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

Details

Stereochemistry ABSOLUTE
Molecular Formula C21H25NO3.ClH
Molecular Weight 375.889
Optical Activity UNSPECIFIED
Defined Stereocenters 4 / 4
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of NALMEFENE HYDROCHLORIDE

SMILES

Cl.[H][C@@]12OC3=C4C(C[C@H]5N(CC6CC6)CC[C@@]14[C@@]5(O)CCC2=C)=CC=C3O

InChI

InChIKey=GYWMRGWFQPSQLK-OPHZJPRHSA-N
InChI=1S/C21H25NO3.ClH/c1-12-6-7-21(24)16-10-14-4-5-15(23)18-17(14)20(21,19(12)25-18)8-9-22(16)11-13-2-3-13;/h4-5,13,16,19,23-24H,1-3,6-11H2;1H/t16-,19+,20+,21-;/m1./s1

HIDE SMILES / InChI
Nalmefene is the first medication approved for alcoholism with the primary goal of reducing alcohol intake in an as needed approach. Nalmefene received a marketing authorization valid throughout the European Union on February 25, 2013 and is under development in Asia. Nalmefene is an opioid system modulator with a distinct μ, δ, and κ receptor profile. In vitro studies have demonstrated that Nalmefene is a selective opioid receptor ligand with antagonist activity at the μ and δ receptors and partial agonist activity at the κ receptor. In vivo studies have demonstrated that nalmefene reduces alcohol consumption, possibly by modulating cortico-mesolimbic functions. In the US, immediate-release injectable nalmefene was approved in 1995 as an antidote for opioid overdose. It was sold under the trade name Revex. The product was discontinued by its manufacturer around 2008. Currently Nalmefene is sold under the trade name Selincro. Selincro is indicated for the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking-risk level, without physical withdrawal symptoms and who do not require immediate detoxification.

Approval Year

TargetsConditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
Selincro

Approved Use

Selincro is indicated for the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking-risk level, without physical withdrawal symptoms and who do not require immediate detoxification.

Launch Date

2013
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
155 ng/mL
200 mg single, oral
dose: 200 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
177 ng/mL
300 mg single, oral
dose: 300 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
24.3 ng/mL
50 mg single, oral
dose: 50 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
57.9 ng/mL
100 mg single, oral
dose: 100 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
109 ng × h/mL
6 mg single, intravenous
dose: 6 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
1320 ng × h/mL
200 mg single, oral
dose: 200 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
16.6 ng × h/mL
1 mg single, intravenous
dose: 1 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
16.9 ng × h/mL
2 mg single, intravenous
dose: 2 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
1876 ng × h/mL
300 mg single, oral
dose: 300 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
191 ng × h/mL
12 mg single, intravenous
dose: 12 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: UNKNOWN
274 ng × h/mL
50 mg single, oral
dose: 50 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
29.4 ng × h/mL
2 mg single, intravenous
dose: 2 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
314 ng × h/mL
20 mg 2 times / day steady-state, oral
dose: 20 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: UNKNOWN
385 ng × h/mL
24 mg single, intravenous
dose: 24 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
647 ng × h/mL
100 mg single, oral
dose: 100 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
8.2 h
6 mg single, intravenous
dose: 6 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
9.8 h
200 mg single, oral
dose: 200 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
10.8 h
1 mg single, intravenous
dose: 1 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
11.7 h
300 mg single, oral
dose: 300 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
8.6 h
12 mg single, intravenous
dose: 12 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: UNKNOWN
10.3 h
50 mg single, oral
dose: 50 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
9.4 h
2 mg single, intravenous
dose: 2 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
9.1 h
20 mg 2 times / day steady-state, oral
dose: 20 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: UNKNOWN
8.9 h
24 mg single, intravenous
dose: 24 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
11.4 h
100 mg single, oral
dose: 100 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
NALMEFENE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: FASTED
Doses

