St. John’s Wort (Hypericum perforatum) can keep you happy


St. John’s Wort (Hypericum perforatum) – This herb is often used to treat mild to moderate depression. It is especially helpful to patients who do not respond well to SSRI medication (selective serotonin reuptake inhibitors). This herb can limit the effectiveness of some prescription medications, though, so double check with your doctor before taking it. A 2009 systematic review of 29 international studies suggested that St. John’s Wort may be better than a placebo (an inactive substance that appears identical to the study substance) and as effective as standard prescription antidepressants for major depression of mild to moderate severity.
| Hypericum perforatum | |
|---|---|
| Scientific classification | |
| Kingdom: | Plantae |
| (unranked): | Angiosperms |
| (unranked): | Eudicots |
| (unranked): | Rosids |
| Order: | Malpighiales |
| Family: | Hypericaceae |
| Genus: | Hypericum |
| Species: | H. perforatum |
| Binomial name | |
| Hypericum perforatum L. |
|
Hypericum perforatum, also known as St John’s wort, is a flowering plant species of the genus Hypericum and a medicinal herb that is sold over-the-counter as a treatment for depression.[1][2] Other names for it include Tipton’s weed, rosin rose, goatweed, chase-devil, or Klamath weed.[1] With qualifiers, St John’s wort is used to refer to any species of the genus Hypericum. Therefore, H. perforatum is sometimes called common St John’s wort or perforate St John’s wort to differentiate it. Hypericum is classified in the family Hypericaceae, having previously been classified as Guttiferae or Clusiaceae.[3][4] Approximately 370 species of the genus Hypericum exist worldwide with a native geographical distribution including temperate and subtropical regions of Europe, Turkey, Ukraine, Russia, Middle East, India, andChina.
Botanical description
Hypericum perforatum is a yellow-flowering, stoloniferous or sarmentose, perennial herb indigenous to Europe. It has been introduced to many temperate areas of the world and grows wild in many meadows. The herb’s common name comes from its traditional flowering and harvesting on St John‘s day, 24 June. The genus name Hypericum is derived from the Greek words hyper (above) and eikon (picture), in reference to the plant’s traditional use in warding off evil by hanging plants over a religious icon in the house during St John’s day. Thespecies name perforatum refers to the presence of small oil glands in the leaves that look like windows, which can be seen when they are held against the light.[1]
St John’s wort is a perennial plant with extensive, creeping rhizomes. Its stems are erect, branched in the upper section, and can grow to 1 m high. It has opposing, stalkless, narrow, oblong leaves that are 12 mm long or slightly larger. The leaves are yellow-green in color, with transparent dots throughout the tissue and occasionally with a few black dots on the lower surface.[1] Leaves exhibit obvious translucent dots when held up to the light, giving them a ‘perforated’ appearance, hence the plant’s Latin name.
Its flowers measure up to 2.5 cm across, have five petals, and are colored bright yellow with conspicuous black dots. The flowers appear in broad cymes at the ends of the upper branches, between late spring and early to mid summer. The sepals are pointed, with glandular dots in the tissue. There are many stamens, which are united at the base into three bundles. The pollen grains are ellipsoidal.[1]
When flower buds (not the flowers themselves) or seed pods are crushed, a reddish/purple liquid is produced.
Ecology
St John’s wort reproduces both vegetatively and sexually. It thrives in areas with either a winter- or summer-dominant rainfall pattern; however, distribution is restricted by temperatures too low for seed germination or seedling survival. Altitudes greater than 1500 m, rainfall less than 500 mm, and a daily mean January (in Southern hemisphere) temperature greater than 24 degrees C are considered limiting thresholds. Depending on environmental and climatic conditions, and rosette age, St John’s wort will alter growth form and habit to promote survival. Summer rains are particularly effective in allowing the plant to grow vegetatively, following defoliation by insects or grazing.
The seeds can persist for decades in the soil seed bank, germinating following disturbance.[5]
Invasive species
Although Hypericum perforatum is grown commercially in some regions of south east Europe, it is listed as a noxious weed in more than twenty countries and has introduced populations in South and North America, India, New Zealand, Australia, and South Africa.[5] In pastures, St John’s wort acts as both a toxic and invasive weed.[6] It replaces nativeplant communities and forage vegetation to the dominating extent of making productive land nonviable[citation needed] or becoming an invasive species in natural habitats andecosystems. Ingestion by livestock can cause photosensitization, central nervous system depression, spontaneous abortion, and can lead to death. Effective herbicides for control of Hypericum include 2,4-D, picloram, and glyphosate. In western North America three beetles Chrysolina quadrigemina, Chrysolina hyperici and Agrilus hyperici have been introduced as biocontrol agents.
Medical uses
Major depressive disorder
St John’s wort is widely known as a herbal treatment for depression. In some countries, such as Germany, it is commonly prescribed for mild to moderate depression, especially in children and adolescents.[7] Specifically, Germany has a governmental organization called Commission E which regularly performs rigorous studies on herbal medicine. It is proposed that the mechanism of action of St. John’s wort is due to the inhibition of reuptake of certain neurotransmitters.[1] The best studied chemical components of the plant are hypericin and pseudohypericin.
An analysis of twenty-nine clinical trials with more than five thousand patients was conducted by Cochrane Collaboration. The review concluded that extracts of St John’s wort were superior to placebo in patients with major depression. St John’s wort had similar efficacy to standard antidepressants. The rate of side-effects was half that of newer SSRIantidepressants and one-fifth that of older tricyclic antidepressants.[8] A report[8] from the Cochrane Review states:
The available evidence suggests that the Hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; and c) have fewer side-effects than standard antidepressants.
However the report also noted that some of the studies they reviewed may have been flawed or biased, as “results from German-language countries are considerably more favourable for Hypericum than trials from other countries”. The authors did not know the reason for this discrepancy.
Other medical uses
St John’s wort is being studied for effectiveness in the treatment of certain somatoform disorders. Results from the initial studies are mixed and still inconclusive; some research has found no effectiveness, other research has found a slight lightening of symptoms. Further study is needed and is being performed.
A major constituent chemical, hyperforin, may be useful for treatment of alcoholism, although dosage, safety and efficacy have not been studied.[9][10] Hyperforin has also displayed antibacterial properties against Gram-positive bacteria, although dosage, safety and efficacy has not been studied.[11] Herbal medicine has also employed lipophilic extracts from St John’s wort as a topical remedy for wounds, abrasions, burns, and muscle pain.[10] The positive effects that have been observed are generally attributed to hyperforin due to its possible antibacterial and anti-inflammatory effects.[10] For this reason hyperforin may be useful in the treatment of infected wounds and inflammatory skin diseases.[10] In response to hyperforin’s incorporation into a new bath oil, a study to assess potential skin irritation was conducted which found good skin tolerance of St John’s wort.[10]
A randomized controlled trial of St John’s wort found no significant difference between it and placebo in the management of ADHD symptoms over eight weeks. However, the St John’s wort extract used in the study, originally confirmed to contain 0.3% hypericin, was allowed to degrade to levels of 0.13% hypericin and 0.14% hyperforin. Given that the level of hyperforin was not ascertained at the beginning of the study, and levels of both hyperforin and hypericin were well below that used in other studies, little can be determined based on this study alone.[12] Hypericin and pseudohypericin have shown both antiviral and antibacterial activities. It is believed that these molecules bind non-specifically to viral and cellular membranes and can result in photo-oxidation of the pathogens to kill them.[1]
A research team from the Universidad Complutense de Madrid (UCM) published a study entitled “Hypericum perforatum. Possible option against Parkinson’s disease”, which suggests that St John’s wort has antioxidant active ingredients that could help reduce the neuronal degeneration caused by the disease.[13][14][15][16]
Recent evidence suggests that daily treatment with St John’s wort may improve the most common physical and behavioural symptoms associated with premenstrual syndrome.[17]
St John’s wort was found to be less effective than placebo, in a randomized, double-blind, placebo-controlled trial, for the treatment of irritable bowel syndrome.[18]
St John’s wort alleviated age-related long-term memory impairment in rats.[19]
Adverse effects and drug interactions
St John’s wort is generally well tolerated, with an adverse effect profile similar to placebo.[20] The most common adverse effects reported are gastrointestinal symptoms, dizziness, confusion, tiredness and sedation.[21][22] It also decreases the levels of estrogens, such as estradiol, by speeding up its metabolism, and should not be taken by women oncontraceptive pills as it upregulates the CYP3A4 cytochrome of the P450 system in the liver.[23]
St John’s wort may rarely cause photosensitivity. This can lead to visual sensitivity to light and to sunburns in situations that would not normally cause them.[20] Related to this, recent studies concluded that the extract reacts with light, both visible and ultraviolet, to produce free radicals, molecules that can damage the cells of the body. These can react with vital proteins in the eye that, if damaged, precipitate out, causing cataracts.[24] Another study found that in low concentrations, St. John’s wort inhibits free radical production in both cell-free and human vascular tissue, revealing antioxidant properties of the compound. The same study found pro-oxidant activity at the highest concentration tested.[25]
St John’s wort is associated with aggravating psychosis in people who have schizophrenia.[26]
Consumption of St. John’s wort is discouraged for those with bipolar disorder. There is concern that people with major depression taking St. John’s wort may be at a higher risk for mania.[27]
While St. John’s wort shows some promise in treating children, it is advised that it is only done with medical supervision. [27]
Pharmacokinetic interactions
St John’s wort has been shown to cause multiple drug interactions through induction of the cytochrome P450 enzymes CYP3A4 and CYP2C9, and CYP1A2 (females only). This drug-metabolizing enzyme induction results in the increased metabolism of certain drugs, leading to decreased plasma concentration and potential clinical effect.[28] The principal constituents thought to be responsible are hyperforin and amentoflavone.
St John’s wort has also been shown to cause drug interactions through the induction of the P-glycoprotein (P-gp) efflux transporter. Increased P-gp expression results in decreased absorption and increased clearance of certain drugs, leading to lower plasma concentration and potential clinical efficacy.[29]
| Class | Drugs |
|---|---|
| Antiretrovirals | Non-nucleoside reverse transcriptase inhibitors, protease inhibitors |
| Benzodiazepines | Alprazolam, midazolam |
| Hormonal contraception | Combined oral contraceptives |
| Immunosuppressants | Calcineurin inhibitors, cyclosporine, tacrolimus |
| Antiarrhythmics | Amiodarone, flecainide, mexiletine |
| Beta-blockers | Metoprolol, carvedilol |
| Calcium channel blockers | Verapamil, diltiazem, amlodipine |
| Statins (cholesterol-reducing medications) | Lovastatin, simvastatin, atorvastatin |
| Others | Digoxin, methadone, omeprazole, phenobarbital, theophylline, warfarin, levodopa, buprenorphine, irinotecan |
| Reference: Rossi, 2005; Micromedex | |
For a complete list, see CYP3A4 ligands and CYP2C9 ligands. For further updating on interactions and appropriate management, see Herbological.com – St John’s Wort Interactions table (outdated since 2005).
