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a tranquilizer (trade name Mellaril) used to treat schizophrenia and other psychotic disorders (同)Mellaril

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/06/14 08:39:57」(JST)

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Thioridazine (Mellaril or Melleril) is a piperidine typical antipsychotic drug belonging to the phenothiazine drug group and was previously widely used in the treatment of schizophrenia and psychosis. The branded product was withdrawn worldwide in 2005 because it caused severe cardiac arrhythmias. However, generic versions are still available in the US.^[1]

Indications

Thioridazine was voluntarily discontinued by its manufacturer, Novartis, worldwide because it caused severe cardiac arrhythmias.^[1]^[3]^[4]^[5]

Its primary use in medicine was the treatment of schizophrenia.^[6] It was also tried with some success as a treatment for various psychiatric symptoms seen in people with dementia,^[7] but chronic use of thioridazine and other anti-psychotics in people with dementia is not recommended.^[8]

Side effects

For further information see: Phenothiazine

Thioridazine prolongs the QTc interval in a dose-dependent manner.^[9] It produces significantly less extrapyramidal side effects than most first-generation antipsychotics.^[10]^[11] Its use, along with the use of other typical antipsychotics, has been associated with degenerative retinopathies.^[12] It has a higher propensity for causing anticholinergic side effects coupled with a lower propensity for causing extrapyramidal side effects and sedation than chlorpromazine, but also has a higher incidence of hypotension and cardiotoxicity.^[13] It is also known to possess a relatively high liability for causing orthostatic hypotension compared to other antipsychotics. Similarly to other first-generation antipsychotics it has a relatively high liability for causing prolactin elevation. It is moderate risk for causing weight gain.^[14] As with all antipsychotics thioridazine has been linked to cases of tardive dyskinesia (an often permanent neurological disorder characterised by slow, repetitive, purposeless and involuntary movements, most often of the facial muscles, that is usually brought on by years of continued treatment with antipsychotics, especially the first-generation (or typical) antipsychotics such as thioridazine) and neuroleptic malignant syndrome (a potentially fatal complication of antipsychotic treatment).^[9] Blood dyscrasias such as agranulocytosis, leukopenia and neutropenia are possible with thioridazine treatment.^[9]

Pharmacology

Thioridazine has the following binding profile:^[15]

Biologic Protein	Binding affinity (K_i[nM])	Binding affinity of Mesoridazine (K_i [nM])	Binding affinity of Sulforidazine (K_i [nM])	Notes
SERT	1259	ND	ND
NET	842	ND	ND
DAT	1684	ND	ND
5-HT_1A	144.35	500 (HB)	ND
5-HT_1B	109	ND	ND
5-HT_1D	579	ND	ND
5-HT_1E	194	ND	ND
5-HT_2A	27.67	4.76 (HB)	ND	The ratio of 5-HT2A to D2 receptor binding is believed to dictate whether or not most antipsychotics are atypical or typical. In thioridazine's case its ratio of 5-HT2A to D2 receptor binding is below the level that's believed to be required for atypicality despite its relatively low extrapyramidal side effect liability in practice.^[6]
5-HT_2C	53	157	ND	Believed to play a role in the weight gain-promoting effects of antipsychotics.^[6]
5-HT₃	>10000	ND	ND
5-HT_5A	364	ND	ND
5-HT₆	57.05	380	ND
5-HT₇	99	73 (RC)	ND
α_1A	3.15	2 (HB)	ND	Likely the receptor responsible for the orthostatic hypotension known to occur in individuals on thioridazine.^[6]
α_1B	2.4	ND	ND
α_2A	134.15	1612.9 (HB)	ND
α_2B	341.65	ND	ND
α_2C	74.9	ND	ND
β₁	>10000	ND	ND
β₂	>10000	ND	ND
M₁	12.8	10	ND	This receptor is believed to be the chief receptor responsible for the anticholinergic side effects of thioridazine (e.g. dry mouth, constipation, blurred vision, etc.). Likely plays a role in thioridazine's low extrapyramidal side effect liability as anticholinergic drugs such as benzatropine are routinely given to treat extrapyramidal side effects resulting from antipsychotic treatment.^[6]
M₂	286.33	15	ND
M₃	29	90	ND
M₄	310.33	19	ND
M₅	12.67	60	ND
D₁	94.5	ND	ND
D₂	0.4	4.3	0.25	Believed to be the receptor responsible for the therapeutic effects of antipsychotics.^[6]
D₃	1.5	2.6	0.7
D₄	1.5	9.1	ND
D₅	258	ND	ND
hERG	191	ND	ND	Likely involved in thioridazine's cardiac effects.
H₁	16.5	1.81 (HB)	ND	Likely responsible for the sedating effects of thioridazine.
H₂	136	ND	ND	Regulates the release of hydrochloric acid into the stomach.
H₄	2400	ND	ND

