• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Drugs in the Pipeline: ALKS–5461

Drugs in the Pipeline: ALKS–5461

November 1, 2012
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue

Since our feature article on “New Antidepressants” in the May 2012 TCPR, you may have heard some buzz about yet another new antidepressant undergoing clinical trials, this one with the less-than-sexy name ALKS-5461. Some news outlets have promoted it as “revolutionary.” What exactly is it?

While most current antidepressants act on the monoamine neurotransmitters (serotonin, norepinephrine, dopamine), ALKS-5461 acts on the endogenous opioid system. It’s actually a combination of two drugs: buprenorphine and a compound called ALKS-33 or samidorphan. (“ALKS,” by the way, refers to Alkermes, the compound’s manufacturer.) You’re probably familiar with buprenorphine; it’s the essential component of Suboxone, the office-based opioid therapy for chronic opioid dependence (see TCPR May 2010, for a discussion of Suboxone). Buprenorphine is a partial agonist of the mu opioid receptor and full antagonist of the kappa receptor; ALKS-33, on the other hand, is a molecule that blocks buprenorphine’s effect on the mu receptor. The combination of buprenorphine and ALKS-33, therefore, should theoretically allow buprenorphine to bind to the kappa opioid receptor but not the mu receptor, thereby avoiding any euphoric effect—or addictive potential.

The ability of opioids to enhance mood has been known for centuries, so it’s no surprise that drug companies are turning to these compounds for their antidepressant properties. Several small studies have shown that buprenorphine can have an antidepressant effect (for a review, see Tenore PL, J Addict Dis 2008;27(3):49–65), but this compound is less than ideal because of its oral abuse potential (even when packaged with naloxone, as in Suboxone) and complicated withdrawal. Some evidence suggests that dynorphin, a natural brain peptide and pure agonist of the kappa receptor, is elevated in depression, so blocking the kappa receptor makes sense (see Knoll AT and Carlezon WA, Brain Res 2010;1314:56–73). The two-drug combination in ALKS-5461 is apparently designed to do just that: prevent mu receptor activation and allow buprenorphine to do its work by blocking the kappa receptor instead.

The efficacy of ALKS-5461 for depression remains to be seen. Some trials of ALKS-33 alone have already been performed, particularly in the areas of alcohol dependence and binge-eating disorder. These have been negative.

TCPR’S VERDICT: Only preliminary data on ALKS-5461 have been released thus far, and a phase II trial is currently under way. But before getting too excited, we should remind ourselves that opioids are not simple drugs. They may be misused, they can cause side effects ranging from constipation to respiratory depression, and they are frequently associated with an agonizing, prolonged withdrawal. It will be crucial to thoroughly evaluate the safety data of ALKS-5461 to determine whether the addition of a mu antagonist prevents withdrawal complications or abuse. And we should use extra caution before using existing compounds such as Suboxone or buprenorphine off label in our depressed patients without a full understanding of the risks involved.
General Psychiatry
KEYWORDS medical_comorbidities
    www.thecarlatreport.com
    Issue Date: November 1, 2012
    SUBSCRIBE NOW
    Table Of Contents
    Integrating Primary Care and Mental Health Care
    Drugs in the Pipeline: ALKS–5461
    Chronic Pain, Comorbidity, and Treatment Complexity
    Fatigue: Causes and Treatments
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.