Mianserin

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Mianserin
Mianserin 2D structure.svg
Mianserin ball-and-stick model.png
Clinical data
Trade names Many[1]
Pregnancy
category
Routes of
administration		 Oral (tablets)
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • UK: POM (Prescription only)
Pharmacokinetic data
Bioavailability 20–30%[2]
Protein binding 95%[2]
Metabolism Hepatic (mediated by CYP2D6; most metabolism occurs via aromatic hydroxylation, N-oxidation and N-demethylation)[2]
Biological half-life 21–61 hours[3]
Excretion Renal (4–7%)
Faecal (14–28%)[2]
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
ECHA InfoCard 100.041.884
Chemical and physical data
Formula C18H20N2
Molar mass 264.365
3D model (JSmol)
 NYesY (what is this?)  (verify)
Mianserin

Mianserin is a tetracyclic antidepressant (TeCA) therapeutic family. It is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA) and was first marketed in 1979. It is chemically related to mirtazapine.

Medical uses[edit]

When used for the treatment of depression, its efficacy appears comparable to that of amitriptyline, citalopram, clomipramine, dothiepin, doxepin, fluoxetine, flupenthixol, fluvoxamine, imipramine, moclobemide, nortriptyline, paroxetine, and trazodone.[2][4] Mianserin received TGA approval in May 1996.[5]

Similarly to its analogue, mirtazapine, mianserin has been tried as an augmentation strategy in treatment-resistant depression with some success.[6] Mianserin has been tried, similarly to mirtazapine, as an adjunct in schizophrenia and has been found to reduce negative and cognitive symptoms.[7][8][9]

Adverse effects[edit]

Very common (incidence>10%) adverse effects include constipation, dry mouth, and drowsiness at the beginning of treatment.[2][3][5][10][11]

Common (1%<incidence≤10%) adverse effects include drowsiness during maintenance therapy, tremor, headache, dizziness, vertigo, and weakness.[3]

Uncommon (0.1%<incidence≤1%) adverse effects include weight gain.[3]

Interactions[edit]

CYP2D6 inhibitors such as the selective serotonin reuptake inhibitors (SSRIs), quinidine, ritonavir, etc. would likely raise plasma levels of mianserin and hence could lead to mianserin toxicity. Conversely, CYP2D6 inducers would likely lead to reduced mianserin plasma concentrations and hence potentially diminish the therapeutic effects of mianserin.[2]

Withdrawal[edit]

Abrupt or rapid discontinuation of mianserin may provoke a withdrawal, the effects of which may include depression, anxiety, panic attacks,[12] decreased appetite or anorexia, insomnia, diarrhea, nausea and vomiting, and flu-like symptoms, such as allergies or pruritus, among others.

Overdose[edit]

Overdose of mianserin is known to produce sedation, coma, hypotension or hypertension, tachycardia, and QT interval prolongation.[13]

Pharmacology[edit]

Mianserin is an antagonist/inverse agonist of the H1, 5-HT1D, 5-HT2A, 5-HT2B, 5-HT2C, 5-HT3, 5-HT6, 5-HT7, α1-adrenergic, and α2-adrenergic receptors, and also inhibits the reuptake of norepinephrine.[14][15] As a high affinity H1 receptor inverse agonist, mianserin has strong antihistamine effects (sedation, weight gain, etc.). Contrarily, it has negligible affinity for the mACh receptors, and thus lacks anticholinergic properties. It was recently found to be a weak (Ki = 1.7 μM, EC50 = 0.53 μM) κ-opioid receptor partial agonist.[16]

In addition, mianserin also appears to be a potent antagonist of the neuronal octopamine receptor.[17] What implications this may have on mood are currently unknown, however octopamine has been implicated in the regulation of sleep, appetite and insulin production and therefore may theoretically contribute to the overall side effect profile of mianserin.[18][19]

Blockade of the H1 and α1-adrenergic receptors has sedative effects,[3] and also antagonism of the 5-HT2A and α1-adrenergic receptors inhibits activation of intracellular phospholipase C (PLC), which seems to be a common target for several different classes of antidepressants.[20] By antagonizing the somatodendritic and presynaptic α2-adrenergic receptors which function predominantly as inhibitory autoreceptors and heteroreceptors, mianserin disinhibits the release of norepinephrine, dopamine, serotonin, and acetylcholine in various areas of the brain and body.

