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Tesofensine Information

Tesofensine (NS2330) is a serotonin–noradrenaline–dopamine reuptake inhibitor from the phenyltropane family of drugs, which is being developed for the treatment of obesity.[1] The right to develop and market tesofensine is held by NeuroSearch, a Danish pharmaceutical company.

Contents

History

Tesofensine was originally investigated for the treatment of Alzheimer's disease and Parkinson's disease,[2] and was subsequently dropped from development for these applications after early trial results showed limited efficacy for treatment of these diseases.[3][4] However, weight loss was consistently reported as an adverse event in the original studies, especially in overweight or obese patients.[5] Therefore, it was decided to pursue development of tesofensine for the treatment of obesity.

Tesofensine primarily acts as an appetite suppressant, but possibly also acts by increasing resting energy expenditure.[6] Phase 2 trials for the treatment of obesity have been successfully completed.

Pharmacology

Tesofensine has a long half-life of about 9 days (220 h)[2] and is mainly metabolized by cytochrome P4503A4 (CYP3A4) to the N-desmethyl-metabolite NS2360.[7][8] NS2360 is the only metabolite detectable in human plasma. It has a longer half-life than tesofensine, i.e. approximately 16 days (374 h) in humans, and has an exposure of 31–34% of the parent compound at steady state. In vivo data indicate that NS2360 is responsible for approximately 6% of the activity of tesofensine. As in animals, the kidney appears to play only a minor role in the clearance of tesofensine in humans (about 15–20%).

Clinical trials

Phase 2b trial (TIPO-1) results reported in The Lancet[9] showed levels of weight loss over a 6-month period that were significantly greater than those achieved with any currently available drugs. Patients lost an average of 12.8 kg on the 1 mg dose, 11.3 kg on the 0.5 mg dose and 6.7 kg on the 0.25 mg dose, compared with a 2.2 kg loss in the placebo group.

All participants were instructed to follow a diet with a 300 kcal deficit and to increase their physical activity gradually to 30–60 minutes of exercise per day. The placebo-subtracted mean weight losses were 4.5%, 9.2% and 10.6% in the 0.25 mg, 0.5 mg and 1 mg dose groups, respectively. This is approximately twice the weight loss produced by medications currently approved by the US Food and Drug Administration (FDA) for the treatment of obesity.

NeuroSearch has also reported interim results[6] from a 48-week, open-label, extension trial (TIPO-4) in which 140 patients who completed the 24-week phase 2b trial (TIPO-1) were re-enrolled after an average of 3 months’ wash-out. All were initially treated with 0.5 mg tesofensine once daily but up-titration to 1.0 mg once daily was allowed in the first 24 weeks of the extension study. At this time point, all subjects were continued on the 0.5 mg dose for an additional 24 weeks. The 24-week interim results for those who were previously treated with tesofensine 0.5 mg in TIPO-1 showed a total mean weight loss of between 13 kg and 14 kg over 48 weeks of treatment. Furthermore, TIPO-4 confirmed the TIPO-1 results since those patients who were previously treated with placebo lost approximately 9 kg in the first 24 weeks of the TIPO-4 study.

Adverse events

In general, the safety profile of tesofensine is similar to currently approved medications for the treatment of obesity. The most commonly reported side effects in the obese population were dry mouth, headache, nausea, insomnia, diarrhoea and constipation. A dose-dependent pattern was observed for dry mouth and insomnia. The overall withdrawal rate due to adverse events in clinical trials in the obese population was 13% with tesofensine and 6% with placebo. Blood pressure and heart rate increases with the therapeutically relevant doses of tesofensine (0.25 mg and 0.5 mg) were 1–3 mmHg and up to 8 bpm, respectively.[6][9]

References

  1. ^ Doggrell SA. "Tesofensine – a novel potent weight loss medicine. Evaluation of: Astrup A, Breum L, Jensen TJ, Kroustrup JP, Larsen TM. Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial. Lancet 2009 372; 1906–13" Doggrell, SA (2009). "Tesofensine--a novel potent weight loss medicine. Evaluation of: Astrup A, Breum L, Jensen TJ, Kroustrup JP, Larsen TM. Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial. Lancet 2008;372:1906-13.". Expert Opin Investig Drugs 18 (7): 1043–6. doi:10.1517/13543780902967632. PMID 19548858.
  2. ^ a b Bara-Jimenez W, Dimitrova T, Sherzai A, Favit A, Mouradian MM, Chase TN (2004). "Effect of monoamine reuptake inhibitor NS 2330 in advanced Parkinson's disease". Mov Disord 19: 1183–6. doi:10.1002/mds.20124. PMID 15390018.
  3. ^ Hauser R, Salin L, Juhel N, Konyago V. (2007). "Randomized trial of the triple monoamine reuptake inhibitor NS 2330 (tesofensine) in early Parkinson's disease". Mov Disord 22: 359–65. doi:10.1002/mds.21258. PMID 17149725.
  4. ^ Rascol O, Poewe W, Lees A et al (2008). "Tesofensine (NS 2330), a monoamine reuptake inhibitor, in patients with advanced Parkinson disease and motor fluctuations: the ADVANS Study". Arch Neurol 65: 577–83. doi:10.1001/archneur.65.5.577. PMID 18474731.
  5. ^ Astrup A, Meier DH, Mikkelsen BO, Villumsen JS, Larsen TM. (2008). "Weight loss produced by tesofensine in patients with Parkinson's or Alzheimer's disease". Obesity (Silver Spring) 16 (6): 1363–9. doi:10.1038/oby.2008.56. PMID 18356831.
  6. ^ a b c NeuroSearch. "Tesofensine". http://www.neurosearch.dk/Default.aspx?ID=118 Accessed 17 May 2010.
  7. ^ Lehr T, Staab A, Tillmann C et al (2007). "Population pharmacokinetic modelling of NS2330 (tesofensine) and its major metabolite in patients with Alzheimer's disease". Br J Clin Pharmacol 64: 36–48. doi:10.1111/j.1365-2125.2007.02855.x. PMID 17324246.
  8. ^ Lehr T, Staab A, Tillmann C (2008). "Contribution of the active metabolite M1 to the pharmacological activity of tesofensine in vivo: a pharmacokinetic-pharmacodynamic modelling approach". Br J Pharmacol 153: 164–74. doi:10.1038/sj.bjp.0707539. PMC 2199391. PMID 17982477. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2199391.
  9. ^ a b Astrup A, Madsbad S, Breum L, Jensen TJ, Kroustrup JP, Larsen TM (2008). "Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial". Lancet 372: 1906–13. doi:10.1016/S0140-6736(08)61525-1. PMID 18950853.

