Etizolam: Wikis

  

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Etizolam
Systematic (IUPAC) name
7-(2-chlorophenyl)- 4-ethyl- 13-methyl- 3-thia- 1,8,11,12- tetraazatricyclo [8.3.0.02,6}] trideca- 2(6),4,7,10,12- pentaene
Identifiers
CAS number 40054-69-1
ATC code N05BA19
PubChem 3307
DrugBank ?
Chemical data
Formula C 17H15ClN4S 
Mol. mass 342.8
Pharmacokinetic data
Bioavailability 93%
Metabolism Hepatic
Half life about 6 hours
Excretion Renal
Therapeutic considerations
Pregnancy cat.  ?
Legal status Schedule IV (US)
Routes Oral

Etizolam (marketed under the brand name Sedekopan, Pasaden or Depas) is a thienodiazepine drug which is a benzodiazepine analog. The etizolam molecule differs from most other benzodiazepines in that the benzene ring has been replaced by a thiophene ring.[1] It possesses amnesic, anxiolytic, anticonvulsant, hypnotic, sedative and skeletal muscle relaxant properties.[2]

Contents

Indications

Dosage

  • For anxiety: 0,25-0,50 mg two or three times per day (maximum 2 mg per day)
  • For insomnia: 1 or 2 mg before bedtime

Side effects

Rare

Tolerance, dependence and withdrawal

Abrupt or over rapid withdrawal from etizolam as with other benzodiazepines may result in the appearance of the benzodiazepine withdrawal syndrome, including rebound insomnia.[7] A neuroleptic malignant syndrome, a rare event in benzodiazepine withdrawal has been documented in a case of abrupt withdrawal from etizolam.[8]

Contraindications and special caution

Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbid psychiatric disorders.[9]

Pharmacology

Etizolam a thienodiazepine benzodiazepine derivative, is absorbed fairly rapidly with peak plasma levels achieved between 30 minutes and 2 hours and has a mean elimination half life of about 3 and a half hours. However, its pharmacologically active metabolite alpha-hydroxyetizolam which has the same potency as etizolam is eliminated more slowly with a mean half life of just over 8 hours. So it can be classified as a short-medium action benzodiazepine.[10] Etizolam possesses potent hypnotic properties.[11] Etizolam acts as a full agonist at the benzodiazepine receptor to produce its range of therapeutic as well as adverse effects.[12] Similar to other benzodiazepines etizolam binds unselectively to benzodiazepine receptor subtypes.[13]

In addition etizolam unlike most other benzodiazepines has prolactogenic effects leading to an increase in prolactin blood levels.[14]

According to the Italian P.I. sheet etizolam belongs to a new class of diazepines, thienotriazolodiazepines. This new class is easily oxidized, rapidly metabolized, and has a lower risk of accumulation, even after prolonged treatment. Etizolam has an anxiolytic action about 6 times greater than that of diazepam. Etizolam produces, especially at higher dosages, a reduction in time taken to fall asleep, an increase in total sleep time and a reduction in the number of awakenings. During tests there were not substantial changes in deep sleep. There is a reduction of REM sleep. In EEG tests of healthy volunteers Etizolam showed some characteristics of tricyclic antidepressants.[4]

Interactions

Itraconazole and fluvoxamine slow down the rate of elimination of etizolam leading to accumulation of etizolam and thus increased pharmacological effects.[15][16] Carbamazepine speeds up the metabolism of etizolam resulting in reduced pharmacological effects of etizolam.[17]

Overdose

Etizolam has been used in cases of suicidal benzodiazepine overdose. An overdose of etizolam can prove fatal.[18]

Abuse

Etizolam is a drug of potential abuse. Etizolam has been shown to be able to substitute for the behavioural effects of barbiturates in primate studies.[19]

