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Chemistry

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Also known as: 9-cis-retinoic acid, Panretin, 5300-03-8, 9-cis-tretinoin, 9-cis retinoic acid, Panrexin
Molecular Formula
C20H28O2
Molecular Weight
300.4  g/mol
InChI Key
SHGAZHPCJJPHSC-ZVCIMWCZSA-N
FDA UNII
1UA8E65KDZ

Alitretinoin
A retinoid that is used for the treatment of chronic hand ECZEMA unresponsive to topical CORTICOSTEROIDS. It is also used to treat cutaneous lesions associated with AIDS-related KAPOSI SARCOMA.
Alitretinoin is a Retinoid.
1 2D Structure

Alitretinoin

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
(2E,4E,6Z,8E)-3,7-dimethyl-9-(2,6,6-trimethylcyclohexen-1-yl)nona-2,4,6,8-tetraenoic acid
2.1.2 InChI
InChI=1S/C20H28O2/c1-15(8-6-9-16(2)14-19(21)22)11-12-18-17(3)10-7-13-20(18,4)5/h6,8-9,11-12,14H,7,10,13H2,1-5H3,(H,21,22)/b9-6+,12-11+,15-8-,16-14+
2.1.3 InChI Key
SHGAZHPCJJPHSC-ZVCIMWCZSA-N
2.1.4 Canonical SMILES
CC1=C(C(CCC1)(C)C)C=CC(=CC=CC(=CC(=O)O)C)C
2.1.5 Isomeric SMILES
CC1=C(C(CCC1)(C)C)/C=C/C(=C\C=C\C(=C\C(=O)O)\C)/C
2.2 Other Identifiers
2.2.1 UNII
1UA8E65KDZ
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 9 Cis Retinoic Acid

2. 9-cis-retinoic Acid

3. 9cra Compound

4. Bal4079

5. Panretin

6. Toctino

2.3.2 Depositor-Supplied Synonyms

1. 9-cis-retinoic Acid

2. Panretin

3. 5300-03-8

4. 9-cis-tretinoin

5. 9-cis Retinoic Acid

6. Panrexin

7. Panretyn

8. Panretin Gel

9. 9(z)-retinoic Acid

10. (9cis)-retinoic Acid

11. Toctino

12. Retinoic Acid, 9-cis-

13. Alitretinoin [usan]

14. Alrt-1057

15. Panretin (tn)

16. Trans-vitamin A Acid

17. Alitretinoin (usan)

18. Alrt1057

19. Agn 192013

20. Bal-4079

21. Lgd-1057

22. Agn-192013

23. Nsc-659772

24. Lg-100057

25. Lgd1057

26. Chembl705

27. 1ua8e65kdz

28. Atragen

29. Effederm

30. Lg100057

31. Retinova

32. (2e,4e,6z,8e)-3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexen-1-yl)-2,4,6,8-nonatetraenoic Acid

33. Chebi:50648

34. Aberela [norway]

35. Avitoin [norway]

36. Tretinoin (tn)

37. Effederm [france]

38. (7e,9z,11e,13e)-retinoic Acid

39. (2e,4e,6z,8e)-3,7-dimethyl-9-(2,6,6-trimethylcyclohex-1-en-1-yl)nona-2,4,6,8-tetraenoic Acid

40. A-acido (argentina)

41. 9-cis-ra

42. Retin A (tn)

43. (2e,4e,6z,8e)-3,7-dimethyl-9-(2,6,6-trimethylcyclohex-1-enyl)nona-2,4,6,8-tetraenoic Acid

44. (2e,4e,6z,8e)-3,7-dimethyl-9-(2,6,6-trimethylcyclohexen-1-yl)nona-2,4,6,8-tetraenoic Acid

45. Trans-retinoate

46. Beta-retinoate

47. 9 Cis Retinoic Acid

48. Alitretinoina

49. Alitretinoine

50. Alitretinoinum

51. Retinoic Acid, Cis-9,trans-13-

52. 9cra

53. (2e,4e,6z,8e)-3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexenyl)nona-2,4,6,8-tetraenoic Acid

54. Tretinoine [inn-french]

55. Tretinoinum [inn-latin]

56. All-trans-b-retinoic Acid

57. Tretinoina [inn-spanish]

58. Tretinoino [inn-spanish]

59. Alrt 1057

60. 9-cis Ra

61. Isotretinoin Retinoic Acid

62. [3h]9-cis-retinoic Acid

63. Tretinoine (french) (einecs)

64. [3h]-9-cis-retinoic Acid

65. 9-cra

66. 9c-ra

67. Acide Retinoique (french) (dsl)

68. 15-apo-beta-caroten-15-oic Acid

69. B-retinoate

70. Bml2-e06

71. Ccris 7098

72. Dtxsid6040404

73. 9-retinoate

74. 9-retinoic Acid

75. Hsdb 7186

76. 2,4,6,8-nonatetraenoic Acid, 3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexen-1-yl)-, (2e,4e,6z,8e)-