Note: The Binding affinities given are towards cloned human receptors unless otherwise specified

Acronyms used
HB — Human brain receptor
RC — Cloned rat receptor
ND — No data

Metabolism

Thioridazine is a racemic compound with two enantiomers, both of which are metabolized, according to Eap et al., by CYP2D6 into (S)- and (R)-thioridazine-2-sulfoxide, better known as mesoridazine,^[16] and into (S)- and (R)-thioridazine-5-sulfoxide.^[17] Mesoridazine is in turn metabolized into sulforidazine.^[18] Thioridazine is an inhibitor of CYP1A2 and CYP3A2.^[19]

History

The manufacturer Novartis/Sandoz/Wander of the brands of thioridazine, Mellaril in the USA and Canada and Melleril in Europe, discontinued the drug worldwide in June 2005.^[1]^[3]

Antibiotic activity

Thioridazine is known to kill XDR-TB^[20]^[21] and to make MRSA sensitive to β-lactam antibiotics.^[22]^[23] A possible mechanism of action for the drug's antibiotic activity is via the inhibition of bacterial efflux pumps.^[21]

References

^ ^a ^b ^c ^d "SHARED CARE PROTOCOL Thioridazine" (PDF). NHS Lothian Joint Formulary. March 2012.
^ Shvartsburd, A; Sajadi, C; Morton, V; Mirabi, M; Gordon, J; Smith, RC (August 1984). "Blood levels of haloperidol and thioridazine during maintenance neuroleptic treatment of schizophrenic outpatients". Journal of Clinical Psychopharmacology. 4 (4): 194–198. PMID 6470190. doi:10.1097/00004714-198408000-00004.
^ ^a ^b Purhonen, M; Koponen, H; Tiihonen, J; Tanskanen, A (November 2012). "Outcome of patients after market withdrawal of thioridazine: A retrospective analysis in a nationwide cohort". Pharmacoepidemiology and Drug Safety. 21 (11): 1227–1231. PMID 22941581. doi:10.1002/pds.3346.
^ "WHO Pharmaceuticals Newsletter 2005, No. 04: REGULATORY MATTERS: Thioridazine - Sale discontinued in Canada". Essential Medicines and Health Products Information Portal. 4 (2). World Health Organization. 2005. p. 5. Retrieved 28 October 2013.
^ "Withdrawal of thioridazine" (PDF). Australian Prescriber. Vol. 30 no. 3. June 2007. p. 82.
^ ^a ^b ^c ^d ^e ^f Brunton, L. L.; Chabner, B.; Knollmann, B. C., eds. (2011). Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York: McGraw-Hill. ISBN 978-0-07-162442-8.
^ Kirchner, V; Kelly, CA; Harvey, RJ (2001). "Thioridazine for dementia". The Cochrane Database of Systematic Reviews (3): CD000464. PMID 11686961. doi:10.1002/14651858.CD000464.
^ Declercq T; et al. (Mar 2013). "Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia". Cochrane Database Syst Rev. 3: CD007726. PMID 23543555. doi:10.1002/14651858.CD007726.pub2.
^ ^a ^b ^c "THIORIDAZINE HYDROCHLORIDE tablet, film coated [Mutual Pharmaceutical]". DailyMed. Mutual Pharmaceutical. September 2010. Retrieved 28 October 2013.
^ Fenton, M; Rathbone, J; Reilly, J; Sultana, A (July 2007). "Thioridazine for schizophrenia". The Cochrane Database of Systematic Reviews (3): CD001944. PMID 17636691. doi:10.1002/14651858.CD001944.pub2.
^ Keks, N; McGrath, J; Lambert, T; Catts, S; Vaddadi, K; Burrows, G; Varghese, F; George, T; Hustig, H; Burnett, P; et al. (November 1994). "The Australian multicentre double-blind comparative study of remoxipride and thioridazine in schizophrenia". Acta Psychiatrica Scandinavica. 90 (5): 358–365. PMID 7872041. doi:10.1111/j.1600-0447.1994.tb01607.x.
^ Fornaro, P; Calabria, G; Corallo, G; Picotti, GB (July 2002). "Pathogenesis of degenerative retinopathies induced by thioridazine and other antipsychotics: a dopamine hypothesis". Documenta Ophthalmologica. 105 (1): 41–49. PMID 12152801. doi:10.1023/A:1015768114192.
^ "Martindale: The Complete Drug Reference". Medicines Complete. The Pharmaceutical Press. 18 August 2010. Retrieved 28 October 2013.
^ "Selected adverse effects of antipsychotic medications for schizophrenia". UpToDate. Wolters Kluwer Health. Retrieved 24 October 2013.
^ Roth, BL; Driscol, J (12 January 2011). "PDSP K_i Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 28 October 2013.
^ PubChem Substance Summary: Mesoridazine National Center for Biotechnology Information.
^ Eap CB, Guentert TW, Schaublin-Loidl M, Stabl M, Koeb L, Powell K, Baumann P (Mar 1996). "Plasma levels of the enantiomers of thioridazine, thioridazine 2-sulfoxide, thioridazine 2-sulfone, and thioridazine 5-sulfoxide in poor and extensive metabolizers of dextromethorphan and mephenytoin". Clinical Pharmacology & Therapy. 59 (3): 322–31. PMID 8653995. doi:10.1016/S0009-9236(96)80010-5.
^ PubChem Substance Summary: Sulforidazine National Center for Biotechnology Information.
^ Daniel WA, Syrek M, Ryłko Z, Kot M (2001). "Effects of phenothiazine neuroleptics on the rate of caffeine demethylation and hydroxylation in the rat liver" (PDF). Pol J Pharmacol. 53 (6): 615–21. PMID 11985335.
^ Amaral L, Boeree MJ, Gillespie SH, Udwadia ZF, van Soolingen D (June 2010). "Thioridazine cures extensively drug-resistant tuberculosis (XDR-TB) and the need for global trials is now!". Int. J. Antimicrob. Agents. 35 (6): 524–6. PMID 20188526. doi:10.1016/j.ijantimicag.2009.12.019.
^ ^a ^b Amaral, L; Viveiros, M (May 2012). "Why thioridazine in combination with antibiotics cures extensively drug-resistant Mycobacterium tuberculosis infections". International Journal of Antimicrobial Agents. 39 (5): 376–380. PMID 22445204. doi:10.1016/j.ijantimicag.2012.01.012.
^ Thanacoody, HKR (November 2007). "Thioridazine: resurrection as an antimicrobial agent?". British Journal of Clinical Pharmacology. 64 (5): 566–574. PMC 2203271 . PMID 17764469. doi:10.1111/j.1365-2125.2007.03021.x.
^ Thorsing, M; Klitgaard, JK; Atilano, ML; Skov, MN; Kolmos, HJ; Filipe, SR; Kallipolitis, BH (May 2013). "Thioridazine Induces Major Changes in Global Gene Expression and Cell Wall Composition in Methicillin-Resistant Staphylococcus aureus USA300". PLOS ONE. 8 (5): e64518. PMC 3656896 . PMID 23691239. doi:10.1371/journal.pone.0064518.

