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Chemistry

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Also known as: Trifluorothymidine, 70-00-8, Viroptic, 5-trifluorothymidine, Trifluoromethyldeoxyuridine, F3dthd

Molecular Formula

C₁₀H₁₁F₃N₂O₅

Molecular Weight

296.20 g/mol

InChI Key

VSQQQLOSPVPRAZ-RRKCRQDMSA-N

FDA UNII

RMW9V5RW38

An antiviral derivative of THYMIDINE used mainly in the treatment of primary keratoconjunctivitis and recurrent epithelial keratitis due to HERPES SIMPLEX virus. (From Martindale, The Extra Pharmacopoeia, 30th ed, p557)

Trifluridine is a Nucleoside Analog Antiviral and Nucleoside Metabolic Inhibitor. The mechanism of action of trifluridine is as a Nucleic Acid Synthesis Inhibitor.

1 2D Structure

Trifluridine

2 Identification

2.1 Computed Descriptors

2.1.1 IUPAC Name

1-[(2R,4S,5R)-4-hydroxy-5-(hydroxymethyl)oxolan-2-yl]-5-(trifluoromethyl)pyrimidine-2,4-dione

2.1.2 InChI

InChI=1S/C10H11F3N2O5/c11-10(12,13)4-2-15(9(19)14-8(4)18)7-1-5(17)6(3-16)20-7/h2,5-7,16-17H,1,3H2,(H,14,18,19)/t5-,6+,7+/m0/s1

2.1.3 InChI Key

VSQQQLOSPVPRAZ-RRKCRQDMSA-N

2.1.4 Canonical SMILES

C1C(C(OC1N2C=C(C(=O)NC2=O)C(F)(F)F)CO)O

2.1.5 Isomeric SMILES

C1[C@@H]([C@H](O[C@H]1N2C=C(C(=O)NC2=O)C(F)(F)F)CO)O

2.2 Other Identifiers

2.2.1 UNII

RMW9V5RW38

2.3 Synonyms

2.3.1 MeSH Synonyms

1. 2'-deoxy-5-(trifluoromethyl)uridine

2. 5 Trifluoromethyl 2' Deoxyuridine

3. 5-trifluoromethyl-2'-deoxyuridine

4. Tft Ophtiole

5. Triflumann

6. Trifluoridine

7. Trifluorothymidine

8. Viromidin

9. Virophta

10. Viroptic

2.3.2 Depositor-Supplied Synonyms

1. Trifluorothymidine

2. 70-00-8

3. Viroptic

4. 5-trifluorothymidine

5. Trifluoromethyldeoxyuridine

6. F3dthd

7. Trifluridina

8. Virophta

9. 5-(trifluoromethyl)deoxyuridine

10. F3tdr

11. Trifluridinum

12. 5-trifluoromethyl-2-deoxyuridine

13. Trifluorothymine Deoxyriboside

14. 5-trifluoromethyl-2'-deoxyuridine

15. 1-((2r,4s,5r)-4-hydroxy-5-(hydroxymethyl)tetrahydrofuran-2-yl)-5-(trifluoromethyl)pyrimidine-2,4(1h,3h)-dione

16. 2'-deoxy-5-trifluoromethyluridine

17. Tfdu

18. 2'-deoxy-5-(trifluoromethyl)uridine

19. Nsc 75520

20. Nsc 529182

21. Uridine, 2'-deoxy-5-(trifluoromethyl)-

22. Trifluridine (viroptic)

23. Chembl1129

24. Rmw9v5rw38

25. Mls000028361

26. Chebi:75179

27. Nsc-75520

28. 1-[(2r,4s,5r)-4-hydroxy-5-(hydroxymethyl)oxolan-2-yl]-5-(trifluoromethyl)pyrimidine-2,4-dione

