Haloperidol is a typical antipsychotic drug (APD) associated with an increased risk of extrapyramidal side-effects (EPS) and hyperprolactinemia relative to atypical APDs such as clozapine. Both drugs are dopamine D 2 receptor (D 2 R) antagonists, with contrasting kinetic profiles. Haloperidol displays fast association/slow dissociation at the D 2 R whereas clozapine exhibits relatively slow association/fast dissociation. Recently, we have provided evidence that slow dissociation from the D 2 R predicts hyperprolactinemia, whereas fast association predicts EPS. Unfortunately, clozapine can cause severe side-effects independent of its D 2 R action. Our results suggest an optimal kinetic profile for D 2 R antagonist APDs that avoids EPS. To begin exploring this hypothesis, we conducted a structure-kinetic relationship study of haloperidol and reveal that subtle structural modifications dramatically change binding kinetic rate constants, affording compounds with a clozapine-like kinetic profile. Thus, optimisation of these kinetic parameters may allow development of novel APDs based on the haloperidol scaffold with improved side-effect profiles.
INTRODUCTIONHaloperidol (1, Figure 1) is an effective, typical antipsychotic drug (APD) used in the treatment of schizophrenia (SCZ). As for all current APDs, its mechanism of action is primarily through antagonism of dopamine (DA) D 2 receptors (D 2 R) in the mesolimbic pathway, where excessive DA activity is thought to underlie the positive symptoms of schizophrenia. [1][2][3] Unfortunately, 1 along with