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Reversal of triazolam- and zolpidem-induced memory impairment by flumazenil

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Abstract

The effects of flumazenil, a benzodiazepine receptor antagonist, on triazolam- and zolpidem-induced memory impairment were investigated. Sixty subjects received oral triazolam 0.5 mg, zolpidem 20.0 mg, or placebo at 10 a.m. (n=20 per drug). Ninety minutes later, half of the subjects (n=10) in each oral drug group were administered flumazenil 1.0 mg, while the remaining half received placebo (normal saline), through indwelling venous catheters. Learning/memory tests (including Simulated Escape, Restricted Reminding, Paired-Associates, and Repeated Acquisition) were administered at that time, and at 1.5-h intervals over the next 6 h. Triazolam/placebo and zolpidem/placebo drug combinations impaired memory on all tests (allPs<0.05). However, the triazolam/flumazenil and zolpidem/flumazenil groups showed no evidence of impairment during any test session. These results demonstrate that flumazenil 1.0 mg rapidly and lastingly reverses memory impairment caused by agonists of the benzodiazepine receptor. Furthermore, nonsignificant trends suggested that performance of the placebo/flumazenil group was consistently better than that of the placebo/placebo group, denoting a possible role of endogenous benzodiazepine agonists in natural sleep/wake processes.

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References

  • Balkin TJ, O'Donnell VM, Kamimori GH, Redmond DP, Belenky G (1989) Sleep inertia following triazolam-induced recovery sleep. Hum Psychopharmacol 4:291–296

    Google Scholar 

  • Balkin TJ, O'Donnell VM, Wesensten N, McCann U, Belenky G (1992) Comparison of the daytime sleep and performance effects of zolpidem versus triazolam. Psychopharmacology 107:83–88

    Google Scholar 

  • Berlin I, Warot D, Hergueta T, Molinier P, Bagot C, Puech AJ (1993) Comparison of the effects of zolpidem and triazolam on memory functions, psychomotor performances, and postural sway in healthy subjects. J Clin Psychopharmacol 13:100–106

    Google Scholar 

  • Bonetti EP, Pieri L, Cumin R, Schaffner R, Pieri M, Gamzu ER, Muller RKM, Haefely W (1982) Benzodiazepine antagonist Ro 15-1788: neurological and behavioral effects. Psychopharmacology 78:8–18

    Google Scholar 

  • Brogden RN, Goa KL (1991) Flumazenil. A reappraisal of its pharmacological properties and therapeutic efficacy as a benzodiazepine antagonist. Drugs 42:1061–1089

    Google Scholar 

  • Burkhart KK, Kulig KW (1990) The diagnostic utility of flumazenil (a benzodiazepine antagonist) in coma of unknown etiology. Ann Emerg Med 19:319–321

    Google Scholar 

  • Buschke H, Fuld PA (1974) Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology 24:1019–1025

    Google Scholar 

  • Curran HV, Birch B (1991) Differentiating the sedative, psychomotor and amnestic effects of benzodiazepines: a study with midazolam and the benzodiazepine antagonist, flumazenil. Psychopharmacology 103:519–523

    Google Scholar 

  • Darragh A, Lambe R, Kenny M, Brick I (1983) Tolerance of healthy volunteers to intravenous administration of the benzodiazepine antagonist Ro 15-1788. Eur J Clin Pharmacol 24:569–570

    Google Scholar 

  • Dixon WJ (1985) BMDP statistical software manual. University of California Press, Berkeley, Los Angeles, London.

    Google Scholar 

  • Dorow R, Berenberg D, Duka T, Sauerbrey N (1987) Amnestic effects of lormetazepam and their reversal by the benzodiazepine antagonist Ro 15-1788. Psychopharmacology 93:507–514

    Google Scholar 

  • Dunton AW, Schwam E, Pitman V, McGrath J, Hendler J, Siegel J (1988) Flumazenil: U.S. clinical pharmacology studies. Eur J Anaesthesiol S2:81–95

