Sympathomimetic drug

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Sympathomimetic drugs are substances that mimic the effects of the hormone epinephrine (adrenaline) and the hormone/neurotransmitter norepinephrine (noradrenaline). They all raise blood pressure and are all weak bases.

Mechanisms of action

The mechanisms of sympathomimetic drugs are to act as catecholamine synthesis precursors, norepinephrine transporter blockade, adrenergic receptor agonism, inhibition of epinephrine and norepinephrine metabolism and/or cholinergic inhibition.

Synthesis precursor

Synthesis precursors of catecholamines stimulate the catecholamine synthesis. One example is levodopa.

Norepinephrine transporter blockade

Classical sympathomimetic drugs are amphetamines (including MDMA), ephedrine and cocaine, which act by blocking and reversing norepinephrine transporter (NET) activity. NET is a transport protein expressed on the surface of some cells that clears noradrenaline and adrenaline from the extracellular space and into cells, terminating the signaling effects.

Adrenergic receptor agonism

Main article: Adrenergic agonist

Direct stimulation of the α- and β-adrenergic receptors can produce sympathomimetic effects. Albuterol is a very commonly used direct-acting β₂-agonist.

Inhibition of epinephrine and norepinephrine metabolism

Inhibition of norepinephrine metabolism can produce sympathomimetic effects. Norepinephrine is mainly metabolized by the enzyme monoamine oxidase, the monoamine oxidase inhibitor (MAOI) drugs can induce such effects.

Cholinergic inhibition

Sympathomimetic drugs may also work by inhibiting the opposite system, i.e. the parasympathetic system. It does so by inhibiting the effects of acetylcholine, e.g. by inhibiting synaptic vesicle release, antagonize acetylcholine receptors,

• synaptic vesicle release inhibitors:
  • botulinum toxin
• ACh receptor inhibitors
  • atropine (all muscarinic)
  • scopolamine (M1 receptors)
  • tubocurarine (Muscle type nicotinic)

Cross-reactivity

Substances like cocaine also affect dopamine, and some substances like MDMA affect serotonin.

Norepinephrine is synthesized by the body into epinephrine, causing central nervous system stimulation. Thus, all sympathomimetic amines fall into the larger group of stimulants (see psychoactive drug chart). Many of these stimulants have therepeutic use and abuse potential, can induce tolerance, and possibly physical dependence.

See also

• Sympathetic nervous system

External links

• MeSH Amines,+Sympathomimetic
• Sympathomimetic+amine at eMedicine Dictionary
• Sympathomimetic at eMedicine Dictionary

v • d • e Sympathomimetic amines (R01, A08 and others)
Alpha-pyrrolidinopropiophenone • Aminorex • d-Amphetamine & l,d-Amphetamine • d-Methamphetamine & l-Methamphetamine • Benzylpiperazine • Cathinone • CFT • Chlorphentermine • Clobenzorex • Cocaine • Cyclopentamine • Desoxypipradrol • Diethylpropion • Ephedrine • 4-FMP • 4-MTA • Fencamfamine • Fenfluramine • Fenproporex • Mazindol • MDPV • 4-Methyl-aminorex • Methylone • Methylphenidate • Naphazoline • Pemoline • Phendimetrazine • Phenmetrazine • Phentermine • Phenylephrine • Pipradrol • Pseudoephedrine • Pyrovalerone • Sibutramine • Synephrine
See also amphetamines

v • d • e Psychoanaleptics: psychostimulants, agents used for ADHD and nootropics (N06B)
Centrally acting sympathomimetics	Amphetamine - Amphetaminil - Atomoxetine - Dextroamphetamine - Dextromethamphetamine - Fencamfamin - Fenozolone - Fenetylline - Methylphenidate - Mesocarb - Pemoline - Pipradrol - Prolintane
Xanthine derivatives	Caffeine - Propentofylline
Racetams	Aniracetam - Oxiracetam - Phenylpiracetam - Piracetam - Pramiracetam
Ampakines	CX-516 - CX-546 - CX-614 - CX-691 - CX-717 - IDRA-21 - LY-503,430 - PEPA
Eugeroics	Adrafinil - Armodafinil - Modafinil
Other psychostimulants and nootropics	Acetylcarnitine - Citicoline - Cyprodenate - Idebenone - Deanol - Dimebon - Fipexide - Linopirdine - Meclofenoxate - Nizofenone - Pirisudanol - Pyritinol - Sulbutiamine - Vinpocetine

v • d • e Decongestants and other nasal preparations (R01)
Topical: sympathomimetics, plain	Cyclopentamine - Ephedrine - Phenylephrine - Oxymetazoline - Tetryzoline - Xylometazoline - Naphazoline - Tramazoline - Metizoline - Tuaminoheptane - Fenoxazoline - Tymazoline - Epinephrine
Topical: antiallergic agents, excluding corticosteroids	Cromoglicic acid - Levocabastine - Azelastine - Antazoline - Spaglumic acid - Thonzylamine - Nedocromil - Olopatadine
Topical: corticosteroids	Beclometasone - Prednisolone - Dexamethasone - Flunisolide - Budesonide - Betamethasone - Tixocortol - Fluticasone - Mometasone furoate - Triamcinolone - Ciclesonide
Topical: other nasal preparations	Calcium hexamine thiocyanate - Retinol - Ipratropium bromide - Ritiometan - Mupirocin - Hexamidine - Framycetin
Systemic use: Sympathomimetics	Phenylpropanolamine - Pseudoephedrine - Phenylephrine

v • d • e Ophthalmologicals: antiglaucoma preparations and miotics (S01E)
Sympathomimetics	Apraclonidine • Brimonidine • Clonidine • Dipivefrine • Epinephrine
Parasympathomimetics	Aceclidine • Acetylcholine • Carbachol • Demecarium • Echothiophate • Stigmine (Fluostigmine, Neostigmine, Physostigmine) • Paraoxon • Pilocarpine
Carbonic anhydrase inhibitors	Acetazolamide • Brinzolamide • Diclofenamide • Dorzolamide • Methazolamide
Beta blocking agents	Befunolol • Betaxolol • Carteolol • Levobunolol • Metipranolol • Timolol
Prostaglandin analogues	Bimatoprost • Latanoprost • Travoprost • Unoprostone
Other agents	Dapiprazole • Guanethidine

v • d • e Ophthalmologicals: mydriatics and cycloplegics (S01F)
Anticholinergics/antimuscarinics	Atropine - Scopolamine - Methylscopolamine - Cyclopentolate - Homatropine - Tropicamide
Sympathomimetics	Phenylephrine - Ephedrine - Ibopamine

de:Sympathomimetikumfr:Sympathicomimétique no:Sympatomimetisk amin fi:Sympatomimeetti

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .