Psychopharmacology EMIs
Michael Reilly, Bangaru Raju in Extended Matching Items for the MRCPsych Part 1, 2018
EscitalopramLofepramine.Maprotiline.Mianserin.Mirtazapine.Reboxetine.Trazadone.Venlafaxine.Viloxazine.
Parasomnias
Stanley R. Resor, Henn Kutt in 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).
Can Narcolepsy Be Eradicated in This Millennium?
Meeta Goswami, Charles P. Pollak, Felissa L. Cohen, Michael J. Thorpy, Neil B. Kavey, Austin H. Kutscher, Jill C. Crabtree in Psychosocial Aspects of Narcolepsy, 2015
The second possibility for the eradication of narcolepsy is the development of a treatment which is so effective that it doesn't matter, really, whether the genetic susceptibility is eliminated or not. The record of new compounds introduced for the control of the symptoms of narcolepsy is lamentable, if not actually shameful. The orphan drug program [as noted earlier] has not been very helpful, and the most recent candidate for treatment of cataplexy, viloxazine, was not approved. The reason was said to be the lack of information on the long-term manifestations and stability of cataplexy, i.e., a normative database against which to compare the potential efficacy of the drug. The lack of longitudinal data is a very serious problem. At any rate, Ritalin, which was introduced in the 1950s, remains the drug of choice for the control of sleepiness. Tricyclic antidepressants, particularly protriptyline, have been the treatment of choice for the control of cataplexy for a generation. Given the rapid progress in neuropsychopharmacology in general, the lack of new treatments for narcolepsy would seem to be reprehensible. However, the strategy of searching for more specific and highly selective compounds and identifying the crucial receptor synaptic complexes that are involved in this illness is a clearly productive way to go. It is here that animal research may be beneficial.
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.
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].
Characterisation of seven medications approved for attention-deficit/hyperactivity disorder using in vitro models of hepatic metabolism
Published in Xenobiotica, 2022
Rebecca Law, David Lewis, Daniel Hain, Rachel Daut, Melissa P. DelBello, Jean A. Frazier, Jeffrey H. Newcorn, Erika Nurmi, Elizabeth S. Cogan, Susanne Wagner, Holly Johnson, Jerry Lanchbury
With the exception of ATX (Sauer et al. 2005) and the recently approved, non-stimulant viloxazine (Case and Reeves 1975; Yu 2020), very little is known about the metabolism of the medications commonly used to treat ADHD. This study aimed to provide a more in-depth understanding of the hepatic metabolism of seven ADHD medications using in vitro models. Most importantly, this study showed significant metabolism of ATX by CYP2D6 and of GUA by CYP3A4/5. The major DME responsible for the breakdown of MPH, dMPH, AMPH, dAMPH, and CLD could not be identified either due to a lack of parent loss or instability of parent compounds. Nonetheless, valuable information regarding metabolite formation for these medications is reported here. Further exploration of the metabolic systems for ADHD medications will be important for clinical considerations surrounding DDIs and GDIs.
Related Knowledge Centers
- Antidepressant
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- Side Effect