Mechanisms of respiratory insufficiency induced by methadone overdose in rats

Addict Biol. 2010 Jan;15(1):62-80. doi: 10.1111/j.1369-1600.2009.00184.x.

Abstract

Methadone may cause respiratory depression. We aimed to understand methadone-related effects on ventilation as well as each opioid-receptor (OR) role. We studied the respiratory effects of intraperitoneal methadone at 1.5, 5, and 15 mg/kg (corresponding to 80% of the lethal dose-50%) in rats using arterial blood gases and plethysmography. OR antagonists, including intravenous 10 mg/kg-naloxonazine at 5 minutes (mu-OR antagonist), subcutaneous 30 mg/kg-naloxonazine at 24 hours (micro1-OR antagonist), 3 mg/kg-naltrindole at 45 minutes (delta-OR antagonist) and 5 mg/kg-Nor-binaltorphimine at 6 hours (kappa-OR antagonist) were pre-administered. Plasma concentrations of methadone enantiomers were measured using high-performance liquid chromatography coupled to mass-spectrometry. Methadone dose-dependent inspiratory time (T(I)) increase tended to be linear. Respiratory depression was observed only at 15 mg/kg and characterized by an increase in expiratory time (T(E)) resulting in hypoxemia and respiratory acidosis. Intravenous naloxonazine completely reversed all methadone-related effects on ventilation, while subcutaneous naloxonazine reduced its effects on pH (P < 0.05), PaCO(2) (P < 0.01) and T(E) (P < 0.001) but only partially on T(I) (P < 0.001). Naltrindole reduced methadone-related effects on T(E) (P < 0.001). Nor-binaltorphimine increased methadone-related effects on pH and PaO(2) (P < 0.05) Respiratory effects as a function of plasma R-methadone concentrations showed a decrease in PaO(2) (EC(50): 1.14 microg/ml) at lower concentrations than those necessary for PaCO(2) increase (EC(50): 3.35 microg/ml). Similarly, increased T(I) (EC(50): 0.501 microg/ml) was obtained at lower concentrations than those for T(E) (EC(50): 4.83 microg/ml). Methadone-induced hypoxemia is caused by mu-ORs and modulated by kappa-ORs. Additionally, methadone-induced increase in T(E) is caused by mu1- and delta-opioid receptors while increase in T(I) is caused by mu-ORs.

MeSH terms

  • Acidosis, Respiratory / chemically induced
  • Acidosis, Respiratory / physiopathology
  • Animals
  • Dose-Response Relationship, Drug
  • Drug Overdose / physiopathology*
  • Exhalation / drug effects
  • Exhalation / physiology
  • Hypoxia / chemically induced
  • Hypoxia / physiopathology
  • Injections, Intraperitoneal
  • Injections, Intravenous
  • Injections, Subcutaneous
  • Male
  • Methadone / pharmacokinetics
  • Methadone / toxicity*
  • Narcotic Antagonists / pharmacology
  • Narcotics / pharmacokinetics
  • Narcotics / toxicity*
  • Oxygen / blood
  • Rats
  • Rats, Sprague-Dawley
  • Receptors, Opioid / drug effects*
  • Receptors, Opioid / physiology
  • Receptors, Opioid, delta / drug effects
  • Receptors, Opioid, delta / physiology
  • Receptors, Opioid, kappa / drug effects
  • Receptors, Opioid, kappa / physiology
  • Receptors, Opioid, mu / drug effects
  • Receptors, Opioid, mu / physiology
  • Respiratory Insufficiency / physiopathology*

Substances

  • Narcotic Antagonists
  • Narcotics
  • Receptors, Opioid
  • Receptors, Opioid, delta
  • Receptors, Opioid, kappa
  • Receptors, Opioid, mu
  • Oxygen
  • Methadone