Omacetaxine mepesuccinate

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Omacetaxine mepesuccinate
Systematic (IUPAC) name
1-((1S,3aR,14bS)-2-Methoxy-1,5,6,8,9,14b-hexahydro-4H-cyclopenta(a)(1,3)dioxolo(4,5-h)pyrrolo(2,1-b)(3)benzazepin-1-yl) 4-methyl (2R)-2-hydroxy-2-(4-hydroxy-4-methylpentyl)butanedioate
Clinical data
Trade names Synribo
AHFS/ monograph
Licence data US FDA:link
Pregnancy cat. D (US)
Legal status -only (US)
Routes Subcutaneous, intravenous infusion
Pharmacokinetic data
Protein binding 50%
Metabolism Mostly via plasma esterases
Half-life 6 hours
Excretion Urine (≤15% unchanged)
CAS number 26833-87-4
ATC code L01XX40
PubChem CID 285033
UNII 6FG8041S5B YesY
KEGG D08956
ChEBI CHEBI:71019 YesY
Chemical data
Formula C29H39NO9 
Mol. mass 545.62 g/mol

Omacetaxine mepesuccinate (INN, trade name Synribo) is a pharmaceutical drug that is indicated for treatment of chronic myelogenous leukemia (CML). It is a semi-synthetic derivative of the alkaloid cephalotaxine from Cephalotaxus harringtonia. It was approved by the US FDA in October 2012 for the treatment of adult patients with CML with resistance and/or intolerance to two or more tyrosine kinase inhibitors (TKIs).[1]

Medical uses[edit]

Omacetaxine is indicated for use as a treatment for patients with chronic myeloid leukaemia who are intolerant of tyrosine kinase inhibitors.[2][3]

In June 2009, results of a long-term open label Phase II study were published, which investigated the use of omacetaxine infusions in CML patients. After twelve months of treatment, about one third of patients showed a cytogenetic response.[4] A study in patients who had failed imatinib and who had the drug resistant T315I mutation achieved cytogenetic response in 28% of patients and haematological response in 80% of patients, according to preliminary data.[5]

Phase I studies including a small number of patients have shown benefit in treating myelodysplastic syndrome (MDS, 25 patients)[6] and acute myelogenous leukaemia (AML, 76 patients).[7] Patients with solid tumors did not benefit from omacetaxine.[8]

Adverse effects[edit]

By frequency:[1][2]
Very common (>10% frequency):

Common (1-10% frequency):

  • Seizures
  • GI haemorrhages

Myelosuppression, including: thrombocytopenia, anaemia, neutropenia and lymphopenia, in descending order of frequency.

Mechanism of action[edit]

Omacetaxine is a protein translation inhibitor. It inhibits protein translation by preventing the initial elongation step of protein synthesis. It interacts with the ribosomal A-site and prevents the correct positioning of amino acid side chains of incoming aminoacyl-tRNAs. Omacetaxine acts only on the initial step of protein translation and does not inhibit protein synthesis from mRNAs that have already commenced translation.[9]


  1. ^ a b "Synribo (omacetaxine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 18 February 2014. 
  2. ^ a b "SYNRIBO (omacetaxine mepesuccinate) injection, powder, lyophilized, for solution [Cephalon, Inc.]". DailyMed. Cephalon, Inc. October 2012. Retrieved 18 February 2014. 
  3. ^ Sweetman, S, ed. (14 November 2012). Omacetaxine Mepesuccinate. "Martindale: The Complete Drug Reference". Medicines Complete (Pharmaceutical Press). 
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  9. ^ Wetzler M, Segal D. Omacetaxine as an Anticancer Therapeutic: What is Old is New Again. Current Pharmaceutical Design 2011;17:59-64