Gardner E L, Chen J, Paredes W
Department of Psychiatry, Albert Einstein College of Medicine, New York, NY 10461-1602.
J Clin Psychiatry. 1994 Sep;55 Suppl B:15-22.
Although weak as an antagonist at brain dopamine receptors, clozapine is very strongly antidopaminergic when measured by in vivo single-neuron electrophysiologic recording, in vivo brain microdialysis, in vivo brain voltammetric electrochemistry, in vivo electrical brain stimulation, or in vivo neurobehavioral techniques. Three aspects of clozapine's strong antidopaminergic actions are remarkable. First, clozapine's antidopaminergic potency is stronger than can be explained by its comparatively weak interaction with dopamine receptors, implying that a significant portion of its antidopaminergic action may be transsynaptic and secondary to actions on nondopamine neurotransmitter systems. Second, clozapine's strong antidopaminergic action is seen more reliably with chronic rather than acute administration, implying that some cumulative neurochemical process underlies the gradual recruitment of dopamine blockade. Third, and most remarkably, clozapine's strong antidopaminergic action is anatomically specific--present in the mesolimbic dopamine system but absent in the nigrostriatal dopamine system. This mesolimbic-specific dopamine blockade may underlie at least a portion of clozapine's atypical clinical profile.
尽管氯氮平作为脑多巴胺受体拮抗剂的作用较弱,但通过体内单神经元电生理记录、体内脑微透析、体内脑伏安电化学、体内脑电刺激或体内神经行为技术测量时,它具有非常强的抗多巴胺能作用。氯氮平强大的抗多巴胺能作用有三个方面值得注意。首先,氯氮平的抗多巴胺能效力比其与多巴胺受体相对较弱的相互作用所能解释的要强,这意味着其抗多巴胺能作用的很大一部分可能是跨突触的,并且是对非多巴胺神经递质系统作用的继发结果。其次,氯氮平的强大抗多巴胺能作用在长期给药而非急性给药时更可靠地显现出来,这意味着某种累积的神经化学过程是多巴胺阻断逐渐形成的基础。第三,也是最值得注意的,氯氮平的强大抗多巴胺能作用在解剖学上具有特异性——存在于中脑边缘多巴胺系统,但在黑质纹状体多巴胺系统中不存在。这种中脑边缘特异性多巴胺阻断可能至少是氯氮平非典型临床特征的一部分原因。