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Metabolism and disposition of trifluoperazine in the rat. I. A thin-layer chromatographic method for the measurement of trifluoperazine and its metabolites in rat tissues.

A method has been developed for quantitative measurement of trifluoperazine and its metabolites, 7-hydroxytrifluoperazine and desmethyltrifluoperazine, in rat organs. Trifluoperazine sulfoxide could also be assayed, but it proved to represent a very minor part only of total biotransformation products in tissues. Alkalinized tissue homogenates were extracted with di-isopropyl ether. Following removal of the bulk of lipids, the compounds to be quantitated were separated by thin-layer chromatography and measured by ultraviolet reflectance photometry on the plates. In recovery experiments, the method proved to possess a high reproducibility. The sensitivity limit for quantitative determination was about 0.1 nmol per extract, and the limit of detectability was 0.025-0.05 nmol. The applicability of the method was shown by analyzing the tissues of rats that had received 12.3 micronmol of trifluoperazine, ip, per kg.

Animals↗

Effects of trifluoperazine on platelet activation.

Previous reports of the inhibitory effects of trifluoperazine on platelet responses to different aggregating agents have been conflicting, and the mechanism of action remains unclear. We have found that aggregation by minimum concentrations of collagen and arachidonic acid, and second phase aggregation by minimum concentrations of ADP, thrombin, epinephrine and the calcium ionophore A23187 were inhibited by 40-60 microM trifluoperazine. The first phase of aggregation by a minimum concentration of epinephrine was completely inhibited by 100 microM trifluoperazine, and the first phase of aggregation induced by ADP, thrombin or A23187 was decreased by 300 microM trifluoperazine. The platelet shape change caused by collagen, but by no other aggregating agent examined, was inhibited by 300 microM trifluoperazine. Secretion of 3H-5 hydroxytryptamine by minimum concentrations of ADP, collagen, epinephrine and arachidonic acid was completely suppressed by 50 microM trifluoperazine. Secretion by thrombin and A23187 was incompletely inhibited by 300 microM trifluoperazine. Thromboxane B2 formation caused by all aggregating agents, except epinephrine, was incompletely suppressed by 50 microM trifluoperazine, and 300 microM trifluoperazine only caused complete inhibition of thromboxane B2 formation by ADP, collagen and epinephrine. The phorbol ester, TPA, which mimics diacylglycerol by activating protein kinase C, caused aggregation and secretion. Aggregation, but not secretion, by low concentrations of TPA was inhibited by concentrations of trifluoperazine as low as 50 microM. However, aggregation by a combination of TPA and A23187 was only inhibited by concentrations of trifluoperazine in excess of 100 microM. Secretion by TPA was inhibited by concentrations of trifluoperazine in excess of 200 microM. Our findings suggest that low concentrations of trifluoperazine inhibit platelet activation by inhibiting phospholipase A2, and that higher concentrations inhibit platelet responses by interfering with protein kinase C.

Adenosine Diphosphate↗

Trifluoperazine for schizophrenia.

