Flunitrazepam (Rohypnol©) is a benzodiazepine that is marketed and licensed for use in Europe, Asia, and Latin America for the short term treatment of insomnia and as a sedative-hypnotic and preanesthetic medication. It has physiological effects similar to other benzodiazepines, with potency approximately ten times that of diazepam. Although not manufactured or sold in the United States, Flunitrazepam / Rohypnol has been available via the black market since the early 1990's. Benzodiazepines are often used both to potentiate and prolong the sedative effects of heroin or methadone, and to attenuate the withdrawal effects of stimulants such as cocaine.(1) Illicit use of Flunitrazepam / Rohypnol is characterized by its use with other drugs, although it may be used alone. It enhances the "high" produced by low-quality heroin and has been so used in Asia since the early 1980's. It mellows the effects of cocaine and eases a user down from a crack or cocaine binge. In the United States, it appears to be used most frequently in conjunction with alcohol, with which it seems to have a synergistic effect, producing disinhibition and amnesia. This has gained Flunitrazepam / Rohypnol the reputation of being a "date-rape" drug. Clinical Pharmacology Flunitrazepam / Rohypnol contains as the active substance: 5-(o-fluorophenyl)-1,3-dihydro-1-methyl-7-nitro-2H-1, 4-benzodiazepin-2-1. Flunitrazepam / Rohypnol tablets are white and contain the name "Roche" and an encircled 1 or 2 on one side (indicating 1mg or 2mg tablets). A single or cross score appears on the other side. Flunitrazepam / Rohypnol is a full benzodiazepine agonist with a highly affinity for the benzodiazepine central site.(2) It has similar lipid solubilities to both diazepam and midazolam at physiological pH and this property has been claimed to be associated with both more rapid brain penetration and the higher likelihood of abuse liability.(3) It shows a preference for BZ2 over BZ1 receptors. These receptors are closely associated with the receptors for GABA, which is the major inhibitory neurotransmitter in the brain. The receptor complex regulates the entrance of chloride into the postsynaptic cells.(4) It is thought that the increase in chloride conductance mediated by GABA is intensified by the benzodiazepines. This facilitation of GABA-induced chloride conductance results in a relatively greater hyperpolarization of these cells and therefore leads to diminished synaptic transmission.(5) As a class, benzodiazepines act via their enhancement of presynaptic inhibition both at spinal and supraspinal sites. This decrease in transmitter output is the result of a decrease in the presynaptic membrane potential associated with an increase in chloride permeability via GABA and GABA-ergic transmission. Pharmacokinetics Flunitrazepam / Rohypnol is rapidly and almost completely absorbed after oral administration. Tmax is achieved for 1mg dosage in 1.2±0.8 hours. Cmax for a therapeutic dose (1mg) is 6.1-10.9 ng/ml. The volume of distribution is large at 3.3-5.5 L/kg. Flunitrazepam / Rohypnol is 78% bound to plasma proteins. The elimination half-life of the parent drug is 16-35 hours.(6) In a study comparing midazolam to Flunitrazepam / Rohypnol, both drugs were rapidly absorbed, with mean values to reach peak serum concentrations, Tmax, being 0.6 hours in the Flunitrazepam / Rohypnol group and 0.95 hours in the midazolam group. The mean elimination half-life of Flunitrazepam / Rohypnol was clearly longer than that of midazolam (10.59±5.7 hours vs. 4.63±1.74 hours). The elimination half-life of midazolam in the elderly has been reported to be about twice as long (around 4 hours) as in healthy adult volunteers. On the contrary, aging does not affect the elimination of Flunitrazepam / Rohypnol.(7) The benzodiazepines are metabolized eventually through N-dealkylation or hydroxylation by liver microsomal systems, followed by conjugation to form inactive glucuronides that are excreted in the urine.(8) Clinical Toxicology The effects seen with Flunitrazepam / Rohypnol are those seen with other benzodiazepines. Most adverse effects associated with the benzodiazepines are related to their ability to produce central nervous system depression. The most common undesirable effects are drowsiness, excessive sedation, impaired motor coordination, confusion, and memory loss.(9) Other CNS effects include blurred vision, hallucinations, and paradoxical reactions consisting of excitement, stimulation, and hyperactivity. Illicit use of Flunitrazepam / Rohypnol exploits these effects in that in combination with alcohol they are enhanced. As with any CNS depressant, depression of the respiratory drive is a possible effect with adequate dosages. Potentiation occurs with nitrous oxide, fentanyl, ketamine, and possibly other opioids. Drug interactions include increased blood levels of imipramine and desipramine in patients receiving benzodiazepines. Erythromycin may increase blood levels of benzodiazepines. Cimetidine coadministered with diazepam has resulted in an increased half-life of both diazepam and its desmethyl derivative. Flunitrazepam / Rohypnol can also contribute to the toxicity of ethanol such that concentrations of Flunitrazepam / Rohypnol and ethanol are individually less than those required for fatal toxicity when used alone.