29. Nsc-529182

30. F3t

31. Triflurdine (viroptic)

32. Fluridine

33. Smr000058583

34. Trifluridinum [inn-latin]

35. Trifluridina [inn-spanish]

36. Dsstox_cid_26602

37. Dsstox_rid_81757

38. Dsstox_gsid_46602

39. 5-trifluoro-2'-deoxythymidine

40. 5-(trifluoromethyl)-2'-deoxyuridine

41. Alpha,alpha,alpha-trifluorothymidine

42. Cf3durd

43. Viroptic (tn)

44. Thymidine, Alpha,alpha,alpha-trifluoro-

45. Ccris 2348

46. Einecs 200-722-8

47. Mfcd00006534

48. Unii-rmw9v5rw38

49. Brn 0568095

50. Nsc75520

51. Nsc529182

52. Trifluridine [usan:usp:inn]

53. Hsdb 8126

54. Cas-70-00-8

55. Ncgc00166323-01

56. Hs-0007

57. Opera_id_1810

58. 5-trifluoromethylthymidine

59. Trifluridine [mi]

60. Trifluridine [inn]

61. Trifluridine [jan]

62. Trifluoromethyl Deoxyuridine

63. Trifluridine [usan]

64. Cid_6256

65. Schembl3479

66. 2,4(1h,3h)-pyrimidinedione, 1-(2-deoxy-beta-d-ribofuranosyl)-5-(trifluoromethyl)-

67. Trifluridine [vandf]

68. Trifluridine [mart.]

69. Mls001148248

70. Mls006010219

71. Trifluridine [usp-rs]

72. Trifluridine [who-dd]

73. Trifluridine (jan/usp/inn)

74. Gtpl8697

75. Dtxsid4046602

76. Cid_6708818

77. Hms2233n19

78. Hms3715c14

79. Trifluridine [orange Book]

80. Trifluridine [ep Monograph]

81. 5-trifluoromethyl-2''-deoxyuridine

82. Bcp09147

83. Hy-a0061

84. Zinc3842753

85. Tox21_112411

86. Trifluridine [usp Monograph]

87. Bdbm50132298

88. Trifluorothymidine, >=99% (hplc)

89. Akos015919482

90. Tox21_112411_1

91. Ccg-221056

92. Cs-1602

93. Db00432

94. Tas-102 Component Trifluridine

95. Trifluridine Component Of Lonsurf

96. Ncgc00166323-02

97. Ncgc00166323-16

98. S-95005 Component Trifluridine

99. 1-[(2r,4s,5r)-4-hydroxy-5-(hydroxymethyl)oxolan-2-yl]-5-(trifluoromethyl)-1,2,3,4-tetrahydropyrimidine-2,4-dione

100. 1-[(2r,4s,5r)-4-hydroxy-5-(hydroxymethyl)tetrahydrofuran-2-yl]-5-(trifluoromethyl)pyrimidine-2,4-dione

101. Sri-10817-12

102. Sri-10817_14

103. Am20100660

104. S1778

105. Sw199522-2

106. T2511

107. D00391

108. Thymidine, .alpha.,.alpha.,.alpha.-trifluoro-

109. 006t534

110. A836733

111. Sr-01000721911

112. J-700255

113. J-700357

114. Q2359590

115. Sr-01000721911-2

116. Brd-k03243820-001-12-1

117. Brd-k03243820-001-25-3

118. Trifluridine, British Pharmacopoeia (bp) Reference Standard

119. Trifluridine;ftd;5-trifluorothymidine;nsc 529182;nsc 75520

120. Trifluridine, United States Pharmacopeia (usp) Reference Standard

121. 1-((2r,4s,5r)-4-hydroxy-5-(hydroxymethyl)-tetrahydrofuran-2-yl)-5-(trifluoromethyl)pyrimidine-2,4(1h,3h)-dione

122. 1-((2r,5r)-4-hydroxy-5-hydroxymethyl-tetrahydro-furan-2-yl)-5-trifluoromethyl-1h-pyrimidine-2,4-dione

