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Amineptine
Systematic (IUPAC) name
7-[(10,11-dihydro-5H-dibenzo[a,d]-cyclohepten-5-yl)amino]heptanoic acid
Identifiers
CAS number 57574-09-1
ATC code N06AA19
PubChem 34870
DrugBank ?
ChemSpider 32091
Chemical data
Formula C22H28NO2 
Mol. mass 337.455 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability  ?
Metabolism Hepatic
Half life 48 mins (original drug)
2.5 hours (metabolites)[1]
Excretion Renal
Therapeutic considerations
Pregnancy cat.  ?
Legal status United Nations: Schedule II
Canada: Schedule III
USA: Unscheduled
UK: Unscheduled
Germany: Anlage II (not prescribable)
Routes Oral

Amineptine (Survector, Maneon, Directim, Neolior, Provector, Viaspera) is an atypical tricyclic antidepressant (TCA) that selectively inhibits the reuptake of dopamine[2] and to a lesser extent norepinephrine, thus exerting a powerful and fast-acting antidepressant effect.[3]

Introduced in France in 1978 by the pharmaceutical giant Servier[4] and marketed under the trade name Survector, amineptine soon gained a reputation for abuse due to its short-lived, but pleasant, stimulant effect experienced by some patients. (This is to be distinguished from its antidepressant effect, which appears in approximately 7 days after commencing treatment.)

After its release into the European market cases of hepatotoxicity emerged, some serious. This, along with the potential for abuse, led to the suspension of the French marketing authorisation for Survector in 1999.

Amineptine was never approved by the FDA for marketing in the United States.

Currently amineptine is off-patent and very difficult to obtain.

Contents

Therapeutic indications

Approved

None

Approved and revoked

Amineptine was approved in France for severe clinical depression of endogenous origin in 1978.[5]

Unapproved/Off-Label/Investigational

Parkinson's Disease, amotivational syndromes, ADHD (Attention Deficit/Hyperactivity Disorder)

Mechanism of action

Side effects

Dermatological

Severe acne due to amineptine was first reported in 1988 by various authors—Grupper, Thioly-Bensoussan, Vexiau, Fiet, Puissant, Gourmel, Teillac, Levigne, to name a few—simultaneously[6][7][8][9][10] in the same issue of Annales de Dermatologie et de Venereologie and in the 12 March 1988 of The Lancet.[11] A year later, Dr Martin-Ortega and colleagues in Barcelona, Spain reported a case of "acneiform eruption" in a 54-year-old woman whose intake of amineptine was described as "excessive."[12] One year after that, Vexiau and colleagues reported six women, one of whom never admitted to using amineptine, getting severe acne concentrated in the face, back and thorax, the severity of which varied with the dosage.[13] Most of them were treated unsuccessfully with isotretinoin (Accutane) for about 18 months; two of the three that discontinued amineptine experienced a reduction in cutaneous symptoms, with the least affected patient going into remission.[13]

This can be seen as a general side effect of central dopamine enhancement, due to the inhibitory effect of dopamine on prolactin, with the subsequent increase in testosterone output, leading in turn to the same potential for acne as is typical of pubescents.

Psychiatric

Psychomotor excitation can very rarely occur with this drug.[14]

  • Nervousness (very rare)
  • Irritability (very rare)
  • Insomnia (very rare)
  • Suicidal ideation (very rare) Seen in beginning of treatment. By lifting of psychomotor inhibition. Increase monitoring at the beginning of treatment.

Cardiovascular

Hepatic

Amineptine can very rarely cause hepatitis, of the cytolytic, cholestatic varieties.[15] Amineptine-induced hepatitis, which is sometimes preceded by a rash, is believed to be due to an allergic reaction.[16] It resolves upon discontinuation of the offending drug.[15] The risk of getting this may or may not be genetically determined.[17]

Additionally, amineptine is known to rarely elevate transaminases, alkaline phosphatase, and bilirubin.[18]

Mixed hepatitis, which is very rare, generally occurs between the 15th and 30th day of treatment. Often preceded by sometimes intense abdominal pains, nausea, vomiting or a rash, the jaundice is variable. Hepatitis is either of mixed type or with cholestatic prevalence. The evolution was, in all the cases, favorable to the discontinuation of the drug. The mechanism is discussed (immunoallergic and/or toxic).[19]

