Ocular hypotensive, vasorelaxant and cyclic AMP intermediation activities of clozapine displaying antiglaucoma properties

Abstract

Clozapine, an atypical antipsychotic agent with multiple receptor antagonist activities, was investigated in vivo and in vitro to discover its effects on intraocular pressure and blood flow, on the contractility of ciliary muscle and nonophthalmologic blood vessels, on calcium concentration in A7r5 smooth muscle cells, and on cyclic AMP intermediation. The adrenergic and muscarinic mechanisms involved in the above effects were also examined. In rabbits, clozapine (0.1, 0.25, and 0.5%) prolonged (IOP) recovery time and inhibited IOP response. Clozapine (0.1 and 0.25%) also produced a significant increase in ocular blood flow in this iris, ciliary, retina, and choroid at 30 to 180 min after drug administration. In isolated guinea pig thoracic aorta, clozapine relaxed phenylephrine (10 μM)- and KCl (75 mM)-induced contractions, the estimated IC50 values being 20.4 ± 3.1 nM and 10.6 ± 1.8 μM, respectively. Clozapine (0.1–100 μM) inhibited phenylephrine (10 μM)-induced influx of Ca2+, the estimated IC50 value being 0.4 ± 0.1 nM. In isolated pig eye ciliary muscles, clozapine (1.0–100 μM) inhibited carbachol (10 μM)-induced contractions, the estimated IC50 value being 5.8 ± 1.2 μM. Clozapine (0.1–100 μM) increased cyclic AMP accumulation in pig's ciliary bodies, including ciliary process, ciliary muscle, and trabecular meshwork. Pretreatment with carbachol (100 μM) first decreased, then increased, clozapine-induced cyclic AMP accumulation. Studies of pretreatments with various muscarinic receptor antagonists at 100 μM revealed that pirenzepine significantly enhanced clozapine (100 μM)-induced cyclic AMP accumulations in trabecular meshwork, while 4-DAMP methiodide inhibited it in ciliary bodies, and methoctramine decreased it in ciliary process. The ocular hypotensive effects of clozapine may be mostly related to its muscarinic agonist/antagonist activities and associated cyclic AMP increasing activities, which lead to ciliary muscle relaxation and a possibly associated increase in uveoscleral outflow. Clozapine's ability to increase blood flow and relax vessels may be attributed to its ability to block α-adrenergic and decrease intracellular calcium. IOP is considered the major cause of glaucoma, and compounds which are capable of reducing IOP are considered useful for glaucoma treatment. Based on the results above, clozapine may potentially be important in the development of new antiglaucoma agents. Drug Dev. Res. 44:163–173, 1998. © 1998 Wiley-Liss, Inc.