|ATC code||N06AX04 (WHO)|
|Biological half-life||1.5–4 hours|
|Excretion||Kidney (88%) within 24 hours|
|Chemical and physical data|
|Molar mass||238.328 g/mol|
|3D model (Jmol)||Interactive image|
|(what is this?)|
Nomifensine (Merital, Alival) is a norepinephrine-dopamine reuptake inhibitor, i.e. a drug that increases the amount of synaptic norepinephrine and dopamine available to receptors by blocking the dopamine and norepinephrine reuptake transporters. This is a mechanism of action shared by some recreational drugs like cocaine and the medication tametraline (see DRI). Research showed that the (S)-isomer is responsible for activity.
The drug was developed in the 1960s by Hoechst AG (now Sanofi-Aventis), who then test marketed it in the United States. It was an effective antidepressant, without sedative effects. Nomifensine did not interact significantly with alcohol and lacked anticholinergic effects. No withdrawal symptoms were seen after 6 months treatment. The drug was however considered not suitable for agitated patients as it presumably made agitation worse. In January 1986 the drug was withdrawn by its manufacturers for safety reasons.
Some case reports in the 1980s suggested that there was potential for psychological dependence on nomifensine, typically in patients with a history of stimulant addiction, or when the drug was used in very high doses (400–600 mg per day).
In a 1989 study it was investigated for use in treating adult ADHD and proven effective. In a 1977 study it has not proven of benefit in advanced parkinsonism, except for depression associated with the parkinsonism.
Nomifensine was investigated for use as an antidepressant in the 1970s, and was found to be a useful antidepressant at doses of 50–225 mg per day, both motivating and anxiolytic.
Side effects and withdrawal from market
During treatment with nomifensine there were relatively few adverse effects, mainly renal failure, paranoid symptoms, drowsiness or insomnia, headache, and dry mouth. Side effects affecting the cardiovascular system included tachycardia and palpitations, but nomifensine was significantly less cardiotoxic than the standard tricyclic antidepressants.
Due to a risk of haemolytic anaemia, the U.S. Food and Drug Administration (FDA) withdrew approval for nomifensine on March 20, 1992. Nomifensine was subsequently withdrawn from the Canadian and UK markets as well. Some deaths were linked to immunohaemolytic anemia caused by this compound, although the mechanism remained unclear.
In 2012 structure-affinity relationship data (compare SAR) were published.
2-Nitro-N-methylbenzylamine with phenylacetyl bromide to give 3. Catalytic hydrogenation over Raney nickel to reduce nitro group, then sodium borohydride reduces keto group to alcohol 4. H2SO4 for ring formation to 5.
- Heptner W, Hornke I, Uihlein M (April 1984). "Kinetics and metabolism of nomifensine". The Journal of Clinical Psychiatry. 45 (4 Pt 2): 21–5. PMID 6370971.
- Brogden, R. N.; Heel, R. C.; Speight, T. M.; Avery, G. S. (1979). "Nomifensine: A Review of its Pharmacological Properties and Therapeutic Efficacy in Depressive Illness". Drugs. 18 (1): 1–24. doi:10.2165/00003495-197918010-00001. PMID 477572.
- 'Chirality and Biological Activity of Drugs' page 138
- US patent 3577424, "4-Phenyl-8-Amino Tetrahydroisoquinolines", issued 1971-05-04, assigned to Farbwerke Hoechst
- Habermann, W. (1977). "A Review of Controlled Studies with Nomifensine, Performed Outside the UK". British Journal of Clinical Pharmacology. 4 (Suppl 2): 237S–241S. doi:10.1111/j.1365-2125.1977.tb05759.x. PMC 1429098. PMID 334230.
- Yakabow, A. L.; Hardiman, S.; Nash, R. J. (1984). "An Overview of Side Effects and long-term Experience with Nomifensine from United States Clinical Trials". The Journal of Clinical Psychiatry. 45 (4 Pt 2): 96–101. PMID 6370985.
- "CSM Update: Withdrawal of nomifensine". British Medical Journal (Clinical Research Ed.). 293 (6538): 41. July 1986. doi:10.1136/bmj.293.6538.41. PMC 1340782. PMID 20742679.
- Böning, J.; Fuchs, G. (2008). "Nomifensine and Psychological Dependence - a Case Report". Pharmacopsychiatry. 19 (5): 386–388. doi:10.1055/s-2007-1017275. PMID 3774872.
- Shekim, W. O.; Masterson, A.; Cantwell, D. P.; Hanna, G. L.; McCracken, J. T. (1989). "Nomifensine Maleate in Adult Attention Deficit Disorder". The Journal of Nervous and Mental Disease. 177 (5): 296–299. doi:10.1097/00005053-198905000-00008. PMID 2651559.
- Bedard, P.; Parkes, J. D.; Marsden, C. D. (1977). "Nomifensine in Parkinson's Disease". British Journal of Clinical Pharmacology. 4 (Suppl 2): 187S–190S. doi:10.1111/j.1365-2125.1977.tb05751.x. PMC 1429119. PMID 334223.
- Hanks GW (1977). "A profile of nomifensine". British Journal of Clinical Pharmacology. 4Suppl 2: 243S–248S. doi:10.1111/j.1365-2125.1977.tb05760.x. PMC 1429121. PMID 911653.
- "Nomifensine DB04821". Drugbank.ca.
- Galbaud du Fort, G. (1988). "Hematologic toxicity of antidepressive agents" [Hematologic Toxicity of Antidepressive Agents]. L'Encephale (in French). 14 (4): 307–318. PMID 3058454.
- Pechulis, AD; et al. (2012). "4-Phenyl tetrahydroisoquinolines as dual norepinephrine and dopamine reuptake inhibitors". Bioorg. Med. Chem. Lett. 22 (23): 7219–22. doi:10.1016/j.bmcl.2012.09.050. PMID 23084899.
- Hoffmann, I; Ehrhart, G; Schmitt, K (1971). "8-amino-4-phenyl-1,2,3,4-tetrahydroisoquinolines, a new group of antidepressive psycholeptic drugs". Arzneimittel-Forschung. 21 (7): 1045. PMID 5109496.
- Zara-Kaczian, E.; Gyorgy, L.; Deak, G.; Seregi, A.; Doda, M. (1986). "Synthesis and pharmacological evaluation of some new tetrahydroisoquinoline derivatives inhibiting dopamine uptake and/or possessing a dopaminomimetic property". Journal of Medicinal Chemistry. 29 (7): 1189. doi:10.1021/jm00157a012. PMID 3806569.