Barbiturate general anesthetic
"Sodium Pentathol" and "C11 H17 N2 O2 S Na" redirect here. For the song by Anthrax, see
Sound of White Noise
.
Sodium thiopental
|
|
|
Trade names
| Pentothal, Trapanal
|
---|
Other names
| Truth serum, thiopentone, thiopental
|
---|
AHFS
/
Drugs.com
| Monograph
|
---|
Pregnancy
category
| |
---|
Routes of
administration
| Intravenous (most common), oral, or rectal
|
---|
Drug class
| Barbiturate
|
---|
ATC code
| |
---|
|
Legal status
|
|
---|
|
Protein binding
| 80%
|
---|
Metabolism
| Liver
|
---|
Metabolites
| Pentobarbital
, others
|
---|
Onset of action
| 30?45 seconds
|
---|
Elimination
half-life
| 5.5
[2]
?26 hours
[3]
|
---|
Duration of action
| 5?10 minutes
|
---|
|
sodium 5-ethyl-5-pentan-2-yl-2-sulfanylidene-1,3-diazinane-4,6-dione
|
CAS Number
| - 71-73-8
Y
(sodium salt)
76-75-5 (free acid)
|
---|
PubChem
CID
| |
---|
DrugBank
| |
---|
ChemSpider
| |
---|
UNII
| |
---|
KEGG
| |
---|
ChEBI
| |
---|
ChEMBL
| |
---|
CompTox Dashboard
(
EPA
)
| |
---|
ECHA InfoCard
| 100.000.694
|
---|
|
Formula
| C
11
H
17
N
2
Na
O
2
S
|
---|
Molar mass
| 264.32
g·mol
?1
|
---|
3D model (
JSmol
)
| |
---|
Chirality
| Racemic mixture
|
---|
[Na+].O=C1NC(=S)/N=C(/[O-])C1(C(C)CCC)CC
|
InChI=1S/C11H18N2O2S.Na/c1-4-6-7(3)11(5-2)8(14)12-10(16)13-9(11)15;/h7H,4-6H2,1-3H3,(H2,12,13,14,15,16);/q;+1/p-1
Y
Key:AWLILQARPMWUHA-UHFFFAOYSA-M
Y
|
N
Y
(what is this?)
(verify)
|
Sodium thiopental
, also known as
Sodium Pentothal
(a trademark of
Abbott Laboratories
),
thiopental
,
thiopentone
, or
Trapanal
(also a trademark), is a rapid-onset short-acting
barbiturate
general anesthetic
. It is the thiobarbiturate
analog
of
pentobarbital
, and an analog of
thiobarbital
. Sodium thiopental was a core medicine in the
World Health Organization's List of Essential Medicines
,
[4]
but was supplanted by
propofol
.
[5]
[6]
[7]
Despite this, thiopental is listed as an acceptable alternative to propofol, depending on local availability and cost of these agents.
[7]
It was previously the first of three drugs administered during most
lethal injections
in the United States, but the US manufacturer
Hospira
stopped manufacturing the drug in 2011 and the
European Union
banned the export of the drug for this purpose.
[8]
Although thiopental abuse carries a dependency risk, its recreational use is rare.
[9]
Sodium thiopental is well-known in
popular culture
, especially under the name "sodium pentothal," as a "
truth serum
," although its efficacy in this role and has been questioned.
[10]
[11]
Uses
[
edit
]
Anesthesia
[
edit
]
Sodium thiopental is an ultra-short-acting
barbiturate
and has been used commonly in the induction phase of
general anesthesia
. Its use has been largely replaced with that of
propofol
, but may retain some popularity as an induction agent for
rapid-sequence induction
and
intubation
, such as in
obstetrics
.
[12]
Following
intravenous injection
, the drug rapidly reaches the brain and causes
unconsciousness
within 30?45 seconds. At one minute, the drug attains a peak concentration of about 60% of the total dose in the brain. Thereafter, the drug distributes to the rest of the body, and in about 5?10 minutes the concentration is low enough in the brain that consciousness returns.
A normal dose of sodium thiopental (usually 4?6 mg/kg) given to a pregnant woman for operative delivery (
caesarean section
) rapidly makes her unconscious, but the baby in her
uterus
remains conscious. However, larger or repeated doses can depress the baby's consciousness.
