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{{Short description|Atypical antipsychotic}}
{{Short description|Atypical antipsychotic}}
{{Infobox drug
{{Drugbox
| IUPAC_name = 2-(4-ethylpiperazin-1-yl)-4-(4-fluorophenyl)-5,6,7,8,9,10-hexahydrocycloocta[b]pyridine
| IUPAC_name = 2-(4-ethylpiperazin-1-yl)-4-(4-fluorophenyl)-5,6,7,8,9,10-hexahydrocycloocta[b]pyridine
| image = Blonanserin.svg
| image = Blonanserin.svg
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<!--Pharmacokinetic data-->
<!--Pharmacokinetic data-->
| bioavailability = 55%<ref name = PC>{{cite journal | vauthors = Wen YG, Shang DW, Xie HZ, Wang XP, Ni XJ, Zhang M, Lu W, Qiu C, Liu X, Li FF, Li X, Luo FT | display-authors = 6 | title = Population pharmacokinetics of blonanserin in Chinese healthy volunteers and the effect of the food intake | journal = Human Psychopharmacology | volume = 28 | issue = 2 | pages = 134–141 | date = March 2013 | pmid = 23417765 | doi = 10.1002/hup.2290 | s2cid = 12623938 }}</ref>
| bioavailability = 55%<ref name="wen">{{cite journal | vauthors = Wen YG, Shang DW, Xie HZ, Wang XP, Ni XJ, Zhang M, Lu W, Qiu C, Liu X, Li FF, Li X, Luo FT | display-authors = 6 | title = Population pharmacokinetics of blonanserin in Chinese healthy volunteers and the effect of the food intake | journal = Human Psychopharmacology | volume = 28 | issue = 2 | pages = 134–141 | date = March 2013 | pmid = 23417765 | doi = 10.1002/hup.2290 | s2cid = 12623938 }}</ref>
| metabolism = [[CYP3A4]]<ref name = PC/>
| metabolism = [[CYP3A4]]<ref name="wen"/>
| elimination_half-life = 12 h<ref name = PC/>
| elimination_half-life = 12 h<ref name="wen"/>
| excretion = 59% (urine), 30% (faeces)<ref name = PC/>
| excretion = 59% (urine), 30% (faeces)<ref name="wen"/>


<!--Identifiers-->
<!--Identifiers-->
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}}
}}


'''Blonanserin''', sold under the brand name '''Lonasen''', is a relatively new [[atypical antipsychotic]] (approved by [[Pharmaceuticals and Medical Devices Agency|PMDA]] in January 2008)<ref>{{cite web|url=http://www.pmda.go.jp/english/service/pdf/list/NewdrugsFY2007.pdf |title= FY2007 List of Approved Products: New Drugs | publisher = Pharmaceuticals and Medical Devices Agency | location = Tokyo, Japan |access-date=2013-08-16 |url-status=dead |archive-url=https://web.archive.org/web/20130119182609/http://www.pmda.go.jp/english/service/pdf/list/NewdrugsFY2007.pdf |archive-date=2013-01-19 }}</ref> commercialized by [[Dainippon Sumitomo Pharma]] in [[Japan]] and [[Korea]] for the treatment of [[schizophrenia]].<ref name = "CNS Drugs">{{cite journal | vauthors = Deeks ED, Keating GM | title = Blonanserin: a review of its use in the management of schizophrenia | journal = CNS Drugs | volume = 24 | issue = 1 | pages = 65–84 | date = January 2010 | pmid = 20030420 | doi = 10.2165/11202620-000000000-00000 }}</ref> Relative to many other antipsychotics, blonanserin has an improved [[tolerability]] profile, lacking [[side effect]]s such as [[extrapyramidal symptom]]s, excessive [[sedation]], or [[hypotension]].<ref name="pmid18465651">{{cite journal | vauthors = Heading CE | title = AD-5423 Dainippon Pharmaceutical Co Ltd | journal = IDrugs | volume = 1 | issue = 7 | pages = 813–817 | date = November 1998 | pmid = 18465651 }}</ref> As with many second-generation (atypical) antipsychotics it is significantly more efficacious in the treatment of the [[Schizophrenia|negative symptoms]] of schizophrenia compared to first-generation [[typical antipsychotics|(typical) antipsychotics]] such as [[haloperidol]].<ref name=kishi>{{cite journal | vauthors = Kishi T, Matsuda Y, Nakamura H, Iwata N | title = Blonanserin for schizophrenia: systematic review and meta-analysis of double-blind, randomized, controlled trials | journal = Journal of Psychiatric Research | volume = 47 | issue = 2 | pages = 149–154 | date = February 2013 | pmid = 23131856 | doi = 10.1016/j.jpsychires.2012.10.011 }}</ref>
'''Blonanserin''', sold under the brand name '''Lonasen''', is a relatively new [[atypical antipsychotic]] (approved by [[Pharmaceuticals and Medical Devices Agency|PMDA]] in January 2008)<ref>{{cite web|url=http://www.pmda.go.jp/english/service/pdf/list/NewdrugsFY2007.pdf |title= FY2007 List of Approved Products: New Drugs | publisher = Pharmaceuticals and Medical Devices Agency | location = Tokyo, Japan |access-date=2013-08-16 |url-status=dead |archive-url=https://web.archive.org/web/20130119182609/http://www.pmda.go.jp/english/service/pdf/list/NewdrugsFY2007.pdf |archive-date=2013-01-19 }}</ref> commercialized by [[Dainippon Sumitomo Pharma]] in [[Japan]] and [[Korea]] for the treatment of [[schizophrenia]].<ref name = "CNS Drugs">{{cite journal | vauthors = Deeks ED, Keating GM | title = Blonanserin: a review of its use in the management of schizophrenia | journal = CNS Drugs | volume = 24 | issue = 1 | pages = 65–84 | date = January 2010 | pmid = 20030420 | doi = 10.2165/11202620-000000000-00000 | s2cid = 23464075 }}</ref> Relative to many other antipsychotics, blonanserin has an improved [[tolerability]] profile, lacking [[side effect]]s such as [[extrapyramidal symptom]]s, excessive [[sedation]], or [[hypotension]].<ref name="pmid18465651">{{cite journal | vauthors = Heading CE | title = AD-5423 Dainippon Pharmaceutical Co Ltd | journal = IDrugs | volume = 1 | issue = 7 | pages = 813–817 | date = November 1998 | pmid = 18465651 }}</ref> As with many second-generation (atypical) antipsychotics it is significantly more efficacious in the treatment of the [[Schizophrenia|negative symptoms]] of schizophrenia compared to first-generation [[typical antipsychotics|(typical) antipsychotics]] such as [[haloperidol]].<ref name=kishi>{{cite journal | vauthors = Kishi T, Matsuda Y, Nakamura H, Iwata N | title = Blonanserin for schizophrenia: systematic review and meta-analysis of double-blind, randomized, controlled trials | journal = Journal of Psychiatric Research | volume = 47 | issue = 2 | pages = 149–154 | date = February 2013 | pmid = 23131856 | doi = 10.1016/j.jpsychires.2012.10.011 }}</ref>


