塞浦西他啶
此條目需要精通或熟悉醫學的編者參與及協助編輯。 (2020年12月15日) |
臨床資料 | |
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讀音 | (/ˌsaɪproʊˈhɛptədiːn/[1] |
商品名 | Periactin, others |
AHFS/Drugs.com | Monograph |
MedlinePlus | a682541 |
核准狀況 | |
懷孕分級 |
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給藥途徑 | Oral |
ATC碼 | |
法律規範狀態 | |
法律規範 |
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藥物動力學數據 | |
血漿蛋白結合率 | 96 to 99% |
藥物代謝 | Hepatic,[3][4] mostly CYP3A4 mediated. |
生物半衰期 | 8.6 hours[2] |
排泄途徑 | 糞便 (2–20%; of which, 34% as unchanged drug) 與 腎 (40%; none as unchanged drug)[3][4] |
識別資訊 | |
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CAS號 | 129-03-3 969-33-5(鹽酸鹽) |
PubChem CID | |
IUPHAR/BPS | |
DrugBank | |
ChemSpider | |
UNII | |
KEGG | |
ChEBI | |
ChEMBL | |
CompTox Dashboard (EPA) | |
ECHA InfoCard | 100.004.482 |
化學資訊 | |
化學式 | C21H21N |
摩爾質量 | 287.41 g·mol−1 |
3D模型(JSmol) | |
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塞浦西他啶(Cyproheptadine),或名賽庚啶 ,是第一代抗組織胺藥,具有抗乙酰膽鹼和局部麻醉的功能,也是兒童抗過敏藥水希普利敏的主要成分。
醫療使用
[編輯]- 塞浦西他啶用於治療過敏反應 (特別是花粉症).[6] 用於此目的證實有效,但是第二代抗組織胺藥像是酮替酚與氯雷他定也有相同的結果,且副作用較少。[7]
- 它也被用作偏頭痛的預防性治療。在2013年的一項研究中,開始治療後7至10天內,患者的偏頭痛發生率顯著降低。這些患者在服藥前偏頭痛發作的平均頻率為每月8.7次,開始治療後3個月降至每月3.1次。[7][8] 在英國和其他一些國家/地區,藥品仿單上有此用法。
- 它也被藥品「仿單核准適應症外的使用」在嬰兒週期性嘔吐症候群的治療。這種用途的唯一證據來自回顧性研究。[9]
- 塞浦西他啶有時被「仿單核准適應症外的使用」,以改善服用抗精神病藥物的患者的靜坐不能。[10]
- 它也被藥品「仿單核准適應症外的使用」於治療各種皮膚病,包括精神性搔癢症|[11]、藥物誘發的多汗症(出汗過多)[12],以及預防表淺性單純性水疱性表皮鬆解症的水皰形成。[13]
- 該藥物的作用之一是食慾增加和體重增加,這導致該藥物在消瘦的兒童以及囊腫性纖維化患者中用於此目的(在美國為「仿單核准適應症外的使用」)。[14][15][16]
- 它也使用在「仿單核准適應症外的使用」治療中度至重度血清素綜合症,與使用血清素類藥物有關的複雜症狀,像是選擇性5-羥色胺再攝取抑制劑 (與單胺氧化酶抑制劑),以及在血清素產生的類癌腫瘤導致血液中5-羥色胺升高的案例。[17][18]
副作用
[編輯]- 鎮靜和睏倦(通常是短暫的)Sedation and sleepiness (often transient)
- 頭暈 Dizziness
- 協調不佳 Disturbed coordination
- 混亂 Confusion
- 躁動不安 Restlessness
- 興奮 Excitation
- 緊張 Nervousness
- 震顫 Tremor
- 易怒 Irritability
- 失眠 Insomnia
- 感覺異常 Paresthesias
- 神經炎 Neuritis
- 抽搐 Convulsions
- 欣快感 Euphoria
- 幻覺 Hallucinations
- 歇斯底里 Hysteria
- 模糊 Faintness
- 皮疹和水腫的過敏表現 Allergic manifestation of rash and edema
- 發汗 Diaphoresis
- 蕁麻疹 Urticaria
- 對光敏感 Photosensitivity
- 急性迷路炎 Acute labyrinthitis
- 複視(雙眼) Diplopia (seeing double)
- 眩暈 Vertigo
- 耳鳴 Tinnitus
- 低血壓 Hypotension (low blood pressure)