External links

Phenyltropanes (classifications)
2-Carboxymethyl Esters

TroparilWIN 35428RTI-31RTI-32RTI-51RTI-55RTI-83

(3,4-Disubstituted Phenyl)-tropanes

DichloropaneRTI-112RTI-353

Arylcarboxy

RTI-113RTI-120

Carboxyalkyl

RTI-121RTI-150

Acyl

PTT/WF-11WF-23PIT/WF-21WF-33

β,α Stereochemistry

RTI-352RTI-274

α,β Stereochemistry

BrasofensineTesofensineNS2359

Heterocycles: 3-Substituted-isoxazol-5-yl

RTI-177RTI-336RTI-371

Heterocycles: 3-Substituted-1,2,4-oxadiazole

RTI-126RTI-371

N-alkyl

FP-β-CPPITFE-β-CPPITAltropaneIoflupane (123I)

N-replaced (S,O,C)

Tropoxane

Irreversible

RTI-76

Nortropanes (N-demethylated)

NS2359 (GSK-372,475)

Antiobesity agents/Anorectics (A08)
Central
Stimulants 4-MethylamphetamineAmfecloralAmfepentorexAmfepramoneAminorexAmphetamineAmphetaminilAtomoxetineBenfluorexBenzphetamineBupropionCathineCathinoneChlorphentermineCiclazindolClobenzorexCloforexClominorexClortermineDexfenfluramineDextroamphetamineDextromethamphetamineDexmethylphenidateDifemetorexDimethylcathinoneDiphemethoxidineEphedrineEphedraEthylamphetamineEtolorexFenbutrazateFencamfamineFenethyllineFenfluramine (+phentermine) • FenproporexFludorexFluminorexFurfenorexIndanorexKhatLevopropylhexedrineLisdexamfetamineManifaxineMazindolMefenorex • Methamphetamine • MethylphenidateNorfenfluraminePemolinePentorex (Phenpentermine) • PhendimetrazinePhenethylaminePhenmetrazinePhenterminePhenylpropanolaminePipradrolProlintanePropylhexedrinePseudoephedrinePyrovaleroneRadafaxineReboxetineSetazindolSibutramineSynephrineTesofensineViloxazineXylopropamineZylofuramine
Cannabinoids IbipinabantOtenabantRimonabantSurinabantTaranabant
Others 5-HTPGalactomannan (Guar gum) • GlucomannanL-DOPAL-PhenylalanineL-TryptophanL-TyrosineLorcaserinLu AA-33810MetforminNaltrexoneNaloxoneOxyntomodulinP57Peptide YYTopiramateYohimbine (Yohimbe) • Zonisamide
Peripheral CetilistatDinitrophenolMitratapideOleoyl-estroneOrlistatSimmondsinSterculia
#WHO-EM. Withdrawn from market. Clinical trials: Phase III. §Never to phase III

: NUT

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, , /,

drug(//)

