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N-demethylation of phenothiazines by lipoxygenase from soybean and human term placenta in the presence of hydrogen peroxide.

Several phenothiazine derivatives have been shown to cause reproductive toxicity. The biochemical mechanisms responsible for these effects are not fully understood at present. In this study, we investigated hydrogen peroxide-dependent oxidation of six phenothiazines by purified lipoxygenase from soybean (SLO) and human term placenta (HTPLO). Chlorpromazine was employed as the prototype phenothiazine drug. Chlorpromazine was easily demethylated releasing formaldehyde when incubated at pH 7.0 and 6.5 with SLO or HTPLO, respectively, in the presence of hydrogen peroxide. The reaction was linear with respect to time, exhibited dependence on the amount of enzyme, and the concentration of chlorpromazine and hydrogen peroxide. Under the optimal assay conditions, the estimated Vmax values for chlorpromazine N-demethylation were 139 and 7.2 nmoles/min/mg of SLO and HTPLO, respectively. Collectively, the results suggest an enzymatic nature of the reaction. In the presence of gossypol and NDGA, the classical inhibitors of different lipoxygenases, the formaldehyde production was significantly decreased, as expected. Similar to SLO, the generation of chlorpromazine cation radical, an initial oxidation product with an absorption maximum at 525 nm, was also observed with HTPLO. The radical generation was detectable only under acidic conditions (pH 3.5-4.5). The formaldehyde production was also decreased by BHT and BHA, suggesting a radical nature of the SLO-mediated chlorpromazine N-demethylation. Reduced glutathione, ascorbate, and dithiothreitol suppressed the rate of SLO-dependent formaldehyde generation, presumably due to the reduction of the cation radical back to chlorpromazine in a concentration-dependent manner. Besides chlorpromazine, SLO also oxidized promazine, triflupromazine, trifluperazine, trimeprazine, and perphenazine, albeit at different rates, in the presence of hydrogen peroxide. The evidence gathered in this in vitro study suggests that phenothiazines can undergo peroxidative N-demethylation via lipoxygenase pathway. The role of this biochemical mechanism in the in vivo developmental toxicity of phenothiazines remains to be established.

Chlorpromazine↗

[Inactivation of Trypanosoma cruzi trypanothione reductase by phenothiazine cationic free radicals].

Peroxidase/H2O2/phenothiazine systems produced irreversible inhibition (inactivation) of Trypanosoma cruzi trypanothione reductase (TR). The enzyme inactivation depended on (a) the incubation time of TR with the peroxidase/H2O2/phenothiazine system; (b) the peroxidase nature and (c) the phenothiazine structure. With the more effective peroxidase/H2O2/phenothiazine systems, TR inactivation kinetics presented a relatively fast initial phase, lasting for about 10 min, in which most of the enzyme activity disappeared. This phase was followed by a slower one and, after 30 min incubation, TR was totally inactivated. Three peroxidases were assayed as catalysts of TR inactivation: the horseradish peroxidase (HRP), leukocyte myeloperoxidase (MPO) and modified myoglobin (Mb). Under comparable experimental conditions, the peroxidase system activity decreased in the given order. With HRP systems, 10 microM Thioridazine (TRDZ), Promazine (PZ), Trimeprazine (TMPZ), Prochlorperazine (PCZ), Propionylpromazine (PPZ), Chlorpromazine (CPZ) and Perphenazine (PFZ), produced 95-100% inactivation of TR. With the MPO/H2O2 systems, PZ. TRDZ and TMPZ were the most effective. Under similar experimental condition, the Mb/H2O2/PZ,/TMPZ, /TRDZ and CPZ systems effectively inactivated TR. The presence of alkylamino, piperazinyl, or piperidinyl groups in PTZ N atom (position 10) and -Cl, -CF3, -SCH3, COCH2CH3 and -CN in position C2 exerted significant influence on phenothiazine activity. Glutathione (GSH) prevented TR inactivation by the HRP/H2O2/PZ and MPO/H2O2/PZ systems. The HRP/H2O2 and MPO/H2O2/phenothiazines systems generated the corresponding cationic radicals (FTZ.+) the stability of which was limited by their conversion into phenothiazine-sulfoxides (PTZ-SO). The latter ones were inactive on TR. GSH rapidly reacted with PTZ+.; thus producing cation radical detoxication. These reactions fit in well with GSH protection of TR against the peroxidase/H2O2/phenothiazine system, as well as with the FTZ.+ role in phenothiazine cytotoxicity.

