Chlorpromazine and its hydrochloride salt darken on prolonged exposure to light. Commercially available preparations of chlorpromazine and its hydrochloride salt should be protected from light.
分解：
When heated to decomposition it emits very toxic fumes of /hydrogen chloride/, nitroxides, and sulfoxides.
Extensively metabolized in the liver and kidneys. It is extensively metabolized by cytochrome P450 isozymes CYP2D6 (major pathway), CYP1A2 and CYP3A4. Approximately 10 to 12 major metabolite have been identified. Hydroxylation at positions 3 and 7 of the phenothiazine nucleus and the N-dimethylaminopropyl side chain undergoes demethylation and is also metabolized to an N-oxide. In urine, 20% of chlopromazine and its metabolites are excreted unconjugated in the urine as unchanged drug, demonomethylchlorpromazine, dedimethylchlorpromazine, their sulfoxide metabolites, and chlorpromazine-N-oxide. The remaining 80% consists of conjugated metabolites, principally O-glucuronides and small amounts of ethereal sulfates of the mono- and dihydroxy-derivatives of chlorpromazine and their sulfoxide metabolites. The major metabolites are the monoglucuronide of N-dedimethylchlorpromazine and 7-hydroxychlorpromazine. Approximately 37% of the administered dose of chlorpromazine is excreted in urine.
Although the exact metabolic fate of chlorpromazine is not clearly established, the drug is extensively metabolized, principally in the liver and kidneys. About 10-12 metabolites which occur in humans in appreciable quantities have been identified. In addition to hydroxylation at positions 3 and 7 of the phenothiazine nucleus, the N-dimethylaminopropyl side chain of chlorpromazine undergoes demethylation and is also metabolized to an N-oxide. Two principal groups of metabolites have been found in urine. The unconjugated fraction, which represents approximately 20% of chlorpromazine and its metabolites excreted in urine, consists of unchanged drug, demonomethylchlorpromazine, dedimethylchlorpromazine, their sulfoxide metabolites, and chlorpromazine-N-oxide. The conjugated fraction, which represents approximately 80% of chlorpromazine and its metabolites excreted in urine, consists principally of O-glucuronides, with small amounts of ethereal sulfates of the mono- and dihydroxy-derivatives of chlorpromazine and their sulfoxide metabolites. The major metabolites found in urine are the monoglucuronide of N-dedimethylchlorpromazine and 7-hydroxychlorpromazine.
Most metabolites of phenothiazines are pharmacologically inactive; however, certain metabolites (eg, 7-hydroxychlorpromazine, mesoridazine) show moderate pharmacologic activity and may contribute to the action of the drugs. There is limited evidence to indicate that some phenothiazines (eg, chlorpromazine) may induce their own metabolism. /Phenothiazine General Statement/
Yields 2-chlorophenothiazine in man; promazine probably in dog and in man ... . Yields demethylchlorpromazine in man, rat, rabbit, mouse, dog, sheep, guinea pig ... . Yields chlorpromazine sulfoxide in man, rat, rabbit, dog ... . Yields chlorpromazine-n-oxide in man, rat, rabbit, dog, pig, sheep, guinea pig, mouse ... . Yields 3-hydroxychlorpromazine in man, rat, dog ... . Yields 7-hydroxychlorpromazine in man, rat, sheep, dog, rabbit, guinea pig ... . /From table/
As least 10 or 12 metabolites of chlorpromazine occur in human beings in appreciable quantities. Quantitatively, the most important of these are nor2-chlorpromazine (doubly methylated), chlorphenothiazine (removal of the entire side chain), methoxy and hydroxy products, and glucuronide conjugates of the hydroxylated compounds. In urine, 7-hydroxylated and dealkylated (nor2) metabolites and their conjugates predominate.
