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Sensitivity of late-latency auditory and somatosensory evoked potentials to threat of electric shock and the sedative drugs diazepam and diphenhydramine in human volunteers.

Late-latency auditory and somatosensory evoked potentials are sensitive to some centrally acting drugs and to certain psychological interventions. In this experiment we compared the effects of acute doses of a benzodiazepine, diazepam and an H(1) histamine receptor-blocking sedative, diphenhydramine, on auditory and somatosensory evoked potentials within the latency range 100-500 ms in a fear conditioning paradigm. Twelve healthy males (18-30 years) participated in three sessions at weekly intervals in which they received diazepam 10mg, diphenhydramine 75 mg and placebo in a balanced, double-blind, crossover protocol. One hundred and twenty min after diphenhydramine or 60 min after diazepam, they underwent an 8 min recording period in which auditory evoked potentials elicited by 40 ms, 95 dB[A], 1 kHz tones, and somatosensory evoked potentials elicited by a mildly painful electric shock (1.8 mA, 50 ms) were recorded at Cz (vertex). Each session consisted of four blocks of trials in which either the sound pulse or the shock was presented. Alternate blocks were designated SAFE or THREAT ('context' conditions); in THREAT blocks subjects were warned that shocks would be delivered via electrodes placed on the wrist (electrodes were removed during SAFE blocks). In one SAFE and one THREAT block, the sound stimuli and shocks (shocks were delivered only in the THREAT block) were preceded by a 2 s conditioned stimulus (CS: a red light) ('cue' condition). Diazepam, but not diphenhydramine, reduced the amplitude of the P2 auditory evoked potential. The THREAT context was associated with increased N1 and reduced N2 potential amplitudes. The CS had no effect on the amplitudes, but markedly reduced the latencies of the N1, P2 and N2 potentials under the THREAT condition. Diazepam reduced the amplitudes of the somatosensory potential evoked by the shock; the CS shortened the latencies of the later components of the response. Diazepam and diphenhydramine were approximately equi-sedative in the doses used in this experiment, as judged by visual analogue self-rating scales. The results indicate that the suppression of late-latency auditory and somatosensory evoked potentials by diazepam is not simply a reflection of sedation. Late-latency evoked potentials can be modified by an aversive CS, but the components that are sensitive to the CS are different from those that are sensitive to diazepam.

Acoustic Stimulation↗

Effect of diazepam on neuromuscular transmission and its interaction with non-depolarizing muscle relaxants.

Neuromuscular blocking actions of diazepam and its interaction with some myoneural blocking agents were studied in dogs and in humans undergoing surgery under general anaesthesia. Diazepam alone had no effect on the response of tibialis anterior muscle to indirect stimulation in dogs. Again, diazepam in a bolus dose of 5 mg did not influence a pre-existing partial block by d-tubocurarine, gallamine or pancuronium. But a significant increase in both the degree and duration of block was observed when diazepam and d-tubocurarine were given simultaneously, suggesting an agonist action in diazepam. On the contrary, simultaneous use of diazepam and gallamine caused a significantly less intense block of tibialis muscle twitch tension as compared to gallamine alone, suggesting an antagonistic action. The degree and duration of block by d-tubocurarine were not affected significantly by simultaneous administration of diazepam in human beings. It is, therefore, concluded that diazepam in clinical doses can be safely used with d-tubocurarine in humans.

Animals↗

Continuous midazolam versus diazepam infusion for refractory convulsive status epilepticus.

