A benzodiazepine, diazepam, has been the leading antidote for seizures caused by nerve agents, the most toxic chemical weapons of mass destruction, since the 1960s. However, its limitations have often brought questions about its usefulness. Extensive effort has been devoted into exploring alternatives, such as other benzodiazepines, anticholinergics, or glutamate antagonists. However, only few showed clear clinical benefit. The only two options to ultimately reach clinical milestones are Avizafone, a water-soluble prodrug of diazepam adopted by the French and UK armed forces, and intramuscular midazolam, adopted by the US Army. The recently FDA-approved new intramuscular application of midazolam brought several advantages, such as rapid onset of action, short duration with predictable pharmacokinetics, increased water solubility for aqueous injectable solutions, and prolonged storage stability. Herein, we discuss the pitfalls and prospects of using midazolam as a substitute in anticonvulsant therapy with a particular focus on military purposes in combat casualty care. We have also considered and discussed several other alternatives that are currently at the experimental level. Recent studies have shown the superiority of midazolam over other benzodiazepines in the medical management of poisoned casualties. While its use in emergency care is straightforward, the proper dose for soldiers under battlefield conditions is questionable due to its sedative effects.

• MeSH
• antikonvulziva * aplikace a dávkování   terapeutické užití   MeSH
• diazepam * aplikace a dávkování   MeSH
• lidé MeSH
• midazolam * aplikace a dávkování   MeSH
• nervová bojová látka * MeSH
• záchvaty * farmakoterapie   chemicky indukované   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antikonvulziva * MeSH
• diazepam * MeSH
• midazolam * MeSH
• nervová bojová látka * MeSH

BACKGROUND AND PURPOSE: Opioids and benzodiazepines are frequently combined in medical as well as in non-medical contexts. At high doses, such combinations often result in serious health complications attributed to pharmacodynamics interactions. Here, we investigate the contribution of the metabolic interactions between oxycodone, diazepam and diclazepam (a designer benzodiazepine) in abuse/overdose conditions through ex vivo, in vivo and in silico approaches. EXPERIMENTAL APPROACH: A preparation of pooled human liver microsomes was used to study oxycodone metabolism in the presence or absence of diazepam or diclazepam. In mice, diazepam or diclazepam was concomitantly administered with oxycodone to mimic acute intoxication. Diclazepam was introduced on Day 10 in mice continuously infused with oxycodone for 15 days to mimic chronic intoxication. In silico modelling was used to study the molecular interactions of the three drugs with CYP3A4 and 2D6. KEY RESULTS: In mice, in acute conditions, both diazepam and diclazepam inhibited the metabolism of oxycodone. In chronic conditions and at pharmacologically equivalent doses, diclazepam drastically enhanced the production of oxymorphone. In silico, the affinity of benzodiazepines was higher than oxycodone for CYP3A4, inhibiting oxycodone metabolism through CYP3A4. Oxycodone metabolism is likely to be diverted towards CYP2D6. CONCLUSION AND IMPLICATIONS: Acute doses of diazepam or diclazepam result in the accumulation of oxycodone, whereas chronic administration induces the accumulation of oxymorphone, the toxic metabolite. This suggests that overdoses of opioids in the presence of benzodiazepines are partly due to metabolic interactions, which in turn explain the patterns of toxicity dependent on usage. LINKED ARTICLES: This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc.

• Klíčová slova
• benzodiazepines, designer benzodiazepines, diazepam, diclazepam, metabolic interactions, opioids, oxycodone,
• MeSH
• benzodiazepiny toxicita   MeSH
• cytochrom P-450 CYP3A MeSH
• diazepam farmakologie   MeSH
• lidé MeSH
• modely u zvířat MeSH
• myši MeSH
• opioidní analgetika toxicita   MeSH
• oxykodon * MeSH
• oxymorfon MeSH
• předávkování léky * MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• benzodiazepiny MeSH
• cytochrom P-450 CYP3A MeSH
• diazepam MeSH
• opioidní analgetika MeSH
• oxykodon * MeSH
• oxymorfon MeSH