2.4 Create Date

2005-06-24

3 Chemical and Physical Properties

Molecular Formula	C₁₀H₁₁F₃N₂O₅
Molecular Weight	296.20 g/mol
XLogP3	-0.5
Hydrogen Bond Donor Count	3
Hydrogen Bond Acceptor Count	8
Rotatable Bond Count	2
Exact Mass	296.06200594 g/mol
Monoisotopic Mass	296.06200594 g/mol
Topological Polar Surface Area	99.1 Å²
Heavy Atom Count	20
Formal Charge	0
Complexity	464
Isotope Atom Count	0
Defined Atom Stereocenter Count	3
Undefined Atom Stereocenter Count	0
Defined Bond Stereocenter Count	0
Undefined Bond Stereocenter Count	0
Covalently Bonded Unit Count	1

4 Drug and Medication Information

4.1 Drug Information

1 of 4
Drug Name	Trifluridine
PubMed Health	Trifluridine (Into the eye)
Drug Classes	Antiviral
Drug Label	Trifluridine Ophthalmic Solution (also known as trifluorothymidine, F3TdR, F3T), an antiviral drug for topical treatment of epithelial keratitis caused by herpes simplex virus. The chemical name of trifluridine is ,,-trifluorothymidine. Triflur...
Active Ingredient	Trifluridine
Dosage Form	Solution/drops
Route	Ophthalmic
Strength	1%
Market Status	Prescription
Company	Alcon Pharms

2 of 4
Drug Name	Viroptic
PubMed Health	Trifluridine (Into the eye)
Drug Classes	Antiviral
Drug Label	VIROPTIC is the brand name for trifluridine (also known as trifluorothymidine, F3TdR,F3T), an antiviral drug for topical treatment of epithelial keratitis caused by herpes simplex virus. The chemical name of trifluridine is ,, -trifluorothymidi...
Active Ingredient	Trifluridine
Dosage Form	Solution/drops
Route	Ophthalmic
Strength	1%
Market Status	Prescription
Company	Monarch Pharms

3 of 4
Drug Name	Trifluridine
PubMed Health	Trifluridine (Into the eye)
Drug Classes	Antiviral
Drug Label	Trifluridine Ophthalmic Solution (also known as trifluorothymidine, F3TdR, F3T), an antiviral drug for topical treatment of epithelial keratitis caused by herpes simplex virus. The chemical name of trifluridine is ,,-trifluorothymidine. Triflur...
Active Ingredient	Trifluridine
Dosage Form	Solution/drops
Route	Ophthalmic
Strength	1%
Market Status	Prescription
Company	Alcon Pharms

4 of 4
Drug Name	Viroptic
PubMed Health	Trifluridine (Into the eye)
Drug Classes	Antiviral
Drug Label	VIROPTIC is the brand name for trifluridine (also known as trifluorothymidine, F3TdR,F3T), an antiviral drug for topical treatment of epithelial keratitis caused by herpes simplex virus. The chemical name of trifluridine is ,, -trifluorothymidi...
Active Ingredient	Trifluridine
Dosage Form	Solution/drops
Route	Ophthalmic
Strength	1%
Market Status	Prescription
Company	Monarch Pharms

4.2 Therapeutic Uses

Trifluridine Ophthalmic Solution is indicated for the treatment of primary keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex virus, types 1 and 2. /Included in US product label/

US Natl Inst Health; DailyMed. Current Medication Information for TRIFLURIDINE solution (August 2011). Available from, as of March 12, 2013: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=abc1d07f-91ee-4421-bc9b-457d0ed41f4c

Trifluridine is also effective in the treatment of epithelial keratitis that has not responded clinically to the topical administration of idoxuridine or when ocular toxicity or hypersensitivity to idoxuridine has occurred. In a smaller number of patients found to be resistant to topical vidarabine, trifluridine was also effective.

