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Objective : The purpose of this study was to compare the binding of various typical and atypical neuroleptics to striatal D 2 dopamine receptors in schizophrenic patients. Method : Fifty-six inpatients with schizophrenia, including 14 with schizoaffective disorder and one with schizophreniform disorder, were evaluated. Fourteen patients were neuroleptic free. Single photon emission computed tomography (SPECT) was performed 90 minutes after intravenous injection of [ 123 I]benzamide ([ 123 I]IBZM). Subsequent semiquantitative analysis of D 2 receptor binding was done with the use of the basal ganglia (striatum)/frontal cortex (BG/FC) ratio of activity. Clinical symptoms were rated with the Positive and Negative Syndrome Scale and the Hamilton Depression Rating Scale. Results : The BG/FC ratios in patients taking typical neuroleptics were significantly lower than those in the neuroleptic-free subjects but not lower than those in the patients taking atypical neuroleptics (clozapine, remoxipride). For atypical antipsychotics, a dose-dependent relationship with striatal D 2 receptor binding could not be demonstrated. BG/FC ratios were not significantly correlated with clinical symptoms or with duration of illness. Conclusions : The results indicate that [ 123 I]IBZM SPECT is useful for semiquantitative imaging of striatal D 2 dopamine receptors and for estimating their blockade by neuroleptics. Thus, it may improve drug monitoring in psychiatric patients. Furthermore, the findings suggest a complex relationship between the antipsychotic effect of atypical neuroleptics and D 2 receptor blockade.

The present studies compared the effects of acute and chronic administration of haloperidol or clozapine on c-fos mRNA expression in the rat medial prefrontal cortex. Acute administration of clozapine, but not haloperidol robustly increased c-fos mRNA expression in the infralimbic and prelimbic cortex of the rat. Even though most c-fos mRNA-expressing neurons in the clozapine- treated animals were localized in deep cortical layers, labeled neurons were found organized into several cell bridges connecting the superficial and deep layers of the cortex. After chronic treatment with clozapine, c-fos mRNA was reduced by approximately 60% of that seen acutely; however, the columns of c-fos mRNA expressing neurons did not show the same magnitude of tolerance. Haloperidol had no significant effect even after chronic treatment. We examined further the role of dopamine D2 versus D3 receptors in c-fos gene induction in the infralimbic cortex by studying the acute effects of remoxipride and U-99194A. Remoxipride, a selective D2 antagonist in vitro, induced c-fos mRNA at very low doses and lost its ability to alter c-fos mRNA at higher doses. Interestingly, U-99194A, an antagonist with 20-fold selectivity for D3 over D2 receptors, also produced greater induction of c-fos mRNA at lower doses. We hypothesize that blockade of D3 receptors may enhance c-fos gene expression in the medial prefrontal cortex but that of D2 receptors may prevent the same.

The present study is a retrospective study of remoxipride therapy. A total of 103 patients, 65 years or older, with a DSM-III-R diagnosis of dementia or delirium, were included. They had all been treated with remoxipride because of psychotic symptoms or behavioural disturbances. The dose range of remoxipride was 50-300 mg, the median dose being 75 mg. The clinical effect was rated as good in two thirds of the patients, and side-effects were noted in one fourth. When psychomotor hyperactivity was the dominating problem, a good effect was rated in 81 % of the patients. Side-effects were few and mild, the most common being tiredness; only 5 patients showed extrapyramidal symptoms.

SummaryTherapeutic effects of neuroleptics (NLP) in schizophrenia are well established in numerous international studies. Varying modalities of evolution under NLP treatment are described and require a clinical analysis. Neuroleptics are a necessary but insufficient condition for the therapy of schizophrenia. Via NLP treatment, other therapeutic approaches, such as psychotherapy, or sociotherapy become more effective. Consecutively, we present the effects of two compounds with dopaminergic selective activity (amisulpride, remoxipride) and of two other compounds with non-selective activity (risperidone, clozapine) regarding rehabilitation in schizophrenic patients. Data were collected from international studies with a medico-economic perspective and from French experience of clozapine in refractory schizophrenic patients. All these data stress the importance of several areas of study: clinical features, everyday life consequences and therapeutical effects observed with the atypical neuroleptics.

Item does not contain fulltext Prolactin elevation is a side effect of all currently available D2 receptor antagonists used in the treatment of schizophrenia. Prolactin elevation is the result of a direct antagonistic D2 effect blocking the tonic inhibition of prolactin release by dopamine. The aims of this work were to assess the correlation between in vitro estimates of D2 receptor affinity and pharmacokinetic-pharmacodynamic model-based estimates obtained from analysis of clinical data using an agonist-antagonist interaction (AAI) model and to assess the value of such a correlation in early prediction of full prolactin time profiles. A population model describing longitudinal prolactin data was fitted to clinical data from 16 clinical phases 1 and 3 trials including five different compounds. Pharmacokinetic data were modeled for each compound and the prolactin model was both fitted in per-compound fits as well as simultaneously to all prolactin data. Estimates of prolactin elevating potency were compared to corresponding in vitro values and their predictability was evaluated through model-based simulations. The model successfully described the prolactin time course for all compounds. Estimates derived from experimental preclinical data and the model fit of the clinical data were strongly correlated (p < 0.001), and simulations adequately predicted the prolactin elevation in five out of six compounds. The AAI model has the potential to be used in drug development to predict prolactin response for a given exposure of D2 antagonists using routinely produced preclinical data.

Schizophrenic patients are deficient in various neurologic measures reflecting information processing. One such measure in prepulse inhibition (PPI) of acoustic startle, in which schizophrenics display less inhibition than normal subjects. PPI is also diminished in rats treated with psychotomimetic drugs such as amphetamine and phencyclidine. PPI has been suggested as a model relevant for studying the pathophysiology of schizophrenia. We studied the effect of a variety of antipsychotics and putative antipsychotics and some key reference compounds on the acoustic startle response (ASR) and PPI. Some, but not all, antipsychotics tested (mainly selective dopamine D2 antagonists) enhanced PPI. Remoxipride and clozapine, both of which are antipsychotics, and the very potent and highly selective D2 antagonist, NCQ-298, did not. It is concluded that enhanced PPI in otherwise untreated rats does not reflect antipsychotic efficacy. We further noted that the effect on PPI was independent of the effect on ASR.

