Clozapin

Gefahreninformationscode (GHS)

• Bildanzeige (GHS)

  

• Alarmwort

  Achtung

• Gefahrenhinweise

  H301：Giftig bei Verschlucken.

  H341：Kann vermutlich genetische Defekte verursachen.

  H361：Kann vermutlich die Fruchtbarkeit beeinträchtigen oder das Kind im Mutterleib schädigen.

• Sicherheit

  P201：Vor Gebrauch besondere Anweisungen einholen.

  P202：Vor Gebrauch alle Sicherheitshinweise lesen und verstehen.

  P264：Nach Gebrauch gründlich waschen.

  P264：Nach Gebrauch gründlich waschen.

  P270：Bei Gebrauch nicht essen, trinken oder rauchen.

  P280：Schutzhandschuhe/Schutzkleidung/Augenschutz tragen.

  P301+P310：BEI VERSCHLUCKEN: Sofort GIFTINFORMATIONSZENTRUM/Arzt/... (geeignete Stelle für medizinische Notfallversorgung vom Hersteller/Lieferanten anzugeben) anrufen.

Clozapine Chemische Eigenschaften,Einsatz,Produktion Methoden

• R-Sätze Betriebsanweisung:

  R22:Gesundheitsschädlich beim Verschlucken.
  R36/37/38:Reizt die Augen, die Atmungsorgane und die Haut.

• S-Sätze Betriebsanweisung:

  S26:Bei Berührung mit den Augen sofort gründlich mit Wasser abspülen und Arzt konsultieren.

• Beschreibung

  Clozapine (5786-21-0) is a dopamine D4?and D2?receptor antagonist. High affinity for the cloned rat dopamine D4?receptor (Ki?< 20 nM).1?Atypical neuroleptic agent.2?Antagonist at 5HT2A, 5HT2C, 5HT3, 5HT6 and 5HT7 receptors.3,4

• Chemische Eigenschaften

  Yellow Crystalline Solid

• Originator

  Leponex,Wander,W. Germany,1974

• Verwenden

  depigmentor

• Verwenden

  An antipsychotic

• Verwenden

  Clozapine is a neuroleptic, which expresses antipsychotic and sedative action. It does not cause general depression and extrapyramidal disorders. It is used for severe and chronic forms of schizophrenia, maniacal conditions, manic-depressive psychosis, psychomotor excitement, and various other psychotic conditions.

• Definition

  ChEBI: A benzodiazepine that is 5H-dibenzo[b,e][1,4]diazepine substituted by a chloro group at position 8 and a 4-methylpiperazin-1-yl group at position 11. It is a second generation antipsychotic used in the treatment of psychiatr c disorders like schizophrenia.

• Manufacturing Process

  7.4 g of 2-amino-4-chlorodiphenylamine-2'-carboxylic acid (4"-methyl) piperazide and 35 ml of phosphoroxychloride are heated for 3 hours under reflux in the presence of 1.4 ml of N,N-dimethylaniline. Upon concentration of the reaction mixture in vacuo as far as possible, the residue is distributed between benzene and ammonia/ice water. The benzene solution is extracted with dilute acetic acid. The acid extract is clarified with charcoal and treated with concentrated ammonia water to precipitate the alkaline substance, which is dissolved in ether. The ethereal solution is washed with water and dried over sodium sulfate. The residue obtained yields, after recrystallization from ether/petroleum ether 2.9 g (41% of the theoretical yield) of 8-chloro-11-(4- methyl-1-piperazinyl)-5H-dibenzo[b,e][1,4]diazepine in the form of yellow grains of melting point 182° to 184°C (from acetone/petroleum ether).

• Trademarks

  Clozaril (Novartis); Fazaclo (Avanir);Leponox.

• Therapeutic Function

  Tranquilizer

• Weltgesundheitsorganisation (WHO)

  Clozapine, a tricyclic neuroleptic, was introduced in 1972 for the treatment of psychosis. In 1975 its use was associated with cases of agranulocytosis, particularly in Finland. These cases, which included several fatalities, resulted in the withdrawal of the drug in some countries. However, clozapine remains available in at least 30 countries, in some cases only on special request, for the treatment of severe psychotic disorders unresponsive to other neuroleptics provided that close monitoring of the blood count is feasible. In 1989, it was introduced in the United States for the treatment of severe schizophrenia. Lately, the use of clozapine in the United Kingdom has been associated with convulsions. (Reference: (WHODIB) WHO Drug Information Bulletin, 2: 10, , 1977)

