BACKGROUND Animal data suggest that the antidepressant and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor modulator tianeptine is able to prevent opioid-induced respiratory depression. The hypothesis was that oral or intravenous tianeptine can effectively prevent or counteract opioid-induced respiratory depression in humans. METHODS Healthy male and female volunteers participated in two studies that had a randomized, double blind, placebo-controlled, crossover design. First, oral tianeptine (37.5-, 50-, and 100-mg doses with 8 subjects) pretreatment followed by induction of alfentanil-induced respiratory depression (alfentanil target concentration, 100 ng/ml) was tested. Primary endpoint was ventilation at an extrapolated end-tidal carbon dioxide concentration of 55 mmHg (V̇E55). Next, the ability of four subsequent and increasing infusions of intravenous tianeptine (target tianeptine plasma concentrations 400, 1,000, 1,500, and 2,000 ng/ml, each given over 15 min) to counteract remifentanil-induced respiratory depression was determined in 15 volunteers. Ventilation was measured at isohypercpania (baseline ventilation 20 ± 2 l/min). The primary endpoint was minute ventilation during the 60 min of tianeptine versus placebo infusion. RESULTS Alfentanil reduced V̇E55 to 13.7 (95% CI, 8.6 to 18.8) l/min after placebo pretreatment and to 17.9 (10.2 to 25.7) l/min after 50-mg tianeptine pretreatment (mean difference between treatments 4.2 (-11.5 to 3.0) l/min, P = 0.070). Intravenous tianeptine in the measured concentration range of 500 to 2,000 ng/ml did not stimulate ventilation but instead worsened remifentanil-induced respiratory depression: tianeptine, 9.6 ± 0.8 l/min versus placebo 15.0 ± 0.9 l/min; mean difference, 5.3 l/min; 95% CI, 2.5 to 8.2 l/min; P = 0.001, after 1 h of treatment. CONCLUSIONS Neither oral nor intravenous tianeptine were respiratory stimulants. Intravenous tianeptine over the concentration range of 500 to 2000 ng/ml worsened respiratory depression induced by remifentanil. EDITOR’S PERSPECTIVE

中文翻译：

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非典型三环类抗抑郁药噻奈普汀在阿片类药物诱导的呼吸抑制人体模型中的呼吸作用。

背景动物数据表明，抗抑郁药和 α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体调节剂噻奈普汀能够预防阿片类药物引起的呼吸抑制。假设是口服或静脉注射噻奈普汀可以有效预防或抵消阿片类药物引起的人类呼吸抑制。方法 健康的男性和女性志愿者参加了两项随机、双盲、安慰剂对照、交叉设计的研究。首先，测试了口服噻奈普汀（37.5-、50-和 100-mg 剂量，8 名受试者）预处理，然后诱导阿芬太尼诱导的呼吸抑制（阿芬太尼目标浓度，100 ng/ml）。主要终点是外推的呼气末二氧化碳浓度为 55 mmHg (V̇E55) 的通气。下一个，在 15 名志愿者中测定了 4 次后续且增加的静脉内噻奈普汀输注（噻奈普汀目标血浆浓度 400、1,000、1,500 和 2,000 ng/ml，每次给药时间超过 15 分钟）对抗瑞芬太尼引起的呼吸抑制的能力。在等高通气时测量通气（基线通气 20 ± 2 l/min）。主要终点是噻奈普汀与安慰剂输注 60 分钟期间的分钟通气量。结果 阿芬太尼在安慰剂预处理后将 V̇E55 降至 13.7（95% CI，8.6 至 18.8）l/min，在 50 mg 噻奈普汀预处理​​后降至 17.9（10.2 至 25.7）l/min（治疗之间的平均差异为 4.2（-11.5 至 3.0）升/分钟，P = 0.070）。在测量浓度范围为 500 至 2 时静脉注射噻奈普汀，000 ng/ml 不会刺激通气，反而会加重瑞芬太尼引起的呼吸抑制：噻奈普汀，9.6 ± 0.8 l/min，安慰剂为 15.0 ± 0.9 l/min；平均差，5.3 l/min；95% CI，2.5 至 8.2 升/分钟；P = 0.001，治疗 1 小时后。结论 口服和静脉内噻奈普汀都不是呼吸兴奋剂。浓度范围为 500 至 2000 ng/ml 的静脉内噻奈普汀可加重瑞芬太尼引起的呼吸抑制。编辑观点 浓度范围为 500 至 2000 ng/ml 的静脉内噻奈普汀可加重瑞芬太尼引起的呼吸抑制。编辑观点 浓度范围为 500 至 2000 ng/ml 的静脉内噻奈普汀可加重瑞芬太尼引起的呼吸抑制。编辑观点