Mazindol

Mazindol
Clinical data
Trade namesMazanor, Sanorex
AHFS/Drugs.comMicromedex Detailed Consumer Information
Routes of
administration		Oral
Drug classSerotonin–norepinephrine–dopamine reuptake inhibitor (SNDRI); Appetite stimulant; Wakefulness-promoting agent; Stimulant
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability93%
MetabolismHepatic
Elimination half-life10–13 hours
ExcretionRenal
Identifiers
  • (±)-5-(4-chlorophenyl)-3,5-dihydro-2H-imidazo[2,1-a]isoindol-5-ol
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.040.764
Chemical and physical data
FormulaC16H13ClN2O
Molar mass284.74 g·mol−1
3D model (JSmol)
ChiralityRacemic mixture
  • ClC1=CC=C(C2(C3=CC=CC=C3C4=NCCN42)O)C=C1
  • InChI=1S/C16H13ClN2O/c17-12-7-5-11(6-8-12)16(20)14-4-2-1-3-13(14)15-18-9-10-19(15)16/h1-8,20H,9-10H2 Y
  • Key:ZPXSCAKFGYXMGA-UHFFFAOYSA-N Y
  (verify)

Mazindol, sold under the brand names Mazanor and Sanorex, is an appetite suppressant which is used in the short-term treatment of obesity.[2] It is also used off-label in the treatment of narcolepsy and cataplexy.[3] The drug is taken orally.

Mazindol was developed by Sandoz-Wander in the 1960s.[4] The US Food and Drug Administration approved mazindol in June 1973, but Novartis, the manufacturer, discontinued it in 1999 for reasons unrelated to its efficacy or safety.[5]

Medical uses

Mazindol is used in short-term (i.e., a few weeks) treatment of obesity, in combination with a regimen of weight reduction based on caloric restriction, exercise, and behavior modification in people with a body mass index greater than 30, or in those with a body mass index greater than 27 in the presence of risk factors such as hypertension, diabetes, or hyperlipidemia. Mazindol is not currently available as a commercially marketed and FDA-regulated prescription agent for the treatment of obesity.

Off-label use of mazindol has demonstrated efficacy in treating symptoms of narcolepsy and cataplexy.[3] Studies beginning in the 1970s indicated that mazindol reduced sleep attacks and cataplexy with comparable efficacy to amphetamine, but with reduced cardiovascular side effects.[3][6][7]

Overdose

Symptoms of a mazindol overdose include restlessness, tremor, rapid breathing, confusion, hallucinations, panic, aggression, nausea, vomiting, diarrhea, irregular heartbeat, and seizures.

Pharmacology

Pharmacodynamics

Mazindol activities
Target Affinity (Ki, nM)
DATTooltip Dopamine transporter 8.1–74 (Ki)
13–43 (IC50Tooltip half-maximal inhibitory concentration)
>10,000 (EC50Tooltip half-maximal effective concentration)
NETTooltip Norepinephrine transporter 0.45–18 (Ki)
0.92–4.9 (IC50)
>10,000 (EC50)
SERTTooltip Serotonin transporter 39–272 (Ki)
54–94 (IC50)
>10,000 (EC50)
SERT2Tooltip Serotonin transporter 1,820 (Ki) (monkey)
H1 600
OX2 35% BI (at 10 μM)
16,000 (EC50)
~25–50% (EmaxTooltip maximal efficacy)
Notes: The smaller the value, the more avidly the drug binds to the site. All proteins are human unless otherwise specified. Refs: [8][9][10][11][12][13][14]

Mazindol is a sympathomimetic amine, which is similar to amphetamine. It stimulates the central nervous system, which increases heart rate and blood pressure, and decreases appetite. Sympathomimetic anoretics (appetite suppressants) are used in the short-term treatment of obesity. Their appetite-reducing effect tends to decrease after a few weeks of treatment. Because of this, these medicines are useful only during the first few weeks of a weight-loss program.

Although the mechanism of action of the sympathomimetics in the treatment of obesity is not fully known, these medications have pharmacological effects similar to those of amphetamines. Like other sympathomimetic appetite suppressants, mazindol is thought to act as a reuptake inhibitor of norepinephrine, dopamine, and serotonin.