Remoxipride, a selective D2-dopamine receptor antagonist with preferential activity for mesolimbic-mediated behaviors, was assessed for its potential to block cocaine self-administration. The effects of remoxipride (RMX) were evaluated using fixed-ratio-1 (FR-1) and progressive-ratio (PR) schedules of reinforcement. On FR-1, RMX pretreatment increased the rate of cocaine injections, while on a PR, breaking points were reduced. Daily RMX treatment also resulted in breaking point reductions, but the decreases in cocaine's reinforcing potency did not result in extinction of cocaine intake and were not sustained upon cessation of RMX. Thus, RMX can reduce the rewarding effects of cocaine, and if safely tolerated over sustained periods of treatment it, or drugs with a similar pharmacological profile, could provide a therapeutic adjunct in the treatment of cocaine addiction.

The antinociceptive potential of remoxipride was investigated in sheep and rats with concurrent motor function assessments. Previous studies of sheep given intravenous remoxipride have revealed increases in mechanical nociceptive thresholds. Here, further investigation in sheep demonstrated elevated thermal nociceptive thresholds with no effect on subjectively assessed sedation or motor impairment scores. However, in rats, the dose of remoxipride (100 mg/kg i.p.) required to produce nociceptive thresholds similar to those elicited by morphine (30 mg/kg i.p.), itself reduced rotarod performance. Medetomidine (200 micrograms/kg i.p.) evoked sedation without influencing rotarod performance or antinociception. The antinociceptive, motor deficit and cataleptogenic actions of remoxipride were similar to those induced by two other dopamine antagonists, haloperidol (5 mg/kg) and raclopride (16 mg/kg i.p). Tocainide (100 mg/kg i.p.) induced thermal antinociception with normal rotarod performance and no catalepsy suggesting that Na+ channel blockade by remoxipride is not responsible for the changes in nociceptive thresholds. This study emphasizes the importance of motor function assessment during acute antinociceptive testing.

Remoxipride, a substituted benzamide, is a selective D-2 antagonist with an atypical neuroleptic profile. Previous studies have demonstrated its antipsychotic efficacy against haloperidol and, more recently, thioridazine. Of the 144 patients enrolled in the Australian remoxipride-thioridazine comparative trial, 28 presented for their first episode of schizophrenia and/or had no previous neuroleptic treatment. These patients form the subject of this paper.

The inhibitory effects of a variety of established and putative antipsychotic compounds on the hypermotility induced by D-amphetamine at two dose levels (0.5 and 2.0 mg/kg) have been studied. Classical antipsychotics (haloperidol, fluphenazine and cis(Z)-flupentixol) and the selective dopamine D2 receptor antagonist remoxipride inhibit hypermotility in the two conditions with similar potencies, whereas sertindole, clozapine, risperidone, ziprasidone and olanzapine preferentially inhibit the effect of the low dose of D-amphetamine (selectivity ratios between 6.5 and 18). Seroquel, amperozide and the selective 5-HT2A receptor antagonist MDL 100.151 ((+/-)-alpha-(2,3-dimethoxyphenyl)-1-[2-(4-fluorophenylethyl)]-4-p iperidine - methanol) have no effect on D-amphetamine 2.0 mg/kg, but inhibit the response to D-amphetamine 0.5 mg/kg. The alpha 1-adrenoceptor antagonist prazosin inhibits the motility response to D-amphetamine 0.5 mg/kg with slightly higher potency than that to D-amphetamine 2.0 mg/kg, whereas the 5-HT2A/2C receptor antagonist ritanserin selectively inhibits the effect of D-amphetamine 0.5 mg/kg. The histamine H1 receptor antagonist mepyramine is ineffective in both models. All compounds, except remoxipride, MDL 100.151 and ritanserin (which are ineffective) inhibit spontaneous locomotor activity at dose levels close to those inhibiting the response to D-amphetamine 2.0 mg/kg. Prazosin has partial inhibitory effect. In conclusion, dopamine antagonism has similar inhibitory effect on hyperactivity induced by low and high D-amphetamine dosages, alpha 1-adrenoceptor antagonism also contributes to both effects, whereas 5-HT2 receptor antagonism selectively interacts with the low D-amphetamine dose. This indicates that the responses to D-amphetamine 0.5 and 2.0 mg/kg are differently modulated by these neurotransmitters.(ABSTRACT TRUNCATED AT 250 WORDS)

Monitoring expression of c- fos and other immediate-early genes has proven a useful method for determining potential sites of action of antipsychotic drugs. Most studies of the effects of antipsychotic drugs on immediate-early gene expression have focused on the basal ganglia and allied cortical regions. We now report that clozapine administration markedly increases both the number of cells expressing Fos protein-like immunoreactivity and the amount of Fos protein in the thalamic paraventricular nucleus, but not the contiguous mediodorsal thalamic nucleus. Comparable doses of several dopamine D 2 -like antagonists, including raclopride, sulpiride, remoxipride and haloperidol, did not induce Fos expression in the paraventricular nucleus. However, loxapine and very high doses of haloperidol resulted in a small but significant increase in paraventricular nucleus Fos expression. The dopamine D 1 receptor antagonist SCH23390 did not induce Fos in the paraventricular nucleus or alter the magnitude of the clozapine-elicited increase in Fos expression. The serotonergic5-hydroxytryptamine 2a/2c antagonist ritanserin, alone or in combination with sulpiride, did not increase Fos expression in the paraventricular nucleus. Similarly, the 5-hydroxytryptamine 2 :D 2 antagonist risperidone did not change the amount of Fos protein in the paraventricular nucleus. Neither the α 1 adrenergic antagonist prazosin nor the muscarinic cholinergic antagonist scopolamine mimicked the effect of clozapine. The key placement of the paraventricular nucleus as an interface between the reticular formation and forebrain dopamine systems suggests that this thalamic nucleus may be an important part of an extended neural network subserving certain actions of antipsychotic drugs.

