Zotepine: preclinical tests predict antipsychotic efficacy and an atypical profile

Zotepine, an atypical antipsychotic structurally similar to clozapine, is in Phase III clinical trials in the United States and Europe for the treatment and management of acute and chronic schizophrenia. Zotepine's pharmacological profile has been compared with those of the atypical antipsychotic clozapine, and the typical neuroleptics haloperidol and chlorpromazine in preclinical tests that predict antipsychotic efficacy and extrapyramidal symptoms (EPS). Because zotepine causes potent, long-lasting inhibition of dopaminergic behavioral responses in animals, it may have an efficacious prolonged antipsychotic action in humans. In contrast, it induces little catalepsy, indicating that it should cause minimal motor side effects, such as EPS. Like clozapine but unlike the typical neuroleptics, zotepine's affinities for cloned human D1 and D2 receptors are very similar. Since a stimulation imbalance favoring D1 over D2 receptors has been suggested to induce dyskinesias, zotepine's reduced EPS profile in humans may derive, in part, from balanced inhibition of these receptors.