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What is Drug (Medicine) ?
Selectivity is Important!
Step 3: Synthesis
❑ Outsourcing with the right partner will drive R&D, not hinder it
Step 4: Animal Study
Pharmacy Practice:
Pharmacovigilence
Thalidomide Tragedy
Post-marketing Surveillance:
Selectivity is Important!
Think differently!
Implication of Stereochemistry of Drug
in Pharmacological Action
23
Stereoisomers in the Context of
Chemistry and Pharmacology
• Stereochemistry deals with the three dimensional structure of
molecules
• Stereoisomers are those molecules in which bond connectivity is
same but the arrangement of atoms in 3D space is different
25
Chiral: Molecule/object that is different from its mirror image
(Enantiomers are chiral)
26
26
Foundation of Stereochemistry
THE CHILDISH FANTASY ???
NOT LONG AGO, I EXPRESSED THE VIEW THAT THE LACK OF GENERAL
EDUCATION AND OF THOROUGH TRAINING IN CHEMISTRY WAS ONE CAUSE OF
DETERIORATION OF CHEMICAL RESEARCH IN GERMANY. WILL ANYONE TO
WHOM MY WORRIES SEEM EXAGGERATED PLEASE READ, IF HE CAN, A RECENT
MEMOIR BY A HERR VAN’T HOFF ON “ THE ARRANGEMENT OF ATOMS IN
SPACE,” A DOCUMENT TO HILT WITH THE OUTPOURING OF A CHILDISH
FANTASY. THIS DR. J. H. VAN’T HOFF, EMPLOYED BY THE VETERINARY
COLLEGE AT UTRECCHT, HAS, SO IT SEEMS, NO TASTE FOR ACCURATE
CHEMICAL RESEARCH. HE FINDS IT MORE CONVENIENT TO MOUNT HIS
PEGASUS (EVIDENTLY TAKEN FROM THE STABLES OF THE VETERINARY
COLLEGE) AND TO ANNOUNCE HOW, ON HIS FLIGHT TO MOUNT PARNASSUS, HE
SAW THE ATOMS ARRANGED IN SPACE.
Reaction of Hermann Kolbe (University of Leipzig), one of the most eminent organic chemists
of the time, in 1877 (nearing the end of his career) to a publication of a 22 year old Dutch
scientist.
30
Pharmacological Aspects of Drug Action
Pharmacological
aspects
Pharmacodynamics
Pharmacokinetics
31
Implication of Chirality
INTERESTING
IMPORTANT
32
The Nose Knows!
Receptors, protein that binds to a particular molecule, are also chiral - allow selective
binding of enantiomers
Receptors in the nose are able to distinguish between 10,000 different smells -
each enantiomer fits into a different receptor
33
33
The Tongue Decides How Sweet it is!
Aspartame
O O
H O H O
O H O H
N CH3 N CH3
H3N O H3N O
O H O H
(S,S) (R,R)
Pharmacological
aspects
Pharmacodynamics
Pharmacokinetics
35
How Drugs Work:
Theories of Drug-receptor Interaction
• Lock and Key theory
“ The drug molecule must fit into the receptor
like a key fits into the lock”
36
Different drug effects
• Biomolecules, thus, can discriminate between
enantiomers (isomers) of a given drug molecule.
38
Theories of Drug-receptor interaction
• Lock and Key Hypothesis
“ The drug molecule must fit into the receptor like a key fits into the
lock”
Known as the Intrinsic Activity.
• Occupancy theory: Ariens and Stephenson
Effectiveness of a drug lasts as long as the receptor is occupied. Many
substance possess different effect, some have high affinity for the receptor,
some have low affinity and some are not effective, and those ineffective
substances block or inhibit the receptor.
• Induced fit theory
Contradictory to Lock and Key concept, This concept states that binding of
drug/ligand receptor is a dynamic process and receptor organize itself to
promote facilitate maximum binding of drug.
• Rate theory
Rate theory suggests that the pharmacological activity is a function of
the rate of association and dissociation of the drug with the receptor.
39
POINTS OF ATTACHMENT OF DRUG TO RECEPTOR
2 POINTS 3 POINTS
ATTACHMENT ATTACHMENT
Pharmocokinetic Pharmacodynamic
(ADME/T) aspects aspects
Distribution/
Disposition
Metabolism
Excretion
41
STERODIFFERENTIATION OF
PHARMACODYNAMIC PROCESS
Racemic Drugs
43
Relative Pharmacodynamic Potency of
Enantiomers of a Few Selected Chiral Drugs
Chiral Drug Relative Activity Biological Response
terbutaline - > + (3000:1) trachea relaxation
propranolol S > R (100:1) block tachycardia
pindolol - > + (200:1) inhibit tachycardia
methadone - > + (3:1) respiratory depression
Ketamine S > R (4:1) anesthesia
tocainide R > S (3:1) antiarrhythmic
flecainide +=- antiarrhythmic
propafenone +=- antiarrhythmic
disopyramide S>R antiarrhythmic
disopyramide S>R anticholinergic
warfarin S > R (8:1) anticoagulant
verapamil - > + (5-18:1) block AV conduction
Propafenone
vi. Anti-hyperlipidem ic
• Atorvastatin, Lovastatin
• R>S
Atorvastatin
46
vii. Psychostim ulants
• Amphetamine, Metamphetamine
viii. T ranquilizers
• Oxazepam, Lorazepam, Temazepam
• S(+) > R(-)
Lorazepam
47
Group 2. Enantiomers with Opposite Biological Activities
Barbiturates
l-isomer is depressant
and
d-isomer is convulsant
Dobutamine
• l-isomer is α-adrenoceptor agonist
• d-isomer is α-adrenoceptor antagonist
48
Group 3. Distomer Possessing Adverse Effects
• Thalidomide: Thalidomide is racemic. One enantiomer is
effective against morning sickness, whereas the other
is teratogenic. However, the enantiomers are converted into each
other in vivo.
