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Eletriptan

From Wikipedia, the free encyclopedia
Chemical compound

Pharmaceutical compound
Eletriptan
Clinical data
Trade namesRelpax, others
Other namesUK-116044; UK116044
AHFS/Drugs.comMonograph
MedlinePlusa603029
License data
Pregnancy
category
Routes of
administration
By mouth
Drug classSerotonin5-HT1B,5-HT1D,5-HT1E, and5-HT1F receptoragonist;Triptan;Antimigraine agent
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability50%[2]
MetabolismMainlyCYP3A4[2]
Eliminationhalf-life4 hours[2]
Identifiers
  • 3-{[(2R)-1-methylpyrrolidin-2-yl]methyl}-5-[2-(benzenesulfonyl)ethyl]-1H-indole
CAS Number
PubChemCID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard(EPA)
ECHA InfoCard100.167.337Edit this at Wikidata
Chemical and physical data
FormulaC22H26N2O2S
Molar mass382.52 g·mol−1
3D model (JSmol)
  • CN1CCC[C@@H]1Cc3c[nH]c4ccc(CCS(=O)(=O)c2ccccc2)cc34
  • InChI=1S/C22H26N2O2S/c1-24-12-5-6-19(24)15-18-16-23-22-10-9-17(14-21(18)22)11-13-27(25,26)20-7-3-2-4-8-20/h2-4,7-10,14,16,19,23H,5-6,11-13,15H2,1H3/t19-/m1/s1 checkY
  • Key:PWVXXGRKLHYWKM-LJQANCHMSA-N checkY
  (verify)

Eletriptan, sold under the brand nameRelpax and used in the form of eletriptan hydrobromide, is a second-generationtriptanmedication intended for treatment ofmigraineheadaches.[2][3][4] It is used as anabortive medication, blocking a migraine attack which is already in progress.[2] Eletriptan is marketed and manufactured byPfizer.[2]

Eletriptan is a therapeutic alternative on theWorld Health Organization's List of Essential Medicines.[5]

Medical uses

[edit]

Eletriptan was approved by the United StatesFood and Drug Administration (FDA) in December 2002, for the acute treatment of migraine with or withoutaura in adults.[6][2] It is available only byprescription in the United States, Canada, and Australia. It is not intended for the prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine.[2] It is available in 20 mg and 40 mg strengths.[2]

Contraindications

[edit]

Eletriptan is contraindicated in patients with various diseases of the heart and circulatory system, such as angina pectoris, severe hypertension, andheart failure, as well as in patients that have had a stroke or heart attack.[2] This is due to the unusual side effect of coronary vasoconstriction due to serotonin 5-HT1B receptor agonism, which can precipitate aheart attack in those already at risk.[2] It is also contraindicated in severekidney (renal) orliver (hepatic) impairment due to its extensive liver metabolism throughCYP3A4.[7][2]

Side effects

[edit]

Common side effects includehypertension,tachycardia, headache, dizziness, drowsiness, and symptoms similar toangina pectoris.[2] Severe allergic reactions have been seen rarely.[7][2]

Interactions

[edit]

Strong inhibitors of the liver enzyme CYP3A4, such aserythromycin andketoconazole, significantly increase blood plasma concentration of eletriptan and should be separated by at least 72 hours.[2]Ergot alkaloids, such asdihydroergotamine, add to the drug's hypertensive effect and should be separated by at least 24 hours.[7][2]

Pharmacology

[edit]

Mechanism of action

[edit]
See also:Triptan § Mechanism of action
Eletriptan activities
TargetAffinity (Ki, nM)
5-HT1A1.9–45 (Ki)
417–1,820 (EC50Tooltip half-maximal effective concentration)
5-HT1B0.52–15.1 (Ki)
8.1–60 (EC50)
83% (
EmaxTooltip maximal efficacy)
5-HT1D0.10–1.5 (Ki)
0.63–0.91 (EC50)
5-HT1E40–62 (Ki)
30–126 (EC50)
5-HT1F5–20 (Ki)
7.4–132 (EC50)
5-HT2A1,150–>3,160 (Ki)
851 (EC50)
5-HT2B447 (Ki)
155 (EC50)
5-HT2C>3,160 (Ki)
ND (EC50)
5-HT3>3,160 (mouse)
5-HT4>3,160 (guinea pig)
5-HT5A977–1,584 (rat)
5-HT6525
5-HT7200 (Ki)
355 (EC50)
α1Aα1DND
α2Aα2CND
β1β3ND
D1D5ND
H1H4ND
M1M5ND
I1,I2ND
σ1,σ2ND
TAAR1Tooltip Trace amine-associated receptor 1ND
SERTTooltip Serotonin transporterND
NETTooltip Norepinephrine transporterND
DATTooltip Dopamine transporterND
Notes: The smaller the value, the more avidly the drug binds to the site. All proteins are human unless otherwise specified.Refs:[8][9][10][11][12][13][14][15]
[16][17][18][19]

Eletriptan is believed to reduce swelling of the blood vessels surrounding the brain. This swelling is associated with the head pain of a migraine attack. Eletriptan blocks the release of substances from nerve endings that cause more pain and other symptoms like nausea, and sensitivity to light and sound. It is thought that these actions contribute to relief of symptoms by eletriptan.