Adrenergics
Receptor ligands
α1 Agonists: 5-FNE • 6-FNEAmidephrineAnisodamineAnisodineCirazolineDipivefrineDopamineEphedrineEpinephrine (Adrenaline) • EtilefrineEthylnorepinephrineIndanidineLevonordefrinMetaraminolMethoxamineMethyldopaMidodrineNaphazolineNorepinephrine (Noradrenaline) • OctopamineOxymetazolinePhenylephrinePhenylpropanolaminePseudoephedrineSynephrineTetrahydrozoline Antagonists: AbanoquilAdimololAjmalicineAlfuzosinAmosulalolArotinololAtiprosin • Benoxathian • BuflomedilBunazosinCarvedilol • CI-926 • CorynanthineDapiprazole • DL-017 • Domesticine • Doxazosin • Eugenodilol • Fenspiride • GYKI-12,743 • GYKI-16,084 • IndoraminKetanserinL-765,314Labetalol • Mephendioxan • Metazosin • MonatepilMoxisylyte (Thymoxamine) • NaftopidilNantenine • Neldazosin • NicergolineNiguldipine • Pelanserin • Phendioxan • PhenoxybenzaminePhentolaminePiperoxanPrazosin • Quinazosin • Ritanserin • RS-97,078 • SGB-1,534 • Silodosin • SL-89.0591 • SpiperoneTalipexoleTamsulosinTerazosin • Tibalosin • Tiodazosin • Tipentosin • TolazolineTrimazosin • Upidosin • Urapidil • Zolertine * Note that many TCAs, TeCAs, antipsychotics, ergolines, and some piperazines like buspirone, trazodone, nefazodone, etoperidone, and mepiprazole all antagonize α1-adrenergic receptors as well, which contributes to their side effects such as orthostatic hypotension.
α2 Agonists: (R)-3-Nitrobiphenyline4-NEMD6-FNEAmitrazApraclonidineBrimonidineCannabivarinClonidineDetomidineDexmedetomidineDihydroergotamineDipivefrineDopamineEphedrineErgotamineEpinephrine (Adrenaline) • Esproquin • EtilefrineEthylnorepinephrineGuanabenzGuanfacineGuanoxabenzLevonordefrinLofexidineMedetomidineMethyldopaMivazerolNaphazolineNorepinephrine (Noradrenaline) • PhenylpropanolaminePiperoxanPseudoephedrineRilmenidineRomifidineTalipexoleTetrahydrozolineTizanidineTolonidineUrapidilXylazineXylometazoline Antagonists: 1-PPAdimololAptazapineAtipamezoleBRL-44408BuflomedilCirazolineEfaroxanEsmirtazapineFenmetozoleFluparoxan • GYKI-12,743 • GYKI-16,084 • IdazoxanMianserinMirtazapine • MK-912 • NAN-190OlanzapinePhentolaminePhenoxybenzaminePiperoxanPiribedilRauwolscineRotigotine • SB-269,970 • SetiptilineSpiroxatrineSunepitronTolazolineYohimbine * Note that many atypical antipsychotics and azapirones like buspirone and gepirone (via metabolite 1-PP) antagonize α2-adrenergic receptors as well.
β Agonists: 2-FNE • 5-FNE • AmibegronArbutamineArformoterolArotinololBAAMBambuterolBefunololBitolterolBroxaterolBuphenineCarbuterolCimaterolClenbuterolDenopamine • Deterenol • DipivefrineDobutamineDopamineDopexamineEphedrineEpinephrine (Adrenaline) • EtafedrineEtilefrineEthylnorepinephrineFenoterolFormoterolHexoprenalineHigenamineIndacaterolIsoetarineIsoprenaline (Isoproterenol) • IsoxsuprineLabetalolLevonordefrinLevosalbutamolMabuterolMethoxyphenamineMethyldopaN-Isopropyloctopamine • Norepinephrine (Noradrenaline) • OrciprenalineOxyfedrinePhenylpropanolaminePirbuterolPrenalterolRactopamineProcaterolPseudoephedrineReproterolRimiterolRitodrineSalbutamol (Albuterol) • SalmeterolSolabegronTerbutalineTretoquinolTulobuterolXamoterolZilpaterolZinterol Antagonists: AcebutololAdaprololAdimololAfurololAlprenololAlprenoximeAmosulalolAncarololArnololArotinololAtenololBefunololBetaxololBevantololBisoprololBopindolol • Bormetolol • Bornaprolol • Brefonalol • Bucindolol • Bucumolol • Bufetolol • Buftiralol • Bufuralol • Bunitrolol • Bunolol • Bupranolol • Burocrolol • Butaxamine • Butidrine • Butofilolol • Capsinolol • Carazolol • Carpindolol • CarteololCarvedilolCeliprolol • Cetamolol • Cicloprolol • Cinamolol • CloranololCyanopindolol • Dalbraminol • Dexpropranolol • DiacetololDichloroisoprenalineDihydroalprenolol • Dilevalol • Diprafenone • Draquinolol • Dropranolol • Ecastolol • Epanolol • Ericolol • Ersentilide • Esatenolol • Esmolol • Esprolol • Eugenodilol • Exaprolol • Falintolol • Flestolol • Flusoxolol • Hydroxycarteolol • Hydroxytertatolol • ICI-118,551 • Idropranolol • Indenolol • Indopanolol • Iodocyanopindolol • Iprocrolol • Isoxaprolol • IsamoltaneLabetalolLandiololLevobetaxololLevobunolol • Levocicloprolol • Levomoprolol • MedroxalolMepindolol • Metalol • MetipranololMetoprolol • Moprolol • Nadolol • Nadoxolol • Nafetolol • Nebivolol • Neraminol • Nifenalol • Nipradilol • Oberadilol • Oxprenolol • Pacrinolol • Pafenolol • Pamatolol • Pargolol • Parodilol • Penbutolol • Penirolol • PhQA-33 • Pindolol • Pirepolol • Practolol • Primidolol • Procinolol • PronethalolPropafenonePropranolol • Ridazolol • Ronactolol • Soquinolol • Sotalol • Spirendolol • SR 59230A • Sulfinalol • TA-2005 • TalinololTazolol • Teoprolol • Tertatolol • Terthianolol • Tienoxolol • TilisololTimolol • Tiprenolol • Tolamolol • Toliprolol • Tribendilol • Trigevolol • XibenololXipranolol
