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'''Pizotifen''' ([[International Nonproprietary Name|INN]]) or '''pizotyline''' ([[United States Adopted Name|USAN]]), trade name '''Sandomigran''', is a [[Benzocycloheptenes|benzocycloheptene]]-based drug used as a medicine, primarily as a preventive to reduce the frequency of recurrent [[migraine]] headaches.<ref name="pmid17680738">{{cite journal | vauthors = Stark RJ, Valenti L, Miller GC | title = Management of migraine in Australian general practice | journal = The Medical Journal of Australia | volume = 187 | issue = 3 | pages = 142–6 | date = August 2007 | pmid = 17680738 | doi = 10.5694/j.1326-5377.2007.tb01170.x | s2cid = 10357983 }}</ref>
'''Pizotifen''' ([[International Nonproprietary Name|INN]]) or '''pizotyline''' ([[United States Adopted Name|USAN]]), trade name '''Sandomigran''', is a [[Benzocycloheptenes|benzocycloheptene]]-based drug used as a medicine, primarily as a preventive to reduce the frequency of recurrent [[migraine]] headaches.<ref name="pmid17680738">{{cite journal | vauthors = Stark RJ, Valenti L, Miller GC | title = Management of migraine in Australian general practice | journal = The Medical Journal of Australia | volume = 187 | issue = 3 | pages = 142–146 | date = August 2007 | pmid = 17680738 | doi = 10.5694/j.1326-5377.2007.tb01170.x | s2cid = 10357983 }}</ref>


==Uses==
==Uses==
The main medical use for pizotifen is for the prevention of [[migraine]] and [[cluster headache]]. Pizotifen is one of a range of medications used for this purpose, other options include [[propranolol]], [[topiramate]], [[valproic acid]], [[cyproheptadine]] and [[amitriptyline]]. While pizotifen is effective in adults,<ref>{{Cite journal |last1=Jackson |first1=Jeffrey L. |last2=Cogbill |first2=Elizabeth |last3=Santana-Davila |first3=Rafael |last4=Eldredge |first4=Christina |last5=Collier |first5=William |last6=Gradall |first6=Andrew |last7=Sehgal |first7=Neha |last8=Kuester |first8=Jessica |date=2015-07-14 |title=A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache |journal=PLOS ONE |volume=10 |issue=7 |pages=e0130733 |doi=10.1371/journal.pone.0130733 |issn=1932-6203 |pmc=4501738 |pmid=26172390|bibcode=2015PLoSO..1030733J |doi-access=free }}</ref> evidence of efficacy in children is limited,<ref name="pmid15210509">{{cite journal | vauthors = Barnes N, Millman G | title = Do pizotifen or propranolol reduce the frequency of migraine headache? | journal = Archives of Disease in Childhood | volume = 89 | issue = 7 | pages = 684–5 | date = July 2004 | pmid = 15210509 | pmc = 1719986 | doi = 10.1136/adc.2004.054668 }}</ref> and its use is limited by side effects, principally drowsiness and weight gain, and it is usually not the first choice medicine for preventing migraines, instead being used as an alternative when other drugs have failed to be effective.<ref>{{cite journal | vauthors = Pierangeli G, Cevoli S, Sancisi E, Grimaldi D, Zanigni S, Montagna P, Cortelli P | title = Which therapy for which patient? | journal = Neurological Sciences | date = May 2006 | volume = 27 | issue = Suppl 2 | pages = S153–8 | doi = 10.1007/s10072-006-0592-0 | pmid = 16688621 | s2cid = 24217802 }}</ref> It is not effective in relieving migraine attacks once in progress. Pizotifen has also been reported as highly effective in a severe case of erythromelalgia, a rare neurovascular disease that is sometimes refractory to the other drugs named above.<ref name="pmid11050591">{{cite journal | vauthors = Cohen JS | title = Erythromelalgia: new theories and new therapies | journal = Journal of the American Academy of Dermatology | volume = 43 | issue = 5 Pt 1 | pages = 841–7 | date = November 2000 | pmid = 11050591 | doi = 10.1067/mjd.2000.109301 | s2cid = 40807034 | url = https://semanticscholar.org/paper/34e5efcbd01c968047f3172803ffcdc2ab7250c3 }}</ref>
The main medical use for pizotifen is for the prevention of [[migraine]] and [[cluster headache]]. Pizotifen is one of a range of medications used for this purpose, other options include [[propranolol]], [[topiramate]], [[valproic acid]], [[cyproheptadine]] and [[amitriptyline]]. While pizotifen is effective in adults,<ref>{{cite journal | vauthors = Jackson JL, Cogbill E, Santana-Davila R, Eldredge C, Collier W, Gradall A, Sehgal N, Kuester J | display-authors = 6 | title = A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache | journal = PloS One | volume = 10 | issue = 7 | pages = e0130733 | date = 2015-07-14 | pmid = 26172390 | pmc = 4501738 | doi = 10.1371/journal.pone.0130733 | doi-access = free | bibcode = 2015PLoSO..1030733J }}</ref> evidence of efficacy in children is limited,<ref name="pmid15210509">{{cite journal | vauthors = Barnes N, Millman G | title = Do pizotifen or propranolol reduce the frequency of migraine headache? | journal = Archives of Disease in Childhood | volume = 89 | issue = 7 | pages = 684–685 | date = July 2004 | pmid = 15210509 | pmc = 1719986 | doi = 10.1136/adc.2004.054668 }}</ref> and its use is limited by side effects, principally drowsiness and weight gain, and it is usually not the first choice medicine for preventing migraines, instead being used as an alternative when other drugs have failed to be effective.<ref>{{cite journal | vauthors = Pierangeli G, Cevoli S, Sancisi E, Grimaldi D, Zanigni S, Montagna P, Cortelli P | title = Which therapy for which patient? | journal = Neurological Sciences | volume = 27 Suppl 2 | issue = Suppl 2 | pages = S153-S158 | date = May 2006 | pmid = 16688621 | doi = 10.1007/s10072-006-0592-0 | s2cid = 24217802 }}</ref> It is not effective in relieving migraine attacks once in progress. Pizotifen has also been reported as highly effective in a severe case of erythromelalgia, a rare neurovascular disease that is sometimes refractory to the other drugs named above.<ref name="pmid11050591">{{cite journal | vauthors = Cohen JS | title = Erythromelalgia: new theories and new therapies | journal = Journal of the American Academy of Dermatology | volume = 43 | issue = 5 Pt 1 | pages = 841–847 | date = November 2000 | pmid = 11050591 | doi = 10.1067/mjd.2000.109301 | s2cid = 40807034 }}</ref>


