TY - JOUR
T1 - Interdose elevation in plasma cortisol during chronic treatment with alprazolam but not lorazepam in the elderly
AU - Pomara, Nunzio
AU - Willoughby, Lisa M.
AU - Ritchie, James C.
AU - Sidtis, John J.
AU - Greenblatt, David J.
AU - Nemeroff, Charles B.
N1 - Funding Information:
We thank Dr Bruno P Imbimbo from Chiesi Farmaceutici, Parma, Italy, for valuable comments on earlier versions of this manuscript. This study was supported in part by Grant R01 MH42499 (NP), MH42088 (CBN), and MH52899 (CBN)
PY - 2004/3
Y1 - 2004/3
N2 - Benzodiazepines (BZPs) have been shown to reduce hypothalamic-pituitary- adrenal (HPA) axis activity acutely in normal humans. In contrast the effects of chronic BZP treatment on the HPA axis have not been well studied, especially in the geriatric population. This study examined the acute and chronic effects (3 weeks) of alprazolam and lorazepam on plasma cortisol in 68 subjects (60-83 years) who received 0.25 or 0.50 mg b.i.d. alprazolam, or 0.50 or 1.0 mg b.i.d. lorazepam, or placebo orally according to a randomized, double-blind, placebo-controlled parallel design. Memory assessment and blood samples for plasma cortisol were obtained prior to the morning dose on days 0, 7, 14, and 21, and at 1, 2.5, and 5 h postdrug on days 0 and 21. Assessments of anxiety and depression were carried out at days 0, 7, 14, and 21 before drug administration. Plasma cortisol was affected compared to placebo only by the 0. 5 mg alprazolam dose. During the first and the last day of treatment, there was a significant drop in cortisol at 2.5 h after alprazolam compared to placebo. The predose cortisol levels increased significantly during chronic alprazolam treatment, and correlations were found between these cortisol changes and changes in depression, anxiety, and memory scores. These findings suggest that even a short period of chronic treatment with alprazolam, but not lorazepam, may result in interdose HPA axis activation in the elderly, consistent with drug withdrawal. If confirmed, this effect may contribute to an increased risk for drug escalation and dependence during chronic alprazolam treatment.
AB - Benzodiazepines (BZPs) have been shown to reduce hypothalamic-pituitary- adrenal (HPA) axis activity acutely in normal humans. In contrast the effects of chronic BZP treatment on the HPA axis have not been well studied, especially in the geriatric population. This study examined the acute and chronic effects (3 weeks) of alprazolam and lorazepam on plasma cortisol in 68 subjects (60-83 years) who received 0.25 or 0.50 mg b.i.d. alprazolam, or 0.50 or 1.0 mg b.i.d. lorazepam, or placebo orally according to a randomized, double-blind, placebo-controlled parallel design. Memory assessment and blood samples for plasma cortisol were obtained prior to the morning dose on days 0, 7, 14, and 21, and at 1, 2.5, and 5 h postdrug on days 0 and 21. Assessments of anxiety and depression were carried out at days 0, 7, 14, and 21 before drug administration. Plasma cortisol was affected compared to placebo only by the 0. 5 mg alprazolam dose. During the first and the last day of treatment, there was a significant drop in cortisol at 2.5 h after alprazolam compared to placebo. The predose cortisol levels increased significantly during chronic alprazolam treatment, and correlations were found between these cortisol changes and changes in depression, anxiety, and memory scores. These findings suggest that even a short period of chronic treatment with alprazolam, but not lorazepam, may result in interdose HPA axis activation in the elderly, consistent with drug withdrawal. If confirmed, this effect may contribute to an increased risk for drug escalation and dependence during chronic alprazolam treatment.
KW - Alprazolam
KW - Cortisol
KW - Elderly
KW - Lorazepam
KW - Tolerance
KW - Withdrawal
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U2 - 10.1038/sj.npp.1300365
DO - 10.1038/sj.npp.1300365
M3 - Article
C2 - 14694352
AN - SCOPUS:1642332888
VL - 29
SP - 605
EP - 611
JO - Neuropsychopharmacology
JF - Neuropsychopharmacology
SN - 0893-133X
IS - 3
ER -