External links

PubChem Substance Summary: Thioridazine National Center for Biotechnology Information,.
Antipsychotic Mellaril Removed from Market Schizophrenia Daily News Blog.
U.S. National Library of Medicine: Drug Information Portal - Thioridazine

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 第1世代抗精神病剤：薬理学、投与、および副作用の比較 first generation antipsychotic medications pharmacology administration and comparative side effects
2. 統合失調症に対する薬物療法：副作用マネージメント pharmacotherapy for schizophrenia side effect management
3. 寄生虫妄想症の治療 treatment of delusional parasitosis
4. 後天性ＱＴ延長症候群 acquired long qt syndrome
5. 抗利尿ホルモン不適合分泌（SIADH）症候群の病態生理および病因 pathophysiology and etiology of the syndrome of inappropriate antidiuretic hormone secretion siadh

English Journal

Effects of proarrhythmic drugs on relaxation time and beating pattern in rat engineered heart tissue.

Eder A1, Hansen A, Uebeler J, Schulze T, Neuber C, Schaaf S, Yuan L, Christ T, Vos MA, Eschenhagen T.
Basic research in cardiology.Basic Res Cardiol.2014 Nov;109(6):436. doi: 10.1007/s00395-014-0436-7. Epub 2014 Sep 11.
The assessment of proarrhythmic risks of drugs remains challenging. To evaluate the suitability of rat engineered heart tissue (EHT) for detecting proarrhythmic effects. We monitored drug effects on spontaneous contractile activity and, in selected cases, on action potentials (sharp microelectrode)
PMID 25209140

Using computational strategies to predict potential drugs for nasopharyngeal carcinoma.