- 心悸 Palpitation
- 期前收縮 Extrasystoles
- 過敏性休克 Anaphylactic shock
- 溶血性貧血 Hemolytic anemia
- 諸如白細胞減少症,粒細胞缺乏症和血小板減少症等血液異常 Blood dyscrasias such as leukopenia, agranulocytosis and thrombocytopenia
- 膽汁淤積 Cholestasis
- 對肝臟的影響:
- 上腹窘迫 Epigastric distress
- 食欲不振 Anorexia
- 噁心 Nausea
- 嘔吐 Vomiting
- 腹瀉 Diarrhea
- 抗膽鹼能副作用:
- 視力模糊 Blurred vision
- 便秘 Constipation
- 口腔乾燥症(口乾) Xerostomia (dry mouth)
- 心動過速(高心率)Tachycardia (high heart rate)
- 尿瀦留 Urinary retention
- 排尿困難 Difficulty passing urine
- 鼻塞 Nasal congestion
- 鼻或喉嚨乾燥 Nasal or throat dryness
- 頻尿 Urinary frequency
- 早期月經 Early menses
- 支氣管分泌物增厚 Thickening of bronchial secretions
- 胸悶氣喘 Tightness of chest and wheezing
- 疲勞 Fatigue
- 寒意 Chills
- 頭痛 Headache
- 食慾增加 Increased appetite
- 體重增加 Weight gain
用藥過量
[編輯]過量使用時,有時建議使用活性炭進行洗胃。這些症狀通常表明中樞神經系統抑制(或在某些情況下相反地刺激中樞神經系統)和過度的抗膽鹼能副作用。小鼠的半數致死量(LD50)為 123 mg/kg,,大鼠的半數致死量為 295 mg/kg 。[3][4]
藥理
[編輯]藥效學
[編輯]塞浦西他啶對此表列出的所有受體均表現為拮抗劑或逆向激動劑。[20]
Site | Ki (nM)[a] | Action[b] | Species | Ref. |
---|---|---|---|---|
H1 | 0.06 | ↓ | Human | |
H2 | ND | ND | ||
H3 | >10,000 | Human | ||
H4 | 202 | Human | ||
M1 | 12 | ↓ | Human | |
M2 | 7 | ↓ | Human | |
M3 | 12 | ↓ | Human | |
M4 | 8 | ↓ | Human | |
M5 | 11.8 | ↓ | Human | |
5-HT1A | 59 | Human | ||
5-HT2A | 1.67 | ↓ | Human | |
5-HT2B | 1.54 | ↓ | Human | |
5-HT2C | 2.23 | ↓ | Human | |
5-HT3 | 228 | Mouse | ||
5-HT6 | 142 | Human | ||
5-HT7 | 123 | Human | ||
D1 | 117 | Human | ||
D2 | 112 | ↓ | Human | |
D3 | 8 | Human | ||
SERT | 4,100 | Rat | ||
NET | 290 | Rat | ||
DAT | ND | ND | ||
塞浦西他啶是一種非常有效的抗組胺藥或H1受體的拮抗劑。它在較高濃度下還具有抗膽鹼能、抗血清素能和抗多巴胺能活性。它是5-HT2受體的強效拮抗劑,這是其治療血清素綜合症的基礎。
藥物代謝動力學
[編輯]塞浦西他啶口服後吸收良好,血漿濃度峰值出現在1至3小時後。[22]口服塞浦西他啶的生物半衰期約為8小時。[2]
化學
[編輯]塞浦西他啶是三環苯並環庚烯,與吡唑替芬和酮替酚以及三環抗抑鬱藥密切相關。
研究
[編輯]在一項規模較小的精神分裂症患者中,輔助使用塞浦西他啶作為輔助治療,該患者的病情穩定且正在接受其他藥物治療。雖然注意力和口語流利性似乎有所改善,但這項研究規模太小,不足以概括。[23]在另兩項針對精神分裂症患者的試驗中,也已對其進行了佐劑研究,總共約有50人,並且似乎沒有效果。[24]
已經進行了一些試驗,以觀察塞浦西他啶是否可以減輕SSRI和抗精神病藥引起的性功能障礙。[25]
塞浦西他啶已被研究用於創傷後壓力症候群(PTSD)。[24]
獸醫用途
[編輯]塞浦西他啶使用在貓的食慾刺激劑[26] ,也可作為哮喘的輔助治療劑。[27] 可能的副作用包括刺激和攻擊行為。[28]它在貓的生物半衰期為 12 小時。[27]
塞浦西他啶也用在馬的垂體中間部功能障礙的二線治療。[29][30]
參考資料
[編輯]- ^ Cyproheptadine. Dictionary.com Unabridged. Random House.