1. The prolactin response following administration of the D2-dopamine receptor antagonist remoxipride was studied in eight healthy male volunteers. The purpose of the study was to investigate the duration of a refractory period of prolactin release following two doses of remoxipride. A further aim was to compare the prolactin response following remoxipride and thyrotropin release hormone (TRH) during the refractory period. The subjects received two 30 min intravenous (i.v.) infusions of remoxipride 50 mg with different time intervals between the two doses, in a randomized six period crossover design. The time intervals between the two remoxipride doses were 2, 8, 12, 24 and 48 h. On one occasion the remoxipride dose was followed by an i.v. injection of TRH after 2 h. 2. The plasma peak prolactin concentrations obtained after the first remoxipride dose correspond to a maximal release of prolactin according to earlier studies. A small second peak of prolactin was observed after 2 h. The release was gradually increased with longer time intervals between the consecutive doses. The refractory period for a second prolactin release similar to the first one after remoxipride was found to be 24 h for most of the subjects. 3. TRH resulted in a faster and higher increase in prolactin response of a shorter duration than after remoxipride administered 2 h after the first dose.

The aim of the present study was to evaluate the psychometric effects of equivalent clinical doses of remoxipride and haloperidol in comparison with placebo in healthy volunteers. In a double-blind design, either 3 mg haloperidol, 150 mg remoxipride, or placebo were administered to 36 healthy male volunteers ranging in age from 19 to 39 years. Performance was assessed using time estimation, critical flicker fusion, and choice reaction time tasks. In addition, self-ratings on subjective well-being were obtained. In healthy subjects, an acute dose of 3 mg haloperidol caused more severe alteration in cognitive functioning, cortical arousal, and psychomotor performance than a clinically equipotent dose of 150 mg remoxipride. Also, self-rating scales showed that subjective tolerance of remoxipride was partly superior to haloperidol. In general, the results of this study strongly suggest a difference between the psychometric profiles of remoxipride and haloperidol. This difference may be essential for maintaining a high level of compliance, especially in the long-term treatment of psychotic patients.

The dopamine D2 receptor antagonist remoxipride (30 microM) stimulated prolactin release from the prolactin-producing rat pituitary tumour cell strains GH3 and GH4C1 as well as from transfected GH4C1 cells expressing the short isoform of the rat D2 receptor (GH4ZR7). The effect of remoxipride on prolactin release is probably not due to an interaction with D2 receptors since GH4C1 cells, in contrast to GH3 and GH4ZR7 cells, are completely devoid of D2 receptors; in contrast, we have previously shown that the D2 antagonist haloperidol causes prolactin release from D2 receptor-expressing cells, only. Exposure of GH3 cells to the inhibitor of intracellular Ca2+ mobilization, 8-(diethylamino)-octyl 3,4,5-trimethoxybenzoate hydrochloride (TMB-8) prevented the prolactin-releasing effect of remoxipride whereas pretreatment with the membrane Ca2+ channel antagonist nimodipine did not influence the response. The D2 receptor antagonist raclopride counteracted the reduction of VIP-stimulated prolactin release induced by the D2 agonist quinpirole but caused no prolactin release per se.

Remoxipride is a dopamine antagonist with more selective affinity for the mesolimbic dopaminergic system than conventional neuroleptic agents. The possible therapeutic and adverse effects of remoxipride were investigated in 7 adolescents with Tourette's syndrome in an open-label pilot study. The design included a 3-week baseline placebo washin period, an 8-week active treatment period, and a 3-week placebo washout period. Active treatment with remoxipride was administered in the dose range of 50–250 mg daily. Remoxipride treatment improved severity of illness ratings in 6 patients and diminished tic ratings in all 7 patients. During the placebo washout period, all patients deteriorated both on the severity of illness and on the tic ratings. In a sustained attention task, a slight reduction of workpace was observed, but accuracy and stability of performance were not affected. Verbal and visual memory functioning also remained intact. Adverse effects were few and mild in severity. Treatment-emergent nonspecific ST-T changes on the electrocardiogram were found in 3 patients and bradycardia in 2 patients. Although remoxipride has been withdrawn from the market in 1994 because of aplastic anemia, these preliminary findings suggest that Tourette's syndrome in adolescents might be improved by a dopamine antagonist with high specificity for D2 receptors in the mesolimbic system.

The binding of the antipsychotic agent 3 H-remoxipride to membranes of rat liver and brain (whole brain and cerebellum) was studied with filtration technique. Saturable high affinity binding was obtained for all three types of tissue preparations. Heterogenous binding sites were found since various types of compounds inhibited the binding of 3 H-remoxipride with shallow dose-response curves. In the liver preparation it was possible to differentiate between two different binding sites. One site, called rem 1 , was defined with 100 nM alaproclate and bound 2 ligands with high affinity, e.g. haloperidol, GBR 12909, DTG and (+)-3-PPP. High correlation (r=0.93) was obtained between the inhibition of the binding of 3 H-remoxipride to the rem 1 site and the inhibition of the binding of the ligand 3 H-DTG reported previously (Ross 1991), indicating that the rem 1 site is identical to a 2 -like binding site. The other 3 H-remoxipride binding site in the rat liver, rem 2 , appears to be identical to the site binding alaproclate, proadifen and cocaine with high affinity. Cd 2+ and Zn 2+ were potent inhibitors of both binding sites, Cd 2+ particularly of rem 2 binding and Zn 2+ preferably of rem 1 binding. The apparent B max (pmol/g original tissue) and K D (nM) values for rem 2 binding were 441±42 and 80±14, and for rem 2 binding 727±116 and 95±6. The binding of 3 H-remoxipride to the brain preparations was also inhibited with shallow dose-response curves. The B max values for the preparations of whole brain and cerebellum were 67±15 and 71±9 pmol/g original tissues respectively and the K D values were 171±19 and 176±6 nM. The IC 50 of the compounds were highly correlated to the IC 50 values for the rem 1 binding in the liver (r=0.96) and to IC 50 values for the inhibition of 3 H-DTG binding in rat brain reported previously (Ross 1991). Cd 2+ and Zn 2+ ions also inhibited the binding of 3 H-remoxipride in the brain preparation but at higher concentrations compared with the liver preparations. The present results indicate that the main part of the binding in the brain preparations occurs to -like recognition sites

We report four people with human immunodeficiency virus (HIV) infection and mania whose manic symptoms improved when given the atypical antipsychotic agent remoxipride as an adjunct, and in whom traditional neuroleptics were not well tolerated due to marked extrapyramidal side effects. General issues surrounding choice of pharmacological agent in HIV-related mania are discussed.

