γ-Hydroxybutyrate (GHB)-induced respiratory depression: combined receptor-transporter inhibition therapy for treatment in GHB overdose

Mol Pharmacol. 2012 Aug;82(2):226-35. doi: 10.1124/mol.112.078154. Epub 2012 May 4.

Abstract

Overdose of γ-hydroxybutyrate (GHB) frequently causes respiratory depression, occasionally resulting in death; however, little is known about the dose-response relationship or effects of potential overdose treatment strategies on GHB-induced respiratory depression. In these studies, the parameters of respiratory rate, tidal volume, and minute volume were measured using whole-body plethysmography in rats administered GHB. Intravenous doses of 200, 600, and 1500 mg/kg were administered to assess the dose-dependent effects of GHB on respiration. To determine the receptors involved in GHB-induced respiratory depression, a specific GABA(B) receptor antagonist, (2S)-(+)-5,5-dimethyl-2-morpholineacetic acid (SCH50911), and a specific GABA(A) receptor antagonist, bicuculline, were administered before GHB. The potential therapeutic strategies of receptor inhibition and monocarboxylate transporter (MCT) inhibition were assessed by inhibitor administration 5 min after GHB. The primary effect of GHB on respiration was a dose-dependent decrease in respiratory rate, accompanied by an increase in tidal volume, resulting in little change in minute volume. Pretreatment with 150 mg/kg SCH50911 completely prevented the decrease in respiratory rate, indicating agonism at GABA(B) receptors to be primarily responsible for GHB-induced respiratory depression. Administration of 50 mg/kg SCH50911 after GHB completely reversed the decrease in respiratory rate; lower doses had partial effects. Administration of the MCT inhibitor l-lactate increased GHB renal and total clearance, also improving respiratory rate. Administration of 5 mg/kg SCH50911 plus l-lactate further improved respiratory rate compared with the same dose of either agent alone, indicating that GABA(B) and MCT inhibitors, alone and in combination, represent potential treatment options for GHB-induced respiratory depression.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bicuculline / pharmacology
  • Bicuculline / therapeutic use
  • Dose-Response Relationship, Drug
  • Drug Overdose
  • Male
  • Morpholines / pharmacology
  • Morpholines / therapeutic use
  • Rats
  • Rats, Sprague-Dawley
  • Receptors, Cell Surface / antagonists & inhibitors*
  • Receptors, Cell Surface / physiology
  • Respiratory Insufficiency / chemically induced*
  • Respiratory Insufficiency / drug therapy*
  • Respiratory Insufficiency / metabolism
  • Sodium Oxybate / metabolism
  • Sodium Oxybate / toxicity*
  • Treatment Outcome

Substances

  • (+)-(S)-5,5-dimethylmorpholinyl-2-acetic acid
  • 4-hydroxybutyric acid receptor
  • Morpholines
  • Receptors, Cell Surface
  • Sodium Oxybate
  • Bicuculline