4.3 Drug Warning

Trifluridine 1% ophthalmic solution is contraindicated in patients who have chemical intolerance or are hypersensitive to the drug or any ingredient in the formulation.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

Trifluridine should be used only under the close supervision of an ophthalmologist. In addition, the recommended dosage and frequency of administration should not be exceeded.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

If trifluridine is used in smallpox vaccinees who have vaccinia lesions on or near the eyelid for prophylaxis to prevent extension of vaccinia infection to the conjunctiva or cornea, the potential benefit of the drug should be balanced against the minimal but potential risk of drug toxicity and of introducing the virus into the eye by frequent manipulation.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

FDA Pregnancy Risk Category: C /RISK CANNOT BE RULED OUT. Adequate, well controlled human studies are lacking, and animal studies have shown risk to the fetus or are lacking as well. There is a chance of fetal harm if the drug is given during pregnancy; but the potential benefits may outweigh the potential risk./

For more Drug Warnings (Complete) data for Trifluridine (8 total), please visit the HSDB record page.

4.4 Drug Indication

Trifluridine is used for the treatment of primay keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex virus, types 1 and 2 in ophthalmic solutions. Trifluridine, in combination with tipiracil as oral tablets, is indicated for the treatment of adult patients with metastatic colorectal cancer who have been previously treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy, an anti-VEGF biological therapy, and if RAS wild-type, an anti-EGFR therapy.

FDA Label

5 Pharmacology and Biochemistry

5.1 Pharmacology

Trifluridine exhibits an antiviral effect against herpes simplex virus, types 1 and 2 and vacciniavirus both in vitro and in vivo. Some strains of adenovirus that contribute to the pathology of keratoconjunctivitis were shown to be susceptible to trifluridine _in vitro_. While there is evidence from a study that cross-resistance may develop between trifluridine and [idoxuridine] or [vidarabine], trifluridine was shown to effective in treating dendritic ulcers in patients with herpetic keratitis who are unresponsive to [idoxuridine] or [vidarabine] based on the results from masked comparative trials. In nonclinical studies, trifluridine/tipiracil hydrochloride demonstrated antitumour activity against both 5-fluorouracil (5-FU) sensitive and resistant colorectal cancer cell lines. The cytotoxic activity of trifluridine and tipiracil against several human tumour xenografts show high correlation with the amount of trifluridine incorporated into DNA, indicating that the primary mechanism of action of trifluridine involves the direct incorporation into the cancer cell DNA. Trifluridine and tipiracil demonstrated anti-tumor activity against KRAS wild-type and mutant human colorectal cancer xenografts in mice. In clinical studies comprised of patients with previously treated metastatic colorectal cancer, treatment of trifluridine in combination with tipiracil in addition to best supportive care over a 5- or 7-month period resulted in increased progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) compared to placebo. In an open-label study, administration of trifluridine at the recommended dosage in patients with advanced solid tumors had no clinically relevant effect on QT/QTc prolongation compared with placebo. Two out of 48 patients displayed had QTc greater than 500 msec and 1 of 42 patients (2.4%) had a QTc increase from baseline greater than 60 msec.

5.2 MeSH Pharmacological Classification

Antiviral Agents

Agents used in the prophylaxis or therapy of VIRUS DISEASES. Some of the ways they may act include preventing viral replication by inhibiting viral DNA polymerase; binding to specific cell-surface receptors and inhibiting viral penetration or uncoating; inhibiting viral protein synthesis; or blocking late stages of virus assembly. (See all compounds classified as Antiviral Agents.)

Antimetabolites

Drugs that are chemically similar to naturally occurring metabolites, but differ enough to interfere with normal metabolic pathways. (From AMA Drug Evaluations Annual, 1994, p2033) (See all compounds classified as Antimetabolites.)

