Nifurtimox

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Nifurtimox
Nifurtimox.svg
Systematic (IUPAC) name
(RS)-3-methyl-N-[(1E)-(5-nitro-2-furyl)methylene]thiomorpholin-4-amine 1,1-dioxide
Clinical data
AHFS/Drugs.com Micromedex Detailed Consumer Information
Pregnancy
category
  • Undetermined
Legal status
  • ℞ Prescription only
    Not available in U.S. or Canada
Routes of
administration
Oral
Pharmacokinetic data
Bioavailability Low
Metabolism Hepatic (CYP involved)
Biological half-life 2.95 ± 1.19 hours
Excretion Renal, very low
Identifiers
CAS Registry Number 23256-30-6 N
ATC code P01CC01 QP51AC01
PubChem CID: 31772
ChemSpider 29464 YesY
UNII M84I3K7C2O YesY
KEGG D00833 YesY
ChEMBL CHEMBL290960 N
Chemical data
Formula C10H13N3O5S
Molecular mass 287.293 g/mol
 N (what is this?)  (verify)

Nifurtimox is a 5-nitrofuran used to treat diseases caused by trypanosomes including Chagas disease and sleeping sickness. It is given by mouth and not by injection.

It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[1]

Medical uses[edit]

Mode of action : being a nitroaromatic compond it undergoes reduction and eventually creates oxygen radicals such as superoxide and hydrogen peroxide. These radicals are toxic to T.cruzi. Mammalian cells are protected by presence of enzymes such as catalase, glutathione, peroxidase, and superoxide dismutase. Nifurtimox has been used to treat Chagas disease, when it is given for 30 to 60 days,[2] but gastrointestinal and neurological side effects have meant that benznidazole is now preferred for that indication.[citation needed]

Nifurtimox has also been used to treat African trypanosomiasis (sleeping sickness), and is active in the second stage of the disease (central nervous system involvement). When nifurtimox is given on its own, about half of all patients will relapse,[3] but the combination of melarsoprol with nifurtimox appears to be efficacious.[4] Trials are awaited comparing melarsoprol/nifurtimox against melarsoprol alone for African sleeping sickness.[5]

Combination therapy with eflornithine and nifurtimox is safer and easier than treatment with eflornithine alone, and appears to be equally or more effective. It has been recommended as first-line treatment for second-stage African trypanosomiasis.[6]

Investigational[edit]

Nifurtimox is in a phase-II clinical trial for the treatment of pediatric neuroblastoma and medulloblastoma.[7][8]

Side effects, contraindications, and interactions[edit]

Side effects are following chronic administration particularly in elderly Major toxicities include immediate hypersensitivity such as anaphylaxis and delayed hypersensitivity reaction involving icterus and dermatitis. GI problems may occur that are severe enough to cause weight loss. CNS disturbances and peripheral neuropathy may also occur. Cell mediated immunity may also be suppressed.


Manufacturing and availability[edit]

Nifurtimox is sold as Lampit by Bayer. It was previously known as Bayer 2502.

Nifurtimox is only licensed for use in Argentina and Germany,[citation needed] where it is sold as 120-mg tablets.

References[edit]

  1. ^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014. 
  2. ^ Coura JR, de Castro SL. (2002). "A critical review of Chagas disease chemotherapy". Mem Inst Oswaldo Cruz 97 (1): 3–24. doi:10.1590/S0074-02762002000100001. PMID 11992141. 
  3. ^ Pepin J, Milord F, Mpia B et al. (1989). "An open clinical trial of nifurtimox for arseno-resistant T. b. gambiense sleeping sickness in central Zaire". Trans R Soc Trop Med Hyg 83 (4): 514–7. doi:10.1016/0035-9203(89)90270-8. PMID 2694491. 
  4. ^ Bisser S, N'Siesi F-X, Lejon V et al. (2007). "Equivalence Trial of Melarsoprol and Nifurtimox Monotherapy and Combination Therapy for the Treatment of Second-Stage Trypanosoma brucei gambiense Sleeping Sickness". J Infect Dis 195 (3): 322–329. doi:10.1086/510534. PMID 17205469. 
  5. ^ Pepin J (2007). "Combination Therapy for Sleeping Sickness: A Wake-Up Call". J Infect Dis 195 (3): 311–13. doi:10.1086/510540. PMID 17205466. 
  6. ^ Priotto G, Kasparian S, Mutombo W et al. (July 2009). "Nifurtimox-eflornithine combination therapy for second-stage African Trypanosoma brucei gambiense trypanosomiasis: a multicentre, randomised, phase III, non-inferiority trial". Lancet 374 (9683): 56–64. doi:10.1016/S0140-6736(09)61117-X. PMID 19559476. 
  7. ^ Clinical trial number NCT00601003 at ClinicalTrials.gov . Retrieved on July 10, 2009.
  8. ^ "http://www.vai.org/en/vari/research-areas/nmtrc/clinical-trials/phase-ii-nifurtimox.aspx".