Darunavir

Source: Wikipedia, the free encyclopedia.

Darunavir
Clinical data
Trade namesPrezista, others[1]
Other namesTMC114, DRV, darunavir ethanolate
AHFS/Drugs.comMonograph
MedlinePlusa607042
License data
Pregnancy
category
Routes of
administration
By mouth
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)[3]
  • CA: ℞-only
  • UK: POM (Prescription only)
  • US: ℞-only
  • EU: Rx-only
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability37% (without ritonavir), 82% (with ritonavir)
Protein binding95%
MetabolismLiver (CYP3A4)
Elimination half-life15 hours (with ritonavir)
ExcretionFeces (80%), urine (14%)
Identifiers
  • [(1R,5S,6R)-2,8-dioxabicyclo[3.3.0]oct-6-yl] N-[(2S,3R)-4- [(4-aminophenyl)sulfonyl- (2-methylpropyl)amino]-3-hydroxy-1-phenyl- butan-2-yl] carbamate
JSmol)
  • O=S(=O)(c1ccc(N)cc1)N(CC(C)C)C[C@@H](O)[C@@H](NC(=O)O[C@H]2CO[C@H]3OCC[C@@H]23)Cc4ccccc4
  • InChI=1S/C27H37N3O7S/c1-18(2)15-30(38(33,34)21-10-8-20(28)9-11-21)16-24(31)23(14-19-6-4-3-5-7-19)29-27(32)37-25-17-36-26-22(25)12-13-35-26/h3-11,18,22-26,31H,12-17,28H2,1-2H3,(H,29,32)/t22-,23-,24+,25-,26+/m0/s1 checkY
  • Key:CJBJHOAVZSMMDJ-HEXNFIEUSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Darunavir (DRV), sold under the brand name Prezista among others, is an

antiretroviral medication used to treat and prevent HIV/AIDS.[1] It is generally recommended for use with other antiretrovirals.[1][4] It is often used with low doses of ritonavir or cobicistat to increase darunavir levels.[1] It may be used for prevention after a needlestick injury or other potential exposure.[1] It is taken by mouth once to twice a day.[1]

Common side effects include

Developed by pharmaceutical company

The

fixed-dose combination medication darunavir/cobicistat (Prezcobix, Rezolsta) is available as a single pill.[9]

Medical uses

Darunavir is an

antiretrovirals, darunavir does not cure HIV/AIDS.[14]

It is indicated for the treatment of human immunodeficiency virus (HIV-1) infection in adults and children three years of age and older when co-administered with ritonavir, in combination with other antiretroviral agents.[4][15]

Adverse effects

Darunavir is generally well tolerated by people. Rash is the most common side effect (7% of patients).[14] Other common side effects are diarrhea (2.3%), headache (3.8%), abdominal pain (2.3%), constipation (2.3%), and vomiting (1.5%).[14] Darunavir can also cause allergic reactions, and people allergic to ritonavir can also have a reaction to darunavir.[14]

diabetes or worsening of diabetes, muscle pain, tenderness or weakness, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines like darunavir.[14] Changes in body fat have been seen in some patients taking medicines for HIV, including loss of fat from legs, arms and face, increased fat in the abdomen and other internal organs, breast enlargement, and fatty lumps on the back of the neck. The cause and long-term health effects of these conditions are not known.[14]

Drug interactions

Darunavir may interact with medications commonly taken by people with

St. John's wort may reduce the effectiveness of darunavir by increasing the breakdown of darunavir by the metabolic enzyme CYP3A.[14]

Mechanism of action

Darunavir is a nonpeptidic inhibitor of protease (PR) that lodges itself in the active site of PR through a number of hydrogen bonds.[16] It was developed to increase interactions with HIV-1 protease and to be more resistant against HIV-1 protease mutations. With a Kd (dissociation constant) of 4.5 x 10−12 M, darunavir has a much stronger interaction with PR and its dissociation constant is 1/100 to 1/1000 of other protease inhibitors.[17] This strong interaction comes from increased hydrogen bonds between darunavir and the backbone of the PR active site (Figure 2). Darunavir's structure allows it to create more hydrogen bonds with the PR active site than most PIs that have been developed and approved by the FDA.[18] Furthermore, the backbone of HIV-1 protease maintains its spatial conformation in the presence of mutations.[19] Because darunavir interacts with this stable portion of the protease, the PR-PI interaction is less likely to be disrupted by a mutation.[18]

Figure 3. Ribbon structure of PR with darunavir in active site: Structures colored as in Fig. 1. with certain residues partaking in hydrogen bonding further highlighted. The catalytic aspartates, 25 and 25’, are in orange and the other interacting residues in green. Right image is a magnified view of the image on the left (PDB 4qdb).