The objective of this study was to compare the efficacy of continuous midazolam and diazepam infusion for the control of refractory status epilepticus. An open-label, randomized control study was undertaken at the Pediatric Emergency and Intensive Care Service of a multidisciplinary teaching and referral hospital. Subjects included 40 children, 2 to 12 years of age, with refractory status epilepticus (motor seizures uncontrolled after two doses of diazepam, 0.3 mg/kg per dose, and phenytoin infusion, 20 mg/kg). Either continuous midazolam (n = 21) or diazepam infusion (n = 19) in incremental doses was administered. The primary outcome measure was the proportion of children in each group with successful control of refractory status epilepticus. The secondary outcome measure was the time to control seizure activity, recurrence of seizure after initial control, if any, the frequency of hypotension, and the need for ventilation. The two groups were similar in age (mean +/- SD = 4.9 +/- 43.6 months) and etiology. Twenty-three (57.5%) patients had acute central nervous system infection. Refractory status epilepticus was controlled in 18 (86%) and 17 (89%) patients in the midazolam and diazepam groups, respectively (P = not significant). The median time to seizure control was 16 minutes in both groups, but in the midazolam group, seizures recurred in more children (57% versus 16% in diazepam group; P < .05). The maximum dose (mean +/- SD) of midazolam and diazepam required was 5.3 +/- 2.6 microg/kg/min and 0.04 +/- 0.02 mg/kg/min, respectively. About half of the patients needed mechanical ventilation and 40% had hypotension in both groups, but the mortality was higher in the midazolam group (38%) as compared to the diazepam group (10.5%, P < .1 > .05). Continuous midazolam and diazepam infusions were equally effective for control of refractory status epilepticus. However, midazolam was associated with more seizure recurrence and higher mortality in refractory status epilepticus predominantly caused by central nervous system infections.

Anticonvulsants↗

A comparative study of haloperidol and diazepam in the treatment of anxiety.

In a single-blind study in general practice, 60 patients with anxiety neuroses were randomly allocated to receive either 0.5 mg haloperidol twice daily or 2 mg diazepam 3-times daily for 6 weeks. Eighteen patients (6 on haloperidol and 12 on diazepam) were excluded from the analysis of efficacy. On the Hamilton Rating Scale both haloperidol and diazepam reduced the anxiety and depression scores. The investigator's assessment of 14 anxiety symptoms and signs indicated that haloperidol produced significantly (p=0.05) greater symptomatic improvement than diazepam after 4 and 6 weeks of treatment, and the patients' overall response was also significantly (p less than 0.005) greater with haloperidol. After 6 weeks, 93% of patients felt 'better' or 'much better' on haloperidol, compared with 83% on diazepam. A few, minor side-effects were reported, slightly fewer on haloperidol than on diazepam. In the parameters tested in this study, haloperidol has been shown to be more effective than diazepam in the treatment of anxiety neuroses and appears to provide significantly better overall symptomatic relief and to be more acceptable to patients than diazepam.

Adult↗

The effect of methysergide, pimozide, and sodium valproate on the diazepam-stimulated growth hormone secretion in man.

Diazepam-induced GH secretion was tested on 28 male volunteers before and after a 3-day treatment with methysergide, pimozide, or sodium valproate. Serum GH, diazepam, and blood glucose levels were determined. Without prior medication, the mean serum GH level increased 336% 1 h after diazepam administration. Treatment with the serotonin antagonist, methysergide, had no effect on the diazepam-stimulated GH secretion, whereas pimozide, the selective dopamine receptor-blocking agent, reduced the GH response to diazepam by 50% (P less than 0.05). Sodium valproate, a gamma-aminobutyric acid transaminase inhibitor, also inhibited diazepam-induced GH secretion; stimulated GH levels were 51% at 30 min (P less than 0.025), 39% at 60 min (P less than 0.025), and 46% at 90 min (P less than 0.025) relative to the stimulated levels without medication. No difference was found in blood glucose or serum diazepam levels after the drug treatments relative to the values obtained under basal conditions. It is suggested that diazepam-induced GH secretion is at least partly mediated via dopaminergic mechanisms. Serotonin does not seem to be involved. It is further proposed that gamma-aminobutyric acid plays an inhibitory role in GH secretion.

Adult↗

Halothane sensitivity in replicate mouse lines selected for diazepam sensitivity or resistance.

