Results from in vivo techniques, especially intracerebral microdialysis in freely-moving rats, have provided insights into potential mechanisms responsible for the efficacy and safety of catecholaminergic drugs for ADHD treatment. The drugs reviewed come from distinct pharmacological classes: psychostimulant releasing agents, eg d-amphetamine; psychostimulant reuptake inhibitors, eg dl-threo-methylphenidate (dl-MPH), and non-stimulant reuptake inhibitors, eg atomoxetine. Psychostimulants, which currently deliver the best efficacy in treating ADHD, exhibit the following characteristics on extraneuronal catecholamine concentrations in rodent brain in vivo: 1) They enhance the efflux and function of both noradrenaline and dopamine in the central nervous system. 2) The increase of dopamine efflux that they produce is not limited to cortical regions. 3) They have a rapid onset of action with no ceiling on drug effect. d-Amphetamine has a mechanism independent of neuronal firing rate, displacing intraneuronal stores of catecholamines, delaying their reuptake and inhibiting catabolism by monoamine oxidase. dl-MPH has an enigmatic, extraneuronal action that is neuronal firing rate-dependent and reuptake transporter-mediated, yet paradoxically, almost as powerful as that of d-amphetamine. In safety terms, these powerful catecholaminergic effects also make the psychostimulants liable for abuse. Since efficacy and safety derive from the same pharmacological mechanisms, it has not yet been possible to separate these two components. However, the development of once-daily psychostimulant formulations and a prodrug, lisdexamfetamine, has improved patient compliance and markedly reduced scope for their diversion/abuse. This review will discuss the in vivo pharmacological profiles of approved catecholaminergic drugs for treatment of ADHD and implications for their clinical efficacy and abuse liability.

译文

:体内技术的结果,尤其是自由移动大鼠的脑内微透析,提供了对儿茶酚胺能药物治疗ADHD的功效和安全性负责的潜在机制的见解。所审查的药物来自不同的药理学类别:精神刺激释放剂,例如d-苯异丙胺;心理刺激性再摄取抑制剂,例如dl-苏式-哌醋甲酯(dl-MPH)和非刺激性再摄取抑制剂,例如阿莫西汀。目前在治疗多动症方面效果最好的精神刺激药在体内对啮齿动物脑中的神经外儿茶酚胺浓度表现出以下特征:1)它们增强去甲肾上腺素和多巴胺在中枢神经系统中的外排和功能。 2)它们产生的多巴胺外排的增加不限于皮质区域。 3)它们起效迅速,对药物作用没有上限。 d-苯丙胺具有独立于神经元放电速率的机制,取代神经内的儿茶酚胺储存,延迟其再摄取并抑制单胺氧化酶的分解代谢。 dl-MPH具有神秘的神经外作用,它依赖于神经元的放电速率并由再摄取转运蛋白介导,但自相矛盾的是,其作用与d-苯异丙胺差不多。在安全方面,这些强大的儿茶酚胺作用也使精神兴奋剂容易受到虐待。由于功效和安全性来自相同的药理机制,因此尚不可能分离这两个成分。但是,每天一次的精神兴奋药制剂和前药赖斯氨苯丙胺的开发,改善了患者的依从性,并大大缩小了其转移/滥用的范围。这篇综述将讨论批准的儿茶酚胺能药物治疗多动症的体内药理作用及其对临床疗效和滥用的影响。

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