Cholinesterase inhibitors reversible

Donepezil is a piperidine cholinesterase inhibitor, which reversibly and non-competitively inhibits centrally active acetylcholinesterase 34 This specificity is claimed to result in fewer peripheral side effects as compared to the other ChE inhibitors. 

The reversible cholinesterase inhibitor indicated in the treatment of Alzheimer s disease is... 

Seto, Y. and T. Shinohara. 1988. Structure-activity relationship of reversible cholinesterase inhibitors including paraquat. Arch. Toxicol. 62 37-40. 

Albuquerque EX, Aracava Y, Cintra WM, Brossi A, Schonenberger B, Deshpande SS. Structure-activity relationship of reversible cholinesterase inhibitors activation, channel blockade and stereospecificity of the nicotinic acetylcholine receptor-ion channel complex. Braz. J. Med. Biol. Res. 21 1173-1196, 1988. 

Journal reports by Bell and Gershon indicated that tetrahydroaminoacridine (THA), a cholinesterase inhibitor, was effective in reversing delirium induced by Ditran (JB-329) as a form of psychiatric treatment It is interesting that their use of Ditran for this purpose was similar to the atropine coma treatment method reported more than a decade earlier by Forrer, Miller et al. In our study, five subjects were given 5.0 mcg/kg of oral BZ on two occasions, 8-14 days apart 60 mcg/kg of THA was administered iv four hours after the time of the second BZ dose. We observed definite partial reversal of impairment soon after injection, but it was brief. An unexpected observation was the general tendency by the subjects to become impaired more rapidly and intensely by BZ on the second occasion - a finding that was later confirmed in a more careful study. 

Sidell FR, Aghajanian GK, Groff WA The reversal of anticholinergic intoxication in man with the cholinesterase inhibitor VX. Proc Soc Exp Biol Medl44- 725-730,1973. 

The key to successful brain protection for Alzheimer s disease is the newly introduced NMDA receptor antagonist, memantine. Family members should be advised that the protection provided by memantine will slow the progression of Alzheimer s disease, but it does not halt or reverse the course of the illness. Memantine is now commonly coadministered with a cholinesterase inhibitor. 

Galanthamine exerts its activity through a competitive and reversible cholinesterase inhibitor action. 

Reversible cholinesterase inhibitors form a transition state complex with the enzyme, just as acetylcholine does. These compounds are in competition with acetylcholine in binding with the active sites of the enzyme. The chemical stracture of classic, reversible inhibitors physostigmine and neostigmine shows their similarity to acetylcholine. Edrophonium is also a reversible inhibitor. These compounds have a high affinity with the enzyme, and their inhibitory action is reversible. These inhibitors differ from acetylcholine in that they are not easily broken down by enzymes. Enzymes are reactivated much slower than it takes for subsequent hydrolysis of acetylcholine to happen. Therefore, the pharmacological effect caused by these compounds is reversible. 

Pharmacology Tacrine is a centrally acting reversible cholinesterase inhibitor, commonly referred to as THA. 

Galantamine is used for the treatment of mild to moderate Alzheimer s disease. However in 2005 the U.S. Food and Drug Administration sent out a warning indicating that the product should not be used in patients with mild cognitive impairment (MCI) because of increased mortality observed in trials for MCI with galantamine. Galantamine is a competitive and reversible cholinesterase inhibitor. 

Tacrine has been found to be somewhat effective in patients with mild-to-moderate symptoms of this disease for improvement of cognitive functions. The drug is primarily a reversible cholinesterase inhibitor that increases the concentration of functional ACh in the brain. However, the pharmacology of tacrine is complex the drug also acts as a muscarinic receptor modulator in that it has partial agonistic activity, as well as weak antagonistic activity on muscarinic receptors in the CNS. In addition, tacrine appears to enhance the release of ACh from cholinergic nerves, and it may alter the concentrations of other neurotransmitters such as dopamine and NE. 

The organophosphate inhibitors are sometimes referred to as "irreversible" cholinesterase inhibitors, and edrophonium and the carbamates are considered "reversible" inhibitors because of the marked differences in duration of action. However, the molecular mechanisms of action of the three groups do not support this simplistic description. 

Both the nicotinic and the muscarinic effects of the cholinesterase inhibitors can be life-threatening. Unfortunately, there is no effective method for directly blocking the nicotinic effects of cholinesterase inhibition, because nicotinic agonists and antagonists cause blockade of transmission (see Chapter 27). To reverse the muscarinic effects, a tertiary (not quaternary) amine drug must be used (preferably... 

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