Other applications for which pizotifen may be used include as an [[antidepressant]], or for the treatment of [[anxiety]] or [[social anxiety disorder|social phobia]].<ref name="pmid335788">{{cite journal | vauthors = Standal JE | title = Pizotifen as an antidepressant | journal = Acta Psychiatrica Scandinavica | volume = 56 | issue = 4 | pages = 276–9 | date = October 1977 | pmid = 335788 | doi = 10.1111/j.1600-0447.1977.tb00228.x | s2cid = 6445059 }}</ref><ref name="pmid348154">{{cite journal | vauthors = Banki CM | title = Clinical observations with pizotifene (Sandomigran) in the treatment of nonmigrainous depressed women | journal = Archiv für Psychiatrie und Nervenkrankheiten| volume = 225 | issue = 1 | pages = 67–72 | date = March 1978 | pmid = 348154 | doi = 10.1007/bf00367352 | s2cid = 13510725 }}</ref> Animal studies also suggest that pizotyline could be used in the treatment of [[serotonin syndrome]] or [[MDMA]] [[overdose]]<ref name="pmid16253319">{{cite journal | vauthors = Young R, Khorana N, Bondareva T, Glennon RA | title = Pizotyline effectively attenuates the stimulus effects of N-methyl-3,4-methylenedioxyamphetamine (MDMA) | journal = Pharmacology, Biochemistry, and Behavior | volume = 82 | issue = 2 | pages = 404–10 | date = October 2005 | pmid = 16253319 | doi = 10.1016/j.pbb.2005.09.010 | s2cid = 20885754 }}</ref> in a similar manner to the closely related antihistamine/antiserotonin medication [[cyproheptadine]].
Other applications for which pizotifen may be used include as an [[antidepressant]], or for the treatment of [[anxiety]] or [[social anxiety disorder|social phobia]].<ref name="pmid335788">{{cite journal | vauthors = Standal JE | title = Pizotifen as an antidepressant | journal = Acta Psychiatrica Scandinavica | volume = 56 | issue = 4 | pages = 276–279 | date = October 1977 | pmid = 335788 | doi = 10.1111/j.1600-0447.1977.tb00228.x | s2cid = 6445059 }}</ref><ref name="pmid348154">{{cite journal | vauthors = Banki CM | title = Clinical observations with pizotifene (Sandomigran) in the treatment of nonmigrainous depressed women | journal = Archiv Fur Psychiatrie Und Nervenkrankheiten | volume = 225 | issue = 1 | pages = 67–72 | date = March 1978 | pmid = 348154 | doi = 10.1007/bf00367352 | s2cid = 13510725 }}</ref> Animal studies also suggest that pizotyline could be used in the treatment of [[serotonin syndrome]] or [[MDMA]] [[overdose]]<ref name="pmid16253319">{{cite journal | vauthors = Young R, Khorana N, Bondareva T, Glennon RA | title = Pizotyline effectively attenuates the stimulus effects of N-methyl-3,4-methylenedioxyamphetamine (MDMA) | journal = Pharmacology, Biochemistry, and Behavior | volume = 82 | issue = 2 | pages = 404–410 | date = October 2005 | pmid = 16253319 | doi = 10.1016/j.pbb.2005.09.010 | s2cid = 20885754 }}</ref> in a similar manner to the closely related antihistamine/antiserotonin medication [[cyproheptadine]].


