Abstract
Rationale
Preclinical studies support the hypothesis that endogenous neuroactive steroids mediate some effects of alcohol.
Objectives
The aim of this study was to examine the effect of dutasteride inhibition of 5α-reduced neuroactive steroid production on subjective responses to alcohol in adult men.
Methods
Using a within-subject factorial design, 70 men completed four randomly ordered monthly sessions in which pretreatment with 4 mg dutasteride or placebo was paired with a moderate dose of alcohol (0.8 g/kg) or placebo beverage. The pharmacologic effect of dutasteride was measured by an assay of serum androstanediol glucuronide. Self-reports of alcohol effects were obtained at 40-min intervals following alcohol administration using the Biphasic Alcohol Effects Scale (BAES) and the Alcohol Sensation Scale (SS). We used linear mixed models to examine the effects of dutasteride and alcohol on BAES and SS responses and the interaction of dutasteride with the GABRA2 alcohol dependence-associated polymorphism rs279858. We also examined whether exposure to dutasteride influenced drinking in the weeks following each laboratory session.
Results
A single 4-mg dose of dutasteride produced a 70 % reduction in androstanediol glucuronide. Dutasteride pretreatment reduced alcohol effects on the BAES sedation and SS anesthesia scales. There was no interaction of dutasteride with rs279858. Heavy drinkers had fewer heavy drinking days during the 2 weeks following the dutasteride sessions and fewer total drinks in the first week after dutasteride.
Conclusions
These results provide evidence that neuroactive steroids mediate some of the sedative effects of alcohol in adult men and that dutasteride may reduce drinking, presumably through its effects on neuroactive steroid concentrations.
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References
Arias AJ, Covault J, Feinn R, Pond T, Yang BZ, Ge W, Oncken C, Kranzler HR (2014) A GABRA2 variant is associated with increased stimulation and 'high' following alcohol administration. Alcohol Alcohol 49(1):1–9
Bitran D, Hilvers RJ, Kellogg CK (1991) Anxiolytic effects of 3 alpha-hydroxy-5 alpha[beta]-pregnan-20-one: endogenous metabolites of progesterone that are active at the GABAA receptor. Brain Res 561(1):157–161
Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S (2004) Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab 89(5):2179–2184
Covault J, Gelernter J, Hesselbrock V, Nellissery M, Kranzler HR (2004) Allelic and haplotypic association of GABRA2 with alcohol dependence. Am J Med Genet B Neuropsychiatr Genet 129(1):104–109
Falsetti L, Gambera A, Legrenzi L, Iacobello C, Bugari G (1999) Comparison of finasteride versus flutamide in the treatment of hirsutism. Eur J Endocrinol 141(4):361–367
First M, Spitzer R, Gibbon M, Williams J (1995) Structured clinical interview for DSM-IV Axis I disorders—patient edition (SCID - I/P, version 2.0). Biometrics Research Department, New York State Psychiatric Institute, New York
Ford MM, Nickel JD, Finn DA (2005) Treatment with and withdrawal from finasteride alter ethanol intake patterns in male C57BL/6J mice: potential role of endogenous neurosteroids? Alcohol 37(1):23–33
Ford MM, Yoneyama N, Strong MN, Fretwell A, Tanchuck M, Finn DA (2008) Inhibition of 5alpha-reduced steroid biosynthesis impedes acquisition of ethanol drinking in male C57BL/6J mice. Alcohol Clin Exp Res 32(8):1408–1416
Frye CA, Van Keuren KR, Erskine MS (1996) Behavioral effects of 3 alpha-androstanediol. I: Modulation of sexual receptivity and promotion of GABA-stimulated chloride flux. Behav Brain Res 79(1–2):109–118
Gilman JM, Ramchandani VA, Crouss T, Hommer DW (2012) Subjective and neural responses to intravenous alcohol in young adults with light and heavy drinking patterns. Neuropsychopharmacology 37(2):467–477
Gisleskog PO, Hermann D, Hammarlund-Udenaes M, Karlsson MO (1998) A model for the turnover of dihydrotestosterone in the presence of the irreversible 5 alpha-reductase inhibitors GI198745 and finasteride. Clin Pharmacol Ther 64(6):636–647
