Opipramol improves subjective quality of sleep the night prior to surgery: confirmatory testing of a double-blind, randomized clinical trial.

OBJECTIVE: Due to its pharmacological properties, opipramol may be useful in the context of evening premedication in anaesthesiology. This trial examines whether quality of sleep the night prior to surgery can be improved by opipramol and whether this effect is dose dependent. A second objective of this study is to examine whether the emotional state (in particular anxiety) is affected by opipramol. METHOD: 72 female patients were randomly assigned to 100 mg opipramol, 150 mg opipramol or placebo (24 patients per group) in a double-blind trial. Drug application was in the evening prior to an elective surgery. Effects were recorded the next morning by means of self-rating questionnaires regarding subjective sleep quality of the last night and patients' current subjective state. The self-rating was done by use of the Wuerzburg Sleep Questionnaire, by use of mood inventories [BSKE (EWL) and STAI-X1] and by use of the Multidimensional Somatic Symptom List. Further dependent variables were heart rate and blood pressure. Confirmatory data analysis was conducted for subjective quality of sleep. RESULTS: 100 mg opipramol as well as 150 mg opipramol significantly improved subjective quality of sleep (p < 0.001). The drug conditions did not differ in this effect. Opipramol marginally reduced anxiety (STAI-X1). The autonomic variables remained uninfluenced. There were no adverse events and no hints for interaction with anaesthesia. CONCLUSION: Opipramol may be used as a premedication in the evening prior to surgery if the primary target is an impact on the experienced quality of sleep. For this a single dosage of 100 mg opipramol is sufficient and can be recommended.

Psychopharmacotherapy of somatoform disorders: effects of opipramol on symptoms of somatization, anxiety, and depression.

BACKGROUND: The psychopharmacotherapy of somatoform disorders (SD; ICD-10: F45) has been less frequently investigated and is not as well established as in other (neurotic) disorders of ICD-10 section F4, i.e. generalized anxiety disorder (GAD; ICD-10: F41.1). The atypical compound opipramol is very often used to treat SD and GAD in clinical practice in Germany. However, state-of-the-art controlled clinical trials have not yet been performed. OBJECTIVES: Two clinical trials were performed with the aim of confirming the efficacy and tolerability of opipramol in SD and GAD. METHODS: Both trials were performed as randomized, double-blind, placebo-controlled, multicenter studies. While the GAD trial was a three-arm study with opipramol (200 mg/day) vs. placebo and alprazolam (2 mg/day) for 28 days, the SD trial was a placebo-controlled two-arm study with a treatment duration of 42 days. Each group consisted of about 100 patients. RESULTS: Significant differences (alpha = 0.05) were found for the primary efficacy criteria (HAMA total score in GAD, HAMA somatic subscore in SD) and most of the secondary criteria in favor of the active drug therapies. Considerable differences between the psychopathology of SD and GAD were detected. CONCLUSION: The well-tolerated anxiolytic opipramol is the first psychotropic drug with proven efficacy in somatoform disorders with effects on symptoms of somatization, anxiety, and depression. The compound is also effective and safe in GAD.

Effects of opipramol as an evening anaesthesiologic premedication.

To date, opipramol has not been examined within the context of evening premedication in anaesthesiology. A suitable drug for such an application should induce anxiolytic and sleep-favouring effects. Due to its pharmacological properties, one would expect opipramol to lead to these effects. In order to test this possibility, 72 female patients were randomly assigned to 50 mg opipramol, 100 mg opipramol, or placebo (n = 24 patients per group) in the evening prior to surgery in a double-blind trial. Effects were recorded in the morning prior to the operation by means of self-rating questionnaires, regarding the patients' current subjective state and their judgement of the quality of sleep during the night before. The self-rating was done by the Multidimensional Mood Inventory BSKE (EWL), by use of the Multidimensional Somatic Symptom List (MSKL), and by use of the Würzburg Sleep Questionnaire. Further dependent variables were heart rate and blood pressure. Opipramol significantly improved sleep quality. Especially the frequency of awakening at night was reduced. These effects could be observed predominantly after 100 mg opipramol. At this dosage, inner excitement was reduced as well. The autonomic variables remained uninfluenced. There were no adverse events and no hints for interactions with anaesthesiology.