Nimodipine in opiate detoxification: a controlled trial

Jiménez-Lerma, Juan Manuel; Landabaso, M.A.; Iraurgi, Ioseba; Calle, R.; Sanz, Juan José Alió; Gutiérrez-Fraile, Miguel

doi:10.1046/j.1360-0443.2002.00196.x

Cited by 23 publications

(7 citation statements)

References 18 publications

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“…This therefore suggests that L-type calcium channel blockers could prove beneficial in the treatment of addiction. Indeed, there is evidence from human studies that this may be the case 195,196 . For example, L-type calcium channel inhibitors such as nifedipine (Procardia/Adalat; Pfizer/Bayer) Figure 5 | Role of L-type calcium channels in drug addiction.…”

Section: Role Of Calcium Channels In Drug Dependencymentioning

confidence: 99%

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Targeting voltage-gated calcium channels in neurological and psychiatric diseases

Zamponi

2015

Nat Rev Drug Discov

342

331

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Voltage-gated calcium channels are important regulators of brain, heart and muscle functions, and their dysfunction can give rise to pathophysiological conditions ranging from cardiovascular disorders to neurological and psychiatric conditions such as epilepsy, pain and autism. In the nervous system, calcium channel blockers have been used successfully to treat absence seizures, and are emerging as potential therapeutic avenues for pathologies such as pain, Parkinson disease, addiction and anxiety. This Review provides an overview of calcium channels as drug targets for nervous system disorders, and discusses potential challenges and opportunities for the development of new clinically effective calcium channel inhibitors.

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Section: Role Of Calcium Channels In Drug Dependencymentioning

confidence: 99%

“…and verapamil (Calan; Pfizer) have been shown to reduce withdrawal symptoms from a number of addictive substances, including opiates and ethanol 195,196 . It remains to be determined whether these effects in humans are dependent on the activity of Cav1.3, Cav1.2, or both types of channels.…”

Section: Amygdalamentioning

confidence: 99%

Targeting voltage-gated calcium channels in neurological and psychiatric diseases

Zamponi

2015

Nat Rev Drug Discov

342

331

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“…The various Cochrane reviews on detoxification indicate that the most extensively tested effective strategy for the detoxification of heroin-dependent patients is to replace the illegal short-acting opioid by the long-acting opioid agonist methadone, which is subsequently tapered and ultimately discontinued (25). The process and outcome of long-acting opioid agonist tapering can be improved through additional prescription of a calcium-channel blocker such as nimodipine (26), whereas additional prescription of amantadine does not seem to improve the effectiveness of methadone tapering in heroin-dependent patients with or without a comorbid cocaine dependency (27).…”

Section: Detoxificationmentioning

confidence: 99%

Evidence-Based Treatment of Opioid-Dependent Patients

2006

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Objective:To provide an overview of treatment options for opioid-dependent patients. Method:We screened all published studies on the treatment of opioid dependence, with a special focus on systematic literature reviews, formal metaanalyses, and recent trials. Results:Both clinical experience and neurobiological evidence indicate that opioid dependence is a chronic relapsing disorder. Treatment objectives depend on the pursued goals: crisis intervention, abstinence-oriented treatment (detoxification and relapse prevention), or agonist maintenance treatment. The high quality of solid evidence in the literature demonstrates that there are numerous effective interventions available for the treatment of opioid dependence. Crisis intervention, frequently necessary owing to the high overdose rate, can be effectively handled with naloxone. Abstinence-oriented interventions are effective for only a few motivated patients with stable living conditions and adequate social support. Agonist maintenance treatment is considered the first line of treatment for opioid dependence. Numerous studies have shown efficacy for methadone and buprenorphine treatment, while maintenance with other agonists is also becoming available to a greater extent. Maintenance treatment with diamorphine should be made available for the small group of treatment-resistant, severely dependent addicts. Other harm-reduction measures can serve to engage individuals with opioid addiction who are not in treatment. Conclusion:Opioid dependence is a chronic relapsing disease that is difficult to cure, but effective treatments are available to stabilize patients and reduce harm, thereby increasing life expectancy and quality of life. (Can J Psychiatry 2006;51:635-646) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications· Agonist maintenance treatment plus psychosocial support should be widely available and freely accessible for all opioid-dependent individuals. · New extended release antagonist maintenance treatments are promising but should be reserved for internally motivated and stabilized opioid-dependent patients. · Prison sentences should be regarded as windows of opportunity for the start or continuation of maintenance treatment and psychosocial rehabilitation. Limitations· The literature is based on patients with heroin dependence, whereas in many places, heroin has been replaced as the drug of abuse by illicit prescription opioids. · New interventions such as heroin-assisted treatment, SROM, and extended release naltrexone have not be studied extensively. · Many prison-based interventions and harm-reduction measures used with opioid-dependent individuals not seeking treatment have not been tested in RCTs.

