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Quantitative determination of diazepam, nitrazepam and flunitrazepam in tablets using thin-layer chromatography-densitometry technique.

A simple and reliable assay for diazepam, nitrazepam and flunitrazepam in tablets by high-performance liquid chromatography (HPLC) and thin-layer chromatography (TLC)-densitometry is described. A quantity of a ground tablet mass, equal to the average weight of one tablet was sonicated in MeOH, mixed with appropriate internal standard, filtered and either injected directly into the liquid chromatograph, or after evaporation and reconstitution of an aliquot of the extract, was spotted on a silica gel thin-layer plate. A variable UV detector, operated at 254 nm was employed in both procedures. A C18, reversed phase 7 microm column was used for HPLC analysis; the mobile phase was a 1:1 (v/v) mixture of MeOH (40 degrees C) and 0.01 M phosphate buffer (pH 7, 80 degrees C). The TLC plate was developed in an unsaturated chromatographic chamber containing 100 ml chloroform-acetone (9:1); at room temperature, the mobile phase was allowed to travel 15 cm. The percentage of the active ingredient content of each tablet obtained by both procedures, was in the range of the stated amount except for one brand of diazepam tablets which contained approximately 23% less active ingredient than the minimum prescribed amount. The TLC densitometry, although yields slightly higher values than the HPLC method, is preferred due to its simplicity, ease and low cost.

Chromatography, Thin Layer↗

[Clonidine combined with flunitrazepam before carotid endarterectomy decreases cerebrovascular CO2 reactivity].

OBJECTIVE: Assess cerebrovascular CO2 reactivity changes using transcranial Doppler sonography (TCD) after oral premedication associating clonidine (2 micrograms.kg-1) and flunitrazepam (70 micrograms.kg-1) in patients scheduled for carotid stenosis surgery. STUDY DESIGN: Prospective study, not randomized, the patient being his own "control". PATIENTS AND METHODS: Thirteen patients undergoing carotid endarterectomy under cervical plexus block were included. The monitoring included: automated arterial pressure cuff, ECG, radial artery catheter, TCD with probe secured in temporal window. The study of the cerebrovascular CO2 reactivity was performed with TCD recording on the side of operation, on the day before, and on the day of carotid endarterectomy, 90 min after the premedication, immediately before surgery. To change PaCO2, four ventilatory states were successively performed: (1) normoventilation, (2) hyperventilation, (3) hypoventilation, (4) "breath-holding test". At each state, it was noted: HR, MAP, PaCO2, mean blood flow velocity in the middle cerebral artery (Vm-MCA), resistance index of Pourcelot (RI), cerebrovascular reactivity (slope Vm-MCA/PaCO2). The results (+/- SEM) were analyzed by Wilcoxon test or t test. RESULTS: After premedication, cerebrovascular CO2 reactivity decreased (0.043 +/- 0.019 vs 0.034 +/- 0.013; p < 0.05) without modification of RI (0.578 +/- 0.291 vs 0.612 +/- 0.025; NS). No complication during carotid clamping was reported. CONCLUSION: Inclusion of clonidine in premedication before carotid stenosis surgery must be questioned because a decrease of cerebrovascular CO2 reactivity could be deleterious in case of intraoperative stroke.

Adrenergic alpha-Agonists↗

[Hemodynamic effects of fentanyl and sufentanil combined with flunitrazepam in coronary artery surgery].