    Google Scholar 

  • Farb DH, Borden LA, Chan CY, Czajkowski CM, Gibbs TT, Schiller GD (1984) Modulation of neuronal function through benzodiazepine receptors: biochemical and electrophysiological studies of neurons in primary monolayer cell culture. Ann NY Acad Sci 435:1–31

    Google Scholar 

  • File SE, Baldwin HA (1987) Flumazenil: a possible treatment for benzodiazepine withdrawal anxiety. Lancet 2:106–107

    Google Scholar 

  • File SE, Pellow S (1986) Intrinsic actions of the benzodiazepine receptor antagonist Ro 15-1788. Psychopharmacology 88:1–11

    Google Scholar 

  • Friedman H, Greenblatt DJ, Burstein ES, Harmatz JS, Shader RI (1986) Population study of triazolam pharmacokinetics. Br J Clin Pharmacol 22:639–642

    Google Scholar 

  • Gallager DW, Heninger K, Heninger G (1986) Periodic benzodiazepine antagonist administration prevents benzodiazepine withdrawal symptoms in primates. Eur J Pharmacol 132:31–38

    Google Scholar 

  • Gentil V, Gorenstein C, Camargo CHP, Singer JM (1989) Effects of flunitrazepam on memory and their reversal by two antagonists. J Clin Psychopharmacol 9:191–197

    Google Scholar 

  • Ghoneim MM (1992) The reversal of benzodiazepine-induced amnesia by flumazenil: a review. Curr Ther Res 52:757–767

    Google Scholar 

  • Grimm G, Katzenschlager R, Holzner F, Ferenci P, Schneeweiss B, Laggner A, Lenz K, Druml W, Madl C (1988) Effect of flumazenil in hepatic encephalopathy. Eur J Anaesthesiol S2:147–149

    Google Scholar 

  • Kelly C, Egner J, Rubin J (1988) Successful treatment of triazolam overdose with Ro 15-1788. S Afr Med J 73:442

    Google Scholar 

  • Kirk RE (1982) Experimental design: procedures for the behavioral sciences, 2nd edn. Brooks/Cole, Belmont, Calif.

    Google Scholar 

  • Klotz U, Ziegler G, Reimann IW (1984) Pharmacokinetics of the selective benzodiazepine antagonist Ro 15-1788 in man. Eur J Clin Pharmacol 27:115–117

    Google Scholar 

  • Langer SZ, Arbilla S, Scatton B, Niddam R, Dubois A (1988) Receptors involved in the mechanism of action of zolpidem. In: Sauvanet JP, Langer SZ, Morselli PL (eds) Imidazopyridines in sleep disorders: a novel experimental and therapeutic approach (L.E.R.S. Monograph Series Volume 6). Raven Press, New York, pp 55–70

    Google Scholar 

  • Lauven PM, Schwilden H, Stoeckel H, Greenblatt, DJ (1985) The effects of a benzodiazepine antagonist Ro 15-1788 in the presence of stable concentrations of midazolam. Anesthesiology 63:61–64

    Google Scholar 

  • Lheureux P, Debailleul G, De Witte O, Askenasi R (1990) Zolpidem intoxication mimicking narcotic overdose: response to flumazenil. Hum Exp Toxicol 9:105–107

    Google Scholar 

  • McKay AC, McKinney MS, Clarke RSJ (1990) Effect of flumazenil on midazolam-induced amnesia. Br J Anaesth 65:190–196

    Google Scholar 

  • Meier R, Gyr K (1988) Treatment of hepatic encephalopathy (HE) with the benzodiazepine antagonist flumazenil: a pilot study. Eur J Anaesthesiol S2:139–146

    Google Scholar 

  • O'Boyle C, Lambe R, Darragh A, Taffe W, Brick I, Kenny M (1983) Ro 15-1788 antagonizes the effects of diazepam in man without affecting its bioavailability. Br J Anaesth 55:349–355

    Google Scholar 

  • O'Donnell VM (1981) Neurochemical correlates of memory function in Korsakoff's syndrome and Alzheimer's disease. PhD thesis, Department of Psychology, University of Houston, Houston, Texas

