Separate and Combined Effects of Naltrexone and Extended-Release Alprazolam on the Reinforcing, Subject-Rated, and Cardiovascular Effects of Methamphetamine

J Clin Psychopharmacol. 2016 Jun;36(3):213-21. doi: 10.1097/JCP.0000000000000488.

Abstract

Opioid antagonists (eg, naltrexone) and positive modulators of γ-aminobutyric acid type A receptors (eg, alprazolam) each modestly attenuate the abuse-related effects of stimulants. A previous study demonstrated that acute pretreatment with the combination of naltrexone and alprazolam attenuated a greater number of the subject-rated effects of D-amphetamine than the constituent drugs alone. This study tested the hypothesis that maintenance on the combination of naltrexone and alprazolam XR would attenuate the reinforcing and "positive" subject-rated effects of methamphetamine to a greater extent than the constituent drugs alone.Eight non-treatment-seeking, stimulant-using individuals completed a placebo-controlled, crossover, double-blind inpatient protocol. Participants were maintained on naltrexone (0 and 50 mg), alprazolam XR (0 and 1 mg), and the combination of naltrexone and alprazolam XR (50 mg and 1 mg, respectively) for 6 to 7 days. Under each maintenance condition, participants sampled intranasal doses of methamphetamine (0, 10, and 30 mg), and were then offered the opportunity to work for the sampled dose on a modified progressive-ratio procedure. Subject-rated drug effect questionnaires, psychomotor, and physiology assessments were collected.Intranasal methamphetamine functioned as a reinforcer and produced prototypical stimulant-like "positive" subject-rated and physiological effects. Maintenance on naltrexone significantly decreased the reinforcing, but not subject-rated drug effects of 10-mg methamphetamine. Alprazolam XR and the combination of naltrexone and alprazolam XR did not impact methamphetamine self-administration or subject-rated drug effects. The results support the continued evaluation of naltrexone for methamphetamine dependence, as well as the identification of other drugs that enhance its ability to reduce drug-taking behavior.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Intranasal
  • Adult
  • Alprazolam / administration & dosage*
  • Amphetamine-Related Disorders / drug therapy*
  • Amphetamine-Related Disorders / psychology
  • Blood Pressure / drug effects*
  • Blood Pressure / physiology
  • Cross-Over Studies
  • Delayed-Action Preparations / administration & dosage
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • GABA Modulators / administration & dosage
  • Heart Rate / drug effects*
  • Heart Rate / physiology
  • Humans
  • Male
  • Methamphetamine / administration & dosage*
  • Middle Aged
  • Naltrexone / administration & dosage*
  • Narcotic Antagonists / administration & dosage
  • Psychomotor Performance / drug effects
  • Psychomotor Performance / physiology
  • Reinforcement, Psychology
  • Self Administration

Substances

  • Delayed-Action Preparations
  • GABA Modulators
  • Narcotic Antagonists
  • Methamphetamine
  • Naltrexone
  • Alprazolam