Because sufentanil has been reported as being able to prevent or treat peroperative hypertensive crises during aorto-coronary artery graft surgery, a study was carried out to compare the haemodynamic effects of sufentanil with those of fentanyl. 20 patients who were to undergo aortocoronary bypass grafting (CABG) were randomly allocated to two equal groups, sufentanil (Sf) and fentanyl (F) groups. A 1 to 5 dose ratio was used so as to have equipotent doses of sufentanil and fentanyl. Induction doses were 10 micrograms.kg-1 sufentanil and 50 micrograms.kg-1 fentanyl. Up to 20 micrograms.kg-1 sufentanil and 100 micrograms.kg-1 fentanyl were then used between intubation and the setting-up of cardiopulmonary bypass (CPB). A bolus of 10 micrograms.kg-1 flunitrazepam was given if necessary, so as to lower the mean arterial pressure (Pa) to below 100 mmHg after intubation, and under 80 mmHg during CPB. Heart rate, Pa, mean pulmonary arterial pressure, pulmonary wedge pressure (Ppw), central venous pressure and cardiac output were measured before anaesthesia, 2 min after intubation, before incision, 2 min after sternotomy, 10 min after the end of CPB, after chest closure, 30 min and 2h after arrival of the patient in the intensive care unit. The only difference found between the two groups was a more rapid drop in left ventricular preload after induction with sufentanil; 2 min after intubation, there was a 26% fall in Ppw with sufentanil (p less than 0.01) and 8% with fentanyl. Before skin incision, this drop was of 32% (p less than 0.01) and 24% (p less than 0.01) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

[Evaluation of the efficacy and tolerance of flumazenil in antagonism of the effects of flunitrazepam on the central nervous system].

The efficacy and tolerance of flumazenil were assessed in a double-blind randomized multicentre trial on 120 ASA I or II patients aged 40.3 +/- 13.9 years. They were anaesthetized with flunitrazepam (25.1 +/- 10.5 micrograms.kg-1.h-1), fentanyl (4.4 +/- 1.9 micrograms.kg-1.h-1) and either vecuronium or pancuronium; residual neuromuscular blockade was antagonized at the end of surgery. 61 patients received flumazenil and 59 a placebo. Sedation comprehension and temporo-spatial orientation were scored at 0, 5, 15, 30, 60, 120 and 240 min after the administration of flumazenil or placebo. Local and general tolerances were evaluated 1 h and 24 h after administration. At the 24th h, the observer's assessment of consciousness, pain, respiration, coughing and vomiting were noted, as well as his identification, or not, of flumazenil or the placebo and their efficacy. Both groups were statistically homogeneous and comparable. Significant and marked efficacy was noted between the 5th and 30th min. There was no difference, at 24 h, between the flumazenil and placebo groups. In most cases, flumazenil was identified by the observer and its efficacy felt to be excellent. No major untoward effect of flumazenil was noted; however a mild and short lasting anxiety occurred in three patients. Tolerance was deemed to be excellent.

Adolescent↗

[Hemodynamic and adrenergic effects of flumazenil after general anesthesia with flunitrazepam].

Reversal of benzodiazepine-induced sedation by flumazenil has been reported to produce no or minor hemodynamic alterations although some adverse responses have been observed. To better delineate circulatory and adrenergic modifications induced by flumazenil, 20 consenting patients scheduled for short orthopedic procedures were included in a double blind controlled study. Anesthesia consisted in flunitrazepam (30 to 40 micrograms.kg-1) plus halothane (0.5 vol. % in N2O-O2, 60-40 vol. %) and alfentanil. At the end of surgery, patients received 15 minutes after discontinuation of halothane and N2O, either flumazenil (1 mg) or placebo according th randomization. Heart rate and blood pressure were obtained before reversal and repeatedly for 30 minutes following flumazenil or placebo. Level of consciousness was also assessed and blood samples were withdrawn for subsequent determination of plasma levels of norepinephrine. Flumazenil administration induced in all cases an immediate and total reversion of sedation while recovery was slow in the placebo group. No significant changes in heart rate and blood pressure values were found in both groups. By contrast, plasma levels of norepinephrine were significantly increased in all patients. It is concluded that reversal of benzodiazepine-induced sedation or anesthesia is not associated with significant variations of usual hemodynamic or adrenergic responses.

Adolescent↗

Hyperbaric oxygen therapy for ischaemia of the hand due to intra-arterial injection of methadone and flunitrazepam.

