Amineptine, formerly sold under the brand name Survector among others, is an atypical antidepressant of the tricyclic antidepressant (TCA) family. It acts as a selective and mixed dopamine reuptake inhibitor and releasing agent, and to a lesser extent as a norepinephrine reuptake inhibitor.
Amineptine was developed by the French Society of Medical research in the 1960s. Introduced in France in 1978 by the pharmaceutical company Servier, amineptine soon gained a reputation for abuse due to its short-lived, but pleasant, stimulant effect experienced by some patients.
After its release into the European market, cases of hepatotoxicity emerged, some serious. This, along with the potential for abuse, led to the suspension of the French marketing authorization for Survector in 1999.
Amineptine was never approved by the U.S. Food and Drug Administration (FDA) for marketing in the United States, meaning that it is not legal to market or sell amineptine for any medical uses in the U.S.
Medical uses
Amineptine was approved in France for severe clinical depression of endogenous origin in 1978.
Contraindications
Chorea
Hypersensitivity: Known hypersensitivity to amineptine, in particular antecedents of hepatitis after dosage of the product. MAO inhibitors
Precautions for use
Warnings and precautions before taking amineptine:
Breast feeding
Children less than 15-year of age
General anaesthesia: Discontinue the drug 24 to 48 hours before anaesthesia. Official sports/Olympic Games: Prohibited substance. 7 March Official Journal 2000. Pregnancy (first trimester)
Effects on the fetus
Lacking information in humans
Non-teratogenic in rodents
Side effects
Dermatological
Severe acne due to amineptine was first reported in 1988 by various authors—Grupper, Thioly-Bensoussan, Vexiau, Fiet, Puissant, Gourmel, Teillac, Levigne, to name a few—simultaneously in the same issue of Annales de Dermatologie et de Vénéréologie and in the 12 March 1988 issue of The Lancet. A year later, Dr Martin-Ortega and colleagues in Barcelona, Spain reported a case of "acneiform eruption" in a 54-year-old woman whose intake of amineptine was described as "excessive." One year after that, Vexiau and colleagues reported six women, one of whom never admitted to using amineptine, getting severe acne concentrated in the face, back and thorax, the severity of which varied with the dosage. Most of them were treated unsuccessfully with isotretinoin (Accutane) for about 18 months; two of the three that discontinued amineptine experienced a reduction in cutaneous symptoms, with the least affected patient going into remission.
Psychiatric
Psychomotor excitation can very rarely occur with this drug.
Insomnia
Irritability
Nervousness
Suicidal ideation. Seen early in the treatment, by lifting of psychomotor inhibition.
Abuse and dependence
The risk of addiction is low, but exists nonetheless. Between 1978 and 1988, there were 186 cases of amineptine addiction reported to the French Regional Centres of Pharmacovigilance; an analysis of 155 of those cases found that they were predominantly female, and that two-thirds of cases had known risk factors for addiction. However, a 1981 study of known opiate addicts and schizophrenia patients found no drug addiction in any of the subjects. In a 1990 study of eight amineptine dependence cases, the gradual withdrawal of amineptine could be achieved without problems in six people; in two others, anxiety, psychomotor agitation, and/or bulimia appeared.
Withdrawal
Pharmacodependence is very common with amineptine compared to other antidepressants. A variety of psychological symptoms can occur during withdrawal from amineptine, such as anxiety and agitation.
Cardiovascular
Very rarely:
Arterial hypotension
Palpitations
Vasomotor episode
Hepatic
Amineptine can rarely cause hepatitis, of the cytolytic, cholestatic varieties. Amineptine-induced hepatitis, which is sometimes preceded by a rash, is believed to be due to an immunoallergic reaction. It resolves upon discontinuation of the offending drug. The risk of getting this may or may not be genetically determined.
Additionally, amineptine is known to rarely elevate transaminases, alkaline phosphatase, and bilirubin.