Eletriptan is aserotonin receptor agonist, specifically anagonist of certain5-HT1 family receptors.[2] Eletriptan binds with high affinity to the5-HT[1B,1D,1F] receptors. It has a modest affinity to the5-HT[1A,1E,2B,7] receptors, and little to no affinity at the5-HT[2A,2C,3,4,5A,6] receptors.

Eletriptan has no significant affinity or pharmacological activity atadrenergicα1,α2, orβ;dopaminergicD1 orD2;muscarinic; oropioid receptors. Eletriptan could be efficiently co-administered with nitric oxide synthase (NOS's) inhibitors for the treatment of NOS-dependent diseases (US patent US 2007/0254940).

Two theories have been proposed to explain the efficacy of 5-HT1 receptor agonists in migraine. One theory suggests that activation of 5-HT1 receptors located on intracranial blood vessels, including those on the arteriovenous anastomoses, leads to vasoconstriction, which is correlated with the relief of migraine headache. The other hypothesis suggests that activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system results in the inhibition of pro-inflammatory neuropeptide release.

The drug is also notable in being a weak serotonin5-HT2A receptor agonist (EC50Tooltip half-maximal effective concentration = 851 nM), albeit with about two to three orders of magnitude lower activational potency than at the serotonin 5-HT1B and 5-HT1D receptors.[16]

Chemistry

[edit]

Eletriptan is atryptamine andpyrrolidinylmethylindolederivative and is a 5-substituted andcyclized tryptamine derivative of thepsychedelic drugdimethyltryptamine (DMT).[20]

The experimentallog P is 3.9 and its predicted log P is 1.78 to 4.1.[21][20][22]

Additional chemical names

[edit]
  • Merck Index: 3-[[(2R)-1-Methyl-2-pyrrolidinyl]methyl]-5-[2-(phenylsulfonyl)ethyl]-1H-indole
  • 5-[2-(benzenesulfonyl)ethyl]-3-(1-methylpyrrolidin-2(R)-ylmethyl)-1H-indole
  • (R)-5-[2-(phenylsulfonyl)ethyl]-3-[(1-methyl-2-pyrrolidinyl)methyl]-1H-indole

History

[edit]

Eletriptan was approved for medical use in the United States in 2002.[2] It was covered byU.S. Patent no. 5545644[6][23] andU.S. Patent no. 6110940;[6][24] both now expired.

Society and culture

[edit]

Brand names

[edit]

Eletriptan is sold in the United States, Canada, Australia, and the United Kingdom under the brand name Relpax,[2][25][1] and in several other countries under the brand name Relert.[citation needed]

In the United States, Relpax is marketed byViatris after Upjohn was spun off from Pfizer.[26][27][28]

