Serotonergic agents

Esters of tropine have a venerable place in medicinal chemistry. One such compound, cocaine, the object of some current interest, was the natural product lead which led eventually to most of today s local anesthetics. A distantly related analogue is prepared by reaction of tropine (132) with 3,5-dimethylbenzoyl chloride. This leads to an ester structurally related to another ]ii ominent natural product, atropine (133). The product, tropanaerin (134), is described as an iinti.serotonergic agent intended for antimigraine use [34]. 

Serotonergic agents Ondansetron, ritanserin, buspirone Large controlled studies are not encouraging. 

Ergotamine derivatives Monitor cardiovascular complications as for serotonergic agents. 

Sibutramine Noradrenergic/serotonergic agent 5-1 5 mg Greater than 3 months3... 

Serotonin syndrome (sibutramine) The rare, but serious, constellation of symptoms also has been reported with the concomitant use of selective serotonin reuptake inhibitors and agents for migraine therapy (eg, sumatriptan, dihydroergotamine), certain opioids (eg, dextromethorphan, meperidine, pentazocine, fentanyl), lithium, or tryptophan. Because sibutramine inhibits serotonin reuptake, it should not be administered with other serotonergic agents. 

Coincident with the addition (or increase) of a known serotonergic agent to an established medication regimen at least 3 of the following ... 

Partial Response to Treatment Maintain CBT + fluvoxamine Adjunct addition of clonazepam Augment addition of other serotonergic agent s... 

Adrenergic and Serotonergic Agents Tricyclic Antidepressants and Venlofoxine... 

Aman M.G., Arnold, L.E., and Armstrong S. (1999) Review of serotonergic agents and perseverative behavior in patients with developmental disabilities. J Child Adolesc Psychopharmacol 5 279-289. 

Phenelzine Blockade of MAO-A and MAO-B (phenelzine, nonselective) MAO-B irreversible selective MAO-B inhibition (low dose selegiline) Transdermal absorption of selegiline achieves levels that inhibit MAO-A Major depression unresponsive to other drugs Very slow elimination Toxicity Hypotension, insomnia Interactions Hypertensive crisis with tyramine, other indirect sympathomimetics serotonin syndrome with serotonergic agents, meperidine... 

Although it is not yet possible to determine who will respond to a serotonergic agent and who to a noradrenergic agent prior to empirical treatment, there is the... 

Novel serotonergic agents The same agents in testing as antidepressants and discussed in the section Other antidepressants in clinical trials, in Chapter 7, may also be promising antipanic agents. Such compounds tend to be tested first as... 

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