Μ Opioid Receptor
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204760Orig1s000
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 204760Orig1s000 OTHER REVIEW(S) MEMORANDUM DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE FOOD AND DRUG ADMINISTRATION CENTER FOR DRUG EVALUATION AND RESEARCH DATE: September 16, 2014 FROM: Julie Beitz, MD SUBJECT: Approval Action TO: NDA 204760 Movantik (naloxegol) tablets AstraZeneca Pharmaceuticals LP Summary Naloxegol is an antagonist of opioid binding at the muͲopioid receptor. When administered at the recommended dose levels, naloxegol functions as a peripherallyͲacting opioid receptor antagonist in tissues such as the gastrointestinal tract, thereby decreasing the constipating effects of opioids. Naloxegol is a PEGylated derivative of naloxone and a new molecular entity. Pegylation confers the following properties: naloxegol has reduced passive permeability across membranes compared to naloxone; naloxegol is a PͲglycoprotein (PͲgp) efflux transporter substrate; and naloxegol is orally bioavailable. The reduced passive permeability and PͲgp efflux transporter properties limit CNS entry of naloxegol compared to naloxone. This memo documents my concurrence with the Division of Gastroenterology and Inborn Errors Product’s recommendation for approval of NDA 204760 for Movantik (naloxegol) tablets for the treatment of opioidͲinduced constipation (OIC) in adult patients with chronic nonͲcancer pain. Discussions regarding product labeling, and postmarketing study requirements and commitments have been satisfactorily completed. There are no inspectional issues that preclude approval. Dosing The recommended dose of Movantik (naloxegol) tablets is 25 mg taken once daily in the morning on an empty stomach. Patients who do not tolerate this dose, may reduce the dose to 12.5 mg once daily. Maintenance laxatives should be discontinued prior to initiation of therapy with Movantik. -
Design and Synthesis of Cyclic Analogs of the Kappa Opioid Receptor Antagonist Arodyn
Design and synthesis of cyclic analogs of the kappa opioid receptor antagonist arodyn By © 2018 Solomon Aguta Gisemba Submitted to the graduate degree program in Medicinal Chemistry and the Graduate Faculty of the University of Kansas in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Chair: Dr. Blake Peterson Co-Chair: Dr. Jane Aldrich Dr. Michael Rafferty Dr. Teruna Siahaan Dr. Thomas Tolbert Date Defended: 18 April 2018 The dissertation committee for Solomon Aguta Gisemba certifies that this is the approved version of the following dissertation: Design and synthesis of cyclic analogs of the kappa opioid receptor antagonist arodyn Chair: Dr. Blake Peterson Co-Chair: Dr. Jane Aldrich Date Approved: 10 June 2018 ii Abstract Opioid receptors are important therapeutic targets for mood disorders and pain. Kappa opioid receptor (KOR) antagonists have recently shown potential for treating drug addiction and 1,2,3 4 8 depression. Arodyn (Ac[Phe ,Arg ,D-Ala ]Dyn A(1-11)-NH2), an acetylated dynorphin A (Dyn A) analog, has demonstrated potent and selective KOR antagonism, but can be rapidly metabolized by proteases. Cyclization of arodyn could enhance metabolic stability and potentially stabilize the bioactive conformation to give potent and selective analogs. Accordingly, novel cyclization strategies utilizing ring closing metathesis (RCM) were pursued. However, side reactions involving olefin isomerization of O-allyl groups limited the scope of the RCM reactions, and their use to explore structure-activity relationships of aromatic residues. Here we developed synthetic methodology in a model dipeptide study to facilitate RCM involving Tyr(All) residues. Optimized conditions that included microwave heating and the use of isomerization suppressants were applied to the synthesis of cyclic arodyn analogs. -
Opioids in Palliative Care: Evidence Update May 2014
