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Chemistry

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Also known as: 1024828-77-0, Cr845, Difelikefalin [inn], Mr13a9, Cr-845, Korsuva
Molecular Formula
C36H53N7O6
Molecular Weight
679.8  g/mol
InChI Key
FWMNVWWHGCHHJJ-SKKKGAJSSA-N
FDA UNII
NA1U919MRO

Difelikefalin
Difelikefalin (CR845) is an agonist of kappa opioid receptors (KORs) useful in the treatment of pruritus secondary to chronic kidney disease. KORs were first associated with itching in 1984. Further investigations revealed that dynorphins, endogenous agonists of KORs, work to inhibit the itching sensation at the spinal cord level, and scratching could be elicited in mouse models with the administration of KOR antagonists. These revelations led to the study of KOR agonists as a potential treatment option in patients suffering from pruritic conditions. Pruritus associated with chronic kidney disease (also called uremic pruritus) affects 50-60% of all patients on dialysis and 25% of non-dialysis patients with chronic kidney disease. The clinical burden of uremic pruritus in this patient population is being increasingly recognized as contributing to a significant reduction in patient quality of life, poor outcomes, and even mortality. Options for therapy are limited - with no FDA-approved treatments, off-label [gabapentin] was the most evidence-based and widely available treatment. Difelikefalin received FDA approval in August 2021 (under the brand name Korsuva), becoming the first FDA-approved therapy for patients with chronic kidney disease suffering from uremic pruritus.
1 2D Structure

Difelikefalin

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
4-amino-1-[(2R)-6-amino-2-[[(2R)-2-[[(2R)-2-[[(2R)-2-amino-3-phenylpropanoyl]amino]-3-phenylpropanoyl]amino]-4-methylpentanoyl]amino]hexanoyl]piperidine-4-carboxylic acid
2.1.2 InChI
InChI=1S/C36H53N7O6/c1-24(2)21-29(32(45)40-28(15-9-10-18-37)34(47)43-19-16-36(39,17-20-43)35(48)49)42-33(46)30(23-26-13-7-4-8-14-26)41-31(44)27(38)22-25-11-5-3-6-12-25/h3-8,11-14,24,27-30H,9-10,15-23,37-39H2,1-2H3,(H,40,45)(H,41,44)(H,42,46)(H,48,49)/t27-,28-,29-,30-/m1/s1
2.1.3 InChI Key
FWMNVWWHGCHHJJ-SKKKGAJSSA-N
2.1.4 Canonical SMILES
CC(C)CC(C(=O)NC(CCCCN)C(=O)N1CCC(CC1)(C(=O)O)N)NC(=O)C(CC2=CC=CC=C2)NC(=O)C(CC3=CC=CC=C3)N
2.1.5 Isomeric SMILES
CC(C)C[C@H](C(=O)N[C@H](CCCCN)C(=O)N1CCC(CC1)(C(=O)O)N)NC(=O)[C@@H](CC2=CC=CC=C2)NC(=O)[C@@H](CC3=CC=CC=C3)N
2.2 Other Identifiers
2.2.1 UNII
NA1U919MRO
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 4-piperidinecarboxylic Acid, 4-amino-1-((2r)-6-amino-2-(((2r)-2-(((2r)-2-(((2r)-2-amino-1-oxo-3-phenylpropyl)amino)-1-oxo-3-phenylpropyl)amino)-4-methyl-1-oxopentyl)amino)-1-oxohexyl)-

2. Korsuva

3. N-((2r)-1-(((2r)-1-(((2r)-6-amino-1-(4-amino-4-carboxy-1-piperidinyl)-1-oxo-2-hexanyl)amino)-4-methyl-1-oxo-2-pentanyl)amino)-1-oxo-3-phenyl-2-propanyl)-d-phenylalaninamide

2.3.2 Depositor-Supplied Synonyms

1. 1024828-77-0

2. Cr845

3. Difelikefalin [inn]

4. Mr13a9

5. Cr-845

6. Korsuva

7. Fe202845

8. Na1u919mro

9. Fe-202845

10. Mr-13a9

11. 1024828-77-0 (free Base)

