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Parasomnias
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Cataplexy mandates treatment when attacks occur at times that put the patient in danger. As the stimulants used to treat the excessive somnolence of narcolepsy are ineffective against the auxiliary symptoms, cataplexy must be addressed with independent therapy. Protriptyline, an activating tricyclic antidepressant, is the standard agent in the United States but other tricyclics including imipramine and desipramine are also effective. Clomipramine is widely used in Europe. Fluoxetine, which specifically inhibits serotonin reuptake, has shown promise in limited trials and appears to produce fewer adverse effects than the tricyclics. MAO inhibitors can be effective but potential toxicity interdicts their use in all but refractory cases. Gamma-hydroxybutyrate, currently under investigation in the United States and available in France and Canada, can be highly effective (16). Viloxazine hydrochloride has proven effective in early investigative trials in the United States (17).
Psychopharmacology EMIs
Published in Michael Reilly, Bangaru Raju, Extended Matching Items for the MRCPsych Part 1, 2018
EscitalopramLofepramine.Maprotiline.Mianserin.Mirtazapine.Reboxetine.Trazadone.Venlafaxine.Viloxazine.
Psychotropic Drugs
Published in Diana Riley, Perinatal Mental Health, 2018
Information on viloxazine (Vivalan) is limited to a single study of one patient who took 300 mg daily for two days (JR Holmes, 1977, internal publication, Fairmile journal). The concentration in breast milk was 10-20% of that in maternal serum. This drug, which is chemically distinct from the tri- and tetracyclics, is probably unsuitable for nursing mothers.
A systematic review of pharmacotherapy for attention-deficit/hyperactivity disorder in children and adolescents with bipolar disorders
Published in Expert Opinion on Pharmacotherapy, 2023
Arnaud Pouchon, Rayan Nasserdine, Clément Dondé, Antoine Bertrand, Mircea Polosan, Stéphanie Bioulac
As a third-line treatment, other therapies appear to be of particular interest in this indication, due to their mechanism of action, but have not yet been published in BD and ADHD comorbidity, like alpha−2-agonists (guanfacine and clonidine) and extended-release viloxazine (SPN−812). Viloxazine has a unique mechanism of action, modulating both serotonin and norepinephrine activity [81]. In a recent meta-analysis, viloxazine proved significantly superior to placebo in ADHD in children and adolescents [82]. The most frequently observed treatment-related adverse effects are drowsiness, reduced appetite, and headaches. There did not appear to be any serious adverse effects significantly superior to the placebo [82]. Extended-release viloxazine may provide a once-daily pharmaceutical treatment option for patients in whom stimulant medications are ineffective or not a desirable option, or in children and adolescents with depressive comorbidity, due to its mechanism of action. However, further testing is necessary to confirm the reduction in ADHD symptoms in children as well as the safety profile [81].
Reviewing the role of emerging therapies in the ADHD armamentarium
Published in Expert Opinion on Emerging Drugs, 2021
Ann C. Childress, Nathalie Beltran, Carl Supnet, Margaret D. Weiss
Several nonstimulant drugs are in the pipeline, with viloxazine closest to receiving marketing approval in the U.S. Although it did not have the efficacy of stimulants in clinical trials, viloxazine’s long safety record in Europe as an antidepressant will make it a welcome addition to the ADHD armamentarium for patients with complex ADHD. Other nonstimulants, including L-Threonic Acid Magnesium Salt (L-TAMS) and tipepidine hibenzate, have not had new data published in the last 5 years [58,110]. The website for L-TAMS reports that further trials are planned. It is unclear whether tipeptidine hibenzate is continuing in development. Other ADHD drugs in various stages of development, from preclinical to phase II, were researched, but peer reviewed trials were not available for most of them. It is unclear how many of these will proceed.
Metabolism and in vitro drug–drug interaction assessment of viloxazine
Published in Xenobiotica, 2020
Supernus Pharmaceuticals, Inc. (Supernus) is currently developing SPN-812 (viloxazine extended released), as a treatment for attention-deficit/hyperactivity disorder (ADHD). SPN-812 is a multimodal serotonergic and noradrenergic modulating agent (SNMA) with demonstrated activity at serotonin receptors and the norepinephrine transporter. In vivo, viloxazine has been shown to increase serotonin (5-HT), norepinephrine (NE), and dopamine (DA) levels in the prefrontal cortex (Garcia-Olivares et al., 2020), a region strongly implicated in ADHD pathophysiology. In vitro, viloxazine exhibits antagonistic activity at 5-HT2B receptors and agonistic activity at 5-HT2C receptors (data on file, Supernus Pharmaceuticals, Inc.), although the downstream effects of this activity remains to be fully elucidated. Viloxazine also increases NE and DA levels through norepinephrine transporter (NET) inhibition.