Fifteen healthy male volunteers received single doses of 100 mg immediate release remoxipride (IR), 150 mg controlled release remoxipride (CR), 50 mg chlorpromazine (CPZ), 2 mg lorazepam (LZ), and placebo in a randomised, five-period cross-over study. Both saccadic (SEM) and smooth pursuit eye movements (SPEM) as well as a battery of psychomotor performance tests were assessed at 1.5-h intervals over 9 h following drug administration. The areas under the response-time curves and the maximum effect during the study period were analysed by analysis of variance. The most consistent impairments were produced by LZ. The neuroleptics caused impairments to SEM, and tended to impair critical flicker fusion, continuous attention and both paced and unpaced versions of the digit-symbol substitution test as well as subjective measures of sedation. Only LZ impaired SPEM. Neither paced nor unpaced psychomotor tests distinguished between neuroleptics and benzodiazepines. The low therapeutic doses of IR and CR produced similar impairments to a sub-therapeutic dose of CPZ. Selectivity of pharmacological action does not appear to predict selectivity of effect on psychomotor function.

Single dose pharmacokinetics and the antipsychotic effect of 4 weeks treatment with three fixed dose levels of remoxipride (a selective D2 receptor antagonist) were studied in chronic, stable schizophrenic inpatients. After a placebo washout of 1 month, 15 patients entered the study. Of these, 11 patients received a single 50 mg oral dose of remoxipride for pharmacokinetic evaluations. All 15 patients were randomly assigned to treatment with oral remoxipride either 25 mg t.i.d., 50 mg t.i.d. or 100 mg t.i.d. for 4 weeks. Blood samples for remoxipride and prolactin assays were taken at 0, 0.33, 0.5, 0.66, 1.0, 1.5, 2, 3, 4, 8, 12, 24, 28, 32 and 48 h after drug intake. The pharmacokinetic characteristics were similar to those previously found in normal healthy volunteers: the mean peak plasma concentration of remoxipride after 50 mg was 3.3 μmol/l, the mean time to reach this was 2.1 h; the mean area under the plasma concentration/time curve was 27.8 μmol/1.h.1 -1 and the mean elimination half-life of remoxipride was 5.5 h. A significant increase in prolactin levels was detected 2 h after administration of remoxipride but they had reverted to normal 8 h after drug intake in all but one patient. Antipsychotic effects were estimated using the brief psychiatric rating scale (BPRS) and the Krawiecka rating scale (KRS) at admission, baseline (end of the 4 week placebo washout period) and after 7, 14 and 28 days treatment. Following an increase in mean psychosis ratings for both positive and negative symptoms during the placebo washout period, these decreased during active treatment and at the end of the study were similar to the scores on admission. Thus the possible efficacy of remoxipride in chronic patients with negative symptoms should be further explored in placebo controlled studies. Remoxipride was well tolerated. Sleep disorders occurred in three patients, extrapyramidal symptoms were not aggravated and no clinically significant effects were observed on the cardiovascular system, in clinical chemistry or haematology.

The aim of this investigation was to develop a mechanism-based pharmacokinetic-pharmacodynamic (PK-PD) model for the biological system prolactin response following a dopamine inhibition challenge using remoxipride as a paradigm compound. After assessment of baseline variation in prolactin concentrations, the prolactin response of remoxipride was measured following (1) single intravenous doses of 4, 8 and 16 mg/kg and (2) following double dosing of 3.8 mg/kg with different time intervals. The mechanistic PK-PD model consisted of: (i) a PK model for remoxipride concentrations in brain extracellular fluid; (ii) a pool model incorporating prolactin synthesis, storage in lactotrophs, release into- and elimination from plasma; (iii) a positive feedback component interconnecting prolactin plasma concentrations and prolactin synthesis; and (iv) a dopamine antagonism component interconnecting remoxipride brain extracellular fluid concentrations and stimulation of prolactin release. The most important findings were that the free brain concentration drives the prolactin release into plasma and that the positive feedback on prolactin synthesis in the lactotrophs, in contrast to the negative feedback in the previous models on the PK-PD correlation of remoxipride. An external validation was performed using a dataset obtained in rats following intranasal administration of 4, 8, or 16 mg/kg remoxipride. Following simulation of human remoxipride brain extracellular fluid concentrations, pharmacodynamic extrapolation from rat to humans was performed, using allometric scaling in combination with independent information on the values of biological system specific parameters as prior knowledge. The PK-PD model successfully predicted the system prolactin response in humans, indicating that positive feedback on prolactin synthesis and allometric scaling thereof could be a new feature in describing complex homeostatic mechanisms.

The effect of various typical (haloperidol) and atypical (clozapine, raclopride, remoxipride) antipsychotics on phencyclidine (PCP)-induced disruption of sensorimotor gating was tested in rats using an acoustic startle paradigm. Clozapine (4-40 mumol/kg), haloperidol (1-5 mumol/kg) and raclopride (1-12 mumol/kg) failed to reverse PCP-induced disruption of prepulse inhibition (PPI) of the acoustic startle response. In contrast, remoxipride (12-60 mumol/kg) caused a dose-dependent block of this effect. PCP-induced disruption of PPI is a widely accepted animal model of a corresponding behavioural deficit observed in schizophrenia although little evidence has been presented that it is in fact sensitive to antipsychotic agents. The present results indicate that remoxipride behaves in a unique way in this model compared to clozapine, haloperidol and raclopride.

Dopamine D 2 receptors were inactivated by N -ethoxycarbony-1,2-ethoxy-1,2-dihydroxyquinoline (EEDQ) (6 mg/kg i.p.). The reduction in dopamine receptors was monitored by quantitative receptor autoradiography using [ 125 I]iodosulpiride or [ 3 H]raclopride as radioligands. Pretreatment of male rats with haloperidol (0.3–3 μmol/kg i.p.) produced a dose-related, complete protection against the decrease in [ 125 I]iodosulpiride binding induced by EEDQ in the dorsal and ventral striata and in all cortical areas examined. Raclopride (0.25–10 μmol/kg i.p.) produced the same pattern of effect as haloperidol but had a weaker effect. In contrast, remoxipride (1–40 μmol/kg i.p. or s.c.) only produced a partial protection against the dopamine D 2 receptor inactivation by EEDQ. The results in the EEDQ test were related to the potency to block d-amphetamine-induced hyperlocomotion and the ability to induce bar-test catalepsy in the rat. The potencies in the behavioural tests were found to correspond to the in vivo occupancy for dopamine D 2 receptors as evaluated by the EEDQ-induced decrease in D 2 binding. However, remoxipride differed from both haloperidol and raclopride by showing a much reduced occupancy of dopamine D 2 receptors at doses with behaviourally equipotent effects. The results support earlier suggestions that remoxipride in vivo may act on a subpopulation of dopamine D 2 receptors.

