Interdose elevation in plasma cortisol during chronic treatment with alprazolam but not lorazepam in the elderly

Nunzio Pomara, Lisa M. Willoughby, James C. Ritchie, John J. Sidtis, David J. Greenblatt, Charles Nemeroff

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)605-611
Number of pages7
JournalNeuropsychopharmacology
Volume29
Issue number3
DOIs
StatePublished - Mar 1 2004
Externally publishedYes

Fingerprint

Alprazolam
Lorazepam
Hydrocortisone
Placebos
Benzodiazepines
Therapeutics
Anxiety
Depression
Geriatrics
Pharmaceutical Preparations
Substance-Related Disorders

Keywords

  • Alprazolam
  • Cortisol
  • Elderly
  • Lorazepam
  • Tolerance
  • Withdrawal

ASJC Scopus subject areas

  • Pharmacology

Cite this

Interdose elevation in plasma cortisol during chronic treatment with alprazolam but not lorazepam in the elderly. / Pomara, Nunzio; Willoughby, Lisa M.; Ritchie, James C.; Sidtis, John J.; Greenblatt, David J.; Nemeroff, Charles.

In: Neuropsychopharmacology, Vol. 29, No. 3, 01.03.2004, p. 605-611.

Research output: Contribution to journalArticle

Pomara, Nunzio ; Willoughby, Lisa M. ; Ritchie, James C. ; Sidtis, John J. ; Greenblatt, David J. ; Nemeroff, Charles. / Interdose elevation in plasma cortisol during chronic treatment with alprazolam but not lorazepam in the elderly. In: Neuropsychopharmacology. 2004 ; Vol. 29, No. 3. pp. 605-611.
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