{{TOC limit|3}}
{{TOC limit|3}}
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===Pharmacodynamics===
===Pharmacodynamics===
Blonanserin acts as a mixed [[5-HT2A receptor|5-HT<sub>2A</sub>]] (K<sub>i</sub> = 0.812 nM) and [[D2 receptor|D<sub>2</sub> receptor]] (K<sub>i</sub> = 0.142&nbsp;nM) [[receptor antagonist|antagonist]] and also exerts some blockade of [[alpha-1 adrenergic receptor|α<sub>1</sub>-adrenergic receptor]]s (K<sub>i</sub> = 26.7&nbsp;nM).<ref name = NDT>{{cite journal | vauthors = Tenjin T, Miyamoto S, Ninomiya Y, Kitajima R, Ogino S, Miyake N, Yamaguchi N | title = Profile of blonanserin for the treatment of schizophrenia | journal = Neuropsychiatric Disease and Treatment | volume = 9 | pages = 587–594 | year = 2013 | pmid = 23766647 | pmc = 3677929 | doi = 10.2147/NDT.S34433 }}</ref><ref name="pmid8093723">{{cite journal | vauthors = Oka M, Noda Y, Ochi Y, Furukawa K, Une T, Kurumiya S, Hino K, Karasawa T | display-authors = 6 | title = Pharmacological profile of AD-5423, a novel antipsychotic with both potent dopamine-D2 and serotonin-S2 antagonist properties | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 264 | issue = 1 | pages = 158–165 | date = January 1993 | pmid = 8093723 | url = http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=8093723 }}</ref> Blonanserin also shows significant affinity for the [[Dopamine receptor D3|D<sub>3</sub> receptor]] (K<sub>i</sub> = 0.494 nM).<ref name=hida>{{cite journal | vauthors = Hida H, Mouri A, Mori K, Matsumoto Y, Seki T, Taniguchi M, Yamada K, Iwamoto K, Ozaki N, Nabeshima T, Noda Y | display-authors = 6 | title = Blonanserin ameliorates phencyclidine-induced visual-recognition memory deficits: the complex mechanism of blonanserin action involving D₃-5-HT₂A and D₁-NMDA receptors in the mPFC | journal = Neuropsychopharmacology | volume = 40 | issue = 3 | pages = 601–613 | date = February 2015 | pmid = 25120077 | pmc = 4289947 | doi = 10.1038/npp.2014.207 }}</ref> It lacks significant [[affinity (pharmacology)|affinity]] for numerous other sites including the [[5-HT1A receptor|5-HT<sub>1A</sub>]], [[5-HT3 receptor|5-HT<sub>3</sub>]], [[D1 receptor|D<sub>1</sub>]], [[alpha-2 adrenergic receptor|α<sub>2</sub>-adrenergic]], [[beta-adrenergic receptor|β-adrenergic]], [[H1 receptor|H<sub>1</sub>]], and [[muscarinic acetylcholine receptor|mACh receptor]]s and the [[monoamine transporter]]s,<ref name="pmid8093723"/> though it does possess low affinity for the [[sigma receptor]] (IC<sub>50</sub> = 286 nM).<ref name="pmid8093723"/>
Blonanserin acts as a mixed [[5-HT2A receptor|5-HT<sub>2A</sub>]] (K<sub>i</sub> = 0.812 nM) and [[D2 receptor|D<sub>2</sub> receptor]] (K<sub>i</sub> = 0.142&nbsp;nM) [[receptor antagonist|antagonist]] and also exerts some blockade of [[alpha-1 adrenergic receptor|α<sub>1</sub>-adrenergic receptor]]s (K<sub>i</sub> = 26.7&nbsp;nM).<ref name = NDT>{{cite journal | vauthors = Tenjin T, Miyamoto S, Ninomiya Y, Kitajima R, Ogino S, Miyake N, Yamaguchi N | title = Profile of blonanserin for the treatment of schizophrenia | journal = Neuropsychiatric Disease and Treatment | volume = 9 | pages = 587–594 | year = 2013 | pmid = 23766647 | pmc = 3677929 | doi = 10.2147/NDT.S34433 | doi-access = free }}</ref><ref name="pmid8093723">{{cite journal | vauthors = Oka M, Noda Y, Ochi Y, Furukawa K, Une T, Kurumiya S, Hino K, Karasawa T | display-authors = 6 | title = Pharmacological profile of AD-5423, a novel antipsychotic with both potent dopamine-D2 and serotonin-S2 antagonist properties | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 264 | issue = 1 | pages = 158–165 | date = January 1993 | pmid = 8093723 | url = http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=8093723 }}</ref> Blonanserin also shows significant affinity for the [[Dopamine receptor D3|D<sub>3</sub> receptor]] (K<sub>i</sub> = 0.494 nM).<ref name=hida>{{cite journal | vauthors = Hida H, Mouri A, Mori K, Matsumoto Y, Seki T, Taniguchi M, Yamada K, Iwamoto K, Ozaki N, Nabeshima T, Noda Y | display-authors = 6 | title = Blonanserin ameliorates phencyclidine-induced visual-recognition memory deficits: the complex mechanism of blonanserin action involving D₃-5-HT₂A and D₁-NMDA receptors in the mPFC | journal = Neuropsychopharmacology | volume = 40 | issue = 3 | pages = 601–613 | date = February 2015 | pmid = 25120077 | pmc = 4289947 | doi = 10.1038/npp.2014.207 }}</ref> It lacks significant [[affinity (pharmacology)|affinity]] for numerous other sites including the [[5-HT1A receptor|5-HT<sub>1A</sub>]], [[5-HT3 receptor|5-HT<sub>3</sub>]], [[D1 receptor|D<sub>1</sub>]], [[alpha-2 adrenergic receptor|α<sub>2</sub>-adrenergic]], [[beta-adrenergic receptor|β-adrenergic]], [[H1 receptor|H<sub>1</sub>]], and [[muscarinic acetylcholine receptor|mACh receptor]]s and the [[monoamine transporter]]s,<ref name="pmid8093723"/> though it does possess low affinity for the [[sigma receptor]] (IC<sub>50</sub> = 286 nM).<ref name="pmid8093723"/>