Lan MY1, Yang WL, Lin KT, Lin JC, Shann YJ, Ho CY, Huang CY.
Head & neck.Head Neck.2014 Oct;36(10):1398-407. doi: 10.1002/hed.23464. Epub 2013 Nov 18.
BACKGROUND: Nasopharyngeal carcinoma (NPC) is a unique cancer. Refinement of current therapy by discovering potential drugs may be approached by several computational strategies.METHODS: We collected NPC genes from published microarray data and the literature. The NPC disease network was constructed
PMID 24038431

Molecular basis of non-mutational derepression of ramA in Klebsiella pneumoniae.

De Majumdar S1, Yu J1, Spencer J2, Tikhonova IG3, Schneiders T4.
The Journal of antimicrobial chemotherapy.J Antimicrob Chemother.2014 Oct;69(10):2681-9. doi: 10.1093/jac/dku203. Epub 2014 Jun 16.
OBJECTIVES: The ram locus, consisting of the romA-ramA genes, is repressed by the tetracycline-type regulator RamR, where regulation is abolished due to loss-of-function mutations within the protein or ligand interactions. The aim of this study was to determine whether the phenothiazines (chlorproma
PMID 25140579

Japanese Journal

薬剤性不整脈のリスクファクターに関する研究

大中博晶,大津史子,矢野玲子,金田典雄,政田幹夫,後藤伸之
医療薬学 33(10), 823-830, 2007-10-10
… In addition, disopyramide, ritodrine, miconazole, halothane, thioridazine and sodium thiopental were found to significantly raise the risk of drug-induced arrhythmia. …
NAID 110006419376

Simple and simultaneous determination for twelve phenothiazines in human serum by reversed-phase high-performance liquid chromatography

Tanaka Einosuke,Nakamura Takako,Terada Masaru,Shinozuka Tatsuo,Hashimoto Chikako,Kurihara Katsuyoshi,Honda Katsuya,田中榮之介
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 854(1), 116-120, 2007-07-01
… A high-performance liquid chromatographic method has been developed for the simultaneous analysis of the 12 phenothiazines (chlorpromazine, fluphenazine, levomepromazine, perazine, perphenazine, prochlorperazine, profenamine, promethazine, propericiazine, thioproperazine, thioridazine and trifluoperazine) in human serum using HPLC/UV. …
NAID 10025805017

IMPACT OF LEGISLATIVE CHANGES ON PATTERNS OF ANTIPSYCHOTIC PRESCRIBING AND SELF-POISONING IN SCOTLAND: 2000-06

Poon H.,Elliot V.,Bateman D. N. [他],WARING W. S.
Journal of toxicological sciences 32(1), 1-7, 2007-02-16
… This has led regulatory authorities in the United Kingdom to restrict the use of thioridazine. … These data indicate that legislative changes that restrict the use of thioridazine and other typical antipsychotics are associated with a measurable reduction in the number of hospital admissions due to overdose with these agents. …
NAID 110006204874

Related Pictures

★リンクテーブル★

リンク元	「フェノチアジン誘導体」「チオリダジン」

「フェノチアジン誘導体」

Thioridazine
Clinical data
AHFS/Drugs.com	Consumer Drug Information
MedlinePlus	a682119
License data	US DailyMed: 9c4bedb4-2d59-4fcd-aad7-fce988cd96d8; US FDA: Thioridazine;
Pregnancy; category	AU: C; US: C (Risk not ruled out); ;
Routes of; administration	Oral
ATC code	N05AC02 (WHO);
Legal status
Legal status	Withdrawn by the manufacturer worldwide;
Pharmacokinetic data
Bioavailability	incomplete
Metabolism	hepatic (at least partly mediated by CYP2D6)
Biological half-life	21-24 hours
Excretion	faeces
Identifiers
	IUPAC name 10-{2-[(RS)-1-Methylpiperidin-2-yl]ethyl}-; 2-methylsulfanylphenothiazine;
CAS Number	50-52-2 ;
PubChem CID	5452;
IUPHAR/BPS	100;
DrugBank	DB00679 ;
ChemSpider	5253 ;
UNII	N3D6TG58NI;
KEGG	D00373 ;
ChEBI	CHEBI:9566 ;
ChEMBL	CHEMBL479 ;
ECHA InfoCard	100.000.041
Chemical and physical data
Formula	C21H26N2S2
Molar mass	370.577
3D model (Jmol)	Interactive image;
	SMILES S(c2cc1N(c3c(Sc1cc2)cccc3)CCC4N(C)CCCC4)C ;
	InChI InChI=1S/C21H26N2S2/c1-22-13-6-5-7-16(22)12-14-23-18-8-3-4-9-20(18)25-21-11-10-17(24-2)15-19(21)23/h3-4,8-11,15-16H,5-7,12-14H2,1-2H3 ; Key:KLBQZWRITKRQQV-UHFFFAOYSA-N ;
(verify)