IDENTIFICATION: Chlorpromazine is an antipsychotic medication. It is a synthetic dimethylamine derivative of phenothiazine. Chlorpromazine is a white to creamy-white (Base and hydrochloride). Powder or waxy solid (Base); crystallline powder (Hydrochloride). Chlorpromzaine is practically insoluble in water. Freely soluble in dilute mineral acids; practically insoluble in dilute alkali hydroxides. HUMAN EXPOSURE: Main risks and target organs: The principal pharmacological actions are psychotropic. It also exerts sedative and antiemetic activity. Chlorpromazine has actions at all levels of the central nervous system, primarily at subcortical levels, as well as on multiple organ systems. Chlorpromazine has strong antiadrenergic and weak peripheral anticholinergic activity; ganglionic blocking action is relatively slight. It also possesses slight antihistaminic and antiserotonin activity. Summary of clinical effects: Central nervous depression may progress from drowsiness to coma, ultimately with areflexia. In early or mild intoxications, some patients suffer from restlessness, confusion and excitement. Tremor or muscular twitching, spasm, rigidity, convulsions, muscular hypotonia, difficulty in swallowing may be present. Extrapyramidal signs of overdose include dystonia, torticollis, oculogyric crises and opisthotonos. Either hypothermia or hyperthermia may be encountered. Difficulty in breathing, cyanosis, respiratory and/or vasomotor collapse, respiratory depression and distress, sudden apnea and even cyanosis may occur. Hypotension, tachycardia, cardiac arrhythmias, conduction defects, ventricular fibrillation or cardiac arrest may occur. Contraindications: Do not use in comatose states or in the presence of large amounts of central nervous system depressants (alcohol, barbiturates, anesthetics, narcotics, etc.) because chlorpromazine prolongs and intensifies the action of such CNS depressants. Chlorpromazine should be administered cautiously to persons with cardiovascular or liver disease. There is evidence that patients with a history of hepatic encephalopathy due to cirrhosis have increased sensitivity to the CNS effect of chlorpromazine (e.g. impaired cerebration and abnormal slowing of the EEG). Because of this CNS depressant effect, it should be used with caution in patients with chronic respiratory disorders such as severe asthma, emphysema and acute respiratory infections, particularly in children. Because it can suppress the cough reflex, aspiration of vomitus is possible. Subcutaneous injection is contraindicated. Routes of entry: Oral: Chlorpromazine is available in tablet or syrup forms for oral ingestion. Parenteral: It is present in injectable forms for use through the intramuscular or intravenous routes. Other: Rectal route with suppositories. Absorption by route of exposure: The absorption of orally administered chlorpromazine is dependent on the dosage form, the elixir giving the highest plasma concentration of drug. Peak plasma levels are reached at 2 to 3 hours. There is a wide inter-subject variability (ten times or more) in the plasma concentrations achieved. Plasma concentrations may be decreased significantly by food in the stomach and by the concomitant administration of anticholinergic antiparkinsonism drugs. Owing to the first-pass effect, plasma concentrations following oral administrations are much lower than those following intramuscular administrations. Distribution by route of exposure: Chlorpromazine is widely distributed in the body and crosses the blood-brain barrier to achieve higher concentrations in the brain than in the plasma. Chlorpromazine and its metabolites also cross the placental barrier and are excreted in milk. Chlorpromazine is highly bound to plasma proteins, varying from 91.8% to 97% over the range of clinical blood concentrations (0.01 to 1 mcg/mL). Binding is easily reversed. Biological half-life by route of exposure: Although the plasma half-life of chlorpromazine itself has been reported to be only a few hours, elimination of the metabolites may be very prolonged. Blood studies show a range of 2 to 3 days and for the urinary studies up to about 18 days. Chlorpromazine brings about changes that can persist much longer than these times after discontinuation of the drug. The exact relationship of persisting therapeutic effects to administered chlorpromazine is uncertain. There is the possibility that minute amounts of chlorpromazine and/or metabolites persist at active sites in slowly reversible or relatively irreversible ways. It also seems that some chlorpromazine is stored in adipose tissue and slowly mobilized after stopping chlorpromazine administration. Metabolism: Paths of metabolism of chlorpromazine include hydroxylation, and conjugation with glucuronic acid, N-oxidation, oxidation of a sulfur atom, and dealkylation. In man, after chronic use, the highest concentration of unconjugated chlorpromazine metabolites is found in the lung and liver. The 7-hydroxy chlorpromazine that is found in body tissues appears to be an active metabolite. Since there is some evidence that chlorpromazine can cause hepatic microsomal enzyme induction, it may accelerate its