Antidepressants Flashcards
What enzyme(s) is/are responsible for TCA metabolism?
CYP 2D6 (major) and 2C19 (minor)
Imipramine metabolism
N-demethylation to Desipramine (active)
Amitriptyline key point
Highest antimuscarinic and sedative SE’s of TCA’s.
Amitriptyline metabolism
N-demethylation to Nortriptyline (active)
Nortriptyline key point
Less antimuscarinic and sedative SE’s than Amitriptyline.
Doxepin isomeric ratio
85% “E” isomer, 15% “Z” isomer
“Z” isomer is more active however.
Doxepin metabolism
N-demethylation to N-desmethyldoxepin (inactive)
Doxepin cousins
Zonalon - 5% Doxepin cream: Topical antihistamine.
Silenor - Sleep aid: CNS antihistamine.
Maprotiline key point(s)
Tetracyclic ring structure.
- Added rigidity: NET > SERT, 500x
Secondary amine.
- Low sedation and antimuscarinic SE’s
Tranylcypromine mechanism
Irreversible inhibition of MAO A and B.
Phenelzine mechanism
Irreversible inhibition of MAO A and B.
Isocarboxazid key point
Prodrug.
“Amide” hydrolysis yields Benzylhydrazine (active) metabolite
Isocarboxazid mechanism
Irreversible inhibition of MAO A and B
- as Benzylhydrazine
Selegiline key point(s)
MAO-B-I
Transdermal patch for Parkinson’s Disease
Fluoxetine key point(s)
"No" antimuscarinic or sedative SE's Long t1/2 Metabolite is active: Norfluoxetine Fluoxetine/Norfluoxetine = 2D6 and 2C19 Inhibitors 30x selective for SERT over NET
Fluoxetine metabolism
N-demethylation to Norfluoxetine (active)
Sertraline key points
1S,4R-Enantiomer 1400x selective SERT > NET Moderate 2C19 inhibition Weak 2D6 inhibition N-desmethylsertraline metabolite is active
Sertraline metabolism
N-demethylation to N-desmethylsertraline (active)
Paroxetine key point(s)
3S,4R-Enantiomer
300x selective SERT > NET
*Potent irreversible 2D6 inhibitor
- 2D6 acts on Paroxetine, reactive intermediate, alkylation of enzyme
Paroxetine metabolism
2D6 removal of “methylene” to form catechol metabolite (inactive)
Fluvoxamine key point(s)
Can be isomerized by UV light (inactive)
Extensive metabolism (inactive)
600x selective SERT > NET
*Potent 1A2 and 2C19 inhibitor
Citalopram key point(s)
Most potent SSRI: >300x selective
Racemic mixture
- “S” isomer = Escitalopram
*Weakest P450 inhibitor of all SSRI’s
Citalopram / Escitalopram metabolism
N-dealkylation to N-desmethylcitalopram (weakly active)
Trazodone key point(s)
Lacks antimuscarinic effects
mCPP metabolite contributes to overall effects
- 5HT2c partial agonist