[13]
Sodium thiopental is not used to maintain anesthesia in surgical procedures because, in infusion, it displays
zero-order
elimination
pharmacokinetics
, leading to a long period before consciousness is regained. Instead, anesthesia is usually maintained with an
inhaled anesthetic
(gas) agent. Inhaled anesthetics are eliminated relatively quickly, so that stopping the inhaled anesthetic will allow rapid return of consciousness. Sodium thiopental would have to be given in large amounts to maintain unconsciousness during anaesthesia due to its rapid redistribution throughout the body (as it has a high
volume of distribution
). Since its
half-life
of 5.5 to 26 hours is quite long, consciousness would take a long time to return.
[3]
In
veterinary medicine
, sodium thiopental is used to induce
anesthesia in animals
. Since it is redistributed to fat, certain lean breeds of dogs such as
sighthounds
will have prolonged recoveries from sodium thiopental due to their lack of body fat and their lean body mass. Conversely, obese animals will have rapid recoveries, but it will take much longer for the drug to be entirely removed (metabolized) from their bodies. Sodium thiopental is always administered intravenously, as it can be fairly irritating to tissue and is a
vesicant
; severe
tissue necrosis
and sloughing can occur if it is injected incorrectly into the tissue around a vein.
[14]
Medically-induced coma
[
edit
]
In addition to anesthesia induction, sodium thiopental was historically used to induce
medical comas
.
[15]
It has now been superseded by drugs such as propofol because their effects wear off more quickly than thiopental.
Patients with
brain swelling
, causing elevation of
intracranial pressure
, either secondary to trauma or following surgery, may benefit from this drug. Sodium thiopental, and the barbiturate class of drugs, decrease neuronal activity thereby decreasing cerebral metabolic rate of oxygen consumption (CMRO
2
), decrease the cerebrovascular response to carbon dioxide, which in turn decreases intracranial pressure. Patients with refractory elevated intracranial pressure (RICH) due to
traumatic brain injury
(TBI) may have improved long term outcome when
barbiturate coma
is added to their neurointensive care treatment.
[16]
Reportedly, thiopental has been shown to be superior to
pentobarbital
in reducing intracranial pressure.
[17]
This phenomenon is also called an inverse steal or Robin Hood effect as cerebral perfusion to all parts of the brain is reduced (due to the decreased cerebrovascular response to carbon dioxide) allowing optimal perfusion to ischaemic areas of the brain which have higher metabolic demands, since vessels supplying ischaemic areas of the brain would already be maximally dilated because of the metabolic demand.
[18]
Status epilepticus
[
edit
]
In refractory
status epilepticus
, thiopental may be used to terminate a seizure.
Euthanasia
[
edit
]
Sodium thiopental is used intravenously for the purposes of
euthanasia
. In both Belgium and the Netherlands, where active euthanasia is allowed by law, the standard protocol recommends sodium thiopental as the ideal agent to induce coma, followed by
pancuronium bromide
to paralyze muscles and stop breathing.
[19]
Intravenous administration is the most reliable and rapid way to accomplish euthanasia. Death is quick. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium (Nesdonal) in a small volume (10 mL physiological saline). Then, a triple dose of a non-depolarizing
neuromuscular blocking
drug is given, such as 20 mg pancuronium bromide (Pavulon) or 20 mg
vecuronium bromide
(Norcuron). The muscle relaxant should be given intravenously to ensure optimal
bioavailability
but pancuronium bromide may be administered intramuscularly at an increased dosage level of 40 mg.
[19]
Lethal injection
[
edit
]
Along with
pancuronium bromide
and
potassium chloride
, thiopental is used in 34 states of the US to execute prisoners by
lethal injection
. A very large dose is given to ensure rapid loss of consciousness. Although death usually occurs within ten minutes of the beginning of the injection process, some have been known to take longer.
[20]
The use of sodium thiopental in execution protocols was challenged in court after a study in the medical journal
The Lancet
reported
autopsies
of executed inmates showed the level of thiopental in their bloodstream was insufficient to cause unconsciousness although this is dependent on different factors and not just on the drug itself.
On December 8, 2009, Ohio became the first state to use a single dose of sodium thiopental for its capital execution, following the failed use of the standard three-drug cocktail during a recent execution, due to inability to locate suitable veins.
Kenneth Biros
was executed using the single-drug method.
[21]
Washington State became the second state in the US to use the single-dose sodium thiopental injections for executions. On September 10, 2010, the execution of
Cal Coburn Brown
was the first in the state to use a single-dose, single-drug injection. His death was pronounced approximately one and a half minutes after the intravenous administration of five grams of the drug.