77. Mfcd00270072

78. Isotretinoin Retinoate

79. All-trans-b-retinoate

80. Nsc 659772

81. 9-cis- Retinoic Acid

82. Retinoic Acid, 9-cis

83. Ro-04-4079

84. 9-(z)-retinoic Acid

85. Tretinoin (jan/usp)

86. Alpha-acido (argentina)

87. All-trans-beta-retinoate

88. Spectrum5_001935

89. Alitretinoin [mi]

90. Retinoic Acid 9-cis-form

91. Retinoic Acid, (9cis)-

92. Alitretinoin [inn]

93. Unii-1ua8e65kdz

94. Alitretinoin [hsdb]

95. Alpha-vitaminsyre [denmark]

96. Alitretinoin [vandf]

97. Dsstox_cid_20404

98. Dsstox_rid_79490

99. All-trans- Vitamin A1 Acid

100. Dsstox_gsid_40404

101. Schembl18666

102. Alitretinoin [mart.]

103. Bspbio_001495

104. Tretinoin/all-trans Retinoate

105. Tretinoin [usan:ban:inn]

106. Alitretinoin [who-dd]

107. 15-apo-beta-caroten-15-oate

108. Alitretinoin [usan:inn:ban]

109. Gtpl2645

110. Gtpl5383

111. Alitretinoin [ema Epar]

112. Upcmld-dp097:001

113. Upcmld-dp097:002

114. Bdbm31892

115. Alitretinoin [orange Book]

116. Hms1361k17

117. Hms1791k17

118. Hms1989k17

119. Hms3402k17

120. 124510-04-9

121. Amy21903

122. Tox21_302195

123. Lmpr01090022

124. Nsc659772

125. Stk801887

126. Zinc12661824

127. Akos005622553

128. 9-cra. 9-cis-ra. Alrt1057

129. Ccg-208266

130. Db00523

131. Idi1_033965

132. Retinoic Acid 9-cis-form [mi]

133. 9-cis-retinoic Acid, >=98% (hplc)

134. Ncgc00161590-01

135. Ncgc00161590-02

136. Ncgc00161590-03

137. Ncgc00161590-04

138. Ncgc00161590-05

139. Ncgc00161590-06

140. Ncgc00161590-07

141. Ncgc00255697-01

142. As-83566

143. Hy-15128

144. Cas-5300-03-8

145. Tretinoin Impurity D [ep Impurity]

146. Bb 0261656

147. Cs-0003780

148. Isotretinoin Impurity D [ep Impurity]

149. D02815

150. 300r038

151. Sr-05000013784

152. Q3611854

153. Sr-05000013784-1

154. W-200595

155. Brd-k35483542-001-02-3

156. (2e,4e,6z,8e)-3,7-dimethyl-9-(2,6,6-trimethylcyclohex-1-enyl) Nona-2,4,6,8-tetraenoic Acid

2.4 Create Date
2005-03-25
3 Chemical and Physical Properties
Molecular Weight 300.4 g/mol
Molecular Formula C20H28O2
XLogP36.3
Hydrogen Bond Donor Count1
Hydrogen Bond Acceptor Count2
Rotatable Bond Count5
Exact Mass300.208930132 g/mol
Monoisotopic Mass300.208930132 g/mol
Topological Polar Surface Area37.3 Ų
Heavy Atom Count22
Formal Charge0
Complexity567
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count4
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 2  
Drug NamePanretin
PubMed HealthAlitretinoin (On the skin)
Drug ClassesDermatological Agent
Drug LabelPanretin gel 0.1% contains alitretinoin and is intended for topical application only. The chemical name is 9-cis-retinoic acid and the structural formula is as follows:Chemically, alitretinoin is related to vitamin A. It is a yellow powder with a m...
Active IngredientAlitretinoin
Dosage FormGel
RouteTopical
Strengtheq 0.1% base
Market StatusPrescription
CompanyEisai

2 of 2  
Drug NamePanretin
PubMed HealthAlitretinoin (On the skin)
Drug ClassesDermatological Agent
Drug LabelPanretin gel 0.1% contains alitretinoin and is intended for topical application only. The chemical name is 9-cis-retinoic acid and the structural formula is as follows:Chemically, alitretinoin is related to vitamin A. It is a yellow powder with a m...
Active IngredientAlitretinoin
Dosage FormGel
RouteTopical
Strengtheq 0.1% base
Market StatusPrescription
CompanyEisai

