Tolerance to and Physical Dependence on Opiates, Barbiturates, and Alcohol

Hf, Fraser

doi:10.1146/annurev.me.08.020157.002235

Cited by 20 publications

(10 citation statements)

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“…11,1966 drug (5,16,4), in this patient, "the symptoms appear red] in a definite time sequence following-withdrawal..., reach red] maximum intensity at a definite time, and declin red] at a definite rate" (22). It is also striking that the withdrawal reaction was almost indistinguishable in sequence and symptoms from that following moderate opiate addiction.…”

Section: ) Dosage Tolerancementioning

confidence: 68%

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Withdrawal Symptoms after Abrupt Termination of Imipramine

Shatan

1966

Canadian Psychiatric Association Journal

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The reports and clinical experience cited illustrate the physiological withdrawal reaction which follows abrupt imipramine withdrawal. Many such reactions have probably gone unreported or have been misinterpreted as incipient exacerbations of the process under treatment. It is suggested that the patient reported here meets the W.H.O. criteria of a true addiction (31). These findings are discussed in terms of life situation and personality predisposition contributing to development of addiction in this patient at this time. He was in a heightened state of anxious oral dependency and wished to make drug therapy almost a way of life. The following conclusions are drawn: 1) A drug's specific psychopharmacologic effect cannot be considered without reference to the emotional significance of drugs to the psychiatric patient, i.e. to each patient's characteristic way of responding to the drug experience. 2) Withdrawal phenomena may interfere with the evaluation of change due to treatment, or may seem to produce a clinically worse patient. This possibility should be considered when a trial without drugs produces symptoms like those which led to treatment. 3) Imipramine and most psychotropic drugs should be withdrawn gradually, especially following prolonged treatment, and in addicted patients. If abstinence symptoms develop, the dosage should be increased and then gradually withdrawn again over a longer period. 4) The imipramine withdrawal syndrome appears to be non-specific and morphine-like. This suggests the speculation that imipramine belongs to the group of physiological C.N.S. ‘depressants’.

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Section: ) Dosage Tolerancementioning

confidence: 68%

“…However the decreased effectiveness of imipramine during the second treatment course points to the development of tolerance (19). Duration of treatment also exceeded the 28 to 30-day periods established as suffi~ient to create a definite degree of physical dependence (30,11).…”

Section: ) Dosage Tolerancementioning

confidence: 99%

Withdrawal Symptoms after Abrupt Termination of Imipramine

Shatan

1966

Canadian Psychiatric Association Journal

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“…Chlordiazepoxide gave equally poor results. 4. Alcohol in these patients did not cure alcohol withdrawal syndromes, nor did it prevent delirium tremens.…”

Section: Commentmentioning

confidence: 82%

“…If the patient remained agitated, the dose was gradually increased to a maximum of 100 mg intramuscularly every hour and an additional 100 mg orally or intramus¬ cularly every two hours (3.6 gm total in 24 hours) until restraints could be removed. 4. Paraldehyde and chloral hydrate.-The initial dose was 10 cc of paraldehyde orally or intramuscu¬ larly and 0.5 or 1 gm of chloral hydrate orally.…”

Section: Methodsmentioning

confidence: 99%

Comparative Evaluation of Treatments of Alcohol Withdrawal Syndromes

Golbert¹,

Sanz²,

Rose³

et al. 1967

JAMA: The Journal of the American Medical Association

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In a clinical comparative study, 49 patients were treated for the tremulous and agitated states and acute hallucinosis of alcohol withdrawal. Thirteen patients were treated with promazine hydrochloride, and 12 each with paraldehyde and chloral hydrate, alcohol, or chlordiazepoxide hydrochloride. Of these therapies, paraldehyde with chloral hydrate was most effective and best tolerated. Twenty-three patients were treated for delirium tremens. Twelve were treated with promazine and suffered numerous complications, including death in two cases. Eleven were treated with paraldehyde and chloral hydrate with prompt clearing of hallucinations; there were no failures and only one complication (transient fever).From the Wood (Wis) Veterans Administration

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“…In effect, the brain slices adapted to morphine are also adapted to the depressant effect of methadone and, partially, of meperidine (Takemori, 1962b) but not to that of both pentobarbital and ethanol (Takemori, 1971). On the other hand, barbiturates and ethanol which both exhibit tolerance and physical dependence (Fraser, 1957) depress the respiration of brain from control animals as well as from tolerant animals to the same degree (Turnbull and Stevenson, 1968;Wallgreen and Lindbohm, 1961).…”

mentioning

confidence: 99%

Metabolic Effects of Pentazocine on Brain Slices of Normal and Tolerant Rats

Ferri¹,

Santagostino²,

Giani³

et al. 1974

Pharmacology

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Pentazocine, like amobarbital, enhances at low concentrations, but depresses at higher concentrations the QO₂ of brain cortical slices from normal rats; under this condition morphine was inactive. This inhibitory effect of pentazocine as well as that of morphine is enhanced in K⁺-stimulated cortical slices. Morphine was confirmed to be unable to inhibit the K⁺-stimulated cortical slices from morphine-tolerant rats, whilst pentazocine inhibited the K⁺-stimulated cortical slices from pentazocine-tolerant rats as well as those from normal animals. The possibility of in vitro demonstration of brain metabolic adaptation to opiates is discussed.

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Tolerance to and Physical Dependence on Opiates, Barbiturates, and Alcohol

Cited by 20 publications

References 0 publications

Withdrawal Symptoms after Abrupt Termination of Imipramine

Withdrawal Symptoms after Abrupt Termination of Imipramine

Comparative Evaluation of Treatments of Alcohol Withdrawal Syndromes

Metabolic Effects of Pentazocine on Brain Slices of Normal and Tolerant Rats

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