[22]
After its use for the
execution of Jeffrey Landrigan
in the US, the United Kingdom introduced a ban on the export of sodium thiopental in December 2010,
[23]
after it was established that no European supplies to the US were being used for any other purpose.
[24]
The restrictions were based on "the European Union Torture Regulation (including licensing of drugs used in execution by lethal injection)".
[25]
From 21 December 2011, the EU extended trade restrictions to prevent the export of certain medicinal products for capital punishment, stating that "the Union disapproves of capital punishment in all circumstances and works towards its universal abolition".
[26]
Truth serum
[
edit
]
Thiopental is still used in some places as a
truth serum
to weaken the resolve of a subject and make the individual more compliant to pressure.
[27]
Barbiturates decrease both higher cortical brain function and inhibition. It is
hypothesized
that because lying is a more mentally involving process than telling the truth, suppression of the higher cortical functions may lead to the uncovering of the truth. The drug tends to make subjects verbose and cooperative with interrogators; however, the reliability of confessions made under thiopental is questionable.
[28]
Psychiatry
[
edit
]
Psychiatrists have used thiopental to desensitize patients with
phobias
[29]
and to "facilitate the recall of painful repressed memories."
[30]
One psychiatrist who worked with thiopental is
Jan Bastiaans
, who used this procedure to help relieve trauma in surviving victims of the
Holocaust
.
[31]
Mechanism of action
[
edit
]
Sodium thiopental is a member of the
barbiturate
class of drugs, which are relatively non-selective compounds that bind to an entire superfamily of
ligand-gated ion channels
, of which the
GABA
A
receptor
channel is one of several representatives. This superfamily of ion channels includes the neuronal
nicotinic acetylcholine receptor
(nAChR), the
5-HT3 receptor
, the
glycine receptor
and others. Surprisingly, while GABA
A
receptor currents are increased by barbiturates (and other general anesthetics), ligand-gated ion channels that are predominantly permeable for cationic ions are blocked by these compounds. For example, neuronal nAChR are blocked by clinically relevant anesthetic concentrations of both sodium thiopental and pentobarbital.
[32]
Such findings implicate (non-
GABAergic
) ligand-gated ion channels, e.g. the neuronal nAChR, in mediating some of the (side) effects of barbiturates.
[33]
The GABA
A
receptor is an inhibitory channel that decreases neuronal activity, and barbiturates enhance the inhibitory action of the GABA
A
receptor.
[34]
Controversies
[
edit
]
Following a shortage that led a court to delay an execution in California, a company spokesman for
Hospira
, the sole American manufacturer of the drug, objected to the use of thiopental in lethal injection. "Hospira manufactures this product because it improves or saves lives, and the company markets it solely for use as indicated on the product labeling. The drug is not indicated for capital punishment and Hospira does not support its use in this procedure."
[35]
On January 21, 2011, the company announced that it would stop production of sodium thiopental from its plant in Italy, because it could not provide Italian authorities with guarantees that exported doses would not be used in executions. According to a company spokesperson, Italy was the only viable place where it could produce the drug, leaving the US without a supplier.
[36]
In October 2015 the
U.S. Food and Drug Administration
confiscated an overseas shipment of thiopental destined for the states of Arizona and Texas. FDA spokesman Jeff Ventura said in a statement, "Courts have concluded that sodium thiopental for the injection in humans is an unapproved drug and may not be imported into the country".
[37]
Metabolism
[
edit
]
Thiopental rapidly and easily crosses the
blood?brain barrier
as it is a
lipophilic
molecule. As with all lipid-soluble anaesthetic drugs, the short duration of action of sodium thiopental is due almost entirely to its redistribution away from central circulation into muscle and fatty tissue, due to its very high lipid?water
partition coefficient
(approximately 10), leading to sequestration in fatty tissue. Once redistributed, the free fraction in the blood is metabolized in the liver by
zero-order kinetics
. Sodium thiopental is mainly metabolized to
pentobarbital
,
[38]
5-ethyl-5-(1'-methyl-3'-hydroxybutyl)-2-thiobarbituric acid, and 5-ethyl-5-(1'-methyl-3'-carboxypropyl)-2-thiobarbituric acid.