Pharmacodynamic interactions
In combination with other drugs that may elevate 5-HT (serotonin) levels in the central nervous system (CNS), St John’s wort may contribute to serotonin syndrome, a potentially life-threatening adverse drug reaction.[30]
| Class | Drugs |
|---|---|
| Antidepressants | MAOIs, TCAs, SSRIs, SNRIs, mirtazapine |
| Opioids | Tramadol, meperidine (pethidine), Levorphanol |
| CNS stimulants | Phentermine, diethylpropion, amphetamines, sibutramine, cocaine |
| 5-HT1 agonists | Triptans |
| Psychedelic drugs | Methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (LSD), psilocybin / psilocin, Mescaline and virtually every serotonergic psychedelic. |
| Others | Selegiline, tryptophan, buspirone, lithium, linezolid, 5-HTP, dextromethorphan |
| Reference:[30] | |
Detection in body fluids
Hypericin, pseudohypericin, and hyperforin may be quantitated in plasma as confirmation of usage and to estimate the dosage. These three active substituents have plasma elimination half-lives within a range of 15–60 hours in humans. None of the three has been detected in urine specimens.[31]
Chemical constituents
The plant contains the following:[32][33]
- Flavonoids (e.g. epigallocatechin, rutin, hyperoside, isoquercetin, quercitrin, quercetin, amentoflavone, biapigenin, astilbin, myricetin, miquelianin, kaempferol, luteolin)
- Phenolic acids (e.g. chlorogenic acid, caffeic acid, p-coumaric acid, ferulic acid, p-hydroxybenzoic acid, vanillic acid)
- Naphthodianthrones (e.g. hypericin, pseudohypericin, protohypericin, protopseudohypericin)
- Phloroglucinols (e.g. hyperforin, adhyperforin)
- Tannins (unspecified, proanthocyanidins reported)
- Volatile oils (e.g. 2-methyloctane, nonane, 2-methyldecane, undecane, α-pinene, β-pinene, α-terpineol, geraniol, myrcene, limonene, caryophyllene, humulene)
- Saturated fatty acids (e.g. isovaleric acid (3-methylbutanoic acid), myristic acid, palmitic acid, stearic acid)
- Alkanols (e.g. 1-tetracosanol, 1-hexacosanol)
- Vitamins & their analogues (e.g. carotenoids, choline, nicotinamide, nicotinic acid)
- Miscellaneous others (e.g. pectin, β-sitosterol, hexadecane, triacontane, kielcorin, norathyriol)
The naphthodianthrones hypericin and pseudohypericin along with the phloroglucinol derivative hyperforin are thought to be among the numerous active constituents.[1][34][35][36]It also contains essential oils composed mainly of sesquiterpenes.[1]
| [show]Selected chemical constituents of Hypericum perforatum |
|---|
Mechanism of action
St. John’s wort (SJW), similarly to other herbal products, contains a whole host of different chemical constituents that may be pertinent to its therapeutic effects.[32] Hyperforin andadhyperforin, two phloroglucinol constituents of SJW, is a TRPC6 receptor agonist and, consequently, it induces noncompetitive reuptake inhibitor of monoamines (specifically,dopamine, norepinephrine, and serotonin), GABA, and glutamate when it activates this receptor.[2][37][38] It inhibits reuptake of these neurotransmitters by increasing intracellularsodium ion concentrations.[2] Moreover, SJW is known to downregulate the β1 adrenoceptor and upregulate postsynaptic 5-HT1A and 5-HT2A receptors, both of which are a type of serotonin receptor.[2] Other compounds may also play a role in SJW’s antidepressant effects such compounds include: oligomeric procyanidines, flavonoids (quercetin),hypericin, and pseudohypericin.[2][39][40][41]
In humans, the active ingredient hyperforin is a monoamine reuptake inhibitor which also acts as an inhibitor of PTGS1, Arachidonate 5-lipoxygenase, SLCO1B1 and an inducer ofcMOAT. Hyperforin is also a powerful anti-inflammatory compound with anti-angiogenic, antibiotic, and neurotrophic properties.[37][38][42][43] Hyperforin also has an antagonistic effect on NMDA receptors, a type of glutamate receptor.[42] According to one study, hyperforin content correlates with therapeutic effect in mild to moderate depression.[44]Moreover, a hyperforin-free extract of St John’s wort (Remotiv) may still have significant antidepressive effects.[45][46] The limited existing literature on adhyperforin suggests that, like hyperforin, it is a reuptake inhibitor of monoamines, GABA, and glutamate.[47]
Livestock
Poisoning
In large doses, St John’s wort is poisonous to grazing livestock (cattle, sheep, goats, horses).[6] Behavioural signs of poisoning are general restlessness and skin irritation. Restlessness is often indicated by pawing of the ground, headshaking, head rubbing, and occasional hindlimb weakness with knuckling over, panting, confusion, and depression. Mania and hyperactivity may also result, including running in circles until exhausted. Observations of thick wort infestations by Australian graziers include the appearance of circular patches giving hillsides a ‘crop circle’ appearance, it is presumed, from this phenomenon. Animals typically seek shade and have reduced appetite. Hypersensitivity to water has been noted, and convulsions may occur following a knock to the head. Although general aversion to water is noted, some may seek water for relief.
Severe skin irritation is physically apparent, with reddening of non-pigmented and unprotected areas. This subsequently leads to itch and rubbing, followed by further inflammation, exudation, and scab formation. Lesions and inflammation that occur are said to resemble the conditions seen in foot and mouth disease. Sheep have been observed to have face swelling, dermatitis, and wool falling off due to rubbing. Lactating animals may cease or have reduced milk production; pregnant animals may abort. Lesions onudders are often apparent. Horses may show signs of anorexia, depression (with a comatose state), dilated pupils, and injected conjunctiva.
Diagnosis[edit]
Increased respiration and heart rate is typically observed while one of the early signs of St John’s wort poisoning is an abnormal increase in body temperature. Affected animals will lose weight, or fail to gain weight; young animals are more affected than old animals. In severe cases death may occur, as a direct result of starvation, or because of secondary disease or septicaemia of lesions. Some affected animals may accidentally drown. Poor performance of suckling lambs (pigmented and non-pigmented) has been noted, suggesting a reduction in the milk production, or the transmission of a toxin in the milk.
Photosensitisation[edit]
Most clinical signs in animals are caused by photosensitisation.[96] Plants may induce either primary or secondary photosensitisation:
- primary photosensitisation directly from chemicals contained in ingested plants
- secondary photosensitisation from plant-associated damage to the liver.
Araya and Ford (1981) explored changes in liver function and concluded there was no evidence of Hypericum-related effect on the excretory capacity of the liver, or any interference was minimal and temporary. However, evidence of liver damage in blood plasma has been found at high and long rates of dosage.
Photosensitisation causes skin inflammation by a mechanism involving a pigment or photodynamic compound, which when activated by a certain wavelength of light leads tooxidation reactions in vivo. This leads to lesions of tissue, particularly noticeable on and around parts of skin exposed to light. Lightly covered or poorly pigmented areas are most conspicuous. Removal of affected animals from sunlight results in reduced symptoms of poisoning.
See also[edit]
References[edit]
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- Jump up^ “St. John’s wort”. Natural Standard. Cambridge, MA. Retrieved 13 December 2013.
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- Jump up^ Jensen, AG; Hansen, SH; Nielsen, EO (February 2001). “Adhyperforin as a contributor to the effect of Hypericum perforatum L. in biochemical models of antidepressant activity.”. Life Sciences 68 (14): 1593–1605. doi:10.1016/S0024-3205(01)00946-8.PMID 11263672.
- ^ Jump up to:a b Krusekopf, S; Roots, I (November 2005). “St. John’s wort and its constituent hyperforin concordantly regulate expression of genes encoding enzymes involved in basic cellular pathways”. Pharmacogenetics and Genomics 15 (11): 817–829.doi:10.1097/01.fpc.0000175597.60066.3d. PMID 16220113.
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- Jump up^ Peebles, KA; Baker, RK; Kurz, EU; Schneider, BJ; Kroll, DJ. “Catalytic inhibition of human DNA topoisomerase IIalpha by hypericin, a naphthodianthrone from St. John’s wort (Hypericum perforatum)”. Biochemical Pharmacology 62 (8): 1059–1070.doi:10.1016/S0006-2952(01)00759-6. PMID 11597574.
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- Jump up^ Meruelo, D; Lavie, G; Lavie, D (July 1988). “Therapeutic agents with dramatic antiretroviral activity and little toxicity at effective doses: Aromatic polycyclic diones hypericin and pseudohypericin” (PDF). Proceedings of the National Academy of Sciences 85 (14): 5230–5234. doi:10.1073/pnas.85.14.5230. PMC 281723.PMID 2839837.
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- Jump up^ Takahashi, I; Nakanishi, S; Kobayashi, E; Nakano, H; Suzuki, K; Tamaoki, T. “Hypericin and pseudohypericin specifically inhibit protein kinase C: Possible relation to their antiretroviral activity”. Biochemical and Biophysical Research Communications 165(3): December 1989. doi:10.1016/0006-291X(89)92730-7. PMID 2558652.
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- Jump up^ Wilsky, S; Sobotta, K; Wiesener, N; Pilas, J; Althof, N; Munder, T; Wutzler, P; Henke, A (February 2012). “Inhibition of fatty acid synthase by amentoflavone reduces coxsackievirus B3 replication”. Archives of Virology 157 (2): 259–269.doi:10.1007/s00705-011-1164-z. PMID 22075919.
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- Jump up^ Bao, YY; Zhou, SH; Fan, J; Wang, QY (September 2013). “Anticancer mechanism of apigenin and the implications of GLUT-1 expression in head and neck cancers”. Future Oncology 9 (9): 1353–1364. doi:10.2217/fon.13.84. PMID 23980682.
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- Jump up^ Crespy, V; Williamson, G. “A Review of the Health Effects of Green Tea Catechins in In Vivo Animal Models” (PDF). The Journal of Nutrition 134 (12): 3431S–3440S.
- Jump up^ Chacko, SM; Thambi, PT; Kuttan, R; Nishigaki, I (April 2010). “Beneficial effects of green tea: A literature review” (PDF). Chinese Medicine 5 (1): 1–9. doi:10.1186/1749-8546-5-13. PMC 2855614. PMID 20370896.
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- Jump up^ Song, M; Hong, M; Lee, MY; Jee, JG; Lee, YM; Bae, JS; Jeong, TC; Lee, S (September 2013). “Selective inhibition of the cytochrome P450 isoform by hyperoside and its potent inhibition of CYP2D6”. Food and Chemical Toxicology 59: 549–553.doi:10.1016/j.fct.2013.06.055. PMID 23835282.
- Jump up^ Li, S; Zhang, Z; Cain, A; Wang, B; Long, M; Taylor, J (January 2005). “Antifungal Activity of Camptothecin, Trifolin, and Hyperoside Isolated from Camptotheca acuminata”.Journal of Agricultural and Food Chemistry 53 (1): 32–37. doi:10.1021/jf0484780.PMID 15631505.
- Jump up^ Zeng, KW; Wang, XM; Ko, H; Kwon, HC; Cha, JW; Yang, HO (December 2011). “Hyperoside protects primary rat cortical neurons from neurotoxicity induced by amyloid β-protein via the PI3K/Akt/Bad/Bcl(XL)-regulated mitochondrial apoptotic pathway”.European Journal of Pharmacology 672 (1-3): 45–55. doi:10.1016/j.ejphar.2011.09.177.PMID 21978835.