Animals↗

Extractive-spectrophotometric determination of some 2- and 10-disubstituted phenothiazines with dipicrylamine.

Dipicrylamine reacts in neutral medium with some 2,10-disubstituted phenothiazines (promazine, chlorpromazine and promethazine hydrochlorides, trifluoperazine dihydrochloride, thioproperazine dimethanosulphonate) forming orange or brown ion-association compounds. The compounds are insoluble in water but quantitatively extracted into chloroform. These properties have been exploited for the determination of phenothiazines in pure solutions and pharmaceuticals.

Calibration↗

Interaction of protonated anticancer thiazines with water-insoluble phospholipids and antineoplastic agents.

A series of neuroleptic protonated phenothiazine derivatives (promethazine, promazine, triflupromazine, methotrimeprazine, propiomazine, trifluoperazine and fluphenazine), some with known anticancer properties, were complexed with water-insoluble antineoplastice agents such as 5-fluorouracil (5FU), methotrexate (MTX) and sulindac, as well as with components of biomembrane and synthetic phospholipids as possible models of cancer and microbial cells. In all cases water-soluble micellar inclusion adducts were formed exhibiting electron charge transfer complex behaviour, with the appearance of thazine free radicals. The thiazines sequestered the drugs and phospholipids in well-defined molar ratios (MR) parabolically-dependent on the dipole moments (mu) of the protonated phenothiazine derivatives. pH comparisons showed that the inclusion adducts followed a model in which the compounds were enveloped in the lipophilic interior of the thiazine aggregates, while the side-chains of the latter faced the aqueous environment. In the model experiment, interaction of the thiazines and the 5FU adducts with E. coli F' lac was additive to marginally synergistic, confirmed by the checkerboard technique. The parabolic dependence of the molar minimum inhibitory concentration of the thiazines and thiazine/5FU adducts on the thiazine dipole moments suggests that their primary loci of interaction are the cell wall or membrane phospholipid components. Thiazines, especially those with dipole moments centered on about 6 D, near which the lowest MR occurs, can act as effective carriers for insoluble or sparsely soluble drugs. Any new thiazine drug for use alone or as a carrier in anticancer therapy should be designed with this criterion in mind.

Antineoplastic Agents↗

An evaluation of sedatives and anesthetics in the agouti (Dasyprocta sp).

Seven drugs administered im were evaluated to determine their efficacy in immobilizing captive agoutis. Ketamine HCl (63-83 mg/kg) and phencyclidine HCl (16.5-22.0 mg/kg) produced immobilization and analgesia. Phencyclidine administration was accompanied by numerous side effects and prolonged recovery. Xylazine HCl (3-70 mg/kg) and fentanyl-droperidol (0.28-1.11 ml/kg( produced varying degrees of ataxia and intermittent recumbency. Acetylpromazine, chlorpromazine, and promazine HCl were ineffective. Surgical anesthesia was successfully induced and maintained with halothane.

Analgesia↗

Serum cytokine level and production of reactive oxygen species (ROS) by blood neutrophils from a schizophrenic patient with hypersensitivity to neuroleptics.

BACKGROUND: There have been few publications concerning the role of the immune system in neuroleptic intolerance. Some studies have shown that in neuroleptic malignant syndrome (NMS), associated with disseminated intravascular coagulation (DIC), the serum level of tumor necrosis factor alpha (TNF-alpha) increases significantly, which is thought to trigger the onset of DIC. CASE REPORT: A 23-year-old woman suffering from catatonic schizophrenia developed hypersensitivity to neuroleptics. One month before being referred to the present authors, she had a haloperidol-induced NMS episode in another psychiatric hospital, with high temperature, CPK activity, muscle rigidity and leukocytosis. On admission to our clinic and after treatment with promazine, laboratory tests showed an increase in serum CPK activity and mild leukocytosis. Neuroleptic treatment was discontinued, and the serum level of CPK and white blood cell count was monitored daily for 7 days, as well as the serum level of some cytokines and the production of reactive oxygen species (ROS) by blood neutrophils. The serum levels of interleukin 1 alpha (IL-1), IL-6 and TNF-alpha changed significantly over the observation period, forming waves with peak activity of IL-6 and TNF-alpha exceeding normal levels. The level of IL-1 alpha was within the control range. ROS production by the patient's blood neutrophils was also increased, as well as catalase serum activity. CONCLUSIONS: Some proinflammatory cytokines may participate in the mechanisms leading to the development of neuroleptic intolerance in schizophrenic patients. Cytokine-stimulated ROS production may participate in tissue injury and increase CPK serum activity.

