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Clemastine
Clinical data
AHFS/ Drugs.com Monograph
MedlinePlus a682542
Routes of
administration		Oral
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability39.2%
Metabolism Hepatic
Elimination half-life21.3 hours
Excretion Renal
Identifiers
  • (2R)-2-{2-[(1R)-1-(4-chlorophenyl)-1-phenylethoxy]ethyl}-1-methylpyrrolidine
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard ( EPA)
Chemical and physical data
FormulaC21H26ClNO
Molar mass343.90 g·mol−1
3D model ( JSmol)
  • Clc1ccc(cc1)[C@](OCC[C@@H]2N(C)CCC2)(c3ccccc3)C
  • InChI=1S/C21H26ClNO/c1-21(17-7-4-3-5-8-17,18-10-12-19(22)13-11-18)24-16-14-20-9-6-15-23(20)2/h3-5,7-8,10-13,20H,6,9,14-16H2,1-2H3/t20-,21-/m1/s1 checkY
  • Key:YNNUSGIPVFPVBX-NHCUHLMSSA-N checkY
   (verify)

Clemastine, also known as meclastin, is a first-generation H1 histamine antagonist ( antihistamine) with anticholinergic properties (drying) and sedative side effects. [1] Like all first-generation antihistamines, it is sedating. [2] [3]

Patented in 1960, it came into medical use in 1967. [4]

Medical uses

Clemastine is used to relieve hay fever and allergy symptoms, including sneezing; runny nose; and red, itchy, tearing eyes. Prescription strength clemastine is also used to relieve the itching and swelling of hives. [5]

Side effects

Overdosage symptoms are paradoxical, ranging from CNS depression to stimulation. Stimulation is most common in children, and is usually followed by excitement, hallucinations, ataxia, loss of coordination, muscle twitching, athetosis, hyperthermia, cyanosis, convulsions, tremors, and hyperreflexia. This may be followed by postictal depression and cardiovascular/respiratory arrest. Other common overdose symptoms include dry mouth, fixed dilated pupils, flushing of the face, and pyrexia. In adults, overdose usually leads to CNS depression, ranging from drowsiness to coma. [6]

Continuous and/or cumulative use of anticholinergic medications, including first-generation antihistamines, is associated with higher risk of cognitive decline and dementia in older people. [7] [8]

Pharmacology

Clemastine is an antihistamine with anticholinergic and sedative effects. Antihistamines competitively bind to histamine receptor sites, thus reducing the neurotransmitter's effects. Effects of histamine (which are countered by antihistamines) include:

  • Increased capillary permeability
  • Increased capillary dilatation
  • Edema (i.e., swelling)
  • Pruritus (Itch)
  • Gastrointestinal/respiratory smooth muscle constriction

Clemastine inhibits both the vasoconstrictor and vasodilator effects of histamine. Depending on the dose, the drug can produce paradoxical effects, including CNS stimulation or depression.

Most antihistamines exhibit some type of anticholinergic activity. Antihistamines act by competitively binding to H1-receptor sites, thus blocking the binding of endogenous histamine. Antihistamines do not chemically inactivate or prevent the normal release of histamine.

Clemastine does also act as FIASMA (functional inhibitor of acid sphingomyelinase). [9]

Clemastine is rapidly absorbed from the gastrointestinal tract and peak plasma concentrations are attained in 2–4 hours. Antihistamines are thought to be metabolized in the liver, mostly by mono-/didemethylation and glucuronide conjugation. It is an inhibitor of cytochrome P450 CYP2D6 and may interfere with other drugs metabolized by this isozyme.