- Jump up^ Kim, SJ; Um, JY; Lee, JY (January 2011). “Anti-Inflammatory Activity of Hyperoside Through the Suppression of Nuclear Factor-κB Activation in Mouse Peritoneal Macrophages”. The American Journal of Chinese Medicine 39 (1): 171–181.doi:10.1142/S0192415X11008737. PMID 21213407.
- Jump up^ Haas, JS; Stolz, ED; Betti, AH; Stein, AC; Schripsema, J; Poser, GL; Rates, SM (March 2011). “The Anti-Immobility Effect of Hyperoside on the Forced Swimming Test in Rats is Mediated by the D2-Like Receptors Activation” (PDF). Planta Medica 77 (4): 334–339. doi:10.1055/s-0030-1250386. PMID 20945276.
- Jump up^ Zheng, M; Liu, C; Pan, F; Shi, D; Zhang, Y (January 2012). “Antidepressant-like effect of hyperoside isolated from Apocynum venetum leaves: Possible cellular mechanisms”.Phytomedicine 19 (2): 145–149. doi:10.1016/j.phymed.2011.06.029.PMID 21802268.
- Jump up^ Pal, D; Mitra, AK (March 2006). “MDR- and CYP3A4-mediated drug-herbal interactions”. Life Sciences 78 (18): 2131–2145. doi:10.1016/j.lfs.2005.12.010.PMID 16442130.
- Jump up^ Hämäläinen, M; Nieminen, R; Vuorela, P; Heinonen, M; Moilanen, E (August 2007).“Anti-Inflammatory Effects of Flavonoids: Genistein, Kaempferol, Quercetin, and Daidzein Inhibit STAT-1 and NF-κB Activations, Whereas Flavone, Isorhamnetin, Naringenin, and Pelargonidin Inhibit only NF-κB Activation along with Their Inhibitory Effect on iNOS Expression and NO Production in Activated Macrophages” (PDF). Mediators of Inflammation 2007: 45673. doi:10.1155/2007/45673. PMC 2220047.PMID 18274639.
- Jump up^ Berger, A; Venturelli, S; Kallnischkies, M; Böcker, A; Busch, C; Weiland, T; Noor, S; Leischner, C; Weiss, TS; Lauer, UM; Bischoff, SC; Bitzer, M (June 2013). “Kaempferol, a new nutrition-derived pan-inhibitor of human histone deacetylases”. The Journal of Nutritional Biochemistry 24 (6): 977–985. doi:10.1016/j.jnutbio.2012.07.001.PMID 23159065.
- ^ Jump up to:a b Calderón-Montaño, JM; Burgos-Morón, E; Pérez-Guerrero, C; López-Lázaro, M (April 2011). “A Review on the Dietary Flavonoid Kaempferol”. Mini-Reviews in Medicinal Chemistry 11 (4): 298–344. doi:10.2174/138955711795305335. PMID 21428901.
- Jump up^ Seelinger, G; Merfort, I; Schempp, CM (November 2008). “Anti-oxidant, anti-inflammatory and anti-allergic activities of luteolin”. Planta Medica 74 (14): 1667–1677.doi:10.1055/s-0028-1088314. PMID 18937165.
- Jump up^ Lin, Y; Shi, R; Wang, X; Shen, HM. “Luteolin, a flavonoid with potential for cancer prevention and therapy” (PDF). Current Cancer Drug Targets 8 (7): 634–646.doi:10.2174/156800908786241050. PMC 2615542. PMID 18991571.
- Jump up^ Theoharides, TC; Asadi, S; Panagiotidou, S (April–June 2012). “A case series of a luteolin formulation (neuroprotek®) in children with autism spectrum disorders”.International Journal of Immunopathology and Pharmacology 25 (2): 317–323.PMID 22697063.
- Jump up^ Yu, MC; Chen, JH; Lai, CY; Han, CY; Ko, WC (February 2010). “Luteolin, a non-selective competitive inhibitor of phosphodiesterases 1-5, displaced [3H]-rolipram from high-affinity rolipram binding sites and reversed xylazine/ketamine-induced anesthesia”.European Journal of Pharmacology 627 (1-3): 269–275.doi:10.1016/j.ejphar.2009.10.031. PMID 19853596.
- Jump up^ Chen, C; Zhou, J; Ji, C (September 2010). “Quercetin: A potential drug to reverse multidrug resistance”. Life Sciences 87 (11-12): 333–338.doi:10.1016/j.lfs.2010.07.004. PMID 20637779.
- ^ Jump up to:a b Kelly, GS (June 2011). “Quercetin” (PDF). Alternative Medicine Review 16 (2): 172–194. ISSN 1089-5159.
- Jump up^ Ko, WC; Shih, CM; Lai, YH; Chen, JH; Huang, HL (November 2004). “Inhibitory effects of flavonoids on phosphodiesterase isozymes from guinea pig and their structure–activity relationships”. Biochemical Pharmacology 68 (10): 2087–2094.doi:10.1016/j.bcp.2004.06.030. PMID 15476679.
- Jump up^ Chua, LS (December 2013). “A review on plant-based rutin extraction methods and its pharmacological activities”. Journal of Ethnopharmacology 150 (3): 805–817.doi:10.1016/j.jep.2013.10.036. PMID 24184193.
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- Jump up^ Hou, J; Fu, J; Zhang, ZM; Zhu, HL. “Biological activities and chemical modifications of caffeic acid derivatives”. Fudan University Journal of Medical Sciences 38 (6): 546–552.doi:10.3969/j.issn.1672-8467.2011.06.017.
- Jump up^ Zhao, Y; Wang, J; Ballevre, O; Luo, H; Zhang, W (April 2012). “Antihypertensive effects and mechanisms of chlorogenic acids”. Hypertension Research 35 (4): 370–374.doi:10.1038/hr.2011.195. PMID 22072103.
- Jump up^ [2][dead link]
- Jump up^ http://www.acdlabs.com/resources/freeware/chemsketch/ACDChemSketch
- Jump up^ Lee, MJ; Maliakal, P; Chen, L; Meng, X; Bondoc, FY; Prabhu, S; Lambert, G; Mohr, S; Yang, CS (October 2002). “Pharmacokinetics of Tea Catechins after Ingestion of Green Tea and (-)-Epigallocatechin-3-gallate by Humans: Formation of Different Metabolites and Individual Variability” (PDF). Cancer Epidemiology, Biomarkers & Prevention 11 (10 pt 1): 1025–1032. PMID 12376503.
- Jump up^ Walle, T; Walle, UK; Halushka, PV (October 2001). “Carbon Dioxide Is the Major Metabolite of Quercetin in Humans” (PDF). The Journal of Nutrition 131 (10): 2648–2652. PMID 11584085.
- Jump up^ St John’s wort effects on animals
Further reading[edit]
- British Herbal Medicine Association Scientific Committee (1983). British Herbal Pharmacopoeia. West Yorkshire: British Herbal Medicine Association. ISBN 0-903032-07-4.
- Müller, Walter (2005). St. John’s Wort and its Active Principles in Depression and Anxiety. Basel: Birkhäuser. doi:10.1007/b137619. ISBN 978-3-7643-6160-0.
External links
| Wikispecies has information related to: Hypericum perforatum |
| Wikimedia Commons has media related to Hypericum perforatum. |
- Barrett S (2000). “St. John’s Wort”. Retrieved 2009-03-08.
- “St. John’s wort: MedlinePlus Supplements”. U.S. National Library of Medicine. Retrieved 7 October 2009.
- Species Profile — St. Johnswort (Hypericum perforatum), National Invasive Species Information Center, United States National Agricultural Library. Lists general information and resources for St John’s wort.
What is it?
Other uses include heart palpitations, moodiness and other symptoms of menopause, attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and seasonal affective disorder (SAD).
St. John’s wort has been tried for exhaustion, stop-smoking help, fibromyalgia, chronic fatigue syndrome (CFS), migraine and other types of headaches, muscle pain, nerve pain, and irritable bowel syndrome. It is also used for cancer, HIV/AIDS, and hepatitis C.
An oil can be made from St. John’s wort. Some people apply this oil to their skin to treat bruises and scrapes, inflammation and muscle pain, first degree burns, wounds, bug bites, hemorrhoids, and nerve pain. But applying St. John’s wort directly to the skin is risky. It can cause serious sensitivity to sunlight.
St. John’s wort is native to Europe but is commonly found in the US and Canada in the dry ground of roadsides, meadows, and woods. Although not native to Australia and long considered a weed, St. John’s wort is now grown there as a crop. Today, Australia produces 20 percent of the world’s supply.
The use of St. John’s wort dates back to the ancient Greeks. Hippocrates recorded the medical use of St. John’s wort flowers. St. John’s wort was given its name because it blooms about June 24th, the birthday of John the Baptist. “Wort” is an old English word for plant.
France has banned the use of St. John’s wort products. The ban appears to be based on a report issued by the French Health Product Safety Agency warning of significant interactions between St. John’s wort and some medications. Several other countries, including Japan, the United Kingdom, and Canada, are in the process of including drug-herb interaction warnings on St. John’s wort products.
The active ingredients in St. John’s wort can be deactivated by light. That’s why you will find many products packaged in amber containers. The amber helps, but it doesn’t offer total protection against the adverse effects of light.
How effective is it?
Likely effective for…
- Mild to moderate depression. Taking St. John’s wort extracts improves mood, and decreases anxiety and insomnia related to depression. It seems to be about as effective in treating depression as many prescription drugs. In fact, clinical guidelines from the American College of Physicians-American Society of Internal Medicine suggest that St. John’s wort can be considered an option along with antidepressant medications for short-term treatment of mild depression. However, since St. John’s wort does not appear to be more effective or significantly better tolerated than antidepressant medications, and since St. John’s wort causes many drug interactions, the guidelines suggest it might not be an appropriate choice for many people, particularly those who take other medications. St. John’s wort might not be as effective for more severe cases of depression.
Possibly effective for…
- Menopausal symptoms. Some research shows that a combination of St. John’s wort plus black cohosh can help improve menopausal symptoms.
- The conversion of mental experiences or states into bodily symptoms (somatization disorder). Treatment with St. John’s wort seems to reduce symptoms after 6 weeks of treatment.
- Wound healing. Some research shows that applying a specific St. John’s wort ointment (Gol-Daru Company) three times daily for 16 days improves wound healing and reduces scar formation after a cesarean section.
Possibly ineffective for…
- Attention deficit-hyperactivity disorder (ADHD). Taking a St. John’s wort extract for 8 weeks does not seem to improve symptoms of ADHD in children ages 6-17 years.
- Hepatitis C virus (HCV) infection.
- HIV/AIDS.
- Irritable bowel syndrome (IBS).
- Pain conditions related to diabetes (polyneuropathy.
Insufficient evidence to rate effectiveness for…
- Obsessive compulsive disorder (OCD). There is conflicting evidence about the effectiveness of St. John’s wort for OCD. The reason for contradictory findings could be due to differences in study design, differences in the St. John’s wort products used, or other factors.
- Premenstrual syndrome (PMS). There is preliminary evidence that St. John’s wort might help reduce PMS symptoms, by even as much as 50% in some women.
