Tetracyclic antidepressant drugs, drug

A Single Comprehensive Gas Chromatographic Assay for Tricyclic and Tetracyclic Antidepressant Drugs and Their Major Metabolites in Plasma... 

Maprotiline is frequently referred to as a tetracyclic antidepressant. This hybrid drug, containing both elements of classic tricyclic antidepressants and protriptyline elements, is pharmacologically and clinically more similar to imipramine. 

Many chromatographic separations of isotopologues of various amines that are biologically active or have drug properties have been achieved. Among these are perdeuteronucleosides 137 a tetracyclic 3,3,4,4-c/4-piperazine with antimigraine activity 138 the tetracyclic antidepressant mianserin with 2H or 3H in the A-methyl 139 A-CH3-tritiated chlorpromazine... 

Mirtazapine is a tetracyclic antidepressant, similar to mianserin, and is a potent 5-HT2a/2c receptor antagonist. It has been successfully used to treat akathisia. In a doubleblind, placebo-controlled study in 26 patients with schizophrenia who were receiving neuroleptic drugs, mirtazapine 15 mg/day for 5 days was associated with less akathisia (227). 

If this option is elected, start the MAOl with the tricyclic/tetracyclic antidepressant simultaneously at low doses after appropriate drug washout, then alternately increase doses of these agents every few days to a week as tolerated... 

Although very strict dietary and concomitant drug restrictions must be observed to prevent hypertensive crises and serotonin syndrome, the most common side effects of MAOl and tricyclic/tetracyclic antidepressant combinations may be weight gain and orthostatic hypotension... 

Adverse drug reacfions can resulfs from combining MAO inhibitors with tricyclic/tetracyclic antidepressants and related compounds, including carbamazepine, cyclobenzaprine, and mirtazapine, and should be avoided except by experts to treat difficult cases (see Pearls)... 

No pharmacokinetic interactions or elevations in plasma drug levels of tricyclic or tetracyclic antidepressants when adding or switching to or from milnacipran... 

Indeed, on the basis of the cyclase assay, amitriptyline is one of the most potent H2-antagonists presently available (KD 0.05 /iM) [ 181, 193]. The dissociation constants for many of the antidepressants are sufficiently low to suggest that the activation of adenylate cyclase by histamine may be inhibited by therapeutically effective concentrations of these compounds [81, 193]. This biochemical action of the tricyclic and tetracyclic antidepressants may thus represent part of the molecular basis of clinical antidepressant activity [193]. It should also be noted that most tricyclic and tetracyclic antidepressants are much more potent inhibitors of H,-receptor responses [67, 120] than they are of the H2-cyclase response, and this property of these compounds may mediate the sedative actions of these drugs [71, 73, 75]. 

For most of the reference-controlled trials, only the number of adverse events has been reported without distinguishing between suspected adverse drug reactions and events that were obviously not related to the study medication. In all the reference-controlled trials, the frequency of adverse events was substantially lower in the patient groups treated with Hypericum than in those treated with the reference substances. This holds in particular for the adverse reactions typically associated with tricyclic and, to a lesser degree, tetracyclic antidepressants, such as dry mouth, constipation, tiredness and drop of blood pressure. No specific risk profile for Hypericum could be derived from the reference-controlled studies. 

Matsumoto, K. Kanba, S. Kubo, H. Yagi, G. Iri, H. Yuki, H. Automated determination of drugs in serum by column-switching high-performance liquid chromatography. IV. Separation of tricyclic and tetracyclic antidepressants and their metabolites. Clin.Chem., 1989, 35, 453-456... 

Negligible capacity to cause the specific adverse effect The adverse effect has not been reported with this drug TCA TeCA inhibitor Tricyclic antidepressant Tetracyclic antidepressant Might also cause inhibited orgasm capacity... 

Many noncyclic antidepressants are now available, including trazodone (Desyrel l), nefazodone (Serzone ), fluoxetine (Prozac ), sertraline (Zolotf ), citalopram (Celexa ), escitalopram (Lexapro ), paroxetine (Paxil ), tluvoxamine (Luvox ), venlafaxine (Effexor ), and bupropion (Wellbutrin ). Bupropion is also marketed under the brand name Zyban tor smoking cessation. Mirtazapine (Remeron ), a tetracyclic antidepressant, has recently become available. In general, these drugs are much less toxic than the tricyclic antidepressants (see p 90) and the monoamine oxidase (MAO) inhibitors (p 269), although serious effects such as seizures and hypotension occasionally occur. Noncyclic and tricyclic antidepressants are described in Table 11-7. 

Apart from these isolated cases the literature seems to be silent about interactions between these antidiabetics and the tricyclic or tetracyclic antidepressants. Bearing in mind the length of time these groups of drugs have been available, the risk of a clinically important interaction would seem to be very small. 

Gundert-Remy U, Amann E, Hildebrandt R, Weber E. Lack of interaction between the tetracyclic antidepressant maprotiline and the centrally acting antihypertensive drug clcmidine. EurJClm Pharmacol (1983) 25,595-9. 

Drug Class tetracyclic antidepressant Manufacturer Bristol-Myers Squibb, 345 Park Ave, New York, NY Apothecon, P.O. Box 4500, Princeton, NJ Labopharm, 480 Armand-Frappier Blvd, LAVAL, Quebec H7V 4B4 (extended-release formula)... 

Cycloaddition of nitrone (26) to allylamine (538) leads to the synthesis of chiral tetracyclic isoxazolidine (539) which is used in the preparation of compound R107500. This compound has been found to be active as an antiolytic and antidepressant. It also has the potential to inhibit drug abuse (Scheme 2.252) (80). 

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