Blonanserin has a relatively high affinity towards the [[5-HT6 receptor|5-HT<sub>6</sub> receptor]] perhaps underpinning its recently unveiled efficacy in treating the cognitive symptoms of schizophrenia.<ref name = NDT/><ref>{{cite journal | vauthors = Tenjin T, Miyamoto S, Miyake N, Ogino S, Kitajima R, Ojima K, Arai J, Teramoto H, Tsukahara S, Ito Y, Tadokoro M, Anai K, Funamoto Y, Kaneda Y, Sumiyoshi T, Yamaguchi N | display-authors = 6 | title = Effect of blonanserin on cognitive function in antipsychotic-naïve first-episode schizophrenia | journal = Human Psychopharmacology | volume = 27 | issue = 1 | pages = 90–100 | date = January 2012 | pmid = 22278973 | doi = 10.1002/hup.1276 | s2cid = 205925034 }}</ref> The efficacy of blonanserin can in part be attributed to its chemical structure, which is unique from those of other atypical antipsychotics.<ref name=suzuki>{{cite journal | vauthors = Suzuki K, Hiyama Y, Une T, Fujiwara I | title = Crystal structure of an antipsychotic agent, 2-(4-ethyl-1-piperazinyl)-4-(4-fluorophenyl)-5,6,7,8,9,10-hexahydrocycloocta[b]pyridine (blonanserin) | journal = Analytical Sciences | volume = 18 | issue = 11 | pages = 1289–1290 | date = November 2002 | pmid = 12458724 | doi = 10.2116/analsci.18.1289 | doi-access = free }}</ref> Specifically, the addition of hydroxyl groups to blonanserin's unique eight membered ring results in the (R) stereoisomer of the compound demonstrating increased affinity for the indicated targets.<ref>{{cite journal | vauthors = Ochi T, Sakamoto M, Minamida A, Suzuki K, Ueda T, Une T, Toda H, Matsumoto K, Terauchi Y | display-authors = 6 | title = Syntheses and properties of the major hydroxy metabolites in humans of blonanserin AD-5423, a novel antipsychotic agent | journal = Bioorganic & Medicinal Chemistry Letters | volume = 15 | issue = 4 | pages = 1055–1059 | date = February 2005 | pmid = 15686911 | doi = 10.1016/j.bmcl.2004.12.028 }}</ref>
Blonanserin has a relatively high affinity towards the [[5-HT6 receptor|5-HT<sub>6</sub> receptor]] perhaps underpinning its recently unveiled efficacy in treating the cognitive symptoms of schizophrenia.<ref name = NDT/> The efficacy of blonanserin can in part be attributed to its chemical structure, which is unique from those of other atypical antipsychotics.<ref name=suzuki>{{cite journal | vauthors = Suzuki K, Hiyama Y, Une T, Fujiwara I | title = Crystal structure of an antipsychotic agent, 2-(4-ethyl-1-piperazinyl)-4-(4-fluorophenyl)-5,6,7,8,9,10-hexahydrocycloocta[b]pyridine (blonanserin) | journal = Analytical Sciences | volume = 18 | issue = 11 | pages = 1289–1290 | date = November 2002 | pmid = 12458724 | doi = 10.2116/analsci.18.1289 | doi-access = free }}</ref> Specifically, the addition of hydroxyl groups to blonanserin's unique eight membered ring results in the (R) stereoisomer of the compound demonstrating increased affinity for the indicated targets.<ref>{{cite journal | vauthors = Ochi T, Sakamoto M, Minamida A, Suzuki K, Ueda T, Une T, Toda H, Matsumoto K, Terauchi Y | display-authors = 6 | title = Syntheses and properties of the major hydroxy metabolites in humans of blonanserin AD-5423, a novel antipsychotic agent | journal = Bioorganic & Medicinal Chemistry Letters | volume = 15 | issue = 4 | pages = 1055–1059 | date = February 2005 | pmid = 15686911 | doi = 10.1016/j.bmcl.2004.12.028 }}</ref>


