Trifluridine (also called trifluorothymidine; abbreviation TFT or FTD[1]) is an anti-herpesvirus antiviral drug, used primarily as prescription eyedrops. It was sold under the trade name Viroptic by Glaxo Wellcome, now merged into GlaxoSmithKline. The brand is now wholly owned by King Pharmaceuticals.
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| Trade names | Viroptic; Lonsurf (+tipiracil) |
| Other names | α,α,α-trifluorothymidine; 5-trifluromethyl-2′-deoxyuridine; FTD5-trifluoro-2′-deoxythymidine; TFT; CF3dUrd; FTD; F3TDR; F3Thd |
| AHFS/Drugs.com | Monograph |
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| Routes of administration | Eye drops; tablets (+tipiracil) |
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| Pharmacokinetic data | |
| Bioavailability | Negligible (eye drops); ≥57% (oral) |
| Protein binding | >96% |
| Metabolism | Thymidine phosphorylase |
| Elimination half-life | 12 minutes (eye drops); 1.4–2.1 hrs (combination with tipiracil) |
| Excretion | Mostly via urine |
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| ECHA InfoCard | 100.000.657 |
| Chemical and physical data | |
| Formula | C10H11F3N2O5 |
| Molar mass | 296.202 g·mol−1 |
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Trifluridine was approved for medical use in 1980.[2] It is also a component of the anti-cancer drug trifluridine/tipiracil, which is taken by mouth.
Medical uses
editTrifluridine eye drops are used for the treatment of keratitis and keratoconjunctivitis caused by the herpes simplex virus types 1 and 2, as well as for prevention and treatment of vaccinia virus infections of the eye.[3]
A Cochrane Systematic Review showed that trifluridine and aciclovir were a more effective treatment than idoxuridine or vidarabine,[4] significantly increasing the relative number of successfully healed eyes in one to two weeks.[4]
Adverse effects
editCommon side effects of trifluridine eye drops include transient burning, stinging, local irritation, and edema of the eyelids.[3]
Adverse effects of the anti-cancer formulation have only been evaluated for the combination trifluridine/tipiracil, not for the individual components.[citation needed]
Interactions
editOnly in vitro interaction studies are available. In these, trifluridine used the concentrative nucleoside transporter 1 (CNT1) and equilibrative nucleoside transporters 1 (ENT1) and 2 (ENT2). Drugs that interact with these transporters could influence blood plasma concentrations of trifluridine. Being a thymidine phosphorylase inhibitor, trifluridine could also interact with substrates of this enzyme such as zidovudine.[5]
For the eye drops, trifluridine absorption is negligible,[3] rendering interactions basically irrelevant.
Pharmacology
editMechanism of action (eye drops)
editIt is a nucleoside analogue, a modified form of deoxyuridine, similar enough to be incorporated into viral DNA replication, but the –CF3 group added to the uracil component blocks base pairing, thus interfering with viral DNA replication.[citation needed]
Pharmacokinetics (eye drops)
editTrifluridine passes the cornea and is found in the aqueous humour. Systemic absorption is negligible.[3]
Pharmacokinetics (oral)
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Pharmacokinetic data of oral trifluridine have only been evaluated in combination with tipiracil, which significantly affects biotransformation of the former. At least 57% of trifluridine are absorbed from the gut, and highest blood plasma concentrations are reached after two hours in cancer patients. The substance has no tendency to accumulate in the body. Plasma protein binding is over 96%. Trifluridine is metabolised by the enzyme thymidine phosphorylase to 5-trifluoromethyl-2,4(1H,3H)-pyrimidinedione (FTY), and also by glucuronidation. Elimination half-life is 1.4 hours on the first day and increases to 2.1 hours on the twelfth day. It is mainly excreted via the kidneys.[5]
Tipiracil causes Cmax (highest blood plasma concentrations) of trifluridine to increase 22-fold, and its area under the curve 37-fold, by inhibiting thymidine phosphorylase.[5]
Chemistry
editThe substance is a white crystalline powder. It is freely soluble in methanol and acetone; soluble in water, ethanol, 0.01 M hydrochloric acid, and 0.01 M sodium hydroxide; sparingly soluble in isopropyl alcohol and acetonitrile; slightly soluble in diethyl ether; and very slightly soluble in isopropyl ether.[6]
References
edit- ^ Patel AK, Abhyankar R, Brais LK, Duh MS, Barghout VE, Huynh L, et al. (December 2021). "Trifluridine/Tipiracil and Regorafenib in Patients with Metastatic Colorectal Cancer: A Retrospective Study at a Tertiary Oncology Center". The Oncologist. 26 (12): e2161–e2169. doi:10.1002/onco.13942. PMC 8649060. PMID 34406678.
- ^ Kimberlin DW (2012). "Antiviral Agents". In Long SS, Pickering LK, Prober CG (eds.). Principles and Practice of Pediatric Infectious Disease. Elsevier Health Sciences. p. 1502. ISBN 978-1437727029.
- ^ a b c d "Trifluridine". Drugs.com.
- ^ a b Wilhelmus KR (January 2015). "Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis". The Cochrane Database of Systematic Reviews. 1 (1): CD002898. doi:10.1002/14651858.CD002898.pub5. PMC 4443501. PMID 25879115.
- ^ a b c Haberfeld H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag.
- ^ "Lonsurf Prescribing Information". Drugs.com.
External links
edit- Costin D, Dogaru M, Popa AS, Cijevschi I (2004). "[Trifluridine therapy in herpetic in keratitis]" [Trifluridine therapy in herpetic in keratitis]. Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi (in Romanian). 108 (2): 409–412. PMID 15688823.
- Kuster P, Taravella M, Gelinas M, Stepp P (April 1998). "Delivery of trifluridine to human cornea and aqueous using collagen shields". The CLAO Journal. 24 (2): 122–124. PMID 9571274.
- O'Brien WJ, Taylor JL (August 1991). "Therapeutic response of herpes simplex virus-induced corneal edema to trifluridine in combination with immunosuppressive agents". Investigative Ophthalmology & Visual Science. 32 (9): 2455–2461. PMID 1907950.
- "Trifluridine Ophthalmic Solution, 1%" (PDF). Archived from the original (PDF) on 2009-09-20. Retrieved 2007-03-24.