BACKGROUND: Neurosteroids are investigated as effective antidotes for the poisoning induced by tetramethylenedisulfotetramine (TMDT) as well as treatments for epileptic spasms during infancy. Both these conditions are quite resistant to pharmacotherapy; thus, a search for new treatments is warranted. METHODS: In this study, we determined the efficacy of two novel neurosteroids, pregnanolone glutamate (PAG) and pregnanolone pyroglutamate (PPG), and tested these drugs in doses of 1-10 mg/kg (ip) against the TMDT syndrome and in our rodent model of infantile spasms. RESULTS: Only PPG in doses 5 and 10 mg/kg suppressed the severity of the TMDT syndrome and TMDT-induced lethality, while the 1 mg/kg dose was without an effect. Interestingly, the 1 mg/kg dose of PPG in combination with 1 mg/kg of diazepam was also effective against TMDT poisoning. Neither PAG nor PPG were effective against experimental spasms in the N-methyl-D-aspartate (NMDA)-triggered model of infantile spasms. CONCLUSIONS: While evidence suggests that PAG can act through multiple actions which include allosteric inhibition of NMDA-induced and glycine receptor-evoked currents as well as augmentation of ɣ-aminobutyric acid subtype A (GABAA) receptor-induced currents, the agent appears to neither have the appropriate mechanistic signature for activity in the infantile spasm model, nor the adequate potency, relative to PPG, for ameliorating the TMDT syndrome. The full mechanisms of action of PPG, which may become a potent TMDT antidote either alone or in combination with diazepam are yet unknown and thus require further investigation.

• Klíčová slova
• Antidote, Neurosteroids, Neurotoxicity, Severe seizures, Tetramethylenedisulfotetramine,
• MeSH
• diazepam farmakologie   MeSH
• hlodavci MeSH
• křeče u dětí * chemicky indukované   farmakoterapie   MeSH
• kyselina glutamová MeSH
• kyselina pyrrolidonkarboxylová MeSH
• N-methylaspartát toxicita   terapeutické užití   MeSH
• neurosteroidy * MeSH
• neurotoxické syndromy * MeSH
• pregnanolon škodlivé účinky   MeSH
• spasmus MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• diazepam MeSH
• kyselina glutamová MeSH
• kyselina pyrrolidonkarboxylová MeSH
• N-methylaspartát MeSH
• neurosteroidy * MeSH
• pregnanolon MeSH
• tetramethylenedisulfotetramine MeSH Prohlížeč

The constitutive androstane receptor (CAR) is the essential regulator of genes involved both in xenobiotic and endobiotic metabolism. Diazepam has been shown as a potent stimulator of CAR nuclear translocation and is assumed as an indirect CAR activator not interacting with the CAR cavity. In this study, we sought to determine if diazepam is a ligand directly interacting with the CAR ligand binding domain (LBD) and if it regulates its target genes in a therapeutically relevant concentration. We used different CAR constructs in translocation and luciferase reporter assays, recombinant CAR-LBD in a TR-FRET assay, and target genes induction studied in primary human hepatocytes (PHHs), HepaRG cells, and in CAR humanized mice. We also used in silico docking and CAR-LBD mutants to characterize the interaction of diazepam and its metabolites with the CAR cavity. Diazepam and its metabolites such as nordazepam, temazepam, and oxazepam are activators of CAR+Ala in translocation and two-hybrid assays and fit the CAR cavity in docking experiments. In gene reporter assays with CAR3 and in the TR-FRET assay, only diazepam significantly interacts with CAR-LBD. Diazepam also promotes up-regulation of CYP2B6 in PHHs and in HepaRG cells. However, in humanized CAR mice, diazepam significantly induces neither CYP2B6 nor Cyp2b10 genes nor does it regulate critical genes involved in glucose and lipids metabolism and liver proliferation. Thus, we demonstrate that diazepam interacts with human CAR-LBD as a weak ligand, but it does not significantly affect expression of tested CAR target genes in CAR humanized mice.