- Seasonal affective disorder (SAD). Early studies suggest that St. John’s wort might help SAD. It appears to improve symptoms of anxiety, decreased sex drive, and sleep disturbances associated with SAD. It is useful alone or in combination with light therapy.
- Smoking cessation. Research to date suggests that taking a specific St. John’s wort extract (LI-160, Lichtwer Pharma US) 300 mg once or twice daily starting 1 week before and continuing for 3 months after quitting smoking does not improve long-term quit rates.
- Stomach upset.
- Bruises.
- Skin conditions.
- Migraine headache.
- Nerve pain.
- Sciatica.
- Excitability.
- Fibromyalgia.
- Chronic fatigue syndrome (CFS).
- Muscle pain.
- Cancer.
- Weight loss.
- Other conditions.
More evidence is needed to rate St. John’s wort for these uses.
How does it work?
Are there safety concerns?
However, St. John’s wort is POSSIBLY UNSAFE when taken by mouth in large doses. It might cause severe reactions to sun exposure. Wear sun block outside, especially if you are light-skinned.
Not enough is known about the safety of St. John’s wort when it is applied to the skin. To be safe, don’t use it topically.
St. John’s wort interacts with many drugs (see the section below). Let your healthcare provider know if you want to take St. John’s wort. Your healthcare provider will want to review your medications to see if there could be any problems.
Special precautions & warnings:
Pregnancy and breast-feeding: St. John’s wort is POSSIBLY UNSAFE when taken during pregnancy. There is some evidence that it can cause birth defects in unborn rats. No one yet knows whether it has the same effect in unborn humans. Nursing infants of mothers who take St. John’s wort can experience colic, drowsiness, and listlessness. Until more is known, don’t use St. John’s wort if you are pregnant or breast-feeding.
Infertility: There are some concerns that St. John’s wort might interfere with conceiving a child. If you are trying to conceive, don’t use St. John’s wort, especially if you have known fertility problems.
Attention deficit-hyperactivity disorder (ADHD): There is some concern that St. John’s wort might worsen symptoms of ADHD, especially in people taking the medication methylphenidate for ADHD. Until more is known, don’t use St. John’s wort if you are taking methylphenidate.
Bipolar disorder: People with bipolar disorder cycle between depression and mania, a state marked by excessive physical activity and impulsive behavior. St. John’s wort can bring on mania in these individuals and can also speed up the cycling between depression and mania.
Major depression: In people with major depression, St. John’s wort might bring on mania, a state marked by excessive physical activity and impulsive behavior.
Schizophrenia: St. John’s wort might bring on psychosis in some people with schizophrenia.
Alzheimer’s disease: There is concern that St. John’s wort might contribute to dementia in people with Alzheimer’s disease.
Anesthesia and surgery: Use of anesthesia in people who have used St. John’s wort for six months may lead to serious heart complications during surgery. Stop using St. John’s wort at least two weeks before a scheduled surgery.
Study suggests consuming whey protein before meals could help improve blood glucose control in people with diabetes
PUBLIC RELEASE DATE:
7-Jul-2014
New research published in Diabetologia (the journal of the European Association for the Study of Diabetes) suggests that consuming whey protein before a regular breakfast reduces the blood sugar spikes seen after meals and also improves the body’s insulin response. Thus whey protein could be an additional tool to help control blood sugar in patients with diabetes. The research was conducted in Israel by Professor Daniela Jakubowicz and Dr Julio Wainstein (Wolfson Medical Center, Tel Aviv University), Professor Oren Froy (Hebrew University of Jerusalem), Professor Bo Ahrén (Lund University, Sweden) and colleagues.
Protein consumption is known to stimulate the production of glucagon-like peptide-1 (GLP-1), a gut hormone that in turn stimulates insulin production. Thus the researchers hypothesised that stimulating GLP-1 production by consuming whey protein before a meal would improve the body’s blood sugar control following a meal.
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Research on inflammasomes opens therapeutic ways for treatment of rheumatoid arthritis
Patients with more or less severe forms of rheumatoid arthritis (RA) may have the same painful symptoms, but does this mean that the cause of their illness is the same? And therefore that they should all receive the same treatment? Scientists at VIB and Ghent University have demonstrated with their research into inflammasomes that RA should be considered as a syndrome rather than a single disease.
Mohamed Lamkanfi (VIB/Ghent University) said: “Rheumatoid arthritis (RA) can be very painful and it is not always easy to find the most suitable medicine. Until recently, RA was considered to be a single disease, but our research suggests that it is more likely to be a syndrome than a single disease. This knowledge could result in a more personalized approach to treatment, with the most suitable medicines selected according to the patient’s profile.”
Rheumatoid arthritis and inflammasomes
Rheumatoid arthritis (RA) is an inflammatory…
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Stem cell mobilization therapy may effectively treat osteoarthritis
Researchers in Taiwan have found that peripheral blood stem cells can be “mobilized” by injection of a special preparation of granulocyte colony-stimulating factor (G-CSF) into rats that modeled osteoarthritis (OA). The bone marrow was stimulated to produce stem cells, leading to the inhibition of OA progression. The finding, they said, may lead to a more effective therapy for OA, a common joint disease that affects 10 percent of Americans over the age of 60.
The study will be published in a future issue of Cell Transplantation and is currently freely available on-line as an unedited early e-pub.
“Currently, OA treatment involves the use of anti-inflammatory drugs, analgesics, lubricating supplements, or surgery,” said study lead author Dr. Shih-Chieh Hung of the Department of Medical Research and Education at the Taipei Veterans general Hospital in Taiwan. “Recently, hematopoietic (blood) stem cells derived from bone marrow have emerged as a potential treatment…
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7 Herbs to Greatly Enhance Happiness
Harvard scientists, along with many others have suggested that being happier can also make you healthier, but they say fleeting positive emotions aren’t enough. We need to lower our stress levels and find healthful ways to mitigate depression, anxiety, and worry. Aside from pursuing activities that engage us fully (as suggested by the influential research by Mihaly Csikszentmihalyi) such as doing good for others and counting our blessings daily, there are some great herbs that can help to lessen insomnia, reduce nervousness, and essentially calm the nervous system – helping to increase the chance of feeling happiness.
Here are 7 herbs that may help you feel better:
- 1. Lemon Balm (Melissa Officinalis) – This is a great, non-habit forming herb that is high in volatile oils (especially citronella) that have mild sedative effects and can reduce nervousness, including nervous headaches, depression, and insomnia. It can also help wounds heal faster and protect against insect bites. It has anti-viral properties, too, so it’s…
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“STEROID” EFFECTS ON BODY ; A CASE OF LADY , TAKING REGULAR STEROIDS IN HUGE DOSES ; DEVELOPED MANY PHYSICAL PROBLEMS
A lady aged 51 years is taking regularly since 8 years , “STEROIDS” prescribed by the Physicians of well known hospital.
She developed many physical problems after taking STEROIDS, but after complaining to the treating physician about her troubles, physician asked that “we have only this medicine for you, which you have to take regularly”.
The lady patient belongs to KAVAL Town of UP. When she felt more and unbearable problem , she asked to everyone who was in her touch, asking any physician, who could suggest any physician, who can well manage her case.
The patient belongs to a city , which is away 350 kilometers from KANPUR. My one lady patient, who was suffering from LEUCODERMA / vitiligo, now totally cured from LEUCODERMA, suggested me for treatment by the sister of this patient, who is working in that city, with this lady visitor.
She was told about my…
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Letrozole boosts fertility in women with PCOS, says study
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Letrozole boosts fertility in women with PCOS, says study
Penn State College of Medicine’s nationwide study showed that Letrozole resulted in higher birth rates in women with polycystic ovary syndrome (PCOS) than the current preferred infertility treatment drug, Clomiphine citrate. http://www.pharmaceutical-technology.com/news/newsletrozole-boosts-fertility-women-pcos-says-study-4314880?WT.mc_id=DN_News
Letrozole (INN, trade name Femara) is an oral non-steroidal aromatase inhibitor for the treatment of hormonally-responsive breast cancer after surgery.
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Uses
FDA-approved use
Letrozole is approved by the United States Food and Drug Administration (FDA) for the treatment of local or metastatic breast cancer that is hormone receptor positive or has an unknown receptor status in postmenopausal women.[2]
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4-[alpha (4-cyanophenyl)-l-(l,2,4-triazoly)-methyl]- benzonitrile
| Systematic (IUPAC) name | |
|---|---|
| 4,4′-((1H-1,2,4-triazol-1-yl)methylene)dibenzonitrile | |
| Clinical data | |
| Trade names | Femara |
| AHFS/Drugs.com | monograph |
| MedlinePlus | a698004 |
| Licence data | US FDA:link |
| Pregnancy cat. | D (US) |
| Legal status | Schedule VII (CA) POM (UK) ℞-only (US) |
| Routes | Oral |
| Pharmacokinetic data | |
| Bioavailability | 99.9% |
| Protein binding | 60%, mainly to albumin |
| Metabolism | pharmacologically-inactive carbinol metabolite (4,4΄-methanol-bisbenzonitrile)[1] |
| Half-life | 2 days[1] |
| Excretion | Kidneys[1] |
| Identifiers | |
| CAS number | 112809-51-5 |
| ATC code | L02BG04 |
| PubChem | CID 3902 |
| DrugBank | DB01006 |
| ChemSpider | 3765 |
| UNII | 7LKK855W8I |
| KEGG | D00964 |
| ChEBI | CHEBI:6413 |
| ChEMBL | CHEMBL1444 |
| Chemical data | |
| Formula | C17H11N5 |
| Mol. mass | 285.303 g/mol |
Off-label uses
Letrozole has been used for ovarian stimulation by fertility doctors since 2001 because it has fewer side-effects than clomiphene (Clomid) and less chance of multiple gestation. A Canadian study presented at the American Society of Reproductive Medicine 2005 Conference suggests that letrozole may increase the risk of birth defects. A more detailed ovulation induction follow-up study found that letrozole, compared with a control group of clomiphene, had significantly lower congenital malformations and chromosomal abnormalities at an overall rate of 2.4% (1.2% major malformations) compared with clomiphene 4.8% (3.0% major malformations).[3] Despite this, India banned the usage of letrozole in 2011, citing potential risks to infants.[4] In 2012, an Indian parliamentary committee said that the drug controller office colluded with letrozole’s makers to approve the drug for infertility in India and also stated that letrozole’s use for infertility was illegal worldwide;[5] however, such off-label uses are legal in many countries such as the US and UK.[6][7]
The anti-estrogen action of letrozole has been shown to be useful in pretreatment for termination of pregnancy, in combination with misoprostol. It can be used in place of mifepristone, which is expensive and unavailable in many countries.[8]
Letrozole is sometimes used as a treatment for gynecomastia, although it is probably most effective at this if caught in an early stage (such as in users of anabolic steroids).[9][10]
Some studies have shown that letrozole can be used to promote spermatogenesis in male patients suffering from nonobstructive azoospermia.[11]
Letrozole has also been shown to delay the fusing of the growth plates in mice.[12] When used in combination with growth hormone, letrozole has been shown effective in one adolescent boy with a short stature.[13]
Letrozole has also been used to treat endometriosis.[14]

Mechanism of action
Estrogens are produced by the conversion of androgens through the activity of the aromatase enzyme. Estrogens then bind to an estrogen receptor, which causes cells to divide.