Adult↗

[Controlled arterial hypotension produced by nitroprusside combined with neuroleptics].

Ganglioplegic drugs, including trimetaphan, have been imperfect agents of arterial hypotension, liable to produce tachyphylaxis, and not blocking intercurrent attacks of adrenergic hypertension the dose is inconstant and reversibility sometimes doubtful. The association of neuroleptics, in particulier promazines, permits an appreciable economy in dosage, stabilises the curves of hypotension, with the disadvantage of blocking normalisation of blood pressure. Sodium nitroprusside does not have the disadvantage of ganglioplegic drugs. Although usable alone, the blood pressure graphs sometimes have a certain instability mainly due to the difficulty of regulating the ideal perfusion flow rate. The authors show that the association of neuroleptic drugs has here also an effect of economy of dosage and facilitates the rise in blood pressure. Verification of reinforcement of the effect of sodium nitroprusside by chlorpromazine, acepromazine and levomepromazine was carried out in the dog. The authors show significant graphs.

Animals↗

[Neuroleptic malignant syndrome].

Neuroleptic malignant syndrome (NMS) is the most dangerous side effect of phenothiazines therapy. In the period of time from 1995 to 2002 in the Intensive Toxicological Unit there were five patients, 3 men and 2 women, aged from 25 to 62 (average 44.2) years-old, admitted from the regional inpatients psychiatric units with the diagnosis of pneumonia and/or sepsis. The patients about 48-72 hours before admittance were given some phenotiazine derivatives (promazine, perphenazine, clozapine, pipamperon) and/or buthyrophenone (haloperidol) because of psychotic state. Altered consciousness, muscle rigidity, hyperpyrexia (39.0-41.0 degrees C), sweating, tachycardia (120-150/min.), tachypnoea (respiratory rate more than 25/min.) and high level of creatine kinase activity (23,751-112,288 U/l) dominated. Only one patient had clinical picture of pneumonia. Because of the rapid development of acute respiratory failure, respirathorotherapy was initiated and continued for 8 and 10 days in two patients respectively. Transient thrombocytopenia (26,000/microliter) in one subject was observed. The neuroleptic drug was withdrawn and intensive supportive care with administration of bromocriptine (15-20 mg/24 h) was provided. None one of the doctors told the patients about the possibility of NMS during phenothiazines therapy.

Adult↗

[Note on the comparative effects of benzodiazepines and chlorpromazine on intracranial pressure in the dog].

The neutrality of the butyrophenones on intracranial pressure has been relatively well shown. That of the phenothiazines and benzodiazepine derivatives has been less well established. The authors studied, by a continuous method, the action of chlorpromazine, acepromazine and three benzodiazepines (diazepam, flunitrazepam and chlorazepam) on intracranial pressure and blood pressure in the dog. These substances seem to be definitely neutral on intracranial pressure, more so in the case of the benzodiazepines than for the promazines, the vasomotor action of which was perceptible when seen closely. The authors produce demonstrative graphs, illustrating the correlation of these two pressures.

Animals↗

Dehalogenation and N-dealkylation of chlorpromazine as revealed by plasma concentrations of metabolites in a population of chronically medicated schizophrenics.

Dehalogenaton and N-demethylation of chlorpromazine (CPZ) were studied in twelve psychotic inpatients orally treated for four weeks with a daily CPZ dose of 6.4 +/- 1.1 (S.E.) mg/kg body weight (1.5-14.1, range). Weekly drug and metabolite plasma concentrations were measured by a gas liquid chromatography-nitrogen/phosphorus detector method (GLC/NPD). Plasma concentrations of the parent compound CPZ, of the dehalogenated metabolite promazine (PZ) and of the N-dealkylated metabolites N-monodemethylated chlorpromazine (CPZ-nor1) and N-didemethylated chlorpromazine (CPZ-nor2) had already reached a steady state by the end of the first week of treatment. During the entire treatment period the major plasma component was found to be PZ. Patients (N = 6) on a low dose regimen (3.7 +/- 0.2 mg/kg body weight) showed significantly lower mean plasma concentrations of CPZ and nor metabolites than patients (N = 6) on a higher dose regimen (8.6 +/- 0.7 mg/kg body weight). PZ mean plasma concentrations, however, were not significantly different in the two groups of patients, indicating that the yield of the CPZ dechlorination pathway, as opposed to that of the N-demethylation pathway, was already maximal at the CPZ concentrations attained under the low dose regimen. Male patients (N = 5) exhibited significantly higher mean PZ plasma concentrations over the 4 week period of the study than female patients (N = 7).

