Pitolisant

Pitolisant, sold under the brand name Wakix, is a medication for the treatment of excessive daytime sleepiness (EDS) in adults with narcolepsy.[1] It is a histamine 3 (H3) receptor antagonist/inverse agonist.[1] It represents the first commercially available medication in its class.[3] Pitolisant enhances the activity of histaminergic neurons in the brain that function to improve a person's wakefulness.[4]

Pitolisant
Clinical data
Trade namesWakix
Other namesTiprolisant; Ciproxidine; BF2.649
AHFS/Drugs.comMonograph
MedlinePlusa619055
License data
Routes of
administration		By mouth
Drug classHistamine H3 receptor inverse agonists
ATC code
Legal status
Legal status
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
FormulaC17H26ClNO
Molar mass295.85 g·mol−1
3D model (JSmol)
 NY (what is this?)  (verify)

The most common side effects include difficulty sleeping, nausea, and feeling worried.[5]

The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication.[6]

Medical uses

Pitolisant is used in adults for the treatment of excessive daytime sleepiness in people with narcolepsy, with or without cataplexy.[2] Narcolepsy is a sleep problem that is characterized by an irresistible urge to sleep and disturbed nighttime sleep, while cataplexy refers to attacks of severe muscle weakness that cause a person to collapse.[2]

Side effects

The most common side effects include insomnia (difficulty sleeping), headache, nausea (feeling sick), anxiety, irritability, dizziness, depression, tremor, sleep disorders, tiredness, vomiting, vertigo (a spinning sensation) and dyspepsia (heartburn).[2] Serious but rare side effects are abnormal loss of weight and spontaneous abortion.[2]

History

Pitolisant was developed by Jean-Charles Schwartz, Walter Schunack, and colleagues after the former discovered the H3 receptor.[7] It was the first H3 receptor inverse agonist to be tested in humans or introduced for clinical use.[7] It was designed and developed by Bioprojet, who has marketed the product in Europe since its approval by the European Medicines Agency in 2016.

The FDA approved pitolisant for excessive daytime sleepiness in participants with narcolepsy based primarily on evidence from two trials (Trial 1/NCT 01067222, Trial 2/NCT 01638403).[5] An additional trial (Trial 3/NCT01800045), in which participants with a different type of narcolepsy were exposed to the same dose of pitolisant, was used to add data for evaluation of side effects.[5] The trials were conducted in Europe and South America.[5]

The two primary trials enrolled adults with narcolepsy and excessive daytime sleepiness.[5] Participants received pitolisant, placebo, or an approved drug for narcolepsy for eight weeks.[5] For participants receiving pitolisant, the dose could be increased during the first three weeks but had to remain the same for the next five weeks.[5] Neither the participants nor the healthcare providers knew which treatment was being given during the trial.[5]

The benefit of pitolisant was evaluated by comparing changes in daytime sleepiness during the trial between pitolisant- and placebo-treated participants.[5] To measure the daytime sleepiness, the investigators used a scale called the Epworth Sleepiness Scale (ESS).[5] The ESS asks participants to rate the likelihood that they would fall asleep while doing eight daily activities (such as sitting and reading or watching television).[5] Participants rate each item from zero (would never doze) to three (high chance of dozing).[5]

Pitolisant was approved by the U.S. Food and Drug Administration (FDA) in August 2019.[5] It was granted orphan drug designation for the treatment of narcolepsy, fast track designation for the treatment of excessive daytime sleepiness (EDS) and cataplexy in people with narcolepsy, and breakthrough therapy designation for the treatment of cataplexy in people with narcolepsy. Pitolisant represents the first new therapy in the U.S. in over fifteen years for the treatment of both EDS and cataplexy in adults with narcolepsy.

References
  1. "Wakix- pitolisant hydrochloride tablet, film coated". DailyMed. 6 November 2019. Retrieved 18 August 2020.
  2. "Wakix EPAR". European Medicines Agency (EMA). Retrieved 18 August 2020. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  3. "FDA Approves Pitolisant for Daytime Sleepiness in Patients with Narcolepsy". Pharmacy Times. Retrieved 18 August 2020.
  4. Syed YY (20 July 2016). "Pitolisant: First Global Approval". Drugs. 76 (13): 1313–1318. doi:10.1007/s40265-016-0620-1. PMID 27438291. S2CID 42684839.
  5. "Drug Trials Snapshots: Wakix". U.S. Food and Drug Administration (FDA). 14 August 2019. Retrieved 18 March 2020. This article incorporates text from this source, which is in the public domain.
  6. "New Drug Therapy Approvals 2019". U.S. Food and Drug Administration. 31 December 2019. Retrieved 15 September 2020.
  7. Schwartz JC (2011). "The histamine H3 receptor: from discovery to clinical trials with pitolisant". Br. J. Pharmacol. 163 (4): 713–21. doi:10.1111/j.1476-5381.2011.01286.x. PMC 3111674. PMID 21615387.
  • "Pitolisant". Drug Information Portal. U.S. National Library of Medicine.
  • "Ciproxidine". Drug Information Portal. U.S. National Library of Medicine.


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