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

Details

Stereochemistry ABSOLUTE
Molecular Formula C36H53N7O6.C2H4O2
Molecular Weight 739.9013
Optical Activity UNSPECIFIED
Defined Stereocenters 4 / 4
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of Difelikefalin acetate

SMILES

CC(O)=O.CC(C)C[C@@H](NC(=O)[C@@H](CC1=CC=CC=C1)NC(=O)[C@H](N)CC2=CC=CC=C2)C(=O)N[C@H](CCCCN)C(=O)N3CCC(N)(CC3)C(O)=O

InChI

InChIKey=MZWHRPKAHCWTOI-KGURMGBCSA-N
InChI=1S/C36H53N7O6.C2H4O2/c1-24(2)21-29(32(45)40-28(15-9-10-18-37)34(47)43-19-16-36(39,17-20-43)35(48)49)42-33(46)30(23-26-13-7-4-8-14-26)41-31(44)27(38)22-25-11-5-3-6-12-25;1-2(3)4/h3-8,11-14,24,27-30H,9-10,15-23,37-39H2,1-2H3,(H,40,45)(H,41,44)(H,42,46)(H,48,49);1H3,(H,3,4)/t27-,28-,29-,30-;/m1./s1

HIDE SMILES / InChI

Molecular Formula C2H4O2
Molecular Weight 60.052
Charge 0
Count
Stereochemistry ACHIRAL
Additional Stereochemistry No
Defined Stereocenters 0 / 0
E/Z Centers 0
Optical Activity NONE

Molecular Formula C36H53N7O6
Molecular Weight 679.8493
Charge 0
Count
Stereochemistry ABSOLUTE
Additional Stereochemistry No
Defined Stereocenters 4 / 4
E/Z Centers 0
Optical Activity UNSPECIFIED

Difelikefalin (Korsuva™) is a synthetic peptide agonist of the kappa opioid receptor being developed by Cara Therapeutics for the treatment of pruritus. In August 2021, intravenous difelikefalin was approved in the USA for the treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD) in adults undergoing haemodialysis. Difelikefalin selectively acts on kappa opioid receptors in peripheral tissues, which contribute to pruritis and nociception. The activation of opioid receptors in peripheral neurons and keratinocytes reduces afferent (sensory) impulses towards the central nervous system, decreasing pain signals. Activating kappa opioid receptors on immune cells, including monocytes and T lymphocytes, decreases the release of pro-inflammatory chemicals such as prostaglandins.

Approval Year

TargetsConditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
Korsuva

Approved Use

Treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD-aP) in adults undergoing hemodialysis.

Launch Date

2021
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
61.9 ng/mL
5 μg/kg single, intravenous
dose: 5 μg/kg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
DIFELIKEFALIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
168.8 ng/mL
15 μg/kg single, intravenous
dose: 15 μg/kg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
DIFELIKEFALIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
94 ng × h/mL
5 μg/kg single, intravenous
dose: 5 μg/kg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
DIFELIKEFALIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
246 ng × h/mL
15 μg/kg single, intravenous
dose: 15 μg/kg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
DIFELIKEFALIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
31 h
unknown, intravenous
DIFELIKEFALIN plasma
Homo sapiens
population: UNHEALTHY
age: UNKNOWN
sex: UNKNOWN
food status: UNKNOWN
2 h
5 μg/kg single, intravenous
dose: 5 μg/kg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
DIFELIKEFALIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
2 h
15 μg/kg single, intravenous
dose: 15 μg/kg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
DIFELIKEFALIN plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
73%
DIFELIKEFALIN plasma
Homo sapiens
population: UNKNOWN
age: UNKNOWN
sex: UNKNOWN
food status: UNKNOWN
Doses

Doses

DosePopulationAdverse events​
15 ug/kg single, intravenous
Highest studied dose
Dose: 15 ug/kg
Route: intravenous
Route: single
Dose: 15 ug/kg
Sources:
healthy, ADULT
Health Status: healthy
Age Group: ADULT
Sex: M+F
Food Status: FASTED
Sources:
Disc. AE: Anxiety, Injection site phlebitis...
AEs leading to
discontinuation/dose reduction:
Anxiety
Injection site phlebitis
Sources:
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Disc. AE: Gastrointestinal disorders, Nausea...
AEs leading to
discontinuation/dose reduction:
Gastrointestinal disorders (1.3%)
Nausea (0.4%)
Dizziness (0.4%)
Headache (0.4%)
Anxiety (0.9%)
Insomnia (0.9%)
Mental status changes (0.9%)
Sources:
0.5 ug/kg 3 times / week multiple, intravenous
Recommended|Studied dose
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Disc. AE: Gastrointestinal disorders, Nausea...
AEs leading to
discontinuation/dose reduction:
Gastrointestinal disorders (0.5%)
Nausea (0.5%)
Dizziness (1.6%)
Headache (0.5%)
Psychiatric disorders (1.6%)
Mental status changes (0.5%)
Sources:
AEs