BACKGROUND: Trifluoperazine is an inexpensive accessible 'high potency' antipsychotic drug, widely used to treat schizophrenia or related psychoses. OBJECTIVES: To estimate the effects of trifluoperazine compared with placebo and other drugs. SEARCH STRATEGY: Searches of the Cochrane Schizophrenia Group's register of trials (March 2002), supplemented with hand searching, reference searching, personal communication and contact with industry. SELECTION CRITERIA: All clinical randomised trials involving people with schizophrenia and comparing trifluoperazine with any other treatment. DATA COLLECTION AND ANALYSIS: Studies were reliably selected and quality rated and data was extracted. For dichotomous data, relative risks (RR) were estimated, with 95% confidence intervals (CI). Where possible, we undertook intention-to-treat analyses. For statistically significant results, the number needed to treat (NNT) was calculated. We estimated heterogeneity (I-square technique) and publication bias. MAIN RESULTS: 1162 people from 13 studies were randomised to trifluoperazine or placebo. For global improvement, small short-term studies favoured trifluoperazine (n=95, 3 RCTs, RR 0.62 CI 0.49 to 0.78 NNT 3 CI 2 to 4). Loss to follow up was about 12% in both groups (n=280, 7 RCTs, RR 0.99 CI 0.62 to 1.57) and more people allocated trifluoperazine used antiparkinson drugs to alleviate movements disorders compared with placebo (n=195, 4 RCTs, RR 5.06 CI 2.49 to 10.27, NNH 4 CI 2 to 9). 2230 people from 49 studies were randomised to trifluoperazine or another older generation antipsychotic. Trifluoperazine was not clearly different in terms of 'no substantial improvement' (n=1016, 27 RCTs, RR 1.06 CI 0.98 to 1.14) or leaving the study early (n=930, 22 RCTs, RR 1.15 CI 0.83 to 1.58). Almost identical numbers of people reported at least one adverse event (60%) in each group (n=585, 14 RCTs, RR 0.99 CI 0.87 to 1.13), although trifluoperazine was more likely to cause extrapyramidal adverse effects overall when compared to low potency antipsychotics such as chlorpromazine (n=130, 3 RCTs, RR 1.66 CI 1.03 to 2.67, NNH 6 CI 3 to 121). One small study (n=38) found no clear differences between trifluoperazine and the atypical drug, sulpiride. REVIEWER'S CONCLUSIONS: Although there are shortcomings and gaps in the data, there appears to be enough consistency over different outcomes and periods to confirm that trifluoperazine is an antipsychotic of similar efficacy to other commonly used neuroleptics for people with schizophrenia. Its adverse events profile is similar to that of other drugs. It has been claimed that trifluoperazine is effective at low doses for patients with schizophrenia but this does not appear to be based on good quality trial based evidence.

Antipsychotic Agents↗

Trifluoperazine inhibits Sendai virus-induced hemolysis.

Sendai virus-induced hemolysis, a manifestation of virus-red cell fusion, is inhibited by exposure of the virus to 50 microM and higher concentrations of trifluoperazine. Trifluoperazine does not disrupt the virus, since trifluoperazine-treated virus with no hemolytic activity sediments slightly faster than untreated virus on sucrose density gradients and contains viral proteins in proportions characteristic of untreated virus. Trifluoperazine affects the fusion protein to a greater extent than the hemagglutinin, since trifluoperazine-treated virus with no hemolytic activity is as active or nearly as active in agglutinating red cells. The partition coefficient of trifluoperazine between the virus membrane and buffer is lower at 4 degrees C than, but the same at 37 degrees C, as that between the red cell membrane and buffer. Nevertheless, virus-independent red cell lysis and inactivation of virus-mediated hemolysis occur when the red cell and viral membranes, respectively, contain similar concentrations of trifluoperazine. Furthermore, 13-28% more trifluoperazine is necessary to achieve either effect at 4 degrees C or at 25 degrees C than at 37 degrees C. Changes in the surface activity of trifluoperazine do not explain these results, insofar as the critical micellar concentration of (0.75 mM) and maximal reduction in surface tension by (40 dyn/cm) trifluoperazine are the same at 25 degrees C and 37 degrees C. The fluorescence of viral tryptophan decreases by approx. 25% when viral hemolysis is inactivated by trifluoperazine, by trypsin treatment or by heating at 100 degrees C for 5 min.

Animals↗

Role for malonyl coenzyme A:acyl carrier protein transacylase (MCAT) in the growth-inhibitory effect of the calmodulin antagonist trifluoperazine in Mycobacterium bovis BCG.

OBJECTIVES: To determine whether the fatty acid synthesis enzyme malonyl coenzyme A:acyl carrier protein transacylase (MCAT) is involved in the growth-inhibitory effect of trifluoperazine in the tubercle bacillus Mycobacterium bovis BCG. METHODS: BCG was grown in liquid culture with various concentrations of trifluoperazine and growth was monitored by OD measurement. To determine the effect of trifluoperazine on MCAT protein level, total protein was extracted from BCG cultures and was analysed by 2D gel electrophoresis and western blot. To confirm trifluoperazine-dependent reduction in the MCAT protein level, two BCG strains overexpressing MCAT at a low and high constitutive level were similarly tested. The synergic effect of trifluoperazine and isoniazid was tested at sub-MIC levels in liquid cultures. RESULTS: Trifluoperazine inhibition of growth correlates with reduction in the steady-state level of MCAT protein. Overexpression of MCAT confers resistance to trifluoperazine. Trifluoperazine acts synergically (albeit weakly) with isoniazid and no resistance towards isoniazid alone was observed due to overexpression of MCAT. This suggests MCAT to be a specific target of trifluoperazine. CONCLUSION: These results indicate MCAT as a target of trifluoperazine and provide an explanation for the inhibitory effect of trifluoperazine on mycobacterial lipid synthesis observed earlier. This makes MCAT a potential target for new antimycobacterials.