　　[★]

英: phenothiazine derivative, phenothiazines
関: フェノチアジン phenothiazine、抗精神病薬

フェノチアジン核/骨格を有する化合物

作用機序

D2受容体拮抗

適応

抗精神病薬：統合失調症、躁病

副作用

錐体外路症状、意識障害、血圧低下(自律神経遮断作用による？)

所属する薬物

抗精神病薬

「チオリダジン」

　　[★]

英: thioridazine
ラ: thioridazinum
化: 塩酸チオリダジン thioridazine hydrochloride
商: メレリル Mellaril(販売中止)
関: フェノチアジン誘導体、抗精神病薬

抗精神病薬

フェノチアジン系

販売中止
現在、日本での販売はない
フェノチアジン誘導体で感情興奮抑制作用や運動抑制作用を有する。

[NHS-1] "SHARED CARE PROTOCOL Thioridazine" (PDF). NHS Lothian Joint Formulary. March 2012.

[2] Shvartsburd, A; Sajadi, C; Morton, V; Mirabi, M; Gordon, J; Smith, RC (August 1984). "Blood levels of haloperidol and thioridazine during maintenance neuroleptic treatment of schizophrenic outpatients". Journal of Clinical Psychopharmacology. 4 (4): 194–198. PMID 6470190. doi:10.1097/00004714-198408000-00004.

[PDS2012-3] Purhonen, M; Koponen, H; Tiihonen, J; Tanskanen, A (November 2012). "Outcome of patients after market withdrawal of thioridazine: A retrospective analysis in a nationwide cohort". Pharmacoepidemiology and Drug Safety. 21 (11): 1227–1231. PMID 22941581. doi:10.1002/pds.3346.

[4] "WHO Pharmaceuticals Newsletter 2005, No. 04: REGULATORY MATTERS: Thioridazine - Sale discontinued in Canada". Essential Medicines and Health Products Information Portal. 4 (2). World Health Organization. 2005. p. 5. Retrieved 28 October 2013.

[5] "Withdrawal of thioridazine" (PDF). Australian Prescriber. Vol. 30 no. 3. June 2007. p. 82.

[GG-6] ^ ^a ^b ^c ^d ^e ^f Brunton, L. L.; Chabner, B.; Knollmann, B. C., eds. (2011). Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York: McGraw-Hill. ISBN 978-0-07-162442-8.

[7] Kirchner, V; Kelly, CA; Harvey, RJ (2001). "Thioridazine for dementia". The Cochrane Database of Systematic Reviews (3): CD000464. PMID 11686961. doi:10.1002/14651858.CD000464.

[8] Declercq T; et al. (Mar 2013). "Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia". Cochrane Database Syst Rev. 3: CD007726. PMID 23543555. doi:10.1002/14651858.CD007726.pub2.

[DM-9] "THIORIDAZINE HYDROCHLORIDE tablet, film coated [Mutual Pharmaceutical]". DailyMed. Mutual Pharmaceutical. September 2010. Retrieved 28 October 2013.

[10] Fenton, M; Rathbone, J; Reilly, J; Sultana, A (July 2007). "Thioridazine for schizophrenia". The Cochrane Database of Systematic Reviews (3): CD001944. PMID 17636691. doi:10.1002/14651858.CD001944.pub2.

[11] Keks, N; McGrath, J; Lambert, T; Catts, S; Vaddadi, K; Burrows, G; Varghese, F; George, T; Hustig, H; Burnett, P; et al. (November 1994). "The Australian multicentre double-blind comparative study of remoxipride and thioridazine in schizophrenia". Acta Psychiatrica Scandinavica. 90 (5): 358–365. PMID 7872041. doi:10.1111/j.1600-0447.1994.tb01607.x.

[12] Fornaro, P; Calabria, G; Corallo, G; Picotti, GB (July 2002). "Pathogenesis of degenerative retinopathies induced by thioridazine and other antipsychotics: a dopamine hypothesis". Documenta Ophthalmologica. 105 (1): 41–49. PMID 12152801. doi:10.1023/A:1015768114192.

[13] "Martindale: The Complete Drug Reference". Medicines Complete. The Pharmaceutical Press. 18 August 2010. Retrieved 28 October 2013.

