Ampakine CX717 Protects against Fentanyl-induced Respiratory Depression and Lethal Apnea in Rats

• Published in: Anesthesiology (Philadelphia) Vol. 110; no. 6; pp. 1364 - 1370
• Main Authors: JUN REN, XIUQING DING, FUNK, Gregory D, GREER, John J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.06.2009
• Subjects: Analgesics, Opioid - antagonists & inhibitors; Analgesics, Opioid - pharmacology; Analgesics, Opioid - toxicity; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Apnea - chemically induced; Apnea - prevention & control; Biological and medical sciences; Brain Stem - physiology; Fentanyl - antagonists & inhibitors; Fentanyl - pharmacology; Fentanyl - toxicity; Heart - physiology; Injections, Intraperitoneal; Injections, Intravenous; Male; Medical sciences; Pain Measurement - drug effects; Pharmaceutical Preparations - administration & dosage; Plethysmography; Postural Balance - drug effects; Rats; Rats, Sprague-Dawley; Receptors, AMPA - drug effects; Respiratory Insufficiency - chemically induced; Respiratory Insufficiency - prevention & control; Agonist; Rat; Rodentia; μ Opioid receptor; Fentanyl; Opiates; Narcotic analgesic; Vertebrata; Mammalia; Apnea; Animal; Anesthesia; Phenylpiperidine derivatives; Respiratory depression
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e31819faa2a

The use of fentanyl as a potent analgesic is contradicted by marked respiratory depression among a subpopulation of patients. The commonly used approach of reversing fentanyl-induced respiratory depression with mu-opiate receptor antagonists such as naloxone has the undesirable effect of blocking analgesia. Here, the authors report a clinically feasible pharmacological solution for countering fentanyl-induced respiratory depression via a mechanism that does not interfere with analgesia. Specifically, to determine if the ampakine CX717, which has been proven metabolically stable and safe for human use, can prevent and rescue from severe fentanyl-induced apnea. Plethsymographic recordings were performed from young and adult rats. Varying doses of fentanyl were administered either intraperitoneally or intravenously to induce moderate to life-threatening apneas. CX717 was administered either before or after fentanyl administration. In addition, phrenic nerve recordings were performed from in situ working heart brainstem preparations from juvenile rats. Preadministration of CX717 markedly attenuated fentanyl-induced respiratory depression. Postadministration of CX717 rescued animals from a lethal dose of fentanyl. Significantly, CX717 countered fentanyl-induced depression of respiratory frequency without suppressing analgesia. The effective dose of CX717 was in the range deemed safe on the basis of clinical trials examining its efficacy for cognitive disorders. In situ, fentanyl-induced depression in respiratory frequency and amplitude was alleviated by CX717. CX717 is an agent that enhances the safety of using opiate drugs while preserving the analgesic effects. This advancement could significantly improve pain management in a variety of clinical settings.