• Klíčová slova
• CAR, NR1I3, cytochrome P450, diazepam, drug interaction, gene regulation,
• MeSH
• buněčné linie MeSH
• diazepam farmakologie   MeSH
• dospělí MeSH
• hepatocyty účinky léků   MeSH
• játra účinky léků   MeSH
• konstitutivní androstanový receptor MeSH
• lidé středního věku MeSH
• lidé MeSH
• ligandy MeSH
• myši MeSH
• proliferace buněk účinky léků   MeSH
• proteinové domény účinky léků   MeSH
• receptory cytoplazmatické a nukleární metabolismus   MeSH
• reportérové geny účinky léků   genetika   MeSH
• transport proteinů účinky léků   MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• myši MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• diazepam MeSH
• konstitutivní androstanový receptor MeSH
• ligandy MeSH
• NR1I3 protein, human MeSH Prohlížeč
• Nr1i3 protein, mouse MeSH Prohlížeč
• receptory cytoplazmatické a nukleární MeSH

Benzodiazepines (BZDs) and Z-drugs are strongly addictive substances, acting on identical GABA receptors. Detoxification should be long-term and gradual, usually by tapering a long-acting BZD (diazepam) but no suitable commercial pharmaceutic product exists with the necessary low drug content. This review describes the specific pharmacological aspects and comparisons of individual BZDs in relation to their effects and addictiveness. The success of the treatment relates to the patients comfort during this process. Patients are typically afraid of switching to a more suitable long-acting BZD (diazepam), and become stressed during the tapering and anxious from withdrawal symptoms. These obstacles could be overcome through individualized detoxification according to already published withdrawal schedules based on the administration of very precise diazepam doses in a long-term gradual tapering with possible addition of adjuvant drugs. Dose reduction does not change external appearance of the dosage form, and the patient could be treated until the placebo phase. Individually prepared pharmaceutics with different and precise diazepam contents can be used for comfortable detoxification and also may eliminate psychogenic stress during switching, tapering, and the withdrawal period.

• Klíčová slova
• Z-drugs, addiction, benzodiazepines, detoxification, tapering, withdrawal,
• MeSH
• abstinenční syndrom prevence a kontrola   MeSH
• benzodiazepiny aplikace a dávkování   škodlivé účinky   MeSH
• diazepam terapeutické užití   MeSH
• lidé MeSH
• metabolická inaktivace MeSH
• poruchy spojené s užíváním psychoaktivních látek farmakoterapie   MeSH
• rozvrh dávkování léků MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• benzodiazepiny MeSH
• diazepam MeSH

Despite the main mechanism of organophosphate (OP) toxicity through inhibition of acetylcholinesterase (AChE) being well known over the years, some chronic adverse health effects indicate the involvement of additional pathways. Oxidative stress is among the most intensively studied. Overstimulation of cholinergic and glutamatergic nervous system is followed by intensified generation of reactive species and oxidative damage in many tissues. In this review, the role of oxidative stress in pathophysiology of OP poisoning and the influence of commonly used medical interventions on its levels are discussed. Current standardized therapy of OP intoxications comprises live-saving administration of the anticholinergic drug atropine accompanied by oxime AChE reactivator and diazepam. The capability of these antidotes to ameliorate OP-induced oxidative stress varies between both therapeutic groups and individual medications within the drug class. Regarding oxidative stress, atropine does not seem to have a significant effect on oxidative stress parameters in OP poisoning. In a case of AChE reactivators, pro-oxidative and antioxidative properties could be found. It is assumed that the ability of oximes to trigger oxidative stress is rather associated with their chemical structure than reactivation efficacy. The data indicating the potency of diazepam in preventing OP-induced oxidative stress are not available. Based on current knowledge on the mechanism of OP-mediated oxidative stress, alternative approaches (including antioxidants or multifunctional drugs) in therapy of OP poisoning are under consideration.

