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Chemistry

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Also known as: 52128-35-5, Ci-898, Jb-11, Trimetrexatum [inn-latin], Trimetrexato [inn-spanish], Nsc-249008
Molecular Formula
C19H23N5O3
Molecular Weight
369.4  g/mol
InChI Key
NOYPYLRCIDNJJB-UHFFFAOYSA-N
FDA UNII
UPN4ITI8T4

Trimetrexate
A nonclassical folic acid inhibitor through its inhibition of the enzyme dihydrofolate reductase. It is being tested for efficacy as an antineoplastic agent and as an antiparasitic agent against PNEUMOCYSTIS PNEUMONIA in AIDS patients. Myelosuppression is its dose-limiting toxic effect.
1 2D Structure

Trimetrexate

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
5-methyl-6-[(3,4,5-trimethoxyanilino)methyl]quinazoline-2,4-diamine
2.1.2 InChI
InChI=1S/C19H23N5O3/c1-10-11(5-6-13-16(10)18(20)24-19(21)23-13)9-22-12-7-14(25-2)17(27-4)15(8-12)26-3/h5-8,22H,9H2,1-4H3,(H4,20,21,23,24)
2.1.3 InChI Key
NOYPYLRCIDNJJB-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CC1=C(C=CC2=C1C(=NC(=N2)N)N)CNC3=CC(=C(C(=C3)OC)OC)OC
2.2 Other Identifiers
2.2.1 UNII
UPN4ITI8T4
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Ci 898

2. Ci-898

3. Ci898

4. Hydrate, Trimetrexate

5. Jb 11

6. Jb-11

7. Jb11

8. Monohydrate, Monoacetate Trimetrexate

9. Nsc 249008

10. Nsc 328564

11. Nsc-249008

12. Nsc-328564

13. Nsc249008

14. Nsc328564

15. Trimetrexate Hydrate

16. Trimetrexate Monohydrate, Monoacetate

2.3.2 Depositor-Supplied Synonyms

1. 52128-35-5

2. Ci-898

3. Jb-11

4. Trimetrexatum [inn-latin]

5. Trimetrexato [inn-spanish]

6. Nsc-249008

7. Neutrexin

8. Tmq

9. Nsc 249008

10. 5-methyl-6-[(3,4,5-trimethoxyanilino)methyl]quinazoline-2,4-diamine

11. Nsc249008

12. Upn4iti8t4

13. Chembl119

14. 2,4-diamino-5-methyl-6-((3,4,5-trimethoxyanilino)methyl)quinazoline

15. 2,4-quinazolinediamine, 5-methyl-6-(((3,4,5-trimethoxyphenyl)amino)methyl)-

16. 5-methyl-6-(((3,4,5-trimethoxyphenyl)amino)methyl)quinazoline-2,4-diamine

17. Trimetrexato

18. Trimetrexatum

19. 5-methyl-6-{[(3,4,5-trimethoxyphenyl)amino]methyl}quinazoline-2,4-diamine

20. Trimetrexate Hydrate

21. Jb 11

22. 2,4-quinazolinediamine,5-methyl-6-[[(3,4,5-trimethoxyphenyl)amino]methyl]-

23. Hsdb 6545

24. Ncgc00161419-02

25. Unii-upn4iti8t4

26. Trimetrexate (usan/inn)

27. Trimetrexate [usan:inn:ban]

28. 5-methyl-6-[[(3,4,5-trimethoxyphenyl)amino]methyl]quinazoline-2,4-diamine

29. 5-methyl-6-(((3,4,5-trimethoxyphenyl)amino)methyl)-2,4-quinazolinediamine

30. Trimetrexate [mi]

31. Trimetrexate [inn]

32. Trimetrexate [hsdb]

33. Trimetrexate [usan]

34. Schembl3983

35. Trimetrexate [vandf]

36. Bidd:gt0129

37. Trimetrexate [who-dd]

38. Chebi:9737

39. Gtpl7613

40. Dtxsid3023714

41. Bdbm18268

42. Zinc598852

43. Bcp15515

44. 6-[((3,4,5-trimethoxyphenyl)amino)methyl]-5-methyl-2,4-quinazolinediamine

45. Db01157

46. 5-methyl-6-({[3,4,5-tris(methyloxy)phenyl]amino}methyl)quinazoline-2,4-diamine