Letrozole prevents the aromatase from producing estrogens by competitive, reversible binding to the heme of its cytochrome P450 unit. The action is specific, and letrozole does not reduce production of mineralo- or corticosteroids.
Contraindications
Letrozole is contraindicated in women having a pre-menopausal hormonal status, during pregnancy and lactation.[15]
Adverse effects
The most common side effects are sweating, hot flashes, arthralgia (joint pain), and fatigue.[15]
Generally, side effects include signs and symptoms of hypoestrogenism. There is concern that long term use may lead to osteoporosis,[2] which is in certain patient populations such as post-menopausal women or osteoporotics, bisphosphonates may also be prescribed.
Interactions
Letrozole inhibits the liver enzyme CYP2A6, and to a lesser extent CYP2C19, in vitro, but no relevant interactions with drugs like cimetidine and warfarin have been observed.[15]
Comparison with tamoxifen
Tamoxifen is also used to treat hormonally-responsive breast cancer, but it does so by interfering with the estrogen receptor. However, letrozole is effective only in post-menopausal women, in whom estrogen is produced predominantly in peripheral tissues (i.e. in adipose tissue, like that of the breast) and a number of sites in the brain.[16] In pre-menopausal women, the main source of estrogen is from the ovaries not the peripheral tissues, and letrozole is ineffective.
In the BIG 1–98 Study, of post-menopausal women with hormonally-responsive breast cancer, letrozole reduced the recurrence of cancer, but did not change survival rate, compared to tamoxifen.[17][18]
Synthesis
Letrozole can by synthesized from 4-cyanobenzyl bromide, triazole, and 4-fluorobenzonitrile:[19] ![]()
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http://www.google.com/patents/EP2212301B1?cl=en
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Letrozole, chemically known as 4-[alpha (4-cyanophenyl)-1-(1,2,4-triazoly)-methyl]-benzonitrile, and represented by formula (I),
is a therapeutically and commercially important non-steroidal aromatase inhibitor, which is widely used for adjuvant treatment of hormonally responsible breast cancer in postmenopausal women. Estrogens are produced by the conversion of androgen through the activity of aromatase enzyme, the suppression of estrogen biosynthesis in peripheral tissues and in the cancer tissue itself can therefore be achieved by specifically inhibiting the aromatase enzyme.
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[0003]1. Bowman et al. were the first to disclose Letrozole in US 4,978,672 , and US 5,352,795 and reported two methods for synthesis of Letrozole, the chemistry for Method-1 is summarized in Scheme-1.
-
[0004]The Method-1 for synthesis of Letrozole as disclosed by Bowman et al. in US 4,978,672 , and US 5,352,795 and as summarized in Scheme-1, comprises reaction of alpha-bromo-4 tolunitrile or 4-bromomethyl benzonitrile (II) with 1H-1, 2,4-triazole (III), in a mixture of chloroform and acetonitrile as solvent at reflux temperature for 15 hours to give 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV), which on reaction with 4-flurobenzonitrile (VI) in the presence of potassium t-butoxide and in N, N-dimethylformamaide, gives crude Letrozole (I), which is recrystallized from 95% ethanol or a mixture of ether and ethyl acetate to give pure Letrozole (I):
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[0005]As would be evident from Examples 9, 25, and 26 of US 4,978,672 , and US 5,352,795 , in the step reaction of alpha-bromo-4 tolunitrile or 4-bromomethyl benzonitrile (II) with 1H-1, 2,4-triazole (III), as per Method-1, Scheme-I, in addition to the desired 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV) an appreciable amount of isomeric 4-[1-(1,3,4-triazolyl) methyl]-benzonitrile (V) is also formed in the reaction, which necessitates separation of the two isomers by column chromatography, subsequent to which the separated pure 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV) is reacted with 4-flurobenzonitrile (VI) to give Letrozole. Example 25 of US 4,978,672 , and US 5,352,795 further report that Letrozole obtained after recrystalization from 95% ethanol has a melting point of 181° – 183°C, while Example 26 reports that Letrozole obtained after recrystalization from a mixture of ether and ethyl acetate has a melting point of 184°- 185° C.
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[0006]The major disadvantage and limitation of the Method-1 disclosed in US 4,978,672 , and US 5,352,795 is that it leads to formation of appreciable amounts of the unwanted isomer i.e. 4-[1-(1,3,4-triazolyl) methyl]-benzonitrile (V), calling for tedious chromatographic techniques for its separation from the desired isomer i.e. 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV), which is expected to result in considerable loss and low yield of the desired isomer. Such a method, obviously, cannot be expected to be economically or commercially viable. Further, nowhere in the Specifications and Experimental Descriptions of US 4,978,672 , and US 5,352,795 there is any mention about the yield and purity of Letrozole obtained by the method described therein.
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[0007]The second method, Method-2, reported by Bowman et al. in US 4,978,672 , and US 5,352,795 is summarized in Scheme-II, which comprises of reaction of N-tert.butyl-4-bromo benzamide (1) with n-butyllithium and ethyl formate to give Bis- (4-N-tert.butyl carbamoylphenyl) methanol (2), which on reaction with thionyl chloride gives 4-(alpha-chloro-4’cyanobenzyl)benzonitrile (3). Reaction of 4-(alpha-chloro-4’cyanobenzyl) benzonitrile (3) with 1H-1,2,4-triazole (III) gives Letrozole (I).
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[0008]The major disadvantage and limitation of the Method-2 disclosed in US 4,978,672 , and US 5,352,795 , as evident from Examples 3, 5 and 28, described therein, is that first of all it utilizes corrosive and hazardous n-butyllithium and thionyl chloride; which require special storage, handling and disposal as well as calls for cryogenic temperatures of -60° C and higher temperatures of about 160° C, which collectively renders the method unsafe and industrially and commercially not of particular viability. Further, as in the case of Method-1, nowhere in the Specifications and Experimental Descriptions of US 4,978,672 , and US 5,352,795 there is any mention about the yield and purity of Letrozole obtained by the Method-2 described therein. Furthermore, the reaction of 4-(alpha-chloro-4’cyanobenzyl) benzonitrile (3) with 1,2,4-triazole (III) would most likely result in formation of the corresponding isomer along with the desired Letrozole, which would involve tedious purification techniques for its separation.
-
[0009]Improvements over the methods disclosed by Bowman et al. in US 4,978,672 , and US 5,352,795 are the subject matter of the following reports, viz.
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[0010]2. Wadhwa et al. in US 2005/0209294 A1 , recite a method for synthesis of the intermediate 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV), comprising reaction of alpha-bromo-4 tolunitrile or 4-bromomethyl benzonitrile (II) with a salt of 1H-1,2,4-triazole, preferably an alkali metal salt of 1H-1,2,4-triazole (4), in a suitable solvent at a temperature of between 10° to 15° C, followed by crystallization of the isolated product. The chemistry is summarized in Scheme-III.
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[0011]Wadhwa et al. in US 2005/0209294 A1 , while stating that the method disclosed by Bowman et al. in US 4,978,672 , and US 5,352,795 is not selective in that it produces the undesired isomeric 4-[1-(1,3,4-triazolyl) methyl]-benzonitrile (V) in about 50%, which as mentioned hereinbefore requires tedious chromatographic separation techniques for its removal, emphasize that by virtue of utilization of an alkali metal salt of 1H-1, 2,4-triazole (4), the desired 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV) is obtained in >96% selectivity, thereby circumventing the utilization of tedious chromatographic techniques for its purification. Wadhwa et al., further state that the said intermediate i.e. 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV), obtained by their method can be converted to Letrozole of US Pharmacopoeial Quality, through conventional procedure.
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[0012]While the method disclosed by Wadhwa et al. in US 2005/0209294 A1 , reportedly affords the intermediate 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV) in >96% selectivity and further, reportedly does away with chromatographic techniques in its isolation, however, the entire Specification and the Experimental Description given in Example-1 therein, is silent about the actual yield and purity of not only the intermediate 4-[1-(1,2,4-triazolyl) methyl]-benzonitrite (IV) but also that of Letrozole obtained by the method. The industrial or commercial viability of the method, therefore, cannot be commented, in view of insufficient disclosure.
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[0013]3. Kompella et al. in WO 2005/047269 A1 , disclose a method for separation of the Letrozole precursor, 4-[1-(1,2,4-triazolyl)methyl]-benzonitrile (IV) from its isomer, 4-[1-(1,3,4-triazolyl) methyl]-benzonitrile (V), comprising treating a solution of the mixture of the two isomeric compounds (IV) and (V) in dichloromethane or chloroform with isopropylalcohol hydrochloride, followed by addition of isopropyl ether, wherein the hydrochloride salt of the undesired 4-[1-(1,3,4-triazolyl) methyl]-benzonitrile (V) precipitates out, which is removed by filtration. Basification of the filtrate, followed by evaporation of solvent and isolation of the residue from hexane or petroleum ether affords the desired 4-[1-(1,2,4-triazolyl)methyl]-benzonitrile (IV). The method is summarized in Scheme-IV.
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[0014]The required isomer is obtained in 47-61 % yield and a purity of about 99%.
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[0015]4. In another variant of the Method-1 of Bowman et al., an improved regiospecific method disclosed by Patel et al. in US 2006/0128775 A1 for synthesis of Letrozole is summarized in Scheme-V.
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[0016]The method disclosed by Patel et al. in US 2006/0128775 A1 utilizes 4-amino-1, 2,4-triazole (5), instead of 1H-1, 2,4-triazole (III) or an alkali metal salt of 1H-1, 2,4-triazole (4), as utilized by Bowman et al. in US 4,978,672 , and US 5,352,795 and Wadhwa et al. in US 2005/0209294 A1 respectively, for reaction with alpha-bromo-4 tolunitrile or 4-bromomethyl benzonitrile (II) to give 4-[(4-amino-1,2,4-triazolium-1-yl)methyl]benzonitrile bromide (6), which on diazotisation leads to the required intermediate, 4-[1-(1,2,4-triazolyl)methyl]-benzonitrile (IV), further reaction of which with 4-flurobenzonitrile (VI) gives crude Letrozole, which is recrystallized from polar or non-polar solvents to give pure Letrozole (I).
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[0017]The method of Patel et al. in US 2006/0128775 A1 , in the first place provides an elegant regiospecific synthesis of Letrozole in that it like the method of Wadhwa et al. in US 2005/0209294 A1 , minimizes the formation of the undesired isomeric 4-[1-(1,3,4-triazolyl) methyl]-benzonitrile (V) and also does away with tedious chromatographic separation techniques.
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[0018]The method of Patel et al. in US 2006/0128775 A1 , albeit, as evident from Example-1, described therein, reportedly gives Letrozole of 99.90% HPLC purity, however, gives Letrozole of the said purity only in an overall yield of 34%, which renders it of not being an particularly economic process. Secondly, the method comprises of an additional step of deamination of the intermediate compound (6), which in turn calls for a diazotization step, through utilization of sodium nitrite, which is hazardous and explosive, more suitable to small scale preparations rather than industrial manufacture. The method, hence, might not be particularly amenable for industrial scale-up and manufacture.