{| class="wikitable sortable"
{| class="wikitable sortable"
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====Action at the Dopamine-D<sub>3</sub> receptor====
====Action at the Dopamine-D<sub>3</sub> receptor====
Blonanserin has antagonistic action at dopamine-D<sub>3</sub> receptors that potentiates [[phosphorylation]] levels of [[Protein kinase A]] (PKA) and counteracts decreased activity at the dopamine-D<sub>1</sub> and/or [[NMDA]] receptors, thus potentiating [[GABA]] induced Cl- currents.<ref name=hida/><ref name=yokota>{{cite journal | vauthors = Yokota K, Tatebayashi H, Matsuo T, Shoge T, Motomura H, Matsuno T, Fukuda A, Tashiro N | display-authors = 6 | title = The effects of neuroleptics on the GABA-induced Cl- current in rat dorsal root ganglion neurons: differences between some neuroleptics | journal = British Journal of Pharmacology | volume = 135 | issue = 6 | pages = 1547–1555 | date = March 2002 | pmid = 11906969 | pmc = 1573270 | doi = 10.1038/sj.bjp.0704608 }}</ref> [[Olanzapine]] does not appear to affect PKA activity.<ref name=hida/><ref>{{cite journal | vauthors = Nagai T, Noda Y, Une T, Furukawa K, Furukawa H, Kan QM, Nabeshima T | title = Effect of AD-5423 on animal models of schizophrenia: phencyclidine-induced behavioral changes in mice | journal = Neuroreport | volume = 14 | issue = 2 | pages = 269–272 | date = February 2003 | pmid = 12598744 | doi = 10.1097/00001756-200302100-00023 | s2cid = 41717348 }}</ref> Many antipsychotics, such as haloperidol, [[chlorpromazine]], [[risperidone]] and olanzapine primarily antagonize serotonin 5-HT2A and dopamine-D<sub>2</sub> receptors and lack known action at dopamine-D<sub>2/3</sub> receptors.<ref name=hida/><ref name=suzuki/>
Blonanserin has antagonistic action at dopamine-D<sub>3</sub> receptors that potentiates [[phosphorylation]] levels of [[Protein kinase A]] (PKA) and counteracts decreased activity at the dopamine-D<sub>1</sub> and/or [[NMDA]] receptors, thus potentiating [[GABA]] induced Cl- currents.<ref name=hida/><ref name=yokota>{{cite journal | vauthors = Yokota K, Tatebayashi H, Matsuo T, Shoge T, Motomura H, Matsuno T, Fukuda A, Tashiro N | display-authors = 6 | title = The effects of neuroleptics on the GABA-induced Cl- current in rat dorsal root ganglion neurons: differences between some neuroleptics | journal = British Journal of Pharmacology | volume = 135 | issue = 6 | pages = 1547–1555 | date = March 2002 | pmid = 11906969 | pmc = 1573270 | doi = 10.1038/sj.bjp.0704608 }}</ref> [[Olanzapine]] does not appear to affect PKA activity.<ref name=hida/><ref>{{cite journal | vauthors = Nagai T, Noda Y, Une T, Furukawa K, Furukawa H, Kan QM, Nabeshima T | title = Effect of AD-5423 on animal models of schizophrenia: phencyclidine-induced behavioral changes in mice | journal = NeuroReport | volume = 14 | issue = 2 | pages = 269–272 | date = February 2003 | pmid = 12598744 | doi = 10.1097/00001756-200302100-00023 | s2cid = 41717348 }}</ref> Many antipsychotics, such as haloperidol, [[chlorpromazine]], [[risperidone]] and olanzapine primarily antagonize serotonin 5-HT2A and dopamine-D<sub>2</sub> receptors and lack known action at dopamine-D<sub>2/3</sub> receptors.<ref name=hida/><ref name=suzuki/>