Doses

DosePopulationAdverse events​
18 mg 1 times / day steady, oral
Recommended
Dose: 18 mg, 1 times / day
Route: oral
Route: steady
Dose: 18 mg, 1 times / day
Sources:
unhealthy, 39 years
n = 1
Health Status: unhealthy
Condition: alcohol dependence and Schizoaffective Disorder
Age Group: 39 years
Sex: M
Population Size: 1
Sources:
Disc. AE: Psychiatric decompensation...
AEs leading to
discontinuation/dose reduction:
Psychiatric decompensation (1 patient)
Sources:
300 mg 1 times / day multiple, oral
Highest studied dose
Dose: 300 mg, 1 times / day
Route: oral
Route: multiple
Dose: 300 mg, 1 times / day
Sources:
healthy, adult
n = 4
Health Status: healthy
Age Group: adult
Sex: M
Population Size: 4
Sources:
300 mg single, oral
Highest studied dose
Dose: 300 mg
Route: oral
Route: single
Dose: 300 mg
Sources:
healthy, adult
n = 4
Health Status: healthy
Age Group: adult
Sex: M
Population Size: 4
Sources:
0.75 ug/kg single, intravenous
Highest studied dose
Dose: 0.75 ug/kg
Route: intravenous
Route: single
Dose: 0.75 ug/kg
Sources:
unhealthy, adult
n = 3
Health Status: unhealthy
Condition: postoperative pain
Age Group: adult
Sex: M+F
Population Size: 3
Sources:
DLT: Anesthesia reversal...
Dose limiting toxicities:
Anesthesia reversal (2 patients)
Sources:
0.5 ug/kg single, intravenous
MTD
Dose: 0.5 ug/kg
Route: intravenous
Route: single
Dose: 0.5 ug/kg
Sources:
unhealthy, adult
n = 18
Health Status: unhealthy
Condition: postoperative pain
Age Group: adult
Sex: M+F
Population Size: 18
Sources:
DLT: Anesthesia reversal...
Dose limiting toxicities:
Anesthesia reversal (3 patients)
Sources:
20 mg 2 times / day steady, oral
Recommended
Dose: 20 mg, 2 times / day
Route: oral
Route: steady
Dose: 20 mg, 2 times / day
Sources:
unhealthy, adult
n = 7
Health Status: unhealthy
Condition: alcohol dependence
Age Group: adult
Sex: M+F
Population Size: 7
Sources:
Disc. AE: Dizziness...
AEs leading to
discontinuation/dose reduction:
Dizziness (1 patient)
Sources:
5 mg 2 times / day steady, oral
Studied dose
Dose: 5 mg, 2 times / day
Route: oral
Route: steady
Dose: 5 mg, 2 times / day
Sources:
unhealthy, adult
n = 7
Health Status: unhealthy
Condition: alcohol dependence
Age Group: adult
Sex: M+F
Population Size: 7
Sources:
Disc. AE: Dizziness, Rash...
AEs leading to
discontinuation/dose reduction:
Dizziness (1 patient)
Rash (1 patient)
Sources:
AEs

AEs

AESignificanceDosePopulation
Psychiatric decompensation 1 patient
Disc. AE
18 mg 1 times / day steady, oral
Recommended
Dose: 18 mg, 1 times / day
Route: oral
Route: steady
Dose: 18 mg, 1 times / day
Sources:
unhealthy, 39 years
n = 1
Health Status: unhealthy
Condition: alcohol dependence and Schizoaffective Disorder
Age Group: 39 years
Sex: M
Population Size: 1
Sources:
Anesthesia reversal 2 patients
DLT
0.75 ug/kg single, intravenous
Highest studied dose
Dose: 0.75 ug/kg
Route: intravenous
Route: single
Dose: 0.75 ug/kg
Sources:
unhealthy, adult
n = 3
Health Status: unhealthy
Condition: postoperative pain
Age Group: adult
Sex: M+F
Population Size: 3
Sources:
Anesthesia reversal 3 patients
DLT
0.5 ug/kg single, intravenous
MTD
Dose: 0.5 ug/kg
Route: intravenous
Route: single
Dose: 0.5 ug/kg
Sources:
unhealthy, adult
n = 18
Health Status: unhealthy
Condition: postoperative pain
Age Group: adult
Sex: M+F
Population Size: 18
Sources:
Dizziness 1 patient
Disc. AE
20 mg 2 times / day steady, oral
Recommended
Dose: 20 mg, 2 times / day
Route: oral
Route: steady
Dose: 20 mg, 2 times / day
Sources:
unhealthy, adult
n = 7
Health Status: unhealthy
Condition: alcohol dependence
Age Group: adult
Sex: M+F
Population Size: 7
Sources:
Dizziness 1 patient
Disc. AE
5 mg 2 times / day steady, oral
Studied dose
Dose: 5 mg, 2 times / day
Route: oral
Route: steady
Dose: 5 mg, 2 times / day
Sources:
unhealthy, adult
n = 7
Health Status: unhealthy
Condition: alcohol dependence
Age Group: adult
Sex: M+F
Population Size: 7
Sources:
Rash 1 patient
Disc. AE
5 mg 2 times / day steady, oral
Studied dose
Dose: 5 mg, 2 times / day
Route: oral
Route: steady
Dose: 5 mg, 2 times / day
Sources:
unhealthy, adult
n = 7
Health Status: unhealthy
Condition: alcohol dependence
Age Group: adult
Sex: M+F
Population Size: 7
Sources:
Overview