Opioids in palliative care Evidence Update May 2014 A summary of selected new evidence relevant to NICE clinical guideline 140 ‘Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults’ (2012) Evidence Update 58 Contents Introduction ................................................................................................................................ 3 Key points .................................................................................................................................. 4 1 Commentary on new evidence .......................................................................................... 5 1.1 Communication .......................................................................................................... 5 1.2 Starting strong opioids – titrating the dose ................................................................ 5 1.3 First-line maintenance treatment ............................................................................... 6 1.4 First-line treatment if oral opioids are not suitable – transdermal patches ................ 6 1.5 First-line treatment if oral opioids are not suitable – subcutaneous delivery ............. 7 1.6 First-line treatment for breakthrough pain in patients who can take oral opioids ...... 7 1.7 Management of constipation ..................................................................................... 8 1.8 Management of nausea .......................................................................................... -
Backing Material Packaging Liner
US009314527B2 (12) United States Patent (10) Patent No.: US 9,314,527 B2 Cottrell et al. (45) Date of Patent: *Apr. 19, 2016 (54) TRANSDERMAL DELIVERY PATCH 9/7061 (2013.01); A61K 9/7084 (2013.01); (71) Applicant: Phosphagenics Limited, Clayton, A61 K3I/355 (2013.01); A61K47/24 Victoria (AU) SE7 8E.O. (72) Inventors: Jeremy Cottrell, Caulfield South (AU); ( .01): ( .01): (2013.01) Giacinto Gaetano, South Melbourne (AU); Mahmoud El-Tamimy, Meadow (58) Field of Classification Search Heights (AU); Nicholas Kennedy, None Boronia (AU); Paul David Gavin, See application file for complete search history. Chadstone (AU) (56) References Cited (73) Assignee: Phosphagenics Limited, Victoria (AU) (*) Notice: Subject to any disclaimer, the term of this U.S. PATENT DOCUMENTS patent is extended or adjusted under 35 2,407,823. A 9, 1946 Fieser U.S.C. 154(b) by 0 days. 2.457,932 A 1/1949 Solmssen et al. This patent is Subject to a terminal dis- (Continued) claimer. (21) Appl. No.: 14/550,514 FOREIGN PATENT DOCUMENTS ppl. No.: 9 (22) Filed: Nov. 21, 2014 A 3.3 5.83 (65) Prior Publication Data (Continued) Related U.S. Application Data Gianello et al. Subchronic Oral Toxicity Study of Mixed Tocopheryl (63) Continuation of application No. 14/086,738, filed on Phosphates in Rates, International Journal of Toxicology, 26:475 Nov. 21, 2013, now abandoned, which is a 490; 2007.* continuation of application No. 13/501,500, filed as (Continued) application No. PCT/AU2011/000358 on Mar. 30, 2011, now Pat. No. 8,652,511. Primary Examiner — Robert A Wax (60) Provisional application No. -
Understanding and Challenging the Drugs: Chemistry and Toxicology
UNDERSTANDING AND CHALLENGING THE DRUGS: CHEMISTRY AND TOXICOLOGY Presenter: • Dr. Jasmine Drake, Graduate Program Director and Assistant Professor, Administration of Justice Department, Barbara Jordan-Mickey Leland School of Public Affairs, Texas Southern University NACDL Training Defending Drug Overdose Homicides in Pennsylvania Penn State Harrisburg, Middletown, PA November 6th, 2019 11:30- 12:45 p.m. Understanding & Challenging the Drugs: Chemistry & Toxicology Dr. Jasmine Drake, Forensic Science Learning Laboratory, Texas Southern University I. Opioid Drug Classifications A. Types of Opioids B. Classic vs. Synthetic C. Toxicology of Opioids 1) How opioids interact with the body 2) Addiction (psychological vs. physiological II. New Classes of Drugs A. Emerging Threats B. Potency III. National Trends in Opioid Overdose Deaths in the U.S. A. Based on State B. Ethnicity C. Drug-Type (prescription vs. fentanyl vs. heroin) IV. Trends of Opioid Overdose Deaths in Philadelphia A. Based on Ethnicity B. Drug Type (prescription vs. fentanyl vs. heroin) V. Legal Considerations to the Opioid Epidemic A. Punitive Measures vs. Rehabilitative Treatment B. Progressive Jurisdictions Nationwide C. New Legal Measures in Philadelphia VI. Toxicology Reports A. What’s in the report? B. Key Aspects of the Tox Report C. Terminology D. Evaluating and Interpreting the data? E. Questions and considerations. VII. Conclusion and Discussion A. Case Specific Examples B. Sample Toxicology Reports The Opioid Epidemic: What labs have to do with it? Ewa King, Ph.D. Associate Director of Health RIDOH State Health Laboratories Analysis. Answers. Action. www.aphl.org Overview • Overdose trends • Opioids and their effects • Analytical testing approaches • Toxicology laboratories Analysis. Answers. Action. -