• Klíčová slova
• antidotes, atropine, diazepam, nerve agents, organophosphate, oxidative stress, oximes, pesticide,
• MeSH
• antidota terapeutické užití   MeSH
• antioxidancia terapeutické užití   MeSH
• atropin terapeutické užití   MeSH
• diazepam terapeutické užití   MeSH
• lidé MeSH
• otrava organofosfáty farmakoterapie   MeSH
• oxidační stres účinky léků   MeSH
• oximy terapeutické užití   MeSH
• reaktivátory cholinesterasy terapeutické užití   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• antidota MeSH
• antioxidancia MeSH
• atropin MeSH
• diazepam MeSH
• oximy MeSH
• reaktivátory cholinesterasy MeSH

Anthropogenic pollutants and in particular pharmaceutical residues are a potential risk for potable water where they are found in increasing concentrations. Different environmental effects could already be linked to the presence of pharmaceuticals in surface waters even for low concentrations. Many pharmaceuticals withstand conventional water treatment technologies. Consequently, there is a need for new water purification techniques. Advanced oxidation processes (AOP), and especially plasmas with their ability to create reactive species directly in water, may offer a promising solution. We developed a plasma reactor with a coaxial geometry to generate large volume corona discharges directly in water and investigated the degradation of seven recalcitrant pharmaceuticals (carbamazepine, diatrizoate, diazepam, diclofenac, ibuprofen, 17α-ethinylestradiol, trimethoprim). For most substances we observed decomposition rates from 45% to 99% for treatment times of 15-66 min. Especially ethinylestradiol and diclofenac were readily decomposed. As an inherent advantage of the method, we found no acidification and only an insignificant increase in nitrate/nitrite concentrations below legal limits for the treatment. Studies on the basic plasma chemical processes for the model system of phenol showed that the degradation is primarily caused by hydroxyl radicals.

• Klíčová slova
• Advanced oxidation, Diclofenac, Ethinylestradiol, Hydroxyl radicals, Non-thermal plasma, Phenol,
• MeSH
• chemické látky znečišťující vodu chemie   MeSH
• čištění vody metody   MeSH
• diatrizoát chemie   MeSH
• diazepam chemie   MeSH
• diklofenak chemie   MeSH
• ethinylestradiol chemie   MeSH
• ibuprofen chemie   MeSH
• karbamazepin chemie   MeSH
• monitorování životního prostředí MeSH
• odpad tekutý - odstraňování metody   MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• chemické látky znečišťující vodu MeSH
• diatrizoát MeSH
• diazepam MeSH
• diklofenak MeSH
• ethinylestradiol MeSH
• ibuprofen MeSH
• karbamazepin MeSH

This study tightly controlled seizure duration and severity during status epilepticus (SE) in postnatal day 10 (P10) rats, in order to isolate hyperthermia as the main variable and to study its consequences. Body temperature was maintained at 39 ± 1 °C in hyperthermic SE rats (HT+SE) or at 35 ± 1 °C in normothermic SE animals (NT+SE) during 30 min of SE, which was induced by lithium-pilocarpine (3 mEq/kg, 60 mg/kg) and terminated by diazepam and cooling to NT. All video/EEG measures of SE severity were similar between HT+SE and NT+SE pups. At 24h, neuronal injury was present in the amygdala in the HT+SE group only, and was far more severe in the hippocampus in HT+SE than NT+SE pups. Separate groups of animals were monitored four months later for spontaneous recurrent seizures (SRS). Only HT+SE animals developed convulsive SRS. Both HT+SE and NT+SE animals developed electrographic SRS (83% vs. 55%), but SRS frequency and severity were higher in hyperthermic animals (12.5 ± 3.5 vs. 4.2 ± 2.0 SRS/day). The density of hilar neurons was lower, thickness of the amygdala and perirhinal cortex was reduced, and lateral ventricles were enlarged in HT+SE over NT+SE littermates and HT/NT controls. In this model, hyperthermia greatly increased the epileptogenicity of SE and its neuropathological sequelae.

• Klíčová slova
• EEG monitoring, immature brain, lithium/pilocarpine model, neuronal injury, temperature,
• MeSH
• adjuvancia imunologická toxicita   MeSH
• agonisté muskarinových receptorů toxicita   MeSH
• antikonvulziva terapeutické užití   MeSH
• apoptóza účinky léků   fyziologie   MeSH
• buněčná smrt účinky léků   MeSH
• časové faktory MeSH
• chlorid lithný toxicita   MeSH
• degenerace nervu etiologie   MeSH
• diazepam terapeutické užití   MeSH
• indukovaná hypertermie škodlivé účinky   MeSH
• krysa rodu Rattus MeSH
• modely nemocí na zvířatech MeSH
• mozek účinky léků   patologie   patofyziologie   ultrastruktura   MeSH
• neurony patologie   ultrastruktura   MeSH
• neuropil patologie   ultrastruktura   MeSH
• novorozená zvířata MeSH
• pilokarpin toxicita   MeSH
• potkani Wistar MeSH
• status epilepticus etiologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Názvy látek
• adjuvancia imunologická MeSH
• agonisté muskarinových receptorů MeSH
• antikonvulziva MeSH
• chlorid lithný MeSH
• diazepam MeSH
• pilokarpin MeSH