Enantioselectivity[edit]

(S)-mianserin

(S)-(+)-Mianserin is approximately 200–300 times more active than its enantiomer (R)-(−)-mianserin.[citation needed]

Binding profile[edit]

Molecular target Binding affinity (Ki [nM])[21]
SERT 4000
NET 71
DAT 9400
5-HT1A 1500
5-HT1F 12.6
5-HT2A 3.21
5-HT2B 10.9
5-HT2C 2.59
5-HT6 68.1
5-HT7 56
α1 adrenoceptor 74 (Cloned rat receptor)
α2A adrenoceptor 4.8
α2B adrenoceptor 27
α2C adrenoceptor 3.8
D1 receptor 923
D2 receptor 2052
D3 receptor 2841
H1 receptor 1.0
H4 receptor 750

Chemistry[edit]

Mianserin is a tetracyclic piperazinoazepine; mirtazapine was developed by the same team of organic chemists and differs via addition of a nitrogen atom in one of the rings.[22][23]

History[edit]

It was developed but not discovered by Organon; the first patents in issued in The Netherlands in 1967 and it was launched in France in 1979 under the brand name Athymil and soon thereafter in the UK as Norval. Investigators conducting clinical trials in the US submitted fraudulent data, and it was never approved in the US.[24]:21[25]:318

Mianserin was one of the first antidepressants to reach the UK market that was less dangerous than the tricyclic antidepressants in overdose; as of 2012 it was not prescribed much in the UK.[26]

Society and culture[edit]

Brands[edit]

As of June 2017 it was marketed in several countries under the following names: Athmyl, Bonserin, Depnon, Deprexolet, Lantanon, Lerivon, Mealin, Miabene, Miagen, Miansec, Miansegen, Mianserin, Mianserin, Mianserina, Mianserine, Miansérine, Miansérine, Mianserinhydrochlorid, Mianserini, Mianserinum , Prevalina, Tetramide, Tolimed, Tolmin, Tolvon, and Tolvon.[1]

References[edit]