Gisleskog PO, Hermann D, Hammarlund-Udenaes M, Karlsson MO (1999) The pharmacokinetic modelling of GI198745 (dutasteride), a compound with parallel linear and nonlinear elimination. Br J Clin Pharmacol 47(1):53–58
Gormley GJ, Stoner E, Rittmaster RS, Gregg H, Thompson DL, Lasseter KC, Vlasses PH, Stein EA (1990) Effects of finasteride (MK-906), a 5 alpha-reductase inhibitor, on circulating androgens in male volunteers. J Clin Endocrinol Metab 70(4):1136–1141
Haughey HM, Ray LA, Finan P, Villanueva R, Niculescu M, Hutchison KE (2007) Human gamma-aminobutyric acid A receptor alpha2 gene moderates the acute effects of alcohol and brain mRNA expression. Genes Brain Behav 7:447–454
Holdstock L, Penland SN, Morrow AL, de Wit H (2006) Moderate doses of ethanol fail to increase plasma levels of neurosteroid 3alpha-hydroxy-5alpha-pregnan-20-one-like immunoreactivity in healthy men and women. Psychopharmacology (Berl) 186(3):442–450
Holzbauer M, Birmingham MK, De Nicola AF, Oliver JT (1985) In vivo secretion of 3 alpha-hydroxy-5 alpha-pregnan-20-one, a potent anaesthetic steroid, by the adrenal gland of the rat. J Steroid Biochem 22(1):97–102
Imperato-McGinley J (1991) 5 Alpha-metabolism in finasteride-treated subjects and male pseudohermaphrodites with inherited 5 alpha-reductase deficiency. A review. Eur Urol 20(Suppl 1):78–81
Irwig MS (2013) Decreased alcohol consumption among former male users of finasteride with persistent sexual side effects: a preliminary report. Alcohol Clin Exp Res 37(11):1823–1826
Jez JM, Flynn TG, Penning TM (1997) A new nomenclature for the aldo-keto reductase superfamily. Biochem Pharmacol 54(6):639–647
Kareken DA, Liang T, Wetherill L, Dzemidzic M, Bragulat V, Cox C, Talavage T, O'Connor SJ, Foroud T (2010) A polymorphism in GABRA2 is associated with the medial frontal response to alcohol cues in an fMRI study. Alcohol Clin Exp Res 34(12):2169–2178
King AC, Houle T, de Wit H, Holdstock L, Schuster A (2002) Biphasic alcohol response differs in heavy versus light drinkers. Alcohol Clin Exp Res 26(6):827–835
Kumar S, Porcu P, Werner DF, Matthews DB, Diaz-Granados JL, Helfand RS, Morrow AL (2009) The role of GABA(A) receptors in the acute and chronic effects of ethanol: a decade of progress. Psychopharmacology (Berl) 205(4):529–564
Maisto SA, Connors GJ, Tucker JA, McCollam JB, Adesso VJ (1980) Validation of the Sensation Scale, a measure of subjective physiological responses to alcohol. Behav Res Ther 18(1):37–43
Majewska MD, Harrison NL, Schwartz RD, Barker JL, Paul SM (1986) Steroid hormone metabolites are barbiturate-like modulators of the GABA receptor. Science 232(4753):1004–1007
Martin CS, Sayette MA (1993) Experimental design in alcohol administration research: limitations and alternatives in the manipulation of dosage-set. J Stud Alcohol 54(6):750–761
Martin CS, Earleywine M, Musty RE, Perrine MW, Swift RM (1993) Development and validation of the Biphasic Alcohol Effects Scale. Alcohol Clin Exp Res 17(1):140–146
Mellon SH, Griffin LD (2002) Neurosteroids: biochemistry and clinical significance. Trends Endocrinol Metab 13(1):35–43
Morrow AL, Suzdak PD, Paul SM (1987) Steroid hormone metabolites potentiate GABA receptor-mediated chloride ion flux with nanomolar potency. Eur J Pharmacol 142(3):483–485
Nyberg S, Andersson A, Zingmark E, Wahlstrom G, Backstrom T, Sundstrom-Poromaa I (2005) The effect of a low dose of alcohol on allopregnanolone serum concentrations across the menstrual cycle in women with severe premenstrual syndrome and controls. Psychoneuroendocrinology 30(9):892–901
Paul SM, Purdy RH (1992) Neuroactive steroids. FASEB J 6(6):2311–2322
Pierucci-Lagha A, Covault J, Feinn R, Nellissery M, Hernandez-Avila C, Oncken C, Morrow AL, Kranzler HR (2005) GABRA2 alleles moderate the subjective effects of alcohol, which are attenuated by finasteride. Neuropsychopharmacology 30(6):1193–1203