    Google Scholar 

  • O'Donnell VM, Balkin TJ, Andrade JR, Simon LM, Kamimori GH, Redmond DP, Belenky G (1988) Effects of triazolam on performance and sleep in a model of transient insomnia. Hum Perform 1:146–160

    Google Scholar 

  • Patat A, Naef MM, Van Gessel E, Forster A, Dubruc C, Rosenzweig P (1994) Flumazenil antagonizes the central effects of zolpidem, an imidazopyridine hypnotic. Clin Pharmacol Ther 6:430–436

    Google Scholar 

  • Penetar D, Belenky G, Garigan JJ, Redmond DP (1989) Triazolam impairs learning and fails to improve sleep in a long-range aerial deployment. Aviat Space Env Med 60:594–598

    Google Scholar 

  • Physician's Desk Reference (1994) PDR(R) Library on CD-ROM(TM). Medical Economics Company, Montvale, N.J.

    Google Scholar 

  • Polc P, Laurent JP, Scherschlicht R, Haefeley W (1981) Electrophysiological studies on the specific benzodiazepine antagonist Ro 15-1788. Arch Pharmacol 316:317–325

    Google Scholar 

  • Preston GC, Ward CE, Broks P, Traub M, Stahl SM (1989) Effects of lorazepam on memory, attention and sedation in man: antagonism by Ro 15-1788. Psychopharmacology 97:222–227

    Google Scholar 

  • Roehrs T, Merlotti L, Zorick F, Roth T (1994) Sedative, memory, and performance effects of hypnotics. Psychopharmacology 116:130–134

    Google Scholar 

  • Roncari G, Ziegler WH, Guentert TW (1986) Pharmacokinetics of the new benzodiazepine antagonist Ro 15-1788 in man following intravenous and oral administration. Br J Clin Pharmacol 22:421–428

    Google Scholar 

  • Rothstein JD, Guidotti A, Tinuper P, Cortelli P, Avoni P, Plazzi G, Lugaresi E, Schoch P, Montagna P (1992) Endogenous benzodiazepine receptor ligands in idiopathic recurring stupor. Lancet 340:1002–1004

    Google Scholar 

  • Sharief MK, Sander JWAS, Shorvon SD (1993) The effect of oral flumazenil on interictal epileptic activity: results of a double-blind, placebo-controlled study. Epilepsy Res 15:53–60

    Google Scholar 

  • Short TG, Galletly DC (1989) Residual psychomotor effects following reversal of midazolam sedation with flumazenil. Anaesth Intensive Care 17:290–297

    Google Scholar 

  • Siegart W, Schuster A (1984) Affinity of various ligands for benzodiazepine receptors in rat cerebellum and hippocampus. Biochem Pharmacol 33:4033–4038

    Google Scholar 

  • Thenot JP, Hermann P, Durand A, Burke JT, Allen J, Garrigou D, Vajta S, Albin H, Thebault JJ, Olive G, Warrington SJ (1988) Pharmacokinetics and metabolism of zolpidem in various animal species and in humans. In: Sauvanet JP, Langer SZ, Morselli PL (eds) Imidazopyridines in sleep disorders: A novel experimental and therapeutic approach (L.E.R.S. Monograph Series Volume 6). Raven Press, New York, pp 139–153

    Google Scholar 

  • Thorne DR, Genser SG, Sing HC, Hegge FW (1985) The Walter Reed performance assessment battery. Neurobehav Toxicol Teratol 7:415–418

    Google Scholar 

  • Unseld E, Fischer C, Rothemund E, Klotz U (1990) Occurrence of “natural” diazepam in human brain. Biochem Pharmacol 39:210–212

    Google Scholar 

  • Young WS, Niehoff D, Kuhar MJ, Beer B, Lippa AS (1981) Multiple benzodiazepine receptor localization by light microscopic radiohistochemistry. J Pharmacol Exp Ther 216:425–430

    Google Scholar 

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Wesensten, N.J., Balkin, T.J., Davis, H.Q. et al. Reversal of triazolam- and zolpidem-induced memory impairment by flumazenil. Psychopharmacology 121, 242–249 (1995). https://doi.org/10.1007/BF02245635

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  • DOI: https://doi.org/10.1007/BF02245635

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