Tetrabenazine

Tetrabenazine
Systematic (IUPAC) name
(SS,RR)-3-Isobutyl-9,10-dimethoxy-1,3,4,6,7,11b-hexahydro-pyrido[2,1-a]isoquinolin-2-one
Clinical data
Trade names Xenazine
AHFS/Drugs.com Consumer Drug Information
Pregnancy cat. C
Legal status ℞-only (US)
Routes Oral (tablets, 25 mg)
Pharmacokinetic data
Bioavailability Low, extensive first pass effect
Protein binding 82–85%
Metabolism Hepatic (CYP2D6-mediated)
Excretion Renal and fecal
Identifiers
CAS number 58-46-8
ATC code N07XX06
PubChem CID 6018
DrugBank DB04844
ChemSpider 5796 YesY
UNII Z9O08YRN8O YesY
KEGG D08575 YesY
ChEMBL CHEMBL117785 YesY
Synonyms Ro-1-9569
Chemical data
Formula C19H27NO3 
Mol. mass 317.427 g/mol
SMILES eMolecules & PubChem
 YesY(what is this?)  (verify)

Tetrabenazine is a drug for the symptomatic treatment of hyperkinetic movement disorder and is marketed under the trade names Nitoman in Canada and Xenazine in New Zealand and some parts of Europe, and is also available in the USA as an orphan drug. On August 15, 2008 the U.S. Food and Drug Administration (FDA) approved the use of tetrabenazine to treat chorea associated with Huntington's disease (HD), the first in the US.[1] The compound has been known since the 1950s. The effort for US FDA approval was led by Dr. Joseph Jankovic. According to a 2008 news report[2], "Americans with Huntington's who weren't Jankovic's patients ordered tetrabenazine from Canada if they could afford it. But the worsening exchange rate put the price out of reach for many. A recent check found Canadian Internet pharmacies selling generic 25-milligram pills for $1.75 or more each in U.S. currency, brand-name 25-mg pills for around $2.35 each." After the FDA approval, Dr. Jancovic said "I'm worried that the drug is just going to be too expensive" and initial pricing was $68.50 per 25 mg tablet.[3]

Contents

Pharmacology

Tetrabenazine works mainly as a VMAT-inhibitor[4] and as such promotes the early metabolic degradation of monoamines, in particular the neurotransmitter dopamine.

Uses

Tetrabenazine is used as a treatment, but not a cure for hyperkinetic disorders[5][6] such as:

Side effects

Because tetrabenazine is closely related to antipsychotics, many of its side effects are similar. Some of these include:[8]

  • Akathisia (aka "restless pacing" – an inability to keep still, with intense anxiety when forced to do so)
  • Depression - the most common side effect, reported in roughly 15% of those who take the medication
  • Dizziness, drowsiness, insomnia, fatigue, nervousness and anxiety
  • Parkinsonism

Unlike many antipsychotics, tetrabenazine is not known to cause tardive dyskinesia.

Warnings

  • Because of the relatively high incidence of depression, it has been recommended that people with a history of depression avoid taking tetrabenazine.
  • The concomitant intake of MAO inhibitors is contraindicated.

References

  1. ^ 1st US drug for Huntington's disease wins approval
  2. ^ Doctor spent decades getting tetrabenazine to market
  3. ^ Specialty TrendsRx Availability Alert:Xenazine® (tetrabenazine)
  4. ^ Zheng G, Dwoskin LP, Crooks PA (2006). "Vesicular monoamine transporter 2: role as a novel target for drug development". AAPS J 8 (4): E682–92. doi:10.1208/aapsj080478. PMC 2751365. PMID 17233532. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2751365. 
  5. ^ Jankovic J, Beach J (1997). "Long-term effects of tetrabenazine in hyperkinetic movement disorders". Neurology 48 (2): 358–62. PMID 9040721. 
  6. ^ Kenney C, Hunter C, Jankovic J (January 2007). "Long-term tolerability of tetrabenazine in the treatment of hyperkinetic movement disorders". Mov. Disord. 22 (2): 193–7. doi:10.1002/mds.21222. PMID 17133512. 
  7. ^ Ondo WG, Hanna PA, Jankovic J (August 1999). "Tetrabenazine treatment for tardive dyskinesia: assessment by randomized videotape protocol". Am J Psychiatry 156 (8): 1279–81. PMID 10450276. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10450276. 
  8. ^ Robertson MM (March 2000). "Tourette syndrome, associated conditions and the complexities of treatment". Brain. 123 Pt 3 (3): 425–62. doi:10.1093/brain/123.3.425. PMID 10686169. http://brain.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10686169. 

External links


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Look at other dictionaries:

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  • tetrabenazine — tet·ra·ben·a·zine …   English syllables

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