{| class="wikitable"
{| class="wikitable"
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===Pharmacokinetics===
===Pharmacokinetics===
Blonanserin is administered 4&nbsp;mg orally 2 times a day or 8&nbsp;mg once a day, for an adult male with a body mass index between 19–24&nbsp;kg/m<sup>2</sup> and a body weight equal to or greater than 50&nbsp;kg.<ref name = chen>{{cite journal | vauthors = Chen X, Wang H, Jiang J, Chen R, Zhou Y, Zhong W, Liu H, Hu P | display-authors = 6 | title = The pharmacokinetic and safety profiles of blonanserin in healthy Chinese volunteers after single fasting doses and single and multiple postprandial doses | journal = Clinical Drug Investigation | volume = 34 | issue = 3 | pages = 213–222 | date = March 2014 | pmid = 24399453 | doi = 10.1007/s40261-013-0167-9 | s2cid = 35831132 }}</ref> The drug is absorbed by a two compartment (central and peripheral) model with first-order absorption and elimination.<ref name=wen>{{cite journal | vauthors = Wen YG, Shang DW, Xie HZ, Wang XP, Ni XJ, Zhang M, Lu W, Qiu C, Liu X, Li FF, Li X, Luo FT | display-authors = 6 | title = Population pharmacokinetics of blonanserin in Chinese healthy volunteers and the effect of the food intake | journal = Human Psychopharmacology | volume = 28 | issue = 2 | pages = 134–141 | date = March 2013 | pmid = 23417765 | doi = 10.1002/hup.2290 | s2cid = 12623938 }}</ref> The [[half-life]] of blonanserin is dependent on the dose. A single dose of 4&nbsp;mg has a half-life of 7.7 ± 4.63 h and a single dose of 8&nbsp;mg has a half-life of 11.9 ± 4.3 h.<ref name=chen/> The increase of half-life with dose is possibly attributed to there being more individual concentration per time points below the lower limit necessary for quantification in the lower single dose.<ref name=chen/>
Blonanserin is administered 4&nbsp;mg orally twice a day or 8&nbsp;mg once a day, for an adult male with a body mass index between 19–24&nbsp;kg/m<sup>2</sup> and a body weight equal to or greater than 50&nbsp;kg.<ref name = chen>{{cite journal | vauthors = Chen X, Wang H, Jiang J, Chen R, Zhou Y, Zhong W, Liu H, Hu P | display-authors = 6 | title = The pharmacokinetic and safety profiles of blonanserin in healthy Chinese volunteers after single fasting doses and single and multiple postprandial doses | journal = Clinical Drug Investigation | volume = 34 | issue = 3 | pages = 213–222 | date = March 2014 | pmid = 24399453 | doi = 10.1007/s40261-013-0167-9 | s2cid = 35831132 }}</ref> The drug is absorbed by a two compartment (central and peripheral) model with first-order absorption and elimination.<ref name=wen>{{cite journal | vauthors = Wen YG, Shang DW, Xie HZ, Wang XP, Ni XJ, Zhang M, Lu W, Qiu C, Liu X, Li FF, Li X, Luo FT | display-authors = 6 | title = Population pharmacokinetics of blonanserin in Chinese healthy volunteers and the effect of the food intake | journal = Human Psychopharmacology | volume = 28 | issue = 2 | pages = 134–141 | date = March 2013 | pmid = 23417765 | doi = 10.1002/hup.2290 | s2cid = 12623938 }}</ref> The [[half-life]] of blonanserin is dependent on the dose. A single dose of 4&nbsp;mg has a half-life of {{nobr|7.7 ± 4.63 h}} and a single dose of 8&nbsp;mg has a half-life of {{nobr|11.9 ± 4.3 h}}.<ref name=chen/> The increase of half-life with dose is possibly attributed to there being more individual concentration per time points below the lower limit necessary for quantification in the lower single dose.<ref name=chen/>


