Effect of quipazine and fluoxetine on analgesic-induced catalepsy and antinociception in the rat

Uses of fluoxetine in nociceptive pain management: A literature overview

Fluoxetine is one of the top ten prescribed antidepressants. Other therapeutic applications were approved for fluoxetine including, anxiety disorders, bulimia nervosa, and premature ejaculation. However, the role of fluoxetine in nociceptive pain management is still unclear. In this review, we discuss an overview of five possible roles of fluoxetine in pain management: intrinsic antinociceptive effect, enhancement of acute opioid analgesia, attenuation of tolerance development to opioid analgesia, attenuation of dependence development and abstinence syndrome, and attenuation of opioid induced hyperalgesia. Conflicting data were reported about fluoxetine intrinsic anti-nociceptive effect in preclinical and clinical studies except for inflammatory pain. Similar controversy was described in preclinical and clinical studies which explored the possible enhancement of opioid analgesia by fluoxetine co-administration. However, fluoxetine was found to have a promising effect on opioid tolerance and dependence in animal and human studies. Regarding opioid induced hyperalgesia, no studies examined fluoxetine effects in this regard. Our literature review revealed that, the most likely beneficial use of fluoxetine in nociceptive pain management is for alleviation of inflammatory pain and attenuation of opioid tolerance and dependence. Non-steroidal anti-inflammatory and corticosteroids carry many adverse effects and toxicities. Effective alleviation of opioid tolerance and dependence represents a huge health burden and growing unmet medical need. Moreover, most agents used to attenuate these phenomena are either experimental or poorly tolerable drugs which limit their transitional value. Fluoxetine offers an effective, safe, and tolerable alternative for management of both inflammatory pain and opioid tolerance and dependence presently available to clinicians.

Serotonergic influence on cholinergic-induced analgesia: differences in two inbred strains of mice

C57BL/6 (C57) and DBA/2 (DBA) inbred mice showed different analgesic responses to cholinergic stimulation. The simultaneous administration of muscarinic and serotonergic agonists, oxotremorine and 5-methoxy-NN-dimethyltryptamine (5-MeODMT), lowered the antinociceptive effect of the cholinergic drug in DBA mice, while no effects were detectable in the C57 strain. These results suggest a strain-dependent behavioural effect of the interaction of cholinergic and serotonergic neuronal systems.

Apparent antinociceptive properties of piperazine-type serotonin agonists: trifluoromethylphenylpiperazine, chlorophenylpiperazine, and MK-212

Squirrel monkeys were studied under a titration procedure in which responding adjusted the intensity of an electrical stimulus delivered to the tail (0.1-3.3 mA range in 15 steps). The 5-HT agonists trifluoromethylphenylpiperazine (TFMPP), chlorophenylpiperazine (mCPP), and 6-chloro-2(1-piperazinyl)pyrazine (MK-212) increased the intensity at which shock was maintained. The order of potency was: MK-212 greater than mCPP greater than TFMPP. Reductions in absolute rates of responding were small, and not related systematically to increases in shock intensity. Pretreatment with the nonselective 5-HT antagonist methysergide (0.1-1.0 mg/kg) resulted in a 3- to 10-fold shift to the right of the dose-effect curves for the 5-HT agonists. In contrast, the selective 5-HT2 antagonists ketanserin (0.3-1.7 mg/kg) and pirenperone (0.001-0.1 mg/kg) did not alter the effects of these agonists. This suggests that the apparent antinociceptive actions of these 5-HT agonists are probably mediated by effects at the 5-HT1 receptor subtype.

