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The efficacy and plasma concentrations of flunitrazepam after oral or intramuscular premedication.

Flunitrazepam premedication administered orally or intramuscularly was compared in 41 surgical patients. The effect of the premedication was assessed both subjectively and objectively. The plasma concentrations were determined just before induction. The mean (+/-SD) plasma concentration in the oral premedication group was 8.2 +/- 2.2 ng/ml and 7.9 +/- 4.6 ng/ml in the intramuscular premedication group. There was a highly significant correlation (p less than 0.001) between the sedative effect and plasma concentration of flunitrazepam in all patients. Oral flunitrazepam was equal to i. m. flunitrazepam as an anxiolytic and sedative with a rapid onset of action. However, the oral route of administration of flunitrazepam is preferable because it is painless and easy to administer.

Administration, Oral↗

[Effect of fentanyl, diazepam and flunitrazepam on memory function. A pharmacopsychologic study].

This study was designed to differentiate possible amnesic effects of diazepam, flunitrazepam and fentanyl into impairment of storage, retention or retrieval of information and to correlate them with alterations in a vigilance task. 4 groups of 7 volunteers each were studied in a double-blind, random fashion. They performed a quasi continuous word recognition task i.e. after a preload list of 150 words played on a tape they had to indicate if the following words (grouped into 10 blocks of 100 words each) were new ones or had occurred already. Interposed were measurements of reaction time to a visual stimulus, and of concentration and short-time memory. During the experiment, unknown to the test person, diazepam 10 mg/70 kg, flunitrazepam 1 mg/70 kg, fentanyl 0.15 mg/70 kg or placebo were infused over 3 min. For evaluation of the word recognition task the d' index drawn from signal detection theory was employed. The results clearly indicated that both benzodiazepines specifically impair memory function the effect of flunitrazepam being more pronounced and longer in duration. Since retrieval of information learnt before administration of either drug was completely unaffected it was concluded that both drugs specifically influence encoding and registration of information. Reaction times were not significantly altered after diazepam, whereas they were prolonged by more than 50% after flunitrazepam indicating a pronounced sedative action of this drug. However, even during this period of maximal effect of flunitrazepam, recognition of words first presented prior to injection was not impaired.(ABSTRACT TRUNCATED AT 250 WORDS)

Diazepam↗

Drug-alcohol interactions on psychomotor skills: zopiclone and flunitrazepam.

Interaction between alcohol and zopiclone or flunitrazepam as well as the residual effects of both these hypnotics were studied in 20 normal male volunteers who received each 3 of 6 different drug and drink combinations according to a balanced incomplete block design as follows: placebo, zopiclone (7.5 mg), or flunitrazepam (2 mg) was administered double-blind in identical capsules at 23.00 h, and 0.5 g/kg body weight of alcohol or placebo alcohol was given at 08.30 h the following morning. Psychomotor skills of the volunteers were measured before drinking and 30 min, 1.5 h and 2.5 h after it. As compared with placebo, zopiclone had no residual effects, while flunitrazepam had some effects on standing steadiness, tracking, and flicker recognition. Alcohol alone had a non-significant effect on skills, and the combination zopiclone plus alcohol behaved as alcohol alone. Flunitrazepam plus alcohol impaired significantly standing steadiness, tracking, and reactive skills when compared with all other treatments. Time anticipation and hand and foot proprioception were not affected by any treatment. The results suggest that flunitrazepam, unlike zopiclone, has residual effects and interacts with alcohol in the morning following overnight ingestion of the drug.

Adult↗

Midazolam and flunitrazepam: pharmacokinetics and effects on night time respiration and body movements in the elderly.

In a double-blind crossover study, the pharmacokinetics and effects on night-time respiration and body movements of midazolam 7.5 mg, flunitrazepam 1 mg, and placebo were studied in 5 elderly insomniac patients with the static charge sensitive bed-method (SCSB). In a supine position, the gastrointestinal absorption rate of flunitrazepam (tmax 0.6 h) was faster than that of midazolam (tmax 0.95 h). The elimination phase half-life of midazolam was about twice as long as reported earlier in healthy adult volunteers, but ageing did not affect the elimination of flunitrazepam. The shape of the serum concentration-time curve of both benzodiazepine derivatives was quite similar. The sleep of these five insomniacs became more peaceful and the respiration more regular during midazolam and flunitrazepam, compared with placebo. Both benzodiazepines significantly decreased body movements and the cumulative movement time remained shorter throughout the night, compared with placebo. Total variability (VI) was clearly decreased with flurazepam, and a similar but not statistically significant tendency was seen with midazolam, compared with placebo. Accordingly, the proportion of quiet sleep (QS) increased (p = 0.014) and the proportion of active sleep (AS) decreased (p = 0.019) with both benzodiazepines, compared with placebo. This reflects the changed control of respiration by higher brain structures. No signs of increased respiratory resistance (i.e. ballistocardiographic respiratory amplitude variation BRV < 60%) were seen with either of the drugs or placebo. There were no differences in the subjects' own estimation of their sleep during medication with these drugs. Only the sleep onset latency was shorter with flunitrazepam compared with midazolam and placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

Flunitrazepam a benzodiazepine most used among drug abusers.

