Provisional registration of useful treatments.
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Biomedical subjects
Publications and source records attributed to F J Lichtigfeld.
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Psychotropic analgesic nitrous oxide (PAN) has been used successfully in the treatment of alcohol and drug withdrawal in > 15,000 cases. It is an opioid and thus the first gaseous member of the opioid family. We propose the existence of two mutually antagonistic opioid systems as underlying addictive withdrawal states; mu and kappa. PAN as a multipotent opioid activates these systems. Dopamine (DA) activity in the nucleus accumbens appears to be controlled by kappa- and mu-receptors, with mu enhancing and kappa inhibiting release. In morphine and alcohol withdrawal, there is severe inhibition of dopamine release from nucleus accumbens. We thus infer that a probable major therapeutic effect of PAN is in modulating this dopamine system, thereby correcting the severe deficit in dopamine release found in withdrawal states. This has been achieved without any transfer of addiction to PAN in any of the treated patients because of modulation of DA in the nucleus accumbens by PAN. This effect may also explain its anticraving action.
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We show that psychotropic analgesic nitrous oxide is a partial opioid agonist since it fulfills all the following criteria to be classified as an opioid: 1) its effects are antagonised by various opioid antagonists including stereospecific naloxone antagonism; 2) it is cross tolerant with morphine; 3) its effects are potentiated by enkephalinase inhibition; 4) it provokes the release of endogenous opioids; 5) it interferes at low concentrations with specific opioid ligand binding at radio-receptor assay. Like the prototype opioid morphine it acts directly and indirectly at opioid receptors. PAN, although considered an exogenous inorganic molecule was also the first gas to be shown to have a direct role in influencing neurotransmission. We also describe some of the relationships that exist between nitrous oxide and its close relative, the endogenous gas nitric oxide. We describe the use of PAN as a safe, effective tool for investigating and treating the endogenous opioid system in man.
We relate the extremely rapid and lasting beneficial effects of psychotropic analgesic nitrous oxide (PAN) on the alcohol withdrawal state (AWS) to the underlying neurotransmitter system disturbances and clinical findings. PAN is an opioid and its main therapeutic effects are produced by stimulating the underactive endogenous opioid system (EOS) found in the AWS. In common with other opioids, PAN also acts on other neurotransmitter systems. While controlling the cholinergic and adrenergic overactivity and the concomitant stress state, through its opioid agonism, it simultaneously stimulates the underactive serotonergic and GABA-ergic systems found in the AWS. PAN also ameliorates disturbances in corticotropin-releasing factor (CRF) dopaminergic, glutaminergic and second messenger function. This unique combination of stimulation and inhibition enables a single 20 minute administration of PAN to rapidly restore the patients' homeostatic balance with lasting effect, and almost no other medication requirements during the entire detoxification period. Unlike other currently available therapies this is achieved without sedation.
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We describe the use of combination therapy with carbamazepine and benzodiazepine (BZ) for treating 4 cases of polydrug analgesic/depressant withdrawal. Carbamazepine appears to be effective in BZ withdrawal through its agonistic action on the peripheral benzodiazepine receptor. In cases where opioid abuse is suspected, analgesic nitrous oxide appears the most suitable agent to be added to this regimen, in view of its opioid properties, rapidity of action, and synergistic actions with benzodiazepines in ameliorating withdrawal from benzodiazepines and alcohol.