Cilansetron

Cilansetron
Clinical data
Pregnancy; category	C;
Routes of; administration	Oral
ATC code	A03AE03 (WHO) ;
Legal status
Legal status	Unlicensed;
Pharmacokinetic data
Bioavailability	87%
Metabolism	Hepatic
Elimination half-life	1.6 - 1.9 hours
Excretion	Renal
Identifiers
	IUPAC name (10R)-10-[(2-methyl-1H-imidazol-1-yl)methyl]-5,6,9,10; -tetrahydro-4H-pyrido(3,2,1-jk)carbazol-11-one;
CAS Number	120635-74-7 ;
PubChem CID	6918107;
IUPHAR/BPS	2297;
ChemSpider	5293321 ;
UNII	2J6DQ1U5B5;
KEGG	D03495 ;
ChEMBL	ChEMBL2103778;
CompTox Dashboard (EPA)	DTXSID40152951 ;
Chemical and physical data
Formula	C20H21N3O
Molar mass	319.4 g/mol g·mol−1
3D model (JSmol)	Interactive image;
	SMILES O=C3c2c1cccc5c1n(c2CC[C@@H]3Cn4ccnc4C)CCC5;
	InChI InChI=1S/C20H21N3O/c1-13-21-9-11-22(13)12-15-7-8-17-18(20(15)24)16-6-2-4-14-5-3-10-23(17)19(14)16/h2,4,6,9,11,15H,3,5,7-8,10,12H2,1H3/t15-/m1/s1 ; Key:NCNFDKWULDWJDS-OAHLLOKOSA-N ;
	(verify)

Cilansetron is a drug that is a 5HT-3 antagonist currently under trial phase in the EU and US it is manufactured by Solvay Pharmaceuticals INC.

5HT-3 receptors are responsible for causing many things from nausea to excess bowel movements. It is thought in conditions like irritable bowel syndrome (IBS) the receptors have become faulty or oversensitive. 5HT-3 antagonists work by blocking the nervous and chemical signals from reaching these receptors.

Studies have shown that the drug can greatly improve quality of life in men and women with diahorrea predominant IBS (1) Cilansetron is the first 5HT antagonist specifically designed for IBS that is effective in men as well as women.(1)

Solvay has had considerable difficulty with the medicines regulators in the UK, EU and USA with regards to licensing the drug. This could possibly be due to the problems discovered after licensing with the drug Lotronex. At time of writing; Solvay had recently withdrawn its application to the U.S. Food and Drug Administration (FDA) but was continuing its talks with the MHRA in the UK and EU regulators. (2)

It is not currently known what sort of timeframe the public are looking at to be able to obtain the drug. This matter is not helped by the lack of information about cilansetron and its trials in the public domain. The regulators have also stated this in their responses.^{[citation needed]}

There is no information about future trials currently available.

Some people have tried the Anti-emetic ondansetron HCl (Zofran) as a substitute for the time being, results are mixed but noted effect has been shown in some males and females (3) However; due to its license in the UK it is usually only prescribable at consultant level. Since the licensing of a generic version it is more likely an NHS prescription will be accepted as the branded version is very expensive (Official NHS pricing.) In the USA and Canada: availability often depends on insurance and the doctors personal opinion on off-label prescribing.

References

http://www.drugdevelopment-technology.com/projects/cilanserton (General info on Cilansetron.)
http://www.solvaypress.com/pressreleases/0,,36423-2-0,00.htm#contact (Sovay press relaase 19 November 2005.)
http://www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2036.1996.30172000.x (Clinical trial for 5-HT3 antagonists use in Diarrhoea-predominant IBS)