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[0019]5. MacDonald et al. in US 2007/0066831 A1 , report another variant of the methods disclosed by Bowman et al. in US 4,978,672 , and US 5,352,795 and Wadhwa et al. in US 2005/0209294 A1 in that the said method, as summarized in Scheme-VI comprises:
- a) Reaction of alpha-bromo-4 tolunitrile or 4-bromomethyl benzonitrile (II) with an alkali metal salt of 1H-1,2,4-triazole (4), in presence of a solvent selected from the group consisting of diemthylacetamide, N-methyl-2-pyrrolididone, or a mixture thereof, at a temperature of about -20° to 0°C to give 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV);
- b) Extracting the impurities form intermediate compound (IV), in a two phase system, comprising an aqueous phase and a water-immiscible phase; and
- c) Reacting compound (IV) with 4-flurobenzonitrile (VI), in presence of a solvent selected from the group consisting of dimethylformamide, diemthylacetamide, N-methyl-2-pyrrolididone, and tetrahydrofuran or a mixture thereof and a base selected from sodium bis(trimethylsilyl)amide, hexyl lithium, butyl lithium, lithium didsopropylamide, alkoxide or mixtures thereof.
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[0020]US 2007/0066831 A1 further, states that the steps (a) and (b) could be combined together resulting in a one-pot synthesis of Letrozole.
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[0021]In the first place, it might be mentioned herein that the chemistry disclosed by Macdonald et al. in US 2007/0066831 A1 is a nominal variation of the method disclosed by Wadhwa et al. in US 2005/0209294 A1 , in that uses specific solvents such as diemthylacetamide, and N-methyl-2-pyrrolididone for formation of compound (IV) and again utilizes the same solvents for obtaining Letrozole from compound (IV), in addition to use of specific lithium containing bases, most of which are hazardous and expensive, requiring special precautions during storage, handling and disposal.
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[0022]6. In yet another variation, Radhakrishnan et al. in WO 2007/039912 provide a method for synthesis of Letrozole, as summarized in Scheme-VII, which is a one-pot synthesis comprising reaction of compounds (II) and (4) to give compound (IV), which without isolation and on further reaction with compound (VI) gives Letrozole.
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[0023]The major disadvantage with the method is that is still does not obliterate the use of chromatographic separation/purification of Letrozole.
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[0024]7. Haider et al. in WO 2007/054964 A2 provide an improvement, as summarized in Scheme- VIII, over Method-1 disclosed by Bowman et al. in US 4,978,672 and US 5,352.795 . in that the improvement comprises of selective removal of the isomeric 4-[1-(1,3,4-triazolyl)methyl]-benzonitrile (V), formed in the reaction of compound (II) and (III) in isopropanol as solvent, through a method of extraction, which provides the desired 4-[1-(1,2,4-triazolyl)methyl]-benzonitrile (IV), of >99% purity, and relatively free of the isomeric impurity (V).
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[0025]The method of extraction, as taught by Haider et al. in WO 2007/054964 A2 comprises repeated extraction of the reaction medium containing mixture of the desired 4-[1-(1,2,4-triazolyl)methyl]-benzonitrile (IV) and the undesired 4-[1-(1,3,4-triazolyl)methyl]-benzonitrile (V) with water and a water-immiscible solvent to afford the pure 4-[1-(1,2,4-triazolyl)methyl]-benzonitrile (IV) in the organic phase, which is then further converted to Letrozole (I) of >99% purity by conventional methods. Haider et al. also teach a process for conversion of the mixture of the desired 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV) and the undesired 4-[1-(1,3,4-triazolyl)methyl]-benzonitrile (V) to Letrozole, from which the isomeric form of Letrozole i.e. Isoletrozole (9) so formed is removed by repeated crystallization to afford Letrozole (I) of >99% purity. –
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[0026]It might be noted that the method of Haider et al., primarily is one for purification of the intermediate 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV) as well as Letrozole (I) for removal of the corresponding isomeric impurities and as such does not provide any inputs for controlling or minimization of the formation of the isomeric 4-(1-(1,3,4-triazolyl)methyl]-benzonitrile (V) in the reaction. Secondly, the method of extraction as well as purification taught by Haider et al. is tedious, comprising multiple extractions, with multiple solvents and this coupled with the fact that it does not provide any improvement in controlling or minimization of the formation of the isomeric 4-[1-(1,3,4-triazolyl)methyl]-benzonitrile (V) in the reaction, leads to significant losses, thereby resulting in rather low yields of Letrozole (I). The method, therefore, is not of commercial significance.
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[0027]8. Pizzocaro et al. in WO 2007/090464 A1 , a process for preparation of Letrozole (I), as summarized in Scheme-IX, characterized in that it teaches either simultaneous addition of a solution of 4-[1-(1,2,4-triazolyl) methyll-benzonitrile (IV) and a solution of 4-fluorobenzonitrile (VI) in an aprotic dipolar solvent to a solution of an alkali metal alkoxide in the same aprotic dipolar solvent or addition of an unique solution in an aprotic dipolar solvent comprising of compounds (IV) and (VI) to aprotic dipolar solvent, and reacting at a temperature of between -20 to + 40° C.
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[0028]
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[0029]9. Srinivas et al. WO 2007/107733 A1 recite a further variation of Method-1 disclosed by et al. in US 4,978,672 and US 5,352,795 , for synthesis of Letrozole, substantially free from its isomeric impurity, which is summarized in Scheme-X. The method comprises reacting 4-bromomethylbenzonitrile (II), with 1H 1,2,4-triazole (III) in an organic solvent in presence of cesium carbonate and precipitation of 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile (IV), thus formed from the reaction medium using a suitable organic solvent. The intermediate (IV) is further converted to Letrozole by reaction with 4-fluorobenzonitrile (VI) in presence of an organic solvent and silicon amine, which are lithium, sodium, or potassium disilazanes or monosilazane.
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[0030]
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[0031]10. Hasson et al. in US 2007/0112203 A1 , provide a method, as summarized in Scheme-XI, for purification of a mixture containing Letrozole (I) and its isomeric impurity i.e. Isoletrozole (IX), which is an extension of Method-2 disclosed by Bowman et al. in US 4,978,672 and US 5,352,795 . The method takes advantage of the rapid oxidation of Isoletrozole (9) to 4,4′-dicyclobenzophenone (10), in comparison to Letrozole (I), the oxidized compound (10), being easily separable from Letrozole, can be removed by crystallization, affording pure Letrozole. The Letrozole product, in turn is prepared by Method-2 disclosed by Bowman et al. in US 4,978,672 and US 5,352,795 .
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[0032]From the Enabling Disclosures of Hasson et al. in US 2007/0112203 A1 , it could be seen that the method of oxidative purification of Letrozole, does not provide the said Letrozole, free of the Isoletrozole impurity (IX), directly and in fact, about 1 to 4% of Isoletrozole (IX) remains in the product, which is further removed by successive crystallizations to provide Letrozole (I) of 99.9% purity.
It is also noted that Letrozole to some extent also undergoes oxidation, albeit slowly, resulting in formation of additional impurities. Removal of such impurities, coupled with the task of removal of Isoletrozole (IX) and 4,4-dicyclobenzophenone (10) results in significant yield loss, rendering the method not particularly attractive, economically.
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[0033]11. Palle et al. in US 2007/0100149 A1 , recite an alternate method for synthesis of Letrozole, as summarized in Scheme-XII.
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[0034]The method of Palle et al. comprises reacting 4,4-(hydroxymethylene)bis benzonitrile (12), in turn obtained from 4,4-dibromobenzophenone (11), with p-toluenesulfonyl chloride to give the corresponding p-tolenesulfonate (13), which on reaction with 1H 1,2,4-triazole (III), gives crude Letrozole, which is further purified by successive chromatography and crystallization.
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[0035]The yield of the p-tolenesulfonate (13), in the key step is only 21%, indicative of formation of large amount of impurities in the said step. Further, the overall yield of Letrozole obtained by the method is only about 14%, which would render the method not viable commercially.
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[0036]12. Friedman et al. in US 2007/0112202 A1 , provide an extension of Method-2 disclosed by Bowman et al. in US 4,978,672 and US 5,352,795 , which is summarized in Scheme-XIII.
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[0037]US 2007/0112202 A1 reports synthesis of Letrozole by the abovementioned method in 54-56% yield and having a HPLC purity 99.4%, which may not suit Pharmacopoeial standards, which suggests that the product obtained requires further purification, which, incidentally, is acknowledged by Friedman et al., who state that single purification using various solvents does not give Letrozole of acceptable purity, and hence multiple purifications are required to achieve the same. Needless to mention, this would result in significant loss of the precious product. Further, the novelty and inventiveness of the method is in question, since Bowman et al. in US 4,978,672 and US 5,352,795 have disclosed the same chemistry earlier.
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[0038]13. Agarwal et al. in WO 2007/074474 A1 recite a synthesis of Letrozole, utilizing novel intermediates, the chemistry of which is summarized in Scheme-XIV.
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[0039]The method is lengthy and the reported overall yield of Letrozole appears to be only 9-11%.
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http://www.google.com/patents/EP2212301B1?cl=en
The process for preparation of 4-[1-(1,2,4-triazolyl) methyl]-benzonitrile hydrochloride of formula (VII) and Letrozole of formula (I), both having a purity of ≥99% as per the present invention is schematically represented in Scheme-XV.
Reference Example – 3 Preparation of 4-[1-(4-cyanophenyl)-1-(1,2,4-trinzol-1yl)methyl]benzonitrile (Letrozole, I)
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[0101]To a mixture of potassium tertiarybutoxide (635.92 gm; 5.66 mol) and N,N-dimethylformamide (3.75 Lt), under an atmosphere of nitrogen and cooled to a temperature of -20° to -25°C, was added 4-(1H-1,2,4-triazol-1-ylmethyl)benzonitrile hydrochloride (VII, as obtained in Reference Examples 1 or 2; 250 gm; 1.13 mol) within 5 minutes and was stirred for 60 minutes at -20°C to -25°C. To the mixture was added 4-fluoro benzonitrile (VI, 150.9 gm; 1.24 mol) within 5 minutes and the mass agitated for an hour at-20°C to -25°C. After completion of the reaction, pH of the mixture was adjusted to between 6.0 to 6.5 by addition of 50% aqueous hydrochloric acid, maintaining the temperature between -20°C to 0°C. After the addition of the hydrochloric acid solution, the reaction mass was stirred for additional 30 minutes and filtered. To the filtrate was added ethyl acetate and water and the ethyl acetate layer was separated and dried over anhydrous sodium sulfate. The solvent was evaporated under vacuum to give a residual solid amounting to 179 gm (55%) of Letrozole (I), having a purity of 83%.
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[0102]The solid was chromatogaphed over silica gel (60-120 mesh) using n-Hexane and ethyl acetate as eluent to give Letrozole (100.5 gm; 56%), having a purity of 99%.
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[0103]The material (100 gm) was further dissolved in ethyl acetate (1.6 Lt) at 70° to 75°C, and the solution was filtered hot. The filtrate was evaporated under vacuum till the volume was between 200 to 220 ml. The solution was cooled to 0° to 5°C for 4 hours, and the solid filtered, washed with cold ethyl acetate and dried to give Letrozole (I, 95 gm; 95%), having a purity of 99.6%.