==Adverse effects==
==Adverse effects==
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==Contraindications==
==Contraindications==
Caution is required in patients having closed angle [[glaucoma]] and in patients with a predisposition to [[urinary retention]] as the medication exhibits a relatively small anticholinergic effect. Dose adjustment is required in people who have [[chronic kidney disease]]. Liver injury has also been reported. Pizotifen treatment should be discontinued if there is any clinical evidence of liver dysfunction during treatment. Caution is advised in patients having a history of [[epilepsy]].
Caution is required in patients having closed angle [[glaucoma]] and in patients with a predisposition to [[urinary retention]] as the medication exhibits a relatively small anticholinergic effect. Dose adjustment is required in people who have [[chronic kidney disease]]. Liver injury has also been reported. Pizotifen treatment should be discontinued if there is any clinical evidence of liver dysfunction during treatment. Caution is advised in patients having a history of [[epilepsy]].
Withdrawal symptoms like depression, tremor, nausea, anxiety, malaise, dizziness, sleep disorder and weight decrease have been reported following abrupt cessation of pizotifen.<ref>{{cite web|url=http://www.medicines.org.uk/emc/medicine/14045/SPC/SANOMIGRAN+1.5mg+Tablets|title=Emedicine}}</ref>
Withdrawal symptoms like depression, tremor, nausea, anxiety, malaise, dizziness, sleep disorder and weight decrease have been reported following abrupt cessation of pizotifen.<ref>{{cite web|url=https://www.medsafe.govt.nz/profs/datasheet/s/Sandomigrantab.pdf|title=SANDOMIGRAN® pizotifen 500 micrograms coated tablets | work = AFT Pharmaceuticals Ltd | date = 21 June 2019 | publisher = Medsafe: New Zealand Medicines and Medical Devices Safety }}</ref>
Pizotifen is contraindicated in patients who suffer from hypersensitivity to any of its components, also Pizotifen is contraindicated in [[gastric outlet obstruction]], [[pregnancy]], angle-closure glaucoma and difficulty urinating.<ref>{{cite web|url=http://lekarstwo.ru/en/preparati/pizotifen.html|title=Likarstwo.ru}}</ref>
Pizotifen is contraindicated in patients who suffer from hypersensitivity to any of its components, also Pizotifen is contraindicated in [[gastric outlet obstruction]], [[pregnancy]], angle-closure glaucoma and difficulty urinating.<ref>{{cite web|url=http://lekarstwo.ru/en/preparati/pizotifen.html | title = Pizotifen | work = Universal reference book of medicines | via = Likarstwo.ru}}</ref>