own metabolism; this may account for progressively decreasing plasma concentrations of free drug during maintenance of a fixed dosage schedule. One hundred and sixty-eight possible metabolites of chlorpromazine have been postulated and many of them actually isolated from human urine. In man, urinary excretion of chlorpromazine plus its sulfoxides varies from 1 to 20% of the daily dose administered. The average ratio of free chlorpromazine to the sulfoxide in the urine is about 1:16. There is much evidence that the sulfoxide undergoes additional metabolism, probably to sulfones. The various phenothiazine congeners of chlorpromazine undergo similar metabolic degradation. Demethylation is another method of detoxication by the liver. Elimination by route of exposure: Chlorpromazine is excreted in both urine and feces. Mode of action: Chlorpromazine has a wide range of activity arising from its depressant actions on the central nervous system and its alpha-adrenergic blocking and weak antimuscarinic activities. Chlorpromazine possesses sedative properties but patients usually develop tolerance rapidly to the sedation. Its action on the autonomic system produces vasodilation, hypotension, and tachycardia. Salivary and gastric secretions are reduced. The sulfoxides of the phenothiazines have been intensively studied and found to be significantly less potent than the parent compound. Teratogenicity: If given in high doses over a long period during pregnancy, chlorpromazine may cause damage to the retina of the fetus. Interactions: Chlorpromazine may block the antihypertensive effects of guanethidine. Patients being treated with phenothiazines should be advised that their susceptibility to alcohol may be increased. Chlorpromazine has been shown to increase the miotic and sedative effects of morphine. Chlorpromazine may enhance the respiratory depression produced particularly by CNS depressants. Mutual inhibition of liver enzymes concerned with the metabolism of both chlorpromazine and the other drug (e.g. a tricyclic antidepressant) might result in increased plasma-concentrations of either drug. Chlorpromazine is reported to interfere with a number of laboratory tests, such as pregnancy tests, thyroid function tests, the Coombs' test where a false positive result can be achieved, and adrenal medullary tests. It is also reported to interfere with estimations for serum 5-hydroxyindole-acetic acid, blood urea, urinary ketones and steroids, urinary porphobilinogen, and vitamin B12. Main adverse effects: Therapeutic doses of chlorpromazine, may cause palpitation, nasal stuffiness, dry mouth, and slight constipation. The patient may complain of being cold, drowsy, or weak. Orthostatic hypotension, which may result in syncope. A mild elevation of temperature may be seen during the first few days, particularly if the drug is given parenterally. On the other hand, hypothermia can occur and may be due both to the action on the heat regulating center and to direct peripheral vasodilation. Sensitivity and adaptation to environmental temperature change are impaired so that fatal hyperthermia and heat stroke are possible complications. Chlorpromazine has produced hematological disorders, including agranulocytosis, eosinophilia, leucopenia, hemolytic anemia, aplastic anemia, thrombocytopenic purpura and pancytopenia. Hyperglycemia, hypoglycemia and glycosuria have also been reported.
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).
Liver test abnormalities have been reported to occur in up to 40% of patients on long term therapy with chlorpromazine, but elevations are uncommonly above 3 times the upper limit of normal. The aminotransferase abnormalities are usually self-limited and unaccompanied by symptoms, reversing even without discontinuation.
Chlorpromazine is also a well known cause of acute cholestatic liver injury. Numerous instances of clinically apparent acute liver injury due to chlorpromazine have been reported in the literature, which is estimated to occur in 1:500 persons exposed. Chlorpromazine was formerly the most common cause of drug induced liver injury in the United States, but with the decrease in its use, chlorpromazine associated jaundice is now rarely reported. The clinical presentation and course are well defined. The onset of jaundice is usually within 1 to 5 weeks, and the pattern of serum enzyme elevations is typically cholestatic or mixed (Case 1). Immunoallergic manifestations (fever, rash and eosinophilia) occur in some but not all cases, and these manifestations are usually mild and self-limited. Autoantibody formation is rare. Most importantly, chlorpromazine jaundice can be prolonged and associated with vanishing bile duct syndrome (Case 2).
Likelihood score: A (well known cause of clinically apparent liver injury).
Chlorpromazine hydrochloride is rapidly absorbed from the GI tract and from parenteral sites of injection; however, following oral administration, the drug undergoes considerable metabolism during absorption (in the GI mucosa) and first pass through the liver. Although not clearly established in humans, chlorpromazine and its metabolites undergo enterohepatic circulation in animals.