Pierucci-Lagha A, Covault J, Feinn R, Khisti RT, Morrow AL, Marx CE, Shampine LJ, Kranzler HR (2006) Subjective effects and changes in steroid hormone concentrations in humans following acute consumption of alcohol. Psychopharmacology (Berl) 186(3):451–461
Porcu P, O'Buckley TK, Alward SE, Song SC, Grant KA, de Wit H, Leslie Morrow A (2010) Differential effects of ethanol on serum GABAergic 3alpha,5alpha/3alpha,5beta neuroactive steroids in mice, rats, cynomolgus monkeys, and humans. Alcohol Clin Exp Res 34(3):432–442
Ramaker MJ, Ford MM, Fretwell AM, Finn DA (2011) Alteration of ethanol drinking in mice via modulation of the GABA(A) receptor with ganaxolone, finasteride, and gaboxadol. Alcohol Clin Exp Res 35(11):1994–2007
Reddy DS (2004) Testosterone modulation of seizure susceptibility is mediated by neurosteroids 3alpha-androstanediol and 17beta-estradiol. Neuroscience 129(1):195–207
Reddy DS, Jian K (2010) The testosterone-derived neurosteroid androstanediol is a positive allosteric modulator of GABAA receptors. J Pharmacol Exp Ther 334(3):1031–1041
Rittmaster RS, Stoner E, Thompson DL, Nance D, Lasseter KC (1989) Effect of MK-906, a specific 5 alpha-reductase inhibitor, on serum androgens and androgen conjugates in normal men. J Androl 10(4):259–262
Roh S, Matsushita S, Hara S, Maesato H, Matsui T, Suzuki G, Miyakawa T, Ramchandani VA, Li TK, Higuchi S (2011) Role of GABRA2 in moderating subjective responses to alcohol. Alcohol Clin Exp Res 35(3):400–407
Sanna E, Talani G, Busonero F, Pisu MG, Purdy RH, Serra M, Biggio G (2004) Brain steroidogenesis mediates ethanol modulation of GABAA receptor activity in rat hippocampus. J Neurosci 24(29):6521–6530
Sobell LC, Sobell MB (1992) In: Litten R, Allen J (eds) Timeline follow-back: a technique for assessing self-reported alcohol consumption. Measuring alcohol consumption: psychosocial and biochemical methods. Humana Press, Totowa, pp 41–42
Torres JM, Ortega E (2003) Alcohol intoxication increases allopregnanolone levels in female adolescent humans. Neuropsychopharmacology 28(6):1207–1209
Torres JM, Ortega E (2004) Alcohol intoxication increases allopregnanolone levels in male adolescent humans. Psychopharmacology (Berl) 172(3):352–355
Uhart M, Weerts EM, McCaul ME, Guo X, Yan X, Kranzler HR, Li N, Wand GS (2013) GABRA2 markers moderate the subjective effects of alcohol. Addict Biol 18(2):357–369
VanDoren MJ, Matthews DB, Janis GC, Grobin AC, Devaud LL, Morrow AL (2000) Neuroactive steroid 3alpha-hydroxy-5alpha-pregnan-20-one modulates electrophysiological and behavioral actions of ethanol. J Neurosci 20(5):1982–1989
Wong IL, Morris RS, Chang L, Spahn MA, Stanczyk FZ, Lobo RA (1995) A prospective randomized trial comparing finasteride to spironolactone in the treatment of hirsute women. J Clin Endocrinol Metab 80(1):233–238
Acknowledgments
Supported by NIH grants R01 AA015606 (to JC), K24 AA13736 (to HRK), P60 AA03510 (Alcohol Research Center), and M01 RR06192 (University of Connecticut General Clinical Research Center). The authors thank Linda Burian and Pamela Fall for their expert technical assistance in the conduct of this study.
Conflict of interest
JC, RF, AJA, and TP have no disclosures to make. HK has been a consultant or advisory board member for the following pharmaceutical companies: Alkermes, Lilly, Lundbeck, Pfizer, and Roche. He is also a member of the American Society of Clinical Psychopharmacology’s Alcohol Clinical Trials Initiative, which is supported by Lilly, Lundbeck, AbbVie, and Pfizer. CO has received study supplies from Pfizer Pharmaceuticals for a smoking cessation study.
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Covault, J., Pond, T., Feinn, R. et al. Dutasteride reduces alcohol’s sedative effects in men in a human laboratory setting and reduces drinking in the natural environment. Psychopharmacology 231, 3609–3618 (2014). https://doi.org/10.1007/s00213-014-3487-4
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DOI: https://doi.org/10.1007/s00213-014-3487-4