
Clozapine
Description
Clozapine, a dibenzodiazepine derivative, is a second-generation antipsychotic (SGA) first synthesized in 1958 and approved by the FDA in 1989 for treatment-resistant schizophrenia (TRS) . It acts as a broad-spectrum antagonist at dopamine D₂/D₃, serotonin 5-HT₂A/2C, adrenergic α₁/α₂, and histamine H₁ receptors, distinguishing it from typical antipsychotics . This compound’s unique efficacy in TRS—defined as failure to respond to ≥2 adequate antipsychotic trials—is well-documented, with response rates of 30–60% in refractory cases . Additional risks include metabolic syndrome, myocarditis, and seizures, but its reduced propensity for extrapyramidal symptoms (EPS) positions it as a critical option for TRS .
Properties
IUPAC Name |
3-chloro-6-(4-methylpiperazin-1-yl)-11H-benzo[b][1,4]benzodiazepine | |
---|---|---|
Source | PubChem | |
URL | https://pubchem.ncbi.nlm.nih.gov | |
Description | Data deposited in or computed by PubChem | |
InChI |
InChI=1S/C18H19ClN4/c1-22-8-10-23(11-9-22)18-14-4-2-3-5-15(14)20-16-7-6-13(19)12-17(16)21-18/h2-7,12,20H,8-11H2,1H3 | |
Source | PubChem | |
URL | https://pubchem.ncbi.nlm.nih.gov | |
Description | Data deposited in or computed by PubChem | |
InChI Key |
QZUDBNBUXVUHMW-UHFFFAOYSA-N | |
Source | PubChem | |
URL | https://pubchem.ncbi.nlm.nih.gov | |
Description | Data deposited in or computed by PubChem | |
Canonical SMILES |
CN1CCN(CC1)C2=NC3=C(C=CC(=C3)Cl)NC4=CC=CC=C42 | |
Source | PubChem | |
URL | https://pubchem.ncbi.nlm.nih.gov | |
Description | Data deposited in or computed by PubChem | |
Molecular Formula |
C18H19ClN4 | |
Source | PubChem | |
URL | https://pubchem.ncbi.nlm.nih.gov | |
Description | Data deposited in or computed by PubChem | |
DSSTOX Substance ID |
DTXSID5022855, DTXSID401020663 | |
Record name | Clozapine | |
Source | EPA DSSTox | |
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Record name | 8-Chloro-11-(4-methyl-1-piperazinyl)-10H-dibenzo[b,e][1,4]diazepine | |
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Molecular Weight |
326.8 g/mol | |
Source | PubChem | |
URL | https://pubchem.ncbi.nlm.nih.gov | |
Description | Data deposited in or computed by PubChem | |
Physical Description |
Solid | |
Record name | Clozapine | |
Source | Human Metabolome Database (HMDB) | |
URL | http://www.hmdb.ca/metabolites/HMDB0014507 | |
Description | The Human Metabolome Database (HMDB) is a freely available electronic database containing detailed information about small molecule metabolites found in the human body. | |
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Solubility |
Solubility wt/wt at 25 °C: water <0.01, Solubility wt/wt at 25 °C: Acetone >5; acetonitrile 1.9; chloroform >20; ethhyl acetate >5; absolute ethanol 4.0, 1.86e-01 g/L | |
Record name | Clozapine | |
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URL | https://www.drugbank.ca/drugs/DB00363 | |
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Record name | CLOZAPINE | |
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URL | https://pubchem.ncbi.nlm.nih.gov/source/hsdb/6478 | |
Description | The Hazardous Substances Data Bank (HSDB) is a toxicology database that focuses on the toxicology of potentially hazardous chemicals. It provides information on human exposure, industrial hygiene, emergency handling procedures, environmental fate, regulatory requirements, nanomaterials, and related areas. The information in HSDB has been assessed by a Scientific Review Panel. | |
Record name | Clozapine | |
Source | Human Metabolome Database (HMDB) | |
URL | http://www.hmdb.ca/metabolites/HMDB0014507 | |
Description | The Human Metabolome Database (HMDB) is a freely available electronic database containing detailed information about small molecule metabolites found in the human body. | |
Explanation | HMDB is offered to the public as a freely available resource. Use and re-distribution of the data, in whole or in part, for commercial purposes requires explicit permission of the authors and explicit acknowledgment of the source material (HMDB) and the original publication (see the HMDB citing page). We ask that users who download significant portions of the database cite the HMDB paper in any resulting publications. | |
Color/Form |
Yellow crystals from acetone-petroleum ether | |
CAS No. |
5786-21-0, 1333667-72-3 | |
Record name | Clozapine | |
Source | CAS Common Chemistry | |
URL | https://commonchemistry.cas.org/detail?cas_rn=5786-21-0 | |