We present a case of accidental injection of oral methadone and flunitrazepam into the ulnar artery, with resultant severe ischaemia of the hand. Initial therapy consisted of systemic vasodilators, low molecular weight dextran and aspirin. When this therapy failed to produce improvement and amputation of the involved hand seemed inevitable, the patient was referred for hyperbaric oxygen (HBO) therapy. In spite of a 12 day delay in the initiation of HBO, the response was dramatic, with almost complete resolution of the ischaemic signs and symptoms. Intra-arterial injection, which is only rarely encountered in drug addicts, frequently results in severe ischaemia of an extremity, and carries with it a poor prognosis with currently accepted therapy. Given the presently reported experience and the known physiology of HBO, we conclude that HBO should be started early in the treatment of intra-arterial injection of drugs, and should also be considered following prolonged delays.

Adult↗

Simultaneous determination of flunitrazepam and 7-aminoflunitrazepam in human serum by ion trap gas chromatography-tandem mass spectrometry.

A method for the determination of flunitrazepam (FNZ) and 7-aminoflunitrazepam (7-AFNZ) in human serum was developed with ion trap gas chromatography (GC)-tandem mass spectrometry. The 7-AFNZ was derivatizated with 50 microl trifluoroacetic anhydride (TFAA), 60 degrees C-20 min. EI mass spectra and tandem mass spectra of FNZ and 7-AFNZ-TFA were m/z 238, 239, 266, 286, 294, 312, 313(M(+)), m/z 350, 351, 360, 378, 379(M(+)), m/z 238, 239, 240 (precursor ion m/z 286, collision energy 1.5 V), and m/z 239, 254, 264, 336 (precursor ion m/z 351, collision energy 1.8 V), respectively. The detection limits of full scan EI mass spectrometry and tandem mass spectrometry for FNZ and 7-AFNZ in human serum were ca. 200 ng/ml, 60 ng/ml, 15 ng/ml and 1 ng/ml, respectively.

Anti-Anxiety Agents↗

Automated solid-phase extraction and liquid chromatography-electrospray ionization-mass spectrometry for the determination of flunitrazepam and its metabolites in human urine and plasma samples.

A sensitive and specific method using reversed-phase liquid chromatography coupled with electrospray ionization-mass spectrometry (LC-ESI-MS) has been developed for the quantitative determination of flunitrazepam (F) and its metabolites 7-aminoflunitrazepam (7-AF), N-desmethylflunitrazepam (N-DMF) and 3-hydroxyflunitrazepam (3-OHF) in biological fluids. After the addition of deuterium labelled standards of F,7-AF and N-DMF, the drugs were isolated from urine or plasma by automated solid-phase extraction, then chromatographed in an isocratic elution mode with a salt-free eluent. The quantification was performed using selected ion monitoring of protonated molecular ions (M+H(+)). Experiments were carried out to improve the extraction recovery (81-100%) and the sensitivity (limit of detection 0.025 ng/ml for F and 7-AF, 0.040 ng/ml for N-DMF and 0.200 ng/ml for 3-OHF). The method was applied to the determination of F and metabolites in drug addicts including withdrawal urine samples and in one date-rape plasma and urine sample.

Adult↗

Pharmacological activity of phenazepam and flunitrazepam in ultralow doses.

Experiments on male outbred albino rats showed that benzodiazepine tranquilizers phenazepam and flunitrazepam in ultralow doses (10(-9)-10(-15) mol/kg) produced an anxiolytic effect in the conflict situation test. This effect was not accompanied by myorelaxing and sedative side effects typical of standard doses of tranquilizers.

Animals↗

Intra-arterial injection of dissolved flunitrazepam tablets.

Intra-arterial application of dissolved tablets is associated with a high risk of tissue necrosis. An early active vasodilatating and recanalising treatment is necessary. We present the case of 21-year-old female who applied three dissolved Flunitrazepam tablets into the ulnar artery and was successfully treated with prostaglandin E1 and recombinant tissue plasminogen activator.

