Chlorpromazine chemical structure
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Thorazine

Chlorpromazine was the first antipsychotic drug, used during the 1950s and 1960s. Used as chlorpromazine hydrochloride and sold under the tradenames Largactil® and Thorazine®, it has sedative, hypotensive and antiemetic properties as well as anticholinergic and antidopaminergic effects. It has also anxiolytic (alleviation of anxiety) properties. Today, chlorpromazine is considered a typical antipsychotic. more...

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Chemistry

Chlorpromazine is derived from phenothiazine, its chemical name is 2-chloro-10- phenothiazine monohydrochloride and its molecular formula is C17H19ClN2S•HCl. Chlorpromazine has an aliphatic side chain, typical for low to middle potency neuroleptics. The oral bioavailability is estimated to be 30% to 50% due to extensive first pass metabolization in the liver. Its elemination-halflife is 16 to 30 hours. It has many active metabolites (approx. 75 different ones) with greatly varying halflives and own pharmacological profiles. The CYP-450 isoenzymes 1A2 and 2D6 are needed for metabolization of chlorpromazine and the subtype 2D6 is inhibited by chlorpromazine (NB: possible interactions with other drugs).

Mechanism of action

Central

Chlorpromazine acts as an antagonist (blocking agent) on different postsysnaptic receptors -on dopaminergic-receptors (subtypes D1, D2, D3 and D4 - different antipsychotic properties on productive and unproductive symptoms), on serotonergic-receptors (5-HT1 and 5-HT2, with anxiolytic, antidepressive and antiaggressive properties as well as an attenuation of extrapypramidal side-effects, but also leading to weight gain, fall in blood pressure, sedation and ejaculation difficulties), on histaminergic-receptors (H1-receptors, sedation, antiemesis, vertigo, fall in blood pressure and weight gain), alpha1/alpha2-receptors (antisympathomimetic properties, lowering of blood pressure, reflex tachycardia, vertigo, sedation, hypersalivation and incontinence as well as sexual dysfunction, but may also attenuate pseudoparkinsonism - controversial) and finally on muscarinic (cholinergic) M1/M2-receptors (causing anticholinergic symptoms like dry mouth, blurred vision, obstipation, difficulty/inability to urinate, sinus tachycardia, ECG-changes and loss of memory, but the anticholinergic action may attenuate extrapyramidal side-effects).

Additionally, Chlorpromazine is a weak presynaptic inhibitor of Dopamine reuptake, which may lead to (mild) antidepressive and antiparkinsonian effects. This action could also account for psychomotor agitation and amplification of psychosis (very rarely noted in clinical use).

Peripheral

Antagonist to H1-receptors (antiallergic effects), H2-recptors (reduction of forming of gastric juice), M1/M2-receptors (dry mouth, reduction in forming of gastric juice) and some 5-HT receptors (different antiallergic/gastrointestinal actions).

Because it acts on so many receptors, chlorpromazine is often referred to as 'dirty drug', whereas the atypical neuroleptic amisulpride e.g. acts only on central D2/D3-receptors and is therefore a 'clean drug'. This distinction expresses no valuation of the drugs.

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From Environmental Health Perspectives, 11/1/04 by W. Conard Holton

The time and cost required to bring a new drug to market can exceed 10 years and $800 million, according to the Tufts Center for the Study of Drug Development. Now researchers at etexx Biopharmaceuticals in Dallas, Texas, are using software that they say will slash this time and cost. How? By mining the medical literature for hints on new uses for drugs already approved by the Food and Drug Administration.

Repurposing existing drugs can offer substantial payoffs for both pharmaceutical companies and the public. For example, bupropion has been licensed separately as an antismoking drug (Zyban) and an antidepressant (Wellbutrin); Rogaine, now used to treat hair loss, was originally developed as a treatment for high blood pressure.

The software was created at The University of Texas (UT) Southwestern Medical Center by biochemistry professor Harold Garner and colleagues, and has been licensed to etexx, which Garner founded. Known as IRIDESCENT (for Implicit Relationship IDEntification by in-Silico Construction of an Entity-Based Network from Text), the program allows full-scale automated analysis of records in MEDLINE, the National Library of Medicine's bibliographic database. Eventually the software could be used with other online resources such as the Physicians' Desk Reference and even internal documents from pharmaceutical and biotech companies.

The software analyzes MEDLINE abstracts to identify and evaluate statistical relationships among biomedical terms such as names of genes, phenotypes, drugs, and diseases. The program compares how often sets of these terms appear in texts relative to random probability. It can identify and compare over 300,000 different biomedical terms along with their spelling variations, synonyms, and acronyms, A network of these "co-mentions" is created and then analyzed by a statistical program to find indirect or implicit connections.

IRIDESCENT then scores the objects for relevance, significance, and interest, allowing the researcher to inspect the resulting connections to trigger hypotheses on new uses for existing drugs. The team showed the value of this approach by validating in several lab trials a connection between the drug Thorazine, used to treat psychotic disorders, and a reduction in the progression of cardiac hypertrophy, or enlargement of the heart, which the program had predicted. The results were published 12 February 2004 in Bioinformatics.

Besides conducting its own lab research on potential repurposed drugs, etexx will help pharmaceutical and genomics organizations sort through existing data and generate hypotheses from high-throughput data processes such as microarrays or proteomics mass spectroscopy analysis. "Everyone is trying to find ways to develop drugs cheaply," says Stephen Johnston, director of the UT Southwestern Center for Biomedical Inventions, which develops new drugs and procedures. "Garner has had very promising preliminary results."

COPYRIGHT 2004 National Institute of Environmental Health Sciences
COPYRIGHT 2005 Gale Group

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