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Alphapharm Brand of Thioridazine Hydrochloride
Also known as: 50-52-2, Mellaril, Thioridazin, Sonapax, Mellerette, Melleril
Molecular Formula
C21H26N2S2
Molecular Weight
370.6  g/mol
InChI Key
KLBQZWRITKRQQV-UHFFFAOYSA-N
FDA UNII
N3D6TG58NI

A phenothiazine antipsychotic used in the management of PHYCOSES, including SCHIZOPHRENIA.
Thioridazine is a Phenothiazine.
1 2D Structure

Alphapharm Brand of Thioridazine Hydrochloride

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
10-[2-(1-methylpiperidin-2-yl)ethyl]-2-methylsulfanylphenothiazine
2.1.2 InChI
InChI=1S/C21H26N2S2/c1-22-13-6-5-7-16(22)12-14-23-18-8-3-4-9-20(18)25-21-11-10-17(24-2)15-19(21)23/h3-4,8-11,15-16H,5-7,12-14H2,1-2H3
2.1.3 InChI Key
KLBQZWRITKRQQV-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CN1CCCCC1CCN2C3=CC=CC=C3SC4=C2C=C(C=C4)SC
2.2 Other Identifiers
2.2.1 UNII
N3D6TG58NI
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Aldazine

2. Apo Thioridazine

3. Apo-thioridazine

4. Apothioridazine

5. Meleril

6. Mellaril

7. Melleretten

8. Melleril

9. Melleryl

10. Melzine

11. Rideril

12. Sonapax

13. Thioridazine Hcl

14. Thioridazine Hydrochloride

15. Thioridazine Neurazpharm

16. Thioridazine-neurazpharm

17. Thioridazineneurazpharm

18. Thiozine

2.3.2 Depositor-Supplied Synonyms

1. 50-52-2

2. Mellaril

3. Thioridazin

4. Sonapax

5. Mellerette

6. Melleril

7. Meleril

8. Mellaril-s

9. Malloryl

10. Dl-thioridazine

11. Mallorol

12. Mellerets

13. Melleretten

14. Tioridazina

15. Tp-21

16. Thioridazine Prolongatum

17. Melleril (liquid)

18. Novoridazine

19. Thioridazinum

20. 10-(2-(1-methylpiperidin-2-yl)ethyl)-2-(methylthio)-10h-phenothiazine

21. Orsanil

22. Thioril

23. 2-methylmercapto-10-(2-(n-methyl-2-piperidyl)ethyl)phenothiazine

24. 10-(2-(1-methyl-2-piperidyl)ethyl)-2-(methylthio)phenothiazine

25. 3-methylmercapto-n-(2'-(n-methyl-2-piperidyl)ethyl)phenothiazine

26. 10-[2-(1-methylpiperidin-2-yl)ethyl]-2-methylsulfanylphenothiazine

27. 10h-phenothiazine, 10-(2-(1-methyl-2-piperidinyl)ethyl)-2-(methylthio)-

28. Melleryl

29. Chembl479

30. 10-[2-(1-methyl-2-piperidyl)ethyl]-2-methylsulfanyl-phenothiazine

31. N3d6tg58ni

32. 10-[2-(1-methylpiperidin-2-yl)ethyl]-2-(methylsulfanyl)-10h-phenothiazine

33. Chebi:9566

34. Ncgc00016059-05

35. (+-)-thioridazine

36. Mellarit

37. Thiozine

38. Malloryl; Meleril; Mellaril S; Mellerets

39. Phenothiazine, 10-((1-methyl-2-piperidyl)ethyl)-2-(methylthio)-

40. Dsstox_cid_3656

41. 10h-phenothiazine, 10-[2-(1-methyl-2-piperidinyl)ethyl]-2-(methylthio)-

42. Dsstox_rid_77130

43. Dsstox_gsid_23656

44. Thioridazinum [inn-latin]

45. Tioridazina [inn-spanish]

46. Thioxidazine

47. Thioridazine, Prolongatum

48. Phenothiazine, 10-[2-(1-methyl-2-piperidyl)ethyl]-2-(methylthio)-

49. 10-[2-(1-methylpiperidin-2-yl)ethyl]-2-(methylthio)-10h-phenothiazine

50. Cas-50-52-2

51. Mellaril-s (tn)

52. Nsc186060

53. Hsdb 3189

54. Einecs 200-044-2

55. Thioridazine (usp/inn)

56. Unii-n3d6tg58ni

57. Mellaril (*hydrochloride*)

58. Ai3-51923

59. Thioridazine [usan:usp:inn:ban]