Acyl-Carrier Protein S-Malonyltransferase↗

Presynaptic action of trifluoperazine at the frog neuromuscular junction.

Treatment of frog neuromuscular preparations bathed in basic frog saline (1.8 mM Ca2+) with trifluoperazine (25 microM) caused an increase in MEPP frequency in 6 out of 10 preparations tested. The mean normalised MEPP frequency after 15 min of treatment was approximately 1.5. 10 microM trifluoperazine had a similar effect. In salines containing low concentrations of Ca2+ (50 microM Ca2+, 2 mM Mg2+ or 0 Ca2+, 1 mM EGTA) the stimulatory action of trifluoperazine was more marked and occurred in a higher proportion of the preparations tested (11 out of 14). When evoked release of transmitter was reduced to very low levels by Mg2+-containing salines treatment with trifluoperazine (2.5-25 microM) caused an increase in quantal content of 20-60%. Depolarisation of preparations bathed in standard frog saline by increasing [K+]o to 10 mM resulted in a 10-fold increase in MEPP frequency. This response was inhibited by about 25% in 10 microM trifluoperazine and by about 45% in 25 microM trifluoperazine. Pre-treatment of preparations with trifluoperazine (25 microM) caused a marked reduction in the response of MEPP frequency to tetanic stimulation (50 Hz) both in the presence of an inward electrochemical gradient for Ca2+ (50 microM Ca2+, 2 mM Mg2+) and in a Ca2+-free saline (0 Ca2+, 1 mM EGTA). The effects of trifluoperazine on tetanic enhancement of MEPP frequency are compared to those of other agents and it is shown that the results are inconsistent with an effect of the drug on Ca2+-fluxes at the plasma membrane. It is concluded that trifluoperazine has both stimulatory and inhibitory effects on transmitter release at the frog neuromuscular junction and that the inhibitory effect is probably due to inhibition of excitation-secretion coupling at a point subsequent to Ca2+ mobilization.

Animals↗

Metabolic effects of trifluoperazine in the liver and the influence of calcium.

The effects of trifluoperazine on hepatic cell metabolism were investigated using isolated perfused rat liver. The following effects of trifluoperazine were found: (1) trifluoperazine inhibited oxygen uptake, the site of action being the mitochondria. Half-maximal inhibition occurred at concentrations around 50 microM; with 100 microM trifluoperazine the effect was already maximal. When Ca2+ was withdrawn from the perfusion medium and the intracellular Ca2+ pools were exhausted, the inhibitory action on respiration was no longer observable. The reintroduction of Ca2+ restored inhibition. (2) Glycogenolysis and glycolysis were not significantly affected during the infusion of trifluoperazine. After stopping trifluoperazine infusion, however, glycogenolysis (glucose release) experienced a transitory stimulation. (3) Gluconeogenesis from lactate as the carbon source was inhibited by trifluoperazine. This inhibition was approximately proportional to the inhibition of oxygen uptake. Withdrawal of Ca2+ diminished, but it did not eliminate, inhibition of gluconeogenesis. (4) Ketogenesis was also inhibited in parallel with the inhibition of oxygen uptake. Withdrawal of Ca2+ from the perfusion fluid also abolished this action. (5) The effects of trifluoperazine were reverted very slowly when its infusion was stopped. The recovery of oxygen uptake at 50 min after cessation of the infusion was only 30%. Uptake of the substance was very fast. Absence of Ca2+ did not affect uptake. It was concluded that inhibition of mitochondrial energy metabolism is one of the most prominent effects of trifluoperazine in the liver. The fact that this inhibition depends on Ca2+ is unique.

Animals↗

Specificity of the binding of trifluoperazine to the calcium-dependent activator of phosphodiesterase and to a series of other calcium-binding proteins.