d-Amphetamine (DEX) and phencyclidine (PCP) increased motor activity in rats as measured in automated activity cages. Analysis of the stimulation indicated that both drugs increased horizontal activity (total activity), locomotion, and peripheral activity. However, DEX increased while PCP decreased the incidence of rearing. The ability of different drugs to antagonise DEX- and PCP-induced increases in total activity (called stimulation) was measured. Dopamine (DA) D1 receptor antagonists (SCH23390, NNC-01-0112) were 7-8 times more potent in blocking DEX than PCP. DA D2 receptor antagonists (raclopride, remoxipride, haloperidol) were only 1-2 times more potent against DEX-induced stimulation. Nonselective DA receptor antagonists were also tested. Chlorpromazine was more potent against DEX than against PCP. Buspirone and sertindole were slightly more potent in blocking PCP than DEX. Ritanserin (5-HT2 receptor antagonist) was inactive against both stimulants. 8-OH-DPAT (5-HT1A receptor agonist) potentiated the stimulant effects of DEX and PCP. Prazosin (alpha 1-adrenergic receptor antagonist) partially blocked both DEX and PCP. Most drugs tested depressed spontaneous motor activity. Remoxipride and sertindole, however, caused very little depression even at doses several times higher than those needed to block DEX or PCP. The data show clear pharmacological differences between DEX- and PCP-induced stimulation.

The potencies of the major neuroleptics used in the treatment of schizophrenia, including haloperidol and remoxipride, correlate with their ability to bind D2-dopaminergic receptors in subcortical structures. On the other hand, the neuroleptic clozapine has a low affinity for these sites, and the pharmacological basis of its beneficial action is less clear. We have found that chronic treatment with clozapine, haloperidol, and remoxipride up-regulates D2 receptors in specific cortical areas of the rhesus monkey frontal, parietal, temporal, and occipital lobes. Of particular interest, all three neuroleptics down-regulated D1 receptors in prefrontal and temporal association regions--the two areas most often associated with schizophrenia. This latter finding raises the possibility that down-regulation of D1 receptors in prefrontal and temporal cortex may be an important component of the therapeutic response to neuroleptic drugs. Further, the common effects of three neuroleptics with different pharmacological profiles in the cerebral cortex is consistent with the idea that this structure is a major therapeutic target in the treatment of schizophrenia.

1. In this study we investigated the effects of dopamine receptor agonists and antagonists on rat striatal synaptosomal aromatic L-amino acid decarboxylase (AADC) activity. 2. The results show that 10(-5)-10(-7) M cis-flupenthixol increased the striatal synaptosomal AADC activity (by 25% to 57%) in a time-dependent manner. SCH 23390 and remoxipride alone had little or no effect on striatal synaptosomal AADC activity, but in combination they increased AADC activity by 20%, suggesting that the increases in striatal synaptosomal AADC activity occurred only after blockade of both dopamine D1 and D2 receptors. 3. Treatment with (+)-amphetamine and (+/-)-2-(N-phenylethyl-N-propyl)amino-5- hydroxytetralin hydrochloride ((+/-)-PPHT) produced a reduction of striatal synaptosomal AADC activity in a concentration- and time-dependent manner. SKF 38393 and (-)-quinpirole, however, exhibited no effect on striatal synaptosomal AADC activity, suggesting that only the mixed dopamine receptor agonists can reduce the AADC activity. Incubation with apomorphine at a concentration of 10(-4) M inhibited the AADC activity by 74% and this inhibition cannot be antagonized by SCH 23390, remoxipride or cis-flupenthixol, suggesting that apomorphine-induced inhibition of striatal synaptosomal AADC activity was not mediated by dopamine receptors. 4. cis-Flupenthixol can reverse the reduction of AADC activity induced by (+)-amphetamine and (+/-)-PPHT. The inhibition of AADC activity elicited by (+/-)-PPHT also can be reversed by SCH 23390 and remoxipride. 5. The inhibition of striatal synaptosomal AADC activity induced by (+/-)-PPHT is calcium-dependent and protein kinase C may play a role in the regulation of striatal AADC activity. 6. These studies show that striatal synaptosomal AADC activity is regulated by dopamine receptors and indicate that in vitro dopamine DI and D2 receptors have a synergistic effect in this regulation.

The quantum mechanical PCILO method has been used to study the conformation of three selective dopamine D2-receptor antagonists: remoxipride, eticlopride and NCQ 115. The calculations were done for both the protonated and ‘free base’ forms of the antagonists. The protonated antagonists all have folded structures due to intramolecular hydrogen bonding between the carbonyl of the amide moiety and the hydrogen on the pyrrolidine nitrogen. The ‘free bases’ on the other hand are characterised by extended structures. An interaction model for these molecules with the dopamine receptor has been proposed.

The dose-dependent and time-dependent effects of the novel antipsychotic compound remoxipride, as well as the reference compounds chlorpromazine, clozapine, haloperidol, pimozide and sulpiride upon the retention of two-way active avoidance (conditioned avoidance responses, CARs) were studied in male rats. The dose-dependent effects of remoxipride as well as haloperidol and chlorpromazine on the acquisition of CARs were also studied. The acquisition and retention of CARs were tested in shuttleboxes using a 1.0-mA shock intensity and a 10-stone signal (1000 Hz). All the compounds studied, including remoxipride, caused a dose-dependent impairment of acquisition and retention of CARs. The effect of remoxipride on CAR acquisition correlated with remoxipride's effectiveness to block the hyperactivity induced by the dopamine (DA) agonist apomorphine. Unlike chlorpromazine and haloperidol, the potency of remoxipride and clozapine for antagonising CAR retention was found at dose levels much lower than those producing cataleptic effects or blocking apomorphine-induced stereotypies. Based on the DA receptor blocking profile and the relative effectiveness to block CAR it is concluded that the mechanism(s) by which clozapine and remoxipride affect CAR differ from typical neuroleptic drugs. This difference may reflect an action upon different subtypes of functionally coupled DA D2 receptors.

