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Current Clinical Pharmacology

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ISSN (Print): 1574-8847
ISSN (Online): 2212-3938

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Clinical Trial

The Effect of Methylphenidate on Reed Scaling in Benzodiazepine Poisoning: A Prospective Trial

Author(s): Masoud Latifi-Pour, Hossein Hassanian-Moghaddam, Helya-Sadat Mortazavi, Shahin Shadnia, Nasim Zamani and Mitra Rahimi*

Volume 15, Issue 1, 2020

Page: [81 - 88] Pages: 8

DOI: 10.2174/1574884714666190112153157

Abstract

Background: Benzodiazepine is one of the most important causes of substance abuse and intoxication throughout the world and Iran.

Objective: The aim of our study is to determine the role of stimulants in reversing CNS level in acute Benzodiazepine poisoning patients who were hospitalized at referral poison center.

Method: This was a randomized double-blind placebo-controlled trial study on 32 cases with pure acute Benzodiazepine poisoning from March 2016 to February 2017. Diagnosis of pure acute poisoning was based on history, and laboratory confirmation. We gathered the demographics, clinical data, laboratory data, hospitalization and outcome. Participants were randomized into two groups: Methylphenidate Group (MPH) and Placebo Group (PBO).

Results: The randomized sample consisted of 32 participants who were predominately female (83%). The majority of the PBO group and the MPH group reported improvement in their consciousness with a significant difference between the two groups (p = .005). Paired sample t-test analyses on Reed Scale data revealed an increase in the probability of improvement during the trial for the MPH group compared to the PBO group. Furthermore, the HCo3 (bicarbonate) level has a significant p-value with respect to age groups (p = .02). None of our cases required either the ICU facility or intubation.

Conclusion: Our study provided the MPH superiority over PBO in reversing CNS symptoms in loss of consciousness in acute BZD poisoned patients. Thus, this trial provides concrete evidence that improvement in consciousness levels (Reed Scale rated) among those patients receiving MPH was associated with a methylphenidate use.

Keywords: Benzodiazepines, poisoning, central nervous system stimulants, methylphenidate, placebo effect, clinical trial.