We have previously shown that mice selected for sensitivity to diazepam are also more sensitive to halothane, and that halothane augments the gamma-aminobutyric acid (GABA)-mediated chloride flux response in brain tissue from diazepam-sensitive (DS) mice to a greater degree than in diazepam-resistant (DR) mice. These findings suggest that the GABAA receptor is an important site of halothane action. To confirm this correlation, halothane requirement was determined in two independently developed replicate lines of DS and DR mice. Association of the traits of diazepam and halothane sensitivity in replicate lines of DS mice diminishes the probability that the original finding was due to a false-positive correlation, and instead suggests that it results from the common action of genes controlling diazepam sensitivity. Halothane median effective concentration (EC50) was determined by using the end-point of loss of righting reflex in two replicate lines of mice selected for diazepam sensitivity (resistant mice = diazepam high performance-1 and -2 [DHP-1 and DHP-2], sensitive mice = diazepam low performance-1 and -2 [DLP-1 and DLP-2]). DLP-1 and DLP-2 mice were sensitive to halothane, whereas DHP-1 and DHP-2 mice were resistant to halothane. Halothane EC50 in the DLP-1 and DHP-1 mice was 0.86 +/- 0.01 (SE) and 1.10 +/- 0.04 atm%, respectively (P < 0.0001), and that in the DLP-2 and DHP-2 mice was 0.88 +/- 0.01 and 0.97 +/- 0.02 atm%, respectively (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Impairment state of cognitive performance and the affecting factors in outpatients following gastrointestinal endoscopy after single-dose diazepam.

Diazepam is commonly used as premedicant for endoscopic procedures. Wide interindividual differences have been observed in the residual cognitive effects of the drug after gastrointestinal endoscopy. Our aim was to clarify the major factors, including pharmacokinetic factors, contributing to this wide variation in residual cognitive effect after gastrointestinal endoscopy in the study. Sixty-one outpatients undergoing gastrointestinal endoscopy participated in the study. Cognitive effects were evaluated in the diazepam group (n=52) by the digit symbol substitution test (DSST) twice before and 30 min after an intravenous administration of 5 mg diazepam; in the intervening time gastrointestinal endoscopy was performed. Plasma concentrations of diazepam were determined by HPLC. The control group (n=9) was tested by DSST in the same manner. The cognitive effects according to the change in DSST score was significantly decline in the diazepam group compared with the control group (by 0.2 versus -4.6; P=0.014). This prospective study confirmed that cognition was significantly impaired after gastrointestinal endoscopy by premedication to subjects with 5 mg diazepam. There were very wide variations in change in DSST score. However we could not identify the independent variables that best predicted DSST score difference in a multiple regression analysis for age, plasma albumin level, and plasma diazepam concentration 30 min after intravenous administration. We should pay attention to patients' individual states in cognitive performance following gastrointestinal endoscopy after single-dose diazepam.

Adult↗

[Effects of diazepam on rage reaction elicited by the lateral hypothalamus (LH) and on single unit activities in the LH and the basal medial amygdaloid nucleus (Abm) in cats (author's transl)].

Effects of diazepam were examined on the whine reaction elicited by LH stimulation and on unit activities in the LH and Abm in cats. The spontaneous firing frequency of Abm neurons was 5 to 30 spikes/sec and in all 6 neurons isolated the firing frequency increased by non-nociceptive and/or clap-stimulation. Diazepam decreased the spontaneous firing frequency of all Abm neurons isolated and the increased firing frequency elicited by non-nociceptive and/or clap-stimulation was also depressed by diazepam. The spontaneous firing frequency of neurons in the LH was 4 to 5 spikes/sec and all 6 neurons isolated firing frequency increased by non-nociceptive stimulation. Only one of 6 neurons, however, was activated by clap-stimulation. Diazepam decreased the spontaneous firing frequency of all LH neurons. Out of 6 neurons responsive to non-nociceptive stimulation, 3 were also depressed by diazepam. The other neurons were not affected by diazepam. These results suggest that depressed action of diazepam on the whine reaction elicited by the LH stimulation may be related to the decrease of firing in the Abm and/or the LH by diazepam.

Amygdala↗

Involvement of the inhibitory GTP-binding regulatory protein and a low-affinity benzodiazepine receptor in the inhibitory effect of diazepam on rat brain adenylate cyclase system.

The effect of diazepam on the adenylate cyclase system was studied in rat synaptosomal membranes. Micromolar concentrations of diazepam inhibited the cyclase activities in the presence or absence of guanylyl-5'-imidodiphosphate (GppNHp). The inhibitory effect of diazepam was greater on the cyclase activity in the presence of GppNHp than on that in the basal state. This effect of diazepam was not antagonized by Ro15-1788, an antagonist of a high affinity benzodiazepine receptor in the central nervous system. Furthermore, micromolar concentrations of Ro15-1788 had no inhibitory effect on cyclase activities in the presence or absence of GppNHp. In addition, the bromide ion enhanced the inhibition by diazepam of the cyclase activity in the presence of GppNHp, but not the basal activity, although the bromide ion had no effect on both activities in the absence of diazepam. On the other hand, the pretreatment of synaptosomal membranes with GppNHp increased the KD value for [3H]diazepam binding from 98 microM to 198 microM. These data led us to conclude that diazepam inhibits rat brain adenylate cyclase through the effects on both a low affinity benzodiazepine receptor coupled with the inhibitory GTP-binding regulatory protein (Gi) and the catalytic protein.