Measures and CDS for Safer Opioid Prescribing: a Literature Review
Measures and CDS for Safer Opioid Prescribing: A Literature Review Measures and CDS for Safer Opioid Prescribing: A Literature Review Executive Summary The U.S. opioid epidemic continues to pose significant challenges for patients, families, clinicians, and public health policy. Opioids are responsible for an estimated 315,000 deaths (from 1999 to 2016) and have caused 115 deaths per day.1 In 2017, the U.S. Department of Health and Human Services declared the opioid epidemic a public health crisis.2 The total economic burden of opioid abuse in the United States has been estimated to be $78.5 billion per year.3 Although providing care for chronic opioid users is important, equally vital are efforts to prevent so-called opioid-naïve patients (patients with no history of opioid use) from developing regular opioid use, misuse, or abuse. However, much remains unclear regarding what role clinician prescribing habits play and what duration or dose of opioids may safely be prescribed without promoting long-term use.4,5 In 2013, ECRI Institute convened the Partnership for Health IT Patient Safety, and its component, single-topic-focused workgroups followed. For this subject, the Electronic Health Record Association (EHRA): Measures and Clinical Decision Support (CDS) for Safer Opioid Prescribing workgroup included members from the Healthcare Information and Management Systems Society (HIMSS) EHRA and the Partnership team. The project was oriented towards exploring methods to enable a synergistic cycle of performance measurement and identifying electronic health record (EHR)/health information technology (IT)–enabled approaches to support healthcare organizations’ ability to assess and measure opioid prescribing. -
Accurate Prediction of Terahertz Spectra of Molecular Crystals of Fentanyl and Its Analogs Chun‑Hung Wang1, Anthony C
www.nature.com/scientificreports OPEN Accurate prediction of terahertz spectra of molecular crystals of fentanyl and its analogs Chun‑Hung Wang1, Anthony C. Terracciano2,3, Artёm E. Masunov1,4,5*, Mengyu Xu3,6 & Subith S. Vasu2,3 Fentanyl is a potent synthetic opioid pain reliever with a high bioavailability that can be used as prescription anesthetic. Rapid identifcation via non‑contact methods of both known and emerging opioid substances in the fentanyl family help identify the substances and enable rapid medical attention. We apply PBEh‑3c method to identify vibrational normal modes from 0.01 to 3 THz in solid fentanyl and its selected analogs. The molecular structure of each fentanyl analog and unique arrangement of H‑bonds and dispersion interactions signifcantly change crystal packing and is subsequently refected in the THz spectrum. Further, the study of THz spectra of a series of stereoisomers shows that small changes in molecular structure results in distinct crystal packing and signifcantly alters THz spectra as well. We discuss spectral features of synthetic opioids with higher potency than conventional fentanyl such as ohmefentanyl and sufentanil and discover the pattern of THz spectra of fentanyl analogs. Fentanyl (N-phenyl-N-[1-(2-phenylethyl)piperidin-4-yl]propionanilide)1 is one kind of synthetic opioid used for pain relief, which has high afnity for μ-opioid receptor and acts as an agonist with higher potency than 2,3 morphine. Its efective dose (ED 95) is 0.45–0.60 μg/kg, partly due to its 92% bioavailability . A comprehensive review of the history of fentanyl and its analogs has been published in 2018 by Armenian et al.4 Carfentanil5, sufentanil6, alfentanil7, and remifentanil8 are fentanyl analogs with additional functional groups which enable a higher potency than fentanyl itself. -
