OBJECTIVETo investigate the pharmacokinetics of nalmefene after intravenous administration at a single or multiple doses in Chinese healthy volunteers.

METHODSThis open, randomized clinical trial involved 12 healthy volunteers, who received a single-dose (2 mg) nalmefene injection. Before and at different time points after the injection, blood sample were obtained from the subjects. After the single intravenous dose trial, 8 healthy volunteers received intravenous nalmefene at 2 mg once daily for 6 consecutive days, and the plasma drug concentrations were determined on the morning of days 4, 5 and 6 using liquid chromatography/tandem mass spectrometry and the pharmacokinetic parameters were calculated using PKS program.

RESULTSThe main pharmacokinetic parameters of nalmefene (Cmax, Tmax, T1/2, AUC0-48, and AUC0-infinity) after the single intravenous dose were 7.34-/+1.56 microg/L, 0.08 h, 12.01-/+2.20 h, 30.29-/+9.84 microg.L(-1).h, and 32.23-/+9.94 microg.L(-1).h, respectively; the parameters after multiple doses were 8.04-/+1.09 microg/L, 0.08 h, 12.43-/+1.44 h, 33.64-/+9.15 microg.L(-1).h and 35.98-/+9.23 microg.L(-1).h, respectively. The steady-state pharmacokinetic parameters including the degree of fluctuation (DF), AUCss and Cav were 4.69-/+1.29, 19.64-/+6.20 microg.L(-1).h and 1.64-/+0.52 microg/L, respectively.

CONCLUSIONNalmefene showed similar pharmacokinetics in Chinese healthy volunteers with those in the foreign testees, and can be safely administered in healthy volunteers without producing unmanageable pain.

Adult ; China ; Female ; Humans ; Injections, Intravenous ; Male ; Naltrexone ; administration & dosage ; analogs & derivatives ; pharmacokinetics ; Narcotic Antagonists ; administration & dosage ; pharmacokinetics

PURPOSE: Nociceptin/orphanin FQ (N/OFQ) as an endogeneous hexadecapeptide is known to exert antinociceptive effects spinally. The aims of this study were to demonstrate the antinociceptive effects of i.t. N/OFQ and to investigate the possible interaction between N/OFQ and endogenous opioid systems using selective opioid receptor antagonists in rat formalin tests. MATERIALS AND METHODS: I.t. N/OFQ was injected in different doses (1-10 nmol) via a lumbar catheter prior to a 50 microL injection of 5% formalin into the right hindpaw of rats. Flinching responses were measured from 0-10 min (phase I, an initial acute state) and 11-60 min (phase II, a prolonged tonic state). To observe which opioid receptors are involved in the anti-nociceptive effect of i.t. N/OFQ in the rat-formalin tests, naltrindole (5-20 nmol), beta-funaltrexamine (1-10 nmol), and norbinaltorphimine (10 nmol), selective delta-, micro- and kappa-opioid receptor antagonists, respectively, were administered intrathecally 5 min after i.t. N/OFQ. RESULTS: I.t. N/OFQ attenuated the formalin-induced flinching responses in a dose-dependent manner in both phases I and II. I.t. administration of naltrindole and beta-funaltrexamine dose-dependently reversed the N/OFQ-induced attenuation of flinching responses in both phases; however, norbinaltorphimine did not. CONCLUSION: I.t. N/OFQ exerted an antinociceptive effect in both phases of the rat-formalin test through the nociceptin opioid peptide receptor. In addition, the results suggested that delta- and micro-opioid receptors, but not kappa-opioid receptors, are involved in the antinociceptive effects of N/OFQ in the spinal cord of rats.
Analgesics/administration & dosage/*pharmacology ; Animals ; Formaldehyde/toxicity ; Injections, Spinal ; Male ; Naltrexone/administration & dosage/analogs & derivatives/pharmacology ; Narcotic Antagonists/administration & dosage/*pharmacology ; Opioid Peptides/administration & dosage/*pharmacology ; Pain Measurement ; Rats ; Rats, Sprague-Dawley ; Receptors, Opioid/*agonists/drug effects