(10) Tolerance and dependence do occur with the use of benzodiazepines. Discontinuation of drug administration, particularly an abrupt withdrawal, can be associated with a variety of symptoms including headaches, muscle pain, extreme anxiety, tension, restlessness, confusion, and irritability. Severe symptoms may include derealization, depersonalization, hyperacusis, numbness and tingling of the extremities, hypersensitivity to light, noise, and physical contact, hallucinations, or seizures. Overdose Overdose with benzodiazepines is common, but fatal toxic occurrences are rare. Deaths caused by benzodiazepines in the absence of other significant toxicological agent or pathology are uncommon. However, one such death has been reported for Flunitrazepam / Rohypnol.(11) Fatal intoxication is more likely in children, in individuals with respiratory difficulties, and in individuals who have consumed another CNS depressant. Onset of CNS depression may be observed within 30-120 minutes of ingestion depending on the compound. Lethargy, slurred speech, ataxia, coma, and respiratory arrest may occur. Generally, patients with benzodiazepine-induced coma have hyporeflexia and midposition or small pupils. Hypothermia may occur. After an overdose, the patient begins a deep sleep that may last for 24-48 hours depending on the dose. However, even with large overdoses the patient can usually still be aroused.(12) If detected and treated with cardiorespiratory support the outcome of poisoning by a benzodiazepine is rarely fatal. If unattended the respiration may be compromised and aspiration of regurgitated stomach contents is a serious risk. In a study by Bond looking at the absorption and abuse of snorted Flunitrazepam / Rohypnol, it produced few side-effects. Of 13 possible bodily symptoms, the drug significantly increased only three: dizziness, physical tiredness, and loss of concentration.(13) Laboratory Analysis Flunitrazepam / Rohypnol is not detected on routine urine toxic screens. Hoffman-La Roche, the manufacturers of Flunitrazepam / Rohypnol, have made available a drug testing service for cases of sexual assault in which Rohypnol is believed to be involved. The testing service is free of charge, and an independent, National Institute on Drug Abuse approved laboratory handles the urine sample. Tests show that Rohypnol can be found in the urine for 72 hours after ingestion. To access the testing service, rape crisis centers, law enforcement, hospital emergency departments, and health care providers can call 1-800-608-6540 to initiate the testing. Treatment Following overdose of a benzodiazepine, vomiting should not be induced because of the rapidity of onset of CNS depression. Gastric lavage should be undertaken within one hour of ingestion with the airway protected. Activated charcoal should be given to reduce absorption. Treat coma, hypotension and hypothermia if they occur. Hypotension usually responds promptly to supine position and intravenous fluids. Flumazenil acts as a selective, competitive antagonist of the benzodiazepines (see Clinical Toxicology Review: vol 12 #5:Feb 1990). It effectively antagonizes the CNS effects of benzodiazepines, including the depression of respiration. Its duration of action is 1-4 hours, and it can precipitate an abstinence syndrome in chronic users References (First Author Only) (1) Bond, A., Seijas: Addiction 89(7):821-30, 1994. (2) International Standard Product Information Ro 05-4200. February 1994. (3) Bond, A: Addiction, 89(7):821-30, 1994. (4) Smith, Cedric: Textbook of Pharmacology W.B. Saunders Co., Philadelphia, PA 1992. (5) Craig, Charles: Modern Pharmacology, 3rd ed. Little, Brown and Co, Boston 1986. (6) International Standard Product Information. Ro5-4200, February, 1994. (7) Seppala M: Intl J Clin Pharmacol Ther Toxicol;31(4):170-6, 1993. (8) Smith, Cedric: Textbook of Pharmacology. W.B. Saunders Co., Philadelphia, PA 1992. (9) Craig, Charles: Modern Pharmacology, 3rd edition. Little, Brown, and Co, Boston,1986. (10) Drummer, OH: Am J Forens Med Pathol ;14(3):238-43, 1993. (11) Drummer OH: Am J Forens Med Pathol; 14(3):238-43, 1993. (12) Craig, Charles: Modern Pharmacology, 3rd edition. Little, Brown, and Co. Boston, MA 1986. (13) Bond, A: Addiction 89(7):821-30, 1994.
   
|
Hydrocodone, Xanax, Valium, Ambien and other medications are easily and legally available with U.S. phone consultations. This website provides reliable sources that have been tested so you can save lots of time and money. Discover foreign pharmacies that sell and ship medications without prescription and consult U.S. licensed doctors over the phone. Sources for all medications available.
|
Buy Discount Prescription Drugs from Online Consultation Services & Foreign Pharmacies Try our free medication and pharmacy search engine! Just enter the name of the medication you are looking for (i.e. Phentermine, Vicodin, Xanax, Lortab, Valium, etc.). Listings are not verified by FindRxOnline.com and filtered from publicly available data. In addition to online pharmacies, searches may also provide other results. You must be 21 years or older to use this search engine.
|
Adipex - Alprazolam - Ambien - Anexsia - Ativan - Celexa - Codeine - Darvocet - Darvon - Diazepam - Dormicum - Fioricet - Flexeril - Flunitrazepam - Haldol - Hydrocodone - Librium - Lorazepam - Lorcet - Lortab - Midazolam - Morphine - Norco - Nubain - Oxycodone - Paxil - Percocet - Phentermine - Prozac - Ritalin - Rohypnol - Soma - Valium - Viagra - Vicodin - Vicoprofen - Wellbutrin - Xanax - Xenical
This website does not sell pharmaceuticals. You should consult a doctor in person for medical evaluations. All trademarks found within this website are owned by their respective owners. Information provided does not contain medical or legal advice and is solely provided for educational and informational purposes. Medical advice should only be obtained from a licensed physician. You must at least be 21 years of age to access, browse and/or subscribe to this website and/or any services offered herein.
AOL Customers Read This
Tell a Friend