Therapeutic Class Overview Irritable Bowel Syndrome and Constipation Agents
Therapeutic Class Overview Irritable Bowel Syndrome and Constipation Agents INTRODUCTION Irritable bowel syndrome (IBS) is a gastrointestinal disorder that most commonly manifests as chronic abdominal pain and altered bowel habits in the absence of any organic disorder (Wald 2017). IBS may consist of diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), IBS with a mixed symptomatology (IBS-M), or unclassified IBS (IBS-U). Switching between the subtypes of IBS is also possible (Ford et al 2014). IBS is a functional disorder of the gastrointestinal tract characterized by abdominal pain, discomfort, and bloating, as well as disturbed bowel habit. The exact pathogenesis of the disorder is unknown; however, it is believed that altered gastrointestinal tract motility, visceral hypersensitivity, autonomic dysfunction, and psychological factors indicate disturbances within the enteric nervous system, which controls the gastrointestinal system (Andresen et al 2008, Ford et al 2009). Prevalence estimates of IBS range from 5 to 15%, and it typically occurs in young adulthood (Ford et al 2014). IBS-D is more common in men, and IBS-C is more common in women (World Gastroenterology Organization [WGO], 2015). Symptoms of IBS often interfere with daily life and social functioning (WGO 2015). The general goals of therapy are to alleviate the patient’s symptoms and to target any specific exacerbating factors (eg, medications, dietary changes), concerns about serious illness, stressors, or potential psychiatric comorbidities that may exist (Wald 2015). Non-pharmacological interventions to combat IBS symptoms include dietary modifications such as exclusion of gas- producing foods (eg, beans, prunes, Brussel sprouts, bagels, etc.), trials of gluten avoidance, and consumption of probiotics, as well as psychosocial therapies (eg, hypnosis, biofeedback, etc.) (Ford et al 2014). -
Values of Several Opioid Receptor Agonists and Their Liability to Cause Depen- Dence
Acta Pharmacologica Sinica (2010) 31: 393–398 npg © 2010 CPS and SIMM All rights reserved 1671-4083/10 $32.00 www.nature.com/aps Original Article Paradoxical relationship between RAVE (relative activity versus endocytosis) values of several opioid receptor agonists and their liability to cause depen- dence Yu-hua WANG1, 2, 3, Jian-feng SUN3, Yi-min TAO3, Xue-jun XU3, Zhi-qiang CHI3, Jing-gen LIU3, * 1School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China; 2School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210046, China; 3State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 201203, China Aim: To examine the relationship between the RAVE (relative activity versus endocytosis) values of opiate agonists and their dependence liability by studying several potent analgesics with special profiles in the development of physical and psychological dependence. Methods: The effects of (–)-cis-(3R,4S,2′R) ohmefentanyl (F9202), (+)-cis-(3R,4S,2′S) ohmefentanyl (F9204), dihydroetorphine (DHE) and morphine on [35S]GTPγS binding, forskolin-stimulated cAMP accumulation, and receptor internalization were studied in CHO cells stably expressing HA-tagged μ-opioid receptors (CHO-HA-MOR). cAMP overshoot in response to the withdrawal of these compound treatments was also tested. Results: All four agonists exhibited the same rank order of activity in stimulation of [35S]GTPγS binding, inhibition of adenylyl cyclase (AC) and induction of receptor internalization: DHE>F9204>F9202>morphine. Based on these findings and the previous in vivo analgesic data obtained from our and other laboratories, the RAVE values of the four agonists were calculated. -
208854Orig1s000
