Open AccessUse of Remifentanil in a Novel Clinical Paradigm to Characterize Onset and Duration of Opioid Blockade by Samidorphan, a Potent μ-Receptor Antagonist
Author(s) -
Megan J. Shram,
Bernard L. Silverman,
Elliot W. Ehrich,
Edward M. Sellers,
Ryan Z. Turncliff
Publication year - 2015
Publication title -
journal of clinical psychopharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.786
H-Index - 121
eISSN - 1533-712X
pISSN - 0271-0749
DOI - 10.1097/jcp.0000000000000320
Subject(s) - remifentanil , blockade , opioid , anesthesia , medicine , visual analogue scale , antagonist , placebo , naltrexone , agonist , pharmacology , receptor , propofol , alternative medicine , pathology
A novel clinical study design was used to evaluate the blockade of a selective short-acting μ-opioid agonist (remifentanil) in 24 opioid-experienced subjects. Samidorphan (3-carboxamido-4-hydroxynaltrexone) is a novel opioid modulator with μ-antagonist properties. Objective (pupil diameter) and subjective (visual analog scale) responses to repeated remifentanil and saline infusion challenges were assessed after single oral administration of placebo (day 1) and samidorphan (day 2). Complete blockade persisted with samidorphan for 24 hours for pupil miosis and 48 hours for the drug liking visual analog scale. Samidorphan effects persisted beyond measurable samidorphan exposure (t½ = 7 hours). Samidorphan was associated with complete blockade of remifentanil, and the duration supports daily administration. This study used a novel approach with multiple administrations of remifentanil to successfully demonstrate a durable effect with samidorphan and a rapid and potent blockade of physiological and subjective μ-opioid effects.