60. Mellaril (salt/mix)

61. Spectrum_001066

62. Prestwick0_000078

63. Prestwick1_000078

64. Prestwick2_000078

65. Prestwick3_000078

66. Spectrum2_001332

67. Spectrum3_000585

68. Spectrum4_000356

69. Spectrum5_001062

70. Thioridazine [mi]

71. (.+/-.)-thioridazine

72. Thioridazine [inn]

73. Biomol-nt_000017

74. Thioridazine [hsdb]

75. Thioridazine [usan]

76. Schembl9566

77. Thioridazine [vandf]

78. Lopac0_001252

79. Bspbio_000295

80. Bspbio_002030

81. Gtpl100

82. Kbiogr_000791

83. Kbiogr_002308

84. Kbioss_001546

85. Kbioss_002310

86. Thioridazine [mart.]

87. (+/-)-thioridazine

88. Divk1c_000066

89. Thioridazine [usp-rs]

90. Thioridazine [who-dd]

91. Spbio_001483

92. Spbio_002216

93. Bpbio1_000325

94. Bpbio1_001175

95. Dtxsid6023656

96. Schembl12434241

97. Hy-b0965a

98. Kbio1_000066

99. Kbio2_001546

100. Kbio2_002308

101. Kbio2_004114

102. Kbio2_004876

103. Kbio2_006682

104. Kbio2_007444

105. Kbio3_001530

106. Kbio3_002788

107. Cmap_000015

108. Ninds_000066

109. Hms2090j04

110. Thioridazine [orange Book]

111. Thioridazine [ep Monograph]

112. Bcp19922

113. Thioridazine [usp Monograph]

114. Tox21_110294

115. Bdbm50002338

116. Ns-835

117. 10-[2-(1-methyl-2-piperidinyl)ethyl]-2-(methylsulfanyl)-10h-phenothiazine

118. Tox21_110294_1

119. Ccg-205326

120. Db00679

121. Sdccgsbi-0051219.p005

122. Idi1_000066

123. Ncgc00016059-03

124. Ncgc00016059-04

125. Ncgc00016059-07

126. Ncgc00016059-08

127. Ncgc00016059-09

128. Ncgc00016059-10

129. Ncgc00016059-11

130. Ncgc00016059-13

131. Ncgc00016059-14

132. Ncgc00016059-24

133. Ncgc00089809-02

134. Ncgc00089809-03

135. As-77485

136. Sbi-0051219.p004

137. Ab00053553

138. Cs-0013830

139. D00373

140. D94995

141. Q58375

142. Ab00053553-16

143. Ab00053553_17

144. Ab00053553_18

145. 242t875

146. L001321

147. Brd-a84481105-003-17-2

148. 10-[2-(1-methyl-2-piperidinyl)ethyl]-2-(methylthio)-10h-phenothiazine

149. 10-[2-(1-methyl-piperidin-2-yl)-ethyl]-2-methylsulfanyl-10h-phenothiazine

150. 10h-phenothiazine, 10-[2-(1-methyl-2-piperidyl)ethyl]-2-methylthio-

151. (thioridazine)10-[2-(1-methyl-piperidin-2-yl)-ethyl]-2-methylsulfanyl-10h-phenothiazine

152. 10-[2-(1-methyl-2-piperidinyl)ethyl]-2-(methylsulfanyl)-10h-phenothiazine #

153. 10-[2-(1-methyl-piperidin-2-yl)-ethyl]-2-methylsulfanyl-10h-phenothiazine (thioridazine)

154. Thioridazine Solution, 1.0 Mg/ml In Methanol, Ampule Of 1 Ml, Certified Reference Material

155. 107388-89-6

2.4 Create Date
2005-03-25
3 Chemical and Physical Properties
Molecular Weight 370.6 g/mol
Molecular Formula C21H26N2S2
XLogP35.9
Hydrogen Bond Donor Count0
Hydrogen Bond Acceptor Count4
Rotatable Bond Count4
Exact Mass370.15374118 g/mol
Monoisotopic Mass370.15374118 g/mol
Topological Polar Surface Area57.1 Ų
Heavy Atom Count25
Formal Charge0
Complexity432
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count1
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Therapeutic Uses

Antipsychotic Agents, Phenothiazine; Dopamine Antagonists

National Library of Medicine's Medical Subject Headings online file (MeSH, 2009)