Adenylyl Cyclase Inhibitors↗

Negative inotropic effect of diazepam in isolated guinea pig heart.

The inotropic effect of diazepam, a benzodiazepine derivative, and its mechanism of action were examined using guinea pig heart and single ventricular cell preparations. In Langendorff hearts and right ventricular free-wall preparations, diazepam (10 to 100 microM) produced a monophasic negative inotropic effect in a concentration dependent manner. Neither a central type (flumazenil 1 microM) nor a peripheral type (PK11195 10 microM) of benzodiazepine receptor antagonist antagonized the monophasic negative inotropic effects of diazepam. Diazepam (10 to 100 microM) shortened action potential duration of papillary muscle in a concentration dependent manner. In isolated single ventricular cells, diazepam (30 and 100 microM) inhibited the calcium current (I(Ca)) in a concentration dependent manner. Diazepam produced a significant decrease in I(Ca) elicited by first depolarizing pulses, however, the decrease of I(Ca) was not augmented during a train of depolarizing pulses. Thus, diazepam appears to produce a tonic block of cardiac calcium channels and the mode of inhibition is clearly different from the use-dependent block of verapamil. From these results, it was concluded that diazepam produces a monophasic negative inotropic effect that is independent of the benzodiazepine receptor, and is probably mediated through an inhibition of I(Ca) in guinea pig heart preparations.

Adjuvants, Anesthesia↗

Anticonvulsant effect of nimodipine alone and in combination with diazepam and phenytoin in a mouse model of status epilepticus.

The effect of nimodipine alone and in combination with diazepam or phenytoin was tested in the electroshock-induced mouse model of status epilepticus. Status epilepticus was induced by transauricular electrical stimulation with a stimulus of 15 mA at 0.5, 3, 10, 20 and 30 min, starting half an hour after intraperitoneal administration of vehicle/drug. The median effective doses of diazepam and phenytoin alone and in combination with a fixed dose of nimodipine (24 mg/kg) was calculated. The ED50s of diazepam and phenytoin were found to be 10.5 and 9 mg/kg, respectively. When nimodipine was combined with diazepam or phenytoin, the ED50 values decreased to 3.77 mg/kg and 7.15 mg/kg, respectively. The severity of seizures was also decreased by combination with nimodipine as compared to diazepam and phenytoin given alone. To study the effect of nimodipine on psychomotor impairments produced by diazepam and phenytoin three tests were performed: rotarod, behavioral despair and hole board. Nimodipine did not show protective effects on its own but potentiated the anticonvulsant effects of diazepam and phenytoin. Furthermore, the combination of nimodipine with diazepam and phenytoin produced lesser impairment of psychomotor functions.

Animals↗

Requirement of alpha5-GABAA receptors for the development of tolerance to the sedative action of diazepam in mice.

Despite its pharmacological relevance, the mechanism of the development of tolerance to the action of benzodiazepines is essentially unknown. The acute sedative action of diazepam is mediated via alpha1-GABA(A) receptors. Therefore, we tested whether chronic activation of these receptors by diazepam is sufficient to induce tolerance to its sedative action. Knock-in mice, in which thealpha1-,alpha2-,alpha3-, oralpha(5)-GABA(A) receptors had been rendered insensitive to diazepam by histidine-arginine point mutation, were chronically treated with diazepam (8 d; 15 mg x kg(-1) x d(-1)) and tested for motor activity. Wild-type, alpha2(H101R), and alpha3(H126R) mice showed a robust diminution of the motor-depressant drug action. In contrast, alpha5(H105R) mice failed to display any sedative tolerance. alpha1(H101R) mice showed no alteration of motor activity with chronic diazepam treatment. Autoradiography with [3H]flumazenil revealed no change in benzodiazepine binding sites. However, a decrease in alpha5-subunit radioligand binding was detected selectively in the dentate gyrus with specific ligands. This alteration was observed only in diazepam-tolerant animals, indicating that the manifestation of tolerance to the sedative action of diazepam is associated with a downregulation of alpha5-GABA(A) receptors in the dentate gyrus. Thus, the chronic activation of alpha(5)-GABA(A) receptors is crucial for the normal development of sedative tolerance to diazepam, which manifests itself in conjunction with alpha1-GABA(A) receptors.