Reuptake inhibitors
NET Selective norepinephrine reuptake inhibitors: AmedalinAtomoxetine (Tomoxetine) • CiclazindolDaledalinEsreboxetineLortalamineMazindolNisoxetineReboxetineTalopramTalsupramTandamineViloxazine; Norepinephrine-dopamine reuptake inhibitors: AmineptineBupropion (Amfebutamone) • FencamineFencamfamineLefetamineLevophacetoperane • LR-5182 • ManifaxineMethylphenidateNomifensineO-2172Radafaxine; Serotonin-norepinephrine reuptake inhibitors: BicifadineDesvenlafaxineDuloxetineEclanamineLevomilnacipranMilnacipranSibutramineVenlafaxine; Serotonin-norepinephrine-dopamine reuptake inhibitors: BrasofensineDiclofensineDOV-102,677DOV-21,947DOV-216,303JNJ-7925476JZ-IV-10MethylnaphthidateNaphyroneNS-2359PRC200-SSSEP-225,289SEP-227,162Tesofensine; Tricyclic antidepressants: AmitriptylineButriptylineCianopramineClomipramineDesipramineDosulepinDoxepinImipramineLofepraminemelitracenNortriptylineProtriptylineTrimipramine; Tetracyclic antidepressants: AmoxapineMaprotilineMianserinOxaprotilineSetiptiline; Others: Cocaine • CP-39,332 • EXP-561FezolamineGinkgo bilobaIndeloxazineNefazodoneNefopamPridefrineTapentadolTedatioxetineTeniloxazineTramadolZiprasidone
VMAT IbogaineReserpineTetrabenazine
Releasing agents
Morpholines: FenbutrazateMorazonePhendimetrazinePhenmetrazine; Oxazolines: 4-MethylaminorexAminorexClominorexCyclazodoneFenozoloneFluminorexPemolineThozalinone; Phenethylamines (also amphetamines, cathinones, phentermines, etc): 2-OH-PEA4-CAB4-FA4-FMA4-MA4-MMAAlfetamineAmfecloralAmfepentorexAmfepramoneAmphetamine (Dextroamphetamine, Levoamphetamine) • Amphetaminilβ-Me-PEABDBBenzphetamineBOHBuphedroneButyloneCathineCathinoneClobenzorexClortermineD-DeprenylDimethylamphetamineDimethylcathinone (Dimethylpropion, metamfepramone) • DMADMMAEBDBEphedrineEthcathinoneEthylamphetamineEthyloneFamprofazoneFenethyllineFenproporexFlephedroneFludorexFurfenorexHordenineIAPIMPL-Deprenyl (Selegiline) • LisdexamfetamineLophophineMBDBMDA (Tenamfetamine) • MDEAMDMAMDMPEAMDOHMDPEAMefenorexMephedroneMephentermine • Methamphetamine (Dextromethamphetamine, Levomethamphetamine) • MethcathinoneMethedroneMethyloneNAPOrtetamineParedrinepBApCAPentorex (Phenpentermine) • PhenethylaminePholedrinePhenpromethaminePhenterminePhenylpropanolaminepIAPrenylaminePropylamphetaminePseudoephedrineTiflorexTyramineXylopropamineZylofuramine; Piperazines: 2C-B-BZPBZPMBZPmCPPMDBZPMeOPPpFPP; Others: 2-Amino-1,2-dihydronaphthalene2-Aminoindane2-Aminotetralin2-Benzylpiperidine4-Benzylpiperidine5-IAIClofenciclanCyclopentamineCypenamineCyprodenateFeprosidnineGilutensinHeptaminolHexacyclonateIndanorexIsomethepteneMethylhexanamineOctodrinePhthalimidopropiophenonePropylhexedrine (Levopropylhexedrine) • Tuaminoheptane
Enzyme inhibitors
Anabolism
PAH 3,4-Dihydroxystyrene
TH 3-IodotyrosineAquayamycinBulbocapnineMetirosineOudenone
AAAD BenserazideCarbidopaGenisteinMethyldopa
DBH Bupicomide • DisulfiramDopastinFusaric acidNepicastat • Phenopicolinic acid • Tropolone
PNMT CGS-19281A • SKF-64139 • SKF-7698
Catabolism
MAO Nonselective: BenmoxinCaroxazoneEchinopsidineFurazolidoneHydralazineIndantadolIproclozideIproniazidIsocarboxazidIsoniazidLinezolidMebanazineMetfendrazineNialamideOctamoxinParaxazonePhenelzinePheniprazinePhenoxypropazinePivalylbenzhydrazineProcarbazineSafrazineTranylcypromine; MAO-A selective: AmiflamineBazinaprineBefloxatoneBefolBrofaromineCimoxatoneClorgilineEsuproneHarmala alkaloids (Harmine, Harmaline, Tetrahydroharmine, Harman, Norharman, etc) • Methylene BlueMetralindoleMinaprineMoclobemidePirlindoleSercloremineTetrindoleToloxatoneTyrima; MAO-B selective: D-DeprenylSelegiline (L-Deprenyl) • LadostigilLazabemideMilacemideMofegilinePargylineRasagilineSafinamide * Note that MAO-B inhibitors also influence norepinephrine/epinephrine levels since they inhibit the breakdown of their precursor dopamine.
COMT EntacaponeTolcapone
Others
Precursors L-PhenylalanineL-TyrosineL-DOPA (Levodopa) → DopamineL-DOPS (Droxidopa)
Cofactors Ferrous Iron (Fe2+) • S-Adenosyl-L-MethionineVitamin B3 (Niacin, NicotinamideNADPH) • Vitamin B6 (Pyridoxine, Pyridoxamine, PyridoxalPyridoxal Phosphate) • Vitamin B9 (Folic acidTetrahydrofolic acid) • Vitamin C (Ascorbic acid) • Zinc (Zn2+)
Others Activity enhancers: BPAPPPAP; Release blockers: BethanidineBretyliumGuanadrelGuanazodine • Guanclofine • GuanethidineGuanoxan; Toxins: Oxidopamine (6-Hydroxydopamine)
List of adrenergic drugs
Dopaminergics
Receptor ligands