Thioridazine is indicated for the management of schizophrenic patients who fail to respond adequately to treatment with other antipsychotic drugs. Due to the risk of significant, potentially life threatening, proarrhythmic effects with thioridazine treatment, thioridazine should be used only in patients who have failed to respond adequately to treatment with appropriate courses of other antipsychotic drugs, either because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse effects from those drugs. Consequently, before initiating treatment with thioridazine, it is strongly recommended that a patient be given at least two trials, each with a different antipsychotic drug product, at an adequate dose, and for an adequate duration. /Included in US product label/

US Natl Inst Health; DailyMed. Current Medication Information for Thioridazine Hydrochloride tablet, film coated (February 2010). Available from, as of June 28, 2010 https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16596


The prescriber should be aware that thioridazine has not been systematically evaluated in controlled trials in treatment refractory schizophrenic patients and its efficacy in such patients is unknown. /Included in US product label/

US Natl Inst Health; DailyMed. Current Medication Information for Thioridazine Hydrochloride tablet, film coated (February 2010). Available from, as of June 28, 2010 https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16596


The US Food and Drug Administration (FDA) currently advises clinicians that antipsychotic agents are not approved for the treatment of dementia-related psychosis. FDA further advises clinicians that no drugs currently are approved for the treatment of patients with dementia-associated psychosis and that other management options should be considered in such patients. /Phenothiazine General Statement/

American Society of Health System Pharmacists; AHFS Drug Information 2010. Bethesda, MD. (2010), p. 2509


4.2 Drug Warning

... Extrapyramidal reactions ... fairly common, usually 3 types ... Parkinsonian-like syndrome ... dystonia and dyskinesia, including torticollis, tics, and other involuntary muscle movements ... akathisia, shown by restlessness ... hyperreflexia, reported in newborn ... ./Phenothiazines/

Osol, A. and J.E. Hoover, et al. (eds.). Remington's Pharmaceutical Sciences. 15th ed. Easton, Pennsylvania: Mack Publishing Co., 1975., p. 1021


Thioridazine has been shown to prolong the QTc interval in a dose related manner, and drugs with this potential, including thioridazine, have been associated with Torsades de pointes type arrhythmias and sudden death. Due to its potential for significant, possibly life threatening, proarrhythmic effects, thioridazine should be reserved for use in the treatment of schizophrenic patients who fail to show an acceptable response to adequate courses of treatment with other antipsychotic drugs, either because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse effects from those drugs

US Natl Inst Health; DailyMed. Current Medication Information for Thioridazine Hydrochloride tablet, film coated (February 2010). Available from, as of June 28, 2010 https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16596


Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Thioridazine hydrochloride is not approved for the treatment of patients with dementia-related psychosis

US Natl Inst Health; DailyMed. Current Medication Information for Thioridazine Hydrochloride tablet, film coated (February 2010). Available from, as of June 28, 2010 https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16596


In common with other phenothiazines, thioridazine is contraindicated in severe central nervous system depression or comatose states from any cause including drug induced central nervous system depression. It should also be noted that hypertensive or hypotensive heart disease of extreme degree is a contraindication of phenothiazine administration.

US Natl Inst Health; DailyMed. Current Medication Information for Thioridazine Hydrochloride tablet, film coated (February 2010). Available from, as of June 28, 2010 https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16596


For more Drug Warnings (Complete) data for Thioridazine (48 total), please visit the HSDB record page.


4.3 Drug Indication

For the treatment of schizophrenia and generalized anxiety disorder.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Thioridazine is a trifluoro-methyl phenothiazine derivative intended for the management of schizophrenia and other psychotic disorders. Thioridazine has not been shown effective in the management of behaviorial complications in patients with mental retardation.


5.2 MeSH Pharmacological Classification

Dopamine Antagonists

Drugs that bind to but do not activate DOPAMINE RECEPTORS, thereby blocking the actions of dopamine or exogenous agonists. Many drugs used in the treatment of psychotic disorders (ANTIPSYCHOTIC AGENTS) are dopamine antagonists, although their therapeutic effects may be due to long-term adjustments of the brain rather than to the acute effects of blocking dopamine receptors. Dopamine antagonists have been used for several other clinical purposes including as ANTIEMETICS, in the treatment of Tourette syndrome, and for hiccup. Dopamine receptor blockade is associated with NEUROLEPTIC MALIGNANT SYNDROME. (See all compounds classified as Dopamine Antagonists.)