See also

References

  1. ^ Niwa T, Shiraga T, Ishii I, Kagayama A, Takagi A (September 2005). "Contribution of human hepatic cytochrome p450 isoforms to the metabolism of psychotropic drugs" (PDF). Biol. Pharm. Bull. 28 (9): 1711–6. doi:10.1248/bpb.28.1711. PMID 16141545. http://www.jstage.jst.go.jp/article/bpb/28/9/1711/_pdf.  
  2. ^ Mandrioli R, Mercolini L, Raggi MA (October 2008). "Benzodiazepine metabolism: an analytical perspective". Curr. Drug Metab. 9 (8): 827–44. doi:10.1021/bi992283h. PMID 18855614. http://www.benthamdirect.org/pages/content.php?CDM/2008/00000009/00000008/0009F.SGM.  
  3. ^ Lopedota A, Cutrignelli A, Trapani A, et al. (May 2007). "Effects of different cyclodextrins on the morphology, loading and release properties of poly (DL-lactide-co-glycolide)-microparticles containing the hypnotic agent etizolam". J Microencapsul 24 (3): 214–24. doi:10.1080/02652040601058152. PMID 17454433.  
  4. ^ a b "Depas". http://www.carloanibaldi.com/terapia/schede/DEPAS.htm. Retrieved February 3 2009.  
  5. ^ Wakakura M, Tsubouchi T, Inouye J (March 2004). "Etizolam and benzodiazepine induced blepharospasm" (PDF). J. Neurol. Neurosurg. Psychiatr. 75 (3): 506–7. doi:10.1136/jnnp.2003.019869. PMID 14966178. PMC 1738986. http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1738986&blobtype=pdf.  
  6. ^ Kuroda K, Yabunami H, Hisanaga Y (January 2002). "Etizolam-induced superficial erythema annulare centrifugum". Clin. Exp. Dermatol. 27 (1): 34–6. doi:10.1046/j.0307-6938.2001.00943.x. PMID 11952667.  
  7. ^ Hirase M, Ishida T, Kamei C (November 2008). "Rebound insomnia induced by abrupt withdrawal of hypnotics in sleep-disturbed rats". Eur. J. Pharmacol. 597 (1-3): 46–50. doi:10.1016/j.ejphar.2008.08.024. PMID 18789918.  
  8. ^ Kawajiri M, Ohyagi Y, Furuya H, et al. (February 2002). "[A patient with Parkinson's disease complicated by hypothyroidism who developed malignant syndrome after discontinuation of etizolam]" (in Japanese). Rinsho Shinkeigaku 42 (2): 136–9. PMID 12424963.  
  9. ^ Authier, N.; Balayssac, D.; Sautereau, M.; Zangarelli, A.; Courty, P.; Somogyi, AA.; Vennat, B.; Llorca, PM. et al. (Nov 2009). "Benzodiazepine dependence: focus on withdrawal syndrome.". Ann Pharm Fr 67 (6): 408-13. doi:10.1016/j.pharma.2009.07.001. PMID 19900604.  
  10. ^ Fracasso C, Confalonieri S, Garattini S, Caccia S (1991). "Single and multiple dose pharmacokinetics of etizolam in healthy subjects". Eur. J. Clin. Pharmacol. 40 (2): 181–5. PMID 2065698.  
  11. ^ Nakamura J, Mukasa H (December 1992). "Effects of thienodiazepine derivatives, etizolam and clotiazepam on the appearance of Fm theta". Jpn. J. Psychiatry Neurol. 46 (4): 927–31. PMID 1363923.  
  12. ^ Yakushiji T, Fukuda T, Oyama Y, Akaike N (November 1989). "Effects of benzodiazepines and non-benzodiazepine compounds on the GABA-induced response in frog isolated sensory neurones" (PDF). Br. J. Pharmacol. 98 (3): 735–40. PMID 2574062. PMC 1854765. http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1854765&blobtype=pdf.  
  13. ^ Ozawa M, Nakada Y, Sugimachi K, et al. (March 1994). "Pharmacological characterization of the novel anxiolytic beta-carboline abecarnil in rodents and primates". Jpn. J. Pharmacol. 64 (3): 179–87. doi:10.1254/jjp.64.179. PMID 7912751. http://www.journalarchive.jst.go.jp/jnlpdf.php?cdjournal=jphs1951&cdvol=64&noissue=3&startpage=179&lang=en&from=jnlabstract.  
  14. ^ Kaneda Y (2000). "Short Communication: Prolactogenic effects of etizolam". Neuro Endocrinol. Lett. 21 (6): 475–476. PMID 11335869. http://www.nel.edu/21_6/NEL21062000B001_Kaneda.htm.  
  15. ^ Araki K, Yasui-Furukori N, Fukasawa T, et al. (August 2004). "Inhibition of the metabolism of etizolam by itraconazole in humans: evidence for the involvement of CYP3A4 in etizolam metabolism". Eur. J. Clin. Pharmacol. 60 (6): 427–30. doi:10.1007/s00228-004-0789-1. PMID 15232663.  
  16. ^ Suzuki Y, Kawashima Y, Shioiri T, Someya T (December 2004). "Effects of concomitant fluvoxamine on the plasma concentration of etizolam in Japanese psychiatric patients: wide interindividual variation in the drug interaction". Ther Drug Monit 26 (6): 638–42. doi:10.1097/00007691-200412000-00009. PMID 15570188.  
  17. ^ Kondo S, Fukasawa T, Yasui-Furukori N, et al. (May 2005). "Induction of the metabolism of etizolam by carbamazepine in humans". Eur. J. Clin. Pharmacol. 61 (3): 185–8. doi:10.1007/s00228-005-0904-y. PMID 15776275.  
  18. ^ Nakamae T, Shinozuka T, Sasaki C, et al. (November 2008). "Case report: Etizolam and its major metabolites in two unnatural death cases". Forensic Sci. Int. 182 (1-3): e1–6. doi:10.1016/j.forsciint.2008.08.012. PMID 18976871.  
  19. ^ Woolverton WL, Nader MA (December 1995). "Effects of several benzodiazepines, alone and in combination with flumazenil, in rhesus monkeys trained to discriminate pentobarbital from saline". Psychopharmacology (Berl.) 122 (3): 230–6. doi:10.1007/BF02246544. PMID 8748392.  

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