Discriminative Stimulus Effects Of Midazolam Research Articles

The discriminative stimulus effects of midazolam are resistant to modulation by morphine, amphetamine, dizocilpine, and γ-butyrolactone in rhesus monkeys

Although abuse of benzodiazepines alone is uncommon, it is high in polydrug abusers, including those who primarily use opioids or stimulants. This study investigated whether drugs that are abused (e.g., amphetamine) or drugs that have mechanisms of action similar to abused drugs (e.g., morphine) alter the discriminative stimulus effects of the benzodiazepine midazolam. Three rhesus monkeys discriminated 0.56 mg/kg of midazolam while responding under a fixed-ratio 10 schedule of food presentation. Dose-effect curves were determined for midazolam alone and in the presence of morphine (opioid receptor agonist), amphetamine (dopamine receptor indirect agonist), dizocilpine (N-methyl-D: -aspartic acid receptor antagonist), or γ-butyrolactone (prodrug of γ-hydroxybutyrate, which acts primarily at GABA(B) receptors). Doses of midazolam larger than 0.32 mg/kg produced ≥80% midazolam-lever responding. When administered alone, morphine, amphetamine, dizocilpine, and γ-butyrolactone did not produce midazolam-lever responding, although large doses of each drug eliminated responding; when administered in combination with midazolam, they did not alter the discriminative stimulus effects of midazolam up to doses that markedly decreased response rates. The current study demonstrates a lack of modulation of the discriminative stimulus effects of midazolam by morphine, amphetamine, dizocilpine, and γ-butyrolactone. Other effects of benzodiazepines, such as their reinforcing effects, might be altered by these other drugs, or benzodiazepines might modulate the discriminative stimulus or reinforcing effects of the other drugs, which might contribute to the relatively high incidence of benzodiazepine abuse among polydrug abusers.

Dizocilpine enhances the discriminative stimulus effects of midazolam in rats discriminating pregnanolone

The discriminative stimulus effects of the neuroactive steroid pregnanolone are thought to be mediated by multiple neurotransmitter systems including positive modulation at GABAA receptors and antagonism of NMDA receptors. This study investigated the contribution of different receptor mechanisms by establishing pregnanolone as a discriminative stimulus and studying the NMDA receptor antagonist dizocilpine alone and in combination with the positive GABAA modulator midazolam. Male Sprague‐Dawley rats (n=10) discriminated pregnanolone (7.5 mg/kg, i.p.) and responded under a fixed ratio 10 schedule for food. Pregnanolone and midazolam produced >80% pregnanolone‐lever responding. In contrast, dizocilpine produced >80% pregnanolone‐lever responding in two rats and <20% pregnanolone‐lever responding in the remaining eight rats, while the mu opioid receptor agonist morphine produced predominantly vehicle‐lever responding. When administered 30 minutes before sessions, dizocilpine shifted the midazolam dose‐effect curve leftward 2‐ to 6‐fold; however, morphine did not alter the midazolam dose‐effect curve. Although dizocilpine did not substitute for pregnanolone, enhancement of the effects of midazolam by dizocilpine suggests that the pregnanolone discriminative stimulus has both GABAA and NMDA components.

Multiple receptors may mediate the behavioral effects of benzodiazepine‐site (BZ) ligands in monkeys

These studies examined the behavioral effects of two novel BZ ligands, NsA and NsB. These compounds nonselectively bind GABAA1, GABAA2, and GABAA3 receptors with little or no efficacy at GABAA1 receptors and weak positive modulatory actions at GABAA2 and GABAA3 receptors. Effects were evaluated in squirrel monkeys (n=3–4) trained to respond either under a multiple fixed-ratio (FR) schedule of punished and nonpunished behavior or to discriminate 0.3 mg/kg midazolam from saline. NsA and NsB, 1-30 mg/kg, had mild and inconsistent effects on punished responding, and produced greater than 90% drug-lever responding in only one monkey. Neither of the novel compounds had response rate-decreasing effects over the doses tested. Further studies examined the abilities of NsA and NsB to antagonize the antipunishment and discriminative stimulus effects of three commonly used BZ agonists, midazolam (0.1–10 mg/kg), lorazepam (0.3–18 mg/kg), and zolpidem (0.1–10 mg/kg). NsA, 1–10 mg/kg, effectively antagonized the antipunishment effects of midazolam, lorazepam and zolpidem, and the discriminative stimulus effects of midazolam and lorazepam, but not zolpidem. In contrast, 1–10 mg/kg NsB antagonized the discriminative stimulus effects of midazolam but not zolpidem or lorazepam, and the antipunishment effects of lorazepam but not midazolam or zolpidem. These results suggest that ligands with varying efficacy at GABAA subtypes may differentially antagonize the behavioral effects of benzodiazepines, and may yield useful tools for understanding BZ pharmacology. (PHS: DA15723, DA11453, DA7252)