Antipsychotic Agents

Agents that control agitated psychotic behavior, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in SCHIZOPHRENIA; senile dementia; transient psychosis following surgery; or MYOCARDIAL INFARCTION; etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus. (See all compounds classified as Antipsychotic Agents.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
THIORIDAZINE
5.3.2 FDA UNII
N3D6TG58NI
5.3.3 Pharmacological Classes
Chemical Structure [CS] - Phenothiazines
5.4 ATC Code

N - Nervous system

N05 - Psycholeptics

N05A - Antipsychotics

N05AC - Phenothiazines with piperidine structure

N05AC02 - Thioridazine


5.5 Absorption, Distribution and Excretion

Absorption

60%


Experimental studies in animals and in vitro have demonstrated that thioridazine has affinity for melanin granules and tends to accumulate in close association with uveal pigment ... .

Grant, W.M. Toxicology of the Eye. 3rd ed. Springfield, IL: Charles C. Thomas Publisher, 1986., p. 908


... Pharmacokinetics and metabolism ... similar ... to chlorpromazine, but strong anticholinergic action of thioridazine on the gut may modify its own absorption ... . Concentrations of thioridazine in plasma are relatively high (hundreds of nanograms per milliliter), possibly owing to its relative hydrophilicity ... .

Gilman, A.G., T.W. Rall, A.S. Nies and P. Taylor (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY. Pergamon Press, 1990., p. 395


In 48 patients taking thiordazine the mean amount not bound to serum proteins was 0.15%, that of the side-chain sulfoxide 1.66%, side-chain sulfone 1.17%, and ring sulfoxide 1.7%.

Reynolds, J.E.F., Prasad, A.B. (eds.) Martindale-The Extra Pharmacopoeia. 28th ed. London: The Pharmaceutical Press, 1982., p. 1560


Thioridazine and metabolites were measured in brain, liver, and kidney specimens, obtained postmortem from two subjects whose deaths were related to acute intoxication with thioridazine, by gas-liquid chromatography. Although the absolute concentration measured for thioridazine and metabolites differed in the two cases, the metabolic pattern for each tissue, expressed in terms of the percentage of total drug in each tissue, was quite similar. The brain, liver, and kidney metabolic patterns, however, are in sharp contrast to the plasma metabolite patterns observed for subjects on a therapeutic regimen of thioridazine. As this example demonstrates, postmortem specimens are a valuable (but seldom used) source of human pharmacological data.

PMID:699294 Dinovo E et al; Clin Chem 24 (10): 1828-30 (1978)


For more Absorption, Distribution and Excretion (Complete) data for Thioridazine (10 total), please visit the HSDB record page.


5.6 Metabolism/Metabolites

Hepatic


Major metabolites include sulfoxy products at ring position 5 (inactive) or at substituent at position 2 (including active metabolite mesoridazine). Demethylation of piperidine ring is very rapid ... .

Gilman, A.G., T.W. Rall, A.S. Nies and P. Taylor (eds.). Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY. Pergamon Press, 1990., p. 395


Although the exact metabolic fate of phenothiazines has not been clearly established, the drugs are extensively metabolized, principally in the liver via hydroxylation, oxidation, demethylation, sulfoxide formation, and conjugation with glucuronic acid; metabolic alterations in the side chain also may occur. /Phenothiazine General Statement/

American Society of Health System Pharmacists; AHFS Drug Information 2010. Bethesda, MD. (2010), p. 2511


Most metabolites of phenothiazines are pharmacologically inactive; however, certain metabolites (eg, 7-hydroxychlorpromazine, mesoridazine) show moderate pharmacologic activity and may contribute to the action of the drugs. There is limited evidence to indicate that some phenothiazines (eg, chlorpromazine) may induce their own metabolism. /Phenothiazine General Statement/

American Society of Health System Pharmacists; AHFS Drug Information 2010. Bethesda, MD. (2010), p. 2511


Thioridazine and metabolites were determined by a selective HPLC technique in blood from five post-mortem cases; two deaths attributed to drug overdose and three deaths due to natural causes or trauma. Additionally, total thioridazine-like compounds were determined in these blood samples and liver specimens by a nonspecific fluorometric technique. Blood concentrations were: thioridazine, 0.78-8.85 mg/L; mesoridazine, 0.52-26.8 mg/L; and sulforidazine, 0.00-0.87 mg/L. Thioridazine-5-sulfoxide stereoisomeric DL,LD, and DD,LL pair concentrations ranged from 0.02-0.56 and 0.03-0.83 mg/L, respectively. Thioridazine metabolite profiles were not helpful in differentiating therapeutic administration from severe overdose. Liver appears to be the specimen of choice in the assessment of thioridazine overdose.