Flunitrazepam (FZ) is a sedative/hypnotic nitro-benzodiazepine. This drug has been accepted by both patients and physicians and in the last 20 years flunitrazepam has been included and studied in many clinical trials so, in many countries, flunitrazepam is one of the most prescribed hypnotic. Since 1980 it has been found that FZ began to be a popular drug among drug abusers all over the word. However, little is known about the difference between Fz and other Benzodiazepines in capacity to produce physiologic dependence or in ability to produce drug taking or drug seeking behaviour. Flunitrazepam has little risk of abuse by the vast majority of patients; however when the drug is taken i. v. or intranasally, its effect is much faster and risk of abuse is much greater. In this report we examine the reasons why some populations of drug abusers prefer flunitrazepam over the other benzodiazepines.

Journal Article↗

Cytotoxic action of lindane in neocortical GABAergic neurons is primarily mediated by interaction with flunitrazepam-sensitive GABA(A) receptors.

The cytotoxic action of the gamma-isomer of hexachlorocyclohexane (y-HCH; lindane) was studied in cultured mouse neocortical neurons by measurements of the reduction in mitochondrial function using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) test. The cells were exposed to 30-300 microM lindane in the culture medium for different periods of time and lindane cytotoxicity was found to be time- and concentration-dependent. Lindane cytotoxicity could be ameliorated by addition of gamma aminobutyric acid (GABA) in a concentration-dependent manner but this effect of GABA was not blocked by bicuculline or picrotoxinin (PTX). Lindane induced cytotoxicity was also reduced by the GABA(A) receptor agonists muscimol and THIP (4,5,6,7-tetrahydroisoxazolo[5,4-c]pyridin-3-ol). This effect was enhanced by the simultaneous presence of flunitrazepam but only at the highest lindane concentrations studied (200 and 300 microM). Flunitrazepam by itself had no effect on lindane-induced cytotoxicity. The protective effect of GABA plus flunitrazepam was blocked by the benzodiazepine receptor antagonist flumazenil and by the GABA(A) antagonist bicuculline, suggesting the involvement of central benzodiazepine receptors allosterically coupled to the GABA recognition site at the GABA(A) receptor. When 100 microM PTX was used to suppress the protective effect of GABA and flunitrazepam, a significant effect of PTX was observed only at 300 microM lindane. The GABA(B) receptor agonist, baclophen, only marginally reduced the cytotoxic effect induced by the highest lindane concentrations. It is concluded that the cytotoxic action of lindane in neocortical neurons in culture is mediated primarily through an interaction with allosterically coupled GABA-benzodiazepine recognition sites at the GABA(A) receptor.

2-Amino-5-phosphonovalerate↗

Pharmacokinetic and clinical observations on prolonged administration of flunitrazepam.

Eight patients were given flunitrazepam 2 mg orally, once daily for 28 consecutive days. The time-course of the plasma concentration of unchanged flunitrazepam and its principal metabolites were studied in detail after the first and last doses. Additional blood samples were collected immediately before administration of the tablet on days 4, 7, 11, 14, 18, 21 and 25. Clinically there were not changes during the trial period in the onset of sleep, duration of sleep, depth of sleep measured as number of spontaneous awakenings, or in the patients' condition on awakening. The time-course of the plasma concentration of flunitrazepam could be described by a three-compartment model, assuming that the rate constants remained unchanged during treatment. Maximal plasma concentrations of unchanged flunitrazepam, found two hours after intake, reached 10-15 ng/ml after the first and 15-20 ng/ml after the last dose. The beta-half-life was found to be between 20 and 36 h.

Adolescent↗

Effects of zolpidem and flunitrazepam on nocturnal sleep of women subjectively complaining of insomnia.