Psychotropic drugs can be classified according to their chemical structures, their neurochemical characteristics, their pharmacological effects, and their clinical qualities. A categorization corresponding to their principal fields of indication results in the following classes: antipsychotic drugs, antidepressive drugs, mood stabilizers, antipanic drugs, anxiolytic drugs, anticonvulsant drugs, drugs for movement disorders, and a residual drug class. Both the chemical structure and the pharmacological properties offer clues to subdivide these psychotropic drug classes. This subdividion is clinically relevant as it corresponds to the efficacy in certain psychic and behavioural disorders and also with the occurrence of certain side effects. Desired and undesired effects are discussed in a general sense.

Most patients on neuroleptic therapy experience extrapyramidal symptoms in one form or another during treatment. While the risk of extrapyramidal symptoms appears diminished with the newer and “atypical” neuroleptics (for example, risperidone, remoxipride, clozapine), it is not eliminated. It is essential that the treating clinician monitor for such side effects since if they are left untreated they can be an ongoing source of discomfort to the patient and may affect compliance with therapy. Antiparkinsonian medication represents the mainstay of treatment for neuroleptic-induced extrapyramidal symptoms. Their clinical use is reviewed here with reference to mode of action, indications, choice, side-effects and precautions.

The present study was designed to evaluate the roles of serotonin 5-HT1A and 5-HT2 receptors in the effects of neuroleptic drugs in the paw test. This behavioural test has been shown to model both the antipsychotic efficacy as well as the extrapyramidal side-effect liability of neuroleptic drugs. Whereas the 5-HT1A receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OHDPAT) reduced the effects of the classical neuroleptic haloperidol, it increased the effects of the atypical neuroleptic clozapine. The 5-HT2 receptor antagonist ketanserin as well as the 5-HT1C/5-HT2 receptor antagonist ritanserin, on the other hand reduced the effects of haloperidol, whereas the 5-HT1C/5-HT2 receptor agonist 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) reduced the effects of clozapine. The most important finding, however, was that the behavioural effects of different (putative) neuroleptics (fluphenazine, SCH-39166, remoxipride, prothipendyl, thioridazine and risperidone) were differentially influenced by both 8-OHDPAT and DOI, suggesting that there are important differences between the neuronal mechanisms underlying the behavioural effects of these neuroleptic drugs, even within the subclasses of classical and atypical neuroleptics.

Effects on human performance of remoxipride (RX), an antipsychotic drug of substituted benzamide structure, were studied in a randomized double-blind crossover trial where 12 young healthy volunteers took at 1 week intervals single oral doses of placebo or remoxipiride 100 mg both alone and in combination with 15 mg diazepam (DZ) or 0.8 g/kg ethanol (EtOH). Objective (digit symbols, tracking, choice reaction, flicker fusion, Maddox wing, body balance, memory) and subjective (visual analogue scales, questionnaire) tests were administered at baseline and 1.5, 3, 4.5 and 6 h post-treatment.

For mechanism-based investigations on PK-PD relationships following intranasal administration, the use of advanced animal models and analytical techniques are crucial. As described in this thesis, quantitative information on distinction between extent as well as rate of absorption between nose-to-systemic and nose-to-brain distribution can now be obtained. Using plasma prolactin concentrations as a biomarker for dopamine D2 inhibition, a mechanism-based PK-PD model was developed. Most important aspects in this approach were incorporation of target site exposure (brain extracellular fluid) of remoxipride and a biological system response (positive feedback) mechanism on the synthesis of prolactin, thereby increasing the mechanistic insight in modulation of the dopaminergic system in rats. Simulating remoxipride brain extracellular fluid concentrations in humans, allometric scaling and use of independent information on interspecies differences proved that the structural model is applicable in both rats and man.

The main metabolites of remoxipride formed in rat and man were examined for their affinities for the [3H] SCH 23390-labelled DA D1 and [3H]-raclopride-labelled D2 receptors in rat striatal homogenates. In addition, their effectiveness in blocking postsynaptic DA receptor activity in vivo was measured by the use of several different test models in the male rat. Phenolic metabolites formed mainly in the rat retained (similar to remoxipride) their selectivity for the D2 receptor with very low affinities for the D1 receptor. The pyrrolidone metabolites formed mainly in man showed very low affinities for both the D1 and D2 receptors. The ability of the metabolites to block postsynaptic DA receptor activity in vivo correlated with their affinities for the D2 receptor. Among the metabolites tested, the phenolic compounds FLA 797 (–) and FLA 908 (–) were much more effective than remoxipride in inducing catalepsy, which is consistent with a higher affinity for [3H] raclopride labelled striatal D2 receptors. However, analysis of the effectiveness of the DA receptor blockade (blockade of d-amphetamine locomotion or DA agonist hypothermia) after intraperitoneal or subcutaneous administration suggested that FLA 797 (–)/FLA 908 (–) may only contribute marginally to the D2 receptor-blocking activity of remoxipride in the rat. This conclusion was further supported by the observation that the atypical antipsychotic profile of remoxipride was not mimicked by the active metabolites. The weak DA D2 blocking effect of the pyrrolidone metabolites indicated that remoxipride is responsible for the clinical action.

Several conformationally restricted derivatives of (S)-3-bromo-N-((1-ethyl-2-pyrrolidinyl)methyl)-2,6-dimethoxybenzamide (remoxipride) were synthesized and evaluated in vitro for their ability to inhibit [3H]raclopride binding at the dopamine D-2 receptor. The cyclic benzamides designed to mimic the intramolecular hydrogen bonding of desmethylremoxipride (4, FLA-797) included 2,3-dihydro-4H-1,3-benzoxazin-4-ones, 2,3-dihydro-4H-1,3-benzthiazin-4-ones, phthalimides, 1-isoindolinones, 1,2-benzisothiazol-3(2H)-ones, and 1,2-benzisothiazol-3(2H)-one 1,1-dioxides. In this series, enhanced affinities to the dopamine D-2 receptor were not observed. The phthalimidine analogue 24b ((S)-6-chloro-2-(1-ethylpyrrolidinyl)-1-isoindolinone) exhibited the highest affinity to the dopamine D-2 receptor with an IC50 of 1.3 microM, which was equipotent to remoxipride.