==Pharmacology==
==Pharmacology==
Pizotifen is a [[serotonin antagonist]] acting mainly at the [[5-HT2A receptor|5-HT<sub>2A</sub>]] and [[5-HT2C receptor|5HT<sub>2C</sub>]] [[serotonin receptor|receptors]]. It also has some activity as an [[antihistamine]] as well as some anticholinergic activity.<ref name="pmid411500">{{cite journal | vauthors = Dixon AK, Hill RC, Roemer D, Scholtysik G | title = Pharmacological properties of 4(1-methyl-4-piperidylidine)-9,10-dihydro-4H-benzo-[4,5]cyclohepta[1,2]-thiophene hydrogen maleate (pizotifen) | journal = Arzneimittel-Forschung | volume = 27 | issue = 10 | pages = 1968–79 | date = 1977 | pmid = 411500 }}</ref>
Pizotifen is a [[serotonin antagonist]] acting mainly at the [[5-HT2A receptor|5-HT<sub>2A</sub>]] and [[5-HT2C receptor|5HT<sub>2C</sub>]] [[serotonin receptor|receptors]]. It also has some activity as an [[antihistamine]] as well as some anticholinergic activity.<ref name="pmid411500">{{cite journal | vauthors = Dixon AK, Hill RC, Roemer D, Scholtysik G | title = Pharmacological properties of 4(1-methyl-4-piperidylidine)-9,10-dihydro-4H-benzo-[4,5]cyclohepta[1,2]-thiophene hydrogen maleate (pizotifen) | journal = Arzneimittel-Forschung | volume = 27 | issue = 10 | pages = 1968–1979 | date = 1977 | pmid = 411500 }}</ref>


==See also==
== See also ==
* [[Benzocycloheptene]]
* [[Benzocycloheptene]]
* [[Cyproheptadine]]
* [[Cyproheptadine]]
* [[Ketotifen]]
* [[Ketotifen]]


==References==
== References ==
{{Reflist|2}}
{{Reflist|2}}


==External links==
== External links ==
* [http://www.medsafe.govt.nz/profs/datasheet/s/Sandomigrantab.pdf Sandomigran drug data sheet]
* [http://www.medsafe.govt.nz/profs/datasheet/s/Sandomigrantab.pdf Sandomigran drug data sheet]


Revision as of 11:19, 5 March 2023

Pizotifen
Clinical data
Trade namesSandomigran
AHFS/Drugs.comInternational Drug Names
Pregnancy
category
  • AU: B1
Routes of
administration		Oral
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability78%
Protein binding91%
MetabolismGlucuronidation (main route). N-glucuronide accounts for >50% of plasma and 60–70% of urinary excreted drug
Elimination half-life23 hours
Excretion18% feces, 55% urine (both as metabolites)
Identifiers
  • 4-(1-methyl-4-piperidylidine)-9,10-dihydro -4H-benzo-[4,5]cyclohepta[1,2]-thiophene
CAS Number
PubChem CID
IUPHAR/BPS
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.036.014 Edit this at Wikidata
Chemical and physical data
FormulaC19H21NS
Molar mass295.44 g·mol−1
3D model (JSmol)
  • s1c3c(cc1)C(\c2c(cccc2)CC3)=C4/CCN(C)CC4
  • InChI=1S/C19H21NS/c1-20-11-8-15(9-12-20)19-16-5-3-2-4-14(16)6-7-18-17(19)10-13-21-18/h2-5,10,13H,6-9,11-12H2,1H3 checkY
  • Key:FIADGNVRKBPQEU-UHFFFAOYSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Pizotifen (INN) or pizotyline (USAN), trade name Sandomigran, is a benzocycloheptene-based drug used as a medicine, primarily as a preventive to reduce the frequency of recurrent migraine headaches.[1]

Uses

The main medical use for pizotifen is for the prevention of migraine and cluster headache. Pizotifen is one of a range of medications used for this purpose, other options include propranolol, topiramate, valproic acid, cyproheptadine and amitriptyline. While pizotifen is effective in adults,[2] evidence of efficacy in children is limited,[3] and its use is limited by side effects, principally drowsiness and weight gain, and it is usually not the first choice medicine for preventing migraines, instead being used as an alternative when other drugs have failed to be effective.[4] It is not effective in relieving migraine attacks once in progress. Pizotifen has also been reported as highly effective in a severe case of erythromelalgia, a rare neurovascular disease that is sometimes refractory to the other drugs named above.[5]

Other applications for which pizotifen may be used include as an antidepressant, or for the treatment of anxiety or social phobia.[6][7] Animal studies also suggest that pizotyline could be used in the treatment of serotonin syndrome or MDMA overdose[8] in a similar manner to the closely related antihistamine/antiserotonin medication cyproheptadine.

Adverse effects

Side effects include sedation, dry mouth, drowsiness, increased appetite and weight gain.[9] Occasionally it may cause nausea, headaches, or dizziness. In rare cases, anxiety, aggression and depression may also occur.