Agonists Adamantanes: AmantadineMemantineRimantadine; Aminotetralins: 7-OH-DPAT8-OH-PBZIRotigotineUH-232; Benzazepines: 6-Br-APBFenoldopamSKF-38,393SKF-77,434SKF-81,297SKF-82,958SKF-83,959; Ergolines: BromocriptineCabergolineDihydroergocryptineLisurideLSDPergolide; Dihydrexidine derivatives: 2-OH-NPAA-86,929CiladopaDihydrexidineDinapsolineDinoxylineDoxanthrine; Others: A-68,930A-77636A-412,997ABT-670ABT-724AplindoreApomorphineAripiprazoleBifeprunoxBP-897CY-208,243DizocilpineEtilevodopaFlibanserinKetamineMelevodopaModafinilPardoprunoxPhencyclidinePD-128,907PD-168,077PF-219,061PiribedilPramipexolePropylnorapomorphinePukateineQuinagolideQuineloraneQuinpiroleRDS-127Ro10-5824RopiniroleRotigotineRoxindoleSalvinorin ASKF-89,145SumaniroleTergurideUmespironeWAY-100,635
Antagonists Typical antipsychotics: AcepromazineAzaperoneBenperidolBromperidolClopenthixolChlorpromazineChlorprothixeneDroperidolFlupentixolFluphenazineFluspirileneHaloperidolLoxapineMesoridazineMethotrimeprazineNemonapridePenfluridolPerazinePericiazinePerphenazinePimozideProchlorperazinePromazineSulforidazineSulpirideSultoprideThioridazineThiothixeneTrifluoperazineTriflupromazineTrifluperidolZuclopenthixol; Atypical antipsychotics: AmisulprideAsenapineBlonanserinCariprazineCarpipramineClocapramineClorotepineClozapineGevotrolineIloperidoneLurasidoneMelperoneMolindoneMosapramineOlanzapinePaliperidonePerospironePiquindoneQuetiapineRemoxiprideRisperidoneSertindoleTiospironeZiprasidoneZotepine; Antiemetics: AS-8112AlizaprideBromoprideCleboprideDomperidoneMetoclopramideThiethylperazine; Others: AmoxapineBuspironeButaclamolEcopipamEEDQEticloprideFananserinL-745,870NafadotrideNuciferinePNU-99,194RacloprideSarizotanSB-277,011-ASCH-23,390SKF-83,959SonepiprazoleSpiperoneSpiroxatrineStepholidineTetrahydropalmatineTiaprideUH-232Yohimbine
Reuptake inhibitors
Plasmalemmal
DAT inhibitors Piperazines: DBL-583GBR-12,935NefazodoneVanoxerine; Piperidines: BTCPDesoxypipradrolDextromethylphenidateDifemetorexEthylphenidateMethylnaphthidateMethylphenidatePhencyclidinePipradrol; Pyrrolidines: DiphenylprolinolMethylenedioxypyrovalerone (MDPV) • NaphyroneProlintanePyrovalerone; Tropanes: β-CPPITAltropaneBrasofensineCFTCocaineDichloropaneDifluoropineFE-β-CPPITFP-β-CPPITIoflupane (123I)IometopaneRTI-112RTI-113RTI-121RTI-126RTI-150RTI-177RTI-229RTI-336TenocyclidineTesofensineTroparilTropoxaneWF-11WF-23WF-31WF-33; Others: AdrafinilArmodafinilAmfonelic acidAmineptineBenzatropine (Benztropine) • BromantaneBTQBTS-74,398Bupropion (Amfebutamone) • CiclazindolDiclofensineDimethocaineDiphenylpyralineDizocilpineDOV-102,677DOV-21,947DOV-216,303Etybenzatropine (Ethylbenztropine) • EXP-561FencamineFencamfamineFezolamineGYKI-52,895IndatralineKetamineLefetamineLevophacetoperane • LR-5182 • ManifaxineMazindolMedifoxamineMesocarbModafinilNefopamNomifensineNS-2359O-2172PridefrinePropylamphetamineRadafaxineSEP-225,289SEP-227,162SertralineSibutramineTametralineTedatioxetineTripelennamine
Vesicular
VMAT inhibitors DeserpidineIbogaineReserpineTetrabenazine
Releasing agents
Morpholines: FenbutrazateMorazonePhendimetrazinePhenmetrazine; Oxazolines: 4-Methylaminorex (4-MAR, 4-MAX) • AminorexClominorexCyclazodoneFenozoloneFluminorexPemolineThozalinone; Phenethylamines (also amphetamines, cathinones, phentermines, etc): 2-Hydroxyphenethylamine (2-OH-PEA) • 4-CAB4-Methylamphetamine (4-MA) • 4-Methylmethamphetamine (4-MMA) • AlfetamineAmfecloralAmfepentorexAmfepramoneAmphetamine (Dextroamphetamine, Levoamphetamine) • Amphetaminilβ-Methylphenethylamine (β-Me-PEA) • Benzodioxolylbutanamine (BDB) • Benzodioxolylhydroxybutanamine (BOH) • BenzphetamineBuphedroneButyloneCathineCathinoneClobenzorexClortermineD-DeprenylDimethoxyamphetamine (DMA) • Dimethoxymethamphetamine (DMMA) • DimethylamphetamineDimethylcathinone (Dimethylpropion, metamfepramone) • Ethcathinone (Ethylpropion) • EthylamphetamineEthylbenzodioxolylbutanamine (EBDB) • EthyloneFamprofazoneFenethyllineFenproporexFlephedroneFludorexFurfenorexHordenineLophophine (Homomyristicylamine) • MefenorexMephedrone • Methamphetamine (Desoxyephedrine, Methedrine; Dextromethamphetamine, Levomethamphetamine) • Methcathinone (Methylpropion) • MethedroneMethoxymethylenedioxyamphetamine (MMDA) • Methoxymethylenedioxymethamphetamine (MMDMA) • Methylbenzodioxolylbutanamine (MBDB) • Methylenedioxyamphetamine (MDA, tenamfetamine) • Methylenedioxyethylamphetamine (MDEA) • Methylenedioxyhydroxyamphetamine (MDOH) • Methylenedioxymethamphetamine (MDMA) • Methylenedioxymethylphenethylamine (MDMPEA, homarylamine) • Methylenedioxyphenethylamine (MDPEA, homopiperonylamine) • MethyloneOrtetamineParabromoamphetamine (PBA) • Parachloroamphetamine (PCA) • Parafluoroamphetamine (PFA) • Parafluoromethamphetamine (PFMA) • Parahydroxyamphetamine (PHA) • Paraiodoamphetamine (PIA) • Paredrine (Norpholedrine, Oxamphetamine) • Phenethylamine (PEA) • PholedrinePhenpromethaminePrenylaminePropylamphetamineTiflorex (Flutiorex) • Tyramine (TRA) • XylopropamineZylofuramine; Piperazines: 2,5-Dimethoxy-4-bromobenzylpiperazine (2C-B-BZP) • Benzylpiperazine (BZP) • Methoxyphenylpiperazine (MeOPP, paraperazine) • Methylbenzylpiperazine (MBZP) • Methylenedioxybenzylpiperazine (MDBZP, piperonylpiperazine); Others: 2-Amino-1,2-dihydronaphthalene (2-ADN) • 2-Aminoindane (2-AI) • 2-Aminotetralin (2-AT) • 4-Benzylpiperidine (4-BP) • 5-IAIClofenciclanCyclopentamineCypenamineCyprodenateFeprosidnineGilutensinHeptaminolHexacyclonateIndanylaminopropane (IAP) • IndanorexIsomethepteneMethylhexanamineNaphthylaminopropane (NAP) • OctodrinePhthalimidopropiophenonePropylhexedrine (Levopropylhexedrine) • Tuaminoheptane (Tuamine)
Enzyme inhibitors
Anabolism
PAH inhibitors 3,4-Dihydroxystyrene
TH inhibitors 3-IodotyrosineAquayamycinBulbocapnineMetirosineOudenone
AAAD/DDC inhibitors BenserazideCarbidopaGenisteinMethyldopa
Catabolism
MAO inhibitors Nonselective: BenmoxinCaroxazoneEchinopsidineFurazolidoneHydralazineIndantadolIproclozideIproniazidIsocarboxazidIsoniazidLinezolidMebanazineMetfendrazineNialamideOctamoxinParaxazonePhenelzinePheniprazinePhenoxypropazinePivalylbenzhydrazineProcarbazineSafrazineTranylcypromine; MAO-A selective: AmiflamineBazinaprineBefloxatoneBefolBrofaromineCimoxatoneClorgilineEsuproneHarmala alkaloidsMethylene BlueMetralindoleMinaprineMoclobemidePirlindoleSercloremineTetrindoleToloxatoneTyrima; MAO-B selective: D-DeprenylL-Deprenyl (Selegiline) • LadostigilLazabemideMilacemidePargylineRasagilineSafinamide
COMT inhibitors EntacaponeTolcapone
DBH inhibitors DisulfiramDopastinFusaric acidNepicastatTropolone
Others
Precursors L-PhenylalanineL-TyrosineL-DOPA (Levodopa)
Cofactors Ferrous iron (Fe2+) • TetrahydrobiopterinVitamin B3 (Niacin, NicotinamideNADPH) • Vitamin B6 (Pyridoxine, Pyridoxamine, PyridoxalPyridoxal phosphate) • Vitamin B9 (Folic acidTetrahydrofolic acid) • Vitamin C (Ascorbic acid) • Zinc (Zn2+)
Others Activity enhancers: Benzofuranylpropylaminopentane (BPAP) • Phenylpropylaminopentane (PPAP); Toxins: Oxidopamine (6-Hydroxydopamine)
List of dopaminergic drugs
Serotonergics
5-HT1 receptor ligands
5-HT1A Agonists: Azapirones: AlnespironeBinospironeBuspironeEnilospironeEptapironeGepironeIpsapironePerospironeRevospironeTandospironeTiospironeUmespironeZalospirone; Antidepressants: EtoperidoneNefazodoneTrazodoneVortioxetine; Antipsychotics: AripiprazoleAsenapineClozapineQuetiapineZiprasidone; Ergolines: DihydroergotamineErgotamineLisurideMethysergideLSD; Tryptamines: 5-CT5-MeO-DMT5-MTBufoteninDMTIndorenatePsilocinPsilocybin; Others: 8-OH-DPATAdatanserinBay R 1531BefiradolBMY-14802CannabidiolDimemebfeEbalzotanEltoprazine • F-11,461 • F-12,826 • F-13,714 • F-14,679 • F-15,063F-15,599FlesinoxanFlibanserinLesopitronLY-293,284 • LY-301,317 • MKC-242NBUMPOsemozotanOxaflozanePardoprunoxPiclozotanRauwolscineRepinotanRoxindole • RU-24,969 • S 14,506 • S-14,671S-15,535Sarizotan • SSR-181,507 • SunepitronU-92,016-AUrapidilVilazodoneXaliprodenYohimbine Antagonists: Antipsychotics: IloperidoneRisperidoneSertindole; Beta blockers: AlprenololCyanopindololIodocyanopindololOxprenolol • Pindobind • PindololPropranololTertatolol; Others: AV965 • BMY-7,378CSP-2503DotarizineFlopropione • GR-46611 • IsamoltaneLecozotanMefwayMetitepine/MethiothepinMPPFNAN-190PRX-00023RobalzotanS-15535SB-649,915 • SDZ 216-525 • SpiperoneSpiramideSpiroxatrineUH-301WAY-100,135WAY-100,635Xylamidine
5-HT1B Agonists: Lysergamides: DihydroergotamineErgotamineMethysergide; Piperazines: EltoprazineTFMPP; Triptans: AvitriptanEletriptanSumatriptanZolmitriptan; Tryptamines: 5-CT5-MT; Others: CGS-12066A • CP-93,129 • CP-94,253 • CP-135,807 • RU-24,969 • Vortioxetine Antagonists: Lysergamides: Metergoline; Others: AR-A000002ElzasonanGR-127,935IsamoltaneMetitepine/MethiothepinSB-216,641 • SB-224,289 • SB-236,057 • Yohimbine
5-HT1D Agonists: Lysergamides: DihydroergotamineMethysergide; Triptans: AlmotriptanAvitriptanEletriptanFrovatriptanNaratriptanRizatriptanSumatriptanZolmitriptan; Tryptamines: 5-CT5-Ethyl-DMT5-MT5-(Nonyloxy)tryptamine; Others: CP-135,807 • CP-286,601 • GR-46611 • L-694,247 • L-772,405 • PNU-109,291 • PNU-142,633 Antagonists: Lysergamides: Metergoline; Others: AlniditanBRL-15,572ElzasonanGR-127,935KetanserinLY-310,762 • LY-367,642 • LY-456,219 • LY-456,220 • Metitepine/MethiothepinRitanserinYohimbineZiprasidone