Despite the enormous benefits provided by antipsychotic medication in the management of schizophrenia, available compounds have serious limitations. Firstly, they are not always effective. Secondly, positive psychopathological symptoms may benefit more than negative or deficit symptoms. Thirdly, antipsychotics are generally associated with a variety of neurological adverse effects. Three drugs have recently been or are close to being introduced into widespread clinical use: clozapine, risperidone and remoxipride. Each of these compounds appears to have some advantages over traditional antipsychotic agents, particularly in terms of reduced propensity to induce adverse neurological effects. All three drugs have been shown to be clinically effective in large scale trials. Future clinical trials are required to establish their relative merits in comparison with one another.

Remoxipride and its active metabolites, the phenolic compounds FLA 797(−) and FLA 908(−) and the catecholic NCQ 436(−) and haloperidol, were examined for their ability to block hypothermia in the rat induced by dopamine (DA) D2 receptor stimulation. In addition, plasma levels of remoxipride and its active metabolites were measured using HPLC methods. Remoxipride (1 μmol/kg), given 30 or 15 min prior to, or 5 and 15 min after, the DA agonists, blocked the hypothermia induced by the DA D2 receptor agonists quinpirole (0.25mg/kg s.c.) and pergolide (0.1 mg/kg s.c). Administration of remoxipride by the i.v. or s.c. routes was more effective than by the i.p. route. FLA 797(−), FLA 908(−), and haloperidol were more effective than remoxipride in preventing the hypothermia caused by quinpirole, while NCQ 436(−) was less effective than remoxipride. The variation in time of remoxipride's action and effectiveness in blocking the induced hypothermia followed the variations in plasma concentrations. The plasma concentrations of the active metabolites were below the limit of determination (

The substituted benzamide, remoxipride, is a new atypical antipsychotic agent with good clinical efficacy and low extrapyramidal side-effect potential. In the present study, the in vitro receptor binding properties of remoxipride and several of its metabolites to rat striatal dopamine D2 and cloned human dopamine D2A and D3 receptors were investigated. Remoxipride bound to [3H]raclopride-labelled dopamine D2 receptors in rat striatum with an affinity (Ki) of 113 nM. The significantly lower affinities of remoxipride reported when [3H]spiperone was used as a radioligand are suggested to be due to methodological problems associated with the use of very high-affinity radioligands. Some of the phenolic metabolites of remoxipride found mainly in rat exhibited considerably higher affinities to dopamine D2 and D3 receptors than remoxipride itself. The pyrrolidone metabolites found mainly in the human had very low dopamine D2 and D3 affinities. The present in vitro results suggest that the behavioural effects of remoxipride in rats may reflect the effect of remoxipride and some of its high-affinity metabolites.

Previous experiments have shown that blockade of dopamine D1 or D2 receptors by SCH 23390 or pimozide increases aromatic L-amino acid decarboxylase (AADC) activity in the rat striatum and the mesolimbic system. This study examined whether other dopamine receptor antagonists affect AADC activity and if there is an interaction between dopamine D1 and D2 receptor blockade on AADC activity. The possible effect of dopamine receptor agonists on AADC activity has been investigated as well. Administration of cis-flupenthixol (0.5 and 1 mg/kg) increased striatal AADC activity (by 25 and 26% above controls) and similar effects were observed with remoxipride (0.5-4 mg/kg) (by 18-27% above controls). Pretreatment with cycloheximide (10 mg/kg) did not change the increases produced by cis-flupenthixol (0.5 mg/kg). The administration of non-neuroleptic trans-flupenthixol did not change AADC activity. Combined treatment with SCH 23390 (0.1 mg/kg) and remoxipride (0.5 mg/kg), but not combination of SCH 23390 (0.1 mg/kg) and pimozide (0.3 mg/kg), showed higher increases of AADC activity than by the individual treatments, suggesting an interaction between the effects of the two drugs. Bromocriptine, but not (-)-quinpirole and d-amphetamine, significantly reduced the striatal AADC activity by 23% at the dose of 10 mg/kg. The results further demonstrate that AADC is a regulated enzyme in the rat brain.

The regioselective syntheses of (S)-5-bromo-2,6-dimethoxy-N-[(1-ethyl-2-pyrrolidinyl)methyl]-3-hydroxybenzamide (2) and (S)-5-bromo-N-[(1-ethyl-2-pyrrolidinyl)methyl]-3-hydroxy-6-methoxy- salicylamide (3) from 2,6-dimethoxybenzoic acid and 4-methoxycatechol are described. The latter compound was protected and ortho-lithiated to introduce the carboxyl function in a regioselective manner. Regiocontrol in bromination and demethylation was achieved by introduction of a bulky pivaloyl group. This strategy also enabled the use of a common intermediate as an alternative synthesis of the catechol 3

506 patients with schizophrenia, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, were included in a long term treatment programme with remoxipride, a selective dopamine (D2)-receptor antagonist. This overview includes pooled data from all patients who have been treated long term with remoxipride in clinical trials, focusing on patients treated for more than 6 months (n = 283). Remoxipride was administered in daily doses of 75 to 600mg. The assessment tools were Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Simpson and Angus scale, Abnormal Involuntary Movements Scale (AIMS) for abnormal involuntary movements, adverse events/symptoms using a 26-item checklist, clinical chemistry, and haematology and cardiovas-cular investigations. The majority of patients had a long duration of illness (median 11 years). 67% of patients (340/506) withdrew from treatment before 12 months and 44% (223/506) stopped treatment before 6 months. The median BPRS total score decreased during the first 3 months from 23 to 12, and this level of improvement was maintained throughout the 12-month period. Treatment-emergent adverse events reported by more than 5% of the patients were insomnia, tiredness, drowsiness and tremor in the group treated for 6 to 12 months. No symptoms, including checklist extrapyramidal symptoms (EPS), were reported by more than 5% of patients treated for 12 months. Low frequencies of EPS according to the Simpson and Angus scale were seen in patients treated for more than 6 months (n = 147). A small but statistically significant reduction of the mean total AIMS score from baseline to last rating was observed. There were infrequent changes in heart rate, resting diastolic blood pressure and electrocardiogram (ECG). Clinical chemistry and haematology data showed no evidence of clinically significant changes over time during the 12 months of treatment. Among 506 patients, 7 suicides and 7 suicide attempts occurred during the study period. Other serious adverse events were abnormal liver function test (2 cases), gastrointestinal, urinary retention, status epilepticus (psychotic polydipsia), granulocytopenia (1 each) and myocardial infarction (5 cases). Remoxipride is of potential value as a drug which is both effective and well tolerated in the long term management of patients with schizophrenia.