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 208854Orig1s000 SUMMARY REVIEW OND=Office of New Drugs OPQ=Office of Pharmaceutical Quality OPDP=Office of Prescription Drug Promotion OSI=Office of Scientific Investigations CDTL=Cross-Discipline Team Leader COA=Clinical Outcome Assessment CSS=Controlled Substance Staff DAAAP= Division of Anesthesia, Analgesia, and Addiction Products OSE= Office of Surveillance and Epidemiology DEPI= Division of Epidemiology DMEPA=Division of Medication Error Prevention and Analysis DPMH = Division of Pediatric and Maternal Health MHT=Maternal Health Team Quality Review Team DISCIPLINE REVIEWER BRANCH/DIVISION Drug Substance Joseph Leginus CDER/OPQ/ONDP/ DNDAPI/NDBII Drug Product Sarah Ibrahim CDER/OPQ/ONDP/ DNDPII/NDPBV Process Zhao Wang CDER/OPQ/OPF/ DPAI/PABI Microbiology Zhao Wang CDER/OPQ/OPF/ DPAI/PABI Facility Donald Lech CDER/OPQ/OPF/DIA/IABIII Biopharmaceutics Peng Duan CDER/OPQ/ONDP/ DB/BBII Regulatory Business Cheronda Cherry-France CDER/OND/ODEIII/ DGIEP Process Manager Application Technical Lead Hitesh Shroff CDER/OPQ/ONDP/ DNDPII/NDPBV Laboratory (OTR) N/A N/A ORA Lead Paul Perdue Jr. ORA/OO/OMPTO/ DMPTPO/MDTP Environmental Analysis James Laurenson CDER/OPQ/ONDP (EA) 2 Reference ID: 4073992 1. Benefit-Risk Assessment I concur with the reviewers’ conclusions that the benefit/risk of naldemedine is favorable in the population for which this product will be approved and that the risks can be managed with labeling. The applicant proposed the following indication for naldemedine, an orally administered peripheral mu opioid receptor antagonist: Symproic is indicated for the treatment of opioid-induced constipation (OIC) in adult patients with chronic non-cancer pain. -
(12) Patent Application Publication (10) Pub. No.: US 2011/0245287 A1 Holaday Et Al
US 20110245287A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2011/0245287 A1 Holaday et al. (43) Pub. Date: Oct. 6, 2011 (54) HYBRD OPOD COMPOUNDS AND Publication Classification COMPOSITIONS (51) Int. Cl. A6II 3/4748 (2006.01) C07D 489/02 (2006.01) (76) Inventors: John W. Holaday, Bethesda, MD A6IP 25/04 (2006.01) (US); Philip Magistro, Randolph, (52) U.S. Cl. ........................................... 514/282:546/45 NJ (US) (57) ABSTRACT Disclosed are hybrid opioid compounds, mixed opioid salts, (21) Appl. No.: 13/024,298 compositions comprising the hybrid opioid compounds and mixed opioid salts, and methods of use thereof. More particu larly, in one aspect the hybrid opioid compound includes at (22) Filed: Feb. 9, 2011 least two opioid compounds that are covalently bonded to a linker moiety. In another aspect, the hybrid opioid compound relates to mixed opioid salts comprising at least two different Related U.S. Application Data opioid compounds or an opioid compound and a different active agent. Also disclosed are pharmaceutical composi (60) Provisional application No. 61/302,657, filed on Feb. tions, as well as to methods of treating pain in humans using 9, 2010. the hybrid compounds and mixed opioid salts. Patent Application Publication Oct. 6, 2011 Sheet 1 of 3 US 2011/0245287 A1 Oral antinociception of morphine, oxycodone and prodrug combinations in CD1 mice s Tigkg -- Morphine (2.80 mg/kg (1.95 - 4.02, 30' peak time -- (Oxycodone (1.93 mg/kg (1.33 - 2,65)) 30 peak time -- Oxy. Mor (1:1) (4.84 mg/kg (3.60 - 8.50) 60 peak tire --MLN 2-3 peak, effect at a hors 24% with closes at 2.5 art to rigg - D - MLN 2-45 (6.60 mg/kg (5.12 - 8.51)} 60 peak time Figure 1. -
WO 2012/109445 Al 16 August 2012 (16.08.2012) P O P C T
(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2012/109445 Al 16 August 2012 (16.08.2012) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/485 (2006.01) A61P 25/04 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BR, BW, BY, BZ, (21) International Application Number: CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, DO, PCT/US20 12/024482 DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, HN, (22) International Filing Date: HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, KR, ' February 2012 (09.02.2012) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SC, SD, (26) Publication Language: English SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (30) Priority Data: 13/024,298 9 February 201 1 (09.02.201 1) US (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, (71) Applicant (for all designated States except US): QRX- GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, PHARMA LTD.