Contraindications

Caution is required in patients having closed angle glaucoma and in patients with a predisposition to urinary retention as the medication exhibits a relatively small anticholinergic effect. Dose adjustment is required in people who have chronic kidney disease. Liver injury has also been reported. Pizotifen treatment should be discontinued if there is any clinical evidence of liver dysfunction during treatment. Caution is advised in patients having a history of epilepsy. Withdrawal symptoms like depression, tremor, nausea, anxiety, malaise, dizziness, sleep disorder and weight decrease have been reported following abrupt cessation of pizotifen.[10] Pizotifen is contraindicated in patients who suffer from hypersensitivity to any of its components, also Pizotifen is contraindicated in gastric outlet obstruction, pregnancy, angle-closure glaucoma and difficulty urinating.[11]

Pharmacology

Pizotifen is a serotonin antagonist acting mainly at the 5-HT2A and 5HT2C receptors. It also has some activity as an antihistamine as well as some anticholinergic activity.[12]

See also

References

  1. ^ Stark RJ, Valenti L, Miller GC (August 2007). "Management of migraine in Australian general practice". The Medical Journal of Australia. 187 (3): 142–146. doi:10.5694/j.1326-5377.2007.tb01170.x. PMID 17680738. S2CID 10357983.
  2. ^ Jackson JL, Cogbill E, Santana-Davila R, Eldredge C, Collier W, Gradall A, et al. (2015-07-14). "A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache". PloS One. 10 (7): e0130733. Bibcode:2015PLoSO..1030733J. doi:10.1371/journal.pone.0130733. PMC 4501738. PMID 26172390.
  3. ^ Barnes N, Millman G (July 2004). "Do pizotifen or propranolol reduce the frequency of migraine headache?". Archives of Disease in Childhood. 89 (7): 684–685. doi:10.1136/adc.2004.054668. PMC 1719986. PMID 15210509.
  4. ^ Pierangeli G, Cevoli S, Sancisi E, Grimaldi D, Zanigni S, Montagna P, Cortelli P (May 2006). "Which therapy for which patient?". Neurological Sciences. 27 Suppl 2 (Suppl 2): S153–S158. doi:10.1007/s10072-006-0592-0. PMID 16688621. S2CID 24217802.
  5. ^ Cohen JS (November 2000). "Erythromelalgia: new theories and new therapies". Journal of the American Academy of Dermatology. 43 (5 Pt 1): 841–847. doi:10.1067/mjd.2000.109301. PMID 11050591. S2CID 40807034.
  6. ^ Standal JE (October 1977). "Pizotifen as an antidepressant". Acta Psychiatrica Scandinavica. 56 (4): 276–279. doi:10.1111/j.1600-0447.1977.tb00228.x. PMID 335788. S2CID 6445059.
  7. ^ Banki CM (March 1978). "Clinical observations with pizotifene (Sandomigran) in the treatment of nonmigrainous depressed women". Archiv Fur Psychiatrie Und Nervenkrankheiten. 225 (1): 67–72. doi:10.1007/bf00367352. PMID 348154. S2CID 13510725.
  8. ^ Young R, Khorana N, Bondareva T, Glennon RA (October 2005). "Pizotyline effectively attenuates the stimulus effects of N-methyl-3,4-methylenedioxyamphetamine (MDMA)". Pharmacology, Biochemistry, and Behavior. 82 (2): 404–410. doi:10.1016/j.pbb.2005.09.010. PMID 16253319. S2CID 20885754.
  9. ^ Crowder D, Maclay WP. Pizotifen once daily in the prophylaxis of migraine: results of a multi-centre general practice study. Current Medical Research and Opinion. 1984;9(4):280-5.
  10. ^ "SANDOMIGRAN® pizotifen 500 micrograms coated tablets" (PDF). AFT Pharmaceuticals Ltd. Medsafe: New Zealand Medicines and Medical Devices Safety. 21 June 2019.
  11. ^ "Pizotifen". Universal reference book of medicines – via Likarstwo.ru.
  12. ^ Dixon AK, Hill RC, Roemer D, Scholtysik G (1977). "Pharmacological properties of 4(1-methyl-4-piperidylidine)-9,10-dihydro-4H-benzo-[4,5]cyclohepta[1,2]-thiophene hydrogen maleate (pizotifen)". Arzneimittel-Forschung. 27 (10): 1968–1979. PMID 411500.
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