Combined discriminative stimulus effects of midazolam with other positive GABAA modulators and GABAA receptor agonists in rhesus monkeys

Interactions among compounds at GABA(A) receptors might have important implications for the therapeutic and other effects of positive GABA(A) modulators (e.g. benzodiazepines). This study examined whether a midazolam discriminative stimulus is modified by GABA(A) agonists that act at sites other than benzodiazepine sites. Rhesus monkeys discriminating midazolam (0.32 mg/kg SC) received direct-acting GABA(A) receptor agonists (e.g. muscimol and gaboxadol), an indirect-acting GABA(A) receptor agonist (progabide), ethanol, another benzodiazepine (triazolam), a barbiturate (pentobarbital), or a neuroactive steroid (pregnanolone) alone and in combination with midazolam. When administered alone, triazolam (0.1 mg/kg), pentobarbital (17.8 mg/kg) and pregnanolone (5.6 mg/kg) occasioned high levels of midazolam lever responding, ethanol (1-3 g/kg) occasioned intermediate levels of midazolam lever responding, and muscimol (0.32-1 mg/kg), gaboxadol (3.2-10 mg/kg) and progabide (10-32 mg/kg) occasioned low levels of midazolam lever responding. When combined with less-than-fully effective doses of midazolam, progabide (32 mg/kg) and ethanol (1 g/kg), but not muscimol and gaboxadol, enhanced the midazolam discriminative stimulus. Triazolam, pregnanolone and pentobarbital increased the potency of midazolam to occasion midazolam lever responding and the effects of these combinations were additive. Direct-acting GABA(A) receptor agonists are qualitatively different from positive GABA(A) modulators in rhesus monkeys trained to discriminate midazolam. Although GABA(A) receptor agonists and modulators can enhance the actions of benzodiazepines at the GABA(A) receptor complex, the same drugs do not necessarily modify the discriminative stimulus effects of benzodiazepines. These results underscore the importance of the mechanism by which drugs alter Cl(-) flux at the GABA(A) receptor complex as a determinant not only of drug action but also of drug interaction and whether any particular drug enhances the behavioral effects of a benzodiazepine.

Discriminative stimulus effects of positive GABAA modulators and other anxiolytics, sedatives, and anticonvulsants in untreated and diazepam-treated monkeys.

Positive GABAA modulators and other sedatives, anxiolytics, and anticonvulsants were used to evaluate mechanisms underlying the discriminative stimulus effects of midazolam in untreated monkeys and of flumazenil in monkeys treated with diazepam (5.6 mg/kg/day). Positive GABAA modulators at benzodiazepine (e.g., flunitrazepam and abecarnil) and neuroactive steroid sites (e.g., androsterone) substituted for midazolam in all monkeys; the neuroactive steroids dihydroandrosterone and epipregnanolone substituted for midazolam in two of three monkeys. All positive GABAA modulators attenuated flumazenil in diazepam-treated monkeys; doses of flunitrazepam and abecarnil larger than doses substituting for midazolam were required to attenuate flumazenil, whereas doses of neuroactive steroids smaller than doses substituting for midazolam attenuated flumazenil. Drugs with mechanisms that do not predominantly involve allosteric modulation of GABA (e.g., buspirone, ketamine, valproic acid, and diphenhydramine) did not substitute for midazolam or flumazenil. However, valproic acid enhanced the midazolam discriminative stimulus and attenuated the flumazenil discriminative stimulus; diphenhydramine attenuated the midazolam discriminative stimulus. These results suggest that drugs not sharing a mechanism of action with benzodiazepines can modulate the behavioral effects of benzodiazepines. In addition, this study demonstrates that endogenous ligands, presumably by acting at neuroactive steroid sites on the GABAA receptor complex, share discriminative stimulus effects with benzodiazepines. This study also suggests that positive GABAA-modulating neuroactive steroids are especially potent in attenuating behavioral effects that are related to diazepam withdrawal.

