Darifenacin

{{Short description|Medication for urinary incontinence}}

{{Drugbox

| Verifiedfields = changed

| Watchedfields = changed

| verifiedrevid = 460773728

| image = Darifenacin.svg

| alt =

| image2 = Darifenacin-hydrobromide-from-xtal-2009-CM-3D-balls.png

| alt2 =

| tradename = Enablex, Emselex

| Drugs.com = {{drugs.com|monograph|darifenacin-hydrobromide}}

| MedlinePlus = a605039

| pregnancy_AU = B3

| pregnancy_US = C

| ATC_prefix = G04

| ATC_suffix = BD10

| ATC_supplemental =

| legal_AU = S4

| legal_UK = POM

| legal_US = Rx-only

| legal_EU = Rx-only

| routes_of_administration = By mouth

| bioavailability = 15 to 19% (dose-dependent)

| protein_bound = 98%

| metabolism = Liver (CYP2D6- and CYP3A4-mediated)

| elimination_half-life = 13 to 19 hours

| excretion = Kidney (60%) and biliary (40%)

| index2_label = as salt

| IUPHAR_ligand = 321

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

| CAS_number = 133099-04-4

| PubChem = 444031

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

| DrugBank = DB00496

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

| ChemSpiderID = 392054

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

| UNII = APG9819VLM

| KEGG_Ref = {{keggcite|changed|kegg}}

| KEGG = D03654

| KEGG2_Ref = {{keggcite|changed|kegg}}

| KEGG2 = D01699

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

| ChEBI = 391960

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

| ChEMBL = 1346

| IUPAC_name = (S)-2-[1-[2-(2,3-dihydrobenzofuran-5-yl)ethyl] pyrrolidin-3-yl] -2,2-diphenyl-acetamide

| C=28 | H=30 | N=2 | O=2

| smiles = O=C(N)C(c1ccccc1)(c2ccccc2)[C@H]3CN(CC3)CCc5cc4c(OCC4)cc5

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

| StdInChI = 1S/C28H30N2O2/c29-27(31)28(23-7-3-1-4-8-23,24-9-5-2-6-10-24)25-14-17-30(20-25)16-13-21-11-12-26-22(19-21)15-18-32-26/h1-12,19,25H,13-18,20H2,(H2,29,31)/t25-/m1/s1

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

| StdInChIKey = HXGBXQDTNZMWGS-RUZDIDTESA-N

}}

Darifenacin (trade name Enablex in United States and Canada, Emselex in the European Union) is a medication used to treat urinary incontinence due to an overactive bladder.{{cite journal | vauthors = Croom KF, Keating GM | title = Darifenacin: in the treatment of overactive bladder | journal = Drugs & Aging | volume = 21 | issue = 13 | pages = 885–92; discussion 893–4 | date = 2004 | pmid = 15493952 | doi = 10.2165/00002512-200421130-00005 | s2cid = 41549419 }}{{cite journal | vauthors = Parsons M, Robinson D, Cardozo L | title = Darifenacin in the treatment of overactive bladder | journal = International Journal of Clinical Practice | volume = 59 | issue = 7 | pages = 831–8 | date = July 2005 | pmid = 15963212 | doi = 10.1111/j.1368-5031.2005.00585.x | s2cid = 39061659 | doi-access = free }}{{cite journal | vauthors = Chughtai B, Levin R, De E | title = Choice of antimuscarinic agents for overactive bladder in the older patient: focus on darifenacin | journal = Clinical Interventions in Aging | volume = 3 | issue = 3 | pages = 503–9 | date = 2008 | pmid = 18982920 | pmc = 2682382 | doi = 10.2147/cia.s3414 | doi-access = free }} It was discovered by scientists at the Pfizer research site in Sandwich, UK under the identifier UK-88,525 and used to be marketed by Novartis. In 2010, the US rights were sold to Warner Chilcott for {{US$|400 million}}.

Adverse effects

Darifenacin should not be used in people with urinary retention. Anticholinergic agents, such as darifenacin, may also produce constipation and blurred vision. Heat prostration (due to decreased sweating) can occur when anticholinergics such as darifenacin are used in a hot environment.{{cite web | title=Enablex- darifenacin tablet, extended release | website=DailyMed | date=24 September 2016 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a712f252-16d9-47df-b2bf-6794228f3a88 | access-date=22 October 2020}}

Medical uses

Darifenacin is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency in adults. It may also be recommended with an alpha blocker to help provide symptomatic benefit for overactive bladder and obstructive symptoms such as those likely associated with benign prostatic hyperplasia. American Urological Association (AUA) Guideline. Diagnosis and Treatment of Overactive Bladder in Adults: AUA/SUFA guideline 2012

Mechanism of action

Darifenacin works by blocking the M3 muscarinic acetylcholine receptor, which is primarily responsible for bladder muscle contractions. It thereby decreases the urgency to urinate.{{cite journal | vauthors = Chapple CR | title = Darifenacin: a novel M3 muscarinic selective receptor antagonist for the treatment of overactive bladder | journal = Expert Opinion on Investigational Drugs | volume = 13 | issue = 11 | pages = 1493–500 | date = November 2004 | pmid = 15500396 | doi = 10.1517/13543784.13.11.1493 | s2cid = 19259076 }} It is not known whether this selectivity for the M3 receptor translates into any clinical advantage when treating symptoms of overactive bladder syndrome. Although it is said to be selective for the M3 receptor, darifenacin is also said to antagonize the other four muscarinic acetylcholine receptors.{{cite journal | vauthors = Lavrador M, Cabral AC, Veríssimo MT, Fernandez-Llimos F, Figueiredo IV, Castel-Branco MM | title = A Universal Pharmacological-Based List of Drugs with Anticholinergic Activity | journal = Pharmaceutics | volume = 15 | issue = 1 | date = January 2023 | page = 230 | pmid = 36678858 | pmc = 9863833 | doi = 10.3390/pharmaceutics15010230 | doi-access = free | url = }}

References

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