Vanoxerine

Overview

Vanoxerine is an investigational drug which is being evaluated for the treatment of heart arrhythmias and cocaine dependence. Vanoxerine is a piperazine derivative which has multiple pharmacological activities including acting as an dopamine reuptake inhibitor, serotonin transporter inhibitor, and as a blocker of the cardiac hERG repolarizing potassium channel (IKr). WP

Risks and side effects

Treatment of cocaine dependence

Vanoxerine has been researched for use in treating cocaine dependence both as a substitute for cocaine and to block the rewarding effects. This strategy of using a competing agonist with a longer half-life has been successfully used to treat addiction to opiates such as heroin by substituting with methadone. It was hoped that vanoxerine would be of similar use in treating cocaine addiction.[1][2] WP

Research also indicates that vanoxerine may have additional mechanisms of action including antagonist action at nicotinic acetylcholine receptors, and it has also been shown to reduce the consumption of alcohol in animal models of alcohol use disorder.[3][4] WP

Vanoxerine has been through human trials up to Phase II, but development was stopped due to observed QTc effects in the context of cocaine use.[5–8] WP

However, vanoxerine analogs continue to be studied as treatments for cocaine addiction. As an example, GBR compounds are piperazine based and contain a proximal and a distal nitrogen. It was found that piperidine analogs are still fully active DRIs, although they do not have any affinity for the "piperazine binding site" unlike the GBR compounds. Further SAR revealed that while there are 4 atoms connecting the two fluorophenyl rings to the piperazine, the ether in the chain could be omitted in exchange for a tertiary nitrogen. Vanoxerine, a blocker of the dopamine carrier devoid of action on the noradrenaline carrier, while greatly increasing dopamine in the nucleus accumbens, is ineffective in raising extracellular dopamine in the prefrontal cortex.[9][10][11] WP

Pharmacology

Mechanism of action

Vanoxerine is a potent and selective dopamine reuptake inhibitor (DRI). Vanoxerine binds to the target site on the dopamine transporter (DAT) ~ 50 times more strongly than cocaine, but simultaneously inhibits the release of dopamine. This combined effect only slightly elevates dopamine levels, giving vanoxerine only mild stimulant effects. Vanoxerine has also been observed to be a potent blocker of the cardiac hERG repolarizing potassium channel (IKr) which has implicated Vanoxerine in having cardiotoxicity concerns. Vanoxerine also binds with nanomolar affinity to the serotonin transporter.[12–15] WP

At a cellular level, vanoxerine acts to block cardiac ion channels. Vanoxerine is a multichannel blocker, acting on IKr (potassium), L-type calcium and sodium ion channels. By blocking these specific channels, there is a prolongation of the action potential of the cell, preventing reactivation by a reentrant circuit. The block is strongly frequency dependant: as the pacing of the heart increases so does the frequency of ion channel blocking by vanoxerine.[16] WP

Research

Antiarrhythmic

Vanoxerine is a potentially effective treatment for abnormal heart rhythms. A significant cause of abnormal heart rhythms is reentry, an electrophysiologic event in which the proliferating signal refuses to terminate, and endures to preexcite the heart after the refractory period.[17] WP

It is likely that vanoxerine acts to prevent reentrant circuits. Vanoxerine terminates atrial flutters and atrial fibrillations (both cardiac abnormal heart rhythms) by blocking the recirculating electrical signal, and preventing the reformation of the reentrant circuit. Vanoxerine has also shown a tendency to reduce the recurrence of cardiac arrhythmias, as it was exceedingly difficult to reproduce an atrial flutter or fibrillation in a subject that had been taking vanoxerine.[14][18] WP

Experiments have successfully been performed on cell cultures, canine hosts and testing has moved towards human trials. WP⚠ Wikipedia itself has flagged this text: citation needed.

In clinical human trials with increasing dosages, vanoxerine has shown to have a highly favourable therapeutic index, showing no side effects at concentrations much higher than the therapeutic dose. In canines, the effective therapeutic dose was between 76 ng/ml and 99 ng/ml, however the drug reached plasma concentrations of 550 ng/ml without harmful side effects, presenting a desirable therapeutic index.[14] WP

One of the major benefits of vanoxerine is that it does not appear to cause the same harmful side effects as its most comparable contender, amiodarone.[16] WP

Miscellaneous

Vanoxerine has paradoxically been found to potentiate the behavioral effects of methamphetamine in rodents.[19] WP

History

History

Vanoxerine is a drug that was in the midst of recruiting participants for a phase III human clinical trial for its use as a cardiac antiarrhythmic when safety concerns arose. It had passed phase IIb human trials without any concerns but the company, Laguna Pharmaceuticals, found safety issues which prompted them to shut down their company and the $30 million effort to produce a new heart medication. It was previously indicated as a treatment for Parkinson's disease and depression; however, it had no significant benefit with these diseases.[16][20] WP

Chemistry

Formula

C28H32F2N2O PC

CAS number

67469-69-6 PC

Molar mass (g/mol)

450.6 PC

IUPAC name (computed by PubChem)

1-[2-[bis(4-fluorophenyl)methoxy]ethyl]-4-(3-phenylpropyl)piperazine PC

SMILES

C1CN(CCN1CCCC2=CC=CC=C2)CCOC(C3=CC=C(C=C3)F)C4=CC=C(C=C4)F PC

InChIKey

NAUWTFJOPJWYOT-UHFFFAOYSA-N PC

PubChem CID

3455

Harm reduction information

No harm reduction data is on file for this compound yet. That means no dose, timing or combination data from PsychonautWiki or TripSit. Please don't guess a dose from similar compounds. If you have taken it and feel unwell, contact emergency services or a poison control center.

User reports

Pop culture

No references added yet.

Sources

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14. Journal / agency Cakulev I, Lacerda AE, Khrestian CM, Ryu K, Brown AM, Waldo AL. Oral vanoxerine prevents reinduction of atrial tachyarrhythmias: preliminary results. Journal of Cardiovascular Electrophysiology. November 2011. doi:10.1111/j.1540-8167.2011.02098.x · PMID 21615815 · PMC3172341
15. Journal / agency Cararas SA, Izenwasser S, Wade D, Housman A, Verma A, Lomenzo SA, Trudell ML. Further structure-activity relationship studies on 8-substituted-3-[2-(diarylmethoxyethylidenyl)]-8-azabicyclo[3.2.1]octane derivatives at monoamine transporters. Bioorganic & Medicinal Chemistry. December 2011. doi:10.1016/j.bmc.2011.10.028 · PMID 22055716 · PMC3230044
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20. Other Glenn B. Drug developer ChanRx closes series A investment, hires CEO. 21 November 2011

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