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[1]
Moore PW, Donovan JW, Burkhart KK, et al. Safety and efficacy of flumazenil for reversal of iatrogenic benzodiazepine-associated delirium toxicity during treatment of alcohol withdrawal, a retrospective review at one center. J Med Toxicol 2014; 10(2): 126-32.
[http://dx.doi.org/10.1007/s13181-014-0391-6] [PMID: 24619543]
[2]
Aduen J, Bernstein WK, Khastgir T, et al. The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA 1994; 272(21): 1678-85.
[http://dx.doi.org/10.1001/jama.1994.03520210062033] [PMID: 7966896]
[3]
Islam MM, Conigrave KM, Day CA, Nguyen Y, Haber PS. Twenty-year trends in benzodiazepine dispensing in the Australian population. Intern Med J 2014; 44(1): 57-64.
[http://dx.doi.org/10.1111/imj.12315] [PMID: 24450521]
[4]
Uhlenhuth EH, Balter MB, Ban TA, Yang K. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: IV. Therapeutic dose dependence and abuse liability of benzodiazepines in the long-term treatment of anxiety disorders. J Clin Psychopharmacol 1999; 19(6)(Suppl. 2): 23S-9S.
[http://dx.doi.org/10.1097/00004714-199912002-00005] [PMID: 10587281]
[5]
Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2010; (3): CD005063
[PMID: 20238336]
[6]
Bråthen G, Ben-Menachem E, Brodtkorb E, et al. EFNS guideline on the diagnosis and management of alcohol-related seizures: report of an EFNS task force. Eur J Neurol 2005; 12(8): 575-81.
[http://dx.doi.org/10.1111/j.1468-1331.2005.01247.x] [PMID: 16053464]
[7]
Gillies D, Beck A, McCloud A, Rathbone J. Benzodiazepines for psychosis‐induced aggression or agitation. Cochrane Libr 2005.
[8]
Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S. Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011. Arch Iran Med 2014; 17(8): 534-8.
[PMID: 25065275]
[9]
Charlson F, Degenhardt L, McLaren J, Hall W, Lynskey M. A systematic review of research examining benzodiazepine-related mortality. Pharmacoepidemiol Drug Saf 2009; 18(2): 93-103.
[http://dx.doi.org/10.1002/pds.1694] [PMID: 19125401]
[10]
Jann M, Kennedy WK, Lopez G. Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract 2014; 27(1): 5-16.
[http://dx.doi.org/10.1177/0897190013515001] [PMID: 24436437]
[11]
Barkley RA. A review of stimulant drug research with hyperactive children. J Child Psychol Psychiatry 1977; 18(2): 137-65.
[http://dx.doi.org/10.1111/j.1469-7610.1977.tb00425.x] [PMID: 326801]
[12]
Kautz HD. Trends in drug therapy. J Am Geriatr Soc 1957; 5(2): 122-9.
[http://dx.doi.org/10.1111/j.1532-5415.1957.tb00036.x] [PMID: 13415864]
[13]
Volkow ND, Wang G, Fowler JS, et al. Therapeutic doses of oral methylphenidate significantly increase extracellular dopamine in the human brain. J Neurosci 2001; 21(2): RC121-.
[http://dx.doi.org/10.1523/JNEUROSCI.21-02-j0001.2001] [PMID: 11160455]
[14]
Ferguson JT, Linn FVZ, Nickels MM, Sheets JA Jr. Methylphenidate (ritalin) hydrochloride parenteral solution; preliminary report. J Am Med Assoc 1956; 162(14): 1303-4.
[http://dx.doi.org/10.1001/jama.1956.02970310031007] [PMID: 13366746]
[15]
Plum F, Posner JB. The diagnosis of stupor and coma. USA: Oxford University Press 1982.
[16]
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2(7872): 81-4.
[http://dx.doi.org/10.1016/S0140-6736(74)91639-0] [PMID: 4136544]
[17]
Hausken AM, Skurtveit S, Tverdal A. Use of anxiolytic or hypnotic drugs and total mortality in a general middle-aged population. Pharmacoepidemiol Drug Saf 2007; 16(8): 913-8.
[http://dx.doi.org/10.1002/pds.1417] [PMID: 17486666]
[18]
Busto U, Sellers EM, Naranjo CA, Cappell HD, Sanchez-Craig M, Simpkins J. Patterns of benzodiazepine abuse and dependence. Br J Addict 1986; 81(1): 87-94.
[http://dx.doi.org/10.1111/j.1360-0443.1986.tb00299.x] [PMID: 2870731]
[19]
Balter MB, Levine J, Manheimer DI. Cross-national study of the extent of anti-anxiety-sedative drug use. N Engl J Med 1974; 290(14): 769-74.