Adult↗

The in vitro activity of phenothiazines against Mycobacterium avium: potential of thioridazine for therapy of the co-infected AIDS patient.

Patients presenting with Acquired Immune Deficiency Syndrome (AIDS) are predisposed to co-infection with Mycobacterium avium. The management of such patients is problematic due to underlying immuno-incompetence and the high resistance of M. avium to most non-toxic compounds. Therefore, the need for effective agents is obvious. Because phenothiazines, especially the relatively mild thioridazine, have significant activity against Mycobacterium tuberculosis, we investigated the in vitro activity of chlorpromazine, thioridazine, promazine, promethazine and desipramine against a reference and clinical strains of M. avium. The results obtained show that whereas all of the phenothiazines employed in this study had an minimum inhibitory concentration (MIC) against the strains studied that ranged from ca. 10 to > 50 mg/L, as was previously shown for M. tuberculosis, thioridazine was the most active of the group against M. avium.

AIDS-Related Opportunistic Infections↗

Direct effects of neuroleptics on the activity of CYP2A in the liver of rats.

The aim of the present study was to investigate the influence of classic and atypical neuroleptics on the activity of rat CYP2A measured as a rate of testosterone 7alpha-hydroxylation. The reaction was studied in control liver microsomes in the presence of neuroleptics, as well as in microsomes of rats treated intraperitoneally (i.p.) for one day or two weeks (twice a day) with pharmacological doses (mg/kg) of the drugs (promazine, levomepromazine, thioridazine, perazine 10, chlorpromazine, haloperidol 0.3, risperidone 0.1, sertindole 0.05), in the absence of the neuroleptics in vitro. Most of the neuroleptics added in vitro to control liver microsomes decreased the activity of the rat CYP2A. Chlorpromazine (Ki = 11 microM) was the most potent inhibitor of the rat CYP2A among the studied drugs, whose effect was more pronounced than that of the other tested phenothiazines (Ki = 41-83 microM), haloperidol (Ki = 190 microM) or sertindole (Ki = 78 microM). Risperidone was not active in this respect. The investigated neuroleptics when given to rats in vivo for one day or two weeks--did not produce any indirect inhibitory effect on CYP2A via other mechanisms. The obtained results show direct inhibitory effects of phenothiazine neuroleptics on the activity of CYP2A in rat liver, which may be of physiological importance for the metabolism of testosterone, considering simultaneous inhibition of CYP2C11 and CYP3A by those drugs.

Animals↗

[Acute psychoses caused by digitalis poisoning].

The course of illness in a 76-year-old woman with a history of dyspnea being treated with medigoxin, 0.1 mg daily, is presented. Five days before the symptoms of acute psychosis developed she had used medigoxin, 0.2 mg per day. On the fifth day of that therapy, the patient developed acute psychosis and was admitted to the Department of Psychiatry. An electrocardiogram recorded monomorphous ventricular premature beats at a frequency of 50%, the S-T segment depression of the anterolateral location with the diphasic T-wave and the corrected Q-T interval of 0.377 to 0.355 seconds. Five days after the discontinuation of medigoxin therapy, serum digoxin concentration was 2.2 nmol/L, out of which follows that two days after digitalis was stopped it was 4.0 nmol/L and that concentration was probably higher at the moment when acute psychosis developed. The patient was free of symptoms of acute psychosis after a single promazine dose and discontinuation of medigoxin.

Acute Disease↗

Short-term sleep EEG recordings after partial sleep deprivation as a routine procedure in order to uncover epileptic phenomena: an evaluation of 719 EEG recordings.