12. 1-(d-phenylalanyl-d-phenylalanyl-d-leucyl-d-lysyl)-4-aminopiperidine-4-carboxylic Acid

13. 4-piperidinecarboxylic Acid, N1-(d-phenylalanyl-d-phenylalanyl-d-leucyl-d-lysyl)-4-amino-

14. 4-amino-1-[(2r)-6-amino-2-[[(2r)-2-[[(2r)-2-[[(2r)-2-amino-3-phenylpropanoyl]amino]-3-phenylpropanoyl]amino]-4-methylpentanoyl]amino]hexanoyl]piperidine-4-carboxylic Acid

15. Difelikefalin Acetate [jan]

16. Unii-na1u919mro

17. Kapruvia

18. Difelikefalin Tfa

19. Cr 845

20. Difelikefalin (cr845)

21. Difelikefalin (usan/inn)

22. Difelikefalin [usan:inn]

23. Difelikefalin [usan]

24. Seq Id No: 2

25. Difelikefalin [who-dd]

26. Gtpl9044

27. Chembl3989915

28. Schembl10316464

29. Bdbm235785

30. Dtxsid401032896

31. Bcp24752

32. Ex-a5855

33. At30197

34. Db11938

35. Bd177570

36. Hy-17609

37. Cr-845; Fe-202845

38. Cs-0014687

39. D11111

40. Us9359399, 2

41. Q21098992

42. D-phe-d-phe-d-leu-d-lys-[gamma-(4-n-piperidinyl)amino Carboxylic Acid]

43. 4-piperidinecarboylic Acid, 4-amino-1-(d-phenylalanyl-d-phenylalanyl-d-leucyl-d-lysyl)-

44. 4-amino-1-(d-phenylalanyl-d-phenylalanyl-d-leucyl-d-lysyl)piperidine-4-carboxylic Acid

45. 4-piperidinecarboxylic Acid, 4-amino-1-((2r)-6-amino-2-(((2r)-2-(((2r)-2-(((2r)-2-amino-1-oxo-3-phenylpropyl)amino)-1-oxo-3-phenylpropyl)amino)-4-methyl-1-oxopentyl)amino)-1-oxohexyl)-

46. N-((2r)-1-(((2r)-1-(((2r)-6-amino-1-(4-amino-4-carboxy-1-piperidinyl)-1-oxo-2-hexanyl)amino)-4-methyl-1-oxo-2-pentanyl)amino)-1-oxo-3-phenyl-2-propanyl)-d-phenylalaninamide

2.4 Create Date
2008-05-26
3 Chemical and Physical Properties
Molecular Weight 679.8 g/mol
Molecular Formula C36H53N7O6
XLogP3-0.6
Hydrogen Bond Donor Count7
Hydrogen Bond Acceptor Count9
Rotatable Bond Count18
Exact Mass679.40573244 g/mol
Monoisotopic Mass679.40573244 g/mol
Topological Polar Surface Area223 Ų
Heavy Atom Count49
Formal Charge0
Complexity1080
Isotope Atom Count0
Defined Atom Stereocenter Count4
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Indication

Difelikefalin is indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD-aP; uremic pruritus) in adults undergoing hemodialysis.


FDA Label


Kapruvia is indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adult patients on haemodialysis (see section 5. 1).


5 Pharmacology and Biochemistry
5.1 Pharmacology

Difelikefalin is administered to patients undergoing hemodialysis for chronic kidney disease (CKD) to prevent and treat the pruritus often associated with CKD. It is administered via bolus intravenous injection at the end of each hemodialysis treatment. As it works on opioid receptors, difelikefalin can cause dizziness, somnolence, and other CNS depressant effects that may impair mental or physical abilities - as such, patients should be advised to avoid operating dangerous machinery until the effect of difelikefalin on that patient is known.