Mechanism of action

Clemastine is a selective histamine H1 antagonist. It binds to the histamine H1 receptor, thus blocking the action of endogenous histamine, which leads to temporary relief of the negative symptoms caused by histamine.[ medical citation needed]

Society and culture

Clemastine is an OTC drug, and is available under many names and dosage forms worldwide. Most common brand name is Tavegyl. [10]

Research

Clemastine has been studied for its potential to treat several psychiatric and neurological disorders, including possibly promoting remyelination and myelin repair in conditions like multiple sclerosis (MS). [11] [12] Early phase II clinical trials showed promise for promoting remyelination in patients with MS, with clemastine improving nerve conduction velocity in the optic nerve. [13] [14] However, a clinical trial (TRAP-MS) was halted in early 2024 after researchers found the disability progression was occurring at a significantly faster rate than anticipated in three participants with MS receiving clemastine. [15] [16] [17]

References

  1. ^ "Clemastine". DrugBank.com.
  2. ^ "Perspectives on Second-Generation OTC Antihistamines". Pharmacy Times. 2012-03-30. Archived from the original on 2012-05-01.
  3. ^ Krouse JH (April 2008). "Allergic rhinitis--current pharmacotherapy". Otolaryngologic Clinics of North America. 41 (2): 347–58, vii. doi: 10.1016/j.otc.2007.11.014. PMID  18328373.
  4. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 547. ISBN  9783527607495.
  5. ^ "Clemastine". MedlinePlus.
  6. ^ "Clemastine Side Effects: Common, Severe, Long Term". Drugs.com. 23 January 2023. Retrieved 13 December 2023.
  7. ^ Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. (March 2015). "Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study". JAMA Internal Medicine. 175 (3): 401–407. doi: 10.1001/jamainternmed.2014.7663. PMC  4358759. PMID  25621434.
  8. ^ Carrière I, Fourrier-Reglat A, Dartigues JF, Rouaud O, Pasquier F, Ritchie K, Ancelin ML (July 2009). "Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study". Archives of Internal Medicine. 169 (14): 1317–1324. doi: 10.1001/archinternmed.2009.229. PMC  2933398. PMID  19636034.
  9. ^ Kornhuber J, Muehlbacher M, Trapp S, Pechmann S, Friedl A, Reichel M, Mühle C, Terfloth L, Groemer T, Spitzer G, Liedl K, Gulbins E, Tripal P (2011). "Identification of novel functional inhibitors of acid sphingomyelinase". PLOS ONE. 6 (8): e23852. Bibcode: 2011PLoSO...623852K. doi: 10.1371/journal.pone.0023852. PMC  3166082. PMID  21909365.
  10. ^ drugs.com Clemastine at drugs.com international listings Page accessed May 10, 2015
  11. ^ Jiang S, Wang X, Cao T, Kang R, Huang L (2023). "Insights on therapeutic potential of clemastine in neurological disorders". Frontiers in Molecular Neuroscience. 16: 1279985. doi: 10.3389/fnmol.2023.1279985. PMC  10568021. PMID  37840769.
  12. ^ Leigh S (12 June 2023). "Can this Medication Reverse MS? Brain Biomarker Shows It Can". UCSF. Retrieved 17 April 2024.
  13. ^ Riboni-Verri G, Chen BS, McMurran CE, Halliwell GJ, Brown JW, Coles AJ, Cunniffe NG (2024). "Visual outcome measures in clinical trials of remyelinating drugs". BMJ Neurology Open. 6 (1): e000560. doi: 10.1136/bmjno-2023-000560. PMC  10882304. PMID  38389586.
  14. ^ Moghaddasi M, Nabovvati M, Koushki A, Soltansanjari M, Sardarinia M, Mohebi N, Rabani S (June 2020). "Randomized control trial of evaluation of Clemastine effects on visual evoked potential, nerve fiber layer and ganglion cell layer complex in patients with optic neuritis". Clinical Neurology and Neurosurgery. 193: 105741. doi: 10.1016/j.clineuro.2020.105741. PMID  32145678.
  15. ^ Ciccone I (2 March 2024). "Clemastine Arm of TRAP-MS Trial Halted Following Increased Disability Accumulation in Progressive Multiple Sclerosis". NeurologyLive. Retrieved 17 April 2024.
  16. ^ Dotinga R (14 March 2024). "Clemastine Tied to Worsening Symptoms in Multidrug MS Trial". Medscape. Retrieved 17 April 2024.
  17. ^ Maia M (7 March 2024). "ACTRIMS 2024: An antihistamine may speed MS disease progression". Multiple Sclerosis News Today. Retrieved 17 April 2024.

External links

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