Example – 3 Preparation of 4-[1-(4-cyanophenyl)-1-(1,2,4-triazol-1-yl)methyl]benzonitrile (Letrozole, I)
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[0104]To a mixture of potassium tertiarybutoxide (635.92 gm; 5.66 mol) and N,N-dimethylformamide (3.75 Lt). under an atmosphere of nitrogen and cooled to a temperature of -20° to -25°C, was added 4-(1H-1,2,4-triazol-1-ylmethyl)benzonitrile hydrochloride (VII, as obtained in Examples 1 or 2; 250 gm; 1.13 mol) within 5 minutes and was stirred for 60 minutes at -20°C to -25°C. To the mixture was added 4-fluoro benzonitrile (VI, 150.9 gm; 1.24 mol) within 5 minutes and the mass agitated for an hour at -20°C to -25°C. After completion of the reaction, pH of the mixture, was adjusted to between 6.0 to 6.5 by addition of 50% aqueous hydrochloric acid, maintaining the temperature between -20°C to 0°C. After the addition of the hydrochloric acid solution, the reaction mass was stirred for additional 30 minutes and filtered. To the filtrate was added ethyl acetate and water and the ethyl acetate layer was separated and dried over anhydrous sodium sulfate. The solvent was evaporated under vacuum to give a residual solid amounting to 244 gm (75%) of Letrozole (I), having a purity of 99%.
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[0105]The material (244 gm) was further dissolved in ethyl acetate (500 ml) at 70° to 75°C, and the solution was filtered hot. The filtrate was cooled to 0° to 5°C for 4 hours, and the solid filtered, washed with cold ethyl acetate and dried to give Letrozole (I, 221 gm; 98.6%), having a purity of 99.7%.
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http://www.google.com/patents/EP2212301A1?cl=en
Reference Example – 3 Preparation of4-ll-(4-cyanophenyl)-l-(l,2,4-triazol-l-yl)methyl]benzonitrile (Letrozole, I)
To a mixture of potassium tertiarybutoxide (635.92 gm; 5.66 mol) and N5N- dimethylformamide (3.75 Lt), under an atmosphere of nitrogen and cooled to a temperature of -20° to -25 °C, was added 4-(lH-l,2,4-triazol-l-ylmethyl)benzonitrile hydrochloride (VII, as obtained in Reference Examples 1 or 2; 250 gm; 1.13 mol) within 5 minutes and was stirred for 60 minutes at -20°C to -25°C. To the mixture was added 4-fluoro benzonitrile (VI, 150.9 gm; 1.24 mol) within 5 minutes and the mass agitated for an hour at – 20°C to -25°C. After completion of the reaction, pH of the mixture was adjusted to between 6.0 to 6.5 by addition of 50% aqueous hydrochloric acid, maintaining the temperature between -200C to 0°C. After the addition of the hydrochloric acid solution, the reaction mass was stirred for additional 30 minutes and filtered. To the filtrate was added ethyl acetate and water and the ethyl acetate layer was separated and dried over anhydrous sodium sulfate. The solvent was evaporated under vacuum to give a residual solid amounting to 179 gm (55%) of Letrozole (I), having a purity of 83%.
The solid was chromatogaphed over silica gel (60-120 mesh) using n-Hexane and ethyl acetate as eluent to give Letrozole (100.5 gm; 56%), having a purity of 99%.
The material (100 gm) was further dissolved in ethyl acetate (1.6 Lt) at 70° to 75°C, and the solution was filtered hot. The filtrate was evaporated under vacuum till the volume was between 200 to 220 ml. The solution was cooled to 0° to 5°C for 4 hours, and the solid filtered, washed with cold ethyl acetate and dried to give Letrozole (I, 95 gm; 95%), having a purity of 99.6%. Example – 3 Preparation of4-[l-(4-cyanophenyl)-l-(l,2,4-triazol-l-yl)methyl]benzonitrile (Letrozole, I)
To a mixture of potassium tertiarybutoxide (635.92 gm; 5.66 mol) and N,N- dimethylformamide (3.75 Lt). under an atmosphere of nitrogen and cooled to a temperature of -20° to -25°C, was added 4-(l H-l ,2,4-triazol-l -ylmethyl)benzonitrile hydrochloride (VII. as obtained in Examples 1 or 2; 250 gm; 1.13 mol) within 5 minutes and was stirred for 60 minutes at -20°C to -25°C. To the mixture was added 4-fluoro benzonitrile (VI, 150.9 gm; 1.24 mol) within 5 minutes and the mass agitated for an hour at -20°C to -25°C. After completion of the reaction, pH of the mixtureJwas adjusted to between 6.0 to 6.5 by addition of 50% aqueous hydrochloric acid, maintaining the temperature between -20°C to 0°C. After the addition of the hydrochloric acid solution, the reaction mass was stirred for additional 30 minutes and filtered. To the filtrate was added ethyl acetate and water and the ethyl acetate layer was separated and dried over anhydrous sodium sulfate. The solvent was evaporated under vacuum to give a residual solid amounting to 244 gm (75%) of Letrozole (I), having a purity of 99%.
The material (244 gm) was further dissolved in ethyl acetate (500 ml) at 70° to 75°C, and the solution was filtered hot. The filtrate was cooled to 0° to 5°C for 4 hours, and the solid filtered, washed with cold ethyl acetate and dried to give Letrozole (I, 221 gm; 98.6%), having a purity of 99.7%.
…………………………
http://www.google.com/patents/EP1945618A2?cl=en
Aromatase is an enzyme, which effects aromatisation of ring A in the metabolic formation of various steroid hormones. Various cancers, for example, breast cancer is dependent upon circulating steroid hormones, which have an aromatic ring A. Such cancers can be treated by removing the source of ring A aromatised steroid hormones, for example by the combination of oophorectomy and adrenalectomy. An alternative way of obtaining the same effect is by administering a chemical compound, which inhibits the aromatisation of the steroid ring A.
Letrozole is a non-steroidal antineoplastic, claimed to inhibit the aromatase (oestrogen synthase) activity. It is useful in the treatment of advanced breast cancer in postmenopausal women.
The growth of some cancers of the breast are stimulated or maintained by estrogens. Treatment of breast cancer thought to be hormonally responsive (i.e., estrogen and/or progesterone receptor positive or receptor unknown) has included a variety of efforts to decrease estrogen levels (ovariectomy, adrenalectomy, hypophysectomy) or inhibit estrogen effects (antiestrogens and progestational agents). These interventions lead to decreased tumor mass or delayed progression of tumor growth in some women.
In postmenopausal women, estrogens are mainly derived from the action of the aromatase enzyme, which converts adrenal androgens (primarily androstenedioήe and testosterone) to estrone and estradiol. The suppression of estrogen biosynthesis in peripheral tissues and in the cancer tissue itself can therefore be achieved by specifically inhibiting the aromatase enzyme.
Letrozole is a nonsteroidal competitive inhibitor of the aromatase enzyme system; it inhibits the conversion of androgens to estrogens. In adult tumor bearing females, Letrozole is as effective as ovariectomy in reducing uterine weight, elevating serum LH, and causing the regression of estrogen-dependent tumors. In contrast to ovariectomy, treatment with Letrozole does not lead to an increase in serum FSH. Letrozole selectively inhibits gonadal steroidogenesis but has no significant effect on adrenal mineralocorticoid or glucocorticoid synthesis. l Letrozole inhibits the aromatase enzyme by competitively binding to the heme of the cytochrome P450 subunit of the enzyme, resulting in a reduction of estrogen biosynthesis in all tissues. Treatment of women with Letrozole significantly lowers serum estrone, estradiol and estrone sulfate and has not been shown to significantly affect adrenal corticosteroid synthesis, aldosterone synthesis, or synthesis of thyroid hormones. Description of prior art
Synthesis of Letrozole is reported in US Patent No. 4,978,672 and EP 236,940. In the above patents the synthesis of Letrozole starts with 4-bromomethylbenzonitrile (1), which undergoes condensation with 1,2,4-triazole (2) to form 4-[(l,2,4-triazol-l- yl)methyl]benzonitrile (3) as an intermediate. The compound of structural formula (3) is purified by column chromatography to remove 4-[(l,3,4-triazol-l- yl)methyl]benzonitrile (4) and followed by reaction with 4-fluorobenzonitrile (5) to
SCHEME – 1
afford Letrozole (6).
In the above process, the undesired intermediate 4-[(l,3,4-triazol-l- yl)methyl]benzonitrile (4) is formed during the course of the preparation 4-[(l,2,4- triazol-l-yl)methyl]benzonitrile (3) in 10%w/w to 30%w/w. The undesired impurity 4- [(l,3,4-triazol-l-yl)methyl]benzonitrile (4) present with 4-[(l,2,4-triazol-l- yl)methyl]benzonitrile (3), further on reaction with 4-fluorobenzonitrile (5) leads to the formation of another impurity 4-[l-(4-cyanophenyl)-l-(l,3,4-triazol-l- yl)methyl]benzonitrile (7) in approximately same ratio.
To control the formation of impurity of structural formula (7), it is required to make intermediate of structural formula (3) in its pure form. The separation of desired compound from isomeric impurities is of great importance. In basic patents US 4,978,672 and EP 236,940; chromatographic technique is used to isolate intermediate (3) from its mixture with regioisomer (4). Chromatography has its own limitations on commercial scale; it is an expensive and time consuming operation at plant scale, which also consumes lots of solvent and is hazardous for environment.
To overcome the above problems, purification of intermediate (3) is reported in PCT application WO 2005/047269 via the hydrochloride salt formation of the mixture of product (3) along with regioisomer (4). Selective crystallisation of regioisomer as hydrochloride using approximately 8.5 volume diisopropyl ether, filtering the resultant and then isolation of the intermediate (3) as pure product from the filtrate in approximately 60% overall yield. Finally washing the product with hexane or petroleum ether. In above PCT application, highly flammable solvents like diisopropyl ether, hexane and petroleum ether are used in process, which require high level of precautions and are never safe to handle on plant scale.
Another process reported in PCT application WO 2004/076409, discloses the different route to prepare the pure intermediate (3). The said patent discloses a reaction of 4-bromomethylbenzonitrile (1) with 4-amino-l,2,4-triazole (8) to give quaternary ammonium salt (9), which undergoes diazotisation reaction to give 4-[(l,2,4-triazol-l- yl)methyl]benzonitrile (3) in approximately 59% molar yield. The process is complicated and involves lengthy steps and tedious operations. Objects of the invention
It is therefore, an important object of the present invention to provide a process for the preparation of Letrozole which avoids the use of highly flammable solvents and is safe and smooth.. Summary of the invention
To overcome the problems in the use of highly flammable solvents, complicated and lengthy steps and tedious operations; we have opted a simple and novel process for the purification of Letrozole intermediate (3), which is free from its regioisomer (4) and other related impurities.
Purification of intermediate (3) to remove its regioisomer (4) using crystallization method to achieve desired level of purity is unsuccessful. We have planned to go for extraction of intermediate (3) selectively from the mixture with regioisomer (4) in aqueous layer using a suitable solvent.
