Nifurtimox

Source: Wikipedia, the free encyclopedia.
Nifurtimox
Clinical data
Trade namesLampit[1]
Other namesBayer 2502[2]
AHFS/Drugs.comDrugs.com archive
Lampit
License data
QP51AC01 (WHO)
Legal status
Legal status
Cytochrome P450 oxidase (CYP) involved)
Elimination half-life2.95 ± 1.19 hours
ExcretionKidney, very low
Identifiers
  • N-(3-Methyl-1,1-dioxido-4-thiomorpholinyl)-1-(5-nitro-2-furyl)methanimine
JSmol)
ChiralityRacemic mixture
Melting point180 to 182 °C (356 to 360 °F)
  • CC1CS(=O)(=O)CCN1N=CC2=CC=C(O2)[N+](=O)[O-]
  • InChI=1S/C10H13N3O5S/c1-8-7-19(16,17)5-4-12(8)11-6-9-2-3-10(18-9)13(14)15/h2-3,6,8H,4-5,7H2,1H3 checkY
  • Key:ARFHIAQFJWUCFH-UHFFFAOYSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Nifurtimox, sold under the brand name Lampit, is a medication used to treat

nifurtimox-eflornithine combination treatment.[4] In Chagas disease it is a second-line option to benznidazole.[5] It is given by mouth.[2]

Common side effects include abdominal pain, headache, nausea, and weight loss.

liver problems.[5] It is a type of nitrofuran.[5]

Nifurtimox came into medication use in 1965.[5] It is on the World Health Organization's List of Essential Medicines.[4] It is not available commercially in Canada.[2] It was approved for medical use in the United States in August 2020.[3] In regions of the world where the disease is common nifurtimox is provided for free by the World Health Organization (WHO).[6]

Medical uses

Nifurtimox has been used to treat Chagas disease, when it is given for 30 to 60 days.[7][8] However, long-term use of nifurtimox does increase chances of adverse events like gastrointestinal and neurological side effects.[8][9] 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.[5][9]

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.[1]

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,[10] but the combination of melarsoprol with nifurtimox appears to be efficacious.[11] Trials are awaited comparing melarsoprol/nifurtimox against melarsoprol alone for African sleeping sickness.[12]

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.[13]

Pregnancy and breastfeeding

Use of nifurtimox should be avoided in pregnant women due to limited use.[5][8][14] There is limited data shown that nifurtimox doses up to 15 mg/kg daily can cause adverse effects in breastfed infants.[15] Other authors do not consider breastfeeding a contraindication during nifurtimox use.[15]

Side effects

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.[8]

Most common side effects[16][8][17][18][19]

  • anorexia
  • weight loss
  • nausea
  • vomiting
  • headache
  • dizziness
  • amnesia

Less common effects[16][8][17][19]

  • rash
  • depression
  • anxiety
  • confusion
  • fever
  • sore throat
  • chills
  • seizures
  • impotence
  • tremors
  • muscle weakness
  • numbness of hands or feet

Contraindications

Nifurtimox is contraindicated in people with severe liver or kidney disease, as well as people with a background of neurological or psychiatric disorders.[5][16][20]

Mechanism of action

Nifurtimox forms a nitro-anion radical metabolite that reacts with nucleic acids of the parasite causing significant breakdown of DNA.[8] 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.[8]

Society and culture

A bottle of nifurtimox

Legal status

Nifurtimox is only licensed for use in Argentina, the United States, and Germany.[citation needed] It was approved for medical use in the United States in August 2020.[3]

Names

Research

Nifurtimox is in a phase-II clinical trial for the treatment of pediatric neuroblastoma and medulloblastoma.[21]

References

  1. ^ a b c "Lampit- nifurtimox tablet, film coated". DailyMed. 27 January 2022. Retrieved 23 February 2023.
  2. ^ a b c d e "Nifurtimox (Systemic)". Drugs.com. 1995. Archived from the original on 20 December 2016. Retrieved 3 December 2016.
  3. ^ a b c "Lampit: FDA-Approved Drugs". U.S. Food and Drug Administration (FDA). Retrieved 6 August 2020.
  4. ^
    hdl:10665/325771
    . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  5. ^
    PMID 18000201
    .
  6. ^ "Trypanosomiasis, human African (sleeping sickness)". World Health Organization. February 2016. Archived from the original on 4 December 2016. Retrieved 7 December 2016.
  7. PMID 11992141
    .
  8. ^ a b c d e f g h "Nifurtimox Drug Information, Professional". www.drugs.com. Archived from the original on 2016-11-08. Retrieved 2016-11-09.
  9. ^
    PMID 20932171
    .
  10. PMID 2694491
    .
  11. PMID 17205469
    .
  12. PMID 17205466
    .
  13. S2CID 32757305
    .
  14. ISBN 9780124079014. Archived
    from the original on 2017-09-08.
  15. ^ a b "Nifurtimox use while Breastfeeding". Drugs.com. Archived from the original on 2016-11-08. Retrieved 2016-11-07.
  16. ^ a b c "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.
  17. ^
    PMID 27432838
    .
  18. S2CID 8980212
    .
  19. ^
    PMID 10677756
    .
  20. ^ "Chagas disease". World Health Organization. Archived from the original on 2014-02-27. Retrieved 2016-11-08.
  21. ^ Clinical trial number NCT00601003 for "Study of Nifurtimox to Treat Refractory or Relapsed Neuroblastoma or Medulloblastoma" at ClinicalTrials.gov. Retrieved on July 10, 2009.

External links

  • "Nifurtimox". Drug Information Portal. U.S. National Library of Medicine.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Nifurtimox&oldid=1196124408"