All night sleep deprivation prior to an EEG registration causes some inconvenience not only to the organization of the EEG department but presents a burden on the patients as well as their family members, and for these reasons is not suitable to be frequently employed as a routine procedure. As an alternative, we performed short-term sleep recordings in the early afternoon following a partial sleep deprivation of the patients during the preceding night. This method was well accepted by the patients and their family. Our only goal was to shorten the total time of night sleep using the following guideline: for very small children 22.00-06.00; for 4-14-year-old patients 24.00-06.00; and for patients older than that 01.00-06.00. 79.9%, out of 719 patients (573) who had been given the above instructions subsequently showed sleep patterns in their EEG. Additionally we had to administer an oral dose of promazine to only 67 patients. However, for the most part, patients showed only light sleep stages: 114 patients only reached sleep stage 1; 323 patients sleep stage 2; 88 patients sleep stage 3; and 48 patients sleep stage 4. As expected, REM sleep was never recorded. Nonetheless, in 32 out of 146 patients who were tired but unable to fall asleep, epileptic patterns could be provoked. In 636 patients, the EEG-recording after sleep reduction was ordered because of a suspected seizure disorder; in the remaining patients it was initiated solely because of sharp components in the routine-EEG. In 341 (53.6%) of the patients with suspected epilepsy, electroencephalographic activity indicative of a seizure disorder was activated. Such epileptic patterns were recorded almost exclusively in stages of waking, 1 and 2. Only in one out of the 124 patients who reached sleep stages 3 and 4 epileptic patterns were not seen until deep sleep was entered. We observed 2/s, 3/s and 6/s spike-and-wave complexes, sharp waves, spikes, polyspikes, groups containing remarkably sharp components and so called sharp vertex grapho-elements. Patients with suspected seizure disorders frequently show grapho-elements which can be interpreted as the expression of a disposition for epilepsy. These sharp vertex elements were evident in 54 out of 719 short term sleep recordings, more often in children than in adults. 49 times they coincided with typical epileptic discharges such as sharp waves, spikes or spike-and-waves in the same recording.

Adolescent↗

[The ectophosphatase activity of cultured endothelial cells of calf aorta and the effect of drugs on ecto-ATPase].

Cultivated endothelial cells of calf aorta (line BKEz-7) possess an effective ectophosphatase system (enzyme activities: ATPase 38.0 +/- 10.2; ADPase 9.2 +/- 4.2; 5'-nucleotidase 4.1 +/- 2.6 fmol/cell.min). Drugs with central depressive activity such as promazine, chlorpromazine, and meprobamate inhibit the activity of the ecto-ATPase. A possible connection between the inhibitory activity on the ecto-ATPase and their central depressive effects is discussed.

5'-Nucleotidase↗

Effect of some quinolizidine derivatives on the release of serotonin, noradrenaline, dopamine and acetylcholine from rat brain synaptosomes.

A set of eleven quinolizidine derivatives together with 10-(quinuclidinyl)phenothiazine, promazine and methixene were tested for their effects on the spontaneous release of serotonin, noradrenaline, dopamine and acetylcholine from rat brain synaptosomes. All tested compounds failed to increase the acetylcholine release, while several of them exhibited rather strong effects on serotonin, noradrenaline and dopamine release at 5-10 microM concentrations. Structure-activity relationships are discussed.

Acetylcholine↗

Immunoassay detection of drugs in racing horses. IX. Detection of detomidine in equine blood and urine by radioimmunoassay.

Detomidine is a potent non-narcotic sedative agent which is currently in the process of being approved for veterinary clinical use in the United States. Since no effective screening method in horses is available for detomidine, we have developed an 125I radioimmunoassay for detomidine in equine blood and urine as part of a panel of tests for illegal drugs in performance horses. Our 125I radioimmunoassay has an I-50 for detomidine of approximately 2 ng/ml. Our assay shows limited cross-reactivity with the pharmacodynamically similar xylazine, but does not cross-react with acepromazine, epinephrine, haloperidol or promazine. The plasma kinetic data from clinical (greater than or equal to 5 mg/horse) as well as sub-clinical doses indicate first-order elimination in a dose-dependent manner. Within the first 30 minutes after intravenous (IV) administration of 30 mg/horse, plasma levels peak at approximately 20 ng/ml and then decline with an apparent plasma half-life of 25 minutes. Diuresis can occur with administration of clinical doses of detomidine and this effect was accounted for in the analysis of urine samples. Using this method, administration of 30 mg/horse can be readily detected in equine urine for up to 8 hours after IV injection. Additionally, doses as low as 0.5 mg/horse can be detected for short periods of time in blood and urine with use of this assay. Utilization of this assay by research scientists and forensic analysts will allow for the establishment of proper guidelines and controls regarding detomidine administration to performance horses and assurance of compliance with these guidelines.

Analgesics↗

A neuropsychopharmacological profile of "Cinkara", a polyherbal preparation.

"Cinkara", a polyherbal preparation reduced pentobarbitone induced hypnosis in mice, decreased apomorphine induced fighting, aggression and stereotypy and increased amphetamine induced aggregated toxicity in mice. It also increased immobility of rats in forced swimming test, an action which was not blocked by chlor-promazine, and increased ambulation in open arena test. It did not modify electrically induced convulsions or haloperidol catalepsy. It is suggested that the preparation possesses a central nervous system stimulant activity but unlike other CNS stimulants, it lowers aggressive activity in rats.

Aggression↗