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“…Given that L-type calcium channel blockers have been shown to attenuate naloxone-precipitated withdrawal in nonhumans (Barrios & Baeyens, 1991; Bongianni, Carla, Moroni, & Pellegrini-Giampietro, 1986; Seth, Upadhyaya, Moghe, & Ahmad, 2011) and humans (Oliveto, Poling, Kosten, & Gonsai, 2004), as well as attenuate withdrawal during opioid detoxification (Jimenez-Lerma et al, 2002; Shulman, Jagoda, Laycock, & Kelly, 1998), this pilot study examined the tolerability and initial efficacy of gabapentin, an N-type calcium channel blocker (Eroglu et al, 2009; e.g., Maneuf et al, 2003; Snutch, Sutton, & Zamponi, 2001) and GABA analogue that promotes release of GABA (Bertrand, Morin, & Lacaille, 2003; Kuzniecky et al, 2002), to attenuate withdrawal and illicit opioid use in opioid dependent volunteers undergoing a buprenorphine detoxification protocol. Gabapentin is indicated for the treatment of post herpetic neuralgia and as adjunct therapy for epilepsy (Pfizer, 2012a).…”

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confidence: 99%

Randomized, placebo-controlled pilot trial of gabapentin during an outpatient, buprenorphine-assisted detoxification procedure.

Sanders

Mancino

Gentry

et al. 2013

Experimental and Clinical Psychopharmacology

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This pilot study examined the efficacy of the N-type calcium channel blocker gabapentin to improve outcomes during a brief detoxification protocol with buprenorphine. Treatment-seeking opioid-dependent individuals were enrolled in a 5-wk, double blind, placebo-controlled trial examining the effects of gabapentin during a 10-day outpatient detoxification from buprenorphine. Participants were inducted onto buprenorphine sublingual tablets during week 1, were randomized and inducted onto gabapentin or placebo during week 2, underwent a 10-day buprenorphine taper during weeks 3–4 and then were tapered off gabapentin/placebo during week 5. Assessments included thrice-weekly opioid withdrawal scales, vitals, and urine drug screens. Twenty-four individuals (13 male, 17 Caucasian, 3 African American, 4 Latino, mean age 29.7 yrs) participated in the detoxification portion of the study (gabapentin, N=11; placebo, N=13). Baseline characteristics did not differ significantly between groups. Self-reported and observer-rated opioid withdrawal ratings were relatively low and did not differ between groups during the buprenorphine taper. Urine results showed a drug x time interaction, such that the probability of opioid-positive urines significantly decreased over time in the gabapentin versus placebo groups during weeks 3–4 (OR=0.73, p=0.004). These results suggest that gabapentin reduces opioid use during a 10-day buprenorphine detoxification procedure.

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Nimodipine in opiate detoxification: a controlled trial

Abstract: The results of the study suggest that the use of calcium channel blockers (CaCB) may be an effective method in opiate detoxification. Full randomized trials are warranted.

Cited by 23 publications

References 18 publications

Targeting voltage-gated calcium channels in neurological and psychiatric diseases

Targeting voltage-gated calcium channels in neurological and psychiatric diseases

Evidence-Based Treatment of Opioid-Dependent Patients

Randomized, placebo-controlled pilot trial of gabapentin during an outpatient, buprenorphine-assisted detoxification procedure.

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