5.2 ATC Code

V03AX


V - Various

V03 - All other therapeutic products

V03A - All other therapeutic products

V03AX - Other therapeutic products

V03AX04 - Difelikefalin


5.3 Absorption, Distribution and Excretion

Absorption

Difelikefalin is administered via bolus intravenous injection with each hemodialysis treatment - for this reason, each dose is effectively 100% bioavailable.


Route of Elimination

Following intravenous difelikefalin administration to hemodialysis patients, approximately 11% of the dose was excreted in the urine, 59% in the feces, and 20% in the dialysate.


Volume of Distribution

The mean volume of distribution of difelikefalin is approximately 238 mL/kg.


Clearance

One cycle of hemodialysis reduces difelikefalin plasma concentrations by 70-80% and no detectable drug remains after two cycles.


5.4 Metabolism/Metabolites

Difelikefalin is not metabolized to any appreciable extent and is not a substrate for cytochrome P450 enzymes.


5.5 Biological Half-Life

The half-life of difelikefalin in hemodialysis patients prior to dialysis ranges between 23 and 31 hours.


5.6 Mechanism of Action

Difelikefalin is a synthetic peptide and agonist of kappa opioid receptors (KORs), which have long been known to be involved with the itching sensation (in addition to playing some role in addiction). Endogenous KOR agonists - called dynorphins - have a neuroinhibitory effect on the itching sensation at the spinal cord level and mouse models have shown KOR agonist antipruritic activity when used to treat itching induced by different pruritogens. Although the specifics of the mechanism have yet to be elucidated, the administration of KOR agonists, like difelikefalin, in patients with uremic pruritus has proven an effective means to suppress scratching and improve their quality of life.


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ABOUT THIS PAGE

Difelikefalin Manufacturers

A Difelikefalin manufacturer is defined as any person or entity involved in the manufacture, preparation, processing, compounding or propagation of Difelikefalin, including repackagers and relabelers. The FDA regulates Difelikefalin manufacturers to ensure that their products comply with relevant laws and regulations and are safe and effective to use. Difelikefalin API Manufacturers are required to adhere to Good Manufacturing Practices (GMP) to ensure that their products are consistently manufactured to meet established quality criteria.

click here to find a list of Difelikefalin manufacturers with USDMF, JDMF, KDMF, CEP, GMP, COA and API Price related information on PhamaCompass.

Difelikefalin Suppliers

A Difelikefalin supplier is an individual or a company that provides Difelikefalin active pharmaceutical ingredient (API) or Difelikefalin finished formulations upon request. The Difelikefalin suppliers may include Difelikefalin API manufacturers, exporters, distributors and traders.

click here to find a list of Difelikefalin suppliers with USDMF, JDMF, KDMF, CEP, GMP, COA and API Price related information on PharmaCompass.

Difelikefalin USDMF

A Difelikefalin DMF (Drug Master File) is a document detailing the whole manufacturing process of Difelikefalin active pharmaceutical ingredient (API) in detail. Different forms of Difelikefalin DMFs exist exist since differing nations have different regulations, such as Difelikefalin USDMF, ASMF (EDMF), JDMF, CDMF, etc.

A Difelikefalin DMF submitted to regulatory agencies in the US is known as a USDMF. Difelikefalin USDMF includes data on Difelikefalin's chemical properties, information on the facilities and procedures used, and details about packaging and storage. The Difelikefalin USDMF is kept confidential to protect the manufacturer’s intellectual property.

click here to find a list of Difelikefalin suppliers with USDMF on PharmaCompass.

Difelikefalin JDMF

The Pharmaceuticals and Medical Devices Agency (PMDA) established the Japan Drug Master File (JDMF), also known as the Master File (MF), to permit Japanese and foreign manufacturers of drug substances, intermediates, excipients, raw materials, and packaging materials (‘Products’) to voluntarily register confidential information about the production and management of their products in Japan.