The possible characteristics of spinal interaction between sildenafil (phosphodiesterase 5 inhibitor) and morphine on formalin-induced nociception in rats was examined. Then the role of the opioid receptor in the effect of sildenafil was further investigated. Catheters were inserted into the intrathecal space of male Sprague-Dawley rats. For induction of pain, 50 microliter of 5% formalin solution was applied to the hindpaw. Isobolographic analysis was used for the evaluation of drug interaction between sildenafil and morphine. Furthermore, naloxone was intrathecally given to verify the involvement of the opioid receptor in the antinociception of sildenafil. Both sildenafil and morphine produced an antinociceptive effect during phase 1 and phase 2 in the formalin test. The isobolographic analysis revealed an additive interaction after intrathecal delivery of the sildenafil-morphine mixture in both phases. Intrathecal naloxone reversed the antinociception of sildenafil in both phases. These results suggest that sildenafil, morphine, and the mixture of the two drugs are effective against acute pain and facilitated pain state at the spinal level. Thus, the spinal combination of sildenafil with morphine may be useful in the management of the same state. Furthermore, the opioid receptor is contributable to the antinocieptive mechanism of sildenafil at the spinal level.
Analgesics/*administration & dosage ; Analgesics, Opioid/*administration & dosage ; Animals ; Behavior, Animal/drug effects ; Dose-Response Relationship, Drug ; Drug Synergism ; Formaldehyde/toxicity ; Injections, Spinal ; Male ; Morphine/*administration & dosage ; Naloxone/administration & dosage ; Narcotic Antagonists/administration & dosage ; Pain/chemically induced/therapy ; Pain Measurement/drug effects ; Phosphodiesterase Inhibitors/*administration & dosage ; Piperazines/*administration & dosage ; Purines/administration & dosage ; Rats ; Rats, Sprague-Dawley ; Sulfones/*administration & dosage ; Time Factors

OBJECTIVETo compare the analgesic effect and side effects of morphine for intravenous patient-controlled analgesia (PCA) with or without low-dose naloxone after abdominal surgery.

METHODSFifty-nine ASA I - II patients undergoing elective abdominal surgery were randomly divided into two groups: group morphine received postoperative PCA with 0.4 mg/ml morphine (a 1 mg bolus with a 5 min lockout), group naloxone received morphine 0.4 mg/ml with 6 microg/kg naloxone. Blood pressure, heart rate, respiratory rate, and pulse oxygen saturation were monitored. Visual analogue scale (VAS), nausea/vomiting, pruritus, sedation and consumption of morphine were recorded for 24 hours.

RESULTSVAS had no difference between group morphine and group naloxone, but group naloxone had significantly lower VAS for pain at rest or movement (beyond 4-8 h), and the incidence of nausea/vomiting significantly decreased in group naloxone (P < 0.05). No differences existed in pruritus, sedation, respiratory rate, and hemodynamic parameters between these two groups. The 24 hours postoperative morphine consumption was (36.6 +/- 13.5) mg in group naloxone and (43.7 +/- 14.6) mg in group morphine (P < 0.05).

CONCLUSIONFor morphine PCA, morphine with 6 microg/kg naloxone is effective in preventing some PCA morphinerelated side effects. Naloxone not only reduces postoperative morphine requirements but also improves the analgesic effect.

Abdomen ; surgery ; Adult ; Analgesia, Patient-Controlled ; methods ; Analgesics, Opioid ; administration & dosage ; adverse effects ; Female ; Humans ; Hysterectomy ; Male ; Middle Aged ; Morphine ; administration & dosage ; adverse effects ; Naloxone ; administration & dosage ; adverse effects ; Narcotic Antagonists ; administration & dosage ; adverse effects ; Pain Measurement ; drug effects ; Pain, Postoperative ; drug therapy ; prevention & control

BACKGROUNDEarly studies showed that naloxone infusion decreases the incidence of morphine-related side effects from intravenous patient-controlled analgesia. This study aimed to determine whether naloxone preserved analgesia while minimizing side effects caused by intravenous tramadol administration.

