U.S. Department of Health & Human Services Divider Arrow National Institutes of Health Divider Arrow NCATS

Details

Stereochemistry RACEMIC
Molecular Formula C11H17NO.ClH
Molecular Weight 215.72
Optical Activity ( + / - )
Defined Stereocenters 0 / 1
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of MEXILETINE HYDROCHLORIDE

SMILES

Cl.CC(N)COC1=C(C)C=CC=C1C

InChI

InChIKey=NFEIBWMZVIVJLQ-UHFFFAOYSA-N
InChI=1S/C11H17NO.ClH/c1-8-5-4-6-9(2)11(8)13-7-10(3)12;/h4-6,10H,7,12H2,1-3H3;1H

HIDE SMILES / InChI
Mexiletine is a non-selective voltage-gated sodium channel blocker which belongs to the Class IB anti-arrhythmic group of medicines. It is used to treat heart arrhythmias. Mexiletine is also used to treat refractory pain and muscle stiffness resulting in myotonic dystrophy or myotonia congenita. Mexiletine was approved for commercial use in 1985 under the brand name Mexitil, but most marketing efforts have since been discontinued. There has been a continued effort to identify other therapeutic use cases and a number of clinical trials have been conducted including ALS and chronic pain from amputation.

Approval Year

Targets

Targets

Primary TargetPharmacologyConditionPotency
Target ID: Q14524|||E9PFW7
Gene ID: 6331.0
Gene Symbol: SCN5A
Target Organism: Homo sapiens (Human)
Target ID: Q15858|||Q8WWN4
Gene ID: 6335.0
Gene Symbol: SCN9A
Target Organism: Homo sapiens (Human)
Conditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
MEXITIL

Approved Use

Mexiletine hydrochloride capsules are indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia, that, in the judgment of the physician, are life-threatening. Because of the proarrhythmic effects of mexiletine, its use with lesser arrhythmias is generally not recommended. Treatment of patients with asymptomatic ventricular premature contractions should be avoided. Initiation of mexiletine treatment, as with other antiarrhythmic agents used to treat life-threatening arrhythmias, should be carried out in the hospital. Antiarrhythmic drugs have not been shown to enhance survival in patients with ventricular arrhythmias.

Launch Date

1985
Primary
MEXITIL

Approved Use

Mexiletine hydrochloride capsules are indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia, that, in the judgment of the physician, are life-threatening. Because of the proarrhythmic effects of mexiletine, its use with lesser arrhythmias is generally not recommended. Treatment of patients with asymptomatic ventricular premature contractions should be avoided. Initiation of mexiletine treatment, as with other antiarrhythmic agents used to treat life-threatening arrhythmias, should be carried out in the hospital. Antiarrhythmic drugs have not been shown to enhance survival in patients with ventricular arrhythmias.

Launch Date

1985
Primary
Unknown

Approved Use

Unknown
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
0.21 μg/mL
100 mg single, oral
dose: 100 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
1.2 μg/mL
200 mg 3 times / day multiple, oral
dose: 200 mg
route of administration: Oral
experiment type: MULTIPLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
0.59 μg/mL
100 mg 3 times / day multiple, oral
dose: 100 mg
route of administration: Oral
experiment type: MULTIPLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
0.35 μg/mL
150 mg single, oral
dose: 150 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
0.46 μg/mL
300 mg single, oral
dose: 300 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
0.45 μg/mL
200 mg single, oral
dose: 200 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
0.81 μg/mL
400 mg single, oral
dose: 400 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
2.96 μg × h/mL
100 mg single, oral
dose: 100 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
22 μg × h/mL
200 mg 3 times / day multiple, oral
dose: 200 mg
route of administration: Oral
experiment type: MULTIPLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
3.7 μg × h/mL
100 mg 3 times / day multiple, oral
dose: 100 mg
route of administration: Oral
experiment type: MULTIPLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
5.8 μg × h/mL
150 mg single, oral
dose: 150 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
6.7 μg × h/mL
300 mg single, oral
dose: 300 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
7.76 μg × h/mL
200 mg single, oral
dose: 200 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
8.3 μg × h/mL
400 mg single, oral
dose: 400 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
9.4 h
100 mg single, oral
dose: 100 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
9.9 h
200 mg 3 times / day multiple, oral
dose: 200 mg
route of administration: Oral
experiment type: MULTIPLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
14.1 h
100 mg 3 times / day multiple, oral
dose: 100 mg
route of administration: Oral
experiment type: MULTIPLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
10.8 h
150 mg single, oral
dose: 150 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
10 h
300 mg single, oral
dose: 300 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
11.1 h
200 mg single, oral
dose: 200 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
7 h
400 mg single, oral
dose: 400 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
40%
100 mg single, oral
dose: 100 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
MEXILETINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
Doses

