Amodiaquine

{{Short description|Chemical compound}}

{{cs1 config|name-list-style=vanc|display-authors=6}}

{{Drugbox

| verifiedrevid = 456692175

| IUPAC_name = 4-[(7-chloroquinolin-4-yl)amino]-2-[(diethylamino)methyl]phenol

| image = Amodiaquine.svg

| image_class = skin-invert-image

| width = 250

| tradename = Amdaquine, Amobin, Camoquin, others{{cite web|title=Amodiaquine|url=https://www.drugs.com/international/amodiaquine.html|website=drugs.com|access-date=27 November 2016|url-status=live|archive-url=https://web.archive.org/web/20161127154249/https://www.drugs.com/international/amodiaquine.html|archive-date=27 November 2016}}

| Drugs.com = {{drugs.com|international|amodiaquine}}

| pregnancy_AU =

| pregnancy_US =

| legal_AU =

| legal_UK =

| legal_US =

| elimination_half-life =

| CAS_number_Ref = {{cascite|correct|??}}

| CAS_number = 86-42-0

| ATC_prefix = P01

| ATC_suffix = BA06

| PubChem = 2165

| DrugBank_Ref = {{drugbankcite|correct|drugbank}}

| DrugBank = DB00613

| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}

| ChemSpiderID = 2080

| UNII_Ref = {{fdacite|correct|FDA}}

| UNII = 220236ED28

| KEGG_Ref = {{keggcite|correct|kegg}}

| KEGG = D02922

| ChEBI_Ref = {{ebicite|correct|EBI}}

| ChEBI = 2674

| ChEMBL_Ref = {{ebicite|correct|EBI}}

| ChEMBL = 682

| C=20 | H=22 | Cl=1 | N=3 | O=1

| smiles = Clc1cc2nccc(c2cc1)Nc3cc(c(O)cc3)CN(CC)CC

| StdInChI_Ref = {{stdinchicite|correct|chemspider}}

| StdInChI = 1S/C20H22ClN3O/c1-3-24(4-2)13-14-11-16(6-8-20(14)25)23-18-9-10-22-19-12-15(21)5-7-17(18)19/h5-12,25H,3-4,13H2,1-2H3,(H,22,23)

| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}

| StdInChIKey = OVCDSSHSILBFBN-UHFFFAOYSA-N

}}

Amodiaquine (ADQ) is a medication used to treat malaria, including Plasmodium falciparum malaria when uncomplicated.{{cite journal | vauthors = Nair A, Abrahamsson B, Barends DM, Groot DW, Kopp S, Polli JE, Shah VP, Dressman JB | title = Biowaiver monographs for immediate release solid oral dosage forms: amodiaquine hydrochloride | journal = Journal of Pharmaceutical Sciences | volume = 101 | issue = 12 | pages = 4390–4401 | date = December 2012 | pmid = 22949374 | doi = 10.1002/jps.23312 }}{{cite journal | vauthors = Olliaro P, Mussano P | title = Amodiaquine for treating malaria | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD000016 | date = 2003 | pmid = 12804382 | pmc = 6532704 | doi = 10.1002/14651858.CD000016 }} It is recommended to be given with artesunate to reduce the risk of resistance. Due to the risk of rare but serious side effects, it is not generally recommended to prevent malaria. Though, the World Health Organization (WHO) in 2013 recommended use for seasonal preventive in children at high risk in combination with sulfadoxine and pyrimethamine.{{cite book |author= |title=Seasonal malaria chemoprevention with sulfadoxine–pyrimethamine plus amodiaquine in children: a field guide. |url=https://apps.who.int/iris/bitstream/handle/10665/85726/9789241504737_eng.pdf |location=Geneva |publisher=The World Health Organization |date=August 2013 |isbn=978-92-4-150473-7}}

Amodiaquine is a 4-aminoquinoline compound related to chloroquine. The side effects of amodiaquine are generally minor to moderate and are similar to those of chloroquine. Rarely liver problems or low blood cell levels may occur. When taken in excess headaches, trouble seeing, seizures, and cardiac arrest may occur. The WHO recommends its use for pregnant women during the second and third trimester as well as during lactation, but reports that evidence for use in the first trimester is still insufficient.{{Cite web |title=WHO Guidelines for malaria |url=https://www.who.int/publications-detail-redirect/guidelines-for-malaria |access-date=2024-01-22 |website=www.who.int |language=en}}

Amodiaquine was first made in 1948.{{cite book | vauthors = Ahmad I, Ahmad T, Usmanghani K | chapter = Amodiaquine hydrochloride |title=Profiles of Drug Substances, Excipients and Related Methodology| series = Analytical Profiles of Drug Substances and Excipients |date=1992| volume = 21 |publisher=Academic Press|isbn=978-0-08-086116-6 | doi = 10.1016/S0099-5428(08)60388-3 |page=45|chapter-url=https://books.google.com/books?id=3mP9TYffnewC&pg=PA44|language=en|url-status=live|archive-url=https://web.archive.org/web/20170908213921/https://books.google.com/books?id=3mP9TYffnewC&pg=PA44|archive-date=2017-09-08}} It is on the World Health Organization's List of Essential Medicines.{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free }}{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 22nd list (2021) | year = 2021 | hdl = 10665/345533 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2021.02 | hdl-access=free }} While not available in the United States,{{cite journal|title=Amodiaquine|url=https://livertox.nih.gov/Amodiaquine.htm|website=Livertox|date=2012 |pmid=31643176 |access-date=27 November 2016|url-status=live|archive-url=https://web.archive.org/web/20161127154244/https://livertox.nih.gov/Amodiaquine.htm|archive-date=27 November 2016}} it is widely available in Africa.{{cite journal | title = Revised recommendations for preventing malaria in travelers to areas with chloroquine-resistant Plasmodium falciparum | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 34 | issue = 14 | pages = 185–90, 195 | date = April 1985 | pmid = 3156271 | author1 = Centers for Disease Control (CDC) }}