Alkynes↗

Toxicological studies on the influence of diazepam following prolonged administration of ethanol in the rhesus monkey and rat.

The influence of diazepam treatment following prolonged ethanol administration was toxicologically examined in rhesus monkeys and rats. In the monkey, ethanol was intragastrically administered through a chronically implanted catheter by programmed infusions at doses of 1.5 g/kg 4 times daily every 6 hours over a period of 5 or 10 weeks and followed by intragastric administration of diazepam 4 mg/kg twice a day for 5 weeks. In the rat, ethanol was administered by gavage at doses of 8 g/kg once a day or 4 g/kg twice a day for 5 weeks after which diazepam 300 mg/kg was intragastrically administered once daily for 5 weeks. In the monkey, ethanol produced such toxic changes as hypertriglyceridaemia, fatty metamorphosis of the hepatocytes associated with megamitochondria, proliferation of smooth endoplasmic reticulum and vacuolation in the hepatocytes, and gastritis. Diazepam did not aggravate but mostly alleviated these changes. In the rat, on the contrary, the serum GPT level slightly elevated due to the ethanol administration, and remained at the elevated level with the diazepam treatment in contrast with the complete recovery with non-treatment for 5 weeks after the ethanol administration. However, such changes as increase of fat droplets in the hepatocytes and the triglyceride concentration in the liver which had been developed by ethanol administration recovered during the diazepam treatment period. In spite of the recovery, the elevation of the serum GPT level being remained by diazepam may indicate possible influence of diazepam on the liver function when the drug is administered after prolonged administration of ethanol.

Alanine Transaminase↗

Chronic treatment with the neuroactive steroid ganaxolone in the rat induces anticonvulsant tolerance to diazepam but not to itself.

Ganaxolone (3alpha-hydroxy-3beta-methyl-5alpha-pregnane-20-one), an orally active synthetic analog of the neuroactive steroid allopregnanolone, is a positive allosteric modulator of gamma-aminobutyric acid(A) receptors with anticonvulsant properties. We sought to determine whether tolerance occurs to the anticonvulsant activity of ganaxolone in the pentylenetetrazol seizure test and whether there is cross-tolerance with diazepam. Rats were treated with two daily injections of a 2 x ED(50) dose of ganaxolone (7 mg/kg s.c.), diazepam (4 mg/kg i.p.), or vehicle for 3 or 7 days. On the day after the chronic treatment periods, the anticonvulsant potencies of ganaxolone and diazepam were determined. The ED(50) values for ganaxolone after 3- and 7-day treatment with ganaxolone were not significantly different from that in naive rats (ED(50) = 3.5 mg/kg). In contrast, in animals that were treated chronically with ganaxolone for 7 days, there was a significant reduction in the anticonvulsant potency of diazepam (ED(50) = 4.0 versus 1.9 mg/kg for naive controls). Chronic treatment with diazepam was not associated with a reduction in the potency of ganaxolone, but there was a reduction in the potency of diazepam (ED(50) = 3.7 mg/kg). Plasma ganaxolone determinations indicated that the pharmacokinetic properties of ganaxolone were unchanged after 7-day chronic ganaxolone treatment. The estimated equilibrium plasma concentrations of ganaxolone associated with threshold (750-950 ng/ml) and 50% seizure protection (1215-1295 ng/ml) were similar in naive and chronically treated rats. We conclude that there is no tolerance to the anticonvulsant activity of ganaxolone nor is there cross-tolerance to ganaxolone when tolerance develops to diazepam. However, there is cross-tolerance to diazepam with chronic ganaxolone treatment.

Animals↗

[Effects of different thyroid status on the pharmacokinetics of diazepam].

