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Experiments ex vivo have shown that vinpocetine acts as a selective inhibitor of Ca 2+ /calmodulin-dependent cyclic nucleotide phosphodiesterase type I [21,108], a potent blocker of voltage-gated sodium channels [109,110], inhibits platelet aggregation, reduces blood viscosity, vasodilates cerebral arteries, and increases cerebral blood flow [111]

2 Tramadol, a synthetic opioid receptor agonist with properties similar to those of SNRIs, inhibits the reuptake of biogenic aminesincluding serotonin and norepinephrine (similar to SNRI antidepressants)and acts as a weak agonist at the mu-opioid receptor

However, it remains unclear whether copper alone, or in combination with iron, triggers this process, as both metals are present in the liver of Wilson disease patients [21,27,45,47,50,52]