[UpToDate-14] "Selected adverse effects of antipsychotic medications for schizophrenia". UpToDate. Wolters Kluwer Health. Retrieved 24 October 2013.

[15] Roth, BL; Driscol, J (12 January 2011). "PDSP K_i Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 28 October 2013.

[16] PubChem Substance Summary: Mesoridazine National Center for Biotechnology Information.

[17] Eap CB, Guentert TW, Schaublin-Loidl M, Stabl M, Koeb L, Powell K, Baumann P (Mar 1996). "Plasma levels of the enantiomers of thioridazine, thioridazine 2-sulfoxide, thioridazine 2-sulfone, and thioridazine 5-sulfoxide in poor and extensive metabolizers of dextromethorphan and mephenytoin". Clinical Pharmacology & Therapy. 59 (3): 322–31. PMID 8653995. doi:10.1016/S0009-9236(96)80010-5.

[18] PubChem Substance Summary: Sulforidazine National Center for Biotechnology Information.

[19] Daniel WA, Syrek M, Ryłko Z, Kot M (2001). "Effects of phenothiazine neuroleptics on the rate of caffeine demethylation and hydroxylation in the rat liver" (PDF). Pol J Pharmacol. 53 (6): 615–21. PMID 11985335.

[20] Amaral L, Boeree MJ, Gillespie SH, Udwadia ZF, van Soolingen D (June 2010). "Thioridazine cures extensively drug-resistant tuberculosis (XDR-TB) and the need for global trials is now!". Int. J. Antimicrob. Agents. 35 (6): 524–6. PMID 20188526. doi:10.1016/j.ijantimicag.2009.12.019.

[XDR-21] Amaral, L; Viveiros, M (May 2012). "Why thioridazine in combination with antibiotics cures extensively drug-resistant Mycobacterium tuberculosis infections". International Journal of Antimicrobial Agents. 39 (5): 376–380. PMID 22445204. doi:10.1016/j.ijantimicag.2012.01.012.

[22] Thanacoody, HKR (November 2007). "Thioridazine: resurrection as an antimicrobial agent?". British Journal of Clinical Pharmacology. 64 (5): 566–574. PMC 2203271 . PMID 17764469. doi:10.1111/j.1365-2125.2007.03021.x.

[23] Thorsing, M; Klitgaard, JK; Atilano, ML; Skov, MN; Kolmos, HJ; Filipe, SR; Kallipolitis, BH (May 2013). "Thioridazine Induces Major Changes in Global Gene Expression and Cell Wall Composition in Methicillin-Resistant Staphylococcus aureus USA300". PLOS ONE. 8 (5): e64518. PMC 3656896 . PMID 23691239. doi:10.1371/journal.pone.0064518.

v t e Antipsychotics (neuroleptics) (N05A)
Typical	Benzamides Levosulpiride Sulpiride Veralipride^‡ Butyrophenones Azaperone Benperidol Bromperidol Droperidol Fluanisone Haloperidol^# Lenperone Moperone Pipamperone Spiperone Timiperone Trifluperidol Diphenylbutylpiperidines Clopimozide Fluspirilene Penfluridol Pimozide Phenothiazines Acepromazine Acetophenazine Butaperazine Carphenazine (carfenazine) Chloracizine Chlorproethazine Chlorpromazine Cyamemazine Dixyrazine Fluacizine Fluphenazine Levomepromazine/Methotrimeprazine Mesoridazine Perazine Periciazine Perphenazine Perphenazine 4-aminobutyrate Piperacetazine Pipotiazine Prochlorperazine Promazine Promethazine Sulforidazine Thiethylperazine Thiopropazate Thioproperazine Thioridazine Trifluoperazine Triflupromazine Thioxanthenes Chlorprothixene Clopenthixol Clothixamide Flupentixol Fluprothixene Piflutixol Teflutixol Thiothixene Zuclopenthixol Tricyclics Fluotracen Loxapine Trimipramine Others Butaclamol Prothipendyl
Atypical	Benzamides Amisulpride Nemonapride Remoxipride^‡ Sultopride Tiapride Butyrophenones Cinuperone Melperone Setoperone Benzo(iso)oxazolepiperidines Iloperidone Ocaperidone^§ Paliperidone Risperidone^# Benzo(iso)thiazolepiperazines Lurasidone Perospirone Revospirone^§ Tiospirone^§ Ziprasidone Diphenylbutylpiperazines Amperozide Phenylpiperazines Aripiprazole Aripiprazole lauroxil Bifeprunox^§ Brexpiprazole Cariprazine Tricyclics Amoxapine Asenapine Carpipramine Clocapramine Clorotepine Clotiapine Clozapine^# Flumezapine Fluperlapine Gevotroline Metitepine Mosapramine Olanzapine Quetiapine Tenilapine Zotepine Others Blonanserin Lumateperone^† Molindone Pimavanserin RP5063^† Sertindole Zicronapine^§
Others	Azacyclonol Cannabidiol Oxypertine Reserpine Tetrabenazine
^#WHO-EM ^‡Withdrawn from market Clinical trials: ^†Phase III ^§Never to phase III

