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Chemical Name:
(±)-2-Methyl-1,2,3,4,10,14b-hexahydropyrazino[2,1-a]pyrido[2,3-c][2]benzazepine
Molecular Weight: 265.35 g/mol
CAS Number: 85650-52-8 12
Class: Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)
Mechanism:
Blocks α2-adrenergic autoreceptors, increasing norepinephrine (NE) release
Enhances 5-HT1A-mediated serotonergic transmission while antagonizing 5-HT2 and 5-HT3 receptors, improving mood and reducing anxiety
Strong H1-histamine receptor antagonism causes sedation and weight gain
Major Depressive Disorder (MDD): First-line treatment for depression, particularly in patients with insomnia or weight loss
Generalized Anxiety Disorder (GDA): Off-label use due to its anxiolytic effects
Insomnia: Low doses (7.5-15 mg) are highly sedating
Appetite Stimulation: Used in cachexia (e.g., cancer/AIDS-related weight loss)
Absorption: Rapid oral absorption (~80% bioavailability)
Metabolism: Hepatic, primarily via CYP3A4, CYP2D6, and CYP1A2
Half-life: 20-40 hours (longer in elderly patients)
Excretion: Renal (75%) and fecal (15%)
Starting Dose: 15 mg once daily at bedtime
Maintenance Dose: 15-45 mg/day (max 45 mg)
Special Populations:
Elderly: Lower initial dose (7.5-15 mg)
Hepatic/Renal Impairment: Dose reduction recommended
Common: Sedation, increased appetite, weight gain, dry mouth, dizziness
Serious (Rare):
Agranulocytosis (monitor WBC if fever/sore throat occurs)
Serotonin syndrome (if combined with other serotonergic drugs)
QT prolongation (caution in cardiac patients)