Doses

DosePopulationAdverse events​
500 mg single, intramuscular
Highest studied dose
Dose: 500 mg
Route: intramuscular
Route: single
Dose: 500 mg
Sources: Page: p.24, 25
unhealthy, 55-78
n = 9
Health Status: unhealthy
Condition: Myocardial infarction
Age Group: 55-78
Sex: M+F
Population Size: 9
Sources: Page: p.24, 25
400 mg 3 times / day multiple, oral
MTD
Dose: 400 mg, 3 times / day
Route: oral
Route: multiple
Dose: 400 mg, 3 times / day
Sources: Page: p.132
unhealthy, 55.5
n = 16
Health Status: unhealthy
Condition: Ventricular arrhythmias
Age Group: 55.5
Sex: M+F
Population Size: 16
Sources: Page: p.132
200 mg 3 times / day multiple, oral
Recommended
Dose: 200 mg, 3 times / day
Route: oral
Route: multiple
Dose: 200 mg, 3 times / day
Sources: Page: p.105, 106, 112
unhealthy
n = 25
Health Status: unhealthy
Condition: Myotonic disorders
Population Size: 25
Sources: Page: p.105, 106, 112
Disc. AE: Tachycardia...
AEs leading to
discontinuation/dose reduction:
Tachycardia (severe, 4%)
Sources: Page: p.105, 106, 112
200 mg 3 times / day multiple, oral (max)
Recommended
Dose: 200 mg, 3 times / day
Route: oral
Route: multiple
Dose: 200 mg, 3 times / day
Sources: Page: p.109
unhealthy
n = 39
Health Status: unhealthy
Condition: Myotonic disorders
Population Size: 39
Sources: Page: p.109
Disc. AE: Diarrhea...
AEs leading to
discontinuation/dose reduction:
Diarrhea (2.6%)
Sources: Page: p.109
200 mg 3 times / day multiple, oral
Recommended
Dose: 200 mg, 3 times / day
Route: oral
Route: multiple
Dose: 200 mg, 3 times / day
Sources: Page: p.109
unhealthy
n = 58
Health Status: unhealthy
Condition: Myotonic disorders
Population Size: 58
Sources: Page: p.109
Disc. AE: Migraine, Gastrointestinal discomfort...
AEs leading to
discontinuation/dose reduction:
Migraine (1.7%)
Gastrointestinal discomfort (1.7%)
Sources: Page: p.109
AEs