5.3 FDA Pharmacological Classification

5.3.1 Active Moiety

TRIFLURIDINE

5.3.2 FDA UNII

RMW9V5RW38

5.3.3 Pharmacological Classes

Nucleoside Analog Antiviral [EPC]; Nucleoside Analog [EXT]; Nucleoside Metabolic Inhibitor [EPC]; Nucleic Acid Synthesis Inhibitors [MoA]

5.4 ATC Code

L01BC59

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355

S - Sensory organs

S01 - Ophthalmologicals

S01A - Antiinfectives

S01AD - Antivirals

S01AD02 - Trifluridine

5.5 Absorption, Distribution and Excretion

Absorption

Systemic absorption of trifluridine following therapeutic dosing with ophthalmic trifluridine appears to be negligible. At least 57% of the orally-administered trifluridine is absorbed. Following twice daily oral dosing of trifluridine in combination with tipiracil, systemic exposure of trifluridine increased more than dose-proportionally over the dose range of 15 to 35 mg/m^2. Trifluridine accumulation was 3-fold for AUC0-last and 2-fold for peak plasma concentration (Cmax) at steady state. The time to reach the peak plasma concentrations (Cmax) was 2 hours. Tipiracil increases the AUC and Cmax of trifluridine. Food intake was shown to decrease the Cmax and AUC compared to those in a fasting state.

Route of Elimination

About 55% of the total recovered radio-labelled trifluridine was detected in the urine within 24 hours. Following oral administration of trifluridine in combination with tipiracil, only 3% of the total dose was excreted into faeces and expired air. Administration of a 60mg single oral dose of the combination product resulted in the mean urinary recovery of 1.5% of unchanged trifluridine and 19.2% for the inactive metabolite FTY after the 48-hour cumulative excretion.

Volume of Distribution

Following a single dose of Lonsurf (35 mg/m2) in patients with advanced solid tumours, the apparent volume of distribution (Vd/F) for trifluridine was 21 L.

Clearance

Following a single dose of Lonsurf (35 mg/m^2) in patients with advanced solid tumours, the oral clearance (CL/F) for trifluridine was 10.5 L/hr.

Following topical application of trifluridine to the eye, the drug penetrates the cornea and can be detected in the aqueous humor.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

Systemic absorption following ocular application of trifluridine appears to be negligible. In one study in healthy individuals, topical application of trifluridine 1% ophthalmic solution to the eyes 7 times daily for 14 consecutive days did not result in detectable serum concentrations of trifluridine or 5-carboxy-2'-deoxyuridine.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

During in vitro studies using excised rabbit corneas, the major metabolite of trifluridine, 5-carboxy-2'-deoxyuridine, was found on the endothelial side of the cornea in addition to the parent compound; however, detectable levels of the metabolite have not been found in the aqueous humor in humans.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

It is unlikely that trifluridine is excreted in human milk after ophthalmic instillation of trifluridine because of the relatively small dosage (

5.6 Metabolism/Metabolites

One major metabolite, 5-carboxy-2'-deoxyuridine found on the endothelial side of the cornea, indicating localized metabolism. Trifluridine is mainly eliminated by metabolism via thymidine phosphorylase (TPase) to form an inactive metabolite, 5-(trifluoromethyl) uracil (FTY).

The major metabolite of trifluridine (5-carboxy-2'-deoxyuridine appears) to have some antiviral activity but substantially less than that of the parent drug.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