This article considers the newest agents available for the treatment of schizophrenia in the United States and elsewhere: clozapine, risperidone, and remoxipride. Most attention is provided to clozapine, which represents a major advance for the therapy for treatment-resistant schizophrenia. Risperidone has promise as a first-line drug with advantages in extrapyramidal symptoms (EPS) and possibly efficacy. Remoxipride appears to be a nonsedative antipsychotic with fewer EPS than haloperidol. Other novel drugs in testing also are mentioned.

A controlled release (CR) formulation of remoxipride (Roxiam®, Astra) given once-daily was compared to immediate release (IR) remoxipride given twice-daily, with respect to efficacy and tolerability, in a 4-week multicentre parallel-group dose titration (200-600 mg/day) study with acutely ill schizophrenic patients. Forty- three patients received remoxipride CR (mean dose 344 mg/day) and 49 patients received remoxipride IR (mean dose 346 mg/day). Efficacy was assessed using the Kolakowska version of the Brief Psychiatric Rating Scale (BPRS score of ≥ 18 points at entry) and the Clinical Global Impression scale (CGI), while extrapyramidal symptoms were rated using the Simpson and Angus scale. Both formulations of remoxipride produced clinical improvement, with the BPRS median total score falling from 35 at baseline to 16 at last rating in the remoxipride CR group, and from 33 to 12.5 in the remoxipride IR group. More than 70% of the patients in both groups were assessed as 'much improved' or 'very much improved' according to the CGI scale. Both formulations of remoxipride were well-tolerated, with a low incidence of treatment-emergent adverse symptoms, including extrapyramidal side effects. No statistically significant differences were detected between the treatment groups with regard to efficacy, safety or tolerability.

Twelve healthy male volunteers took part in a double-blind randomised cross-over study composed of three treatment sessions: remoxipride 100 mg; remoxipride 100 mg plus biperiden 4 mg; and biperiden 4 mg. Plasma and urine concentrations of remoxipride and biperiden, plasma prolactin levels, salivary flow and adverse events were recorded to assess pharmacodynamic interactions. Remoxipride and biperiden had no effect on each other's plasma concentrations. Biperiden did not affect the urinary recovery or renal clearance of remoxipride. Prolactin levels were unaffected by biperiden but increased following remoxipride administration. Differences in prolactin Cmax and tmax following remoxipride versus concomitant (remoxipride + biperiden) treatment were not statistically significant. However, a slight but statistically significant (P = 0.04) increase in prolactin AUC was observed after concomitant treatment. No significant differences could be observed between the recorded salivary flow in all the treatment sessions. Single doses of remoxipride and biperiden showed no pharmacokinetic or pharmacodynamic interaction.

Remoxipride, a D2-dopamine receptor antagonist, is well tolerated and completely absorbed after oral administration. Because of its extremely bitter taste, an oral palatable suspension was developed by using a taste-masking microencapsulation. The bioavailability of remoxipride was investigated in two studies in healthy volunteers after administration of a 100-mg dose in suspension. The first study used a capsule as reference, and the second study a plain solution. Taste assessment was carried out in the second study. The extent of bioavailability was the same when comparing the oral suspension to a capsule and to a plain solution. However, the rate of absorption is delayed, and Tmax was 3.0 hr after the suspension, 1.0 hr after the oral solution, and 1.6 hr after the capsule. The release rate in vitro from the suspension was determined by applying the USP-paddle method. By using numerical convolution and deconvolution, the release rates in vivo and in vitro were shown to be similar when using water with 0.5% sodium lauryl sulfate as dissolution liquid. The taste-masked oral suspension is suitable for full-scale production, with good control of the encapsulation process and of the preparation of a suspension.

The retentions and enantiomeric resolutions of remoxipride, propranolol, and trimipramine were studied using a CHIRAL-AGP column with micellar mobile phases and aliphatic, anionic additives. The retentions of the compounds, which in neat buffer solution were very high (k′ > 50), could be decreased to k′ < 10 by adding a mixture of Tween® 20 and heptanoic acid to the mobile phase. The presence of the aliphatic acid was essential in order to increase the enantiomeric selectivity. An efficiency enhancement was obtained by increasing the temperature. With a mobile phase composition optimized for the separation of remoxipride, the possibility of detecting levels of the enantiomeric impurity (R-remoxipride) down to 0.025% in the drug was demonstrated. © 1993 Wiley-Liss, Inc.

Conclusions: The ultimate goal of our study was to determine whether remoxipride had the ability to improve recognition memory in rats. Even if our results did not show any significant enhancement in recognition memory by remoxipride, the up-going trend is evident. Stipulated this tendency is accurate, remoxiprides mechanism of action would be an invaluable tool if implemented in the pharmaceutical industry, as it might enable the development of novel pro-cognitive agents, which in turn may improve the quality of life of millions of patients suffering from schizophrenia.

The tolerance to the prolactin response following administration of antipsychotic drugs has been modelled as a depletion of a prolactin pool (pool model) and a model where the tolerance is explained by a feedback loop including the dopamine interaction of prolactin release (agonist-antagonist interaction model, (AAI model)). The AAI model was superior to the pool model when analyzing data from clinical trials of risperidone and paliperidone. Here we evaluated the two models using the remoxipride data, designed to challenge the short-term prolactin response, from which the original pool model was built.The remoxipride data were collected from a study where eight healthy male subjects received two remoxipride infusions on five occasions. The intervals between the first and second dose on each occasion were 2, 8, 12, 24 and 48 h, respectively. The pool and AAI models were fitted using NONMEM.According to the objective function values the pool model with a circadian rhythm function fitted the data slightly better, while the AAI model was better in describing the circadian rhythm of prolactin. Visual predictive checks revealed that the models predicted the prolactin profiles equally well.According to the analysis performed here, a previous analysis of several clinical studies and literature reports on prolactin concentrations, it appears that the dopamine feedback mechanism included in the AAI model is better than the storage depletion mechanism in the pool model to estimate the bio-rhythm of prolactin time-course and the tolerance development across different populations, drugs, treatment schedules and time.