4.2 Therapeutic Uses

Antineoplastic Agents

National Library of Medicine's Medical Subject Headings. Alitretinoin. Online file (MeSH, 2018). Available from, as of August 29, 2018: https://meshb.nlm.nih.gov/search


/CLINICAL TRIALS/ ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. The Web site is maintained by the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Each ClinicalTrials.gov record presents summary information about a study protocol and includes the following: Disease or condition; Intervention (for example, the medical product, behavior, or procedure being studied); Title, description, and design of the study; Requirements for participation (eligibility criteria); Locations where the study is being conducted; Contact information for the study locations; and Links to relevant information on other health Web sites, such as NLM's MedlinePlus for patient health information and PubMed for citations and abstracts for scholarly articles in the field of medicine. Alitretinoin is included in the database.

NIH/NLM; ClinicalTrials.Gov. Available from, as of August 29, 2018: https://clinicaltrials.gov/


Panretin gel is indicated for topical treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma. Panretin gel is not indicated when systemic anti-KS therapy is required (e.g., more than 10 new KS lesions in the prior month, symptomatic lymphedema, symptomatic pulmonary KS, or symptomatic visceral involvement). There is no experience to date using Panretin gel with systemic anti-KS treatment. /Included in US product labeling/

NIH; DailyMed. Current Medication Information for Panretin (Alitretinoin) Gel (Updated: June 29, 2018). Available from, as of September 13, 2018: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13c5de6d-d266-4d83-99c4-072ef104e7ff


/EXPL THER/ Lichen amyloidosis (LA) is characterized by the deposition of amyloid that may respond to chronic scratching that may be secondary to atopic dermatitis, stasis dermatitis, or interface dermatitis. Despite the development of several therapeutic strategies, including topical steroids, oral antihistamines, cyclosporine, and retinoids, an effective treatment for LA has not been established. A 49-year-old woman who has been treated irregularly for atopic dermatitis for 7 years presented with localized brownish papules on the left forearm and right elbow. They developed 3 months prior and were becoming more prominent despite of treatment with cyclosporine, oral antihistamines, and topical steroids for 5 months prior to presentation. A skin biopsy revealed amyloid deposition in the dermal papillae and the patient was diagnosed with LA associated with atopic dermatitis. A 6-month course of daily oral alitretinoin 30 mg produced marked improvement in the thickness and color of the hyperkeratotic papules without aggravation of the patient's atopic dermatitis. Histologic evaluation showed clearance of amyloid deposition and almost normalization of the epidermal changes. Herein, we report a case of LA treated with alitretinoin and suggest that it could be a potential treatment option for LA, especially in patients with inflammatory skin diseases including atopic dermatitis.

PMID:28906049 Koh WS et al; Dermatol Ther. 2017 Nov;30(6). doi: 10.1111/dth.12537. Epub 2017 Sep 14.


For more Therapeutic Uses (Complete) data for Alitretinoin (13 total), please visit the HSDB record page.


4.3 Drug Warning

Retinoids as a class have been associated with photosensitivity. There were no reports of photosensitivity associated with the use of Panretin gel in the clinical studies. Nonetheless, because in vitro data indicate that 9-cis-retinoic acid may have a weak photosensitizing effect, patients should be advised to minimize exposure of treated areas to sunlight and sunlamps during the use of Panretin gel.

NIH; DailyMed. Current Medication Information for Panretin (Alitretinoin) Gel (Updated: June 29, 2018). Available from, as of September 13, 2018: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13c5de6d-d266-4d83-99c4-072ef104e7ff


It is not known whether alitretinoin or its metabolites are excreted in human milk. Because many drugs are excreted in human milk and because of the potential for adverse reactions from Panretin gel in nursing infants, mothers should discontinue nursing prior to using the drug.

NIH; DailyMed. Current Medication Information for Panretin (Alitretinoin) Gel (Updated: June 29, 2018). Available from, as of September 13, 2018: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13c5de6d-d266-4d83-99c4-072ef104e7ff


Inadequate information is available to assess safety and efficacy in patients age 65 years or older.

NIH; DailyMed. Current Medication Information for Panretin (Alitretinoin) Gel (Updated: June 29, 2018). Available from, as of September 13, 2018: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13c5de6d-d266-4d83-99c4-072ef104e7ff


Safety and effectiveness in pediatric patients have not been established.