• Allgemeine Beschreibung

  The dibenzodiazepine derivative is clozapine(Clozaril). It is not a potent antipsychotic on a milligrambasis (note the orientation of the N-methyl piperazino grouprelative to the chlorine atom). In addition to their moderatepotencies at DA receptors (mainly D₄), clozapine interactwith varying affinities at several other classes of receptors(α₁ and α₂ adrenergic, 5-HT_1A, 5-HT_2A, 5-HT_2C, muscariniccholinergic, histamine H₁, and others). It is effective againstboth positive and negative symptoms of schizophrenia andhas a low tendency to produce EPS. Clozapine has proved effectiveeven in chronically ill patients who respond poorly tostandard neuroleptics. However, there are legal restrictionson its use because of a relatively high frequency of agranulocytosis.As a rule, two other antipsychotics are tried beforerecourse to therapy with clozapine. Clozapine is metabolized preferentially by CYP3A4 into demethylated, hydroxylated,and N-oxide derivatives that are excreted in urine and feces.Elimination half-life averages about 12 hours. Other clozapine-like atypical antipsychotics may lack a 2-Cl substituenton the aromatic ring (e.g., olanzapine and quetiapine).

• Allgemeine Beschreibung

  Clozapine, 8-chloro-11-(4-methyl-1-piperazinyl)5H-dibenzo[b,e] [1,4] diazepine (Clozaril), is a yellowcrystalline powder that is only slightly soluble in water. Withthe introduction of clozapine, a different pharmacological antipsychotics.106 Unlike typical antipsychotics, clozapine is largelydevoid of EPS. The lack of EPS with this compound waspostulated to be caused by its preferential binding tomesolimbic rather than striatal DA receptors.Furthermore,clozapine was shown to exhibit potent affinity for 5-HT2Areceptors.
  DMCZ shows partial agonism at D₂ and D₃ receptors andexhibits a distinctly different pharmacological profile comparedwith clozapine and other atypical antipsychotics.Unlike clozapine, which is a potent M₁ muscarinic antagonist,DMCZ is a potent M₁ agonist. Agonism at muscarinicreceptors has been proposed to be useful for impaired cognitionin schizophrenia. Burnstein et al.found thatDMCZ acted as a partial agonist at DA D₂ and D₃ receptors.These investigators suggested that the low incidence of EPSassociated with clozapine may be caused by the partial agonismof DMCZ at D₂ and D₃ receptors. Thus, DMCZ maybe of interest as an atypical antipsychotic with an improvedside effect profile compared with clozapine.

• Biologische Aktivität

  Atypical antipsychotic drug, with a much lower tendency to cause extrapyramidal side effects than conventional neuroleptics. Displays a broad range of pharmacological actions; the antipsychotic effects are thought to be mediated principally by 5-HT 2A/2C and dopamine receptor blockade (K i values are 21, 170, 170, 230 and 330 nM for D 4 , D 3 , D 1 , D 2 and D 5 receptors respectively).

• Biochem/physiol Actions

  Atypical antipsychotic compound. Selective antagonist for D4-dopamine receptor. Antagonist at 5-HT2A, 5-HT2C, 5-HT3, 5-HT6, and 5-HT7 serotonin receptors.

• Clinical Use

  Although clozapine demonstrates a favorable pharmacologicalprofile compared with typical antipsychotics, its useis restricted by a relatively high incidence of agranulocytosis.The exact mechanism for the cause of agranulocytosishas not been confirmed, but a highly reactive nitrenium ionthat is formed by the action of hepatic enzymes appears tobe involved.The mean elimination half-life of clozapine following a single 75-mg dose is 8 hours. Because of severaladverse effects, clozapine is only used in refractory casesof schizophrenia. Individuals with a history of seizures orpredisposed to seizures should be cautioned when takingclozapine. Similar to other atypical antipsychotic agents,clozapine causes an increased risk of mortality in elderly individualswith dementia-related psychoses.

• Nebenwirkungen

  A serious drawback to the use of clozapine, however, is the potentially fatal agranulocytosis that is reported to occur in 1 to 2% of unmonitored patients, necessitating weekly white blood cell counts for at least the first 6 months of pharmacotherapy.