[39]
Dosage
[
edit
]
The usual dose range for induction of anesthesia using thiopental is from 3 to 6 mg/kg; however, there are many factors that can alter this. Premedication with sedatives such as
benzodiazepines
or
clonidine
will reduce requirements due to
drug synergy
, as do specific disease states and other patient factors. Among patient factors are: age, sex, and lean body mass.
[40]
Specific disease conditions that can alter the dose requirements of thiopentone and for that matter any other intravenous anaesthetic are:
hypovolemia
, burns,
azotemia
,
liver failure
,
hypoproteinemia
, etc.
[41]
Side effects
[
edit
]
As with nearly all
anesthetic
drugs
, thiopental causes cardiovascular and
respiratory depression
resulting in
hypotension
,
apnea
, and
airway
obstruction. For these reasons, thiopental should only be administered by suitably trained medical personnel, who should give thiopental in an environment equipped to provide (respiratory) support, such as
mechanical ventilation
. Other side-effects include headache,
agitated emergence
, prolonged
somnolence
, and
nausea
. Intravenous administration of sodium thiopental is followed instantly by an odor and/or taste sensation, sometimes described as being similar to rotting onions, or to garlic. Residual side-effects may last up to 36 hours.
Although each
molecule
of thiopental contains one
sulfur
atom, it is not a
sulfonamide
, and does not show the allergic reactions of sulfa/sulpha drugs.
Contraindications
[
edit
]
Thiopental should be used with caution in cases of
liver disease
,
Addison's disease
,
myxedema
, severe
heart disease
, severe
hypotension
, a severe
breathing disorder
, or a family history of
porphyria
.
[42]
[43]
Co-administration of
pentoxifylline
and thiopental causes death by acute
pulmonary edema
in rats. This pulmonary edema was not mediated by
cardiac failure
or by
pulmonary hypertension
but was due to increased pulmonary
vascular permeability
.
[44]
History
[
edit
]
Sodium thiopental was discovered in the early 1930s by
Ernest H. Volwiler
and Donalee L. Tabern, working for
Abbott Laboratories
. It was first used in human beings on March 8, 1934, by Dr. Ralph M. Waters
[45]
in an investigation of its properties, which were short-term anesthesia and surprisingly little analgesia.
[46]
Three months later,
[47]
Dr. John S. Lundy started a clinical trial of thiopental at the
Mayo Clinic
at the request of Abbott.
[48]
Abbott continued to make the drug until 2004, when it spun off its hospital-products division as
Hospira
.
Thiopental is famously associated with a number of anesthetic deaths in victims of the
attack on Pearl Harbor
. These deaths, relatively soon after the drug's introduction, were said to be due to excessive doses given to shocked trauma patients. However, recent evidence available through
freedom of information legislation
was reviewed in the
British Journal of Anaesthesia
,
[49]
which has suggested that this story was grossly exaggerated. Of the 344 wounded that were admitted to the
Tripler Army Hospital
, only 13 did not survive, and it is unlikely that thiopentone overdose was responsible for more than a few of these.
See also
[
edit
]
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[
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RXList
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WebMD
. 15 November 2021
. Retrieved
18 June
2023
.
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"Pentothal (thiopental)"
. eMedicineHealth. 12 April 2009. Archived from
the original
on 18 January 2015
. Retrieved
15 October
2010
.
- ^
James MF, Hift RJ (July 2000).
"Porphyrias"
.
British Journal of Anaesthesia
.
85
(1): 143?53.
doi
:
10.1093/bja/85.1.143
.
PMID
10928003
.
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Pereda J, Gomez-Cambronero L, Alberola A, Fabregat G, Cerda M, Escobar J, et al. (October 2006).
"Co-administration of pentoxifylline and thiopental causes death by acute pulmonary oedema in rats"
.
British Journal of Pharmacology
.
149
(4): 450?5.
doi
:
10.1038/sj.bjp.0706871
.
PMC
1978439
.
PMID
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.
- ^
"This Month in Anesthesia History: March"
. Anesthesia History Association. Archived from
the original
on 2011-05-01.
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Steinhaus JE (September 2001).
"The Investigator and His 'Uncompromising Scientific Honesty'
"
.
ASA Newsletter
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65
(9). American Society of Anesthesiologists: 7?9. Archived from
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on 2011-05-13.
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Lundy JS (April 1966).
"From this point in time: some memories of my part in the history of anesthesia"
.
The Journal of the American Association of Nurse Anesthetists
.
