Opioid antagonist

Naltrexone (Trexan) is the only opioid antagonist currently in use for treatment of addiction. Naloxone is used to treat opioid overdose and to test for opioid addiction but has a short half-life and is relatively ineffective orally cyclazocine s dysphoric side effects make it unacceptable (Resnick et al. 1980). Patients who are likely to continue to use naltrexone and to benefit from treatment are those who have established careers (e.g., health professionals) and family support and are well motivated. Up to 70% of such clients are abstinent at 1-year follow-up (Washton et al. 1984). Programs that utili2e additional rehabilitative services have better results than those that provide minimal services. Successful treatment is also associated with taking naltrexone 

At the doses used, there is blockage of the effects of as much as 25 mg of injected heroin. Toxicity in heroin addicts is low, but some reported subtle adverse effects of naltrexone such as decreased energy (Hollister et al. 1981). Nonaddicted obese subjects have been known to develop markedly elevated transaminase levels at doses of 300 mg/day (Mitchell et al. 1987). The inference has been drawn that high doses are potentially hepatotoxic (Pfohl et al. 1986), and the drug is contraindicated in liver failure or acute hepatitis. 

Portoghese and Suzuki have studied the possibility of reducing the undesirable side effects of p opioid agonists by combining them with a 8 opioid antagonist. This concept is based on the cross-talk among all three types of opioid receptors. 

Kamei and colleagues discovered that an opioid network was involved in the cough reflex. A selective 8 antagonist, TRK-851 (Toray, Fig. 3), is a clinical candidate in development as an antitussive agent [6]. This compound will be discussed in detail in Sect. 2. 

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Substitution of Trp by D-Trp increased the potency of somatostatin (101). Most other substitutions, however, are deleterious to biological activity. Cychc octapeptide analogues of somatostatin retain high potency one of them, CTOP, is a potent mu-opioid antagonist. 

Inhibition of human multidrug resistance P-glycoprotein 1 was investigated by analogs of a potent. 5-opioid antagonist, including (35, 1 lu5)-3-[(4-hydroxy-2,6-dimethylphenyl)methyl]-11,11 u-dihydro-2//-pyrazino[l, 1-b] isoquinoline-l,4(3//,6//)-dione (OIMIIO). Opioid antagonist activity of... 

Opioidergic agents. Naltrexone and nalmefene, opioid antagonists with no intrinsic agonist properties, have been studied for the treatment of alcohol dependence. Naltrexone has been studied much more extensively than nalmefene for this indication. In 1984 naltrexone was approved by the FDA for the treatment of opioid dependence, and in 1994 it was approved for the treatment of alcohol dependence. Nalmefene is approved in the United States as a parenteral formulation for the acute reversal of opioid effects (e.g., after opioid overdose or analgesia). 

Summary. Currently, the most promising agents that directly reduce alcohol consumption are the opioid antagonists and acamprosate. Further re-... 

Srisurapanont M, Jamsuraisin N Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev (2) CD001867, 2002... 

The term opioid refers to any exogenous substance that acts as an agonist at any of several receptors. Opioid antagonists are drugs that bind to a receptor but produce no actions. The poppy plant, Papaver somniferum, from which opium is obtained, is grown in many areas of the world. Morphine constitutes 10% of opium, and codeine can be obtained direcdy from opium. Semisynthetic opioids such as heroin and oxycodone are obtained directly or indirectly from morphine. There are other distinct chemical classes of drugs with opioid actions, including the methadones. 

Administration of sufficient doses of an opioid antagonist after only a single therapeutic dose of morphine results in withdrawal phenomena (Bickel et al. 1987 Heishman et al. 1989 Jones 1979). Some degree of physical dependence... 

Ultrarapid detoxification employs general anesthesia and opioid antagonists to accomplish withdrawal more quickly (Alvarez and Carmen del Rio 1999 Bell et al. 1999 Brewer et al. 1998 Brewer and Maksoud 1997 Gerra et al. 2000 Kleber 1998 Rabinowitz et al. 1998 SanandArranz 1999 Shreeram et al. 2001 Stephenson 1997 Strang et al. 1997). Its efficacy and safety are being studied. 

Bossert JM, Franklin KB Pentobarbital-induced place preference in rats is blocked by GABA, dopamine, and opioid antagonists. Psychopharmacology (Bed) 157 115— 122, 2001... 

The opioid antagonists naloxone and naltrexone bind to aU three opioid receptors, p, K, and 8. These compounds are antagonists due to their inability to elicit downstream effects of these receptors once bound (Sarton et al. 2008 Yaksh and Rudy 1977). Interestingly, both antagonists have a high binding affinity for MORs. Naloxone is used to reverse the effects of an acute opioid overdose because of its rapid onset of action. Naltrexone elicits similar actions, but has a longer onset and duration of action and hence, is used for the maintenance of treatment for opioid addicts. 

Henry, B and Brotchie, JM (1996) Potential of opioid antagonists in the treatment of levodopa, induced dyskinesias in Parkinson s disease. Drugs and Ageing 9 149-158. 

The intoxicating effects of opioids appear to be due to their action as agonists on mu (p) receptors of the opioid neurotransmitter system. Competitive p opioid antagonists such as naloxone and naltrexone acutely reverse many of the adverse effects of opioids. To date we do not have specific antagonists for most other abused substances, so rapid pharmacologic reversal of intoxication is usually not possible. 

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