Discriminative stimulus effects of benzodiazepine (BZ)(1) receptor-selective ligands in rhesus monkeys.

Drug discrimination was used to examine the effects of benzodiazepine (BZ)(1) receptor-selective ligands in rhesus monkeys. In diazepam-treated (5.6 mg/kg, p.o.) monkeys discriminating the nonselective BZ antagonist flumazenil (0.32 mg/kg, s.c.), the BZ(1)-selective antagonist beta-carboline-3-carboxylate-t-butyl ester (beta-CCt) substituted for flumazenil. The onset of action of beta-CCt was delayed with a dose of 5.6 mg/kg beta-CCt substituting for flumazenil 2 h after injection. In monkeys discriminating the nonselective BZ agonist midazolam (0.56 mg/kg, s.c.), the BZ(1)-selective agonists zaleplon (ED(50) = 0.78 mg/kg) and zolpidem (ED(50) = 1.73 mg/kg) substituted for midazolam. The discriminative stimulus effects of midazolam, zaleplon, and zolpidem were antagonized by beta-CCt (1.0-5.6 mg/kg, s.c.), and the effects of zaleplon and zolpidem were also antagonized by flumazenil (0.01-0.32 mg/kg, s.c.). Schild analyses supported the notion of a simple, competitive interaction between beta-CCt and midazolam (slope = -1.08; apparent pA(2) = 5.41) or zaleplon (slope = -1.57; apparent pA(2) = 5.49) and not between beta-CCt and zolpidem. Schild analyses also were consistent with a simple, competitive interaction between flumazenil and zaleplon (slope = -1.03; apparent pA(2) = 7.45) or zolpidem (slope = -1.11; apparent pA(2) = 7.63). These results suggest that the same BZ receptor subtype(s) mediate(s) the effects of midazolam, zolpidem, and zaleplon under these conditions and that selective binding of BZ ligands does not necessarily confer selective effects in vivo.

Post-injection delays in experimental chambers, but not in home cages, produce both sensitization and tolerance of operant behaviour to midazolam: relation to pharmacokinetics.

The effects of post-injection delay time and environmental context on behaviour after subcutaneous administration of 3 mg/kg midazolam were investigated under a differential reinforcement of low rate schedule (i.e. DRL 45 s) in 3 h sessions. Post-injection delays were varied (0-120 min) for two groups of rats placed in either the experimental chamber (group 1) or home cage (group 2) during the pre-session delay times. Midazolam increased shorter-response (inter-response times < 45 s) rates and decreased reinforcement rates in a time-related manner. Reinforcement rate-time profiles were also integrated with parallel pharmacokinetics. Post-injection delays in either environment yielded performances that mirrored the pharmacokinetic profile operative at the corresponding time-delay points. At higher concentrations (> 0.12 microg/ml) the pharmacokinetics of midazolam largely determined the behavioural effects in both groups, regardless of post-injection delays. However, at lower drug concentrations, longer post-injection delays (> 60 min) in the experimental chamber produced both sensitization and tolerance, as measured by greater increases in shorter-response rates and a more rapid return of the reinforcement rate, respectively. Interaction of the discriminative stimulus effects of midazolam with the context probably alters the magnitude of behavioural effects when the delay occurs in the experimental chambers, whereas no such interaction is present in group 2. The DRL schedule with post-injection delays in experimental chambers provides a useful behavioural paradigm for studying both sensitization and tolerance.