34
(2). American Association of Nurse Anesthetists: 95?102.
PMID
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Thatcher VS (1953).
"Chapter 7: Illegal or Legal?"
.
History of Anesthesia with Emphasis on the Nurse Specialist
. J.B. Lippincott.
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. Archived from
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Bennetts FE (September 1995).
"Thiopentone anaesthesia at Pearl Harbor"
.
British Journal of Anaesthesia
.
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(3): 366?8.
doi
:
10.1093/bja/75.3.366
.
PMID
7547061
.
External links
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Alcohols
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Barbiturates
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Benzodiazepines
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Carbamates
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Flavonoids
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Imidazoles
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Kava
constituents
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Monoureides
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Neuroactive steroids
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Nonbenzodiazepines
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Phenols
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Piperidinediones
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Pyrazolopyridines
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Quinazolinones
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Volatiles
/
gases
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Others/unsorted
|
- 3-Hydroxybutanal
- α-EMTBL
- AA-29504
- Alogabat
- Avermectins
(e.g.,
ivermectin
)
- Bromide
compounds (e.g.,
lithium bromide
,
potassium bromide
,
sodium bromide
)
- Carbamazepine
- Chloralose
- Chlormezanone
- Clomethiazole
- Darigabat
- DEABL
- Deuterated etifoxine
- Dihydroergolines
(e.g.,
dihydroergocryptine
,
dihydroergosine
,
dihydroergotamine
,
ergoloid (dihydroergotoxine)
)
- DS2
- Efavirenz
- Etazepine
- Etifoxine
- Fenamates
(e.g.,
flufenamic acid
,
mefenamic acid
,
niflumic acid
,
tolfenamic acid
)
- Fluoxetine
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- Hopantenic acid
- KRM-II-81
- Lanthanum
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(e.g.,
4-O-methylhonokiol
,
honokiol
,
magnolol
,
obovatol
)
- Loreclezole
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- Monastrol
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- Org 25,435
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(e.g.,
sulfonmethane (sulfonal)
,
tetronal
,
trional
)
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(e.g.,
borneol
)
- Topiramate
- Valerian
constituents (e.g.,
isovaleric acid
,
isovaleramide
,
valerenic acid
,
valerenol
)
|
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Receptor
(
ligands
)
| GlyR
Tooltip Glycine receptor
|
- Positive modulators:
Alcohols
(e.g.,
brometone
,
chlorobutanol (chloretone)
,
ethanol (alcohol)
,
tert
-butanol (2M2P)
,
tribromoethanol
,
trichloroethanol
,
trifluoroethanol
)
- Alkylbenzene sulfonate
- Anandamide
- Barbiturates
(e.g.,
pentobarbital
,
sodium thiopental
)
- Chlormethiazole
- D12-116
- Dihydropyridines
(e.g.,
nicardipine
)
- Etomidate
- Ginseng
constituents (e.g.,
ginsenosides
(e.g.,
ginsenoside-Rf
))
- Glutamic acid (glutamate)
- Ivermectin
- Ketamine
- Neuroactive steroids
(e.g.,
alfaxolone
,
pregnenolone (eltanolone)
,
pregnenolone acetate
,
minaxolone
,
ORG-20599
)
- Nitrous oxide
- Penicillin G
- Propofol
- Tamoxifen
- Tetrahydrocannabinol
- Triclofos
- Tropeines
(e.g.,
atropine
,
bemesetron
,
cocaine
,
LY-278584
,
tropisetron
,
zatosetron
)
- Volatiles
/
gases
(e.g.,
chloral hydrate