Experimental models of hypothyroidism and hyperthyroidism in Sprague-Dawley rats were established in this study. Diazepam was given to rats at a single oral dose of 30-40 mg.kg-1 and the plasma concentration of diazepam was detected by HPLC. The results showed that the plasma concentration of diazepam was significantly higher in hypothyroid rats than that in controls (P < 0.05). The Cmax, AUC and T1/2 (Ka) were increased. The Vd was decreased and the elimination was slowed. Mild hyperthyroidism showed nearly no effect on the plasma concentration, Cmax and AUC of diazepam in the rats. But when the rats became more heavily hyperthyroid, the plasma concentration, Cmax and AUC of diazepam were increased gradually. The absorption of diazepam was changed slightly in mild and moderate hyperthyroid rats, the Vd was decreased and the elimination was accelerated. In heavily hyperthyroid rats, however, the absorption of diazepam was obviously accelerated. The Vd was decreased and the elimination was slowed. Therefore, we conclude that different thyroid status may have different effects on the pharmacokinetics of diazepam.

Animals↗

Diazepam loading in alcohol withdrawal: clinical pharmacokinetics.

The pharmacokinetics of diazepam and its major active metabolite, desmethyl-diazepam, following a loading dose of diazepam (fixed oral doses of 20 mg) were studied in 16 patients on alcohol withdrawal. No toxic drug levels were measured irrespective of the amount of diazepam needed on the loading (83 +/- 27 mg on average). The mean elimination half-life of diazepam fell within the range observed in healthy persons after the ingestion of therapeutic doses (5), or it was only moderately prolonged (t1/2 49.7 h). The ageing process was associated with a slightly prolonged half-life of diazepam. Standard liver function tests could not predict the length of the elimination half-life of diazepam. Active drug concentrations remained high during the first 48 h of treatment, followed by a steady decline. On the basis of this study, it seems that diazepam can be safely and effectively used in loading doses in the treatment of alcohol withdrawal.

Administration, Oral↗

Preference for diazepam in anxious adults.

This study investigated whether anxious adults desiring treatment for their anxiety would choose to take 10 mg of diazepam (Valium) or placebo after sampling both substances under double-blind conditions. Subjective effects of the drugs were also assessed, and the relationship between self-reported subjective effects and the number of times subjects chose diazepam or placebo was examined. Fourteen male and female volunteers meeting criteria for generalized anxiety disorder were recruited. They participated in a nine-session choice experiment in which they sampled diazepam 10 mg and a placebo on the first four sessions and chose whichever they preferred on the next five sessions. Only three subjects chose diazepam on all five choice occasions, no subjects chose diazepam on three or four occasions, and 11 subjects chose diazepam on two or fewer occasions. Overall, diazepam produced typical, tranquilizer-like subjective effects. However, subjective responses to diazepam differed in the 0-2-time choosers compared with the 5-time choosers: the 0-2-time choosers showed an increase on the measure of confusion, while the 5-time choosers showed decreases on measures of anxiety and confusion and increases on measures of stimulation.

Adult↗

[The effect of diazepam on exploratory behavior and its strain differences in inbred rats].

The effect of diazepam on exploratory behavior was investigated in two inbred strains of rats, Fischer 344 (F344) and Lewis (LEW). The total numbers of head-dips and head-dipping duration in the rat hole-board test, and the total number of rearing and locomotor activity in the open-field test were measured after diazepam administration. The numbers of head-dips and rearings, and head-dipping duration and locomotor activity in naive F344 were significantly greater than those in naive LEW (P less than 0.001), suggesting that LEW is more emotional than F344. Diazepam, 0.31 and 0.63 mg/kg for F344 and 0.31-1.25 mg/kg for LEW, increased head-dips, head-dipping duration and rearings. However, there were no strain differences in enhancing effect of diazepam on locomotor activity. On the contrary, higher doses of diazepam, 0.94-2.50 mg/kg for F344 and 2.50 mg/kg for LEW, decreased head-dips, head-dipping duration, and rearings. However, the effect of diazepam on rotarod performance in LEW was similar to that in F344. These results suggest that F344 is more sensitive to sedative effect of diazepam than LEW, and that the sensitivity to diazepam may be strongly influenced by genetic factors.

Animals↗