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Combination therapy with two or more analgesics is widely used for conditions associated with moderate to severe pain. Combinations of diverse analgesics with different modes of action can improve the risk-benefit ratio of analgesic treatments. The aim of this study is to evaluate the antinociceptive effect of tapentadol (TAP) and flupirtine (FLP), when administered separately or in combination, as well as their synergistic interaction in the orofacial formalin test in rats. After i.p. injection of TAP at different doses (2, 5, 10 and 15 mg/kg), the biphasic nociceptive behavior was reduced in a dose-dependent manner in both phase I and II. Conversely, i.p. injection of FLP at different doses (0.6, 1.6, 3.3, 6.6, 16.6 and 22.2 mg/kg) induced a dose-dependent antinociceptive effect in phase II only. TAP was found to be more effective than FLP. The interaction between TAP and FLP was synergistic in phase II with an interaction index (γ) of 0.50±0.24. The data reported in this study indicate that FLP enhances the antinociceptive effect of TAP and this drug combination might be potentially useful in the treatment of chronic pain.

Flupirtine is a triaminopyridine analogue which has been successfully applied in clinics as a non-opiate analgesic drug. Previously we described that flupirtine acts like an N-methyl-D-aspartate (NMDA) receptor antagonist in neuronal cells both in vitro and in vivo. Here we show that flupirtine displays its anti-apoptotic effect also in hNT (human Ntera/D1) neurons. hNT neurons were induced to apoptosis applying glutamate (Glu; at concentrations > or = 1 mM) or NMDA (> or = 1 mM). During Glu/NMDA-mediated apoptosis the levels of the intracellular anti-apoptotic agents Bc1-2 and glutathione dropped by more than 50%. Flupirtine completely abolished this reduction of Bc1-2 and glutathione level at a concentration of 10 microM. In the presence of 3 microM flupirtine a > 6-fold increase of the Bc1-2 (B-cell leukemia/lymphoma-2) level was observed in hNT neurons. At the same concentration, the intracellular level of glutathione increased to 200%. We conclude that the Glu/NMDA-mediated neuronal cell death in vitro is controlled at least partially by Bc1-2 and glutathione. Neuronal cell death by Glu or NMDA in vitro can be overcome applying the drug flupirtine which is in clinical use.

We tested the effect of flupirtine against ischemic and excitotoxic neuronal damage as well as on the glutamate-induced rise in cytosolic calcium ion concentration (= [Ca2+]i). For in vivo experiments we used a model of focal cerebral ischemia in mice. The middle cerebral artery was permanently occluded and 48 h afterwards brain tissue was stained with neutral red, perfusion-fixed and the infarct surface was determined planimetrically. Pretreatment with flupirtine significantly reduced the infarct area (controls: 24.3 +/- 4.8 mm2, 1 mg/kg flupirtine: 20.1 +/- 3.6 mm2 and 10 mg/kg flupirtine: 19.5 +/- 3.9 mm2; P < 0.05), whereas postischemic application of flupirtine failed to reduce the infarct area. For in vitro studies, primary neuronal cultures were prepared from the hippocampi of newborn rats and excitotoxic damage was induced by exposing the cells to 500 mu M L-glutamate for 30 min. We could demonstrate that flupirtine (1-10 microM) was capable of protecting neurons against glutamate-induced cytotoxicity. In order to elucidate the underlying mechanism of action, we tested the effect of flupirtine on the glutamate-induced rise in [Ca2+]i using the Ca2+-indicator fura-2. L-Glutamate added in a final concentration of 100 microM to the cultured cells for 16 s caused a rise in [Ca2+]i from about 100 nM to 900 nM. Flupirtine (0.1-10 microM) reduced the glutamate-induced rise in [Ca2+]i concentration dependently.