Overview

CYP3A4CYP2C9CYP2D6hERG



Drug as perpetrator​

Drug as perpetrator​

TargetModalityActivityMetaboliteClinical evidence
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
Drug as victim

Drug as victim

TargetModalityActivityMetaboliteClinical evidence
minor
minor
no
no
no
no
no
no
yes
yes
yes
Tox targets
PubMed

PubMed

TitleDatePubMed
Nalmefene: intravenous safety and kinetics of a new opioid antagonist.
1986 Jan
A panic attack precipitated by opiate blockade--a case study.
1987 Oct
A double-blind, placebo-controlled pilot study to evaluate the efficacy and safety of oral nalmefene HCl for alcohol dependence.
1994 Oct
Standard binding and functional assays related to medications development division testing for potential cocaine and opiate narcotic treatment medications.
1998 Mar
Dynorphin A1-13 causes elevation of serum levels of prolactin through an opioid receptor mechanism in humans: gender differences and implications for modulation of dopaminergic tone in the treatment of addictions.
1999 Jan
The impact of nalmefene on side effects due to intrathecal morphine at cesarean section.
2001 Jun
A review of the potential role of methylnaltrexone in opioid bowel dysfunction.
2001 Nov
Preclinical models to evaluate potential pharmacotherapeutic agents in treating alcoholism and studying the neuropharmacological bases of ethanol-seeking behaviors in rats.
2002 Aug
Rapid and sensitive determination of nalmefene in human plasma by gas chromatography-mass spectrometry.
2002 Jun 25
Potentiation of the excitatory action of NMDA in ventrolateral periaqueductal gray by the mu-opioid receptor agonist, DAMGO.
2002 May 10
[Pathogenesis and treatment of pruritus in patients with cholestasis].
2003 Mar
A multi-site dose ranging study of nalmefene in the treatment of alcohol dependence.
2004 Aug
Central opioid receptors differentially regulate the nalmefene-induced suppression of ethanol- and saccharin-reinforced behaviors in alcohol-preferring (P) rats.
2004 Feb
Chronic administration of nalmefene leads to increased food intake and body weight gain in mice.
2004 Jul 8
Synergistic effects of cannabinoid inverse agonist AM251 and opioid antagonist nalmefene on food intake in mice.
2004 Mar 5
Effects of naltrexone and nalmefene on subjective response to alcohol among non-treatment-seeking alcoholics and social drinkers.
2004 Sep
Nalmefene induced elevation in serum prolactin in normal human volunteers: partial kappa opioid agonist activity?
2005 Dec
Unexpected placebo response in premenstrual dysphoric disorder: implication of endogenous opioids.
2005 Oct
Acamprosate: a new tool in the battle against alcohol dependence.
2006 Dec
Epidemiologic and clinical updates on impulse control disorders: a critical review.
2006 Dec
Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling.
2006 Feb
Pharmacologic treatments for opioid dependence: detoxification and maintenance options.
2007
Opioids, dopamine, stress, and the addictions.
2007
Pharmacoprophylaxis of alcohol dependence: Review and update Part I: Pharmacology.
2007 Jan
Targeted nalmefene with simple medical management in the treatment of heavy drinkers: a randomized double-blind placebo-controlled multicenter study.
2007 Jul
Application of a sensitive liquid chromatographic/tandem mass spectrometric method to pharmacokinetic study of nalmefene in humans.
2007 Jun 1
Plasma met-enkephalin, beta-endorphin and leu-enkephalin levels in human hepatic encephalopathy.
2007 Mar-Apr
Emerging pharmacologic options for treating postoperative ileus.
2007 Oct 15
Evidence of accelerated ageing in clinical drug addiction from immune, hepatic and metabolic biomarkers.
2007 Sep 24
Methylnaltrexone in the treatment of opioid-induced constipation.
2008
Pharmacological evidence for a motivational role of kappa-opioid systems in ethanol dependence.
2008 Feb
Opioid-dependent anticipatory negative contrast and binge-like eating in rats with limited access to highly preferred food.
2008 Feb
Effects of opioid receptor gene variation on targeted nalmefene treatment in heavy drinkers.
2008 Jul
Imaging of opioid receptors in the central nervous system.
2008 May
Cholestatic hepatitis as a possible new side-effect of oxycodone: a case report.
2008 May 1
Opioid antagonists for pharmacological treatment of alcohol dependence - a critical review.
2008 Nov
Predicting response to opiate antagonists and placebo in the treatment of pathological gambling.
2008 Nov
[Pharmacokinetics of nalmefene after a single or multiple intravenous doses in Chinese healthy volunteers].
2008 Oct
The effects of herkinorin, the first mu-selective ligand from a salvinorin A-derived scaffold, in a neuroendocrine biomarker assay in nonhuman primates.
2008 Oct
Unconditioned behavioral effects of the powerful kappa-opioid hallucinogen salvinorin A in nonhuman primates: fast onset and entry into cerebrospinal fluid.
2009 Feb
Primary biliary cirrhosis.
2009 Sep
Pediatric sedation: a global challenge.
2010
In vivo characterization of the opioid antagonist nalmefene in mice.
2010 Apr 10
Human exposures to immobilising agents: results of an online survey.
2010 Aug 28
Emerging drugs to treat alcoholism.
2010 Dec
Opioid antagonists for alcohol dependence.
2010 Dec 8
[Clinical observation of the effect of nalmefene in treatment of septic shock].
2010 Jun
Nalmefene in the treatment of pathological gambling: multicentre, double-blind, placebo-controlled study.
2010 Oct
Brain imaging studies in pathological gambling.
2010 Oct
Antipruritic treatment with systemic μ-opioid receptor antagonists: a review.
2010 Oct
Patents