Adult↗

Flunitrazepam rapidly reduces GABA(A) receptor subunit protein expression via a protein kinase C-dependent mechanism.

Acute flunitrazepam (1 microM) exposure for 1 h reduced GABA(A) receptor alpha1 (22+/-4%, mean+/-s.e.mean) and beta2/3 (21+/-4%) subunit protein levels in cultured rat cerebellar granule cells. This rapid decrease in subunit proteins was completely prevented by bisindolymaleimide 1 (1 microM), an inhibitor of protein kinase C, but not by N-[2-((p-bromocinnamyl)amino)ethyl]-5-isoquinolinesulfonamide (H-89, 4.8 microM), an inhibitor of protein kinases A and G. These results suggest the existence of a benzodiazepine-induced mechanism to rapidly alter GABA(A) receptor protein expression, that appears to be dependent on protein kinase C activity.

Animals↗

Effect of flunitrazepam on sleep and memory.

Flunitrazepam's (FNZ) effect on sleep and memory 1 mg and 2 mg was investigated in 6 healthy volunteers (mean age 21.5 +/- 0.8 years) by polysomnography (PSG) and memory testing. A PSG was recorded on each study night. Memory testing was done before sleep (40 min after taking FNZ or placebo), and after waking (560 min after medication). Rapid eye movement (REM) latency was found to be prolonged on the FNZ 2 mg night (FNZ2N) compared to the baseline night (BN). Percentage of stage 2 sleep was increased in the FNZ2N as compared to BN, while REM percentage on both FNZ nights did not significantly differ from BN. The number of total REM and REM density were decreased in the FNZ2N compared to BN. Memory testing showed significant differences between before sleep and after waking on the FNZ2N. There was a significant correlation between the degree of impairment on memory testing and the rate of reduced REM density, but there was no significant correlation between degree of impairment on memory testing and the rate of increased non-REM sleep on the FNZ2N. The results of this study suggest that impairments in memory result from the dose of FNZ, and that there is a possibility of a relationship between memory disturbance and REM sleep suppression caused by this benzodiazepine.

Adult↗

[Acute ischemia of the hand after intra-arterial injection of flunitrazepam. Local combined fibrinolysis therapy in three cases].

HISTORY AND ADMISSION FINDINGS: Three drug addicts presented as emergencies with severe pain in one hand. 1 to 3 hours previously they had accidentally injected dissolved flunitrazepam tablets intra-arterially. The affected hands were pale and cold. Two of the patients had injected into the brachial artery, one into the radial artery. DIAGNOSTICS: The brachial and radial arteries were palpable in all three patients, but immediate angiography showed complete occlusion of all arteries to the hand and fingers. TREATMENT AND COURSE: Initial local treatment with intra-arterial infusion of prostanoids (PGE(1)) did not improve hand perfusion. Subsequently, a combination of PGE(1) and local fibrinolytic therapy with rt-PA was given intra-arterially over 12 to 22 hours. In two of the patients complete reperfusion was achieved, but one, in whom the delay between injection and treatment had been the longest, lost the distal phalanges of digits 1, 2 and 3. No bleeding complications were observed. CONCLUSION: Peripheral ischemia as a result of an accidental intra-arterial injection of dissolved tablets in drug addicts is an emergency which requires immediate action. The combined administration of prostanoids and rt-PA-lysis is a promising therapeutic option that should be employed in such patients.

Adult↗

Tagetone modulates the coupling of flunitrazepam and GABA binding sites at GABAA receptor from chick brain membranes.