Trifluoperazine inhibits the activation of phosphodiesterase by binding to the calcium-dependent activator. To determine further the specificity by which trifluoperazine binds to activator, we compared the binding of trifluoperazine to activator prepared from several species and tissues and to a number of other calcium-binding proteins devoid of activator activity. Trifluoperazine binds to activator prepared from human, bovine, rat and rabbit brain and from chick embryo fibroblasts. In each case, the binding of trifluoperazine to activator was qualitatively similar and related quantitatively to the ability of the preparation to activate phosphodiesterase. Of the other calcium-binding proteins examined, namely, troponin-C, S-100 protein, phospholipase A, phospholipase B and myosin light chain, only troponin-C displayed any significant calcium-specific binding of trifluoperazine. The binding to troponin-C, however, appeared to be different from the binding to activator; whereas the binding of trifluoperazine to actovator showed no cooperativity, the binding to troponin-C showed positive cooperatively. These results and earlier data showing that trifluoperazine fails to bind to a variety of other proteins, indicate that the binding of trifluoperazine to the calcium-dependent activator of phosphodiesterase is selective and suggest that this binding may explain some of the biochemical and pharmacological actions of this antipsychotic agent.

3',5'-Cyclic-AMP Phosphodiesterases↗

Influence of trifluoperazine on ACTH- or angiotensin-stimulated mineralocorticoid and glucocorticoid secretion in man.

During stimulation of adrenocortical secretion the calcium--calmodulin system is activated to a different extent, depending on the secretagogue substance. In the submitted paper the influence of therapeutic doses of the calmodulin inhibitor, trifluoperazine, on aldosterone and cortisol secretion stimulated by ACTH or by activation of endogenous angiotensin by furosemide was investigated in healthy subjects. Trifluoperazine already in amounts of 6 mg/day administered for one week inhibited the "basal" aldosterone secretion assessed in a vertical position (p less than 0.01) and ACTH stimulated secretion (during the 30th minute p less than 0.05). The basal aldosterone secretion assessed in a horizontal position was not affected by trifluoperazine, similarly as it did not affect the secretory response to endogenous angiotensin activated by furosemide, regardless whether a dose of 6 mg or 12 mg/day was used. ACTH stimulated cortisol blood levels were after trifluoperazine insignificantly but constantly lower throughout the test, while they were not altered by trifluoperazine in the furosemide test. The plasma calcium level was not significantly affected by trifluoperazine. It may be concluded that trifluoperazine alters ACTH stimulated mineralocorticoid secretion, while it does not influence angiotensin stimulated secretion. The revealed differences in adrenocortical response to trifluoperazine in vivo cannot be explained merely by a different sensitivity of the calcium-calmodulin system to stimulation by two different secretagogues, but by interaction of some regulatory mechanisms influenced by trifluoperazine with adrenocortical secretion.

Adrenal Cortex↗

Antagonism of acetaminophen-induced hepatocellular destruction by trifluoperazine in mice.

The effect of trifluoperazine, a specific calmodulin inhibitor, on hepatocellular destruction induced by acetaminophen was investigated in mice. Trifluoperazine 30 mg/kg administered intraperitoneally 30 min. or 0 min. before acetaminophen blocked hepatocellular destruction induced by the hepatotoxin, as evidenced by the determination of plasma GPT activity. Trifluoperazine also completely inhibited an increase of calcium contents in liver induced by acetaminophen administration. Furthermore, the increase of hepatic phosphorylase a activity induced by acetaminophen administration was completely abolished by pretreatment with trifluoperazine. However, hepatic glutathione depletion induced by acetaminophen was not prevented by pretreatment with trifluoperazine. Trifluoperazine administration caused a marked decrease in the body temperature of acetaminophen-treated animals. However, when the trifluoperazine-treated acetaminophen-poisoned animals were kept normothermic, the preventive effects were abolished. These findings suggest that this protective effect may be mediated by the trifluoperazine blockade of the deleterious effects of calcium accumulation in liver or the trifluoperazine decreasing effects on body temperature.

Acetaminophen↗

Radioimmunoassay for the sulfoxide metabolite of trifluoperazine and its application to a kinetic study in humans.

