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Chemistry

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Also known as: 59729-37-2, 1-methyl-2-((4-(methylthio)phenoxy)methyl)-5-nitro-1h-imidazole, Hoe-239, Hoe 239, 1-methyl-2-[(4-methylsulfanylphenoxy)methyl]-5-nitroimidazole, 306erl82ir
Molecular Formula
C12H13N3O3S
Molecular Weight
279.32  g/mol
InChI Key
MIWWSGDADVMLTG-UHFFFAOYSA-N
FDA UNII
306ERL82IR

Fexinidazole
Human African trypanosomiasis (HAT, also colloquially referred to as sleeping sickness), caused by T. brucei gambiense and T. brucei rhodesiense, remains a moderate risk (>1/10,000 inhabitants per year in endemic areas) despite focussed control efforts. Transmitted by the bite of an infected tsetse fly, HAT is biphasic with a first (hemolymphatic) stage that progresses to a second (meningoencephalitic) stage in which patients experience progressively worsening neurological symptoms and eventually die if left untreated. Historical treatment options for meningoencephalitic HAT include [melarsoprol], [eflornithine], and [nifurtimox]/[eflornithine] combination therapy (NECT), though [melarsoprol] is highly toxic and each treatment requires lengthy infusions that are difficult to administer in resource-limited settings. Fexinidazole, which was originally developed in the 1970s/80s by Hoechst AG and subsequently rediscovered through the Drugs for Neglected Diseases Initiative (DNDi) in 2005, is the first all-oral treatment for first and second stage HAT caused by T. brucei gambiense. Fexinidazole received a positive opinion from the European Medicines Agency (EMA) in November 2018 and was approved by the FDA on July 16, 2021. It is currently marketed by Sanofi-Aventis.
Fexinidazole is a Nitroimidazole Antimicrobial. The mechanism of action of fexinidazole is as a Cytochrome P450 1A2 Inhibitor, and Cytochrome P450 2B6 Inhibitor, and Cytochrome P450 2C19 Inhibitor, and Cytochrome P450 2D6 Inhibitor, and Cytochrome P450 3A4 Inhibitor, and Cytochrome P450 3A5 Inhibitor, and Cytochrome P450 1A2 Inducer, and Cytochrome P450 2B6 Inducer, and Organic Anion Transporting Polypeptide 1B1 Inhibitor, and Organic Anion Transporting Polypeptide 1B3 Inhibitor, and Organic Cation Transporter 2 Inhibitor, and Organic Anion Transporter 1 Inhibitor, and Organic Anion Transporter 3 Inhibitor, and Multidrug and Toxin Extrusion Transporter 1 Inhibitor, and Multidrug and Toxin Extrusion Transporter 2 K Inhibitor.
1 2D Structure

Fexinidazole

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
1-methyl-2-[(4-methylsulfanylphenoxy)methyl]-5-nitroimidazole
2.1.2 InChI
InChI=1S/C12H13N3O3S/c1-14-11(13-7-12(14)15(16)17)8-18-9-3-5-10(19-2)6-4-9/h3-7H,8H2,1-2H3
2.1.3 InChI Key
MIWWSGDADVMLTG-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CN1C(=CN=C1COC2=CC=C(C=C2)SC)[N+](=O)[O-]
2.2 Other Identifiers
2.2.1 UNII
306ERL82IR
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Hoe 239

