However it occurs more frequently early in treatment, and this amelioration may relate to the compensatory up-regulation of alpha1 adrenoceptors that is seen with asenapine [Choi et al. 2010]. QT interval prolongation, involving disturbance of potassium channel function, is induced by some antipsychotics occasionally, but not inevitably, resulting in the arrhythmia of toursades de
pointes and, potentially, sudden cardiac death [Alvarez and Pahissa, 2010]. This has been a particular concern with several of the conventional Inhibitors,research,lifescience,medical antipsychotic drugs, as well as the atypical antipsychotic sertindole [Yap and Camm, 2003]. However all the atypicals studied in a major survey (including olanzapine, quetiapine and risperidone) are associated Inhibitors,research,lifescience,medical with an increased
rate of sudden cardiac death [Ray et al. 2009], no less so than the conventional drugs, and drug-induced arrhythmia was considered to be the most plausible mechanism, PDK-1 inhibitor although other factors may contribute. Ziprasidone can cause substantial QT prolongation but there is no consistent evidence of further Inhibitors,research,lifescience,medical cardiac pathology with this agent. Asenapine appears to have small effects on the QT interval, less than quetiapine, and below the threshold considered to be clinically significant [Chapel et al. 2009]. Mechanisms underlying iatrogenic QT-interval prolongation include inhibition of
the repolarising cardiac potassium channel Kv11.1 coded by the hERG (KCNH2) gene. As there is much individual variability in the QT interval and susceptibility to arrhythmias, a variety of genetic risk factors Inhibitors,research,lifescience,medical may also contribute, as will other influences including electrolyte abnormalities and acquired cardiac dysfunction [Yap and Camm, 2003]. Nevertheless Inhibitors,research,lifescience,medical many of the atypicals appear to depress the function of the hERG channel in experimental models [Alvarez and Pahissa, 2010]. Concluding comments The oxyclozanide atypical antipsychotics are, as a class, effective agents for the treatment of bipolar mania, reflecting their activity as antagonists at dopamine D2 receptors. This review has attempted to demonstrate that they can be distinguished not so much in this effect but in other aspects of the clinical consequences of their pharmacology. These pharmacological mechanisms may lead to differences in their potential in ameliorating other affective symptoms and, most obviously, in certain common and limiting adverse effects. For asenapine, this may particularly reflect the uniquely complex breadth of actions at 5-HT receptors, several of which are implicated as antidepressant targets, as well as the relative freedom from weight gain through as yet undefined mechanisms.