Blonanserin is not a charged compound and exhibits very little [[chemical polarity]]. The [[polar surface area]] of Blonanserin is 19.7 Å<ref name=chem>{{cite web|url=https://pubchem.ncbi.nlm.nih.gov/compound/Blonanserin|title=Blonanserin | work = PubMed | publisher = U.S. National Library of Medicine }}</ref> It is commonly accepted that a compound needs to have polar surface area less than 90 Å to cross the [[blood brain barrier]] so blonanserin is expected to be quite permeable as is demonstrated by a high brain/ plasma ratio of 3.88.<ref>{{cite journal | vauthors = Tateno A, Arakawa R, Okumura M, Fukuta H, Honjo K, Ishihara K, Nakamura H, Kumita S, Okubo Y | display-authors = 6 | title = Striatal and extrastriatal dopamine D2 receptor occupancy by a novel antipsychotic, blonanserin: a PET study with [11C]raclopride and [11C]FLB 457 in schizophrenia | journal = Journal of Clinical Psychopharmacology | volume = 33 | issue = 2 | pages = 162–169 | date = April 2013 | pmid = 23422369 | doi = 10.1097/jcp.0b013e3182825bce | s2cid = 33775568 }}</ref>
Blonanserin is not a charged compound and exhibits very little [[chemical polarity]]. The [[polar surface area]] of Blonanserin is 19.7&nbsp;Å<ref name=chem>{{cite web|url=https://pubchem.ncbi.nlm.nih.gov/compound/Blonanserin|title=Blonanserin | work = PubMed | publisher = U.S. National Library of Medicine }}</ref> It is commonly accepted that a compound needs to have polar surface area less than 90&nbsp;Å to cross the [[blood brain barrier]] so blonanserin is expected to be quite permeable as is demonstrated by a high brain/ plasma ratio of 3.88.<ref>{{cite journal | vauthors = Tateno A, Arakawa R, Okumura M, Fukuta H, Honjo K, Ishihara K, Nakamura H, Kumita S, Okubo Y | display-authors = 6 | title = Striatal and extrastriatal dopamine D2 receptor occupancy by a novel antipsychotic, blonanserin: a PET study with [11C]raclopride and [11C]FLB 457 in schizophrenia | journal = Journal of Clinical Psychopharmacology | volume = 33 | issue = 2 | pages = 162–169 | date = April 2013 | pmid = 23422369 | doi = 10.1097/jcp.0b013e3182825bce | s2cid = 33775568 }}</ref>


Due to the good permeability of blonanserin, the [[volume of distribution]] in the [[central nervous system]] is greater than that in the periphery (Vd central = 9500 L, Vd periphery = 8650 L) although it is slower to absorb into the central compartment.<ref name=wen/>
Due to the good permeability of blonanserin, the [[volume of distribution]] in the [[central nervous system]] is greater than that in the periphery (Vd central = 9500&nbsp;L, Vd periphery = 8650&nbsp;L) although it is slower to absorb into the central compartment.<ref name=wen/>


Blonanserin does not meet the criteria in [[Lipinski's rule of five]].<ref name=chem/>
Blonanserin does not meet the criteria in [[Lipinski's rule of five]].<ref name=chem/>


====Effects of food intake====
====Effects of food intake====
Food intake slows the absorption of blonanserin and increases the bioavailability peripherally relative to centrally.<ref name=wen/> Single fasting doses are safe and the effects of feeding intake are possibly explained by an interaction between blonanserin and [[CYP3A4|Cytochrome P450 3A4]] in the gut.<ref name=chen/>
Food intake slows the absorption of blonanserin and increases the bioavailability peripherally relative to centrally.<ref name=wen/> Single fasting doses are safe and the effects of feeding intake are possibly explained by an interaction between blonanserin and [[CYP3A4|cytochrome P450 3A4]] in the gut.<ref name=chen/>


== See also ==
== See also ==
* [[Dopamine receptor D3|Dopamine Receptor D<sub>3</sub>]]
* [[Dopamine receptor D3|Dopamine receptor D<sub>3</sub>]]
* [[Lipinski's rule of five]]
* [[Lipinski's rule of five]]


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[[Category:D2 antagonists]]
[[Category:D2 antagonists]]
[[Category:D3 antagonists]]
[[Category:D3 antagonists]]
[[Category:Fluoroarenes]]
[[Category:4-Fluorophenyl compounds]]
[[Category:Piperazines]]
[[Category:Piperazines]]

Latest revision as of 09:30, 29 October 2024

Blonanserin
Clinical data
Trade namesLonasen
Routes of
administration		By mouth
ATC code
  • none
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability55%[1]
MetabolismCYP3A4[1]
Elimination half-life12 h[1]
Excretion59% (urine), 30% (faeces)[1]
Identifiers
  • 2-(4-ethylpiperazin-1-yl)-4-(4-fluorophenyl)-5,6,7,8,9,10-hexahydrocycloocta[b]pyridine
CAS Number
PubChem CID
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.211.656 Edit this at Wikidata
Chemical and physical data
FormulaC23H30FN3
Molar mass367.512 g·mol−1
3D model (JSmol)
  • Fc1ccc(cc1)c2cc(nc3c2CCCCCC3)N4CCN(CC)CC4

Blonanserin, sold under the brand name Lonasen, is a relatively new atypical antipsychotic (approved by PMDA in January 2008)[2] commercialized by Dainippon Sumitomo Pharma in Japan and Korea for the treatment of schizophrenia.[3] Relative to many other antipsychotics, blonanserin has an improved tolerability profile, lacking side effects such as extrapyramidal symptoms, excessive sedation, or hypotension.[4] As with many second-generation (atypical) antipsychotics it is significantly more efficacious in the treatment of the negative symptoms of schizophrenia compared to first-generation (typical) antipsychotics such as haloperidol.[5]

Medical uses

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Blonanserin is used to treat schizophrenia in Japan and South Korea but not in the US.[6]