The Difelikefalin Drug Master File in Japan (Difelikefalin JDMF) empowers Difelikefalin API manufacturers to present comprehensive information (e.g., production methods, data, etc.) to the review authority, i.e., PMDA (Pharmaceuticals & Medical Devices Agency).

PMDA reviews the Difelikefalin JDMF during the approval evaluation for pharmaceutical products. At the time of Difelikefalin JDMF registration, PMDA checks if the format is accurate, if the necessary items have been included (application), and if data has been attached.

click here to find a list of Difelikefalin suppliers with JDMF on PharmaCompass.

Difelikefalin NDC

National Drug Code is a comprehensive database maintained by the FDA that contains information on all drugs marketed in the US. This directory includes information about finished drug products, unfinished drug products, and compounded drug products, including those containing Difelikefalin as an active pharmaceutical ingredient (API).

Finished drug products

The FDA updates the NDC directory daily. The NDC numbers for Difelikefalin API and other APIs are published in this directory by the FDA.

Unfinished drugs

The NDC unfinished drugs database includes product listing information submitted for all unfinished drugs, such as active pharmaceutical ingredients (APIs), drugs intended for further processing and bulk drug substances for compounding.

Pharmaceutical companies that manufacture Difelikefalin as an active pharmaceutical ingredient (API) must furnish the FDA with an updated record of all drugs that they produce, prepare, propagate, compound, or process for commercial distribution in the US at their facilities.

Compounded drug products

The NDC directory also contains data on finished compounded human drug products that contain Difelikefalin and are produced by outsourcing facilities. While these outsourcing facilities are not mandated to assign a Difelikefalin NDC to their finished compounded human drug products, they may choose to do so.

click here to find a list of Difelikefalin suppliers with NDC on PharmaCompass.

Difelikefalin GMP

Difelikefalin Active pharmaceutical ingredient (API) is produced in GMP-certified manufacturing facility.

GMP stands for Good Manufacturing Practices, which is a system used in the pharmaceutical industry to make sure that goods are regularly produced and monitored in accordance with quality standards. The FDA’s current Good Manufacturing Practices requirements are referred to as cGMP or current GMP which indicates that the company follows the most recent GMP specifications. The World Health Organization (WHO) has its own set of GMP guidelines, called the WHO GMP. Different countries can also set their own guidelines for GMP like China (Chinese GMP) or the EU (EU GMP).

PharmaCompass offers a list of Difelikefalin GMP manufacturers, exporters & distributors, which can be sorted by USDMF, JDMF, KDMF, CEP (COS), WC, API price, and more, enabling you to easily find the right Difelikefalin GMP manufacturer or Difelikefalin GMP API supplier for your needs.

Difelikefalin CoA

A Difelikefalin CoA (Certificate of Analysis) is a formal document that attests to Difelikefalin's compliance with Difelikefalin specifications and serves as a tool for batch-level quality control.

Difelikefalin CoA mostly includes findings from lab analyses of a specific batch. For each Difelikefalin CoA document that a company creates, the USFDA specifies specific requirements, such as supplier information, material identification, transportation data, evidence of conformity and signature data.

Difelikefalin may be tested according to a variety of international standards, such as European Pharmacopoeia (Difelikefalin EP), Difelikefalin JP (Japanese Pharmacopeia) and the US Pharmacopoeia (Difelikefalin USP).

Inform the supplier about your product requirements, specifying if you need a product with particular monograph like EP (Ph. Eur.), USP, JP, BP, or any other quality. In addition, clarify whether you need hydrochloride (HCl), anhydricum, base, micronisatum or a specific level of purity. To find reputable suppliers, utilize the filters and select those certified by GMP, FDA, or any other certification as per your requirement.
For your convenience, we have listed synonyms and CAS numbers to help you find the best supplier. The use of synonyms and CAS numbers can be helpful in identifying potential suppliers, but it is crucial to note that they might not always indicate the exact same product. It is important to confirm the product details with the supplier before making a purchase to ensure that it meets your requirements.
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