Eighteen non-pregnant woman complaining about insomnia were polysomnographically investigated for 3 nights with weekly intervals. They received placebo, 2 mg flunitrazepam or 10 mg zolpidem according to a cross-over double blind design. The patients were selected by general practitioners on the basis of subjective complaints. Zolpidem is a recently introduced short-acting imidazopyridine hypnotic, binding to a subunit of the benzodiazepine 1 receptor. Flunitrazepam is a well-known hypnotic, binding to both the benzodiazepine 1 and 2 receptor subtypes. Objective recording did not substantiate the subjective complaint of insomnia. Sleep patterns during placebo differed only little from that expected from age matched healthy persons. Both flunitrazepam and zolpidem significantly shortened sleep onset (5 min of continuous sleep beginning with NREM 1 sleep). The sleep composition following flunitrazepam was characterized by an increase in NREM 2, a prolongation of the time of REM sleep, a reduction of REM sleep and an increase in NREM 3-4 sleep during the first 2 h of sleep. The sleep composition following zolpidem resembled more than seen in persons without sleep complaints. However, as compared to placebo, there was a decrease of the time spent awake during sleep and an increase in NREM 3-4 during the first 2 of sleep.

Adult↗

GABA and flunitrazepam binding to neuroblastoma cell membranes--effects of growth conditions, ethanol and pentobarbital.

Strain N2a neuroblastoma cells were grown in monolayer and in spinner culture in Coon's modified Hamms F12 medium, or in Dulbecco's modified Eagle Medium with either high (4.5 g/l) or low (1.0 g/l) glucose, and the specific binding of [3H]GABA and [3H]flunitrazepam were determined. GABA binding was highest in monolayer cells grown in low glucose Dulbecco's, and undetectable in monolayer or spinner cells grown in high glucose Dulbecco's. Binding of flunitrazepam was not sensitive to the medium or culture conditions. Flunitrazepam binding suggested the presence of a 'peripheral' benzodiazepine receptor, because: (a) binding was blocked by RO5-4864 but not clonazepam; (b) binding was not enhanced by 0.1 mM GABA or 50 mM Cl-; and (c) the Kd value was approximately 300 nM. Neither ethanol (100 mM) nor pentobarbital (0.2 mM) had any effect on the binding of GABA; flunitrazepam binding was not affected by ethanol but was decreased about 20% by pentobarbital. GABA, muscimol and veratridine did not alter the membrane potential of the cells, as measured by tetraphenylphosphonium accumulation. The data are discussed in terms of separate receptors for GABA and for benzodiazepines which are not incorporated into a GABA--benzodiazepine receptor--chloride ionophore complex.

Anti-Anxiety Agents↗

Benzodiazepine receptors: labeling in intact animals with [3H] flunitrazepam.

[3H]Flumitrazepam appears to label specific benzodiazepine receptors in vitro after i.v. injection in mice. Benzodiazepine potencies in reducing [3H]flunitrazepam binding in vivo correspond to pharmacological potencies and parallel relative affinites for [3H]flunitrazepam binding sites in isolated brain membranes. However, 50% occupation of [3H]-flunitrazepam sites by benzodiazepines in vivo requires brain concentrations of the drugs about 1000 times higher than their Ki values for the binding sites in vitro. In pharmacologically active doses sodium pentobarbital, strychnine, picrotoxin and bicuculline fail to influence [3H] flunitrazepam binding in vivo.

Animals↗

Properties of [3H]flunitrazepam binding to different benzodiazepine binding proteins.

Membranes from cerebellum or hippocampus were incubated with various concentrations of [3H]flunitrazepam in the absence or presence of diazepam, Cl 218 872 or ethyl-beta-carboline-3-carboxylate (beta-CCE). After binding equilibrium of [3H]flunitrazepam had been established, the membranes were either filtered for determination of reversible binding or were irradiated with UV light for determination of irreversible binding. Irradiated membranes were then subjected to SDS-polyacrylamide gel electrophoresis and fluorography. Individual photolabeled proteins were identified, appropriate sections cut out of the gel, and the radioactivity in the gel pieces measured. The results indicate that [3H]flunitrazepam binding to individual benzodiazepine binding proteins and its inhibition by various drugs can be measured by the present technique and support previous evidence for the independent existence of various proteins irreversibly labeled by [3H]flunitrazepam and their possible association with different benzodiazepine receptors.

Animals↗

Modulation of [3H]flunitrazepam binding to rat cerebellar benzodiazepine receptors by phosphatidylserine.

