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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by PeterMartin on April 6, 2021, at 10:16:29
A new SNRI, Viloxazine/Qelbree, was approved by the FDA (April 5, 2021):
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https://en.wikipedia.org/wiki/Viloxazine
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Viloxazine, like imipramine, inhibited norepinephrine reuptake in the hearts of rats and mice; unlike imipramine, it did not block reuptake of norepinephrine in either the medullae or the hypothalami of rats. As for serotonin, while its reuptake inhibition was comparable to that of desipramine (i.e., very weak), viloxazine did potentiate serotonin-mediated brain functions in a manner similar to amitriptyline and imipramine, which are relatively potent inhibitors of serotonin reuptake.[11] Unlike any of the other drugs tested, it did not exhibit any anticholinergic effects.[11]More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12]
It has also been found to up-regulate GABAB receptors in the frontal cortex of rats.[13]
https://www.empr.com/home/news/qelbree-viloxazine-extended-release-serotonin-approved-attention-deficit-hyperactivity-disorder/
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The Food and Drug Administration (FDA) has approved Qelbree (viloxazine extended-release capsules; Supernus Pharmaceuticals), a serotonin norepinephrine reuptake inhibitor, for the treatment of attention-deficit hyperactivity disorder (ADHD) in patients 6 to 17 years of age.
Posted by linkadge on April 6, 2021, at 19:39:04
In reply to New SNRI approved for ADHD: Viloxazine, posted by PeterMartin on April 6, 2021, at 10:16:29
Interesting. Although, the 5-ht2c agonism, would counteract (to some extent) the increase in prefrontal dopamine from the NRI action.
Linkadge
Posted by rjlockhart37 on April 9, 2021, at 12:03:10
In reply to New SNRI approved for ADHD: Viloxazine, posted by PeterMartin on April 6, 2021, at 10:16:29
there getting really scientific now on treating things, ADHD, etc. Stimulants have been used for year years years there simple on how they work - dopamine and norephinphrine release and reptake
let's see how Viloxazine will do well with people in school. It defeontly is not abuse potential
Posted by SLS on April 9, 2021, at 13:04:03
In reply to Re: New SNRI approved for ADHD: Viloxazine, posted by rjlockhart37 on April 9, 2021, at 12:03:10
Viloxazine has been around for awhile and had previous been characterized as a selective NE reuptake inhibitor. The discovery of serotonergic modulation is a new finding.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473988/
Linkadge - Do you have any thoughts as to why modulation 5-HT activity would help treat ADHD? Is it possible that the 5-HT effects don't contribute to its clinical effect in ADHD? I have done no reading about this.
Europe has always been more creative and liberal with its psychotropic drugh.
- Scott
Posted by linkadge on April 9, 2021, at 13:59:07
In reply to Re: New SNRI approved for ADHD: Viloxazine, posted by SLS on April 9, 2021, at 13:04:03
It's difficult to say whether the 5-ht actions confer any added benefit over NRI activity. Other selective (or nonselective) NRIs seem to work for ADHD.
If 5-ht activities were to be pursued, I would think that 5-ht1a or 5-ht1b receptors would be the first target. 5-ht2c agonism could decrease appetite, which tends to be an undesirable side effect of traditional stimulants. 5-ht2c agonism would also decrease dopamine release in the prefrontal cortex (which you wouldn't think would benefit ADHD). However, mice lacking the 5-ht2c receptor exhibit a hyperactive phenotype and irritability. They are also more prone to seizures. This drug may have some anticonvulsant effect, which could benefit ADHD comorbid with epilepsy. It might also be good in ADHD with comorbid obesity. 5-ht2c agonism is purportedly involved in synaptic pruning. It can enhance declarative memory, but can sometimes also be anxiogenic. Both 5-ht2c agonism and antagonism can have antidepressant effects depending on the paradigm. I know that 5-ht2c antagonists can be good for sleep regulation (they tend to advance the sleep cycle). 5-ht2c agonists may delay the sleep cycle (which would not benefit many ADHDers who tend to be night owls already).
I would tend to think of 5-ht2c agonism as an unrelated target, but I don't really know for sure. Also, there may be subtypes of ADHD which benefit from it.
Linkadge
Posted by SLS on April 9, 2021, at 21:39:52
In reply to Re: New SNRI approved for ADHD: Viloxazine, posted by linkadge on April 9, 2021, at 13:59:07
Hi, Linkadge.
On behalf of everyone who reads your posts, thank you. It's hard not to appreciate your efforts to help people.
- Scott
Posted by linkadge on April 10, 2021, at 6:21:56
In reply to Re: New SNRI approved for ADHD: Viloxazine » linkadge, posted by SLS on April 9, 2021, at 21:39:52
Oh goodness. I wish I could actually turn my interest into something meaningful.
It will be interesting to see how this medication performs.
Linkadge
Posted by rjlockhart37 on April 10, 2021, at 19:51:27
In reply to New SNRI approved for ADHD: Viloxazine, posted by PeterMartin on April 6, 2021, at 10:16:29
this seems a bit more scientific than strattera, selective on norepiephrine and serotonin. Strattera made me irrtible, too much NE.
Modafinil and armodafnil seemed just to help wakefulness, but it doenst really treat the ADHD spectrum. Stimulants ... d-amphetamine have been long studied, concerta. Modafinil really only keeps you alert, It's a good med to keep you awake, that's about it. There really getting scientific now on antidepressant-like medications for ADD
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