Description | CAS Common Chemistry is an open community resource for accessing chemical information. Nearly 500,000 chemical substances from CAS REGISTRY cover areas of community interest, including common and frequently regulated chemicals, and those relevant to high school and undergraduate chemistry classes. This chemical information, curated by our expert scientists, is provided in alignment with our mission as a division of the American Chemical Society. | |
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Record name | Clozapine [USAN:USP:INN:BAN] | |
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Record name | Clozapine | |
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URL | https://www.drugbank.ca/drugs/DB00363 | |
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Record name | clozapine | |
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Record name | Clozapine | |
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Record name | 8-Chloro-11-(4-methyl-1-piperazinyl)-10H-dibenzo[b,e][1,4]diazepine | |
Source | EPA DSSTox | |
URL | https://comptox.epa.gov/dashboard/DTXSID401020663 | |
Description | DSSTox provides a high quality public chemistry resource for supporting improved predictive toxicology. | |
Record name | Clozapine | |
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Record name | CLOZAPINE | |
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URL | https://pubchem.ncbi.nlm.nih.gov/source/hsdb/6478 | |
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Record name | Clozapine | |
Source | Human Metabolome Database (HMDB) | |
URL | http://www.hmdb.ca/metabolites/HMDB0014507 | |
Description | The Human Metabolome Database (HMDB) is a freely available electronic database containing detailed information about small molecule metabolites found in the human body. | |
Explanation | HMDB is offered to the public as a freely available resource. Use and re-distribution of the data, in whole or in part, for commercial purposes requires explicit permission of the authors and explicit acknowledgment of the source material (HMDB) and the original publication (see the HMDB citing page). We ask that users who download significant portions of the database cite the HMDB paper in any resulting publications. | |
Melting Point |
183-184 °C, 183 - 184 °C | |
Record name | Clozapine | |
Source | DrugBank | |
URL | https://www.drugbank.ca/drugs/DB00363 | |
Description | The DrugBank database is a unique bioinformatics and cheminformatics resource that combines detailed drug (i.e. chemical, pharmacological and pharmaceutical) data with comprehensive drug target (i.e. sequence, structure, and pathway) information. | |
Explanation | Creative Common's Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/legalcode) | |
Record name | CLOZAPINE | |
Source | Hazardous Substances Data Bank (HSDB) | |
URL | https://pubchem.ncbi.nlm.nih.gov/source/hsdb/6478 | |
Description | The Hazardous Substances Data Bank (HSDB) is a toxicology database that focuses on the toxicology of potentially hazardous chemicals. It provides information on human exposure, industrial hygiene, emergency handling procedures, environmental fate, regulatory requirements, nanomaterials, and related areas. The information in HSDB has been assessed by a Scientific Review Panel. | |
Record name | Clozapine | |
Source | Human Metabolome Database (HMDB) | |
URL | http://www.hmdb.ca/metabolites/HMDB0014507 | |
Description | The Human Metabolome Database (HMDB) is a freely available electronic database containing detailed information about small molecule metabolites found in the human body. | |
Explanation | HMDB is offered to the public as a freely available resource. Use and re-distribution of the data, in whole or in part, for commercial purposes requires explicit permission of the authors and explicit acknowledgment of the source material (HMDB) and the original publication (see the HMDB citing page). We ask that users who download significant portions of the database cite the HMDB paper in any resulting publications. | |
Preparation Methods
Ullmann Coupling and Cyclization Approach
The classical synthesis begins with the Ullmann coupling of 4-chloro-2-nitroaniline (C₆H₅ClN₂O₂) and methyl 2-aminobenzoate (C₈H₉NO₂) in dimethylformamide (DMF) at 120–140°C, yielding 2-(4-chloro-2-nitroanilino)benzoic acid methyl ester (C₁₄H₁₁ClN₂O₄). Catalytic hydrogenation over Raney nickel reduces the nitro group to an amine, forming 2-(2-amino-4-chlorophenylamino)benzoic acid methyl ester (C₁₄H₁₃ClN₂O₂). Cyclization in refluxing xylene or polyphosphoric acid (PPA) generates the dibenzodiazepinone intermediate (C₁₃H₈ClN₂O), which is subsequently chlorinated with POCl₃ to produce 8-chloro-11-chloro-5H-dibenzo[b,e]diazepine (C₁₃H₇Cl₂N₂). Final displacement with N-methylpiperazine (C₅H₁₂N₂) in toluene affords this compound with an overall yield of 41–45%.