5-HT1E Agonists: Lysergamides: Methysergide; Triptans: Eletriptan; Tryptamines: BRL-54443Tryptamine Antagonists: Metitepine/Methiothepin
5-HT1F Agonists: Triptans: EletriptanNaratriptanSumatriptan; Tryptamines: 5-MT; Others: BRL-54443LasmiditanLY-334,370 Antagonists: Metitepine/Methiothepin
5-HT2 receptor ligands
5-HT2A Agonists: Lysergamides: ALD-52ErgometrineLisurideLA-SS-AzLSDLSD-PipLysergic acid 2-butyl amideLysergic acid 3-pentyl amideMethysergide; Phenethylamines: 25I-NBF25I-NBMD25I-NBOH25I-NBOMe2C-B2C-B-FLY2CB-Ind2C-C-NBOMe2C-E2C-I2C-TFM-NBOMe2C-T-22C-T-72C-T-212CBCB-NBOMe2CBFly-NBOMeBromo-DragonFLYDOBDOCDOIDOMMDAMDMAMescalineTCB-2TFMFly; Piperazines: BZPQuipazineTFMPP; Tryptamines: 5-CT5-MeO-α-ET5-MeO-α-MT5-MeO-DET5-MeO-DiPT5-MeO-DMT5-MeO-DPT5-MTα-ETα-Methyl-5-HTα-MTBufoteninDETDiPTDMTDPTPsilocinPsilocybin; Others: AL-34662AL-37350ADimemebfeMedifoxamineOxaflozanePNU-22394RH-34 Antagonists: Atypical antipsychotics: AmperozideAripiprazoleCarpipramineClocapramineClorotepineClozapineGevotrolineIloperidoneMelperoneMosapramineOlanzapinePaliperidonePimozideQuetiapineRisperidoneSertindoleZiprasidoneZotepine; Typical antipsychotics: LoxapinePipamperone; Antidepressants: AmitriptylineAmoxapineAptazapineEtoperidoneMianserinMirtazapineNefazodoneTeniloxazineTrazodone; Others: 5-I-R911505-MeO-NBpBrT • AC-90179 • AdatanserinAltanserinAMDA • APD-215 • BlonanserinCinanserinCSP-2503CyproheptadineDeramciclaneDotarizineEplivanserinEsmirtazapineFananserinFlibanserinKetanserinKML-010LubazodoneMepiprazoleMetitepine/MethiothepinNanteninePimavanserinPizotifenPruvanserinRauwolscineRitanserinS-14,671SarpogrelateSetoperoneSpiperoneSpiramide • SR-46349B • VolinanserinXylamidineYohimbine
5-HT2B Agonists: Oxazolines: 4-MethylaminorexAminorex; Phenethylamines: ChlorphentermineCloforexDOBDOCDOIDOMFenfluramineMDAMDMANorfenfluramine; Tryptamines: 5-CT5-MTα-Methyl-5-HT; Others: BW-723C86CabergolinemCPPPergolidePNU-22394Ro60-0175 Antagonists: AgomelatineAsenapine • EGIS-7625 • KetanserinLisurideLY-272,015Metitepine/MethiothepinPRX-08066RauwolscineRitanserinRS-127,445Sarpogrelate • SB-200,646 • SB-204,741SB-206,553SB-215,505 • SB-221,284 • SB-228,357 • SDZ SER-082TegaserodYohimbine
5-HT2C Agonists: Phenethylamines: 2C-B2C-E2C-I2C-T-22C-T-72C-T-21DOBDOCDOIDOMMDAMDMAMescaline; Piperazines: AripiprazolemCPPTFMPP; Tryptamines: 5-CT5-MeO-α-ET5-MeO-α-MT5-MeO-DET5-MeO-DiPT5-MeO-DMT5-MeO-DPT5-MTα-ETα-Methyl-5-HTα-MTBufoteninDETDiPTDMTDPTPsilocinPsilocybin; Others: A-372,159AL-38022A • CP-809,101 • DimemebfeLorcaserinMedifoxamine • MK-212 • Org 12,962ORG-37,684OxaflozanePNU-22394Ro60-0175Ro60-0213VabicaserinWAY-629WAY-161,503YM-348 Antagonists: Atypical antipsychotics: ClorotepineClozapineIloperidoneMelperoneOlanzapinePaliperidonePimozideQuetiapineRisperidoneSertindoleZiprasidoneZotepine; Typical antipsychotics: ChlorpromazineLoxapinePipamperone; Antidepressants: AgomelatineAmitriptylineAmoxapineAptazapineEtoperidoneFluoxetineMianserinMirtazapineNefazodoneNortriptylineTedatioxetineTrazodone; Others: AdatanserinCinanserinCyproheptadineDeramciclaneDotarizineEltoprazineEsmirtazapine • FR-260,010 • KetanserinKetotifenLatrepirdineMetitepine/MethiothepinMethysergidePizotifenRitanserinRS-102,221S-14,671 • SB-200,646 • SB-206,553 • SB-221,284 • SB-228,357 • SB-242,084 • SB-243,213 • SDZ SER-082Xylamidine
5-HT3, 5-HT4, 5-HT5, 5-HT6, 5-HT7 ligands
5-HT3 Agonists: Piperazines: BZPQuipazine; Tryptamines: 2-Methyl-5-HT5-CT; Others: ChlorophenylbiguanideButanolEthanolHalothaneIsofluraneRS-56812 • SR-57,227 • SR-57,227-A • TolueneTrichloroethaneTrichloroethanolTrichloroethyleneYM-31636 Antagonists: Antiemetics: AS-8112AlosetronAzasetronBatanoprideBemesetronCilansetronDazoprideDolasetronGranisetronLerisetronOndansetronPalonosetronRamosetronRenzaprideTropisetronZacoprideZatosetron; Atypical antipsychotics: ClozapineOlanzapineQuetiapine; Tetracyclic antidepressants: AmoxapineMianserinMirtazapine; Others: CSP-2503 • ICS-205,930 • MDL-72,222 • MemantineNitrous OxideRicasetronSevofluraneTedatioxetineThujoneVortioxetineXenon
5-HT4 Agonists: Gastroprokinetic Agents: CinitaprideCisaprideDazoprideMetoclopramideMosapridePrucaloprideRenzaprideTegaserodVelusetragZacopride; Others: 5-MTBIMU8CJ-033,466PRX-03140RS-67333 • RS-67506 • SL65.0155Antagonists: GR-113,808 • GR-125,487 • L-LysinePiboserod • RS-39604 • RS-67532 • SB-203,186 • SB-204,070
5-HT5A Agonists: Lysergamides: ErgotamineLSD; Tryptamines: 5-CT; Others: Valerenic Acid Antagonists: AsenapineLatrepirdineMetitepine/MethiothepinRitanserin • SB-699,551 * Note that the 5-HT5B receptor is not functional in humans.