Considerable interindividual variations in peak plasma concentrations have been reported with the same oral dose of chlorpromazine. The variability is thought to result from wide interindividual variation in bioavailability, apparently because of genetic differences in the rate of first-pass metabolism. As a result of first-pass metabolism, less chlorpromazine reaches systemic circulation as unchanged drug, and peak plasma chlorpromazine concentrations are much lower following oral administration than following im administration.
[EN] SUBSTITUTED N-HETEROCYCLIC CARBOXAMIDES AS ACID CERAMIDASE INHIBITORS AND THEIR USE AS MEDICAMENTS<br/>[FR] CARBOXAMIDES N-HÉTÉROCYCLIQUES SUBSTITUÉS UTILISÉS EN TANT QU'INHIBITEURS DE LA CÉRAMIDASE ACIDE ET LEUR UTILISATION EN TANT QUE MÉDICAMENTS
申请人：BIAL BIOTECH INVEST INC
公开号：WO2021055627A1
公开（公告）日：2021-03-25
The invention provides substituted N-heterocyclic carboxamides and related compounds, compositions containing such compounds, medical kits, and methods for using such compounds and compositions to treat a medical disorder, e.g., cancer, lysosomal storage disorder, neurodegenerative disorder, inflammatory disorder, in a patient.
[EN] COMPOUNDS AND THEIR USE AS BACE INHIBITORS<br/>[FR] COMPOSÉS ET LEUR UTILISATION EN TANT QU'INHIBITEURS DE BACE
申请人：ASTRAZENECA AB
公开号：WO2016055858A1
公开（公告）日：2016-04-14
The present application relates to compounds of formula (I), (la), or (lb) and their pharmaceutical compositions/preparations. This application further relates to methods of treating or preventing Αβ-related pathologies such as Down's syndrome, β- amyloid angiopathy such as but not limited to cerebral amyloid angiopathy or hereditary cerebral hemorrhage, disorders associated with cognitive impairment such as but not limited to MCI ("mild cognitive impairment"), Alzheimer's disease, memory loss, attention deficit symptoms associated with Alzheimer's disease, neurodegeneration associated with diseases such as Alzheimer's disease or dementia, including dementia of mixed vascular and degenerative origin, pre-senile dementia, senile dementia and dementia associated with Parkinson's disease.
[EN] METHYL OXAZOLE OREXIN RECEPTOR ANTAGONISTS<br/>[FR] MÉTHYLOXAZOLES ANTAGONISTES DU RÉCEPTEUR DE L'OREXINE
申请人：MERCK SHARP & DOHME
公开号：WO2016089721A1
公开（公告）日：2016-06-09
The present invention is directed to methyl oxazole compounds which are antagonists of orexin receptors. The present invention is also directed to uses of the compounds described herein in the potential treatment or prevention of neurological and psychiatric disorders and diseases in which orexin receptors are involved. The present invention is also directed to compositions comprising these compounds. The present invention is also directed to uses of these compositions in the potential prevention or treatment of such diseases in which orexin receptors are involved.
4' SUBSTITUTED COMPOUNDS HAVING 5-HT6 RECEPTOR AFFINITY
申请人：Dunn Robert
公开号：US20080318941A1
公开（公告）日：2008-12-25
The present disclosure provides compounds having affinity for the 5-HT
6
receptor which are of the formula (I):
wherein R
1
, R
2
, R
5
, R
6
, B, D, E, G, Q, x and n are as defined herein. The disclosure also relates to methods of preparing such compounds, compositions containing such compounds, and methods of use thereof.
Heterobicyclic compounds of Formula (I):
or a pharmaceutically-acceptable salt, tautomer, or stereoisomer thereof, as defined in the specification, and compositions containing them, and processes for preparing such compounds. Provided herein also are methods of treating disorders or diseases treatable by inhibition of PDE10, such as obesity, non-insulin dependent diabetes, schizophrenia, bipolar disorder, obsessive-compulsive disorder, Huntington's Disease, and the like.
Formula (I)的杂环化合物：
或其药用可接受的盐、互变异构体或立体异构体，如规范中所定义，并含有它们的组合物，以及制备这种化合物的方法。本文还提供了通过抑制PDE10来治疗由此可治疗的疾病或疾病的方法，如肥胖症、非胰岛素依赖型糖尿病、精神分裂症、躁郁症、强迫症、亨廷顿病等。