2.3.2 Depositor-Supplied Synonyms

1. 59729-37-2

2. 1-methyl-2-((4-(methylthio)phenoxy)methyl)-5-nitro-1h-imidazole

3. Hoe-239

4. Hoe 239

5. 1-methyl-2-[(4-methylsulfanylphenoxy)methyl]-5-nitroimidazole

6. 306erl82ir

7. 1-methyl-2-((p-(methylthio)phenoxy)methyl)-5-nitroimidazole

8. 1-methyl-2-((4-(methylthio)phenoxy)-methyl)-5-nitro-1h-imidazole

9. Fexinidazol

10. Fexinidazolum

11. Fexinidazole [inn]

12. Fexinidazol [inn-spanish]

13. Fexinidazolum [inn-latin]

14. Unii-306erl82ir

15. Fexinidazole (usan/inn)

16. Fexinidazole [usan:inn]

17. Fexinidazole [usan]

18. Fexinidazole (hoe-239)

19. Mls006010234

20. Fexinidazole [who-dd]

21. Schembl1163575

22. Zinc1448

23. Chembl1631694

24. Dtxsid00208448

25. 1-methyl-2-(4-methylthiophenyl-oxymethyl)-5-nitro-imidazole

26. Fexinidazole [orange Book]

27. Bcp07460

28. Who 4142

29. Mfcd00866607

30. S2600

31. Akos016010427

32. Cs-5535

33. Db12265

34. Sb16940

35. Hy-13801

36. Smr004701311

37. D11252

38. A869137

39. Q5446115

40. 1-methyl-2-(4-methylthiophenyloxymethyl)-5-nitro-imidazole

41. 1h-imidazole, 1-methyl-2-((4-(methylthio)phenoxy)methyl)-5-nitro-

2.4 Create Date
2005-08-08
3 Chemical and Physical Properties
Molecular Weight 279.32 g/mol
Molecular Formula C12H13N3O3S
XLogP32.5
Hydrogen Bond Donor Count0
Hydrogen Bond Acceptor Count5
Rotatable Bond Count4
Exact Mass279.06776246 g/mol
Monoisotopic Mass279.06776246 g/mol
Topological Polar Surface Area98.2 Ų
Heavy Atom Count19
Formal Charge0
Complexity305
Isotope Atom Count0
Defined Atom Stereocenter Count0
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

Fexinidazole is a nitroimidazole indicated for the treatment of both first-stage (hemolymphatic) and second-stage (meningoencephalitic) _Trypanosoma brucei gambiense_ human African trypanosomiasis (HAT) in patients 6 years of age and older weighing at least 20 kg. Due to the decreased efficacy observed in patients with severe second stage HAT (cerebrospinal fluid white blood cell count (CSF-WBC) >100 cells/L), fexinidazole should only be used in these patients if there are no other available treatment options.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Fexinidazole is a 2-substituted 5-nitroimidazole that is likely activated by parasitic nitroreductases to highly reactive species, leading to DNA and protein damage and eventual parasite death. The dosing schedule is designed to ensure a high enough concentration of fexinidazole and its reactive metabolites for at least 48 hours, which from _in vitro_ studies was shown to be the minimum exposure time that was effectively trypanocidal. Although fexinidazole is effective in late-stage _T. brucei gambiense_ HAT, it is less effective than NECT therapy in patients with severe (cerebrospinal fluid white blood cell count (CSF-WBC) >100 cells/L at baseline) disease. It should only be used in these patients if there are no other available treatment options. Fexinidazole has been shown to prolong the QT interval in a dose-dependent manner and was also associated with a higher incidence of insomnia, headache, tremors, psychiatric disorders, and suicidal ideation in clinical trials; patients with pre-existing conditions or concomitant medications that could aggravate any of these effects should be treated with caution. In addition, fexinidazole has been associated with neutropenia and elevations in liver transaminases, which should be monitored. Nitroimidazoles like fexinidazole have been associated with a disulfiram-like reaction when used concomitantly with alcohol and psychotic reactions when taken with [disulfiram] itself; patients should avoid alcohol and [disulfiram] when taking fexinidazole.


5.2 FDA Pharmacological Classification
5.2.1 Active Moiety
FEXINIDAZOLE
5.2.2 FDA UNII
306ERL82IR
5.2.3 Pharmacological Classes
Cytochrome P450 1A2 Inhibitors [MoA]; Cytochrome P450 2B6 Inducers [MoA]; Cytochrome P450 2B6 Inhibitors [MoA]; Cytochrome P450 2C19 Inhibitors [MoA]; Cytochrome P450 2D6 Inhibitors [MoA]; Cytochrome P450 3A4 Inhibitors [MoA]; Cytochrome P450 3A5 Inhibitors [MoA]; Multidrug and Toxin Extrusion Transporter 1 Inhibitors [MoA]; Multidrug and Toxin Extrusion Transporter 2 K Inhibitors [MoA]; Nitroimidazole Antimicrobial [EPC]; Nitroimidazoles [CS]; Organic Anion Transporter 1 Inhibitors [MoA]; Organic Anion Transporter 3 Inhibitors [MoA]; Organic Anion Transporting Polypeptide 1B1 Inhibitors [MoA]; Organic Anion Transporting Polypeptide 1B3 Inhibitors [MoA]; Organic Cation Transporter 2 Inhibitors [MoA]; Cytochrome P450 1A2 Inducers [MoA]
5.3 ATC Code

