FDA APPROVED, 2020/8/6, LAMPIT
|melting point (°C)||177-183||https://www.chemicalbook.com/ChemicalProductProperty_US_CB3903922.aspx|
- ClassAntiprotozoals; Nitrofurans; Small molecules; Thiamorpholines; Thiazines
- Mechanism of ActionDNA damage modulators
- RegisteredChagas disease
- 07 Aug 2020Registered for Chagas disease (In adolescents, In children, In infants) in USA (PO)
- 31 Jan 2020Preregistration for Chagas disease (In infants, In children, In adolescents) in USA (PO)
- 29 Jan 2020Bayer completes a phase I trial in Chagas disease in Argentina (PO) (NCT03334838)
Nifurtimox, sold under the brand name Lampit, is a medication used to treat Chagas disease and sleeping sickness. For sleeping sickness it is used together with eflornithine in nifurtimox-eflornithine combination treatment. In Chagas disease it is a second-line option to benznidazole. It is given by mouth.
Common side effects include abdominal pain, headache, nausea, and weight loss. There are concerns from animal studies that it may increase the risk of cancer but these concerns have not be found in human trials. Nifurtimox is not recommended in pregnancy or in those with significant kidney or liver problems. It is a type of nitrofuran.
Nifurtimox came into medication use in 1965. It is on the World Health Organization’s List of Essential Medicines. It is not available commercially in Canada. It was approved for medical use in the United States in August 2020. In regions of the world where the disease is common nifurtimox is provided for free by the World Health Organization (WHO).
Chagas disease, caused by a parasite known as Trypanosoma cruzi (T.cruzi), is a vector-transmitted disease affecting animals and humans in the Americas. It is commonly known as American Trypanosomiasis.11
The CDC estimates that approximately 8 million people in Central America, South America, and Mexico are infected with T. cruzi, without symptoms. If Chagas disease is left untreated, life-threatening sequelae may result.11
Nifurtimox, developed by Bayer, is a nitrofuran antiprotozoal drug used in the treatment of Chagas disease. On August 6 2020, accelerated FDA approval was granted for its use in pediatric patients in response to promising results from phase III clinical trials. Continued approval will be contingent upon confirmatory data.10 A convenient feature of Bayer’s formulation is the ability to divide the scored tablets manually without the need for pill-cutting devices.10
Nifurtimox has been used to treat Chagas disease, when it is given for 30 to 60 days. However, long-term use of nifurtimox does increase chances of adverse events like gastrointestinal and neurological side effects. Due to the low tolerance and completion rate of nifurtimox, benznidazole is now being more considered for those who have Chagas disease and require long-term treatment.
In the United States nifurtimox is indicated in children and adolescents (birth to less than 18 years of age and weighing at least 2.5 kilograms (5.5 lb) for the treatment of Chagas disease (American Trypanosomiasis), caused by Trypanosoma cruzi.
Nifurtimox has also been used to treat African trypanosomiasis (sleeping sickness), and is active in the second stage of the disease (central nervous system involvement). When nifurtimox is given on its own, about half of all patients will relapse, but the combination of melarsoprol with nifurtimox appears to be efficacious. Trials are awaited comparing melarsoprol/nifurtimox against melarsoprol alone for African sleeping sickness.
Combination therapy with eflornithine and nifurtimox is safer and easier than treatment with eflornithine alone, and appears to be equally or more effective. It has been recommended as first-line treatment for second-stage African trypanosomiasis.
Pregnancy and breastfeeding
Use of nifurtimox should be avoided in pregnant women due to limited use. There is limited data shown that nifurtimox doses up to 15 mg/kg daily can cause adverse effects in breastfed infants. Other authors do not consider breastfeeding a contraindication during nifurtimox use.
Side effects occur following chronic administration, particularly in elderly people. Major toxicities include immediate hypersensitivity such as anaphylaxis and delayed hypersensitivity reaction involving icterus and dermatitis. Central nervous system disturbances and peripheral neuropathy may also occur.
Mechanism of action
Nifurtimox forms a nitro-anion radical metabolite that reacts with nucleic acids of the parasite causing significant breakdown of DNA. Its mechanism is similar to that proposed for the antibacterial action of metronidazole. Nifurtimox undergoes reduction and creates oxygen radicals such as superoxide. These radicals are toxic to T. cruzi. Mammalian cells are protected by presence of catalase, glutathione, peroxidases, and superoxide dismutase. Accumulation of hydrogen peroxide to cytotoxic levels results in parasite death.
Manufacturing and availability
Nifurtimox is sold under the brand name Lampit by Bayer. It was previously known as Bayer 2502.
