoxifying the patient in less than 14 days (instead of the usual three to six months) with a high rate of success in achieving zero dosage. The results of a clinical investigation of clonidine are presented and discussed in this paper. It has been shown to suppress signs and symptoms of opiate withdrawal in patients taking up to 75 mg of methadone daily. Shorter-acting narcotics may be withdrawn in less than a week. To prevent relapse, post-detoxification counselling and the use of the narcotic antagonist, naltrexone, are recommended.

Clonidine↗
PubMed1979

Detecting depressive disorders in drug abusers: a comparison of screening instruments.

Previous investigators have reported a high prevalence of depressive symptoms in drug-dependent patients. Given the responsiveness of depressive disorders to both psychological and pharmacological treatments, it is desirable to find an economical, efficient screening instrument to detect depressive disorders in this population. In this study, 6 depression symptom screening scales (Beck Depression Inventory, Hamilton Depression Scale, Raskin Depression Scale, Degree of Illness Rating, Symptom Checklist 90 Overall, and Depression Subscale) based on either clinician interview or patient self report, were compared according to their utility in detecting cases of depression among 64 applicants for treatment at a substance abuse treatment unit of a community mental health center. The criteria for a case of depression were the Research Diagnostic Criteria (RDC) which are specified and operationalized. Cases identified using previously described cutoff scores on the screening scales were compared to rates based on the RDC and sensitivity and specificity were determined. The results showed that: (1) although the sensitivity of the symptom scales was applicable, ranging from 65--94%, the specificity was less impressive, ranging from 39--61%, and (2) the Beck Depression Inventory, a 13-item patient self report was the most sensitive and specific and is recommended for screening drug-dependent populations for depression.

Adult↗
PubMed1979

A rationale for opiate withdrawal symptomatology.

The discovery of opioid peptide transmitters and the delineation of their interactions with the noradrenergic locus ceruleus (LC) has led to our proposing that opiate effects on mood and physiological responses result from the opiate-induced inhibition of the LC. Withdrawal of opiates removes this "tonic" inhibition of the LC and could readily result in a piperoxane-like release from inhibition. The hypothesis that noradrenergic hyperactivity underlies the physiologic and affective changes seen in opiate withdrawal and spontaneous panic seen in man can be readily tested in man by evaluating the efficacy of drugs which inhibit the LC and block piperoxane- and LC-elicited increases in specific behaviors for the treatment of opiate withdrawal and naturally occurring panic-anxiety states in man.

Animals↗