Details
Stereochemistry | ACHIRAL |
Molecular Formula | C24H28N2O3 |
Molecular Weight | 392.4907 |
Optical Activity | NONE |
Defined Stereocenters | 0 / 0 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
CC(C)(C)C1=CC(=C(NC(=O)C2=CNC3=CC=CC=C3C2=O)C=C1O)C(C)(C)C
InChI
InChIKey=PURKAOJPTOLRMP-UHFFFAOYSA-N
InChI=1S/C24H28N2O3/c1-23(2,3)16-11-17(24(4,5)6)20(27)12-19(16)26-22(29)15-13-25-18-10-8-7-9-14(18)21(15)28/h7-13,27H,1-6H3,(H,25,28)(H,26,29)
Ivacaftor (trade names KALYDECO® (ivacaftor) and ORKAMBI® (lumacaftor/ivacaftor)) is a cystic fibrosis transmembrane conductance regulator potentiator indicated for the treatment of cystic fibrosis in patients age 6 years and older who have one of the following mutations in the CFTR gene: G551D, G1244E, G1349D, G178R, G551S, S1251N, S1255P, S549N, or S549R. One such defect G551D is characterized by a dysfunctional CFTR protein on the cell surface. Although the defective protein is trafficked to the correct area, the epithelial cell surface, while there it cannot transport chloride through the channel. Ivacaftor, a CFTR potentiator, improves the transport of chloride through the ion channel by binding to the channels directly to induce a non-conventional mode of gating which in turn increases the probability that the channel is open. Ivacaftor regulates fluid flow within cells and affects the components of sweat, digestive fluids, and mucus.
Originator
Curator's Comment: Vertex initiated its CF research program in 1998 as part of a collaboration with CFFT, the nonprofit drug discovery and development affiliate of the Cystic Fibrosis Foundation. KALYDECO® (ivacaftor) and ORKAMBI® (lumacaftor/ivacaftor) were discovered by Vertex as part of this collaboration.
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: CHEMBL4051 |
100.0 nM [EC50] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Primary | KALYDECO Approved UseKALYDECO is indicated for the treatment of CF in patients age 6 years and older who have an R117H mutation in the CFTR gene Launch Date2012 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
2212 ng/mL |
150 mg single, oral dose: 150 mg route of administration: Oral experiment type: SINGLE co-administered: |
IVACAFTOR plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: HIGH-FAT |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
44916 ng × h/mL |
150 mg single, oral dose: 150 mg route of administration: Oral experiment type: SINGLE co-administered: |
IVACAFTOR plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: HIGH-FAT |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
15 h |
150 mg single, oral dose: 150 mg route of administration: Oral experiment type: SINGLE co-administered: |
IVACAFTOR plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: HIGH-FAT |
Doses
Dose | Population | Adverse events |
---|---|---|
50 mg 2 times / day steady, oral Recommended Dose: 50 mg, 2 times / day Route: oral Route: steady Dose: 50 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2 years n = 1 Health Status: unhealthy Age Group: 2 years Sex: M Population Size: 1 Sources: Page: p. 27 |
Disc. AE: ALT increased... AEs leading to discontinuation/dose reduction: ALT increased (1 patient) Sources: Page: p. 27 |
50 mg 2 times / day steady, oral Recommended Dose: 50 mg, 2 times / day Route: oral Route: steady Dose: 50 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Disc. AE: Elevated liver enzymes, Croup... AEs leading to discontinuation/dose reduction: Elevated liver enzymes (2 patients) Sources: Page: p. 27Croup (1 patient) Sepsis (1 patient) |
75 mg 2 times / day steady, oral Recommended Dose: 75 mg, 2 times / day Route: oral Route: steady Dose: 75 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Disc. AE: Elevated liver enzymes, Vomiting... AEs leading to discontinuation/dose reduction: Elevated liver enzymes (1 patient) Sources: Page: p. 27Vomiting (2 patients) Gastroenteritis (1 patient) Retching (1 patient) Rash (1 patient) Cough increased (1 patient) |
450 mg 2 times / day multiple, oral Overdose Dose: 450 mg, 2 times / day Route: oral Route: multiple Dose: 450 mg, 2 times / day Sources: |
healthy, adult Health Status: healthy Age Group: adult Sources: |
Other AEs: Dizziness, Diarrhea... Other AEs: Dizziness Sources: Diarrhea |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
ALT increased | 1 patient Disc. AE |
50 mg 2 times / day steady, oral Recommended Dose: 50 mg, 2 times / day Route: oral Route: steady Dose: 50 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2 years n = 1 Health Status: unhealthy Age Group: 2 years Sex: M Population Size: 1 Sources: Page: p. 27 |
Croup | 1 patient Disc. AE |
50 mg 2 times / day steady, oral Recommended Dose: 50 mg, 2 times / day Route: oral Route: steady Dose: 50 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Sepsis | 1 patient Disc. AE |