47. Ncgc00161419-01

48. Ncgc00161419-03

49. Ncgc00161419-04

50. Hy-10373

51. Ft-0649497

52. D06238

53. A913386

54. Q7842225

55. 2, 5-methyl-6-[[(3,4,5-trimethoxyphenyl)amino]methyl]-

56. 2,4-diamino-5-methyl-6-[(3,4,5-trimethoxyphenylamino)methyl]quinazoline

57. 251301-18-5

2.4 Create Date
2005-03-25
3 Chemical and Physical Properties
Molecular Weight 369.4 g/mol
Molecular Formula C19H23N5O3
XLogP32.5
Hydrogen Bond Donor Count3
Hydrogen Bond Acceptor Count8
Rotatable Bond Count6
Exact Mass369.18008961 g/mol
Monoisotopic Mass369.18008961 g/mol
Topological Polar Surface Area118 Ų
Heavy Atom Count27
Formal Charge0
Complexity457
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 Therapeutic Uses

Antifungal Agents; Antimetabolites; Antimetabolites, Antineoplastic; Folic Acid Antagonists

National Library of Medicine's Medical Subject Headings online file (MeSH, 1999)


Antineoplastic

Budavari, S. (ed.). The Merck Index - Encyclopedia of Chemicals, Drugs and Biologicals. Rahway, NJ: Merck and Co., Inc., 1989., p. 1529


Trimetrexate glucuronate is an investigational drug that is available for treatment use ... in a hospital setting in qualifying patients with Pneumocystis carinii pneumonia and who have exhibited serious ... intolerance to both co-trimoxazole and pentamidine. /Trimetrexate glucuronate/

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 93. Bethesda, MD: American Society of Hospital Pharmacists, Inc., 1993 (Plus Supplements, 1993)., p. 2395


4.2 Drug Warning

Even though trimetrexate does not compete with the folate transport system for entry into cells, utilization of folates is reduced due to inhibition of dihydrofolate reductase. When trimetrexate is administered in high doses for the treatment of pneumocystis carinii pneumonia, leucovorin must be given concurrently with trimetrexate to reduce toxic effects on human tissues. It has been postulated that the absence of a folate transport system in pneumocystis carinii provides the opportunity for differential rescue of host tissue affecting antiprotozoal action.

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


Patients receiving trimetrexate should have frequent laboratory monitoring of hepatic and hematologic prameters, including serum alanine aminotransferase, serum aspartate aminotransferase, bilirubin, alkaline phosphatase, platelet count, and total and differential leukocyte counts. Although uncommon in AIDS patients receiving trimetrexate for pneumocystis carinii pneumonia, slight elevations of blood urea nitrogen and/or serum creatinine have been reported in patients receiving the drug for various cancers.

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


Isolated perfused rat liver has been used to study potential drug interactions with trimetrexate metabolism in vitro. Cimetidine, which inhibits oxidative drug metabolizing enzymes, decreased the clearance of trimetrexate to approximately one half of control values. Whether this occurs to a significant extent in vivo is unknown.

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


4.3 Drug Indication

For use, with concurrent leucovorin administration (leucovorin protection), as an alternative therapy for the treatment of moderate-to-severe Pneumocystis carinii pneumonia (PCP) in immunocompromised patients, including patients with the acquired immunodeficiency syndrome (AIDS). Also used to treat several types of cancer including colon cancer.


FDA Label


5 Pharmacology and Biochemistry
5.1 Pharmacology

Trimetrexate, a non-classical folate antagonist, is a synthetic inhibitor of the enzyme dihydrofolate reductase (DHFR). During DNA synthesis and cellular reproduction, folic acid is reduced to tetrahydrofolic acid by the enzyme folic acid reductase. By interfering with the reduction of folic acid, trimetrexate interferes with tissue cell reproduction. Generally, the most sensitive cells to the antimetabolite effect of trimetrexate are those cells which are most actively proliferating such as malignant cells, dermal epithelium, buccal and intestinal mucosa, bone marrow, fetal cells, and cells of the urinary bladder. Because the proliferation of cells in malignant tissues is greater than in most normal tissues, trimetrexate may impair the growth of the malignant tissues without causing irreversible damage to normal tissues. Due to very serious and potentially life-threatening side-effects of this drug, leucovorin must be co-administered for at least 72 hours after the last dose.


