Moricizine

Originator

Ethmozine,Bristol-Myers Squibb

Uses

Moricizine, is Phenothiazine (P318040) derivative, which It was used as an Antiarrhythmic agent. It is also shown that moracizine is effective in suppressing premature ventricular contractions, couplets, and nonsustained ventricular tachycardia.

Uses

Cardiac depressant (anti-arrhythmic).

Definition

ChEBI: A phenothiazine substituted on the nitrogen by a 3-(morpholin-4-yl)propanoyl group, and at position 2 by an (ethoxycarbonyl)amino group.

Manufacturing Process

To a solution of 10 g (0.035 mole) of ethyl phenthiazine-2-carbamate in 30 ml of anhydrous toluene is added dropwise 5.3 g (0.042 mole) of 3- chloropropionyl chloride, and the mixture is refluxed at 110-120°C for 4 hours, followed by clarifying the mixture with activated carbon and cooling it to room temperature. A precipitate of ethyl 10-(3-chloropropionyl)- phenthiazine-2-carbamate is removed by filtration. The yield is 10.2 g (77.5% of the theoretical amount), M.P. 169-170°C.
10.2 g of ethyl 10-(3-chloropropionyl)-phenthiazine-2-carbamate ester is dissolved in 50 ml of toluene, 4.72 g of morpholine is added thereto, and the mixture is refluxed at 110-120°C for a period of 3 hours. A precipitate of morpholine hydrochloride is removed by filtration, and the filtrate is washed with water in order to remove excess morpholine, followed by acidulating with dilute hydrochloric acid to adjust the pH of the filtrate is adjusted at 3. The acidic aqueous layer is separated, clarified by treatment with activated carbon and made alkaline until the pH equals 8-9. This procedure yields the free base of ethyl 10-(β-morpholylpropionyl)-phenthiazine-2-carbamate, M.P. 156- 157°C.
The free base thus obtained is extracted with toluene, the extract is dried over magnesium sulphate and to the anhydrous toluene solution is added an anhydrous ethereal solution of hydrogen chloride until the precipitation of the target compound is complete. This procedure yields 9.53 g (76.2% of the theoretical amount) of ethyl 10-(β-morpholylpropionyl)-phenthiazine-2- carbamate hydrochloride. After recrystallization from dichloroethane, the target compound melts at 189°C. (decomp.).

brand name

Ethmozine (Roberts Pharmaceutical).

Therapeutic Function

Antiarrhythmic

General Description

Moricizine, ethyl 10-(3-morpholinopropionyl)phenothiazine-2-carbamate (Ethmozine), is aphenothiazine derivative used for the treatment of malignantventricular arrhythmias. It is categorized as a class ICantiarrhythmic agent, blocking the Na⁺ channel with 1:1stochiometry. The drug has higher affinity for the inactivatedstate than the activated or resting states. It appearsto bind to a site on the external side of the Na channelmembrane. It has been used to suppress life-threateningventricular arrhythmias.

Clinical Use

Moricizine (Ethmozine) is an antiarrhythmic used to treat documented life-threatening arrhythmias.
Moricizine is indicated for the treatment of documented ventricular arrhythmias, particularly sustained ventricular tachycardia. Moricizine was evaluated in the CAST II clinical trial for the prevention of postinfarction ventricular premature complexes. It was ineffective and found to be proarrhythmic. Patients in the moricizine arm of the trial exhibited a greater incidence of sudden cardiac death than did controls.

Side effects

The principal adverse gastrointestinal effect of moricizine is nausea (7%). Abdominal discomfort has also been reported. Dizziness (11%) is the most frequently reported CNS-related adverse effect. Such reactions increase in frequency with prolonged drug administration. As with other antiarrhythmic drugs, moricizine has proarrhythmic activity, which may manifest as new ventricular ectopic beats or a worsening of preexisting ventricular arrhythmias. These effects are most common in patients with depressed left ventricular function and a history of congestive heart failure. Cardiovascular effects requiring drug withdrawal include conduction defects, sinus pauses, junctional rhythm, and A-V block.

Drug interactions

Clinically significant interactions with moricizine do not appear to exist.

Precautions

Patients with preexisting second- or third-degree A-V block, cardiogenic shock, or drug hypersensitivity should not be treated with moricizine.