The influence of phosphatidylserine on ligand binding to the benzodiazepine/GABA receptor complex was assessed in rat cerebellar synaptic membranes and in a detergent-solubilized membrane preparation. Intact synaptic membranes or membranes solubilized with the zwitterionic detergent CHAPS (3-[(3-cholamidopropyl)-dimethylammonio]propanesulfonate) were incubated with a range of concentrations of phosphatidylserine for 2 h at 4 degrees C, prior to use in radioligand binding assays. Phosphatidylserine, an endogenous membrane phospholipid, facilitated the site-specific binding of [3H]flunitrazepam to synaptic membranes and CHAPS-solubilized preparations. In addition, phosphatidylserine inhibited the facilitation of [3H]flunitrazepam binding induced by either cartazolate or gamma-aminobutyric acid (GABA). Although the maximum effect (38% facilitation of [3H]flunitrazepam binding; greater than 90% inhibition of the cartazolate action) was produced using 130 microM phosphatidylserine, a significant enhancement of [3H]flunitrazepam binding could be observed upon preincubation of synaptic membranes with concentrations of phosphatidylserine as low as 5 microM. These results suggest that endogenous phosphatidylserine may play a role in the regulation of benzodiazepine/GABA receptor function, possibly through modulation of the mechanisms which functionally link the various components of this complex receptor system.

Animals↗

Differential modulation of [3H]flunitrazepam binding in female rat brain by sex steroid hormones.

Quantitative autoradiographic analysis revealed changes in [3H]flunitrazepam (a benzodiazepine agonist) binding in the anterior hypothalamus nucleus, the medial preoptic area and the cortico-medial amygdala nucleus following in vivo estradiol. The administration of 4 mg of progesterone, but not 1 mg, increased the binding of [3H]flunitrazepam in the basolateral amygdaloid nucleus and in the oriens-pyramidalis CA1 layer of the hippocampus. Exposure of brain sections in vitro to the potent, naturally occurring progesterone metabolite, 3 alpha-hydroxy-5 alpha-dihydroprogesterone, induced GABA-dependent changes in flunitrazepam binding, similar to the changes induced by progesterone, thus suggesting that different steroid mechanisms are implicated in the control of flunitrazepam binding.

Animals↗

Loreclezole modulates [35S]t-butylbicyclophosphorothionate and [3H]flunitrazepam binding via a distinct site on the GABAA receptor complex.

The allosteric modulation of [35S]t-butylbicyclophosphorothionate ([35S]TBPS) and [3H]flunitrazepam binding was utilized to evaluate the actions of loreclezole at the GABAA receptor complex in the rat brain. Loreclezole was observed to allosterically inhibit the binding of [35S]TBPS in a dose-dependent manner with micromolar potency (IC50 = 1 microM). Loreclezole was found to have an additive effect on neuroactive steroid modulation of [35S]TBPS binding, but merely potentiated the effect of Ro5-4864 (4"-chlorodiazepam) modulation of [35S]TBPS binding. These observations suggest that loreclezole modulates [35S]TBPS binding through a site independent of the neuroactive steroid and Ro5-4864 sites on the GABAA receptor complex. The enhancement of [3H]flunitrazepam binding to the benzodiazepine receptor by loreclezole as well as the effect of loreclezole on CL218872/[3H]flunitrazepam dose-response curves suggest that loreclezole does not act through the benzodiazepine site on the GABAA receptor complex, nor does it selectively modulate benzodiazepine receptor subtypes. The potency of loreclezole as and inhibitor of [35S]TBPS binding in rat brain was regionally dependent and GABA-sensitive. Loreclezole modulation of [35S]TBPS binding showed greater potency and GABA sensitivity in the cerebellum and thalamus when compared to other brain regions such as the cortex, hippocampus and striatum. This finding is consistent with previous reports of the selectivity of loreclezole for GABAA receptor complex's containing beta 2 and beta 3 subunits. These beta subunit isoforms predominate in the cerebellum and thalamus. Collectively the evidence suggests that loreclezole modulates [35S]TBPS and [3H]flunitrazepam binding through a site distinct from benzodiazepine, neuroactive steroid, Ro5-4864 and GABA sites on the GABAA receptor complex.

Animals↗

Photoaffinity labeling of [3H]flunitrazepam- and [3H]Ro15-4513-bound pellets in rat cerebral cortex and cerebellum.

Irreversible incorporation of [3H]flunitrazepam and [3H]Ro15-4513 into GABA/benzodiazepine receptor subunits was studied by UV irradiation using ligand-bound membrane pellets from rat cerebral cortical and cerebellar synaptic membranes. Specific incorporation for [3H]flunitrazepam was greater in the pellet than in the suspension. The incorporation was identical for [3H]Ro15-4513 in both pellet and suspension. With the ligand-bound pellets, 50% of the available binding sites were photolabeled by both ligands in cortex and cerebellum. SDS polyacrylamide gel electrophoresis and fluorography of [3H]flunitrazepam photo-labeled receptor revealed the same number of major sites in both brain regions. In contrast, [3H]Ro15-4513 appears to label fewer sites in cortex and cerebellum. Photoaffinity labeling with [3H]flunitrazepam in ligand-bound membrane pellet provides a more selective and reliable method for studying the subunit structure of GABA/benzodiazepine receptor complex.