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- ^ Fischer, Jnos; Ganellin, C. Robin. Analogue-based Drug Discovery. John Wiley & Sons. 2006: 547 [2020-12-15]. ISBN 9783527607495. (原始內容存檔於2021-08-29) (英語).
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- ^ 7.0 7.1 De Bruyne, P; Christiaens, T; Boussery, K; Mehuys, E; Van Winckel, M. Are antihistamines effective in children? A review of the evidence. Archives of Disease in Childhood. January 2017, 102 (1): 56–60. PMID 27335428. S2CID 21185048. doi:10.1136/archdischild-2015-310416.
- ^ Saito, Y; Yamanaka, G; Shimomura, H; Shiraishi, K; Nakazawa, T; Kato, F; Shimizu-Motohashi, Y; Sasaki, M; Maegaki, Y. Reconsideration of the diagnosis and treatment of childhood migraine: A practical review of clinical experiences. Brain & Development. May 2017, 39 (5): 386–394. PMID 27993427. S2CID 34703034. doi:10.1016/j.braindev.2016.11.011.
- ^ Salvatore, S; Barberi, S; Borrelli, O; Castellazzi, A; Di Mauro, D; Di Mauro, G; Doria, M; Francavilla, R; Landi, M; Martelli, A; Miniello, VL; Simeone, G; Verduci, E; Verga, C; Zanetti, MA; Staiano, A; SIPPS Working Group on, FGIDs. Pharmacological interventions on early functional gastrointestinal disorders. Italian Journal of Pediatrics. 16 July 2016, 42 (1): 68. PMC 4947301 . PMID 27423188. doi:10.1186/s13052-016-0272-5.
- ^ Taylor, David; Paton, Carol; Kapur, Shitij. The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons. 2015: 85 [2020-12-15]. ISBN 9781118754573. (原始內容存檔於2021-08-28) (英語).
- ^ Szepietowski, JC; Reszke, R. Psychogenic Itch Management 50. 2016: 124–32. ISBN 978-3-318-05888-8. PMID 27578081. doi:10.1159/000446055.
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- ^ Bioplex NF. [2020-12-15]. (原始內容存檔於2018-04-18).
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- ^ Rossi, S (編). Australian Medicines Handbook 2013. Adelaide: The Australian Medicines Handbook Unit Trust. 2013. ISBN 978-0-9805790-9-3.
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- ^ Chertoff, Jason. Cyproheptadine-Induced Acute Liver Failure. ACG Case Reports Journal. 8 July 2014, 1 (4): 212–213. PMC 4286888 . PMID 25580444. doi:10.14309/crj.2014.56.
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