Adverse effects

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As with many of the atypical antipsychotics, blonanserin can elicit cardio metabolic risks. While the side effects of blonanserin – such as weight gain, cholesterol and triglyceride levels, glucose levels and other blood lipid levels – do not differ greatly from other atypical antipsychotics, the specificity of blonanserin appears to elicit milder side effects, with less weight gain in particular.[5]

Pharmacology

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Pharmacodynamics

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Blonanserin acts as a mixed 5-HT2A (Ki = 0.812 nM) and D2 receptor (Ki = 0.142 nM) antagonist and also exerts some blockade of α1-adrenergic receptors (Ki = 26.7 nM).[7][8] Blonanserin also shows significant affinity for the D3 receptor (Ki = 0.494 nM).[9] It lacks significant affinity for numerous other sites including the 5-HT1A, 5-HT3, D1, α2-adrenergic, β-adrenergic, H1, and mACh receptors and the monoamine transporters,[8] though it does possess low affinity for the sigma receptor (IC50 = 286 nM).[8]

Blonanserin has a relatively high affinity towards the 5-HT6 receptor perhaps underpinning its recently unveiled efficacy in treating the cognitive symptoms of schizophrenia.[7] The efficacy of blonanserin can in part be attributed to its chemical structure, which is unique from those of other atypical antipsychotics.[10] Specifically, the addition of hydroxyl groups to blonanserin's unique eight membered ring results in the (R) stereoisomer of the compound demonstrating increased affinity for the indicated targets.[11]

Receptor Ki [nM] (Blonanserin)* [7] Ki [nM] (N-deethylblonanserin)* [3]
D1 1070 1020
D2 0.142 1.38
D3 0.494 0.23
D4 150 -
D5 2600 -
5-HT1A 804 -
5-HT2A 0.812 1.28
5-HT2C 26.4 4.50
5-HT6 11.7 5.03
5-HT7 183 -
α1 26.7 (Rat brain) 206 (Rat receptor)
α2 530 (Rat cloned) -
M1 100 -
H1 765 -

* Towards human receptors unless otherwise specified.

Action at the Dopamine-D3 receptor

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Blonanserin has antagonistic action at dopamine-D3 receptors that potentiates phosphorylation levels of Protein kinase A (PKA) and counteracts decreased activity at the dopamine-D1 and/or NMDA receptors, thus potentiating GABA induced Cl- currents.[9][12] Olanzapine does not appear to affect PKA activity.[9][13] Many antipsychotics, such as haloperidol, chlorpromazine, risperidone and olanzapine primarily antagonize serotonin 5-HT2A and dopamine-D2 receptors and lack known action at dopamine-D2/3 receptors.[9][10]

Blonanserin Cartoon
Blonanserin action at dopamine-D3 receptor. Cartoon of blonanserin's antagonistic impact at the dopamine-D3 receptor, reversing inhibition of PKA activity (also regulated by dopamine-D1 and NMDA activity) thus potentiating GABA induced Cl- current. Inset illustrates uninterrupted dopamine (DA) activity at the dopamine-D3 receptor. Inspired by Hida et al. (2014) and Yokota et al. (2002).[9][12]

Pharmacokinetics

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Blonanserin is administered 4 mg orally twice a day or 8 mg once a day, for an adult male with a body mass index between 19–24 kg/m2 and a body weight equal to or greater than 50 kg.[14] The drug is absorbed by a two compartment (central and peripheral) model with first-order absorption and elimination.[1] The half-life of blonanserin is dependent on the dose. A single dose of 4 mg has a half-life of 7.7 ± 4.63 h and a single dose of 8 mg has a half-life of 11.9 ± 4.3 h.[14] The increase of half-life with dose is possibly attributed to there being more individual concentration per time points below the lower limit necessary for quantification in the lower single dose.[14]

Blonanserin is not a charged compound and exhibits very little chemical polarity. The polar surface area of Blonanserin is 19.7 Å[15] It is commonly accepted that a compound needs to have polar surface area less than 90 Å to cross the blood brain barrier so blonanserin is expected to be quite permeable as is demonstrated by a high brain/ plasma ratio of 3.88.[16]

Due to the good permeability of blonanserin, the volume of distribution in the central nervous system is greater than that in the periphery (Vd central = 9500 L, Vd periphery = 8650 L) although it is slower to absorb into the central compartment.[1]

Blonanserin does not meet the criteria in Lipinski's rule of five.[15]

Effects of food intake

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Food intake slows the absorption of blonanserin and increases the bioavailability peripherally relative to centrally.[1] Single fasting doses are safe and the effects of feeding intake are possibly explained by an interaction between blonanserin and cytochrome P450 3A4 in the gut.[14]