PMID:7176556 Poklis A et al; J Anal Toxicol 6 (5): 250-2 (1982)


For more Metabolism/Metabolites (Complete) data for Thioridazine (8 total), please visit the HSDB record page.


Thioridazine has known human metabolites that include N-desmethylthioridazine, Thioridazine 2-sulfoxide, and Thioridazine 5-sulfoxide.

Sulphoridazine is a known human metabolite of schembl149458.

S73 | METXBIODB | Metabolite Reaction Database from BioTransformer | DOI:10.5281/zenodo.4056560


5.7 Biological Half-Life

21-25 hours


Serum half-life of thioridazine has been estimated to range from about 6 to over 40 hours.

Reynolds, J.E.F., Prasad, A.B. (eds.) Martindale-The Extra Pharmacopoeia. 28th ed. London: The Pharmaceutical Press, 1982., p. 1560


5.8 Mechanism of Action

Thioridazine blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain; blocks alpha-adrenergic effect, depresses the release of hypothalamic and hypophyseal hormones and is believed to depress the reticular activating system thus affecting basal metabolism, body temperature, wakefulness, vasomotor tone, and emesis.


The basic pharmacological activity of thioridazine is similar to that of other phenothiazines, but is associated with minimal extrapyramidal stimulation.

US Natl Inst Health; DailyMed. Current Medication Information for Thioridazine Hydrochloride tablet, film coated (February 2010). Available from, as of June 28, 2010 https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16596


The principal pharmacologic effects of thioridazine are similar to those of chlorpromazine. On a weight basis, thioridazine is about as potent as chlorpromazine. Thioridazine has strong anticholinergic and sedative effects and weak extrapyramidal effects. Thioridazine has little antiemetic activity.

American Society of Health System Pharmacists; AHFS Drug Information 2010. Bethesda, MD. (2010)


The development of phenothiazine derivatives as psychopharmacologic agents resulted from the observation that certain phenothiazine antihistaminic compounds produced sedation. In an attempt to enhance the sedative effects of these drugs, promethazine and chlorpromazine were synthesized. Chlorpromazine is the pharmacologic prototype of the phenothiazines. The pharmacology of phenothiazines is complex, and because of their actions on the central and autonomic nervous systems, the drugs affect many different sites in the body. Although the actions of the various phenothiazines are generally similar, these drugs differ both quantitatively and qualitatively in the extent to which they produce specific pharmacologic effects. /Phenothiazine General Statement/

American Society of Health System Pharmacists; AHFS Drug Information 2010. Bethesda, MD. (2010), p. 2510


In the CNS, phenothiazines act principally at the subcortical levels of the reticular formation, limbic system, and hypothalamus. Phenothiazines generally do not produce substantial cortical depression; however, there is minimal information on the specific effects of phenothiazines at the cortical level. Phenothiazines also act in the basal ganglia, exhibiting extrapyramidal effects. The precise mechanism(s) of action, including antipsychotic action, of phenothiazines has not been determined, but may be principally related to antidopaminergic effects of the drugs. There is evidence to indicate that phenothiazines antagonize dopamine-mediated neurotransmission at the synapses. There is also some evidence that phenothiazines may block postsynaptic dopamine receptor sites. However, it has not been determined whether the antipsychotic effect of the drugs is causally related to their antidopaminergic effects. Phenothiazines also have peripheral and/or central antagonistic activity against alpha-adrenergic, serotonergic, histaminic (H1-receptors), and muscarinic receptors. Phenothiazines also have some adrenergic activity, since they block the reuptake of monoamines at the presynaptic neuronal membrane, which tends to enhance neurotransmission. The effects of phenothiazines on the autonomic nervous system are complex and unpredictable because the drugs exhibit varying degrees of alpha-adrenergic blocking, muscarinic blocking, and adrenergic activity. The antipsychotic activity of phenothiazines may be related to any or all of these effects, but it has been suggested that the drugs' effects on dopamine are probably most important. It has also been suggested that effects of phenothiazines on other amines (eg, gamma-aminobutyric acid [GABA]) or peptides (eg, substance P, endorphins) may contribute to their antipsychotic effect. Further study is needed to determine the role of central neuronal receptor antagonism and of effects on biochemical mediators in the antipsychotic action of the phenothiazines and other antipsychotic agents. /Phenothiazine General Statement/

American Society of Health System Pharmacists; AHFS Drug Information 2010. Bethesda, MD. (2010), p. 2510


For more Mechanism of Action (Complete) data for Thioridazine (13 total), please visit the HSDB record page.


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