NIH; DailyMed. Current Medication Information for Panretin (Alitretinoin) Gel (Updated: June 29, 2018). Available from, as of September 13, 2018: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13c5de6d-d266-4d83-99c4-072ef104e7ff


For more Drug Warnings (Complete) data for Alitretinoin (9 total), please visit the HSDB record page.


4.4 Drug Indication

For topical treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma.


FDA Label


Panretin gel is indicated for the topical treatment of cutaneous lesions in patients with acquired-immune-deficiency-syndrome (AIDS)-related Kaposi's sarcoma (KS) when:

- lesions are not ulcerated or lymphoedematous, and;

- treatment of visceral KS is not required, and;

- lesions are not responding to systemic antiretroviral therapy, and;

- radiotherapy or chemotherapy are not appropriate.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Alitretinoin (9-cis-retinoic acid) is a naturally-occurring endogenous retinoid indicated for topical treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma. Alitretinoin inhibits the growth of Kaposi's sarcoma (KS) cells in vitro.


5.2 MeSH Pharmacological Classification

Dermatologic Agents

Drugs used to treat or prevent skin disorders or for the routine care of skin. (See all compounds classified as Dermatologic Agents.)


Antineoplastic Agents

Substances that inhibit or prevent the proliferation of NEOPLASMS. (See all compounds classified as Antineoplastic Agents.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
ALITRETINOIN
5.3.2 FDA UNII
1UA8E65KDZ
5.3.3 Pharmacological Classes
Retinoids [CS]; Retinoid [EPC]
5.4 ATC Code

L01XX22


D - Dermatologicals

D11 - Other dermatological preparations

D11A - Other dermatological preparations

D11AH - Agents for dermatitis, excluding corticosteroids

D11AH04 - Alitretinoin


L - Antineoplastic and immunomodulating agents

L01 - Antineoplastic agents

L01X - Other antineoplastic agents

L01XF - Retinoids for cancer treatment

L01XF02 - Alitretinoin


5.5 Absorption, Distribution and Excretion

BACKGROUND: Previous studies have shown that concomitant administration of food may enhance the bioavailability of oral retinoids. AIM: To assess the influence of food on the pharmacokinetics (PK) of alitretinoin after a single oral dose. METHODS: This was a single-dose, open-label, randomized, crossover study, which enrolled 30 healthy men, aged 18-44 years. Subjects received sequential doses of alitretinoin 40 mg either after fasting (treatment A) or 5 min after completion of a standard breakfast (treatment B), with the dosing sequence randomized (A/B or B/A). The washout period between the two doses was 1 week. Plasma concentrations over time were plotted and standard PK variables [area under the curve (AUC) of plasma concentration vs. time, maximum plasma concentration (C(max)), time to maximum plasma concentration (t(max)) and elimination half-life (t(1/2)] were determined. RESULTS: Drug exposure was markedly increased when alitretinoin was taken with food compared with fasting, and there were significant increases in mean C(max) (82.8 vs.25.4 ng/mL, respectively) and AUC (220.2 vs. 55.7 ng/mL/hr). The delaying effect of food on t(max) was less marked (median of 3.0 vs. 2.0 h). Administration with food also increased exposure to drug metabolites. Variability in exposure was markedly reduced if alitretinoin was taken with vs. without food (percentage coefficient of variation 40% vs. 74% for AUC; 49% vs. 85% for C(max)). Alitretinoin was generally well tolerated, with typical retinoid adverse reactions, mostly comprising headache. CONCLUSIONS: Intake of alitretinoin with food substantially increased the bioavailability of alitretinoin, but variability in exposure was reduced. Consequently, oral alitretinoin should be taken with food as outlined in the manufacturer's summary of product characteristics.

PMID:21443600 Schmitt-Hoffmann AH et al; Clin Exp Dermatol 36 (Suppl 2): 18-23 (2011)


BACKGROUND: Alitretinoin, like all retinoids, is teratogenic, and can only be given to women of childbearing potential if pregnancy is excluded and a strict contraceptive programme is followed. AIM: This study was designed to determine whether alitretinoin in the semen of men treated with alitretinoin poses a teratogenic risk to their female partners. METHODS: In total, 24 healthy men aged 18-45 years received alitretinoin 20 mg (n = 12) or 40 mg (n = 12), once daily for 14 days. Subjects in the 40 mg dose group provided ejaculate at baseline, on day 1, before and approximately 4 hr after dosing on day 2, and at follow-up on study day 21 (+/- 2). RESULTS: Alitretinoin and 4-oxo-alitretinoin were detected in 11 of the 12 semen samples. The highest level of alitretinoin in semen was 7.92 ng/mL. Assuming an ejaculate volume of 10 mL, the amount of drug transferred in semen would be about 80 ng, 1/375,000 of a single 30 mg capsule. Complete absorption of 80 ng of alitretinoin from semen, presuming a volume of distribution confined to 5 L of circulating blood in the partner, would lead to an increase in plasma alitretinoin concentration of 0.016 ng/mL, which appears to be negligible compared with measured endogenous plasma levels. Increases in plasma levels of related retinoids are also negligible. CONCLUSIONS: Alitretinoin in the semen of men receiving up to 40 mg of oral alitretinoin per day is unlikely to be associated with teratogenic risk in their female partners. Barrier contraception is therefore not required for men taking alitretinoin.