The effects of tagetone on flunitrazepam (FNTZ) binding to synaptosomal membranes from chick brains in the presence and absence of allosteric modulations induced by gamma-aminobutyric acid (GABA) were investigated. Tagetone, at 50 micrograms/ml (final concentration), decreased the binding affinity of [3H]FNTZ to synaptosomal membranes form chick brain (Kd = 3.34 +/- 0.36 nM without tagetone and Kd,t = 5.86 +/- 0.86 nM with tagetone; p < 0.05, two tailed Student's t-test) without affecting maximal binding (Bmax = 488 +/- 24 fmoles/mg protein, and Bmax,t = 500 +/- 25 fmoles/mg protein in the absence and in the presence of tagetone respectively). The potency of GABA to stimulate [3H]FNTZ binding increased in the presence of tagetone (EC50 values were 2.78 and 1.12 microM with and without tagetone respectively). GABA was able to decrease merocyanine delta A570-610 values in a concentration dependent manner; half maximal effect was attained at a GABA concentration of 34 +/- 13 microM. Tagetone, at a concentration of 50 micrograms/ml and in the presence of GABA 30 microM or 60 microM, enhanced the ability of GABA alone on decreasing delta A570-610. Tagetone alone did not change delta A570-610 values. FNTZ, a well known GABA modulator, could also potentiate the effect of GABA. Theoretical calculations indicate that the effects on merocyanine delta A570-610 value are mainly exerted at the membrane potential level (delta psi m). The present results strongly suggest that tagetone affected the function of GABAA receptor in a complex way: on the one hand it impaired FNTZ binding: on the other hand tagetone improved both the coupling between FNTZ and GABA binding sites and it enhanced GABA-induced chloride permeability. Changes in the geometrical and electrostatic properties of the self-organized membrane structure may account for these effects of tagetone.

Acyclic Monoterpenes↗

NADPH-cytochrome P-450 reductase is involved in flunitrazepam reductive metabolism in Hep G2 and Hep 3B cells.

Flunitrazepam (FNTZ), like other benzodiazepines, has a high affinity for the benzodiazepine receptor within the gama-aminobutyric acid (GABA) complex. These affinities correlate with the pharmacological and therapeutic potencies of the drug. FNTZ is a drug commonly abused by young adults. In humans, FNTZ is oxidized to the major metabolites N-demethylflunitrazepam (DM FNTZ) and 3-hydroxyflunitrazepam (3-OH FNTZ) and reduced to 7-aminoflunitrazepam (7A FNTZ). Human CYP2C19 and CYP3A4 are the principal P-450 cytochromes involved in DM FNTZ and 3-OH FNTZ formation. However, it is not clear which enzyme is responsible for the reduction of FNTZ to 7-aminoflunitrazepam (7A FNTZ). In this study, the involvement of NADPH-cytochrome P-450 reductase in the conversion of FNTZ to 7A FNTZ was investigated in two human hepatoma cell lines, human lymphoblast microsomes specifically expressing human NADPH-cytochrome P-450 reductase and purified recombinant human HADPH-cytochrome P-450 reductase. Significantly more FNTZ was converted to 7A FNTZ in Hep G2 than in Hep 3B cells, and this difference was associated with the catalytic activity and protein levels of NADPH-cytochrome P-450 reductase in these cells. In Hep G2 cells, conversion of FNTZ to 7A FNTZ was effectively inhibited by alpha-lipoic acid, an NADPH-cytochrome P-450 reductase inhibitor. In addition, formation of 7A FNTZ by the microsomal fraction of Hep G2 cells was specifically inhibited by antibody against NADPH-cytochrome P-450 reductase. Under hypoxia (N2 85%; CO2 5%; H2 10%), human lymphoblast microsomes specifically expressing human NADPH-cytochrome P-450 reductase and purified recombinant human NADPH-P-450 reductase catabolized FNTZ to 7A FNTZ in a concentration-dependent manner. These results suggest that NADPH-cytochrome P-450 reductase is involved in the reductive metabolism of FNTZ to 7A FNTZ under hypoxic conditions.

Carcinoma, Hepatocellular↗

Regional mirex distribution and its effects on gamma-aminobutyric acid and flunitrazepam binding in mouse brains.