5-HT6 Agonists: Lysergamides: DihydroergotamineErgotamineLisurideLSDMesulergineMetergolineMethysergide; Tryptamines: 2-Methyl-5-HT5-BT5-CT5-MTBufoteninE-6801E-6837EMD-386,088EMDT • LY-586,713 • N-Methyl-5-HT • Tryptamine; Others: WAY-181,187 • WAY-208,466 Antagonists: Antidepressants: AmitriptylineAmoxapineClomipramineDoxepinMianserinNortriptyline; Atypical antipsychotics: AripiprazoleAsenapineClorotepineClozapineFluperlapineIloperidoneOlanzapineTiospirone; Typical antipsychotics: ChlorpromazineLoxapine; Others: BGC20-760 • BVT-5182 • BVT-74316 • CerlapirdineEGIS-12,233 • GW-742,457 • KetanserinLatrepirdineLu AE58054Metitepine/MethiothepinMS-245PRX-07034RitanserinRo04-6790 • Ro 63-0563 • SB-258,585SB-271,046SB-357,134SB-399,885SB-742,457
5-HT7 Agonists: Lysergamides: LSD; Tryptamines: 5-CT5-MTBufotenin; Others: 8-OH-DPATAS-19BifeprunoxE-55888LP-12LP-44 • RU-24,969 • Sarizotan Antagonists: Lysergamides: 2-Bromo-LSDBromocriptineDihydroergotamineErgotamineMesulergineMetergolineMethysergide; Antidepressants: AmitriptylineAmoxapineClomipramineImipramineMaprotilineMianserin; Atypical antipsychotics: AmisulprideAripiprazoleClorotepineClozapineOlanzapineRisperidoneSertindoleTiospironeZiprasidoneZotepine; Typical antipsychotics: ChlorpromazineLoxapine; Others: ButaclamolEGIS-12,233Ketanserin • LY-215,840 • Metitepine/MethiothepinPimozideRitanserinSB-258,719 • SB-258,741 • SB-269,970 • SB-656,104 • SB-656,104-A • SB-691,673 • SLV-313 • SLV-314 • Spiperone • SSR-181,507 • Vortioxetine
Reuptake inhibitors
SERT Selective serotonin reuptake inhibitors (SSRIs): AlaproclateCitalopramDapoxetineDesmethylcitalopramDesmethylsertralineEscitalopramFemoxetineFluoxetineFluvoxamineIndalpineIfoxetineLitoxetineLubazodonePanuramineParoxetinePirandamineRTI-353SeproxetineSertralineTedatioxetineVilazodoneVortioxetineZimelidine; Serotonin-norepinephrine reuptake inhibitors (SNRIs): BicifadineDesvenlafaxineDuloxetineEclanamineLevomilnacipranMilnacipranSibutramineVenlafaxine; Serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRIs): BrasofensineDiclofensineDOV-102,677DOV-21,947DOV-216,303NS-2359SEP-225289SEP-227,162Tesofensine; Tricyclic antidepressants (TCAs): AmitriptylineButriptylineCianopramineClomipramineDesipramineDosulepinDoxepinImipramineLofepramineNortriptylinePipofezineProtriptylineTrimipramine; Tetracyclic antidepressants (TeCAs): Amoxapine; Piperazines: NefazodoneTrazodone; Antihistamines: BrompheniramineChlorphenamineDiphenhydramineMepyramine/PyrilaminePheniramineTripelennamine; Opioids: PethidineMethadonePropoxyphene; Others: Cocaine • CP-39,332 • CyclobenzaprineDextromethorphanDextrorphanEXP-561FezolamineMesembrineNefopamPIM-35PridefineRoxindoleSB-649,915Ziprasidone
VMAT IbogaineReserpineTetrabenazine
Releasing agents
Aminoindanes: 5-IAIAMMIETAIMDAIMDMAIMMAITAI; Aminotetralins: 6-CAT8-OH-DPATMDATMDMAT; Oxazolines: 4-MethylaminorexAminorexClominorexFluminorex; Phenethylamines (also Amphetamines, Cathinones, Phentermines, etc): 2-Methyl-MDA4-CAB4-FA4-FMA4-HA4-MTA5-APDB5-Methyl-MDA6-APDB6-Methyl-MDA • AEMMA • AmiflamineBDBBOHBrephedroneButyloneChlorphentermineCloforexAmfepramoneMetamfepramoneDCADFMDADMADMMAEBDBEDMAEthyloneEtolorexFenfluramine (Dexfenfluramine) • FlephedroneIAPIMPLophophineMBDBMDAMDEAMDHMAMDMAMDMPEAMDOHMDPEAMephedroneMethedroneMethyloneMMAMMDAMMDMA • MMMA • NAPNorfenfluramine • 4-TFMA • pBApCApIAPMAPMEAPMMATAP; Piperazines: 2C-B-BZP • 2-BZP • 3-MeOPP • BZP • DCPP • MBZPmCPPMDBZPMeOPPMepiprazolepCPPpFPPpTFMPPTFMPP; Tryptamines: 4-Methyl-αET4-Methyl-αMT5-CT5-MeO-αET5-MeO-αMT5-MTαETαMTDMTTryptamine (itself); Others: IndeloxazineTramadolViqualine
Enzyme inhibitors
Anabolism
TPH AGN-2979Fenclonine
AAAD BenserazideCarbidopaGenisteinMethyldopa
Catabolism
MAO Nonselective: BenmoxinCaroxazoneEchinopsidineFurazolidoneHydralazineIndantadolIproclozideIproniazidIsocarboxazidIsoniazidLinezolidMebanazineMetfendrazineNialamideOctamoxinParaxazonePhenelzinePheniprazinePhenoxypropazinePivalylbenzhydrazineProcarbazineSafrazineTranylcypromine; MAO-A Selective: AmiflamineBazinaprineBefloxatoneBefolBrofaromineCimoxatoneClorgilineEsuproneHarmala alkaloids (Harmine, Harmaline, Tetrahydroharmine, Harman, Norharman, etc) • Methylene BlueMetralindoleMinaprineMoclobemidePirlindoleSercloremineTetrindoleToloxatoneTyrima
Others
Precursors L-Tryptophan5-HTP
Cofactors Ferrous iron (Fe2+) • Magnesium (Mg2+) • TetrahydrobiopterinVitamin B3 (Niacin, NicotinamideNADPH) • Vitamin B6 (Pyridoxine, Pyridoxamine, PyridoxalPyridoxal phosphate) • Vitamin B9 (Folic AcidTetrahydrofolic acid) • Vitamin C (Ascorbic acid) • Zinc (Zn2+)
Others Activity enhancers: BPAPPPAP; Reuptake enhancers: Tianeptine

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