19F NMR spectroscopy has been used to study further the metabolism of 5-trifluoromethyl-2'-deoxyuridine (trifluridine; F3TdR). The synthesis and characterization of alpha-trifluoromethyl-beta-alanyl glycine (F3MBAG), a putative new metabolite of F3TdR, are now reported. This study describes ex vivo and in vivo detection of F3MBAG and other previously reported metabolites of trifluridine, using 19F NMR spectroscopy, in male BALB/C mice bearing EMT-6 tumors. A parallel 19F NMR spectroscopic study was also performed on rats dosed with F3TdR, to observe the qualitative pattern of F3TdR metabolism in another species. Unexpectedly, 5-trifluoromethyl-5,6-dihydroxyuracil (DOHF3T), alpha-trifluoromethyl-beta-ureidopropionic acid (F3MUPA) and fluoride, which result from the metabolic degradation of F3TdR and which were detected in various biological samples from mice dosed with F3TdR, could not be identified in rat urine or in homogenized tissue extracts. The presence of these metabolites in intact tissues is uncertain since in this study 19F NMR spectroscopy of these samples always displayed a broad resonance "hump" across the range of chemical shifts that would encompass these metabolites. No clear explanation for the loss of spectroscopic resolution in this region has been rationalized. N-Carboxy-alpha-trifluoromethyl-beta-alanine (F3MBA-CO2), alpha-trifluoromethyl-beta-alanyl alanine (F3MBAA) and N-acetyl-alpha-trifluoromethyl-beta-alanine (Ac-F3MBA) were synthesized and characterized, but were not detected as metabolites in any of the biological specimens examined.

PMID:8093091 Tandon M et al; Biochem Pharmacol. 48 (5):1033-41 (1994)

5.7 Biological Half-Life

The half life is 12 to 18 minutes following ophthalmic administration. After administration of trifluridine with tipiracil at oral doses 35 mg/m^2 twice daily, the mean elimination half-life (t1/2) of trifluridine was 1.4 hours following a single dose. At steady state, the mean elimination half-life was 2.1 hours.

5.8 Mechanism of Action

The mechanism of action of trifluridine as an antiviral agent has not been fully elucidated, but appears to involve the inhibition of viral replication. Trifluridine gets incorporated into viral DNA during replication, which leads to the formation of defective proteins and an increased mutation rate. Trifluridine also mediates antineoplastic activities via this mechanism; following uptake into cancer cells, trifluridine is rapidly phosphorylated by thymidine kinase to its active monophosphate form. Subsequent phosphorylation produces trifluridine triphosphate, which is readily incorporated into the DNA of tumour cells in place of thymidine bases to perturb DNA function, DNA synthesis, and tumour cell proliferation. As trifluridine is subject to rapid degradation by TPase and readily metabolised by a first-pass effect following oral administration, tipiracil is added in the antineoplastic combination product as an inhibitor of TPase to increase the bioavailability of trifluridine. Trifluridine monophosphate also reversibly inhibits thymidylate synthetase (TS), an enzyme that is necessary for DNA synthesis and which levels are shown to be elevated different cancer cell lines. Up-regulation of the expression of the TS enzyme may also lead to the resistance to antineoplastic therapies, such as 5-fluorouracil (5-FU). However, this inhibitory effect is not considered to be sufficient enough to fully contribute to the cytotoxicity in cancer cells.

Trifluridine is a fluorinated pyrimidine nucleoside with in vitro and in vivo activity against herpes simplex virus, types 1 and 2 and vacciniavirus. Some strains of adenovirus are also inhibited in vitro. ...Trifluridine interferes with DNA synthesis in cultured mammalian cells. However, its antiviral mechanism of action is not completely known

The exact mechanism of antiviral activity of trifluridine has not been fully elucidated, but appears to involve inhibition of viral replication. Trifluridine, instead of thymidine, is incorporated into viral DNA during replication which results in the formation of defective proteins and an increased mutation rate. Trifluridine also reversibly inhibits thymidylate synthetase, an enzyme required for DNA synthesis.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

Trifluridine has shown antiviral activity in vitro and in vivo against herpes simplex virus types 1 and 2 (HSV-1 and HSV-2). The drug is active in vitro against vaccinia virus and has shown in vivo activity in the treatment of vaccinia keratitis in rabbits. Trifluridine also has shown antiviral activity in cell culture against some strains of adenovirus. Trifluridine is inactive against bacteria, fungi, and Chlamydia.

American Society of Health-System Pharmacists 2012; Drug Information 2012. Bethesda, MD. 2012

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