Sally Guthrie

Effects of Ethanol on Drug and Metabolite Pharmacokinetics

SummaryPharmacokinetic interactions of ethanol with other drugs, including its effects upon drug metabolite disposition, are reviewed in terms of clearance concepts. This approach is particularly useful in understanding the mechanisms of ethanol-drug interactions, i.e. in separating the effects of ethanol upon drug clearance, volume of distribution and plasma protein binding. The application of clearance concepts provides the basis for understanding the qualitative differences in ethanol interactions with low and high hepatic extraction ratio drugs.The effects of short and long term ethanol consumption upon different types of drug metabolism (oxidative, acetylation and glucuronidation) have been considered. Long term ethanol consumption may increase the clearance of a drug by induction of oxidative metabolism whereas short term consumption may decrease the clearance of such a drug. Clearance by N-acetylation appears to be increased in the presence of ethanol, and clearance by conjugation to glucuronic acid is decreased for some drugs by single-dose consumption of ethanol.

Plasma norepinephrine responses to cold challenge in depressed patients and normal controls.

Thirty depressed patients were compared with 39 controls for their plasma norepinephrine (NE) levels in relation to a cold challenge (placing a hand in ice cold water for 1 minute). Depressed patients showed significantly higher plasma NE levels than controls. Unipolar, but not bipolar patients, had significantly higher plasma NE levels than age- and sex-matched controls. Unipolar melancholic patients who were nonsuppressors on the dexamethasone suppression test showed a strong trend to have higher plasma NE levels than suppressors. These results are further evidence that the NE system is dysregulated in depression.

Clinical studies on norepinephrine metabolism: how to interpret the numbers.

Metabolism, synthesis rates, and pharmacokinetics of major metabolites of endogenous norepinephrine were investigated in 38 drug-free depressed patients receiving a low monoamine diet on a closed ward. In a group of 21 patients, plasma and cerebrospinal fluid (CSF) concentrations of 3-methoxy-4-hydroxyphenyl-glycol (MHPG) correlated positively, but not significantly. In two groups of eight patients each, effects of desipramine and zimelidine on the central production rate of MHPG were examined using CSF and urine data. Both desipramine and zimelidine significantly reduced the central production rate of MHPG.

Regional brain [11C]carfentanil binding following tobacco smoking

Objective To determine if overnight tobacco abstinent carriers of the AG or GG (*G) vs. the AA variant of the human mu opioid receptor (OPRM1) A118G polymorphism (rs1799971) differ in [11C]carfentanil binding after tobacco smoking. Methods Twenty healthy American male smokers who abstained from tobacco overnight were genotyped and completed positron emission tomography (PET) scans with the mu opioid receptor agonist, [11C]carfentanil. They smoked deniconized (denic) and average nicotine (avnic) cigarettes during the PET scans. Results Smoking avnic cigarette decreased the binding potential (BPND) of [11C]carfentanil in the right medial prefrontal cortex (mPfc; 6,56,18), left anterior medial prefrontal cortex (amPfc; −2,46,44), right ventral striatum (vStr; 16, 3, −10), left insula (Ins; −42,10, −12), right hippocampus (Hippo; 18, −6, −14) and left cerebellum (Cbl; −10, −88, −34), and increased the BPND in left amygdala (Amy; −20,0, −22), left putamen (Put; −22, 10, −6) and left nucleus accumbens (NAcc; −10,12, −8). In the AA allele carriers, avnic cigarette smoking significantly changed the BPND compared to after denic smoking in most brain areas listed above. However in the *G carriers the significant BPND changes were confirmed in only amPfc and vStr. Free mu opioid receptor availability was significantly less in the *G than the AA carriers in the Amy and NAcc. Conclusion The present study demonstrates BPND changes induced by avnic smoking in OPRM1 *G carriers were blunted compared to the AA carriers. Also *G smokers had less free mu opioid receptor availability in Amy and NAcc.