In addition to its other actions, mazindol has been found to act as a very-low-potency partial agonist of the orexin OX2 receptor.[14][3] It showed 35% binding inhibition at the human orexin OX2 receptor at a concentration of 10,000 nM (a measure of binding affinity), an activational potency (EC50Tooltip half-maximal effective concentration) of 16,000 nM, and an activational efficacy (EmaxTooltip maximal efficacy) of approximately 25 to 50%.[14] This action is profoundly less potent than mazindol's monoamine reuptake inhibition.[14] Whether the orexin OX2 receptor partial agonism of mazindol occurs at clinically relevant concentrations or is pharmacologically significant is unclear.[14]

Chemistry

Tautomers

Mazindol exhibits pH dependent tautomerization between the keto form and the cyclic hemiaminal. Mazindol exists in the tricyclic (-ol) form in neutral media and undergoes protonation to the benzophenone tautomer in acidic media. QSAR studies have indicated that the ability of mazindol to inhibit NE and DA reuptake may be mediated by the protonated (benzophenone) tautomer.[15]

Synthesis

The chemical synthesis of mazindol has been described.[16][17][18][4][19]

Some analogues and related compounds include ciclazindol, setazindol, trazium, dazadrol, and AW-15'1129, among others.

Research

Additional patented uses include for the treatment of schizophrenia,[20] reducing cravings for cocaine,[21] and for the treatment of neurobehavioral disorders.[22]

Attention deficit hyperactivity disorder

As of 2016 mazindol was being studied in clinical trials for attention-deficit hyperactivity disorder (ADHD).[23] There is a Swiss study investigating its efficacy in treating attention deficit hyperactivity disorder (ADHD).[24]