Sample Use Guides

How much to take - The recommended dose is one tablet on days when you think there is a risk you will drink alcohol - The maximum dose is one tablet per day. How and when to take - You should take the tablet 1-2 hours before you start drinking alcohol. - Swallow the tablet whole, do not crush or divide the tablet. - You can take Selincro (Nalmefene) with or without food. Each film-coated tablet contains 18.06 mg nalmefene (as hydrochloride dihydrate).
Route of Administration: Oral
In Vitro Use Guide
Nalmefene antagonized the bindings of [3H]-dihydromorphine, [3H]-ethylketocyclazocine and [3H]-D-ala-D-leu enkephalin with IC50's in the low nanomolar range in rat brain membranes.. At the central mu receptor, nalmefene bound with an IC50 of 1.0 nM
Name Type Language
NALMEFENE HYDROCHLORIDE
MART.   MI   ORANGE BOOK   VANDF   WHO-DD  
Common Name English
Nalmefene hydrochloride [WHO-DD]
Common Name English
JF-1 HYDROCHLORIDE
Code English
NALMEFENE HYDROCHLORIDE [VANDF]
Common Name English
NALMEFENE HCL
Common Name English
OPVEE
Brand Name English
NALMEFENE HYDROCHLORIDE [MART.]
Common Name English
17-CYCLOPROPYLMETHYL-4,5A-EPOXY-6-METHYLENEMORPHINAN-3,14-DIOL HYDROCHLORIDE
Common Name English
NALMEFENE HYDROCHLORIDE [MI]
Common Name English
NALMEFENE HYDROCHLORIDE [ORANGE BOOK]
Common Name English
REVEX
Brand Name English
Classification Tree Code System Code
NCI_THESAURUS C681
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
Code System Code Type Description
RXCUI
236069
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY RxNorm
SMS_ID
100000076270
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
DAILYMED
K7K69QC05X
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
ChEMBL
CHEMBL982
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
FDA UNII
K7K69QC05X
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
EVMPD
SUB14628MIG
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
NCI_THESAURUS
C47631
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
CAS
58895-64-0
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
MERCK INDEX
m7715
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY Merck Index
DRUG BANK
DBSALT001446
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY
PUBCHEM
5388881
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PRIMARY
EPA CompTox
DTXSID70891705
Created by admin on Fri Dec 15 15:48:05 GMT 2023 , Edited by admin on Fri Dec 15 15:48:05 GMT 2023
PRIMARY