Fluoxetine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness

Fluoxetine is a new antidepressant which enhances serotoninergic neurotransmission through potent and selective inhibition of neuronal reuptake of serotonin. Metabolism by N-desmethylation occurs in man yielding desmethylfluoxetine, which also inhibits serotonin reuptake. Both the parent compound and metabolite possess elimination half-lives of several days facilitating the maintenance of steady-state plasma concentrations during long term treatment. Fluoxetine has overall therapeutic efficacy comparable with imipramine, amitriptyline and doxepin in patients with unipolar depression treated for 5 to 6 weeks, although it may be less effective than tricyclic antidepressants in relieving sleep disorders in depressed patients. Geriatric patients also responded as well to fluoxetine as to doxepin. The symptomatic improvement in patients with unipolar depression during short term fluoxetine treatment has been satisfactorily maintained when therapy was extended for at least 6 months: the relapse rate was low and similar to that of imipramine. Preliminary data have shown that patients with bipolar depression gained similar therapeutic benefit from fluoxetine or imipramine. Other preliminary trials have indicated that fluoxetine may be useful in obsessive-compulsive disorders. Usual doses of fluoxetine cause significantly fewer anticholinergic-type side effects than tricyclic antidepressants. Nausea, nervousness and insomnia are the most frequently reported fluoxetine-related adverse effects, but these have usually not been severe. Therapeutic doses of fluoxetine do not affect cardiac conduction intervals in patients without pre-existing cardiovascular disease and fluoxetine has been relatively safe in the small number of patients who have taken overdoses. It has not been clearly established whether some types of depression may respond more readily to fluoxetine than other antidepressants, and its overall therapeutic efficacy has not been compared with other second generation antidepressants. Thus, with its different and perhaps improved side effect profile compared with older tricyclic antidepressants, fluoxetine offers properties that could be used to advantage in many patients with depression.

5-HT-uptake inhibition potentiates antinociception induced by morphine, pethidine, methadone and ketobemidone in rats

The effect of the specific 5-HT-uptake inhibitor citalopram on the antinociception induced by morphine, pethidine, methadone and ketobemidone was examined in rats by means of the hot plate test. Further the 5-HT-uptake-inhibiting potency of these opioid-receptor stimulants was examined in vitro in rat brain synaptosomes. In doses devoid of antinociceptive activity, citalopram in a dose-dependent manner potentiated the antinociception induced by the four opioid analgesics. The potentiation of the ketobemidone-induced antinociception was not influenced by the spasmolytic agent A 29 (N,N-dimethyl-3,3-diphenyl-1-methylallylamine) which together with ketobemidone constitutes the active substances in Ketogan. The 5-HT-uptake-inhibiting potencies of the opioid receptor stimulants were from 21 to more than 56000 times lower than that of citalopram, the order of potency being methadone greater than pethidine greater than ketobemidone greater than morphine. The results support the suggested role of 5-HT in morphine-induced antinociception and indicate a similar role in the antinociceptive effect induced by other opioid-receptor stimulants.

Fluoxetine, a selective inhibitor of serotonin uptake, potentiates morphine analgesia without altering its discriminative stimulus properties or affinity for opioid receptors

The analgesic effect of morphine in the rat tail jerk assay was enhanced by the serotonin uptake inhibitor, fluoxetine. Tail jerk latency was not affected by fluoxetine alone. Morphine's affinity for opioid receptors labeled in vitro with 3H-naloxone or 3H-D-Ala2-D-Leu5-enkephalin was not altered by fluoxetine, which has no affinity for these sites at concentrations as high as 1000 nM. In rats trained to discriminate morphine from saline, fluoxetine at doses of 5 or 10 mg/kg were recognized as saline. Increasing the fluoxetine dose to 20 mg/kg did not result in generalization to either saline or morphine. The dose response curve for morphine generalization was not significantly altered by fluoxetine doses of 5 or 10 mg/kg. Those rats treated with the combination of morphine and 20 mg/kg of fluoxetine did not exhibit saline or morphine appropriate responding. Fluoxetine potentiates the analgesic properties of morphine without enhancing its affinity for opioid receptors or its discriminative stimulus properties.

