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Randomized Controlled Trial
. 2015 Feb 25;18(7):pyv008.
doi: 10.1093/ijnp/pyv008.

A placebo-controlled trial of dextromethorphan as an adjunct in opioid-dependent patients undergoing methadone maintenance treatment

Sheng-Yu Lee  1 , Shiou-Lan Chen  1 , Yun-Hsuan Chang  1 , Chun-Hsien Chu  1 , Shih-Heng Chen  1 , Po See Chen  1 , San-Yuan Huang  1 , Nian-Sheng Tzeng  1 , Liang-Jen Wang  1 , I Hui Lee  1 , Tzu-Yun Wang  1 , Kao Chin Chen  1 , Yen Kuang Yang  1 , Jau-Shyong Hong  1 , Ru-Band Lu  2
Affiliations
Randomized Controlled Trial

A placebo-controlled trial of dextromethorphan as an adjunct in opioid-dependent patients undergoing methadone maintenance treatment

Sheng-Yu Lee et al. Int J Neuropsychopharmacol. .

Abstract

Background: Low-dose dextromethorphan (DM) might have anti-inflammatory and neurotrophic effects mechanistically remote from an NMDA receptor. In a randomized, double-blind, controlled 12 week study, we investigated whether add-on dextromethorphan reduced cytokine levels and benefitted opioid-dependent patients undergoing methadone maintenance therapy (MMT).

Methods: Patients were randomly assigned to a group: DM60 (60mg/day dextromethorphan; n = 65), DM120 (120mg/day dextromethorphan; n = 65), or placebo (n = 66). Primary outcomes were the methadone dose required, plasma morphine level, and retention in treatment. Plasma tumor necrosis factor (TNF)-α, C-reactive protein, interleukin (IL)-6, IL-8, transforming growth factor-β1, and brain-derived neurotrophic factor (BDNF) levels were examined during weeks 0, 1, 4, 8, and 12. Multiple linear regressions with generalized estimating equation methods were used to examine the therapeutic effect.

Results: After 12 weeks, the DM60 group had significantly longer treatment retention and lower plasma morphine levels than did the placebo group. Plasma TNF-α was significantly decreased in the DM60 group compared to the placebo group. However, changes in plasma cytokine levels, BDNF levels, and the methadone dose required in the three groups were not significantly different.

Conclusions: We provide evidence-decreased concomitant heroin use-of low-dose add-on DM's efficacy for treating opioid-dependent patients undergoing MMT.

Keywords: Cytokines; Dextromethorphan; Heroin; cytokine; dextromethorphan; methadone maintenance therapy; opioid dependence.

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Figures

Figure 1.
Figure 1.
CONSORT diagram showing the disposition of patients in the study. DM, dextromethorphan.
Figure 2.
Figure 2.
Change in the mean plasma morphine levels in the DM60, DM120, and placebo groups after 12 weeks of treatment. DM, dextromethorphan.
Figure 3.
Figure 3.
The retention rates in the DM60, DM120, and placebo groups after 12 weeks of treatment. DM, dextromethorphan.
See this image and copyright information in PMC

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