,
chloroform
,
desflurane
,
diethyl ether (ether)
,
enflurane
,
halothane
,
isoflurane
,
methoxyflurane
,
sevoflurane
,
toluene
,
trichloroethane (methyl chloroform)
,
trichloroethylene
)
- Xenon
- Zinc
- Antagonists:
2-Aminostrychnine
- 2-Nitrostrychnine
- 4-Phenyl-4-formyl-N-methylpiperidine
- αEMBTL
- Bicuculline
- Brucine
- Cacotheline
- Caffeine
- Colchicine
- Colubrine
- Cyanotriphenylborate
- Dendrobine
- Diaboline
- Endocannabinoids
(e.g.,
2-AG
,
anandamide (AEA)
)
- Gaboxadol (THIP)
- Gelsemine
- iso-THAZ
- Isobutyric acid
- Isonipecotic acid
- Isostrychnine
- Laudanosine
- N-Methylbicuculline
- N-Methylstrychnine
- N,N-Dimethylmuscimol
- Nipecotic acid
- Pitrazepin
- Pseudostrychnine
- Quinolines
(e.g.,
4-hydroxyquinoline
,
4-hydroxyquinoline-3-carboxylic acid
,
5,7-CIQA
,
7-CIQ
,
7-TFQ
,
7-TFQA
)
- RU-5135
- Sinomenine
- Strychnine
- Thiocolchicoside
- Tutin
- Negative modulators:
Amiloride
- Benzodiazepines
(e.g.,
bromazepam
,
clonazepam
,
diazepam
,
flunitrazepam
,
flurazepam
)
- Corymine
- Cyanotriphenylborate
- Daidzein
- Dihydropyridines
(e.g.,
nicardipine
,
nifedipine
,
nitrendipine
)
- Furosemide
- Genistein
- Ginkgo
constituents (e.g.,
bilobalide
,
ginkgolides
(e.g.,
ginkgolide A
,
ginkgolide B
,
ginkgolide C
,
ginkgolide J
,
ginkgolide M
))
- Imipramine
- NBQX
- Neuroactive steroids
(e.g.,
3α-androsterone sulfate
,
3β-androsterone sulfate
,
deoxycorticosterone
,
DHEA sulfate
,
pregnenolone sulfate
,
progesterone
)
- Opioids
(e.g.,
codeine
,
dextromethorphan
,
dextrorphan
,
levomethadone
,
levorphanol
,
morphine
,
oripavine
,
pethidine
,
thebaine
)
- Picrotoxin
(i.e.,
picrotin
and
picrotoxinin
)
- PMBA
- Riluzole
- Tropeines
(e.g.,
bemesetron
,
LY-278584
,
tropisetron
,
zatosetron
)
- Verapamil
- Zinc
|
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NMDAR
Tooltip N-Methyl-D-aspartate receptor
| |
---|
|
---|
Transporter
(
blockers
)
| GlyT1
Tooltip Glycine transporter 1
| |
---|
GlyT2
Tooltip Glycine transporter 2
| |
---|
|
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|
|
---|
AMPAR
Tooltip α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor
| |
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KAR
Tooltip Kainate receptor
| |
---|
NMDAR
Tooltip N-Methyl-D-aspartate receptor
| |
---|
|
|
---|
nAChRs
Tooltip Nicotinic acetylcholine receptors
| Agonists
(and
PAMs
Tooltip positive allosteric modulators
)
|
- 5-HIAA
- 6-Chloronicotine
- A-84,543
- A-366,833
- A-582,941
- A-867,744
- ABT-202
- ABT-418
- ABT-560
- ABT-894
- Acetylcholine
- Altinicline
- Anabasine
- Anatabine
- Anatoxin-a
- AR-R17779
- Bephenium hydroxynaphthoate
- Butinoline
- Butyrylcholine
- Carbachol
- Choline
- Cotinine
- Cytisine
- Decamethonium
- Desformylflustrabromine
- Dianicline
- Dimethylphenylpiperazinium
- Epibatidine
- Epiboxidine
- Ethanol (alcohol)
- Ethoxysebacylcholine
- EVP-4473
- EVP-6124
- Galantamine
- GTS-21
- Ispronicline
- Ivermectin
- JNJ-39393406
- Levamisole
- Lobeline
- MEM-63,908 (RG-3487)
- Morantel
- Nicotine
(
tobacco
)
- NS-1738
- PHA-543,613
- PHA-709,829
- PNU-120,596
- PNU-282,987
- Pozanicline
- Pyrantel
- Rivanicline
- RJR-2429
- Sazetidine A
- SB-206553
- Sebacylcholine
- SIB-1508Y
- SIB-1553A
- SSR-180,711
- Suberyldicholine
- Suxamethonium (succinylcholine)
- Suxethonium (succinyldicholine)
- TC-1698
- TC-1734
- TC-1827
- TC-2216
- TC-5214
- TC-5619
- TC-6683
- Tebanicline
- Tribendimidine
- Tropisetron
- UB-165
- Varenicline
- WAY-317,538
- XY-4083
|
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Antagonists
(and
NAMs
Tooltip negative allosteric modulators
)
| |
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|
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Precursors
(and
prodrugs
)
| |
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|
|