Nifurtimox, 1,1-dioxide 4-[(5-nitrofuryliden)amino]-3-methylthiomorpholine (37.4.7), is made by the following scheme. Interaction of 2-mercaptoethanol with propylene oxide in the presence of potassium hydroxide gives (2-hydroxyethyl)-(2-hydroxypropylsul-fide) (37.4.3), which undergoes intramolecular dehydration using potassium bisulfate to make 2-methyl-1,4-oxithiane (37.4.4). Oxidation of this using hydrogen peroxide gives 2-methyl-1,4-oxithian-4,4-dioxide (37.4.5), which when reacted with hydrazine transforms to 4-amino-3-methyltetrahydro-1,4-thiazin-1,1-dioxide (37.4.6). Reacting this with 5-nitrofurfurol gives the corresponding hydrazone—the desired nifurtimox [58,59].
58. H. Herlinger, K.H. Heinz, S. Petersen, M.Bock, Ger. Pat. 1.170.957 (1964).
59. H. Herlinger, K.H. Heinz, S. Petersen, M. Bock, U.S. Pat. 3.262.930 (1966)
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- World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- Bern, Caryn; Montgomery, Susan P.; Herwaldt, Barbara L.; Rassi, Anis; Marin-Neto, Jose Antonio; Dantas, Roberto O.; Maguire, James H.; Acquatella, Harry; Morillo, Carlos (2007-11-14). “Evaluation and Treatment of Chagas Disease in the United States”. JAMA. 298 (18): 2171–81. doi:10.1001/jama.298.18.2171. ISSN 0098-7484. PMID 18000201.
- “Trypanosomiasis, human African (sleeping sickness)”. World Health Organization. February 2016. Archived from the original on 4 December 2016. Retrieved 7 December2016.
- Coura JR, de Castro SL (2002). “A critical review of Chagas disease chemotherapy”. Mem Inst Oswaldo Cruz. 97 (1): 3–24. doi:10.1590/S0074-02762002000100001. PMID 11992141.
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- Bisser S, N’Siesi FX, Lejon V, et al. (2007). “Equivalence Trial of Melarsoprol and Nifurtimox Monotherapy and Combination Therapy for the Treatment of Second-Stage Trypanosoma brucei gambiense Sleeping Sickness”. J Infect Dis. 195 (3): 322–329. doi:10.1086/510534. PMID 17205469.
- Pepin J (2007). “Combination Therapy for Sleeping Sickness: A Wake-Up Call”. J Infect Dis. 195 (3): 311–13. doi:10.1086/510540. PMID 17205466.
- Priotto G, Kasparian S, Mutombo W, et al. (July 2009). “Nifurtimox-eflornithine combination therapy for second-stage African Trypanosoma brucei gambiensetrypanosomiasis: a multicentre, randomised, phase III, non-inferiority trial”. Lancet. 374(9683): 56–64. doi:10.1016/S0140-6736(09)61117-X. hdl:10144/72797. PMID 19559476.
- Schaefer, Christof; Peters, Paul W. J.; Miller, Richard K. (2014-09-17). Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment. Academic Press. ISBN 9780124079014. Archived from the original on 2017-09-08.
- “Nifurtimox use while Breastfeeding | Drugs.com”. http://www.drugs.com. Archived from the original on 2016-11-08. Retrieved 2016-11-07.
- “Parasites – American Trypanosomiasis (also known as Chagas Disease)”. U.S. Centers for Disease Control and Prevention (CDC). Archived from the original on 2016-11-06. Retrieved 2016-11-09.
- Forsyth, Colin J.; Hernandez, Salvador; Olmedo, Wilman; Abuhamidah, Adieb; Traina, Mahmoud I.; Sanchez, Daniel R.; Soverow, Jonathan; Meymandi, Sheba K. (2016-10-15). “Safety Profile of Nifurtimox for Treatment of Chagas Disease in the United States”. Clinical Infectious Diseases. 63 (8): 1056–1062. doi:10.1093/cid/ciw477. ISSN 1537-6591. PMC 5036918. PMID 27432838.
- Castro, José A.; de Mecca, Maria Montalto; Bartel, Laura C. (2006-08-01). “Toxic side effects of drugs used to treat Chagas’ disease (American trypanosomiasis)”. Human & Experimental Toxicology. 25 (8): 471–479. doi:10.1191/0960327106het653oa. ISSN 0960-3271. PMID 16937919.
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- “Chagas disease”. World Health Organization. Archived from the original on 2014-02-27. Retrieved 2016-11-08.
- Clinical trial number NCT00601003 for “Study of Nifurtimox to Treat Refractory or Relapsed Neuroblastoma or Medulloblastoma” at ClinicalTrials.gov. Retrieved on July 10, 2009.
- “Nifurtimox”. Drug Information Portal. U.S. National Library of Medicine.
|Other names||Bayer 2502|
|Metabolism||Liver (Cytochrome P450 oxidase (CYP) involved)|
|Elimination half-life||2.95 ± 1.19 hours|
|Excretion||Kidney, very low|
|CompTox Dashboard (EPA)|
|Chemical and physical data|
|Molar mass||287.29 g·mol−1|
|3D model (JSmol)|
|Melting point||180 to 182 °C (356 to 360 °F)|
///////////Nifurtimox, LAMPIT, 2020 APPROVALS, FDA 2020, ニフルチモックス, CHAGAS DISEASE, ANTI PROTOZOAL