Zotepine
Template:Short description Template:Cs1 config Template:Drugbox
Zotepine is an atypical antipsychotic drug indicated for acute and chronic schizophrenia. It has been used in Germany since 1990 (although it has been discontinued in Germany) and Japan since 1982.
Zotepine is not approved for use in the United States, United Kingdom, Australia, Canada or New Zealand.[1]
Medical uses
Zotepine's primary use is as a treatment for schizophrenia[2] although clinical trials have been conducted (with positive results) into its efficacy as an antimanic agent in patients with acute bipolar mania.[3][4][5] In a 2013 study in a comparison of 15 antipsychotic drugs in effectivity in treating schizophrenic symptoms, zotepine demonstrated medium-strong effectivity. Less effective than clozapine, slightly less effective than olanzapine and risperidone, approximately as effective as paliperidone, and slightly more effective than haloperidol, quetiapine, and aripiprazole.[6]
Side effects
<templatestyles src="Div col/styles.css"/>
- Tachycardia
- Hypotension
- Orthostatic hypotension
- Palpitations
- Hyperprolactinaemia
- Weight gain (produces a similar degree of weight gain to that seen with clozapine and olanzapine treatment)[8]
- Somnolence (2nd highest effect size for causing sedation out of fifteen antipsychotics compared in a recent meta-analysis)[8]
- Extrapyramidal side effects [EPSE] (2nd largest odds ratio for causing EPSE out of fifteen antipsychotics compared in a recent meta-analysis, second only to haloperidol)[8]
- Constipation
- Xerostomia (dry mouth)
- Blurred vision
- Hypersalivation (drooling)
- Mydriasis
- Anxiety
- Agitation
- Rhinitis
- Sexual dysfunction
- Dyspnoea
- Diarrhoea
- Influenza-like symptoms
- Cough
- Vertigo
- Confusion
- Dyspepsia
- Flushing dry skin
- Arthralgia
- Myalgia
- Acne
- Conjunctivitis
- Thrombocythaemia
<templatestyles src="Div col/styles.css"/>
- QT interval prolongation
- Hyperthermia
- Hypothermia
- Increased serum creatinine
- Hyperglycaemia
- Hypoglycaemia
- Hyperlipidaemia
- Thirst
- Urinary incontinence
<templatestyles src="Div col/styles.css"/>
- Angle-closure glaucoma
- Agranulocytosis
- Neutropaenia
- Eosinophilia
- Leukocytopenia
- Hypoesthesia
- Anaemia
- Myoclonus
- Myasthenia
- Alopecia
- Thrombocytopaenia
- Bradycardia
- Epistaxis
- Abdominal enlargement
- Deep vein thrombosis
- Paralytic ileus
- Leukopenia
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Laryngeal edema
- Urinary retention
- Depression
- Ataxia
- Amnesia
- Seizure (dose-dependent risk)[1]
- Metabolic syndrome
- Diabetes mellitus type II
- Cholestasis
- Increased liver enzymes
- Photosensitivity
- Exanthema
- Pruritus
- Hypouricemia
- Oedema
Pharmacology
Pharmacodynamics
The antipsychotic effect of zotepine is thought to be mediated through antagonist activity at dopamine and serotonin receptors. Zotepine has a high affinity for the D1 and D2 receptors. It also affects the 5-HT2A, 5-HT2C, 5-HT6, and 5-HT7 receptors.[9] In addition, its active metabolite, norzotepine, serves as a potent norepinephrine reuptake inhibitor.[10]
| Macromolecule (Receptor or transporter protein) | Ki [nM][9] |
|---|---|
| SERT | 151 |
| NET | 530 |
| DAT | 3621 |
| 5-HT1A | 470.5 |
| 5-HT1B | 59.5 |
| 5-HT1D | 119 |
| 5-HT1E | 700 |
| 5-HT2A | 2.7 |
| 5-HT2C | 2.6 |
| 5-HT3 | 472 |
| 5-HT5A | 29 |
| 5-HT6 | 6 |
| 5-HT7 | 12 |
| α1A | 7 |
| α1B | 5 |
| α2A | 180 |
| α2B | 5.35 |
| α2C | 106 |
| M1 | 18 |
| M2 | 140 |
| M3 | 73 |
| M4 | 77 |
| M5 | 260 |
| D1 | 71 |
| D2 | 25 |
| D2S | 5.4 |
| D2L | 11 |
| D3 | 6.4 |
| D4 | 18 |
| D5 | 248 |
| H1 | 3.21 |
| H2 | 500 |
| H4 | 1977 |
Synthesis
The reaction of 2-chloroacetophenone with 4-chlorothiophenol gives a thioether. This is treated with morpholine and sulfur in a Willgerodt–Kindler reaction to give a phenylacetic acid derivative after acid hydrolysis of the amide intermediate. Cyclization of this compound in the presence of polyphosphoric acid forms the dibenzothiepin ring system of the drug. The enol ether, zotepine, is produced when this is treated with the chloroethyl amine and potassium carbonate in methyl isobutyl ketone as solvent. Under these conditions, the undesired product of C-alkylation is minimised.[11][12][13]
Society and culture
Brand names
Brand names include Losizopilon (JP), Lodopin (ID, JP), Setous (JP), Zoleptil (CZ, PT, TR, UK†), Zotewin (IN); where † indicates a formulation that has been discontinued.
See also
- Carbinoxamine, diphenhydramine, doxylamine, orphenadrine — the termination chain is the same
- Clotiapine - the base is similar
- Noxiptyline - the termination chain is similar
- Toll-like receptor 4 — investigating probable antagonistic (antiinflammatory) property of several TCA-based molecules
References
<templatestyles src="Reflist/styles.css" />
- ↑ a b Script error: No such module "citation/CS1".
- ↑ a b c d British National Formulary 58. British Medical Association and Royal Pharmaceutical Society of Great Britain; 2009.
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ a b c Cite error: Script error: No such module "Namespace detect".Script error: No such module "Namespace detect".
- ↑ a b c Script error: No such module "Citation/CS1".
- ↑ a b Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
Script error: No such module "Check for unknown parameters".
Further reading
<templatestyles src="Refbegin/styles.css" />
- Script error: No such module "citation/CS1".
- Script error: No such module "Citation/CS1".
Script error: No such module "Navbox".
Script error: No such module "navboxes". Script error: No such module "Navbox". Script error: No such module "Navbox". Script error: No such module "Navbox". Template:Monoamine reuptake inhibitors Template:Muscarinic acetylcholine receptor modulators Script error: No such module "navbox".Script error: No such module "navboxes".Script error: No such module "Check for unknown parameters". Script error: No such module "Navbox".
- Pages with script errors
- Pages with reference errors
- Pages with broken file links
- Alpha-2 blockers
- Atypical antipsychotics
- Chloroarenes
- Dibenzothiepines
- Dimethylamino compounds
- M1 receptor antagonists
- M2 receptor antagonists
- M3 receptor antagonists
- M4 receptor antagonists
- M5 receptor antagonists
- Norepinephrine reuptake inhibitors
- Enol ethers