References

  1. ^ Anvisa (2023-03-31). "RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 2023-04-04). Archived from the original on 2023-08-03. Retrieved 2023-08-16.
  2. ^ Carruba MO, Zambotti F, Vicentini L, Picotti GB, Mantegazza P (1978). "Pharmacology and biochemical profile of a new anorectic drug: mazindol". Cent. Mech. Anorectic Drugs: 145–64.
  3. ^ a b c d Konofal E (August 2024). "From past to future: 50 years of pharmacological interventions to treat narcolepsy". Pharmacology, Biochemistry, and Behavior. 241 173804. doi:10.1016/j.pbb.2024.173804. PMID 38852786.
  4. ^ a b US granted 3597445, Houlihan WJ, Eberle MK, "1H-Isoindole Intermediates", issued 3 August 1971, assigned to Sandoz AG 
  5. ^ "Determination That SANOREX (Mazindol) Tablets 1 and 2 Milligrams Were Not Withdrawn From Sale for Reasons of Safety or Effectiveness". Federal Register. 15 July 2008. Retrieved 28 December 2024.
  6. ^ Parkes JD, Schachter M (October 1979). "Mazindol in the treatment of narcolepsy". Acta Neurologica Scandinavica. 60 (4): 250–4. doi:10.1111/j.1600-0404.1979.tb02976.x. PMID 525256.
  7. ^ Alvarez B, Dahlitz M, Grimshaw J, Parkes JD (May 1991). "Mazindol in long-term treatment of narcolepsy". Lancet. 337 (8752): 1293–4. doi:10.1016/0140-6736(91)92966-6. PMID 1674093.
  8. ^ "PDSP Database". UNC (in Zulu). Retrieved 17 March 2026.
  9. ^ Rothman RB, Baumann MH, Dersch CM, Romero DV, Rice KC, Carroll FI, Partilla JS (January 2001). "Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin". Synapse. 39 (1): 32–41. doi:10.1002/1098-2396(20010101)39:1<32::AID-SYN5>3.0.CO;2-3. PMID 11071707. S2CID 15573624.
  10. ^ Liu T. "BindingDB BDBM50005536 42-548::5-(4-Chloro-phenyl)-2,5-dihydro-3H-imidazo[2,1-a]isoindol-5-ol::5-(4-chlorophenyl)-3,5-dihydro-2H-imidazo[2,1-a]isoindol-5-ol::5-Thiophen-2-yl-2,3,5,6-tetrahydro-imidazo[2,1-a]isoquinolin-5-ol::CHEMBL781::MAZINDOL::Mazanor::Sanorex::mazindole". BindingDB. Retrieved 17 March 2026.
  11. ^ Rothman RB, Baumann MH (2006). "Therapeutic potential of monoamine transporter substrates". Curr Top Med Chem. 6 (17): 1845–1859. doi:10.2174/156802606778249766. PMID 17017961.
  12. ^ Rothman RB, Baumann MH (October 2003). "Monoamine transporters and psychostimulant drugs". Eur J Pharmacol. 479 (1–3): 23–40. doi:10.1016/j.ejphar.2003.08.054. PMID 14612135.
  13. ^ Rothman RB, Silverthorn ML, Glowa JR, Matecka D, Rice KC, Carroll FI, Partilla JS, Uhl GR, Vandenbergh DJ, Dersch CM (April 1998). "Studies of the biogenic amine transporters. VII. Characterization of a novel cocaine binding site identified with [125I]RTI-55 in membranes prepared from human, monkey and guinea pig caudate". Synapse. 28 (4): 322–338. doi:10.1002/(SICI)1098-2396(199804)28:4<322::AID-SYN8>3.0.CO;2-B. PMID 9517841.
  14. ^ a b c d e Konofal E, Arnulf I, Bizot JC, Corser BC, Figadère B, Kushida CA, Newcorn JH, Lecendreux M, Peyron C, Thorpy MJ, Wigal SB, Wigal TL (March 2026). "Mazindol Immediate-Release/Sustained-Release (IR/SR): A 50-Year Legacy of Multifaceted Mechanisms and Emerging Therapeutic Potential". Clin Drug Investig. 46 (3): 259–280. doi:10.1007/s40261-025-01510-2. PMID 41667893.
  15. ^ Koe BK (December 1976). "Molecular geometry of inhibitors of the uptake of catecholamines and serotonin in synaptosomal preparations of rat brain". The Journal of Pharmacology and Experimental Therapeutics. 199 (3): 649–661. doi:10.1016/S0022-3565(25)30726-3. PMID 994022.
  16. ^ Aeberli P, Eden P, Gogerty JH, Houlihan WJ, Penberthy C (February 1975). "5-aryl-2,3-dihydro-5H-imidazo[2,1-a]isoindol-5-ols. A novel class of anorectic agents". Journal of Medicinal Chemistry. 18 (2): 177–82. doi:10.1021/jm00236a014. PMID 804553.
  17. ^ DE granted 1814540, Houlihan WJ, "Improvements in or Relating to Imidazoisoindole Derivatives", issued 3 July 1969, assigned to Sandoz AG 
  18. ^ DE granted 1930488, Houlihan WJ, Eberle MK, "Heterocyclische Verbindungen und Verfahren zu ihrer Herstellung", issued 19 March 1970, assigned to Sandoz AG 
  19. ^ US granted 3763178, Sulkowski TS, "Midazolinyl Phenyl Carbonyl Acid Addition Salts and Related Compounds", issued 2 October 1973, assigned to American Home Products 
  20. ^ US 5447948, "Dopamine and noradrenergic reuptake inhibitors in treatment of schizophrenia", issued 5 September 1995, assigned to Yale University 
  21. ^ US 5217987, Berger SP, "Dopamine uptake inhibitors in reducing substance abuse and/or craving", issued 8 June 1993 
  22. ^ WO 2009155139, Kovacs B, Pinegar L, "se of isoindoles for the treatment of neurobehavioral disorders", published 23 December 2009, assigned to Afecta Pharmaceuticals Inc 
  23. ^ Mattingly GW, Anderson RH (December 2016). "Optimizing outcomes in ADHD treatment: from clinical targets to novel delivery systems". CNS Spectrums. 21 (S1): 45–59. doi:10.1017/S1092852916000808. PMID 28044946. S2CID 24310209.
  24. ^ Grover N (2017-05-31). "Swiss biotech NLS Pharma's ADHD drug succeeds in mid-stage study". Reuters. Retrieved 2021-07-15.
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