v t e Histamine receptor modulators
H₁	Agonists: 2-Pyridylethylamine Betahistine Histamine HTMT L-Histidine UR-AK49 Antagonists: First-generation: 4-Methyldiphenhydramine Alimemazine Antazoline Azatadine Bamipine Benzatropine (benztropine) Bepotastine Bromazine Brompheniramine Buclizine Captodiame Carbinoxamine Chlorcyclizine Chloropyramine Chlorothen Chlorphenamine Chlorphenoxamine Cinnarizine Clemastine Clobenzepam Clocinizine Cloperastine Cyclizine Cyproheptadine Dacemazine Decloxizine Deptropine Dexbrompheniramine Dexchlorpheniramine Dimenhydrinate Dimetindene Diphenhydramine Diphenylpyraline Doxylamine Embramine Etodroxizine Etybenzatropine (ethylbenztropine) Etymemazine Fenethazine Flunarizine Histapyrrodine Homochlorcyclizine Hydroxyethylpromethazine Hydroxyzine Isopromethazine Isothipendyl Meclozine Medrylamine Mepyramine (pyrilamine) Mequitazine Methafurylene Methapyrilene Methdilazine Moxastine Orphenadrine Oxatomide Oxomemazine Phenindamine Pheniramine Phenyltoloxamine Pimethixene Piperoxan Pipoxizine Promethazine Propiomazine Pyrrobutamine Talastine Thenalidine Thenyldiamine Thiazinamium Thonzylamine Tolpropamine Tripelennamine Triprolidine Second/third-generation: Acrivastine Alinastine Astemizole Azelastine Bamirastine Barmastine Bepiastine Bepotastine Bilastine Cabastinen Carebastine Cetirizine Clemastine Clemizole Clobenztropine Desloratadine Dorastine Ebastine Efletirizine Emedastine Epinastine Fexofenadine Flezelastine Ketotifen Latrepirdine Levocabastine Levocetirizine Linetastine Loratadine Mapinastine Mebhydrolin Mizolastine Moxastine Noberastine Octastine Olopatadine Perastine Pibaxizine Piclopastine Quifenadine (phencarol) Rocastine Rupatadine Setastine Sequifenadine (bicarphen) Talastine Temelastine Terfenadine Vapitadine Zepastine Non-generational: Atypical antipsychotics (e.g., aripiprazole, asenapine, brexpiprazole, clozapine, iloperidone, olanzapine, paliperidone, quetiapine, risperidone, RP-5063, ziprasidone, zotepine) Tetracyclic antidepressants (e.g., amoxapine, loxapine, maprotiline, mianserin, mirtazapine, oxaprotiline) Tricyclic antidepressants (e.g., amitriptyline, butriptyline, clomipramine, desipramine, dosulepin (dothiepin), doxepin, imipramine, iprindole, lofepramine, nortriptyline, protriptyline, trimipramine) Typical antipsychotics (e.g., chlorpromazine, flupenthixol, fluphenazine, loxapine, perphenazine, prochlorperazine, thioridazine, thiothixene) Unknown/unsorted: Belarizine Elbanizine Flotrenizine Napactadine Tagorizine Trelnarizine Trenizine
H₂	Agonists: Amthamine Betazole Dimaprit Histamine HTMT Impromidine L-Histidine UR-AK49 Antagonists: Bisfentidine Burimamide Cimetidine Dalcotidine Donetidine Ebrotidine Etintidine Famotidine Isolamtidine Lafutidine Lamtidine Lavoltidine (loxtidine) Lupitidine Metiamide Mifentidine Niperotidine Nizatidine Osutidine Oxmetidine Pibutidine Quisultazine (quisultidine) Ramixotidine Ranitidine Roxatidine Sufotidine Tiotidine Tuvatidine Venritidine Xaltidine Zolantidine
H₃	Agonists: α-Methylhistamine Cipralisant Histamine Imetit Immepip Immethridine L-Histidine Methimepip Proxyfan Antagonists: A-349,821 A-423,579 ABT-239 ABT-652 AZD5213 Betahistine Burimamide Ciproxifan Clobenpropit Conessine Enerisant GSK-189,254 Impentamine Iodophenpropit Irdabisant JNJ-5207852 MK-0249 NNC 38-1049 PF-03654746 Pitolisant SCH-79687 Thioperamide VUF-5681
H₄	Agonists: 4-Methylhistamine α-Methylhistamine Histamine L-Histidine OUP-16 VUF-8430 Antagonists: JNJ-7777120 Mianserin Thioperamide Toreforant VUF-6002
See also: Receptor/signaling modulators • Monoamine metabolism modulators • Monoamine reuptake and release modulators

