ChemInform Abstract: Structure of a Synthetic Tricyclic Dione with an Ingenol‐Like Ring System.
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Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 100 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a “Full Text” option. The original article is trackable via the “References” option.Keywords:
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Herein, we disclose the first report on the generation of cyanonitrone in situ from diazoacetonitrile and nitrosoarene, and its subsequent [3+2] cycloaddition with oxabicyclic alkenes to access fused tricyclic cyanoisoxazolidines. Further, this methodology could be extended to access fused tricyclic trifluoromethylated and phosphonylated isoxazolidines. Surprisingly, the reductive ring-opening of cyanoisoxazolidines was followed by a spontaneous lactonization to produce fused tricyclic amino lactones. Moreover, the N-O bond of the obtained tricyclic trifluoromethylated isoxazolidines could be cleaved to obtain 1,3-amino alcohols.
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Combined fluoxetine‐tricyclic medication has been recommended for patients who are partial responders or nonresponders to tricyclic medication alone. Three cases were encountered in which the addition of fluoxetine to tricyclic medication resulted in toxic, potentially dangerous elevations in tricyclic blood level amounting to approximately 100–300% increases over recent tricyclic levels. In reducing the tricyclic dosage after fluoxetine, blood level decreases were behind dosage decreases; and blood level and dosage decreases were not well correlated with each other. Symptoms associated with toxic levels are described. Due to the long half‐life of fluoxetine, such increases in tricyclic medication must be anticipated well in advance of initiating treatment with these two compounds. Based on these few cases, a procedure is tentatively recommended for patients on combined fluoxetine‐tricyclic regimens, until such time as a definitive regimen can be developed.
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Improvements of individual depressive symptoms in patients with depression was compared between those treated with tricyclic antidepressants (TAD) and those treated with other psychoactive drugs or placebo. In the majority of comparisons, patients did not improve significantly more with TAD than with other drugs or placebo. These findings indicated that tricyclic antidepressants are not useful in the treatment of most patients with depression. Despite our findings, it is realized that a minority of patients with depression may benefit by treatment with tricyclic antidepressants.
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To describe a case of cross hepatotoxicity between tricyclic antidepressants and phenothiazines.A woman who developed three episodes of drug-induced hepatitis within 3 years as a result of successive treatment with two tricyclic antidepressants, trimipramine and desipramine, and one neuroleptic derivative, cyamemazine.The drugs were withdrawn after the patient experienced liver dysfunction, although bromazepam was later administered with no side effects.After three episodes of drug-induced hepatitis the patient's serum aspartate aminotransferase and alanine aminotransferase levels returned to normal when the tricyclic antidepressants and cyamemazine were withdrawn.Trimipramine, desipramine and cyamemazine are related by their chemical structures which include a tricyclic ring. This suggests that this chemical moiety might be involved in the hepatotoxicity of tricyclic antidepressants and phenothiazine derivatives.
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Psychiatric toxicity to tnicycic antidepressants may be an underrecognized adverse effect of treatment with tricyclics, possibly occurring in between 5 and 15 percent of patients. Such toxicity is probably mediated by a central antimuscarinic action of the tricyclics and is associated with elevated plasma tricyclic levels, age, polypharmacy, and perhaps underlying cholinergic defects in susceptible individuals. Once tricyclic-induced toxicity is recognized, the treatment consists of discontinuing the tricyclic and providing supportive care as necessary. Many cases of tricyclic-induced toxicity may be preventable through close attention to the mental status examination and judicious monitoring of plasma tricyclic levels during treatment.
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Doxepin
Clomipramine
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ABSTRACT Thirty severely depressed patients who were resistant to tricyclic antidepressant therapy were randomly allocated to treatment either with electroconvulsive therapy (ECT) or addition of lithium (Li) to the tricyclic. Twenty‐one of the 30 patients significantly improved at the end of 3 weeks of treatment. There were no differences in improvement rates between the two groups. However, the patients treated with a Li/tricyclic combination improved more rapidly, showing significant alterations in mental state by day 7. It is suggested that in otherwise physically healthy patients who are tricyclic nonresponders, the addition of U may be a more rapid treatment than the use of ECT.
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Nortriptyline
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Article AbstractBecause this does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: Cyclobenzaprine, a tricyclic compound, is closely related to the tricyclic antidepressants. Structurally, it differs from amitriptyline only by 1 double bond. It is classified as a muscle relaxant and is used frequently in primary care settings to treat musculoskeletal pain, sometimes in combination with tricyclic antidepressants.†‹†‹†‹†‹
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In older persons with depression, three classes of antidepressants are equally effective: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and tricyclic-like compounds. More patients taking classic tricyclic antidepressants stopped their medications because of adverse events than did those taking SSRIs. Tricyclic-like medications had withdrawal rates similar to SSRIs, but the studies were small. The strongest evidence supports using SSRIs as first-line pharmacotherapy in older patients with depression.
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Depression
Pharmacotherapy
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Tricyclic antidepressant
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