Comparison of anorexia and motor disruption by cyclazocine and quipazine

The mixed narcotic agonist-antagonist cyclazocine and the 5-HT agonist quipazine disrupt food-rewarded fixed ratio-40 (FR-40) operant behavior in rats as a dose-dependent decrease in the number of reinforcers obtained and a reciprocal increase in the number of 10-second intervals between responding ("pausing"). This disruption has been shown to result in part from interaction with 5-HT neuronal systems, and may be a consequence of: (1) disruption of cognitive processes, (2) motivational impairment, or (3) motor deficits. To identify which of these components is (are) involved in the disruption of operant responding, female Sprague-Dawley rats were tested for food consumption, spontaneous locomotor activity, or rotarod performance following intraperitoneal injection of cyclazocine, quipazine, or both. Cyclazocine decreased food consumption at doses larger than those required to disrupt operant behavior, while quipazine decreased consumption at doses disruptive to operant responding. Little effect was exerted by either drug on spontaneous locomotor activity, while rotarod performance was disrupted only by very large doses of either drug relative to effects of FR-40 behavior. These data indicate that neither drug appears to disrupt operant behavior by causing gross motor deficits. Thus, cyclazocine may disrupt operant responding by impairing cognition, while quipazine may act through food satiation mechanisms.

Akinesia after locally applied morphine near the nucleus raphe pontis of the rat

Morphine (10 micrograms/microliter) was injected into different sites within the pontine brainstem in different groups of rats with indwelling guide cannulae. The rats were tested for the persistence of abnormal postures as a measure for the degree of akinesia. Local morphine was most effective in inducing akinesia at a site identical or close to the nucleus raphe pontis. Midline injections were effective in contrast to bilateral injections. Fenfluramine, a serotonin releaser, strongly potentiated morphine akinesia.

Naloxone alters the effects of LSD, DOM and quipazine on operant behavior of rats

Administration of the indolealkylamine hallucinogen d-lysergic acid diethylamide (LSD), the phenethylamine hallucinogen 2,5-dimethoxy-4-methylamphetamine (DOM) and the putative 5-hydroxytryptamine (5-HT) agonist quipazine all produced a dose-dependent decrease in fixed ratio (FR-40) response rates and a concomitant increase in the number of 10-second pause intervals. Although naloxone (4.0 mg/kg) had no effect on FR-40 responding per se, the pause-producing effects of LSD and, to a lesser extent, DOM were potentiated by pretreatment with naloxone. The action of quipazine on reinforcers was unaffected by combination with naloxone, while the effect on pause intervals was slightly attenuated by naloxone pretreatment. These data and previous studies suggest that the pause-producing effects of indolealkylamine and phenethylamine hallucinogens reflect their activation of a selective portion of brain 5-HT receptors. The potentiation of these effects by naloxone may relate to a modulation of central 5-HT systems by endogenous opioid mechanisms tending to restore an imbalance in various 5-HT pathways caused by the hallucinogenic 5-HT agonists. The more generalized disruptive effects of quipazine on brain 5-HT systems may be less susceptible to the endogenous opioid modulation or may actually combine with it to induce a greater disruption.

Test-dependent variations in the antinociceptive effect of p-chloroamphetamine-induced release of 5-hydroxytryptamine

p-Chloroamphetamine (PCA), in doses that did not significantly impair motor performance in a rotating-wheel task, induced marked analgesia in rats tested with the hot-plate and flinch-jump methods. In the tail-flick test, moderate hyper- or hypo-analgesia was found to be dependent on dose. In hot-plate experiments the analgesia was attenuated by inhibition of uptake of 5-HT (with zimelidine), depletion of stores of 5-HT (with PCPA) and by lesioning of 5-HT-containing terminals (long-term PCA treatment). Blockade of serotonin receptors by metergoline produced hyperalgesia, but failed to reduce the analgesia induced by p-chloroamphetamine. Manipulation of catecholaminergic and opioid systems did not reduce the effect of p-chloramphetamine. It is concluded that induction of release of 5-HT by chloroamphetamine induces antinociception which varies in magnitude between tests, suggesting that different serotonergic mechanisms modulate complex and reflex responses to noxious stimulation. The failure of metergoline to antagonize the analgesia induced by p-chloroamphetamine suggests an involvement of 5-HT receptors different from the ones implicated in other types of behaviour mediated by 5-HT.