The Influence of Menstrual Cycle Phase on Sensitivity to Ethanol-Like Discriminative Stimulus Effects of GABA A-Positive Modulators

Previous studies showed that sensitivity to the ethanol-like discriminative stimulus effects of allopregnanolone and ethanol are enhanced during the luteal phase of the menstrual cycle when progesterone levels peak in monkeys trained to discriminate 1.0 g/kg ethanol. The present study further explored the influence of the menstrual cycle phase on the discriminative stimulus effects of ethanol, allopregnanolone, and midazolam. Female adult cynomolgus monkeys ( Macaca fascicularis) were trained to discriminate 1.0 g/kg ethanol ( n = 3) or 2.0 g/kg ethanol ( n = 4) (20% w/v; IG) from water (IG). A cumulative dosing procedure was used to test discriminative stimulus effects of ethanol (0.5–2.5 g/kg; IG) and the ethanol-like discriminative stimulus effects of allopregnanolone (0.1–1.0 mg/kg; IV) or midazolam (1.0–17 mg/kg; IG) during the follicular vs. luteal phase of the menstrual cycle. In the 2.0-g/kg group, sensitivity to the ethanol- like effects of allopregnanolone was increased during the luteal vs. follicular phase in two of three monkeys. In contrast, average sensitivity to ethanol was not different in the luteal compared to the follicular phase in the 2.0-g/kg group. Finally, there was no difference in sensitivity to midazolam between the follicular and luteal phases in monkeys trained with either 2.0 g/kg or 1.0 g/kg ethanol. Overall, the ethanol-like discriminative stimulus effects of midazolam are not sensitive to the menstrual cycle phase. In addition, there was less influence of the menstrual cycle phase on allopregnanolone and ethanol sensitivity in a 2.0-g/kg compared to a 1.0-g/kg ethanol training dose.

Punishment alters the discriminative stimulus effects of midazolam.

Experiment 1 examined the effects of punishment on the discriminative stimulus (DS) effects of midazolam (M) and pentobarbital (P) in 3 pigeons. Sessions began with a fixed-interval (FI) 3-min schedule of food reinforcement. After 40 min, either saline (S) or 0.56 mg/kg of M was injected. A drug-discrimination (DD) component began 10 min later. Pecking the left key produced grain after S injections, whereas pecking the right key produced grain after M. Dose-response curves for M and P were obtained under these conditions and also when every 30th peck during the FI was punished by shock. The introduction of punishment increased sensitivity to the DS effects of M and P. Experiment 2 examined whether a punishment history increases sensitivity to the DS effects of M. After DD training and testing, pecking was punished for 10 sessions. This history shifted the M dose-response curve to the left for 3 of 4 pigeons. These results emphasize the contribution of behavioral variables to the DS effects of drugs. Environmental variables appear to play a prominent role in guiding sensitivity to the subjective effects of drugs.

Punishment alters the discriminative stimulus effects of midazolam.

Punishment alters the discriminative stimulus effects of midazolam.

Discriminative stimulus effects of midazolam and abecarnil in rats treated chronically with diazepam or abecarnil.

Abecarnil (ABC) is a beta-carboline that acts as an agonist at benzodiazepine (BZD) receptors. It possesses anxiolytic and anticonvulsant properties, but produces little sedation and is without muscle relaxant effects. To explain this unusual profile of activity, two hypotheses have been advanced: either 1) ABC acts as a partial agonist or 2) ABC acts as a full agonist, but only at a sub-population of BZD receptors. The present experiment used cross-tolerance profiles between BZDs and ABC to differentiate these hypotheses based upon predictions of receptor theory: tolerance produced to a full agonist should confer even greater cross-tolerance to a partial agonsit. Rats were trained in a three-choice drug discrimination procedure to detect the benzodiazepine, midazolam (MDZ, 1.0 mg/kg) from pentylenetetrazole (PTZ, 20 mg/kg) from saline. Tested acutely, MDZ and ABC substituted for MDZ with similar potencies. Following chronic treatment with the BZD-agonist diazepam (DZP; 20 mg/kg per 8 h for 7 days), both the MDZ and ABC dose-effect curves were significantly shifted to the right, and both drugs showed a comparable three-fold decrease in potency. The chronic administration of ABC (4.0 mg/kg per 8 h for 7 days) produced a different spectrum of results. No significant shift occurred in the MDZ dose-effect curve, but there was a significant seven-fold shift to the right of the ABC dose-effect curve. Throughout all test, PTZ-lever responding rarely occurred and did not account for more than 20% of lever selections for any individual test. These data support the hypothesis that ABC acts as a full agonist at a sub-population of BZD receptors, which mediate its substitution for MDZ.