In urethane-chloralose anesthetised rats the muscle relaxant activity of flupirtine was investigated on the monosynaptic Hoffmann reflex recorded from plantar foot muscles and on the polysynaptic flexor reflex recorded from tibialis muscle. Intraperitoneal (i.p.; 2.5–25 μmol/kg) and intrathecal (i.t.; 33–330 nmol) administration of flupirtine depressed the polysynaptic flexor reflex in anesthetised rats in a dose-dependent manner without affecting the monosynaptic Hoffmann reflex. Flupirtine produced a similar pattern on spinal reflexes as NMDA receptor antagonists, such as (−)-2-amino-7-phosphonoheptanoic acid (500 nmol i.t.) and memantine (125 μmol/kg i.p.), the benzodiazepines diazepam (18 μmol/kg i.p.) and midazolam (80 nmol i.t.), and the α2-adrenoceptor agonist tizanidine (2 μmol/kg). In contrast, the GABAA receptor agonist muscimol (21 μmol/kg i.p.; 20 nmol i.t.) and the GABAB receptor agonist baclofen (47 μmol/kg i.p.; 2 nmol i.t.) reduced the magnitude of both the flexor and the Hoffmann reflex, whereas the non-NMDA receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX; 10 nmol i.t.) depressed the Hoffmann reflex without affecting the flexor reflex. The effect of i.t. injection of flupirtine was prevented by coadministration of the mixed α1α2-adrenoceptor antagonist yohimbine (10 nmol) and the excitatory amino acid N-methyl-d-aspartate (NMDA; 0.1 nmol), but neither by coadministration of the α1-adrenoceptor antagonist prazosine (10 nmol), the GABAA receptor antagonist bicuculline (1 nmol), the GABAB receptor antagonist phaclofen (100 nmol), the non-NMDA receptor agonist α-amino-3-hydroxy-5-tertbutyl-4-isoxazolepropionic acid (ATPA; 0.1 pmol) nor by pre-treatment with the benzodiazepine receptor antagonist flumazenil (16 μmol/kg). These observations suggest that α2-adrenoceptors and NMDA receptors might be involved in the mediation of the muscle relaxant activity of flupirtine. The presumed NMDA receptor antagonistic effect of flupirtine would be of particular clinical relevance, since flupirtine is free of typical side effects of NMDA receptor antagonists.

Flupirtine is an analgesic drug thought to have NMDA receptor antagonistic and antiapoptotic effects. We investigated the effects of Ethyl-2-amino-6-(4-(4-fluorbenzyl)amino)-pyridine-3-carbamamic acid, maleate (flupirtine) and the related compound N -(2-amino-4-(4-fluorobenzylamino)-phenyl)-carbamic acid, ethyl ester) (retigabine) (Desaza-flupirtine) on the toxicity of l -glutamate and l -3,4-dihydroxyphenylalanine ( l -DOPA) in rat pheochromocytoma PC 12 cells in vitro. Both drugs (10 μM) markedly decreased nonreceptor-mediated necrotic cell death in PC 12 cultures treated with l -glutamate (10 mM) for 72 h. In contrast, apoptosis induced by l -DOPA (250 μM) after 48 h was not affected by either substance. While l -DOPA elicited massive generation of reactive oxygen intermediates, l -glutamate-induced cell death was accompanied by only slightly increased levels of reactive oxygen intermediates. Flupirtine and retigabine exerted anti-oxidative effects in PC 12 cultures independent of their ability to prevent cell death. Further examination of the protective action of flupirtine and retigabine against l -glutamate toxicity showed that it had no influence on monoamine oxidase (monoamine: oxygen oxidoreductase (deaminating), EC 1.4.3.4., MAO) activity. Thus, flupirtine and retigabine provided protection against cystine deprivation and l -glutamate toxicity but did not protect against l -glutamate under cystine-free conditions indicating that both compounds are sufficiently effective to compensate the oxidative stress elicited by cystine deprivation but not excessive activity of monoamine oxidase after l -glutamate treatment.

In this study we attempted to specify the behavioural profile of the analgesic flupirtine (1, 10 and 20 mg/kg p.o.) in the rat with respect to (i) its antiparkinsonian potential alone and as an adjunct to L-dihydroxyphenylalanine (L-DOPA) in the haloperidol-induced catalepsy (0.5 mg/kg haloperidol i.p.), (ii) locomotion and exploratory behaviour in the open field with holeboard, and (iii) possible psychomotor stimulating effects in the experimental chamber. In the two latter tests, behaviour was additionally challenged by D-amphetamine (2 mg/kg i.p.). In the catalepsy tests (horizontal bar, podium, grid) flupirtine alone was anticataleptic at doses of 10 and 20 mg/kg p.o., and the antiparkinsonian potential of a subthreshold dose of L-DOPA (50 mg/kg p.o.) was potentiated by 1 and 10 mg/kg p.o. flupirtine. On spontaneous forward locomotion in the open field with holeboard, flupirtine (1 and 10 mg/kg p.o.) had no marked effect but increased the frequency and duration of head dips, indicative for augmenting exploratory behaviour. Spontaneous rearing was reduced and D-amphetamine-induced rearing was enhanced by 1 mg/kg p.o. flupirtine. Grooming was reduced by 1 and 10 mg/kg p.o. flupirtine. In contrast, turning and grooming behaviour (spontaneous as well as D-amphetamine-induced) was not markedly influenced by flupirtine in the experimental chamber. Sniffing was increased in this test by 1 mg/kg p.o. flupirtine but not by the higher dose. Flupirtine is highly effective in antagonising neuroleptic-induced catalepsy as well as in potentiating L-DOPA treatment in the rat, suggesting it is a prospective new candidate for the therapy of Parkinson's disease.