v t e Tricyclics
Classes	Acridine Anthracene Dibenzazepine Dibenzocycloheptene Dibenzodiazepine Dibenzothiazepine Dibenzothiepin Dibenzoxazepine Dibenzoxepin Phenothiazine Pyridazinobenzoxazine Pyridinobenzodiazepine Thioxanthene
Antidepressants (TCAs and TeCAs)	7-OH-Amoxapine Amezepine Amineptine Amitriptyline Amitriptylinoxide Amoxapine Aptazapine Azepindole Azipramine Batelapine Butriptyline Cianopramine Ciclazindol Ciclopramine Cidoxepin Clomipramine Cotriptyline Cyanodothiepin Demexiptiline Depramine/Balipramine Desipramine Dibenzepin Dimetacrine Dosulepin/Dothiepin Doxepin Enprazepine Esmirtazapine Fantridone Fluotracen Hepzidine Homopipramol Imipramine Imipraminoxide Intriptyline Iprindole Ketipramine Litracen Lofepramine Losindole Loxapine Maprotiline Mariptiline Mazindol Melitracen Metapramine Mezepine Mianserin Mirtazapine Monometacrine Naranol Nitroxazepine Nortriptyline Noxiptiline Octriptyline Opipramol Oxaprotiline Pipofezine Pirandamine Propizepine Protriptyline Quinupramine Setiptiline/Teciptiline Spiroxepin Tandamine Tampramine Tianeptine Tienopramine Trimipramine
Antihistamines	Azatadine Clobenzepam Cyproheptadine Dacemazine Deptropine Desloratadine Epinastine Etymemazine Fenethazine Hydroxyethylpromethazine Isopromethazine Isothipendyl Ketotifen Latrepirdine Loratadine Mebhydrolin Mequitazine Methdilazine Olopatadine Oxomemazine Phenindamine Pimethixene Promethazine Propiomazine Rupatadine Thiazinamium
Antipsychotics	Acetophenazine Alimemazine Amoxapine Asenapine Butaclamol Butaperazine Carfenazine (carphenazine) Carpipramine Chlorpromazine Chlorprothixene Ciclindole Citatepine Clocapramine Clomacran Clorotepine Clotiapine Clozapine Cyanothepin Doclothepin Docloxythepin Erizepine Flucindole Flumezapine Fluotracen Flupentixol Fluphenazine Gevotroline Homopipramol Isofloxythepin Levomepromazine/Methotrimeprazine Loxapine Maroxepin Meperathiepin Mesoridazine Metiapine Metitepine Metoxepin Mosapramine Naranol Octomethothepin Olanzapine Oxyclothepin Oxyprothepin Pentiapine Peradithiepin Perathiepin Perazine Perphenazine Periciazine Pinoxepin Piperacetazine Pipotiazine Piquindone Prochlorperazine Promazine Prothipendyl Quetiapine Savoxepin/Cipazoxapine Sulforidazine Tenilapine Thiethylperazine Thiopropazate Thioridazine Thiothixene Tilozepine Traboxopine Trifluoperazine Triflupromazine Trifluthepin Zotepine Zuclopenthixol
Anticonvulsants	Carbamazepine Dizocilpine Eslicarbazepine Eslicarbazepine acetate Etazepine Licarbazepine Oxcarbazepine Oxitriptyline Rispenzepine
Others	Adosopine Aminopromazine Atiprosin Beloxepin Benzoctamine Carvedilol Cidoxepin Cyclobenzaprine Damotepine Darenzepine Elanzepine Methylene blue Monatepil Nuvenzepine Oxetorone Perlapine P7C3 Pinadoline Pirenzepine Pirolate Pitrazepin Pizotifen Profenamine Serazapine Siltenzepine Telenzepine Tipindole Tropatepine Zolenzepine

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thioridazine