Side Effects: Sedation Parkinsonism symptoms QT prolongation (may be significant if taking with drugs inhibiting CYP3A4/5 or 2D6) Pharmacokinetics: undergoes rapid hepatic metabolism involving carbonyl reductase and CYP2D6 to 2 deuterated active metabolites -dihydrotetrabenazine (-HTBZ) and -dihydrotetrabenazine (-HTBZ), with eventual renal elimination of metabolites the -HTBZ and -HTBZ metabolites are primarily responsible for the pharmacological & therapeutic effects produced by the parent prodrug twice a day dosing effect half life 9.4 hours (Schneider et al, 2021) HT: Resistant Hypertension
Gut dysbiosis and reactive oxygen species (ROS)-induced oxidative stress contribute to the accumulation of -syn, which subsequently propagates to the brain via the vagus nerve, thereby establishing a gut-brain axis mechanism in disease progression (Soni et al., 2024)
Radioactive iodine therapy, which aims to destroy overactive thyroid cells, frequently results in hypothyroidism, necessitating lifelong thyroid hormone replacement therapy
Conclusions and Recommendations Key messages for at-risk populations: The EVOKE trial failure does not invalidate GLP-1 agonists for preventionthe epidemiological signal remains strong, and these drugs may provide metabolic and cardiovascular benefits with potential cognitive co-benefits when used for approved indications SS-31s approval establishes precedent for mitochondrial-targeted therapeuticswatch this space for expanded indications Popular biohacker peptides (BPC-157, Dihexa, P21) have essentially no human cognitive evidence