Spinal 5-HT or NA uptake inhibition potentiates supraspinal morphine antinociception in rats

Spinal injection of the specific uptake inhibitor of 5-hydroxytryptamine (5-HT), citalopram, or of noradrenaline (NA), desipramine, potentiated the antinociception following intracerebroventricular injection of morphine in rats tested on the hot plate. Combined spinal injection of citalopram and desipramine caused a synergistic potentiation. The unselective and less potent inhibitor of both 5-HT and NA uptake, amitriptyline, did not cause potentiation. The results support the suggested involvement of both 5-HT and NA pathways in supraspinal morphine antinociception.

Differences in the effects of d-fenfluramine and morphine on various responses of rats to painful stimuli

The effects of d-fenfluramine and morphine on various nociceptive responses of rats were investigated. Unlike morphine, which inhibited all the responses examined, d-fenfluramine inhibited jumping and paw licking of rats on a hot plate, but did not increase the latency of tail withdrawal from hot water. The effects of d-fenfluramine on both responses on the hot plate were prevented by pretreatment with metergoline, a serotonin antagonist, whereas this pretreatment only reduced the effect of morphine on paw licking. The inhibition of tail withdrawal by morphine was also significantly reduced by metergoline treatment. The results confirm previous findings suggesting a role of serotonin in the mechanism by which morphine inhibits some nociceptive responses in rats. They also show that d-fenfluramine, a selective releaser and uptake inhibitor of serotonin at nerve endings, does not completely reproduce the antinociceptive effects of morphine in this species.

Serotonin-mimetic and antidepressant drugs on passive avoidance learning by olfactory bulbectomised rats

Olfactory bulbectomised rats were treated with drugs and their rate of acquisition of a passive avoidance task was measured. The acquisition-rate, which is disturbed by the bilateral ablations, was completely restored by acute administration of fenfluramine or fluoxetine. Partial restoration was found with quipazine. Clonidine was without effect. Repeated treatments with imipramine and mianserine improved passive avoidance of bulbectomised rats. Metergoline blocked these effects of imipramine and mianserin. These results indicate a serotonergic mechanism in the effect of antidepressants on olfactory bulbectomised rats.

Evidence against a serotonin involvement in the tonic descending inhibition of nociceptor-driven neurons in the cat spinal cord

To determine whether serotonin (5-HT) is involved in the powerful tonic descending inhibition which exists on dorsal horn nociceptor-driven neurons, their response to a noxious stimulus was tested with drugs that enhance (fluoxetine) or decrease (p-chlorophenylalanine) 5-HT synaptic activity. Neither the response with the spinal cord intact nor the enhanced response with the spinal cord cold blocked was altered by these drugs. Thus we conclude that 5-HT is not involved in this tonic descending inhibition.

The influence of 5-HT receptor blocking agents on the behavioral effects of analgesics in rats

The influence of methergoline, methysergide, mianserine, cyproheptadine, and pizotifen on catalepsy induced by morphine, codeine, and fentanyl, and antinociception induced by these three drugs and by pentazocine was studied in rats. Methergoline dose-dependently reduced catalepsy induced by these three drugs. Methysergide abolished only morphine catalepsy, while mianserine significantly reduced the effect of morphine and codeine. Cyprohepatide and pizotifen did not modify the cataleptic effect of the three analgesics used. Antinociceptive action of morphine, codeine, fentanyl, and pentazocine, measured by the hot plate method, was not influenced or changed differentially by any serotonin receptor blocking compounds. One may conclude that catalepsy induced by morphine is, in general, antagonized by serotonin receptor blockade, but this does not concern all narcotic analgesics. In the antinociceptive effects of drugs used, the serotonergic influence seems to play a less important role than in catalepsy.