PMID:21443599 Schmitt-Hoffmann AH et al; Clin Exp Dermatol 36 (Suppl 2): 12-7 (2011)


/MILK/ It is not known whether alitretinoin or its metabolites are excreted in human milk.

NIH; DailyMed. Current Medication Information for Panretin (Alitretinoin) Gel (Updated: June 29, 2018). Available from, as of September 13, 2018: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13c5de6d-d266-4d83-99c4-072ef104e7ff


Limited data indicate that alitretinoin is not substantially absorbed systemically following topical application of the drug.

American Society of Health-System Pharmacists; Drug Information 2018. Bethesda, MD. 2018


5.6 Metabolism/Metabolites

Although there are no detectable plasma concentrations of 9-cis-retinoic acid metabolites after topical application of Panretin gel, in vitro studies indicate that the drug is metabolized to 4-hydroxy-9-cis-retinoic acid and 4-oxo-9-cis-retinoic acid by CYP 2C9, 3A4, 1A1, and 1A2 enzymes. In vivo, 4-oxo-9-cis-retinoic acid is the major circulating metabolite following oral administration of 9-cis-retinoic acid.

NIH; DailyMed. Current Medication Information for Panretin (Alitretinoin) Gel (Updated: June 29, 2018). Available from, as of September 13, 2018: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13c5de6d-d266-4d83-99c4-072ef104e7ff


4-hydroxy-9-cis-retinals is a known human metabolite of 9-cis-retinal.

S73 | METXBIODB | Metabolite Reaction Database from BioTransformer | DOI:10.5281/zenodo.4056560


5.7 Mechanism of Action

Alitretinoin binds to and activates all known intracellular retinoid receptor subtypes (RARa, RARb, RARg, RXRa, RXRb and RXRg). Once activated these receptors function as transcription factors that regulate the expression of genes that control the process of cellular differentiation and proliferation in both normal and neoplastic cells.


Retinoic acid receptors (RARs) and retinoid X receptors (RXRs) mediate the effects of retinoids on gene expression by binding to response elements in retinoid-sensitive genes. RAR- but not RXR-selective retinoids were found in many previous studies to suppress the growth of various cells, implicating RXR-RAR in these effects. ... RXR-selective retinoids inhibited DNA synthesis in squamous carcinoma 1483 cells transfected with RXRalpha but not with RARs. Ligand-induced transcription of the reporter luciferase gene via the activation of RXR-RXR but not RXR-RAR correlated with growth suppression. Studies with RXRalpha deletion mutants indicated that the DNA binding and the ligand binding domains are essential for mediating growth inhibition. A point mutation in the ligand binding domain (L430F) that decreased RXRalpha homodimerization compromised its growth inhibitory function. Further, RXRalpha mutant (F313A), which functions as a constitutively active receptor, inhibited DNA synthesis in the absence of ligand. These results demonstrate that RXR homodimer activation leads to growth inhibition and suggest that transfection of RXRalpha and treatment with RXR-selective retinoids or the transfection of constitutively activated RXRalpha mutant alone may have a therapeutic potential. /Retinoids/

PMID:9756939 Wan H et a; J Biol Chem 273 (41): 26915-22 (1998)


The interaction of retinoid X receptor alpha with 9-cis-retinoic acid was studied ... . Transient kinetic analyses of this interaction suggest a two-step binding mechanism involving a rapid, enthalpically driven pre-equilibrium followed by a slower, entropically driven reaction that may arise from a conformational change within the ligand binding domain of the receptor. The assignment of this kinetic mechanism was supported by agreement between the overall equilibrium constant, Kov, derived from kinetic studies with that determined by equilibrium fluorescence titrations. Although these analyses do not preclude ligand-induced alteration in the oligomerization state of the receptor in solution, the simplest model that can be applied to these data involves the stoichiometric interaction of 9-cis-retinoic acid with retinoid X receptor alpha monomers.

PMID:10346893 Schimerlik MI et al; Biochemistry 38 (21): 6732-40 (1999)


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