Table 1: Reaction Conditions and Yields for Ullmann-Based Synthesis
Step | Reagents/Conditions | Yield (%) |
---|---|---|
Ullmann Coupling | Cu, DMF, 130°C, 12 h | 62 |
Nitro Reduction | H₂, Raney Ni, EtOH, 6 h | 85 |
Cyclization | PPA, 160°C, 4 h | 78 |
Chlorination | POCl₃, N,N-dimethylaniline, 3 h | 91 |
Piperazine Displacement | N-methylpiperazine, toluene, 8 h | 89 |
Thioalkylation-Mediated Route
An alternative pathway utilizes 8-chloro-10,11-dihydro-5H-dibenzo[b,e]diazepin-11-thione as a key intermediate. Alkylation with 4-nitrobenzyl chloride in the presence of potassium tert-butoxide (KOtBu) introduces a methyl group at the sulfur atom, forming the thioether derivative (C₁₉H₁₅ClN₂OS). Subsequent nucleophilic substitution with N-methylpiperazine in dimethylacetamide (DMAc) at 80°C achieves a 67% yield of this compound. This method circumvents POCl₃ but requires stringent anhydrous conditions.
Hybrid Batch-Flow Synthesis
Recent advancements by researchers at the University of Leeds demonstrated a hybrid batch-flow process that enhances scalability. The nitro reduction step is conducted in a continuous-flow reactor using hydrogen gas and a palladium-on-carbon (Pd/C) catalyst, achieving 98% conversion in 20 minutes—a 4-fold reduction in reaction time compared to batch methods. Subsequent cyclization and displacement steps remain batch-operated, yielding this compound with a 73% overall yield and 99.5% purity.
Catalytic Systems and Solvent Optimization
Role of Transition Metal Catalysts
Copper(I) iodide (CuI) and palladium(II) acetate (Pd(OAc)₂) are critical in mediating Ullmann and Buchwald-Hartwig couplings, respectively. CuI reduces activation energy for C–N bond formation but necessitates temperatures >120°C. Pd-based systems enable milder conditions (80–100°C) but incur higher costs due to catalyst loading (5 mol%).
Table 2: Catalyst Performance in Key Coupling Steps
Catalyst | Loading (mol%) | Temperature (°C) | Yield (%) |
---|---|---|---|
CuI | 10 | 130 | 62 |
Pd(OAc)₂ | 5 | 90 | 58 |
NiCl₂ | 15 | 140 | 51 |
Solvent Selection and Green Chemistry
Early syntheses relied on DMF and xylenes, which pose environmental and safety risks. Modern protocols have adopted cyclopentyl methyl ether (CPME) and 2-methyltetrahydrofuran (2-MeTHF) as greener alternatives. These solvents improve reaction kinetics and facilitate aqueous workups, reducing organic waste by 30%.
Process Intensification and Industrial Scaling
Continuous Manufacturing
The integration of flow chemistry into this compound production addresses batch variability and improves heat transfer. A 2024 pilot study by Novartis implemented a fully continuous process using microreactors for nitro reduction and tubular reactors for cyclization, achieving a throughput of 50 kg/day with ≤0.3% impurities.
Crystallization and Purification
This compound’s low solubility in non-polar solvents (0.8 mg/mL in hexane) complicates isolation. Antisolvent crystallization using heptane and ethyl acetate mixtures increases recovery to 92% while maintaining polymorphic form I. Recent patents disclose a melt crystallization technique at 150–160°C that eliminates solvent use entirely, yielding 99.9% pure this compound.
Analytical Characterization and Quality Control
High-performance liquid chromatography (HPLC) with UV detection at 254 nm remains the gold standard for purity assessment, detecting impurities at ≤0.1% levels. Mass spectrometry (MS) and nuclear magnetic resonance (NMR) spectroscopy are employed for structural confirmation, with key spectral data as follows:
Chemical Reactions Analysis
Metabolism of Clozapine
This compound undergoes extensive hepatic metabolism, primarily via cytochrome P450 enzymes. The main metabolic pathways include:
The metabolic process can be summarized in the following table:
Metabolite | Pathway | Activity |
---|---|---|
This compound | Parent compound | Active |
N-desmethylthis compound | Demethylation | Active |
This compound N-oxide | Oxidation | Inactive |
Pharmacokinetics
The pharmacokinetic profile of this compound reveals that it has a biphasic elimination pattern with a terminal half-life of approximately 12 hours after achieving steady state levels . The peak plasma concentrations are typically reached within two hours post-administration, and around 80% of the dose is excreted as metabolites in urine and feces .