AEs

AESignificanceDosePopulation
Tachycardia severe, 4%
Disc. AE
200 mg 3 times / day multiple, oral
Recommended
Dose: 200 mg, 3 times / day
Route: oral
Route: multiple
Dose: 200 mg, 3 times / day
Sources: Page: p.105, 106, 112
unhealthy
n = 25
Health Status: unhealthy
Condition: Myotonic disorders
Population Size: 25
Sources: Page: p.105, 106, 112
Diarrhea 2.6%
Disc. AE
200 mg 3 times / day multiple, oral (max)
Recommended
Dose: 200 mg, 3 times / day
Route: oral
Route: multiple
Dose: 200 mg, 3 times / day
Sources: Page: p.109
unhealthy
n = 39
Health Status: unhealthy
Condition: Myotonic disorders
Population Size: 39
Sources: Page: p.109
Gastrointestinal discomfort 1.7%
Disc. AE
200 mg 3 times / day multiple, oral
Recommended
Dose: 200 mg, 3 times / day
Route: oral
Route: multiple
Dose: 200 mg, 3 times / day
Sources: Page: p.109
unhealthy
n = 58
Health Status: unhealthy
Condition: Myotonic disorders
Population Size: 58
Sources: Page: p.109
Migraine 1.7%
Disc. AE
200 mg 3 times / day multiple, oral
Recommended
Dose: 200 mg, 3 times / day
Route: oral
Route: multiple
Dose: 200 mg, 3 times / day
Sources: Page: p.109
unhealthy
n = 58
Health Status: unhealthy
Condition: Myotonic disorders
Population Size: 58
Sources: Page: p.109
Overview

Overview

CYP3A4CYP2C9CYP2D6hERG


OverviewOther

Other InhibitorOther SubstrateOther Inducer



Drug as victim

Drug as victim

TargetModalityActivityMetaboliteClinical evidence
likely
major
minor
yes (co-administration study)
Comment: coadminitration with fluvoxamine decreased mexiletine clearance by 38%
Page: 1, 2
Tox targets
PubMed

PubMed

TitleDatePubMed
Torsades de pointes as a manifestation of mexiletine toxicity.
1980 Dec
International mexiletine and placebo antiarrhythmic coronary trial: I. Report on arrhythmia and other findings. Impact Research Group.
1984 Dec
Hemodynamic effects of mexiletine.
1984 May
Mexiletine for recurring ventricular arrhythmias: assessment by long-term electrocardiographic recordings and sequential electrophysiologic studies.
1984 Sep
Long-term effect of mexiletine on left ventricular function and relation to suppression of ventricular arrhythmia.
1990 Nov 15
Mexiletine-associated left ventricular dysfunction: a case study.
1991 Jun
Mexiletine's antifibrillatory actions are limited by the occurrence of convulsions in conscious animals.
1992 Jan 21
Neurotoxicity of lidocaine combined with mexiletine.
1993 Dec
Mexiletine-induced severe skin eruption, fever, eosinophilia, atypical lymphocytosis, and liver dysfunction.
1997 Oct
Effects of mexiletine on algogenic mediator-induced nociceptive responses in mice.
1999 Jul-Aug
Mexiletine block of wild-type and inactivation-deficient human skeletal muscle hNav1.4 Na+ channels.
2004 Feb 1
Antinociceptive effects of sodium channel-blocking agents on acute pain in mice.
2004 Jun
Analysis of human Nav1.8 expressed in SH-SY5Y neuroblastoma cells.
2005 Dec 28
Effect of mexiletine on vincristine-induced painful neuropathy in mice.
2006 Apr 24
Digoxin and mexiletine sensitivity in a Collie with the MDR1 mutation.
2006 Mar-Apr
Experimental studies of potential analgesics for the treatment of chemotherapy-evoked painful peripheral neuropathies.
2008 Jul-Aug
Pharmacological characterization and gene expression profiling of an L5/L6 spinal nerve ligation model for neuropathic pain in mice.
2008 May 2
Synergistic drug-cytokine induction of hepatocellular death as an in vitro approach for the study of inflammation-associated idiosyncratic drug hepatotoxicity.
2009 Jun 15
Refining the human iPSC-cardiomyocyte arrhythmic risk assessment model.
2013 Dec
Patents