[http://dx.doi.org/10.1056/NEJM197404042901404] [PMID: 4815224]
[20]
Ferrence RG, Whitehead PC. Sex differences in psychoactive drug use Alcohol and drug problems in women. Springer 1980; pp. 125-201.
[http://dx.doi.org/10.1007/978-1-4615-7737-9_4]
[21]
Cooperstock R. Sex differences in psychotropic drug use. Soc Sci Med 1978; 12(3B): 179-86.
[PMID: 725615]
[22]
Bronstein AC, Spyker DA, Cantilena LR Jr, Rumack BH, Dart RC. 2011. Annual report of the American Association of Poison Control Centers’ National Poison data system (NPDS): 29th annual report. Taylor & Francis 2012.
[http://dx.doi.org/10.3109/15563650.2012.746424]
[23]
Buckland PR. Will we ever find the genes for addiction? Addiction 2008; 103(11): 1768-76.
[http://dx.doi.org/10.1111/j.1360-0443.2008.02285.x] [PMID: 18705689]
[24]
Wang J-C, Kapoor M, Goate AM. The genetics of substance dependence. Annu Rev Genomics Hum Genet 2012; 13: 241-61.
[http://dx.doi.org/10.1146/annurev-genom-090711-163844] [PMID: 22703173]
[25]
Wojcik SM, Tantra M, Stepniak B, et al. Genetic markers of a Munc13 protein family member, BAIAP3, are gender specifically associated with anxiety and benzodiazepine abuse in mice and humans. Mol Med 2013; 19(1): 135-48.http: //www.ncbi.nlm. nih.gov/pmc/articles/PMC3745598/ [Internet].
[http://dx.doi.org/10.2119/molmed.2013.00033] [PMID: 23698091]
[26]
Herman RJ, Wilkinson GR. Disposition of diazepam in young and elderly subjects after acute and chronic dosing. Br J Clin Pharmacol 1996; 42(2): 147-55.
[http://dx.doi.org/10.1046/j.1365-2125.1996.03642.x] [PMID: 8864311]
[27]
Yaraghi A, Eizadi-Mood N, Katani M, et al. Arterial blood gas analysis and the outcome of treatment in tricyclic antidepressants poisoned patients with benzodiazepine coingestion. Anesthesiol Res Pract 2015; 2015 232401
[http://dx.doi.org/10.1155/2015/232401]
[28]
Eizadi-Mood N, Sabzghabaee AM, Saghaei M, Gheshlaghi F, Mohammad-Ebrahimi B. Benzodiazepines co-ingestion in reducing tricyclic antidepressant toxicity. Med Arh 2012; 66(1): 49-52.
[http://dx.doi.org/10.5455/medarh.2012.66.49-52] [PMID: 22482344]
[29]
Buckley NA, Dawson AH, Whyte IM, O’Connell DL. Relative toxicity of benzodiazepines in overdose. BMJ 1995; 310(6974): 219-21.
[http://dx.doi.org/10.1136/bmj.310.6974.219] [PMID: 7866122]
[30]
Isbister GK, O’Regan L, Sibbritt D, Whyte IM. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol 2004; 58(1): 88-95.
[http://dx.doi.org/10.1111/j.1365-2125.2004.02089.x] [PMID: 15206998]
[31]
An H, Godwin J. Flumazenil in benzodiazepine overdose. CMAJ 2016; 188(17-18) E537
[32]
Chew E, Zafonte RD. Pharmacological management of neurobehavioral disorders following traumatic brain injury--a state-of-the-art review. J Rehabil Res Dev 2009; 46(6): 851-79.
[http://dx.doi.org/10.1682/JRRD.2008.09.0120] [PMID: 20104408]
[33]
de Sonneville LM, Njiokiktjien C, Hilhorst RC. Methylphenidate-induced changes in ADDH information processors. J Child Psychol Psychiatry 1991; 32(2): 285-95.
[http://dx.doi.org/10.1111/j.1469-7610.1991.tb00307.x] [PMID: 2033109]
[34]
ADHD.. clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Am Acad Pediatr 2011; 2011-654.
[35]
Levin HS, Peters BH, Kalisky Z, et al. Effects of oral physostigmine and lecithin on memory and attention in closed head-injured patients. Cent Nerv Syst Trauma 1986; 3(4): 333-42.
[http://dx.doi.org/10.1089/cns.1986.3.333] [PMID: 3555852]
[36]
Plenger PM, Dixon CE, Castillo RM, Frankowski RF, Yablon SA, Levin HS. Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: a preliminary double-blind placebo-controlled study. Arch Phys Med Rehabil 1996; 77(6): 536-40.
[http://dx.doi.org/10.1016/S0003-9993(96)90291-9] [PMID: 8831468]
[37]
Scheidtmann K, Fries W, Müller F, Koenig E. Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study. Lancet 2001; 358(9284): 787-90.
[http://dx.doi.org/10.1016/S0140-6736(01)05966-9] [PMID: 11564483]

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