Pizotifen

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Pizotifen
Pizotifen.svg
Systematic (IUPAC) name
4-(1-methyl-4-piperidylidine)-9,10-dihydro -4H-benzo-[4,5]cyclohepta[1,2]-thiophene
Clinical data
Trade names Sandomigran
AHFS/Drugs.com International Drug Names
Pregnancy cat. B1 (AU)
Legal status Prescription Only (S4) (AU) -only (CA) POM (UK)
Routes Oral
Pharmacokinetic data
Bioavailability 78%
Protein binding 91%
Metabolism Glucuronidation (main route). N-glucuronide accounts for >50% of plasma and 60–70% of urinary excreted drug
Half-life 23 hours
Excretion 18% feces, 55% urine (both as metabolites).
Identifiers
CAS number 15574-96-6 N
ATC code N02CX01
PubChem CID 27400
IUPHAR ligand 93
ChemSpider 25497 YesY
UNII 0BY8440V3N YesY
KEGG D05523 YesY
ChEMBL CHEMBL294951 YesY
Chemical data
Formula C19H21NS 
Mol. mass 295.443 g/mol
 N (what is this?)  (verify)

Pizotifen (INN) or pizotyline (USAN), trade name Sandomigran, is a benzocycloheptene-based drug used as a medicine, primarily as a preventative to reduce the frequency of recurrent migraine headaches.[1]

Uses[edit]

The main medical use for pizotifen is for the prevention of vascular headache including migraine and cluster headache. Pizotifen is one of a range of medications used for this purpose, other options include propranolol, topiramate, valproic acid and amitriptyline. While pizotifen is reasonably effective,[2] its use is limited by side effects, principally drowsiness and weight gain, and it is usually not the first choice medicine for preventing migraines, instead being used as an alternative when other drugs have failed to be effective.[3] It is not effective in relieving migraine attacks once in progress

Other applications for which pizotifen may be used include as an antidepressant, or for the treatment of anxiety or social phobia.[4][5] Animal studies also suggest that pizotyline could be used in the treatment of serotonin syndrome or MDMA overdose[6] in a similar manner to the closely related antihistamine/antiserotonin drug cyproheptadine.

Adverse effects[edit]

Side effects include sedation, dry mouth, drowsiness, increased appetite and weight gain.[7] Occasionally it may cause nausea, headaches, or dizziness. In rare cases, anxiety, aggression and depression may also occur.

Contraindications[edit]

Caution is required in patients having closed angle glaucoma and in patients with a predisposition to urinary retention as the drug exhibits a relatively small anticholinergic effect. Dose adjustment is required in patients having renal insufficiency. Hepatic injury has also been reported. Pizotifen treatment should be discontinued if there is any clinical evidence of hepatic dysfunction during treatment.Caution is advised in patients having a history of epilepsy. Withdrawal symptoms like depression, tremor, nausea, anxiety, malaise, dizziness, sleep disorder and weight decrease have been reported following abrupt cessation of pizotifen.[8] Pizotifen is contraindicated in patients who suffer from hypersensitivity to any of its components, also Pizotifen is contraindicated in gastric outlet obstruction, pregnancy, angle-closure glaucoma and difficulty urinating.[9]

Mechanism of Action[edit]

Pizotifen is a serotonin antagonist acting mainly at the 5-HT2A and 5HT2C receptors. It also has some activity as an antihistamine as well as some anticholinergic activity.[10]

See also[edit]

References[edit]

  1. ^ Stark RJ, Valenti L, Miller GC. Management of migraine in Australian general practice. Medical Journal of Australia. 2007 Aug 6;187(3):142-6.
  2. ^ Barnes N, Millman G. Do pizotifen or propranolol reduce the frequency of migraine headache? Archives of Disease in Childhood. 2004 Jul;89(7):684-5.
  3. ^ Pierangeli G, Cevoli S, Sancisi E, Grimaldi D, Zanigni S, Montagna P, Cortelli P. Which therapy for which patient? Neurological Sciences. 2006 May;27 Suppl 2:S153-8.
  4. ^ Standal JE. Pizotifen as an antidepressant. Acta Psychiatrica Scandinavica. 1977 Oct;56(4):276-9.
  5. ^ Banki CM. Clinical observations with pizotifene (Sandomigran) in the treatment of nonmigrainous depressed women. Archiv fur Psychiatrie und Nervenkrankheiten. 1978 Mar 7;225(1):67-72.
  6. ^ Young R, Khorana N, Bondareva T, Glennon RA. Pizotyline effectively attenuates the stimulus effects of N-methyl-3,4-methylenedioxyamphetamine (MDMA). Pharmacology, Biochemistry and Behavior. 2005 Oct;82(2):404-10.
  7. ^ Crowder D, Maclay WP. Pizotifen once daily in the prophylaxis of migraine: results of a multi-centre general practice study. Current Medical Research and Opinion. 1984;9(4):280-5.
  8. ^ "Emedicine". 
  9. ^ "Likarstwo.ru". 
  10. ^ Dixon AK, Hill RC, Roemer D, Scholtysik G. Pharmacological properties of 4-(1-methyl-4-piperidylidine)-9,10-dihydro-4H-benzo-[4,5]cyclohepta[1,2]-thiophene hydrogen maleate (pizotifen). Arzneimittelforschung. 1977;27(10):1968-79.

External links[edit]