Catalytic site

The chemical activity of the HIV-1 protease depends on two residues in the active site, Asp25 and Asp25’, one from each copy of the homodimer.[20] Darunavir interacts with these catalytic aspartates and the backbone of the active site through hydrogen bonds, specifically binding to residues Asp25, Asp25’, Asp 29, Asp 30, Asp 30’, and Gly 27 (Figure 3). This interaction prevents viral replication, as it competitively inhibits the viral polypeptides from gaining access to the active site and strongly binds to the enzymatic portions of this protein.[16]

Cost

In the US and UK, healthcare costs were estimated to be lower with boosted darunavir than with investigator-selected control protease inhibitors in treatment-experienced patients.[21]

History

Figure 2. Hydrogen bonds between darunavir and HIV-1 protease: The bonds with the red residues indicate hydrogen bonds that are also present between the PI saquinavir and HIV-1 protease. The hydrogen bonds with the blue residue are unique to darunavir.

Darunavir was approved for use in the United States in June 2006 and for use in the European Union in February 2007.[22][23][24][25][15][excessive citations]

The development of first-generation clinical inhibitors was founded on creating more protease-ligand interactions through hydrogen bonding and hydrophobic interactions.[16] The first HIV protease inhibitor approved by the FDA was saquinavir, which was designed to target wild-type HIV-1 protease.[26] However, this inhibitor is no longer effective due to resistance-causing mutations on the HIV-1 protease structure. The HIV genome has high plasticity, so has been able to become resistant to multiple HIV-1 protease inhibitors.[27] Since saquinavir, the FDA has approved several PIs, including darunavir.[24]

References

  1. ^ a b c d e f g h i "Darunavir". The American Society of Health-System Pharmacists. Archived from the original on 10 November 2016. Retrieved 28 November 2016.
  2. ^ a b "Darunavir (Prezista) Use During Pregnancy". Drugs.com. 23 October 2018. Retrieved 21 April 2020.
  3. ^ "Prescription medicines: registration of new generic medicines and biosimilar medicines, 2017". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 30 March 2024.
  4. ^ a b c "Prezista- darunavir tablet, film coated Prezista- darunavir suspension". DailyMed. 6 June 2019. Retrieved 21 April 2020.
  5. ^ "HIV/AIDS Research". Purdue Chemistry: The Ghosh Laboratory. Retrieved 24 June 2021.
  6. S2CID 31175809
    .
  7. . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  8. ^ "2022 First Generic Drug Approvals". U.S. Food and Drug Administration (FDA). 3 March 2023. Archived from the original on 30 June 2023. Retrieved 30 June 2023.
  9. ^ "Darunavir / Cobicistat". AIDSinfo. U.S. Department of Health and Human Services. Archived from the original on 3 March 2020. Retrieved 29 June 2018.
  10. ^ Panel on Antiretroviral Guidelines for Adults and Adolescents (18 December 2019). "Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV" (PDF). Department of Health and Human Services. Archived from the original (PDF) on 13 August 2020. Retrieved 21 April 2020.
  11. ^ "What's New in the Guidelines? Adult and Adolescent ARV". AIDSinfo. 26 June 2018. Archived from the original on 14 September 2020. Retrieved 22 April 2023.
  12. ^ hivandhepatitis.com Archived 13 July 2007 at the Wayback Machine, Efficacy and Safety of Boosted Darunavir (Prezista) Are Superior to Lopinavir/ritonavir (Kaletra) at 96 Weeks: ARTEMIS Trial, 2008-10-28, URL Archived 19 July 2009 at the Wayback Machine.
  13. ^ hivandhepatitis.com Archived 13 July 2007 at the Wayback Machine, Darunavir (Prezista) Receives Full Traditional Approval, Dose Set for Treatment-naive Patients, Caution Urged for Pregnant Women, 2008-10-24, URL Archived 19 May 2009 at the Wayback Machine.
  14. ^ a b c d e f g h "Drug Monograph, Prezista". Archived from the original on 11 November 2016.
  15. ^ a b "Prezista EPAR". European Medicines Agency (EMA). 17 September 2018. Retrieved 21 April 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  16. ^
    PMID 22587384
    .
  17. .
  18. ^ .
  19. .
  20. .
  21. .
  22. .
  23. ^ "FDA Approves New HIV Treatment for Patients Who Do Not Respond to Existing Drugs". U.S. Food and Drug Administration (FDA) (Press release). Archived from the original on 13 November 2016. Retrieved 10 November 2016.
  24. ^ a b "HIV/AIDS Historical Time Line 2000 - 2010". U.S. Food and Drug Administration. 5 January 2018. Archived from the original on 1 July 2019. Retrieved 21 April 2020.
  25. ^ "Drug Approval Package: Prezista (Darumavir) NDA #021976". U.S. Food and Drug Administration (FDA). 6 September 2006. Retrieved 21 April 2020.
  26. PMID 18597780
    .
  27. .

Further reading