References

[edit]
  1. ^ab"Relpax 20mg Film-Coated Tablets. - Summary of Product Characteristics (SmPC)".(emc). 3 July 2020. Retrieved11 November 2020.
  2. ^abcdefghijklmnopqrst"Relpax- eletriptan hydrobromide tablet, film coated".DailyMed. 10 December 2019. Retrieved11 November 2020.
  3. ^Bhambri R, Mardekian J, Liu LZ, Schweizer E, Ramos E (2015)."A review of the pharmacoeconomics of eletriptan for the acute treatment of migraine".International Journal of General Medicine.8:27–36.doi:10.2147/IJGM.S73673.PMC 4296958.PMID 25624770.
  4. ^Capi M, Curto M, Lionetto L, de Andrés F, Gentile G, Negro A, et al. (September 2016)."Eletriptan in the management of acute migraine: an update on the evidence for efficacy, safety, and consistent response".Therapeutic Advances in Neurological Disorders.9 (5):414–23.doi:10.1177/1756285616650619.PMC 4994780.PMID 27582896.
  5. ^World Health Organization (2025).The selection and use of essential medicines, 2025: WHO Model List of Essential Medicines, 24th list. Geneva: World Health Organization.doi:10.2471/B09474.hdl:10665/382243.
  6. ^abc"Drug Approval Package: Relpax (Eletriptan) NDA #021016".U.S.Food and Drug Administration (FDA). 4 April 2002. Archived fromthe original on 12 November 2020. Retrieved11 November 2020.
  7. ^abcJasek W, ed. (2007).Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 6984–8.ISBN 978-3-85200-181-4.
  8. ^Liu T."BDBM50103594 CHEBI:50922::Eletriptan::UK-116044::UK-116044-04::UK-116044-04 [As Hydrobromide)".BindingDB. Retrieved19 July 2025.
  9. ^De Vries P, Villalón CM, Saxena PR (1999). "Pharmacology of triptans".Emerging Drugs.4 (1):107–125.doi:10.1517/14728214.4.1.107.ISSN 1361-9195.
  10. ^Tfelt-Hansen P, De Vries P, Saxena PR (December 2000). "Triptans in migraine: a comparative review of pharmacology, pharmacokinetics and efficacy".Drugs.60 (6):1259–1287.doi:10.2165/00003495-200060060-00003.PMID 11152011.
  11. ^Saxena PR, Tfelt-Hansen P (2001)."Success and failure of triptans".The Journal of Headache and Pain.2 (1):3–11.doi:10.1007/s101940170040.ISSN 1129-2369.PMC 3611827.
  12. ^van den Brink M (22 December 1999)."Coronary Side Effects of Antimigraine Drugs From Patient to Receptor".RePub, Erasmus University Repository. Retrieved19 June 2025.Table 1.2 Receptor binding properties (pKi values) of sumatriptan and second-generation triptans at 5-HT receptors. [...]
  13. ^Deleu D, Hanssens Y (July 2000). "Current and emerging second-generation triptans in acute migraine therapy: a comparative review".J Clin Pharmacol.40 (7):687–700.doi:10.1177/00912700022009431.PMID 10883409.
  14. ^Cole P, Rabasseda X (March 2001). "Migraine headache treatment with eletriptan, a second-generation serotonin receptor agonist".Drugs Today (Barc).37 (3):159–171.doi:10.1358/dot.2001.37.3.614851.PMID 12783088.
  15. ^van den Broek RW (13 March 2002)."Vascular Effects of Antimigraine Drugs: pharmacology of human in vitro models in migraine".RePub, Erasmus University Repository. Retrieved19 June 2025.Table 1.2 Receptor binding properties (pKi values) of the triptans at human 5-HT receptors. [...]
  16. ^abRubio-Beltrán E, Labastida-Ramírez A, Haanes KA, van den Bogaerdt A, Bogers AJ, Zanelli E, et al. (December 2019)."Characterization of binding, functional activity, and contractile responses of the selective 5-HT1F receptor agonist lasmiditan".British Journal of Pharmacology.176 (24):4681–4695.doi:10.1111/bph.14832.PMC 6965684.PMID 31418454.TABLE 1 Summary of pIC50 (negative logarithm of the molar concentration of these compounds at which 50% of the radioligand is displaced) and pKi (negative logarithm of the molar concentration of the Ki ) values of individual antimigraine drugs at 5‐HT receptors [...] TABLE 2 Summary of pEC50 values of cAMP (5‐HT1A/B/E/F and 5‐HT7), GTPγS (5‐HT1A/B/D/E/F), and IP (5‐HT2) assays of individual antimigraine drugs at 5‐HT receptors [...]
  17. ^Perez, M., Halazy, S., Pauwels, P.J., Colpaert, F.C., John, G.W. (1999)."F-11356".Drugs of the Future.24 (6): 0605.doi:10.1358/dof.1999.024.06.537284. Retrieved23 June 2025.
  18. ^Mitsikostas DD, Ward TN (2024). "Evidence-based symptomatic treatment of migraine".Migraine Management. Handbook of Clinical Neurology. Vol. 199. pp. 203–218.doi:10.1016/B978-0-12-823357-3.00004-5.ISBN 978-0-12-823357-3.PMID 38307647.
  19. ^Comer MB (April 2002). "Pharmacology of the selective 5-HT(1B/1D) agonist frovatriptan".Headache.42 (Suppl 2):S47 –S53.doi:10.1046/j.1526-4610.42.s2.2.x.PMID 12028320.
  20. ^ab"Eletriptan".PubChem. Retrieved27 June 2025.
  21. ^Tekes K, Szegi P, Hashemi F, Laufer R, Kalász H, Siddiq A, et al. (2013). "Medicinal chemistry of antimigraine drugs".Curr Med Chem.20 (26):3300–3316.doi:10.2174/0929867311320260012.PMID 23746273.
  22. ^"Eletriptan: Uses, Interactions, Mechanism of Action".DrugBank Online. 31 July 2019. Retrieved27 June 2025.
  23. ^U.S. Patent no. 5545644, John E. Macor & Martin J. Wythes,Indole Derivatives, 13 August 1996.
  24. ^U.S. Patent no. 6110940, Valerie Denise Harding,et al.,Salts of an anti-migraine indole derivative, 29 August 2000.
  25. ^"Relpax Product information".Health Canada. 25 April 2012. Retrieved11 November 2020.
  26. ^"Pfizer Completes Transaction to Combine Its Upjohn Business with Mylan". Pfizer. 16 November 2020. Retrieved17 June 2024 – via Business Wire.
  27. ^"Relpax".Pfizer. Retrieved17 June 2024.
  28. ^"Brands".Viatris. 16 November 2020. Retrieved17 June 2024.
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