title: Yohimbine-induced withdrawal and anxiety symptoms in opioid-dependent patients.
abstract: BACKGROUND
  Alteration in noradrenergic regulation as well as alteration in the hypothalamic-pituitary-adrenal (HPA) axis have been associated with opioid dependence and acute abstinence symptoms.
  
  
  METHODS
  This double-blind, placebo-controlled study evaluated subjective, physiologic, and biochemical responses to yohimbine (.4 mg/kg, IV) in eight patients receiving methadone and compared results to those from a pool of nine healthy volunteers. All subjects were compared for panic anxiety symptom scale (PASS) scores, systolic and diastolic blood pressure, heart rate, plasma 3-methoxy-4 hydroxyphenethyleneglycol (MHPG), and cortisol.
  
  
  RESULTS
  Yohimbine elicited objective and subjective opioid withdrawal and elevated craving for opioid drugs in methadone patients. Significant yohimbine effects were seen across the combined subject group for PASS, physiologic measures, MHPG, and cortisol. Methadone patients had lower baseline MHPG levels. Methadone group interactions with yohimbine were seen for systolic blood pressure and cortisol levels.
  
  
  CONCLUSIONS
  Methadone-maintained patients are sensitive to the postsynaptic effects of noradrenergic-facilitating medications, experiencing greater physiologic and psychological symptoms, including an increase in craving. The effect on cortisol supports the above conclusion and is consistent with HPA axis perturbation in opioid dependence as reported in other studies and extends these observations to stable methadone-maintained patients. Medications that increase synaptic noradrenaline should be used with care in opioid-dependent patients.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 2761 E. Jefferson Avenue, Detroit, MI 48207, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Stine
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
authors.forename: Ismene L
authors.initials: IL
authors.lastname: Petrakis
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Kosten
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Charney
authors.forename: John H
authors.initials: JH
authors.lastname: Krystal
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001007:Anxiety / Q000139:chemically induced*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008734:Methoxyhydroxyphenylglycol / Q000097:blood; D009293:Opioid-Related Disorders / Q000503:physiopathology* / Q000534:rehabilitation; D013375:Substance Withdrawal Syndrome; D015016:Yohimbine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000317:Adrenergic alpha-Antagonists; D000701:Analgesics, Opioid; D015016:Yohimbine; D008734:Methoxyhydroxyphenylglycol; D008691:Methadone; D006854:Hydrocortisone