See also

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References

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  1. ^ a b c d e f g Wen YG, Shang DW, Xie HZ, Wang XP, Ni XJ, Zhang M, et al. (March 2013). "Population pharmacokinetics of blonanserin in Chinese healthy volunteers and the effect of the food intake". Human Psychopharmacology. 28 (2): 134–141. doi:10.1002/hup.2290. PMID 23417765. S2CID 12623938.
  2. ^ "FY2007 List of Approved Products: New Drugs" (PDF). Tokyo, Japan: Pharmaceuticals and Medical Devices Agency. Archived from the original (PDF) on 2013-01-19. Retrieved 2013-08-16.
  3. ^ a b Deeks ED, Keating GM (January 2010). "Blonanserin: a review of its use in the management of schizophrenia". CNS Drugs. 24 (1): 65–84. doi:10.2165/11202620-000000000-00000. PMID 20030420. S2CID 23464075.
  4. ^ Heading CE (November 1998). "AD-5423 Dainippon Pharmaceutical Co Ltd". IDrugs. 1 (7): 813–817. PMID 18465651.
  5. ^ a b Kishi T, Matsuda Y, Nakamura H, Iwata N (February 2013). "Blonanserin for schizophrenia: systematic review and meta-analysis of double-blind, randomized, controlled trials". Journal of Psychiatric Research. 47 (2): 149–154. doi:10.1016/j.jpsychires.2012.10.011. PMID 23131856.
  6. ^ Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU (2013). "Asenapine, blonanserin, iloperidone, lurasidone, and sertindole: distinctive clinical characteristics of 5 novel atypical antipsychotics". Clinical Neuropharmacology. 36 (6): 223–238. doi:10.1097/wnf.0b013e3182aa38c4. PMID 24201235. S2CID 21426260.
  7. ^ a b c Tenjin T, Miyamoto S, Ninomiya Y, Kitajima R, Ogino S, Miyake N, Yamaguchi N (2013). "Profile of blonanserin for the treatment of schizophrenia". Neuropsychiatric Disease and Treatment. 9: 587–594. doi:10.2147/NDT.S34433. PMC 3677929. PMID 23766647.
  8. ^ a b c Oka M, Noda Y, Ochi Y, Furukawa K, Une T, Kurumiya S, et al. (January 1993). "Pharmacological profile of AD-5423, a novel antipsychotic with both potent dopamine-D2 and serotonin-S2 antagonist properties". The Journal of Pharmacology and Experimental Therapeutics. 264 (1): 158–165. PMID 8093723.
  9. ^ a b c d e Hida H, Mouri A, Mori K, Matsumoto Y, Seki T, Taniguchi M, et al. (February 2015). "Blonanserin ameliorates phencyclidine-induced visual-recognition memory deficits: the complex mechanism of blonanserin action involving D₃-5-HT₂A and D₁-NMDA receptors in the mPFC". Neuropsychopharmacology. 40 (3): 601–613. doi:10.1038/npp.2014.207. PMC 4289947. PMID 25120077.
  10. ^ a b Suzuki K, Hiyama Y, Une T, Fujiwara I (November 2002). "Crystal structure of an antipsychotic agent, 2-(4-ethyl-1-piperazinyl)-4-(4-fluorophenyl)-5,6,7,8,9,10-hexahydrocycloocta[b]pyridine (blonanserin)". Analytical Sciences. 18 (11): 1289–1290. doi:10.2116/analsci.18.1289. PMID 12458724.
  11. ^ Ochi T, Sakamoto M, Minamida A, Suzuki K, Ueda T, Une T, et al. (February 2005). "Syntheses and properties of the major hydroxy metabolites in humans of blonanserin AD-5423, a novel antipsychotic agent". Bioorganic & Medicinal Chemistry Letters. 15 (4): 1055–1059. doi:10.1016/j.bmcl.2004.12.028. PMID 15686911.
  12. ^ a b Yokota K, Tatebayashi H, Matsuo T, Shoge T, Motomura H, Matsuno T, et al. (March 2002). "The effects of neuroleptics on the GABA-induced Cl- current in rat dorsal root ganglion neurons: differences between some neuroleptics". British Journal of Pharmacology. 135 (6): 1547–1555. doi:10.1038/sj.bjp.0704608. PMC 1573270. PMID 11906969.
  13. ^ Nagai T, Noda Y, Une T, Furukawa K, Furukawa H, Kan QM, Nabeshima T (February 2003). "Effect of AD-5423 on animal models of schizophrenia: phencyclidine-induced behavioral changes in mice". NeuroReport. 14 (2): 269–272. doi:10.1097/00001756-200302100-00023. PMID 12598744. S2CID 41717348.
  14. ^ a b c d Chen X, Wang H, Jiang J, Chen R, Zhou Y, Zhong W, et al. (March 2014). "The pharmacokinetic and safety profiles of blonanserin in healthy Chinese volunteers after single fasting doses and single and multiple postprandial doses". Clinical Drug Investigation. 34 (3): 213–222. doi:10.1007/s40261-013-0167-9. PMID 24399453. S2CID 35831132.
  15. ^ a b "Blonanserin". PubMed. U.S. National Library of Medicine.
  16. ^ Tateno A, Arakawa R, Okumura M, Fukuta H, Honjo K, Ishihara K, et al. (April 2013). "Striatal and extrastriatal dopamine D2 receptor occupancy by a novel antipsychotic, blonanserin: a PET study with [11C]raclopride and [11C]FLB 457 in schizophrenia". Journal of Clinical Psychopharmacology. 33 (2): 162–169. doi:10.1097/jcp.0b013e3182825bce. PMID 23422369. S2CID 33775568.
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