LETROZOLE
In order to obtain the pure Letrozole (6), we have planned to get intermediate (3) in its pure form and free from its regioisomer (4). For the said purpose, we have used solvent extraction method using suitable solvent system and selectively extract the desired intermediate 4-[(l,2,4-triazol-l-yl)methyl]benzonitrile (3), from a mixture with regioisomer 4-[(l,3,4-triazol-l-yl)methyl]benzonitrile (4). The control of the regioisomer at intermediate level leads its control at the final stage. Therefore, in an embodiment, the present invention relates to Letrozole (6) with its regioisomer 4-[l-(4-cyanophenyl)-l-(l,3,4-triazol-l-yl)methyl]benzonitrile (7), preferably, less than 0.3%w/w, more preferably, less than 0.1%w/w and most preferably, below the quantitation limit.
In another feature, the present invention provides an improved process for the preparation of Letrozole with its regioisomer 4-[l-(4-cyanophenyl)-l-(l,3,4-triazol-l- yl)methyl]benzonitrile (7), preferably, less than 0.3%w/w, more preferably, less tjian 0.1%w/w and most preferably, below the quantitation limit.
In another feature, the present invention provides 4-[(l,2,4-triazol-l- yl)methyl]benzonitrile (3) with its regioisomer 4-[(l,3,4-triazol-l- yl)methyl]benzonitrile (4), preferably, less than 0.3%w/w, more preferably, less than 0.1%w/w and most preferably, below the quantitation limit.
SCHEME – 4
(5)
In yet another feature, the present invention provides an improved process for the preparation of 4-[(l,2,4-triazol-l-yl)methyl]benzonitrile (3) with its regioisomer A- [(l,3,4-triazol-l-yl)methyl]benzonitrile (4), preferably, less than 0.3%w/w, more preferably, less than 0.1%w/w and most preferably, below the quantitation limit.
In order to obtain Letrozole (6) in purer form and free from its regioisomer (7) and other related impurities; intermediate 4-[(l,2,4-triazol-l-yl)methyl]benzonitrile (3) is to be prepared in its pure form, free from its regioisomer 4-[(l,3,4-triazol-l- yl)methyl]benzonitrile (4) and other related impurities. Thus, the main aspect of the present invention relates to the preparation of Letrozole (6) with its regioisomer (7) preferably less than 0.3%, more preferably less than 0.1% and most preferably below quantitation limit. For this purpose intermediate 4-[(l,2,4-triazol-l- yl)methyl]benzonitrile (3) is required to be of the same purity level. Another aspect of the present invention relates to the preparation of 4-[(l,2,4-triazol-l- yl)methyl]benzonitrile (3) with its regioisomer 4-[(l,3,4-triazol-l- yl)methyl]benzonitrile (4) preferably less than 0.3%, more preferably less than 0.1% and most preferably below quantitation limit.
It has been also found that during the preparation of Letrozole intermediate A- [(l,2,4-triazol-l-yl)methyl]benzonitrile (3) another impurity is formed, which is characterized as the quaternary salt (10). To control the formation of this quaternary salt, mole ratio of 1,2,4-triazole is optimized preferably from 1.5 mole to 4.4 mole equivalents and more preferably to 3.0 mole equivalents with respect to A- bromomethylbenzonitrile (1). Thus, another aspect of the present invention relates to the preparation of Letrozole (6) with quaternary salt (10) preferably less than 0.1% and more preferably below quantitation limit. Another important aspect of the present invention relates to the preparation of 4-
[(l,2,4-triazol-l-yl)methyl]benzonitrile (3) in the pure form, free from its regioisomer 4-[(l,3,4-triazol-l-yl)methyl]benzonitrile (4). The purification of 4-[(l,2,4-triazol-l- yl)methyl]-benzonilrilc (3) takes place by its selective extraction from a mixture with its regioisomer 4-[(l,3,4-triazol-l-yl)methyl]benzonitrile (4) by using suitable solvents and/or mixture of solvents.
According to another aspect of the present invention Letrozole intermediate A- [(l,2,4-triazol-l-yl)methyl]benzonitrile (3) is prepared with its regioisomer 4-[(l,3,4- triazol-l-yl)methyl]benzonitrile (4) less than 30% and followed by the preparation of Letrozole enriched with its regioisomer (7), which is removed by using crystallisation method using suitable solvent system.
Example – 3
4-[(l,2,4-triazol-l-yl)methyl]benzonitrile (S) with a mixture of 4-[(l,3,4-triazol-l- yl)methyl]benzonitrile (4) To a 250 mL three neck R. B. Flask fitted with a reflux condenser and a thermometer pocket, isopropanol (37.5 mL), p-cyanobenzylbromide (25 g), 1,2,4- triazole (26.4 g) and potassium carbonate (52.8 g) were charged to the reaction mixture at RT with stirring. The reaction mixture was heated to 60-65 0C for 1.0 hr. The progress of reaction was monitored over TLC for the absence of p- cyanobenzylbromide. After completion, the reaction mixture was cooled down to RT and water (100 mL) was added to the reaction mixture and reaction mass was transferred to a one lit R. B. Flask containing water (275 mL). Cone. HCl (50 mL) was added very slowly to the reaction mass to adjust pH 7 – 8. The reaction mixture was extracted from dichloromethane (250 mL). Dichloromethane layer was distilled out at 50 0C giving 21.0 gm viscous oily residue. The residue is crystallized from a mixture of IPA: Cyclohexane (1:10) to give 18 g of 4-[(l,2,4-triazol-l-yl)methyl]benzonitrile (3) with a mixture of its regioisomer (4). HPLC Purity ~ 85%; Regioisomer ~ 13%. Example – 4 4-[l-(4-cyanophenyl)-l-(l,2,4-triazol-l-yl)methyl]benzonitrile (6) & 4-[l-(4- cyanophenyl)-l-(l,3,4-triazol-l-yl)methyl]benzonitrile (7)
In a 250 mL three neck flask, equipped with thermometer pocket, mechanical stirrer and a guard tube, THF (50 mL) was charged at room temperature. Potassium tert-butoxide (12.3 gm) is added in small portions in 30 minutes. The solution was cooled to -15 0C and a solution of product from example-3 (10 g) and p- fluorobenzonitrile (8.5 g) in THF (50 mL) is added very slowly to the reaction mixture in 4-5 hrs. Stir the reaction mixture at same temperature for 3 hrs. Progress of the reaction is monitored on TLC. Dichloromethane (200 mL) is added to the reaction mixture followed by the addition of acetic acid (7 g). Reaction mixture is added to another flask containing water (220 mL). pH of the reaction mixture is adjusted to 7-8 by addition of 5% sodium bicarbonate solution (180 mL). Dichloromethane layer is washed with water (200 mL), separated, filtered through hyfiow bed and distilled at a temperature below 50 0C. The residue obtained was crystallized from Isopropanol (20 mL) to get the solid product (4.9 g). HPLC Purity: 89.6%. Regioisomer: 7.41%. Example – 5
Removal of regioisomer (7) from Letrozole (6)
To a 250 mL R. B. Flask crude Letrozole (4.5 g) was charged in methanol (115 mL) and heated to 60 0C to dissolve completely and get clear solution. Methanol (approx. 100 mL) was distilled out and the solution was cooled to 25 – 30 0C, and was stirred for 2 hrs at this temperature. Solid product was filtered and washed with methanol (10 mL x 2) to get solid product, which was dried in vacuum to get 3.5 gm of product.
HPLC Purity: 96.33%, Regioisomer: 3.4%
Using the same purification method, desired purity of Letrozole had been achieved containing acceptable level of regioisomer (7).
Following the above purification from methanol repeatedly, the Letrozole may be prepared with the desired limit of its regioisomer (7).
References
- 003330 Letrozole
- Drugs.com: monograph for letrozole. It is also used for ovarian cancer patients after they have completed chemotherapy.
- Tulandi T, Martin J, Al-Fadhli R, et al. (June 2006). “Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate”. Fertility and Sterility 85 (6): 1761–5. doi:10.1016/j.fertnstert.2006.03.014. PMID 16650422.
- Sinha, Kounteya (18 October 2011). “Finally, expert panel bans fertility drug Letrozole”. The Times of India. Retrieved 14 November 2011.
- “House panel to govt: Punish those guilty of approving Letrozole”. The Times of India. 10 April 2007. Retrieved 9 May 2012.
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- Santen, R. J.; Brodie, H.; Simpson, E. R.; Siiteri, P. K.; Brodie, A. (2009). “History of Aromatase: Saga of an Important Biological Mediator and Therapeutic Target”. Endocrine Reviews 30 (4): 343–375. doi:10.1210/er.2008-0016. PMID 19389994.
- “Gynecomastia and Letrozole”. GYNECOMASTIA-GYNO.COM: …a resource for gynecomastia sufferers... 16 December 2008. Archived from the original on 26 June 2010. Retrieved 26 April 2012.
- Geneviève Patry, Keith Jarvi, Ethan D. Grober, Kirk C. Lo (August 2009). “Use of the aromatase inhibitor letrozole to treat male infertility”. Fertility and Sterility 92 (2): 829.e1–829.e2. doi:10.1016/j.fertnstert.2009.05.014.
- R Eshet, G Maor, T Ben Ari, M Ben Eliezer, G Gat-Yablonski, M Phillip (2004). “The aromatase inhibitor letrozole increases epiphyseal growth plate height and tibial length in peripubertal male mice”. Journal of Endocrinology 182 (1): 165–172. doi:10.1677/joe.0.1820165. PMID 15225141.
- Ping Zhou MD, Bina Shah MD, Kris Prasad PhD, Raphael David MD (2005). “Letrozole Significantly Improves Growth Potential in a Pubertal Boy With Growth Hormone Deficiency”. Journal of the American Academy of Pediatrics 115 (2): 245–248. doi:10.1542/peds.2004-1536. PMID 15653791.
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- 32nd Annual San Antonio Breast Cancer Symposium
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External links
Ario Kicks Off Efficacy Trial of Chronic Idiopathic Cough Drug
XEN-D0501
Xention (Originator)
XEN-D0501, a novel TRPV1 antagonist, is being developed to treat overactive bladder.
in phase 2 Chronic obstructive pulmonary disease (COPD)
Ario Kicks Off Efficacy Trial of Chronic Idiopathic Cough Drug
Ario Pharma Ltd, the biopharmaceutical company developing innovative new treatments for respiratory disease, announced that it has commenced a Phase 2a study of its oral TRPV1 antagonist, XEN-D0501, for the treatment and prevention of cough in patients with chronic idiopathic cough (CIC).http://www.dddmag.com/news/2014/07/ario-kicks-efficacy-trial-chronic-idiopathic-cough-drug?et_cid=4039308&et_rid=523035093&type=cta
How To Apply QbD Principles In Clinical Trials

By Frederic L. “Rick” Sax, M.D., global head for the Center for Integrated Drug Development, Quintiles.
The biopharmaceutical manufacturing industry has used quality by design (QbD) principles for decades. The essence of QbD is designing with the end in mind (in this case, the efficient manufacture of a high-quality drug product). This approach emphasizes that the operative word in QbD is not quality, but design.
read all at
http://www.pharmaceuticalonline.com/doc/how-to-apply-qbd-principles-in-clinical-trials-0001



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Discovery of a new means to erase pain
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DRUG APPROVALS BY DR ANTHONY MELVIN CRASTO
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