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Comparison of Antimanic Efficacy of Clonidine and Verapamil
Author(s) -
Giannini A. James,
Loiselle Robert H.,
Price William A.,
Giannini Matthew C.
Publication year - 1985
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1002/j.1552-4604.1985.tb02845.x
Subject(s) - verapamil , clonidine , pharmacology , mania , lithium (medication) , medicine , endocrinology , chemistry , calcium , bipolar disorder
The standard treatment for mania has been lithium carbonate, alone or in combination with neuroleptics. Unfortunately, lithium is refractory in some patients and may possess potential thyroid and renal toxicity. 1 Neuroleptics also are not without risks and can cause extrapyramidal symptoms as well as tardive dyskinesia. 2 As a result, other less potentially troubling agents have been sought to control the symptoms of mania. Two such drugs are the antihypertensive agent, clonidine, and the antianginal drug, verapamil. Clonidine is an alpha 2 agonist. It exerts central pharmacologic effects by stimulating inhibitory auto‐receptors. 2 This reduction in noradrenergic activity has proven useful in reducing tension and nervousness associated with opiate withdrawal, 3 and panicanxiety disorders. 4 Clonidine has also been used successfully as an antimanic drug in two separate trials. 5,6 This has been hypothesized to be a result of reduction in the hypernoradrenergic tone associated with mania. 6,7 Verapamil, a slow‐channel calcium blocker, has also been shown to be effective in reducing manic symptoms. 8,9 In addition to blocking calcium influx in myocardial cells, it inhibits neurosecretory processes including excitation‐secretion coupling at noradrenergic synapses. 10 Verapamil's action on calcium metabolism may mimic lithium's; both drugs block adenyl cyclase activity in most organ systems and as well as competing with calcium ions in neuromuscular cells. 11 Calcium metabolism is of interest, since the onset of manic episodes are associated with transient increases in serum calcium. 12 Since clonidine and verapamil are both cardiovascular drugs as well as putative antimanic agents, the authors thought it appropriate to compare their antimanic effects in the double‐blind, crossover study described below.