• Ethambutol: One enantiomer (R) is used to treat tuberculosis,
the other causes blindness.
• Naproxen: One enantiomer (S) is used to treat arthritis pain, but
the other (R) causes liver poisoning with no analgesic effect.
• (d,l)- Dopa: Owing to the grave toxicity (agranulocytosis) of the
d-isomer, only levorotatory form called l-Dopa is actually used in
therapeutics.
• Secobarbital: Enantiomers are equipotent as anticonvulsants,
but the S-(-)-isomer is more toxic than the R-(+)-isomer
49
THALIDOMIDE: DISASTROUS BIOLOGICAL ACTIVITY OF THE
“WRONG” ENANTIOMER
O O H H O O
N N
N O O N
*
*
H H
O O
(R)-isomer (S)-isomer
51
Group 4. Racemic Drugs with Chiral Switch
52
Group 5. Racemic Drugs with Equally Bioactive
Enantiomers
53
Group 6.
Enantiomers with Different Therapeutic Action
QUININE QUINIDINE
Antimalarial Antiarrythmic
Propafenone
55
Diastereomeric Drugs
• Diastereomers are non-superimposable non-mirror images having
different spatial arrangement of atoms.
• Diastereomers can be easily separated by chromatography or
recrystalization and they can be tested for biological activity.
• Anti-histaminic activity of E-triprolidine is 1000-fold greater than it’s Z-
isomer.
• Neuroleptic potency of Z-chlorprothixene is 12 times greater than that
of the E-isomer.
56
STERODIFFERENTIATION OF
PHARMACOKINETIC PROCESS
Stereodifferentiation of Pharmacokinetic Process
• The absorption of chiral drug appears to be stereoselective.
• Their distribution, metabolism, and renal excretion usually
favour one enantiomer versus the other.
• In terms of distribution, plasma protein binding is
stereoselective for most of these drugs, resulting in up to two-
fold differences between the enantiomers in their unbound
fractions in plasma and volume of distribution.
• Methadone, a central-acting analgesic (opiod), is a racemate
with predominantly active R-(+)-isomer. In humans, the ratios
of R/S methadone levels varied from 0.6 to 2.0 in serum and
1.2- 2.0 in urine.
• Hepatic metabolism of one enantiomer also differs from
another due to the enzyme selectivity of enantiomers.
Eur. J. Clin. Pharmacol. 1996, 50, 385-389. 58
Pharmacokinetic Aspects of Drug Action
• S-(-)-Warfarin (anticoagulant) is oxidised by cytochrome
CYP2C9 and then excreted into bile whereas R-(+)-warfarin is
metabolised by CYP1A2 to an inactive alcohol that is excreted
into urine.
• R-(+)-Warfarin is in itself a competitive inhibitor of CYP2C9.
• S-(-)-Warfarin is 3 to 5 times more potent than R-(+)-warfarin
whereas the clearance of R-(+)-warfarin is 70% that of S-(-)-
warfarin.
• The half-life of R-(+)-warfarin is longer than that of S-(-)-
warfarin (43 versus 32 h).
59
STERODIFFERENTIATION OF
PHARMACOKINETIC PROCESS
A. ABSORPTION
Frel D-Methotrexate/L-Methotrexate = 0.025
(anti-cancer and immuno-suppressant)
60
STERODIFFERENTIATION OF
PHARMACOKINETIC PROCESS
B. DISTRIBUTION
Drug Free Fraction Ratio (+/-)
+ -
disopyramide 0.27 0.39 0.7
ibuprofen 0.006 0.0039 1.5
mexilitine 0.283 0.198 1.4
methadone 0.092 0.124 0.7
propoxyphene 0.018 0.018 1.0
propranolol 0.203 0.176 1.2
tocainide 0.17 0.14 1.2
verapamil 0.064 0.11 0.6
warfarin 0.012 0.009 1.3
61
C. METABOLISM
Drug Clearance Form (+) (-) Ratio
disopyramide Clu,nr.iv isomer 0.23 0.18 1.28
62
Differntial Metabolism
63
From: Olbe et al, Nat Rev Drug Discovery 2:132, 2003 64
CYP Isoforms Different Between Enantiomers
O O
O O O
P O P
CYP2B6 P
NHCH2CH2Cl H2N N
NH NHCH2CH2Cl
N
ClH2CH2C
S-3-Dechloroethylifosfamide CYP3A4 CH2CH2Cl
R-Ifosfamide S-2-Dechloroethylifosfamide
O
O CYP2B6
P O
O
NH2 O P
N O
P CYP3A4 ClH2CH2CHN
CH2CH2Cl HN
ClH2CH2CHN N
R-2-Dechloroethylifosfamide R-3-Dechloroethylifosfamide
ClH2CH2C
+ +
S-Ifosfamide
ClCH2CHO ClCH2CHO
Chloroacetaldehyde Chloroacetaldehyde
(Neurotoxic) (Neurotoxic)
65
D. EXCRETION
Drug Clearance Form (+) (-) Ratio
chloroquine CLR,u racemate 824 519 1.6
66
Omeprazole Esomeprazole
• Heal the erosion in the esophagus caused
by gastroesophageal reflux disease, thus
providing a clinical advantage
67
Chiral Switch:
Racemic to Pure Enantiomeric Form
68
• The chiral switch process provides a strategy to extend
the profitable life of a pharmaceutical “bestseller“, and
may result in extended patent protection and provide an
advantage against generic competition
69