P - Antiparasitic products, insecticides and repellents

P01 - Antiprotozoals

P01C - Agents against leishmaniasis and trypanosomiasis

P01CA - Nitroimidazole derivatives

P01CA03 - Fexinidazole


5.4 Absorption, Distribution and Excretion

Absorption

Fexinidazole is well absorbed, although the rate and extent of absorption are less than dose-proportional; after a 14-day administration schedule, the mean Cmax and AUClast increased by 1.17 and 1.34, or by 1.5 and 1.61, when the dose was either doubled or tripled. Following absorption, fexinidazole is rapidly converted to its M1 metabolite, which undergoes a slower transformation to M2 over time. This is reflected in the Tmax of fexinidazole, M1, and M2 as 4 (0-9), 4 (0-6), and 6 (0-24) hours, respectively. In healthy adults given an 1800 mg loading dose followed by 1200 mg daily over 14 days, the mean Cmax for fexinidazole was 1.6 0.4 g/mL on day 1, 0.8 0.3 g/mL on day 2, and 0.5 0.2 g/mL on day 3. The relevant values for M1 were 8.1 2.2, 8.0 2.3, and 5.9 2.1, while for M2 they were 7.5 3.3, 19.6 5.4, and 12.5 3.5 g/mL. Similarly, the AUC for fexinidazole was 14.3 2.6, 11.6 2.2, and 7.0 2.5, for M1 was 102.3 28.5, 127.9 49.2, and 84.2 36.3, and for M2 was 110.1 41.1, 391.5 126.7, and 252.4 73.6 g\*h/mL. Concomitant food intake increases the Cmax and AUC of fexinidazole, M1, and M2 by 2-5 fold without significantly changing the metabolite ratios. There are no clear effects of age, renal, or hepatic impairment on absorption or plasma parameters of fexinidazole or its metabolites; further studies may be required to confirm/refute these observations.


Route of Elimination

Elimination is almost entirely extra-renal; roughly 0.75-3.15% of a fexinidazole dose was recovered in urine over 168 h, primarily as M1 and M2 metabolites.


Volume of Distribution

Fexinidazole has an apparent volume of distribution of 3222 1199 L.


Clearance

Fexinidazole has a mean apparent day 4 clearance of 161 37 L/h.


5.5 Metabolism/Metabolites

Fexinidazole is metabolized by a variety of enzymes including the CYP450 enzymes CYP1A2, 2B6, 2C19, 2D6, 3A4, and 3A5 as well as flavin mono-oxygenase-3 (FMO-3). Fexinidazole is first transformed to the sulfoxide M1 and then the sulfone M2, which does not appear to undergo further metabolism.


5.6 Biological Half-Life

Fexinidazole, M1, and M2 have mean day 10 half-lives of 15 6, 16 6, and 23 4 hours, respectively.


5.7 Mechanism of Action

Human African trypanosomiasis (HAT) is caused by two subspecies of _Trypanosoma brucei_, _T. brucei gambiense_ and _T. brucei rhodesiense_, with _T. brucei gambiense_ HAT accounting for ~97% of the total disease burden. Transmitted by the bite of an infected tsetse fly, HAT begins as a local infection at the bite site before disseminating throughout the blood and reticuloendothelial system (first or hemolymphatic stage) and eventually crossing the blood-brain barrier (second or meningoencephalitic stage). First stage _T. brucei gambiense_ HAT is characterized by fever, headache, swollen lymph nodes, pruritus, and other non-specific symptoms. Progression to the second stage results in progressive deterioration of neurological function, including sleep disturbances (HAT is also referred to as sleeping sickness), tremors, ataxia, abnormal behaviour, confusion, and coma; myocarditis and endocrine hypothalamic-hypophyseal dysfunction may also be present. If left untreated, HAT is fatal. Fexinidazole is the first all-oral treatment for _T. brucei gambiense_ HAT. Both fexinidazole and its two main metabolites, a sulfoxide (M1) and sulfone (M2) metabolite, possess _in vitro_ activity against _T. brucei gambiense_, _T. brucei rhodesiense_, and _T. brucei brucei_ in the 0.2-0.9 g/mL range. Further studies revealed _in vivo_ efficacy in HAT animal models and acceptable toxicity profiles, both in animal and human subjects. Crucially, fexinidazole was shown to be non-inferior to existing [nifurtimox]/[eflornithine] combination therapy (NECT) in late-stage _T. brucei gambiense_ infection. The precise mechanism of action of fexinidazole remains unknown. However, it is suggested that bacterial-like nitroreductases encoded by trypanosomes activate fexinidazole and its M1/M2 metabolites through reduction to form reactive intermediates capable of damaging DNA and proteins. Whole-body autoradiography of [14C]-labelled fexinidazole in rats revealed broad distribution into all tissues, including an observed brain-to-blood concentration ratio of 0.4-0.6. Therefore, fexinidazole is capable of direct toxicity against trypanosomes throughout the body and in the brain, which is consistent with its efficacy against both early and late-stage infections.


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ABOUT THIS PAGE

Fexinidazole Manufacturers

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

Fexinidazole Suppliers

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

Fexinidazole 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 Fexinidazole as an active pharmaceutical ingredient (API).

Finished drug products

The FDA updates the NDC directory daily. The NDC numbers for Fexinidazole 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 Fexinidazole 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 Fexinidazole and are produced by outsourcing facilities. While these outsourcing facilities are not mandated to assign a Fexinidazole NDC to their finished compounded human drug products, they may choose to do so.

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

Fexinidazole GMP

Fexinidazole 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 Fexinidazole 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 Fexinidazole GMP manufacturer or Fexinidazole GMP API supplier for your needs.

Fexinidazole CoA

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

Fexinidazole CoA mostly includes findings from lab analyses of a specific batch. For each Fexinidazole 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.

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