5.2 MeSH Pharmacological Classification

Antifungal Agents

Substances that destroy fungi by suppressing their ability to grow or reproduce. They differ from FUNGICIDES, INDUSTRIAL because they defend against fungi present in human or animal tissues. (See all compounds classified as Antifungal Agents.)


Antimetabolites, Antineoplastic

Antimetabolites that are useful in cancer chemotherapy. (See all compounds classified as Antimetabolites, Antineoplastic.)


Folic Acid Antagonists

Inhibitors of the enzyme, dihydrofolate reductase (TETRAHYDROFOLATE DEHYDROGENASE), which converts dihydrofolate (FH2) to tetrahydrofolate (FH4). They are frequently used in cancer chemotherapy. (From AMA, Drug Evaluations Annual, 1994, p2033) (See all compounds classified as Folic Acid Antagonists.)


5.3 ATC Code

P - Antiparasitic products, insecticides and repellents

P01 - Antiprotozoals

P01A - Agents against amoebiasis and other protozoal diseases

P01AX - Other agents against amoebiasis and other protozoal diseases

P01AX07 - Trimetrexate


5.4 Absorption, Distribution and Excretion

Route of Elimination

Ten to 30% of the administered dose is excreted unchanged in the urine.


Volume of Distribution

20 8 L/m2

36.9 6 L/m2 [cancer patients]


Clearance

38 +/- 15 mL/min/m2 [patients with acquired immunodeficiency syndrome (AIDS) who had Pneumocystis carinii pneumonia (4 patients) or toxoplasmosis (2 patients). Trimetrexate was administered intravenously as a bolus injection at a dose of 30 mg/m2/day along with leucovorin 20 mg/m2 every 6 hours for 21 days]

53 +/- 41 mL/min/m2 [Cancer patients with advanced solid tumors using various dosage regimensreceiving a single-dose administration of 10 to 130 mg/m2]

30 +/- 8 mL/min/m2 [Cancer patients with advanced solid tumors using various dosage regimensafter a five-day infusion]


Clinical pharmacokinetic studies in cancer patients show that trimetrexate plasma concentration-time curves are biphasic or triphasic in form. The terminal elimination half-life averages 13.6 hr. Mean total plasma clearance and volume of distribution as steady-state values were 27.9 ml/min/sq m and 21.1 l/sq m, respectively. Cerebrospinal fluid concentration was 3.4% of that in plasma, which shows that trimetrexate does not cross the blood-brain barrier well. Trimetrexate is 86 to 94% bound to plasma proteins.

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


Mean oral bioavailability of the parenteral solution (glucuronate) in AIDS patients was 42%, with a mean maximum plasma concentration of 1182 ng/ml (3.2 umole/l) achieved 1.8 hr postdose. /Trimetrexate glucuromate/

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


5.5 Metabolism/Metabolites

Hepatic. Preclinical data strongly suggest that the major metabolic pathway is oxidative O-demethylation, followed by conjugation to either glucuronide or the sulfate.


Trimetrexate is highly metabolized by the liver. At least 2 metabolites are excreted in urine. One metabolite has been identified a 4'-O-glucuronide conjugate of trimetrexate, which is formed as a result of oxidative O-dimethylation at the 4'-position and subsequent conjugation with glucuronic acid. About 15% of a dose is excreted in urine as unchanged trimetrexate, while another 20% apparently excreted as metabolites.

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


5.6 Biological Half-Life

11 to 20 hours


The terminal elimination half-life averages 13.6 hours.

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


5.7 Mechanism of Action

In vitro studies have shown that trimetrexate is a competitive inhibitor of dihydrofolate reductase (DHFR) from bacterial, protozoan, and mammalian sources. DHFR catalyzes the reduction of intracellular dihydrofolate to the active coenzyme tetrahydrofolate. Inhibition of DHFR results in the depletion of this coenzyme, leading directly to interference with thymidylate biosynthesis, as well as inhibition of folate-dependent formyltransferases, and indirectly to inhibition of p.r.n. biosynthesis. The end result is disruption of DNA, RNA, and protein synthesis, with consequent cell death.


Trimetrexate binds to dihydrofolate reductase and prevents the conversion of dihydrofolate to biologically active tetrahydrofolate. It inhibits nucleic acid synthesis as a result of antithymidylate and antipurine effects.

US Pharmacopeial Convention; US Pharmacopeia Dispensing Information (USP DI); Drug Information for the Health Care Professional 12th ed, V.I p.V/56 (1992)


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