Sample Use Guides

Mexiletine dosage must be individualized on the basis of response and tolerance. Administration with food is recommended. Initiate Mexiletine hydrochloride therapy with 200 mg every 8 hours when rapid control of arrhythmia is not essential. A minimum of two to three days between dose adjustments is recommended. The dose may be adjusted up or down in 50 or 100 mg increments. Most patients achieve satisfactory control with between 200 - 300 mg every 8 hours.The total daily dose should not exceed 400 mg.
Route of Administration: Oral
HEK293 cells stably expressing human homolog of human Nav1.5 and human Nav1.7 channels were maintained under standard tissue culture conditions (5% CO2; 37°C) in Dulbecco’s modified Eagle’s medium and F-12 medium mixture at 1:1 supplemented with 10% fetal bovine serum under selection of antibiotic G418 with a concentration of 500 μg/mL. Cells were passaged every three days with 0.25% Trypsin-EDTA. Whole-cell recordings were performed 18–24 h after plating at room temperature. Whole-cell patch-clamp recordings were conducted at room temperature (22–25°C) using an EPC-10 USB amplifier. The pipette solution contained (in mM): 140 CsF, 10 NaCl, 1 EGTA, and 10 HEPES; pH 7.3 with CsOH. The bath solution for recording contained (in mM): 140 NaCl, 3 KCl, 10 HEPES, 1 MgCl2, 1 CaCl2; pH 7.3 with NaOH. Mexiletine was diluted in bath solution to the desired concentration. Bath application of 0.3 mM mexiletine resulted in a reduction of Nav1.5 or Nav1.7 currents, while V1/2 values were not significantly shifted for even up to 1.0 mM.
Name Type Language
MEXILETINE HYDROCHLORIDE
EP   MART.   MI   ORANGE BOOK   USAN   USP   USP-RS   VANDF   WHO-DD  
USAN  
Official Name English
MEXILETINE HYDROCHLORIDE [EP MONOGRAPH]
Common Name English
MEXILETINE HYDROCHLORIDE [USAN]
Common Name English
MEXILETINE HYDROCHLORIDE [USP MONOGRAPH]
Common Name English
KO 1173 CL
Code English
(±)-1-METHYL-2-(2,6-XYLYLOXY)ETHYLAMINE HYDROCHLORIDE
Systematic Name English
MEXILETINE HYDROCHLORIDE [USP IMPURITY]
Common Name English
MEXILETINE HYDROCHLORIDE [MI]
Common Name English
KO-1173
Code English
KATEN
Brand Name English
MEXILETINE HYDROCHLORIDE [VANDF]
Common Name English
KO-1173 CL
Code English
MEXILETINE HYDROCHLORIDE [MART.]
Common Name English
MEXILETINE HCL
Common Name English
MEXILETINE HYDROCHLORIDE [JAN]
Common Name English
2-PROPANAMINE, 1-(2,6-DIMETHYLPHENOXY)-, HYDROCHLORIDE, (±)-
Systematic Name English
MEXILETINE HYDROCHLORIDE [USP-RS]
Common Name English
MEXITIL
Brand Name English
2-PROPANAMINE, 1-(2,6-DIMETHYLPHENOXY)-, HYDROCHLORIDE (1:1)
Systematic Name English
KO-1173-CL
Code English
Mexiletine hydrochloride [WHO-DD]
Common Name English
NSC-758639
Code English
MEXILETINE HYDROCHLORIDE [ORANGE BOOK]
Common Name English
Classification Tree Code System Code
NCI_THESAURUS C47793
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
EU-Orphan Drug EU/3/14/1353
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
NCI_THESAURUS C93038
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
Code System Code Type Description
CAS
5370-01-4
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
USAN
X-90
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
RS_ITEM_NUM
1443250
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
PUBCHEM
21467
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
ECHA (EC/EINECS)
226-362-1
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
MERCK INDEX
m7518
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY Merck Index
DAILYMED
606D60IS38
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
CHEBI
6917
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
SMS_ID
100000092433
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
FDA UNII
606D60IS38
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
EPA CompTox
DTXSID2045783
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
DRUG BANK
DBSALT000449
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
EVMPD
SUB03281MIG
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
RXCUI
142138
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY RxNorm
CAS
25670-67-1
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
SUPERSEDED
NSC
758639
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
NCI_THESAURUS
C652
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY
ChEMBL
CHEMBL558
Created by admin on Fri Dec 15 17:32:22 GMT 2023 , Edited by admin on Fri Dec 15 17:32:22 GMT 2023
PRIMARY