Medical uses

Amodiaquine has become an important drug in the combination therapy for malaria treatment in Africa.{{cite journal | vauthors = Kerb R, Fux R, Mörike K, Kremsner PG, Gil JP, Gleiter CH, Schwab M | title = Pharmacogenetics of antimalarial drugs: effect on metabolism and transport | journal = The Lancet. Infectious Diseases | volume = 9 | issue = 12 | pages = 760–774 | date = December 2009 | pmid = 19926036 | doi = 10.1016/S1473-3099(09)70320-2 }} It is often used in combination with artesunate as a by mouth artemisinin-based combination therapy (ACT) for uncomplicated P. falciparum malaria.{{cite book | vauthors=((World Health Organization)) | year=2015 | title=Guidelines for the treatment of malaria | edition=3rd |publisher=World Health Organization | hdl=10665/162441 |hdl-access=free | isbn=978-92-4-154912-7}} Amodiaquine has also been found to work against chloroquine-resistant P. falciparum strains of malaria, though there is geographic variation in its activity against chloroquine-resistant strains.{{Cite web |url= https://pubchem.ncbi.nlm.nih.gov/compound/amodiaquine#section=Top |title=Amodiaquine | work = PubChem | publisher = U.S. National Library of Medicine |access-date=2016-10-28 |url-status=live |archive-url= https://web.archive.org/web/20161029043608/https://pubchem.ncbi.nlm.nih.gov/compound/amodiaquine#section=Top |archive-date=2016-10-29 }}{{Cite book |title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases |date=2020 |publisher=Elsevier |isbn=978-0-323-48255-4 | veditors = Bennett JE, Dolin R, Blaser MJ |edition=Ninth |location=Philadelphia, PA |pages=519–534 |chapter=41 - Antimalarial Drugs }}

It is also used in combination with sulfadoxine/pyrimethamine.{{cite journal | vauthors = Staedke SG, Kamya MR, Dorsey G, Gasasira A, Ndeezi G, Charlebois ED, Rosenthal PJ | title = Amodiaquine, sulfadoxine/pyrimethamine, and combination therapy for treatment of uncomplicated falciparum malaria in Kampala, Uganda: a randomised trial | journal = Lancet | volume = 358 | issue = 9279 | pages = 368–374 | date = August 2001 | pmid = 11502317 | doi = 10.1016/S0140-6736(01)05557-X | s2cid = 42745422 }}{{cite book | vauthors=((World Health Organization)) | year=2013 | title=Seasonal malaria chemoprevention with sulfadoxine–pyrimethamine plus amodiaquine in children: a field guide | publisher=World Health Organization | hdl=10665/85726 | hdl-access=free | isbn=978-92-4-150473-7}}

Interactions

There have been reports of increased liver toxicity in people with HIV/AIDS on zidovudine or efavirenz when treated with amodiaquine-containing ACT regimens, therefore it is recommended that these people avoid amodiaquine.

== Pharmacokinetics and pharmacogenetics ==

It is bioactivated hepatically to its primary metabolite, N-desethylamodiaquine, by the cytochrome p450 enzyme CYP2C8. Among amodiaquine users, several rare but serious side effects have been reported and linked to variants in the CYP2C8 alleles. CYP2C8*1 is characterized as the wild-type allele, which shows an acceptable safety profile, while CYP2C8*2, *3 and *4 all show a range of "poor metabolizer" phenotypes. People who are poor metabolizers of amodiaquine display lower treatment efficacy against malaria, as well as increased toxicity.{{cite journal | vauthors = Elyazar IR, Hay SI, Baird JK | title = Malaria distribution, prevalence, drug resistance and control in Indonesia | journal = Advances in Parasitology | volume = 74 | issue = 74 | pages = 41–175 | date = April 2011 | pmid = 21295677 | pmc = 3075886 | doi = 10.1016/B978-0-12-385897-9.00002-1 | isbn = 978-0-12-385897-9 }} Several studies have been conducted to determine the prevalence of CYP2C8 alleles amongst malaria patients in East Africa, and have tentatively shown the variant alleles have significant prevalence in that population.{{cite journal | vauthors = Roederer MW, McLeod H, Juliano JJ | title = Can pharmacogenomics improve malaria drug policy? | journal = Bulletin of the World Health Organization | volume = 89 | issue = 11 | pages = 838–845 | date = November 2011 | pmid = 22084530 | pmc = 3209725 | doi = 10.2471/BLT.11.087320 }} About 3.6% of the population studied showed high risk for a poor reaction to or reduced treatment outcomes when treated with amodiaquine. This information is useful in developing programs of pharmacovigilance in East Africa, and have important clinical considerations for prescribing antimalarial medications in regions with high CYP2C8 variant frequency.

See also

References

{{Reflist}}