Stereospecific transduction of behavioral effects via diazepam-insensitive GABA A receptors

Previous studies reported a positive correlation between ligand affinities at diazepam-insensitive GABA A receptors and substitution for the discriminative stimulus effects of the benzodiazepine receptor antagonist, flumazenil, in pigeons. In the present experiments, bretazenil and Ro 14-5974 (ethyl-( S)-11,12,13,13a-tetrahydro-9-oxo-9 H-imidazo[1,5-a]-pyrrolo-[2,1-c][1,4]benzodiazepine-1-carboxylate) partially substituted for, and blocked the discriminative stimulus effects of midazolam, congruent with their actions at diazepam-sensitive GABA A receptors in vitro. In addition, bretazenil and Ro 14-5974, but not their R-enantiomers, had high affinity for diazepam-insensitive receptors and fully substituted for the discriminative stimulus effects of flumazenil. The R-enantiomers of these compounds had low affinity ( K i > 1 μM) for diazepam-sensitive and diazepam-insensitive receptors, and did not share discriminative stimulus effects with flumazenil or midazolam. Ro 19-0528 (7-chloro-3-(3-cyclopropyl-1,2,4-oxadiazol-5-yl)-4,5-dihydro-5-methyl-6 H-imidazo[1,5-a][1,4]benzodiazepin-6-one), a structurally related compound with full agonist actions at diazepam-sensitive GABA A receptors, had high diazepam-insensitive receptor affinity ( K i = 96 nM) and partially substituted for the discriminative stimulus effects of flumazenil. These results are consistent with stereospecific mediation of the discriminative stimulus effects of flumazenil through high affinity binding to diazepam-insensitive receptors in pigeons.

Tolerance to the discriminative stimulus effects of midazolam

The ability of behavioral variables to modify the development of tolerance to the discriminative stimulus effects of midazolam was evaluated. Rats were trained to discriminate 0.32mg/kg s.c. or 1.0mg/kg i.p. midazolam from no-drug, under a two-lever procedure, in daily experimental sessions consisting of multiple discrete 20-min trials: 15-min time-out, followed by 5-min under a fixed-ratio 15 schedule of food pellet delivery. Generalization testing was accomplished by administering progressively increasing doses of midazolam before each time-out period. During the chronic phases, twice daily injections of 10mg/kg midazolam or saline were given while discrimination training was either suspended or continued; generalization gradients for midazolam were determined weekly for 4 weeks. Chronic saline given when training was continued or suspended produced slight fluctuations in the midazolam minimal discriminable dose (MDD) (the first dose of midazolam in an individual generalization gradient to produce >/=90% drug-lever responding). Tolerance developed to the discriminative stimulus effects of midazolam when chronic midazolam was given while training was suspended: at Week 4, chronic midazolam produced 3-to 57-fold rightward shifts in the midazolam generalization gradient. In contrast, continued training during chronic midazolam produced no tolerance to the discriminative stimulus effects of midazolam: at Week 4 of chronic midazolam the MDD of midazolam was not different from pre-chronic and not different from either saline condition. The effects of chronic midazolam on stimulus effects and response rates were differentiated: despite tolerance to the stimulus effects of midazolam, there were no consistent changes in response rates during chronic midazolam administration.

Comparison of the discriminative stimulus effects of midazolam after intracranial and peripheral administration in the rat

Rats were trained in a two-lever drug discrimination paradigm to discriminate midazolam (0.32 mg/kg, i.p. or 1.0 mg/kg, i.p.) from the no-drug condition. After completion of i.p. and s.c. midazolam generalization gradients (0.032–1.0 mg/kg), rats were surgically implanted with unilateral cannulae into the lateral ventricles. Intracerebroventricular (i.c.v.) doses of 1.1–44.2 μg midazolam were delivered to unrestrained rats. Midazolam produced dose-dependent increases in drug-appropriate responding by all three routes of administration, but was 2.4- to 4.3-fold more potent when given i.c.v. than when given s.c. or i.p. Midazolam, over the dose range tested, did not produce substantial decreases in response rate by any route of administration. The discriminative-stimulus effect of i.c.v. midazolam was blocked by peripherally administered flumazenil, and such antagonism was surmounted by a 2- to 5-fold increase in the i.c.v. midazolam dose. Taken together, these data suggest that the discriminative-stimulus effects of midazolam are mediated via central benzodiazepine (BZ) receptors.