Amodiaquine

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Amodiaquine
Amodiaquine.png
Clinical data
AHFS/Drugs.comInternational Drug Names
ATC code
Pharmacokinetic data
Elimination half-life5.2 ± 1.7 (range 0.4 to 5.5) minutes
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PubChem CID
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UNII
KEGG
ChEBI
ChEMBL
E number{{#property:P628}}
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Chemical and physical data
FormulaC20H22ClN3O
Molar mass355.861 g/mol
3D model (JSmol)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Amodiaquine (trade names Camoquin, Flavoquine), a 4-aminoquinoline compound related to chloroquine, is used as an antimalarial and anti-inflammatory agent.

Amodiaquine has been shown to be more effective than chloroquine in treating chloroquine-resistant Plasmodium falciparum malaria infections and may afford more protection than chloroquine when used as weekly prophylaxis. Amodiaquine, like chloroquine, is generally well tolerated. Although licensed, this drug is not marketed in the United States, but is widely available in Africa. Its use, therefore, is probably more practicable in long-term visitors and persons who will reside in Africa.[1]

Amodiaquine is a histamine N-methyltransferase inhibitor.

It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[2]

Medical uses

Amodiaquine has become an important drug in the combination therapy for malaria treatment in Africa.[3]

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.[4] 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.[5] 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.

Cancer

Recent research suggests that amodiaquine targets malignant melanoma cells through induction of autophagic-lysosomal and proliferative blockade sensitizing cancer cells to starvation- and chemotherapy-induced cell death.[6]

References

  1. CDC recommendations for travel to areas with malaria
  2. "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
  3. Kerb, Reinhold; Fux; Morike; Kremsner; Gil; Gleiter; Schwab (2009). "Pharmacogenetics of antimalarial drugs: effect on metabolism and transport". Lancet Infectious Disease. 9 (12): 760–774. doi:10.1016/S1473-3099(09)70320-2.
  4. Elyazar, Iqbal; Hay, Baird (April 2011). "Malaria Distribution, Prevalence, Drug Resistance, and control in Indonesia". Advanced Parasitology. Advances in Parasitology. 74 (74): 41–175. doi:10.1016/B978-0-12-385897-9.00002-1. ISBN 9780123858979.
  5. Roederer, Mary; Mcleod, Juliano (2011). "Can pharmacogenetics improve malaria". Bulletin of World Health Organization. 89 (11): 838–845. doi:10.2471/BLT.11.087320.
  6. PMID 24113242 (PMID 24113242)
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