Flupirtine, a triaminopyridine derivative, is a non-opiate centrally acting analgesic agent with muscle relaxant properties. Now we show that this drug displays a potent cytoprotective effect on neurons (rat cortical cells) treated with (i) the excitatory amino acid N-methyl- d -aspartate (NMDA) or (ii) with the human immunodeficiency virus type 1 (HIV-1) coat protein gp120. In the absence of the drug the two agents cause a >90% reduction of cell viability after a 18 h incubation. During this period the DNA in the cells undergoes fragmentation and shows a pattern which is typical for cell death. If the neurons were preincubated with flupirtine for 2 h and subsequently exposed to the cytotoxic agents an almost complete protection was achieved. The cytoprotective effect of flupirtine in vitro was significant (above 10 μM). Because flupirtine displays almost no clinical side effects and in light of the data presented here, flupirtine may be a promising drug also for the treatment of NMDA-mediated neurodegenerative disorders in general and for the treatment of AIDS-related encephalopathy in particular.

The analgesic agent, flupirtine, was tested on motor and sensory responses of the nociceptive system in rats. The motor response was determined in the tail-flick test with radiant heat. The sensory response was determined as activity evoked in ascending axons by electrical stimulation of nociceptive afferents in the sural nerve. The tail-flick latency was dose dependently increased by flupirtine administered by intraperitoneal (i.p.) injection (ED50 7.8 mg/kg), intrathecal (i.t.) injection (ED50 14.8 micrograms/rat) or bilateral microinjection into the periaqueductal grey (PAG; ED50 2.6 micrograms/rat). Naloxone reduced the effect of an i.p. injection of flupirtine but was ineffective against an i.t. injection of the drug. The activity in ascending axons responding to afferent C fibre stimulation was depressed by flupirtine administered by intravenous (i.v.) injection (7 mg/kg) under urethane anaesthesia with an intact spinal cord and brain, and by i.t. injection (14 micrograms/rat) to decerebrated spinal rats. Naloxone did not abolish the depressant effect of i.t. injections of flupirtine. Microinjection of flupirtine (1.7 micrograms/rat) made in the PAG did not reduce, but increased the spontaneous and C fibre-evoked activity in ascending axons. The results indicate that flupirtine selectively depresses responses of the nociceptive system by a spinal (motor and sensory responses) and a supraspinal (motor response) action in which opiate-like mechanisms play no or a minor role.

Flupirtine, a novel analgesic agent, was tested on nociceptive activity in neurones of the dorsomedial part of the ventral nucleus of the thalamus (VDM) and ascending axons of the spinal cord of rats under urethane anaesthesia. Activity was elicited supramaximal stimulation of the sural nerve. Flupirtine injected i.v. dose dependently reduced nociceptive activity in the thalamus and ascending axons. The ED50 of flupirtine is depressing the thalamic response was 1.9 mg/kg, and the ED50 in depressing the C fibre-evoked response in ascending axons was 18 mg/kg. Naloxone reduced the depression of the nociceptive response evoked in the thalamus when applied before but not when applied after flupirtine. The results indicate that flupirtine produces analgesia by spinal inhibition of nociceptive impulse transmission from afferent nerve fibres to neurones sending their axons to the brain and, in addition, by supraspinal inhibition of nociceptive impulse transmission to the thalamus. Opioid mechanisms could be involved in these effects.

Flupirtine is a novel analgesic recently introduced with therapy. The present study assessed the role of opioid mechanisms in flupirtine-induced antinociception, localized its site of action along the neuraxis and evaluated its relative potency. Analgesic and general behavioral effects of flupirtine (0.3–10 mg/kg i.v.) were compared to those of the opioid analgesic pentazocine (0.3–5 mg/kg i.v.) in chronic spinal dogs. Flupirtine was slightly less effective than pentazocine in depressing the supraspinally mediated skin twitch nociceptive reflex. But in contrast to pentazocine, flupirtine only weakly depressed the flexor reflex, a spinally mediated nociceptive reflex. Statistically reliable potency estimates for antinociception were not obtained. Both drugs constricted pupils and lowered body temperature. In drug interaction studies, a relatively high dose (1 mg/kg i.v.) of the opioid antagonist naltrexone antagonized the effects of pentazocine but not those of flupirtine. It is concluded that flupirtine-induced antinociception is not opiate-receptor mediated, that its antinociceptive actions occur primarily at supraspinal sites and that its potency is less than that of pentazocine in the dog.