Affinity Labels↗

Enhancement of the in vivo binding of [3H]flunitrazepam by the atypical neuroleptic, clozapine.

Modulation of the benzodiazepine receptor/GABA receptor/chloride ionophore complex in vivo involves a number of intricate regulatory interactions between the three components of the receptor complex. One way to assess these potential interactions involves the in vivo labelling of the benzodiazepine receptor with [3H]flunitrazepam. In these studies, we used this approach to demonstrate that the neuroleptic, clozapine, increases [3H]flunitrazepam binding in mouse brain in a bicuculline-reversible manner. This potentiation of benzodiazepine binding was not antagonized by picrotoxin and was found to result from a slower dissociation of [3H]flunitrazepam from the benzodiazepine receptor. These data suggest that clozapine acts to increase [3H]flunitrazepam binding via a GABAergic mechanism, independent of the chloride channel.

Animals↗

Expression of GABAA/benzodiazepine receptor alpha 1-subunit mRNA and [3H]flunitrazepam binding sites during postnatal development of the mouse cerebellum.

Previous studies have shown that the alpha subunit of the GABAA receptor contains the flunitrazepam binding site. In the present study, in situ hybridization and receptor autoradiography were used to examine the temporal and spatial relationships between alpha 1 subunit mRNA and [3H]flunitrazepam binding sites in the developing mouse cerebellum. A [35S]cRNA probe was used to study the expression of GABAA/benzodiazepine receptor alpha 1 subunit mRNA by in situ hybridization. At postnatal day (P) 1, a diffuse band of labeling was observed in the molecular/Purkinje cell layer; subsequently, this band became progressively more concentrated and restricted to the interface between the granular and molecular layers. By P5-P7, high intensity labeling was clearly associated with Purkinje cells. Clusters of grains became visible over basket and stellate cells in the molecular layer between P11 and P13; the internal granule cell layer and the deep cerebellar nuclei showed an increasingly strong hybridization signal during postnatal development. The external germinal layer was devoid of labeling throughout its existence. The developmental distribution of [3H]flunitrazepam binding sites was studied by receptor autoradiography. Cerebellar labeling was detectable at birth, with the highest levels present over the deep cerebellar nuclei, and relatively low levels equally distributed over the molecular and Purkinje cell layers. Cerebellar cortical grain density increased gradually during postnatal weeks 1 and 2, with the molecular, Purkinje and granule cell layers remaining essentially equally labeled. Between P11 and P15, the labeling over the molecular layer increased dramatically, reaching the high adult levels by P20. As with the in situ hybridization studies, there was a complete absence of [3H]flunitrazepam binding sites in the external germinal layer throughout development. These results indicate that, in the Purkinje cell, the production of mRNA and the synthesis of the alpha 1 subunit occur prior to the formation of afferent inhibitory synapses, suggesting that GABAA/benzodiazepine receptor expression precedes, and is independent of GABAergic synaptic input.

Aging↗

Study of the mechanisms involved in behavioral changes induced by flunitrazepam in morphine withdrawal.

1. The attenuation of morphine withdrawal syndrome by acute benzodiazepine administration has been well documented. However, the pharmacological mechanisms implicated in this effect remain unclear. 2. In this study, the possible participation of noradrenergic, serotonergic and benzodiazepine receptors on flunitrazepam-modified morphine withdrawal syndrome was investigated in mice. Flunitrazepam was associated to the noradrenergic antagonists prazosin (1 mg/kg) and propranolol (0.5 mg/kg), the serotonergic agents ritanserine (1 mg/kg) and p-chloro phenylalanine (600 mg/kg), the benzodiazepine antagonist flumazenil (10 mg/kg), and the benzodiazepine partial inverse agonist Ro 15-4513 (5 mg/kg). 3. The decrease in jumping behavior-induced by flunitrazepam was potentiated by prazosin, while ritanserine, flumazenil and Ro 15-4513 blocked this effect. 4. Flunitrazepam-induced increase on wet dog shake frequency was partially reduced by flumazenil, and strongly antagonized by ritanserine and Ro 15-4513. 5. Noradrenergic and serotonergic systems seem to be primarily implicated in the changes induced on jumping and wet dog shakes respectively. These modifications are induced through the activation of the benzodiazepine receptors.

Animals↗