Following ip injection of [14C]mirex, its regional distribution was studied parallel to its in vitro effects on [3H]-gamma-aminobutyric acid (GABA) and [3H]flunitrazepam (FNZ) binding to, and [3H]GABA release from, synaptosomes of various mouse brain regions, in order to determine the relationship between relative mirex distribution and its neurotoxic effects mediated through the GABA receptor-ionophore complex. The pattern of mirex uptake into cerebral cortex (CC), brainstem (BS), and cerebellum (CB) showed an initial linear dose-dependent uptake, followed by a decline at higher concentration. The Vmax and Km values determined for the linear mirex uptake phase indicated varied affinities by brain regions, CB and BS being more susceptible to mirex uptake than CC. Both synaptosomal GABA binding and FNZ binding were significantly reduced by mirex in the order of BS approximately equal to CB greater than CC for GABA, and BS approximately equal to CC greater than CB for FNZ. However, mirex lacked any significant effect on the Ca2+-dependent, K+-stimulated release of GABA from radio-prelabeled synaptosomes. While the data indicate no significant differences between brain regions in mirex uptake, they suggest that regional specificities do exist with respect to the inhibition caused by mirex on GABA and FNZ binding to synaptosomes. Unlike the major effects of chlordecone (an analog of mirex) on the dopaminergic system, mirex seems to be primarily neurotoxic through its more specific interaction with the GABA and FNZ binding sites.

Animals↗

Simultaneous HPLC analysis of the hypnotic benzodiazepines nitrazepam, estazolam, flunitrazepam, and triazolam in plasma.

A new analytical methodology was developed for simultaneous high-performance liquid chromatographic quantitation of nitrazepam, estazolam, flunitrazepam, and triazolam in plasma. After addition of the internal standard nor-prazepam, biological samples and calibration standards were extracted at basic pH into diethyl ether-methylene chloride (2:1, v/v). The reconstituted extract was separated on a reversed-phase Nova Pak C18 column with acidic buffer (6mM)-acetonitrile-methanol (64:23:13, v/v) as mobile phase. The detection was performed at 242 nm. Within-run and day-to-day precision values were about 2-8%. The method is thus sensitive and reproducible for use in clinical and experimental toxicokinetic studies.

Chromatography, High Pressure Liquid↗

A sensitive GC-MS procedure for the analysis of flunitrazepam and its metabolites in urine.

Analysis of urine specimens collected from individuals ingesting 2 and 4 mg flunitrazepam (FN) showed positive results by OnLine and OnTrak immunoassays for up to 60 h. Gas chromatographic-mass spectrometric (GC-MS) analysis of these specimens for FN, 3-OH-FN, 7-amino-FN, 7-amino-3-OH-FN, desmethyl-FN, and 3-OH-desmethyl-FN after glucuronidase treatment showed only low levels of 7-amino-FN with almost none of the other metabolites. These levels were far below the expected results based on the immunoassay data. This study reports on a GC-MS procedure for FN and the previously listed metabolites. The method is based on acid hydrolysis of the urine specimens, which converts FN and all its metabolites described previously to one of four amino-benzophenone derivatives (1-4) with oxazepam-d5 as the internal standard. Under the experimental conditions, the internal standard is converted to 2-amino-5-chloro-benzophenone-d5. The limit of detection for 7-amino-FN and 7-amino-desmethyl-FN and their 3-OH derivatives was less than 1 ng/mL. Analysis of urine specimens collected for 72-h postingestion of 1, 2, or 4 mg FN showed appreciable levels of benzophenone 3 (product of 7-amino-FN and 7-amino-3-OH-FN) and lower levels of benzophenone 4 (product of 7-amino-desmethyl-FN and 7-amino-3-OH-desmethyl-FN) with no detectable levels of benzophenones 1 and 2. The method makes it possible to confirm the presence of FN metabolites in urine at least 72-h postingestion of small doses of the drug.

Anti-Anxiety Agents↗