The design and development of fesoterodine as a prodrug of 5-hydroxymethyl tolterodine (5-HMT), the active metabolite of tolterodine.

Abstract

This review highlights the design and development of fesoterodine (Toviaz) as a prodrug of 5-hydroxymethyl tolterodine (5-HMT), which is also the active metabolite of tolterodine, for the treatment of overactive bladder (OAB). Tolterodine and 5-HMT are both potent antimuscarinic agents. A prodrug approach was necessary for systemic bioavailability of 5-HMT after oral administration. Fesoterodine was selected amongst a series of ester analogues of 5-HMT to develop an advanced OAB treatment with an optimum biopharmaceutics profile, while maintaining a pharmacological link to tolterodine. While tolterodine and 5-HMT have similar antimuscarinic activity, the logD value, a determinant of lipophilicity and permeability across biological interfaces such as the gut wall and blood-brain barrier, is considerably lower for 5-HMT (0.74) versus tolterodine (1.83). In contrast to the cytochrome P450 (CYP) 2D6-mediated metabolism of tolterodine, 5-HMT formation from fesoterodine occurs via ubiquitous nonspecific esterases. Consequently, treatment with fesoterodine results in consistent, genotype-independent exposure to a singular active moiety (5-HMT); treatment with tolterodine results in CYP2D6 genotype-dependent exposure to varying proportions of two active moieties (5-HMT and tolterodine). At least partially due to the avoidance of variations in pharmacokinetic exposures observed with tolterodine, it was possible to develop fesoterodine with the flexibility of two efficacious and well-tolerated dosage regimens of 4 and 8 mg daily.

• Authors: B Malhotra, K Gandelman, R Sachse, N Wood, M C Michel
• Journal: Current medicinal chemistry (Curr Med Chem) Vol. 16 Issue 33 Pg. 4481-9 ( 2009) ISSN: 1875-533X [Electronic] United Arab Emirates
• PMID: 19835561 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• 5-hydroxymethyl tolterodine
• Benzhydryl Compounds
• Cresols
• Muscarinic Antagonists
• Prodrugs
• Phenylpropanolamine
• Tolterodine Tartrate
• fesoterodine

Topics

• Benzhydryl Compounds (chemistry, metabolism, pharmacokinetics)
• Cresols (chemistry, metabolism, pharmacokinetics)
• Drug Design
• Muscarinic Antagonists (chemistry, metabolism, pharmacokinetics)
• Phenylpropanolamine (chemistry, metabolism, pharmacokinetics)
• Prodrugs (chemistry, metabolism, pharmacokinetics)
• Tolterodine Tartrate