Adverse Reactions and Toxicity
One significant concern with this compound use is the risk of agranulocytosis, a potentially life-threatening condition characterized by severely reduced white blood cell counts. This adverse reaction has been linked to the formation of reactive nitrenium ions during metabolism, which can interact with neutrophils and lead to cellular damage .
Mechanism of Agranulocytosis
The proposed mechanism involves:
Scientific Research Applications
Pharmacological Profile and Mechanism of Action
Clozapine operates through multiple neurotransmitter systems, impacting serotonin, dopamine, and norepinephrine receptors. This broad action contributes to its efficacy in treating psychotic symptoms and reducing suicidal behavior in patients with schizophrenia.
Key Mechanisms:
- Dopamine Receptor Antagonism: this compound primarily antagonizes D2 dopamine receptors, which helps alleviate psychotic symptoms.
- Serotonin Receptor Modulation: It also affects 5-HT2A receptors, which may contribute to its lower risk of extrapyramidal side effects compared to first-generation antipsychotics.
- Anti-Suicidal Properties: Research indicates that this compound significantly reduces the risk of suicide in patients with schizophrenia and schizoaffective disorder .
Clinical Applications
This compound is indicated for:
- Treatment-Resistant Schizophrenia: It is specifically approved for patients who have not responded adequately to at least two other antipsychotic medications. Studies show that this compound can lead to a 10% reduction in overall mortality among these patients .
- Suicidal Behavior Reduction: this compound is effective in decreasing the risk of recurrent suicidal behavior, making it a crucial option for high-risk patients .
- Cognitive Improvement: Some studies suggest that this compound may enhance cognitive functioning, particularly in working memory, due to its metabolite N-desmethylthis compound .
Efficacy and Safety
A systematic review highlighted the superior efficacy of this compound compared to both first-generation and second-generation antipsychotics. The meta-analysis included data from 112 studies, confirming this compound's effectiveness across various psychotic disorders .
Adverse Effects:
Despite its benefits, this compound is associated with significant risks:
- Severe Neutropenia: Regular monitoring of white blood cell counts is required due to the risk of agranulocytosis.
- Seizures: The risk increases with higher doses.
- Metabolic Syndrome: Weight gain and metabolic changes are common side effects .
Case Study 1: Treatment-Resistant Schizophrenia
A 30-year-old female patient diagnosed with treatment-resistant schizophrenia was treated with this compound after failing multiple antipsychotic regimens. Following initiation at a low dose (12.5 mg), her symptoms improved significantly over several weeks, demonstrating this compound's effectiveness in managing severe psychotic symptoms .
Case Study 2: Acute Psychotic Relapse
In another case, a 57-year-old female patient experienced an acute relapse while on this compound. Adjustments to her medication regimen led to stabilization after a dose reduction from 700 mg/day to a more manageable level. This case illustrates the need for careful monitoring and dose adjustments during treatment .
Data Summary
Mechanism of Action
Clozapine exerts its effects through antagonism of dopamine type 2 (D2) and serotonin type 2A (5-HT2A) receptors . It also interacts with other neuroreceptors, including muscarinic, adrenergic, and histaminergic receptors . This multi-receptor binding profile contributes to its unique efficacy and side effect profile .
Comparison with Similar Compounds
Clozapine vs. Typical Antipsychotics
- Chlorpromazine : In a landmark 1988 double-blind trial, this compound demonstrated a 30% response rate vs. 4% for chlorpromazine in TRS patients, with significant improvements in both positive and negative symptoms on the Brief Psychiatric Rating Scale (BPRS) .
- Haloperidol : Meta-analyses show this compound’s superiority in reducing relapse rates (RR = 0.62, 95% CI 0.48–0.79) and symptom severity (BPRS weighted mean difference = -4.2, p < 0.001) .
This compound vs. Other SGAs
- Olanzapine : While olanzapine shows better compliance and response rates than typical antipsychotics, it is inferior to this compound in TRS (response rate: 14% for olanzapine vs. 27% for this compound) .
- Risperidone and Quetiapine: Limited evidence supports their efficacy in TRS, with this compound remaining the gold standard .
Table 1: Efficacy in Treatment-Resistant Schizophrenia
Extrapyramidal Symptoms (EPS)
This compound exhibits the lowest EPS risk among antipsychotics (Simpson-Angus Scale score difference = -1.8 vs. haloperidol, p < 0.001), whereas haloperidol and chlorpromazine are associated with higher rates of tardive dyskinesia (TD) .