Rocuronium is a neuromuscular blocking agent acting as a competitive antagonist of acetylcholine. Results of an inhibition of eight individual liver microsomal cytochromes P450 (CYP) are presented. As the patients are routinely premedicated with diazepam, possible interaction of diazepam with rocuronium has been also studied. Results indicated that rocuronium interacts with human liver microsomal CYPs by binding to the substrate site. Next, concentration dependent inhibition of liver microsomal CYP3A4 down to 42% (at rocuronium concentration 189 μM) was found. This effect has been confirmed with two CYP3A4 substrates, testosterone (formation of 6β-hydroxytestosterone) and diazepam (temazepam formation). CYP2C9 and CYP2C19 activities were inhibited down to 75-80% (at the same rocuronium concentration). Activities of other microsomal CYPs have not been inhibited by rocuronium. To prove the possibility of rocuronium interaction with other drugs (diazepam), the effect of rocuronium on formation of main diazepam metabolites, temazepam (by CYP3A4) and desmethyldiazepam, (also known as nordiazepam; formed by CYP2C19) in primary culture of human hepatocytes has been examined. Rocuronium has caused inhibition of both reactions by 20 and 15%, respectively. The results open a possibility that interactions of rocuronium with drugs metabolized by CYP3A4 (and possibly also CYP2C19) may be observed.

• Klíčová slova
• Cytochrome P450, Drug interactions, Rocuronium,
• MeSH
• androstanoly metabolismus   farmakologie   MeSH
• cytochrom P-450 CYP3A metabolismus   fyziologie   MeSH
• cytochrom P450 CYP2C19 metabolismus   fyziologie   MeSH
• cytochrom P450 CYP2C9 metabolismus   MeSH
• cytochromy metabolismus   MeSH
• diazepam farmakologie   MeSH
• hepatocyty metabolismus   MeSH
• inhibitory cytochromu P450 MeSH
• jaterní mikrozomy enzymologie   MeSH
• kultivované buňky MeSH
• lékové interakce MeSH
• lidé MeSH
• nedepolarizující myorelaxancia farmakologie   MeSH
• rokuronium MeSH
• systém (enzymů) cytochromů P-450 metabolismus   MeSH
• vazebná místa MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• androstanoly MeSH
• cytochrom P-450 CYP3A MeSH
• cytochrom P450 CYP2C19 MeSH
• cytochrom P450 CYP2C9 MeSH
• cytochromy MeSH
• diazepam MeSH
• inhibitory cytochromu P450 MeSH
• nedepolarizující myorelaxancia MeSH
• rokuronium MeSH
• systém (enzymů) cytochromů P-450 MeSH

A fatal poisoning case involving etizolam, phenobarbital, promethazine and chlorpromazine is presented. Quantitative toxicological analysis showed that the concentrations of etizolam, phenobarbital, promethazine and chlorpromazine in the femoral blood were 86 ng/ml, 5082 microg/ml, 0.107 microg/ml and 0.144 microg/ml, respectively, and large amounts of drugs were also detected in the stomach contents. We conclude that the cause of death was due to the interaction of multiple psychotropic drugs.

• MeSH
• chlorpromazin otrava   MeSH
• diazepam analogy a deriváty   MeSH
• dospělí MeSH
• fenobarbital otrava   MeSH
• lékové interakce MeSH
• lidé MeSH
• promethazin otrava   MeSH
• psychotropní léky otrava   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• chlorpromazin MeSH
• diazepam MeSH
• etizolam MeSH Prohlížeč
• fenobarbital MeSH
• promethazin MeSH
• psychotropní léky MeSH