In circa 1994 Spain, there was a case associating acute pancreatitis and mixed hepatitis, after three weeks of treatment.[20]

Lazaros and colleagues at the Western Attica General Hospital in Athens, Greece reported two cases of drug induced hepatitis 18 and 15 days of treatment.[21]

One case of cytolytic hepatitis occurred after ingestion of only one tablet.[22]

Gastrointestinal

  • Acute pancreatitis (very rare) A case associating acute pancreatitis and mixed hepatitis after three weeks of treatment.[20]

Immunological

In 1989, Sgro and colleagues at the Centre de Pharmacovigilance in Dijon reported a case of anaphylactic shock in a woman who had been taking amineptine.[23]

Effects on the unborn child

  • Non-teratogenic in animals
  • Lacking information in humans

Abuse and Dependence

The risk of addiction is low, but it is there nonetheless. Between 1978 and 1988, there were 186 cases of amineptine addiction reported to the French Regional Centres of Pharmacovigilance; an analysis of 155 of those cases found that they were predominantly female, and that two-thirds of cases had known risk factors for addiction.[24] However, a 1981 study of known opiate addicts and schizophrenia patients found no drug addiction in any of the subjects.[25] In a 1990 study of eight amineptine dependence cases, the gradual withdrawal of amineptine could be achieved without problems in six people; in two others, anxiety, psychomotor agitation, and/or bulimia appeared.[26]

Precautions for use

Contraindications

  • Chorea
  • MAO inhibitors
  • Children less than 1 year of age
  • Hypersensitivity: Known hypersensitivity to amineptine, in particular antecedents of hepatitis after dosage of the product.

