4.19 : Desensitization and Tachyphylaxis

Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.

Several mechanisms can contribute to tachyphylaxis. One common mechanism involves receptor desensitization, where persistent receptor stimulation leads to a reduced response. For example, in G protein–coupled receptors, extended drug exposure results in its phosphorylation. The phosphorylated receptor binds β-arrestin, which blocks the binding of additional G proteins and leads to endocytosis of the receptor. The internalized receptor is either degraded by endosome-lysosome fusion or returned to the plasma membrane when the drug levels drop.

Another mechanism is the depletion of signaling molecules or neurotransmitters in the response. For example, drugs like amphetamine, which work by releasing amines from nerve terminals, cause a rapid decrease in response due to the depletion of amine storage. This means that with repeated use, the drug becomes less effective over time as the body's supply of amines is exhausted.

Tachyphylaxis has important clinical implications. It may necessitate increasing the dose of a drug to maintain its effectiveness or require the use of alternative treatments. Understanding this process is important for optimizing drug therapy and developing strategies to mitigate tachyphylaxis and maintain the desired therapeutic effects.