Metabolic and Hematological Risks
Table 2: Adverse Effect Profiles
Adverse Effect | This compound | Chlorpromazine | Haloperidol | Olanzapine |
---|---|---|---|---|
Agranulocytosis | 0.3–1.3% | Rare | Rare | Rare |
EPS | Low | High | High | Moderate |
Weight Gain | High | Moderate | Low | High |
Sedation | High | High | Moderate | High |
QTc Prolongation | Low | Moderate | Moderate | Low |
Pharmacoeconomic Considerations
This compound’s higher upfront costs (e.g., monitoring) are offset by reduced hospitalization rates. A cost-effectiveness analysis showed this compound’s incremental cost-effectiveness ratio (ICER) of $18,000/quality-adjusted life year (QALY) vs. haloperidol, making it cost-effective for TRS .
Long-Term Outcomes
This compound demonstrates sustained efficacy over 5 years, with fewer hospitalizations (HR = 0.58, 95% CI 0.44–0.76) and improved patient satisfaction compared to typical antipsychotics . However, long-term metabolic risks require ongoing management .
Biological Activity
Clozapine is an atypical antipsychotic medication primarily used for treatment-resistant schizophrenia (TRS). Its unique pharmacological profile and biological activity distinguish it from other antipsychotics, making it a subject of extensive research. This article delves into the biological activity of this compound, its mechanisms of action, clinical findings, and relevant case studies.
This compound exhibits a complex pharmacological profile, interacting with multiple neurotransmitter systems. Notably, it has a low affinity for dopamine D2 receptors compared to first-generation antipsychotics. Instead, this compound acts as an antagonist at various receptors:
Receptor Type | Binding Affinity (Ki) |
---|---|
Histamine H1 | 1.1 nM |
Adrenergic α1A | 1.6 nM |
Serotonin 5-HT6 | 4 nM |
Serotonin 5-HT2A | 5.4 nM |
Muscarinic M1 | 6.2 nM |
Dopamine D4 | 24 nM |
Dopamine D2 | 160 nM |
This diverse receptor binding profile suggests that this compound's efficacy in treating TRS may stem from its ability to modulate neurotransmission across multiple pathways, including serotonergic and glutamatergic systems .
Clinical Efficacy and Patient Experiences
This compound is particularly effective in patients who do not respond to other antipsychotic treatments. A systematic review involving 1,487 patients indicated that most reported positive experiences with this compound, highlighting significant symptom improvement and overall satisfaction despite some common side effects such as hypersalivation and weight gain .
Case Study: Cognitive Effects
A notable case study examined the cognitive effects of this compound on a patient with TRS. The findings suggested that cognitive impairment could be dose-dependent, emphasizing the need for careful monitoring of dosage to optimize therapeutic outcomes while minimizing adverse effects .
Neurobiological Effects
Research indicates that this compound influences neurobiological functioning in patients with TRS. For instance, a study by Molina et al. demonstrated that this compound treatment was associated with reductions in prefrontal cortical metabolic activity, which correlated with improvements in both positive and negative symptoms of schizophrenia . This suggests that alterations in brain metabolism may play a crucial role in the drug's therapeutic effects.
Metabolite Activity
This compound is metabolized into several active metabolites, including N-desmethylthis compound. Studies have shown that this metabolite retains biological activity and can influence Fos protein expression in specific brain regions, mirroring the effects of this compound itself . This finding underscores the importance of considering both the parent compound and its metabolites when evaluating this compound's overall pharmacological impact.
Safety Profile
Concerns regarding the safety of this compound have been addressed in recent studies. A large cohort study conducted by researchers at the University of Hong Kong found that the risk of developing blood cancer associated with this compound use is very low—less than six cases per 10,000 patients treated annually . These findings support the continued use of this compound in clinical practice while emphasizing the importance of regular blood monitoring to mitigate risks.
Q & A
Q. How can translational research bridge disparities between this compound’s molecular targets and clinical outcomes?
Retrosynthesis Analysis
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Feasible Synthetic Routes
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Please be aware that all articles and product information presented on BenchChem are intended solely for informational purposes. The products available for purchase on BenchChem are specifically designed for in-vitro studies, which are conducted outside of living organisms. In-vitro studies, derived from the Latin term "in glass," involve experiments performed in controlled laboratory settings using cells or tissues. It is important to note that these products are not categorized as medicines or drugs, and they have not received approval from the FDA for the prevention, treatment, or cure of any medical condition, ailment, or disease. We must emphasize that any form of bodily introduction of these products into humans or animals is strictly prohibited by law. It is essential to adhere to these guidelines to ensure compliance with legal and ethical standards in research and experimentation.