• Synthese

  Clozapine, 8-chloro-11-(4-methyl-1-piperazinyl)-5H-dibenzo[b,e] [1,4]diazepine (6.5.7) is synthesized by two methods. According to the first, 4-chloro-2-nitroaniline in the presence of copper filings is acylated by the o-chlorobenzoic acid methyl ester, forming the corresponding diphenylamine (6.5.4). By reacting this with N-methyl piperazine, the ester group in the resulting polyfunctional diphenylamine is transformed into the amide (6.5.5). The nitro group in the resulting 4-chloro-2- nitro-2′-carb-(N′-methyl piperazino)amide (6.5.5) is further reduced into an amine group by hydrogen in the presence of Raney nickel. Reacting the resulting product (6.5.6) with phosphorous oxychloride yields in heterocyclization into the desired dibenzodiazepine, clozapine (6.5.7).
  
  The other way of synthesis of clozapine is from 8-chloro-10,11-dihydro-5H-dibenzo[b,e]1, 4-diazepin-11-thione, which is alkylated at the sulfur atom of the dibenzodiazepine ring by 4-nitrobenzylchloride in the presence of potassium tert-butoxide, giving N-methyl derivative (6.5.8). Reaction of this with N-methylpiperazine gives the desired clozapine (6.5.7).
  

• Arzneimittelwechselwirkung

  Potentially hazardous interactions with other drugs
  Anaesthetics: enhanced hypotensive effect.
  Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioids; increased risk of ventricular arrhythmias with methadone.
  Anti-arrhythmics: increased risk of ventricular arrhythmias with anti-arrhythmics that prolong the QT interval; increased risk of arrhythmias with flecainide.
  Antibacterials: concentration possibly increased by erythromycin (possible increased risk of convulsions); concentration increased by ciprofloxacin; concentration possibly reduced by rifampicin; avoid with chloramphenicol and sulphonamides (increased risk agranulocytosis).
  Antidepressants: concentration possibly increased by citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline and venlafaxine (increased risk of toxicity); possibly increased CNS effects of MAOIs; possibly increased antimuscarinic effects with tricyclics; increased concentration of tricyclics.
  Antiepileptics: antagonises anticonvulsant effect; metabolism accelerated by carbamazepine, phenytoin and possibly phenobarbital; avoid with drugs known to cause agranulocytosis; concentration possibly increased or decreased by valproate.
  Antimalarials: avoid with artemether/lumefantrine.
  Antipsychotics: avoid with depot formulations (cannot be withdrawn quickly if neutropenia occurs); possible increased risk of ventricular arrhythmias with risperidone - avoid.
  Antivirals: concentration increased by ritonavir - avoid; increased risk of ventricular arrhythmias with saquinavir - avoid.
  Anxiolytics and hypnotics: increased sedative effects; adverse reports with clozapine and benzodiazepines.
  Atomoxetine: increased risk of ventricular arrhythmias.
  Cytotoxics: increased risk of agranulocytosis - avoid; increased risk of ventricular arrhythmias with arsenic trioxide.
  Lithium: increased risk of extrapyramidal side effects and possibly neurotoxicity.
  Penicillamine: increased risk of agranulocytosis - avoid.
  Ulcer-healing drugs: effects possibly enhanced by cimetidine; concentration possibly reduced by omeprazole.

• Stoffwechsel

  Clozapine is orally active and metabolized mainly by CYP3A4 to inactive desmethyl, hydroxyl, and N-oxide derivatives, with a half-life of approximately 12 hours. Clozapine has relatively low affinity for brain dopamine D1 and D2 receptors (moderate affinity for D4) in comparison to its affinity at adrenergic α1 and α2, histamine H1, muscarinic M1 and serotonin 5-HT2A receptors.

• Lager

  Room temperature

• Einzelnachweise

  1) Seeman and Van Tol (1994),?Dopamine receptor pharmacology;? Trends Pharmacol. Sci.,?15?264 2) Ellenbroek?et al. (1991),?The involvement of dopamine D1 and D2 receptors in the effects of the classical neuroleptic haloperidol and the atypical neuroleptic clozapine;? Eur. J. Pharmacol.,?196?103 3) Canton?et al.?(1990),?Binding of the typical and atypical antipsychotics to 5-HT1C and 5-HT2 sites: clozapine potently interacts with 5-HT1C sites;? Eur. J. Pharmacol.,?191?93 4) Kuoppamaki?et al.?(1993),?Clozapine and N-desmethylclozapine are potent 5-HT1C receptor antagonists;? Eur. J. Pharmacol., 245?179

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