50 mg 2 times / day steady, oral Recommended Dose: 50 mg, 2 times / day Route: oral Route: steady Dose: 50 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Elevated liver enzymes | 2 patients Disc. AE |
50 mg 2 times / day steady, oral Recommended Dose: 50 mg, 2 times / day Route: oral Route: steady Dose: 50 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Cough increased | 1 patient Disc. AE |
75 mg 2 times / day steady, oral Recommended Dose: 75 mg, 2 times / day Route: oral Route: steady Dose: 75 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Elevated liver enzymes | 1 patient Disc. AE |
75 mg 2 times / day steady, oral Recommended Dose: 75 mg, 2 times / day Route: oral Route: steady Dose: 75 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Gastroenteritis | 1 patient Disc. AE |
75 mg 2 times / day steady, oral Recommended Dose: 75 mg, 2 times / day Route: oral Route: steady Dose: 75 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Rash | 1 patient Disc. AE |
75 mg 2 times / day steady, oral Recommended Dose: 75 mg, 2 times / day Route: oral Route: steady Dose: 75 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Retching | 1 patient Disc. AE |
75 mg 2 times / day steady, oral Recommended Dose: 75 mg, 2 times / day Route: oral Route: steady Dose: 75 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Vomiting | 2 patients Disc. AE |
75 mg 2 times / day steady, oral Recommended Dose: 75 mg, 2 times / day Route: oral Route: steady Dose: 75 mg, 2 times / day Sources: Page: p. 27 |
unhealthy, 2-6 years n = 34 Health Status: unhealthy Age Group: 2-6 years Population Size: 34 Sources: Page: p. 27 |
Diarrhea | 450 mg 2 times / day multiple, oral Overdose Dose: 450 mg, 2 times / day Route: oral Route: multiple Dose: 450 mg, 2 times / day Sources: |
healthy, adult Health Status: healthy Age Group: adult Sources: |
|
Dizziness | 450 mg 2 times / day multiple, oral Overdose Dose: 450 mg, 2 times / day Route: oral Route: multiple Dose: 450 mg, 2 times / day Sources: |
healthy, adult Health Status: healthy Age Group: adult Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Page: 35.0 |
no | |||
Page: 52.0 |
no | |||
Page: 35.0 |
no | |||
Page: 52.0 |
no | |||
Page: 35.0 |
no | |||
Page: 52.0 |
no | |||
Page: 35.0 |
no | |||
Page: 52.0 |
no | |||
Page: 35.0 |
no | |||
Page: 35.0 |
no | |||
Page: 52.0 |
no | |||
Page: 52.0 |
no | |||
Page: 35.0 |
no | |||
Page: 6.0 |
weak [IC50 11 uM] | |||
Page: 6.0 |
weak [IC50 3.8 uM] | |||
Page: 3.0 |
weak [IC50 41 uM] | weak (co-administration study) Comment: ivacaftor increased midazolam exposure 1.5x, cmax 1.38x, auc 1.54x Page: 3.0 |
||
Page: 3.0 |
yes [IC50 0.17 uM] | |||
Page: 34.0 |
yes [IC50 3.4 uM] |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Page: 3.0 |
major | yes (co-administration study) Comment: ketoconazole increased ivacaftor exposure by 8.5x; fluconazole increased ivacaftor exposure by 3x; rifampin decreased ivacaftor exposure by 9x Page: 3.0 |
||
Page: 35.0 |
no | |||
Page: 6.0 |
no | no (co-administration study) Comment: rosiglitazone had no effect on cmax and auc of ivacaftor Page: 6.0 |
||
Page: 6.0 |
no | no (co-administration study) Comment: desipramine had no effect on cmax and auc of ivacaftor Page: 6.0 |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Page: 34.0 |
||||
Page: 59.0 |
PubMed
Title | Date | PubMed |
---|---|---|
Probing conformational rescue induced by a chemical corrector of F508del-cystic fibrosis transmembrane conductance regulator (CFTR) mutant. | 2011 Jul 15 |
|
Cystic fibrosis transmembrane regulator potentiators as promising cystic fibrosis therapies. | 2011 Mar |
|
A CFTR potentiator in patients with cystic fibrosis and the G551D mutation. | 2011 Nov 3 |
|
Cystic fibrosis transmembrane conductance regulator (CFTR) potentiator VX-770 (ivacaftor) opens the defective channel gate of mutant CFTR in a phosphorylation-dependent but ATP-independent manner. | 2012 Oct 26 |
Sample Use Guides
Adults and pediatric patients age 6 years and older: one 150 mg tablet taken orally every 12 hours with fat-containing food. Reduce dose in patients with moderate and severe hepatic impairment. Reduce dose when co-administered with drugs that are moderate or strong CYP3A inhibitors.
Route of Administration:
Oral
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Classification Tree | Code System | Code | ||
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FDA ORPHAN DRUG |
647618
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WHO-VATC |
QR07AX02
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FDA ORPHAN DRUG |
228306
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LIVERTOX |
NBK547889