AEs

AESignificanceDosePopulation
Anxiety Disc. AE
15 ug/kg single, intravenous
Highest studied dose
Dose: 15 ug/kg
Route: intravenous
Route: single
Dose: 15 ug/kg
Sources:
healthy, ADULT
Health Status: healthy
Age Group: ADULT
Sex: M+F
Food Status: FASTED
Sources:
Injection site phlebitis Disc. AE
15 ug/kg single, intravenous
Highest studied dose
Dose: 15 ug/kg
Route: intravenous
Route: single
Dose: 15 ug/kg
Sources:
healthy, ADULT
Health Status: healthy
Age Group: ADULT
Sex: M+F
Food Status: FASTED
Sources:
Dizziness 0.4%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Headache 0.4%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Nausea 0.4%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Anxiety 0.9%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Insomnia 0.9%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Mental status changes 0.9%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Gastrointestinal disorders 1.3%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Gastrointestinal disorders 0.5%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended|Studied dose
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Headache 0.5%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended|Studied dose
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Mental status changes 0.5%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended|Studied dose
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Nausea 0.5%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended|Studied dose
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Dizziness 1.6%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended|Studied dose
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
Psychiatric disorders 1.6%
Disc. AE
0.5 ug/kg 3 times / week multiple, intravenous
Recommended|Studied dose
Dose: 0.5 ug/kg, 3 times / week
Route: intravenous
Route: multiple
Dose: 0.5 ug/kg, 3 times / week
Sources:
unhealthy, ADULT
Health Status: unhealthy
Age Group: ADULT
Sex: M+F
Food Status: UNKNOWN
Sources:
OverviewDrug as perpetrator​

Drug as perpetrator​

TargetModalityActivityMetaboliteClinical evidence
no [Inhibition 10 uM]
no [Inhibition 10 uM]
no [Inhibition 10 uM]
no
no
no
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
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
Tox targets

Tox targets

Sample Use Guides

Recommended dosage is 0.5 mcg/kg. Administer by intravenous bolus injection into the venous line of the dialysis circuit at the end of each HD treatment. Do not mix or dilute KORSUVA prior to administration. Administer within 60 minutes of syringe preparation.
Route of Administration: Intravenous
Difelikefalin activates KOR in HEK293 cells expressing the human receptor (EC50 = 0.16 nM in a transactivation assay) and inhibits forskolin-induced cAMP production in R1.G1 mouse thyoma cells (EC50 = 0.048 nM).
Substance Class Chemical
Created
by admin
on Mon Mar 31 18:35:46 GMT 2025
Edited
by admin
on Mon Mar 31 18:35:46 GMT 2025
Record UNII
0P70AR5BYB
Record Status Validated (UNII)
Record Version
  • Download
Name Type Language
Difelikefalin acetate
Common Name English
CR-845 ACETATE
Preferred Name English
4-AMINO-1-(D-PHENYLALANYL-D-PHENYLALANYL-D-LEUCYL-D-LYSL)-PIPERIDINE-4-CARBOXYLIC ACID, ACETATE SALT
Common Name English
Difelikefalin acetate [WHO-DD]
Common Name English
DIFELIKEFALIN ACETATE [ORANGE BOOK]
Common Name English
KORSUVA
Brand Name English
Code System Code Type Description
PUBCHEM
91864509
Created by admin on Mon Mar 31 18:35:46 GMT 2025 , Edited by admin on Mon Mar 31 18:35:46 GMT 2025
PRIMARY
RXCUI
2569090
Created by admin on Mon Mar 31 18:35:46 GMT 2025 , Edited by admin on Mon Mar 31 18:35:46 GMT 2025
PRIMARY
EVMPD
SUB195303
Created by admin on Mon Mar 31 18:35:46 GMT 2025 , Edited by admin on Mon Mar 31 18:35:46 GMT 2025
PRIMARY
SMS_ID
100000181569
Created by admin on Mon Mar 31 18:35:46 GMT 2025 , Edited by admin on Mon Mar 31 18:35:46 GMT 2025
PRIMARY
FDA UNII
0P70AR5BYB
Created by admin on Mon Mar 31 18:35:46 GMT 2025 , Edited by admin on Mon Mar 31 18:35:46 GMT 2025
PRIMARY
CAS
1024829-44-4
Created by admin on Mon Mar 31 18:35:46 GMT 2025 , Edited by admin on Mon Mar 31 18:35:46 GMT 2025
PRIMARY
DAILYMED
0P70AR5BYB
Created by admin on Mon Mar 31 18:35:46 GMT 2025 , Edited by admin on Mon Mar 31 18:35:46 GMT 2025
PRIMARY
Related Record Type Details
PARENT -> SALT/SOLVATE
Related Record Type Details
ACTIVE MOIETY