Pronunciation: MA-zin-doll (also pronounced MAYZ-in-dohl) Chemical Abstracts Service Registry Number: 22232-71-9 Formal Names: Mazanor, Sanorex, Teronac Type: Stimulant (anorectic class). See page 15 Federal Schedule Listing: Schedule IV (DEA no. 1605) USA Availability: Prescription Pregnancy Category: C

Uses. Mazindol reduces appetite, and the drug's main medical usage is short-term promotion of weight loss. For that purpose one study showed mazindol having about 10% to 20% of dextroamphetamine's strength; another study noted that regardless of relative strength per milligram, patients on mazindol shed about twice as many pounds as those on dextroamphetamine. In studies examining diet drugs, persons using mazindol lost as many or even more pounds compared to persons using phenmetrazine. One 12-week experiment found mazindol considerably more effective than diethylpropion for human weight loss, although a rat study found those two drugs' effectiveness comparable. Some human studies put mazindol as about equal to fenflura-mine for weight loss. Still other studies call mazindol's performance the same as a placebo. Perhaps these various findings are less a commentary on mazin-dol than on the unclear effectiveness of diet drugs in general.

Although mazindol appears to produce depression among some users, in others the drug works as an antidepressant. This antidepressant characteristic is considered helpful in promoting weight loss, as some overweight persons use food to compensate for sadness. As one condition improves, generally the other one does also. Mazindol's dual action as an anorectic and antidepressant can make it especially appropriate for persons struggling to lose both melancholy and weight.

Some mazindol effects are like those of amphetamine, but the two substances are described as chemically unrelated. Mazindol seems to pep up rats. In rat experiments the drug increases tendency to move around, more in females than in males. In humans the compound is used to combat narcolepsy and the decline of muscle tone sometimes associated with that affliction. Mazindol acts as a pain reliever in mice. One study found the drug made humans more sensitive to pain, but other experimental usage reduced pain in terminal cancer patients. Researchers believe mazindol can aid sufferers from Parkinson's disease. A case is reported of the drug acting as an aphrodisiac in a human female. The compound can reduce cholesterol levels.

Drawbacks. Mazindol increases pulse rate, may cause hallucinations, and disrupts sleep. In one study users complained of headache, skin rash, dry mouth, perspiration, tremor in heart and other muscles, nausea, and difficult urination and bowel movements. Users also report being wired, edgy, and dizzy. In human males mazindol can make the testes painful, interfere with erection and ejaculation, and cause urine retention. The latter effect has been exploited to treat incontinence. Mazindol may interfere with production of human growth hormone, a consideration when juveniles take the drug. When tested as a treatment for schizophrenia the drug at best had no effect and even worsened some symptoms. A medical journal article published in 2000 linked mazindol to pulmonary hypertension, the first time such an association was reported. Earlier reports noted development of heart disorder after taking mazindol in combination with fenfluramine or dexfenfluramine, but such affliction has been attributed to those latter two drugs by themselves, so mazindol's role is uncertain.

Abuse factors. In rhesus monkey experiments the animals show a liking for mazindol, but a review of clinical studies found no instances of patients becoming addicted. Although reports exist of mazindol inducing euphoria, human users show no particular liking for the drug. Volunteers comparing several diet drugs found mazindol to have the least appeal by far. Scientists evaluating another experimental study of the drug described it as a "punisher" that persons wanted to avoid.

Drug interactions. Researchers say mazindol and alcohol have a multiplier effect when used together, boosting each other's potency and producing an extra buzz for recreational users. Mazindol interferes with some cocaine effects, but studies examining mazindol's potential for treating cocaine addiction find a placebo to be about as good. One study even found the two drugs to have a hazardous multiplier effect raising blood pressure and pulse rate, and rat experiments find that mazindol reduces the size of a cocaine dose needed to cause death. Mazindol can react adversely with antimania drug lithium and can counteract drugs intended to lower blood pressure.

Cancer. Laboratory experiments show mazindol promoting cell mutations and chromosome breaks (traditional signs of cancer-causing potential), but that finding's real-life meaning is unclear.

Pregnancy. The drug's influence on fetal development is unestablished. Whether the drug passes into milk of nursing mothers is unknown. Doses that kill female rats while pregnant or after giving birth can leave males and non-pregnant females unscathed. Whether such findings mean that pregnancy increases human sensitivity to the drug is unknown.

Additional scientific information may be found in:

Alvarez, B., et al. "Mazindol in Long-Term Treatment of Narcolepsy." Lancet 337 (1991): 1293-94.

Bierger, P., F. Gawin, and T.R. Kosten. "Treatment of Cocaine Abuse with Mazindol." Lancet 1 (1989): 283.

Chait, L.D., E.H. Uhlenhuth, and C.E. Johanson. "Reinforcing and Subjective Effects of Several Anorectics in Normal Human Volunteers." Journal of Pharmacology and Experimental Therapeutics 242 (1987): 777-83.

Hagiwara, M., et al. "Delayed Onset of Pulmonary Hypertension Associated with an Appetite Suppressant, Mazindol: A Case Report." Japanese Circulation Journal 64 (2000): 218-21.

Preston, K.L., et al. "Effects of Cocaine Alone and in Combination with Mazindol in Human Cocaine Abusers." Journal of Pharmacology and Experimental Therapeutics 267 (1993): 296-307.

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