Antibodies were produced in rabbits immunized with 10-[[3-[4-(2-carboxyethyl)-1-piperazinyl]-propyl]]-2 -trifluoromethyl-10H-phenothiazine sulfoxide-bovine serum albumin conjugate. The subsequently developed radioimmunoassay (RIA) procedure enables, for the first time, the quantitation of the sulfoxide metabolite of trifluoperazine in the plasma of humans after administration of therapeutic doses of trifluoperazine, in which 60 pg of the sulfoxide metabolite in 200 microL of plasma can be measured with a CV of less than 3%. Similar results were obtained by this assay with or without a benzene extraction step and also in the presence or absence of a large excess of trifluoperazine and suspected major metabolites of trifluoperazine. This RIA procedure, together with a previously developed RIA for trifluoperazine was used to directly determine plasma concentrations of trifluoperazine and its sulfoxide metabolite after administration of a single, low, oral dose of trifluoperazine to five healthy volunteers. The rapidly appearing, relatively high concentrations of the sulfoxide metabolite are indicative of presystemic sulfoxidation. The mean plasma elimination half-life for the sulfoxide metabolic of trifluoperazine was 5.8 +/- 1.3 h.

Humans↗

Effects of trifluoperazine and pimozide on stimulus-secretion coupling in pancreatic B-cells. Suggestion for a role of calmodulin?

The possible involvement of calmodulin in insulin release was evaluated by studying the effects on intact islets of trifluoperazine and pimozide, two antipsychotic agents known to bind strongly to calmodulin in cell-free systems. Trifluoperazine (10-100mum) produced a dose- and time-dependent inhibition of the two phases of glucose-stimulated insulin release. The effect was not reversible by simple washing of the drug, but could be prevented by cytochalasin B or theophylline. Trifluoperazine also inhibited the release induced by glyceraldehyde, oxoisocaproate, tolbutamide or barium, but not that stimulated by 10mm-theophylline or 1mm-3-isobutyl-1-methylxanthine. Pimozide (0.5-10mum) also produced a dose-dependent inhibition of insulin release triggered by glucose, leucine or barium, but did not affect the release induced by methylxanthines. Glucose utilization by islet cells was not modified by trifluoperazine (25mum), which slightly increased cyclic AMP concentration in islets incubated without glucose. The drug did not prevent the increase in cyclic AMP concentration observed after 10min of glucose stimulation, but suppressed it after 60min. Basal or glucose-stimulated Ca(2+) influx (5min) was unaffected by 25mum-trifluoperazine, whereas Ca(2+)net uptake (60min) was inhibited by 20%. Glucose-stimulated Ca(2+) uptake was almost unaffected by pimozide. In a Ca(2+)-free medium, trifluoperazine decreased Ca(2+) efflux from the islets and did not prevent the further decrease by glucose; in the presence of Ca(2+), the drug again decreased Ca(2+) efflux and inhibited the stimulation normally produced by glucose. In the absence of glucose, trifluoperazine lowered the rate of Rb(+) efflux from the islets, decreased Rb(+) influx (10min), but did not affect Rb(+) net uptake (60min). It did not interfere with the ability of glucose to decrease Rb(+) efflux rate further and to increase Rb(+) net uptake. The results show thus that trifluoperazine does not alter the initial key events of the stimulus-secretion coupling. Its inhibition of insulin release suggests a role of calmodulin at late stages of the secretory process.

Animals↗

Effects of trifluoperazine on beta-adrenergic responses of rat papillary muscle: related to calmodulin?

The beta-adrenergic stimulation of cardiac contraction and relaxation is related to an augmented Ca++ oscillation mediated by cAMP. This Ca++ mobilization may secondarily involve calmodulin in a way modulating the mechanical responses. We tested this possibility by studying interferences of trifluoperazine (which is able to block Ca++-calmodulin) with beta-adrenergic responses in rat heart papillary muscles. Trifluoperazine up to 10(-5) mol/l did not change the basal function. 10(-5) mol/l trifluoperazine augmented the contractile response to isoprenaline above 10(-7) mol/l. The inotropic effects of isoprenaline below 10(-7) mol/l and of the partial beta-agonist prenalterol were not influenced by trifluoperazine. 10(-5) mol/l trifluoperazine attenuated the stimulation of initial relaxation by isoprenaline in the entire concentration range. Thus this beta-adrenergic response was more sensitive to trifluoperazine than the contractile response. But trifluoperazine only slightly and non-significantly attenuated the stimulation of initial relaxation by prenalterol. From experiments on broken cell preparations the present results can be explained in terms of calmodulin blockade and thus inhibition of Ca++ efflux across the sarcolemma and of Ca++ uptake by the sarcoplasmic reticulum. Trifluoperazine effects unrelated to calmodulin can hardly account for the results. Thus a full beta-agonist can apparently mobilize enough Ca++ to activate calmodulin systems important for the final effects on the contraction-relaxation cycle.

Adrenergic beta-Agonists↗

Possible role of calmodulin in renin secretion from isolated rat kidneys and renal cells: studies with trifluoperazine.

Trifluoperazine, an inhibitor of calmodulin and calmodulin-directed secretion, was used to examine a possible role of calmodulin in renin secretion from isolated perfused kidneys and renal cortical cells. In isolated perfused kidneys trifluoperazine stimulated basal renin secretion in a dose-dependent manner, with 10 microM causing no stimulation and 50 microM causing 167% increase. Trifluoperazine potentiated the elevated renin secretion induced by isoprenaline and low Ca in isolated kidneys. In renal cortical cells trifluoperazine increased basal renin secretion and potentiated the secretion induced by Ca omission. Cells homogenized immediately after 1 h exposure to trifluoperazine had a substantial reduction in soluble renin without any effect on the change in granular renin. In the absence of trifluoperazine, soluble renin increased with O Ca and decreased with 1.5 mM-Ca. It is concluded that trifluoperazine stimulates renin secretion by a cellular mechanism possibly at the level of the juxtaglomerular cell. It is suggested that the role of trifluoperazine, and by inference calmodulin, in the secretion of renin may be quite different from its role in secretion of several other substances.

Animals↗

Inhibition of human ether-a-go-go-related gene K+ channel and IKr of guinea pig cardiomyocytes by antipsychotic drug trifluoperazine.

Trifluoperazine, a commonly used antipsychotic drug, has been known to induce QT prolongation and torsades de pointes, which can cause sudden death. We studied the effects of trifluoperazine on the human ether-a-go-go-related gene (HERG) channel expressed in Xenopus oocytes and on the delayed rectifier K(+) current of guinea pig cardiomyocytes. The application of trifluoperazine showed a dose-dependent decrease in current amplitudes at the end of voltage steps and tail currents of HERG. The IC(50) for a trifluoperazine block of HERG current progressively decreased according to depolarization: IC(50) values at -40, 0, and +40 mV were 21.6, 16.6, and 9.29 microM, respectively. The voltage dependence of the block could be fitted with a monoexponential function, and the fractional electrical distance was estimated to be delta = 0.65. The block of HERG by trifluoperazine was use-dependent, exhibiting more rapid onset and greater steady-state block at higher frequencies of activation; there was partial relief of the block with decreasing frequency. In guinea pig ventricular myocytes, bath applications of 0.5 and 2 microM trifluoperazine at 36 degrees C blocked the rapidly activating delayed rectifier K(+) current by 32.4 and 72.9%, respectively; however, the same concentrations of trifluoperazine failed to significantly block the slowly activating delayed rectifier K(+) current. Our findings suggest the arrhythmogenic side effect of trifluoperazine is caused by a blockade of HERG and the rapid component of the delayed rectifier K(+) current rather than by the blockade of the slow component.

Animals↗

Possible role for calmodulin in insulin release. Studies with trifluoperazine in rat pancreatic islets.

The role of calmodulin in insulin secretion from rat pancreatic islets has been examined by the use of trifluoperazine, an inhibitor of calmodulin-Ca++-directed functions. It was found that 30 microM trifluoperazine caused 50% inhibition, and 100 microM, up to 73% inhibition of 16.7 mM glucose-stimulated insulin release. 100 microM trifluoperazine caused a similar inhibition of 10 mM glyceraldehyde-stimulated release. Therefore, the site of action of trifluoperazine in glucose stimulus-secretion coupling appears to be after the trioses. As trifluoperazine had no effect upon insulin release stimulated by 1 mM 3-isobutyl-1-methylxanthine, the inhibitory effect of trifluoperazine appears to be rather specific. Further, the process of exocytosis per se is not affected. It was also found that although trifluoperazine inhibited the effect of glucose to stimulate insulin release, it did not affect the synergism between glucose and 3-isobutyl-1-methylxanthine to potentiate insulin release. It may be concluded that trifluoperazine selectively inhibits one part of the mechanism by which glucose stimulates insulin release. Calmodulin plays a role in the stimulation of insulin release by glucose at a site between metabolism of trioses and elevation of cytosol Ca++, but is not involved in the final process of exocytosis.

1-Methyl-3-isobutylxanthine↗