  1. ^ a b "Mianserin - International Brand Names". Drugs.com. Retrieved 21 June 2017. 
  2. ^ a b c d e f g Truven Health Analytics, Inc. DRUGDEX® System (Internet) [cited 2013 Sep 29]. Greenwood Village, CO: Thomsen Healthcare; 2013.
  3. ^ a b c d e Merck Sharp & Dohme (Australia) Pty Limited. "Tolvon Product Information" (PDF). GuildLink Pty Ltd. 
  4. ^ Wakeling A (April 1983). "Efficacy and side effects of mianserin, a tetracyclic antidepressant". Postgrad Med J. 59 (690): 229–31. PMC 2417496 Freely accessible. PMID 6346303. doi:10.1136/pgmj.59.690.229. 
  5. ^ a b AlphaPharm. "Lumin Mianserin hydrochloride product information" (PDF). GuildLink Pty Ltd. 
  6. ^ Ferreri M, Lavergne F, Berlin I, Payan C, Puech AJ (January 2001). "Benefits from mianserin augmentation of fluoxetine in patients with major depression non-responders to fluoxetine alone". Acta Psychiatr Scand. 103 (1): 66–72. PMID 11202131. doi:10.1111/j.1600-0447.2001.00148.x. 
  7. ^ Poyurovsky, M; Koren, D; Gonopolsky, I; Schneidman, M; Fuchs, C; Weizman, A; Weizman, R (March 2003). "Effect of the 5-HT2 antagonist mianserin on cognitive dysfunction in chronic schizophrenia patients: an add-on, double-blind placebo-controlled study". European Neuropsychopharmacology. 13 (2): 123–128. PMID 12650957. doi:10.1016/S0924-977X(02)00155-4. 
  8. ^ Shiloh, R; Zemishlany, Z; Aizenberg, D; Valevski, A; Bodinger, L; Munitz, H; Weizman, A (March 2002). "Mianserin or placebo as adjuncts to typical antipsychotics in resistant schizophrenia". International Clinical Psychopharmacology. 17 (2): 59–64. PMID 11890187. doi:10.1097/00004850-200203000-00003. 
  9. ^ Mizuki, Y; Kajimura, N; Imai, T; Suetsugi, M; Kai, S; Kaneyuki, H; Yamada, M (April 1990). "Effects of mianserin on negative symptoms in schizophrenia". International Clinical Psychopharmacology. 5 (2): 83–95. PMID 1696292. doi:10.1097/00004850-199004000-00002. 
  10. ^ "Australian Medicines Handbook". Australian Medicines Handbook Pty Ltd. 2013. 
  11. ^ British National Formulary (BNF) (65th ed.). Pharmaceutical Press. p. 1120. ISBN 978-0857110848. 
  12. ^ Kuniyoshi M, Arikawa K, Miura C, Inanaga K (June 1989). "Panic anxiety after abrupt discontinuation of mianserin". Jpn. J. Psychiatry Neurol. 43 (2): 155–9. PMID 2796025. doi:10.1111/j.1440-1819.1989.tb02564.x. 
  13. ^ Taylor D, Paton C, Kapur S, Taylor D. The Maudsley prescribing guidelines in psychiatry. 11th ed. Chichester, West Sussex: John Wiley & Sons; 2012.
  14. ^ Leonard B, Richelson H (2000). "Synaptic Effects of Antidepressants: Relationship to Their Therapeutic and Adverse Effects". In Buckley JL, Waddington PF. Schizophrenia and Mood Disorders: The New Drug Therapies in Clinical Practice. Oxford: Butterworth-Heinemann. pp. 67–84. ISBN 978-0-7506-4096-1. 
  15. ^ Müller G (8 May 2006). "Target Family-directed Masterkeys in Chemogenomics". In Kubinyi H, Müller G, Mannhold R, Folkers G. Chemogenomics in Drug Discovery: A Medicinal Chemistry Perspective. John Wiley & Sons. p. 25. ISBN 978-3-527-60402-9. Retrieved 13 May 2012. 
  16. ^ Olianas MC, Dedoni S, Onali P (November 2012). "The atypical antidepressant mianserin exhibits agonist activity at κ-opioid receptors". Br. J. Pharmacol. 167 (6): 1329–41. PMC 3504997 Freely accessible. PMID 22708686. doi:10.1111/j.1476-5381.2012.02078.x. 
  17. ^ Roeder T (November 1990). "High-affinity antagonists of the locust neuronal octopamine receptor". Eur. J. Pharmacol. 191 (2): 221–4. PMID 2086239. doi:10.1016/0014-2999(90)94151-M. 
  18. ^ Crocker A, Sehgal A (September 2008). "Octopamine regulates sleep in drosophila through protein kinase A-dependent mechanisms". J. Neurosci. 28 (38): 9377–85. PMC 2742176 Freely accessible. PMID 18799671. doi:10.1523/JNEUROSCI.3072-08a.2008. 
  19. ^ Bour S, Visentin V, Prévot D, Carpéné C (September 2003). "Moderate weight-lowering effect of octopamine treatment in obese Zucker rats". J. Physiol. Biochem. 59 (3): 175–82. PMID 15000448. doi:10.1007/BF03179913. 
  20. ^ Dwivedi Y, Agrawal AK, Rizavi HS, Pandey GN (December 2002). "Antidepressants reduce phosphoinositide-specific phospholipase C (PI-PLC) activity and the mRNA and protein expression of selective PLC beta 1 isozyme in rat brain". Neuropharmacology. 43 (8): 1269–79. PMID 12527476. doi:10.1016/S0028-3908(02)00253-8. 
  21. ^ Roth, BL; Driscol, J (12 January 2011). "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Archived from the original on 8 November 2013. Retrieved 13 October 2013. 
  22. ^ "Mirtazapine label - Australia". GuildLink, a wholly owned subsidiary company of the Pharmacy Guild of Australia. 27 May 2016. 
  23. ^ Kelder, J; Funke, C; De Boer, T; Delbressine, L; Leysen, D; Nickolson, V (April 1997). "A comparison of the physicochemical and biological properties of mirtazapine and mianserin.". The Journal of pharmacy and pharmacology. 49 (4): 403–11. PMID 9232538. doi:10.1111/j.2042-7158.1997.tb06814.x. 
  24. ^ Shorter, Edward (2005). A historical dictionary of psychiatry. Oxford [u.a.]: Oxford Univ. Press. ISBN 978-0-19-517668-1. 
  25. ^ Stahl, Stephen M. (2013). Stahl's essential psychopharmacology : neuroscientific basis and practical application (4th ed. ed.). Cambridge: Cambridge University Press. ISBN 9781107025981. 
  26. ^ Pratt, J.P. (2012). "29. Affective Disorders". In Walker, Roger; Whittlesea, Cate. Clinical pharmacy and therapeutics (5th ed. ed.). Edinburgh: Churchill Livingston/Elsevier. p. 472. ISBN 978-0702042935. 

Further reading[edit]

External links[edit]

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