See also

References

  1. ^ Lachatre G, Piva C, Riche C, et al. (1989). "Single-dose pharmacokinetics of amineptine and of its main metabolite in healthy young adults". Fundamental & Clinical Pharmacology 3 (1): 19–26. doi:10.1111/j.1472-8206.1989.tb00026.x. PMID 2714729. 
  2. ^ Vaugeois JM, Corera AT, Deslandes A, Costentin J (June 1999). "Although chemically related to amineptine, the antidepressant tianeptine is not a dopamine uptake inhibitor". Pharmacology, Biochemistry, and Behavior 63 (2): 285–90. doi:10.1016/S0091-3057(98)00242-1. PMID 10371658. 
  3. ^ Wishart DS, Knox C, Guo AC, et al. (January 2006). "DrugBank: a comprehensive resource for in silico drug discovery and exploration". Nucleic Acids Research 34 (Database issue): D668–72. doi:10.1093/nar/gkj067. PMID 16381955. 
  4. ^ Sittig, Marshall (1988-04-01) [1979]. Pharmaceutical Manufacturing Encyclopedia (2nd ed.). Park Ridge, New Jersey, United States American: William Andrew Publishing/Noyes Publications. ISBN 0-8155-1144-2. http://www.amineptine.com/synthesis/manufacture.html. Retrieved 2005-10-29. 
  5. ^ Doctissimo (2005). "SURVECTOR - Amineptine" (in French). http://www.doctissimo.fr/medicament-SURVECTOR.htm. Retrieved 27 October 2005. 
  6. ^ Grupper C (1988). "[New iatrogenic acne: acne caused by amineptin (Survector)]" (in French). Annales De Dermatologie et De Vénéréologie 115 (11): 1174–6. PMID 2977079. 
  7. ^ Thioly-Bensoussan D, Charpentier A, Triller R, et al. (1988). "[Iatrogenic acne caused by amineptin (Survector). Apropos of 8 cases]" (in French). Annales De Dermatologie et De Vénéréologie 115 (11): 1177–80. PMID 2977080. 
  8. ^ Vexiau P, Gourmel B, Husson C, et al. (1988). "[Severe lesions of acne type induced by chronic amineptin poisoning: apropos of 6 cases]" (in French). Annales De Dermatologie et De Vénéréologie 115 (11): 1180–2. PMID 2977081. 
  9. ^ Teillac D, Weber MJ, Lowenstein W, de Prost Y (1988). "[Acne caused by Survector]" (in French). Annales De Dermatologie et De Vénéréologie 115 (11): 1183–4. PMID 2977082. 
  10. ^ Lévigne V, Faisant M, Mourier C, et al. (1988). "[Monstrous acne in the adult. Inducer role of Survector?]" (in French). Annales De Dermatologie et De Vénéréologie 115 (11): 1184–5. PMID 2977083. 
  11. ^ Vexiau P, Gourmel B, Julien R, et al. (March 1988). "Severe acne-like lesions caused by amineptine overdose". Lancet 1 (8585): 585. doi:10.1016/S0140-6736(88)91373-6. PMID 2894512. 
  12. ^ Martín-Ortega E, Zamora E, Herrero C, Palou J (1989). "[Acneiform eruption induced by amineptin (Survector)]" (in Spanish). Medicina Cutánea Ibero-latino-americana 17 (6): 414–6. PMID 2534534. 
  13. ^ a b Vexiau P, Gourmel B, Castot A, et al. (1990). "Severe acne due to chronic amineptine overdose". Archives of Dermatological Research 282 (2): 103–7. doi:10.1007/BF00493467. PMID 2141246. 
  14. ^ "AMINEPTINE CHLORHYDRATE" (in French). BIAM. http://www.biam2.org/www/Gsu238.html. Retrieved 27 October 2005. 
  15. ^ a b Bories P, Pomier-Layrargues G, Chotard JP, et al. (December 1980). "[Amineptine-induced cholestatic hepatitis. 5 cases (author's transl)]" (in French). La Nouvelle Presse Médicale 9 (48): 3689–92. PMID 7454584. 
  16. ^ Pessayre D, Larrey D (April 1988). "Acute and chronic drug-induced hepatitis". Baillière's Clinical Gastroenterology 2 (2): 385–422. doi:10.1016/0950-3528(88)90009-7. PMID 3044468. 
  17. ^ Larrey D, Pageaux GP (1997). "Genetic predisposition to drug-induced hepatotoxicity". Journal of Hepatology 26 (Suppl 2): 12–21. doi:10.1016/S0168-8278(97)80492-8. PMID 9204405. 
  18. ^ "Questions au Professeur Daniel Dhumeaux [Drug-induced liver disorders. Questions for Professor Daniel Dhumeaux]" (in French). Gastroentérologie Clinique et Biologique 23 (8-9): 917–20. 1999. PMID 10533145. http://www.masson.fr/masson/MDOI-GCB-08-1999-23-8-9-0399-8320-101019-ART15. 
  19. ^ Concours Med 1982; 104:5733-5734
  20. ^ a b Sebastián Domingo JJ, Simón Marco MA, Uribarrena Echebarría R (March 1994). "Hepatic and pancreatic injury associated with amineptine therapy". Journal of Clinical Gastroenterology 18 (2): 168–9. doi:10.1097/00004836-199403000-00023. PMID 8189020. 
  21. ^ Lazaros GA, Stavrinos C, Papatheodoridis GV, Delladetsima JK, Toliopoulos A, Tassopoulos NC (1996). "Amineptine induced liver injury. Report of two cases and brief review of the literature". Hepato-gastroenterology 43 (10): 1015–9. PMID 8884331. 
  22. ^ Jonville AP, Dutertre JP, Autret E (1992). "[Immediate acute hepatic cytolysis after the administration of a single amineptin tablet]" (in French). Gastroentérologie Clinique et Biologique 16 (4): 368. PMID 1397859. 
  23. ^ Sgro C, Lacroix S, Waldner A, Lacroix M, Ferrut O, Bureau A (1989). "[Anaphylactic shock caused by amineptine. Report of a case]" (in French). La Revue De Médecine Interne 10 (5): 461–2. PMID 2488491. 
  24. ^ Castot A, Benzaken C, Wagniart F, Efthymiou ML (1990). "[Amineptin abuse. Analysis of 155 cases. An evaluation of the official cooperative survey of the Regional Centers of Pharmacovigilance]" (in French). Thérapie 45 (5): 399–405. PMID 2260032. 
  25. ^ Deniker P, Lôo H, Zarifian E, et al. (1981). "[Amineptine and amotival syndrome (author's transl)]" (in French). L'Encéphale 7 (1): 59–64. PMID 7227285. 
  26. ^ Bertschy G, Luxembourger I, Bizouard P, Vandel S, Allers G, Volmat R (1990). "[Amineptin dependence. Detection of patients at risk. Report of 8 cases]" (in French). L'Encéphale 16 (5): 405–9. PMID 2265603. 

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