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EMA ASSESSMENT REPORTS |
ORKAMBI (AUTHORIZED: CYSTIC FIBROSIS)
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EU-Orphan Drug |
EU/3/18/2116
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EMA ASSESSMENT REPORTS |
KALYDECO (AUTHORIZED: CYSTIC FIBROSIS)
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FDA ORPHAN DRUG |
577517
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FDA ORPHAN DRUG |
434814
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NDF-RT |
N0000184146
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WHO-ATC |
R07AX30
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FDA ORPHAN DRUG |
638618
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WHO-ATC |
R07AX02
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WHO-ATC |
R07AX31
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Code System | Code | Type | Description | ||
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SUB33103
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PRIMARY | |||
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4342
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PRIMARY | |||
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Lumacaftor and Ivacaftor
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PRIMARY | |||
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N0000184145
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PRIMARY | Chloride Channel Activation Potentiators [MoA] | ||
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9263
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PRIMARY | |||
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66901
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PRIMARY | |||
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4228
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PRIMARY | |||
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1243041
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PRIMARY | RxNorm | ||
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1Y740ILL1Z
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PRIMARY | |||
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16220172
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PRIMARY | |||
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WW-53
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PRIMARY | |||
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N0000185504
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PRIMARY | Cytochrome P450 2C9 Inhibitors [MoA] | ||
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N0000190114
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PRIMARY | Cytochrome P450 3A Inhibitors [MoA] | ||
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CHEMBL2010601
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PRIMARY | |||
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100000126135
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PRIMARY | |||
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Elexacaftor, Tezacaftor and Ivacaftor
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PRIMARY | |||
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DB08820
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PRIMARY | |||
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873054-44-5
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PRIMARY | |||
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N0000185503
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PRIMARY | P-Glycoprotein Inhibitors [MoA] | ||
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C166523
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PRIMARY | |||
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Tezacaftor and Ivacaftor
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PRIMARY | |||
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DTXSID00236281
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PRIMARY | |||
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1Y740ILL1Z
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PRIMARY | |||
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IVACAFTOR
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PRIMARY | |||
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N0000182141
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PRIMARY | Cytochrome P450 3A4 Inhibitors [MoA] | ||
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m6565
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PRIMARY | Merck Index | ||
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Ivacaftor
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PRIMARY |
ACTIVE MOIETY
METABOLITE ACTIVE (PARENT)
METABOLITE INACTIVE (PARENT)