METHODSEighty patients undergoing general anesthesia for cervical vertebrae surgery were randomly divided into four groups. All patients received 1 mg/kg tramadol 30 minutes before the end of surgery, followed by a continuous infusion with 0.3 mg x kg(-1) x h(-1) tramadol with no naloxone (group I, n = 20), 0.05 microg x kg(-1) x h(-1) naloxone (group II, n = 20), 0.1 microg x kg(-1) x h(-1) naloxone (group III, n = 20) and 0.2 microg x kg(-1) x h(-1) naloxone (group IV, n = 20). Visual analog scales (VAS) for pain during rest and cough, nausea five-point scale (NFPS) for nausea and vomiting, and ramsay sedation score (RSS) for sedation were assessed at 2, 6, 12, 24 and 48 hours postoperatively. Analgesia and side effects were evaluated by blinded observers.

RESULTSSeventy-eight patients were included in this study. The intravenous tramadol administration provided the satisfied analgesia. There was no significant difference in either resting or coughing VAS scores among naloxone groups and control group. Compared with control group, sedation was less in groups II, III, and IV at 6, 12, and 24 hours (P < 0.05); nausea was less in groups II, III and IV than group I at 2, 6, 12, 24 and 48 hours postoperatively (P < 0.05). The incidence of vomiting in the control group was 35% vs. 10% for the highest dose naloxone group (group IV) (P < 0.01).

CONCLUSIONA small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesic effects.

Analgesia, Patient-Controlled ; methods ; Analgesics, Opioid ; administration & dosage ; adverse effects ; therapeutic use ; Anesthesia, General ; methods ; Cervical Vertebrae ; surgery ; Female ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Naloxone ; administration & dosage ; adverse effects ; therapeutic use ; Narcotic Antagonists ; administration & dosage ; adverse effects ; therapeutic use ; Nausea ; chemically induced ; Tramadol ; administration & dosage ; adverse effects ; therapeutic use

Spinal gabapentin has been known to show the antinociceptive effect. Although several assumptions have been suggested, mechanisms of action of gabapentin have not been clearly established. The present study was undertaken to examine the action mechanisms of gabapentin at the spinal level. Male SD rats were prepared for intrathecal catheterization. The effect of gabapentin was assessed in the formalin test. After pretreatment with many classes of drugs, changes of effect of gabapentin were examined. General behaviors were also observed. Intrathecal gabapentin produced a suppression of the phase 2 flinching, but not phase 1 in the formalin test. The antinociceptive action of intrathecal gabapentin was reversed by intrathecal NMDA, AMPA, D-serine, CGS 15943, atropine, and naloxone. No antagonism was seen following administration of bicuculline, saclofen, prazosin, yohimbine, mecamylamine, L-leucine, dihydroergocristine, or thapsigargin. Taken together, intrathecal gabapentin attenuated only the facilitated state. At the spinal level, NMDA receptor, AMPA receptor, nonstrychnine site of NMDA receptor, adenosine receptor, muscarinic receptor, and opioid receptor may be involved in the antinociception of gabapentin, but GABA receptor, L-amino acid transporter, adrenergic receptor, nicotinic receptor, serotonin receptor, or calcium may not be involved.
Acetic Acids/administration & dosage ; Acetic Acids/metabolism ; Acetic Acids/pharmacology* ; Adrenergic Antagonists/metabolism ; Adrenergic alpha-Antagonists/metabolism ; Analgesics/administration & dosage ; Analgesics/metabolism ; Analgesics/pharmacology* ; Animals ; Atropine/metabolism ; Dihydroergocristine/metabolism ; Enzyme Inhibitors/metabolism ; Excitatory Amino Acid Agonists/metabolism ; GABA Antagonists/metabolism ; Injections, Spinal ; Leucine/metabolism ; Male ; Mecamylamine/metabolism ; Muscarinic Antagonists/metabolism ; N-Methylaspartate/metabolism ; Naloxone/metabolism ; Narcotic Antagonists/metabolism ; Nicotinic Antagonists/metabolism ; Pain Measurement ; Quinazolines/metabolism ; Rats ; Rats, Sprague-Dawley ; Serine/metabolism ; Spinal Cord/drug effects* ; Thapsigargin/metabolism ; Triazoles/metabolism ; alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid/metabolism