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II
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II
PubChem Compound Summary - Atosiban
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Bank - Atosiban
KEGG (Kyoto Encyclopedia of Genes and Genomes) - Atosiban
http://www.ebi.ac.uk/
- Atosiban
http://www.ncbi.nlm.nih.gov/ - Atosiban
Atosiban
is a chemically-synthesised nonapeptide of the following
formula [Mpa1,D-Tyr(Et)2,Thr4, Orn8] oxytocin. The active
substance atosiban employed for the most of the batches
used in preclinical and clinical studies was obtained
by solid phase peptide synthesis (SPPS) and after 1994
by liquid phase peptide synthesis (LPPS) followed by
a more efficient purification process. The impurity
profiles obtained with the two methods have been shown
to be similar. However, the impurity level obtained
with the LPPS is lower. Thereby, the difference in manufacture
of the active substance is considered of no clinical
importance. The starting materials are amino-acid derivates,
solvents and other reagents. Protected peptide fragments
are synthesised by Boc-chemistry, to yield a linear
nonapeptide, followed by deprotection by reduction with
sodium in liquid ammonia and by disulphide formation
by iodine oxidation. The final purification involves
dilution in ethanol and purification by ion exchange
chromatography (cation) and reverse phase chromatography.
Finally the active substance is concentrated by reversed
osmosis and thereafter lyophilised. The synthesis has
been sufficiently validated with 4 batches of 2 kg atosiban
acetate. The atosiban molecule contains nine chiral
centres. The amino acid residues of tyrosine, aspargine,
cyteine, proline and ornithine have one asymmetrical
carbon each and the residues of isoleucine and threonine
have two each. All of them are in the L-form, except
for tyrosine, which is in the D-form. The D-form respectively
the L-form have not been found in production batches
in levels above 0.1%. Eleven diastereomers with one
chiral centre can potentially be present in the raw
material or formed during the synthesis of atosiban.
However, neither of the epimers have been found in concentration
above 0.1%. Cis-trans isomerisation occurs at the Ys-Pro
bond. The trans form is the major form Atosiban is a
white to off-white, very hygroscopic, freeze-dried amorphous
powder, which is soluble in water, acetic acid, 0.1
M ammonium acetate, pH 6.0 and 6.8, methanol, ethanol
and dimethylformamide. Atosiban, an oxytocin receptor antagonist, is no better than other drugs in
delaying or preventing preterm birth but has fewer maternal side-effects. (http://www.emea.europa.eu/)
Tocolytic agents may postpone preterm delivery long enough to improve
neonatal outcome, allow corticosteroids to be given to help the baby's lungs and
other organs to mature and, if necessary, to allow transfer of the mother to a
hospital that has facilities to provide neonatal intensive care. Tocolytic drugs
called oxytocin receptor antagonists work by inhibiting the hormone oxytocin
that stimulates labour. This review found that, although the oxytocin receptor
antagonist atosiban resulted in fewer maternal side-effects than other tocolytic
drugs (betamimetics), no benefit was shown in delaying or preventing preterm
birth, and atosiban was associated with more infant deaths in one placebo
controlled trial. Further well-designed trials are needed. (http://www.cochrane.org/)
Beta-sympathomimetics
- salbutamol These are the most widely used tocolytics
and have been extensively studied in randomised controlled
trials. Salbutamol has been the most widely used beta-sympathomimetic
in Australia and was recommended by the NHMRC in its
1996 report1. It must be given intravenously, it has
several maternal contraindications and significant maternal
side effects. Recently more information has become available
from trials comparing nifedipine (a calcium antagonist)
atosiban (an oxytocin antagonist) and indomethacin (a
prostaglandin antagonist) with beta-mimetics. Calcium
antagonists – nifedipine Nifedipine is an equally
effective tocolytic, as shown by a recent Cochrane Review
4. It is administered orally and has fewer maternal
side effects. However, nifedipine is not approved for
use in pregnancy and is classified as a risk Category
C drug by the Australian Drug Evaluation Committee. Oxytocin
antagonists - atosiban Atosiban appears to be as
effective as beta-mimetics. It has fewer maternal side
effects but is much more expensive than other options
in preterm labour. However, it is not approved for use
in Australia. Prostaglandin antagonists – indomethacin Indomethacin
has been compared in small trials with beta-mimetics.
These have suggested equal efficacy in delaying preterm
birth but there are concerns about adverse affects on
the fetal circulation. Other agents – glyceryl trinitrate Glyceryl
trinitrate patches have been evaluated in a small number
of women and there is insufficient evidence to support
use in routine clinical practice. Clinicians should
ensure their choice of agent is informed by the balance
of evidence, as well as their experience in use of a
given agent and in the light of advice from clinicians
at the receiving hospital. Choice of tocolytic drug
is also discussed in a recent RCOG draft evidence-based
guideline for the use of tocolytics.(http://www.health.nsw.gov.au/)
Tocolytic
agents
|
Product
|
CAS
RN
|
Albuterol |
18559-94-9 |
Atosiban |
90779-69-4 |
Fenoterol |
13392-18-2 |
Hexoprenaline sulfate |
32266-10-7 |
Indomethacin
|
53-86-1
|
Isoxsuprine |
395-28-8 |
Levalbuterol |
34391-04-3 |
Magnesium sulfate |
7487-88-9 |
Metaproterenol |
586-06-1 |
Nifedipine |
21829-25-4 |
Nitroglycerin |
55-63-0 |
Nylidrin
|
447-41-6 |
Ritodrine |
26652-09-5 |
Salbutamol |
35763-26-9 |
Salmeterol xinafoate
|
94749-08-3
|
Salmeterol |
89365-50-4 |
Sulindac |
38194-50-2 |
Sulindac sulfide |
32004-67-4 |
Terbutaline |
23031-25-6 |
|