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Details

Stereochemistry ABSOLUTE
Molecular Formula C36H53N7O6
Molecular Weight 679.8493
Optical Activity UNSPECIFIED
Defined Stereocenters 4 / 4
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of DIFELIKEFALIN

SMILES

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=FWMNVWWHGCHHJJ-SKKKGAJSSA-N
InChI=1S/C36H53N7O6/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/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)/t27-,28-,29-,30-/m1/s1

HIDE SMILES / InChI

Molecular Formula C36H53N7O6
Molecular Weight 679.8493
Charge 0
Count
MOL RATIO 1 MOL RATIO (average)
Stereochemistry ABSOLUTE
Additional Stereochemistry No
Defined Stereocenters 4 / 4
E/Z Centers 0
Optical Activity UNSPECIFIED

Description

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.

CNS Activity

Approval Year

Targets

Primary TargetPharmacologyConditionPotency
0.16 nM [null]

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
Korsuva

Cmax

ValueDoseCo-administeredAnalytePopulation
61.9 ng/mL
5 μg/kg single, intravenous
DIFELIKEFALIN plasma
Homo sapiens
168.8 ng/mL
15 μg/kg single, intravenous
DIFELIKEFALIN plasma
Homo sapiens

AUC

ValueDoseCo-administeredAnalytePopulation
94 ng × h/mL
5 μg/kg single, intravenous
DIFELIKEFALIN plasma
Homo sapiens
246 ng × h/mL
15 μg/kg single, intravenous
DIFELIKEFALIN plasma
Homo sapiens

T1/2

ValueDoseCo-administeredAnalytePopulation
31 h
unknown, intravenous
DIFELIKEFALIN plasma
Homo sapiens
2 h
5 μg/kg single, intravenous
DIFELIKEFALIN plasma
Homo sapiens
2 h
15 μg/kg single, intravenous
DIFELIKEFALIN plasma
Homo sapiens

Funbound

ValueDoseCo-administeredAnalytePopulation
73%
DIFELIKEFALIN plasma
Homo sapiens

Doses

AEs

Drug as perpetrator​

Drug as victim

Tox targets

Sample Use Guides

In Vivo Use Guide
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
In Vitro Use Guide
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
Record UNII
NA1U919MRO
Record Status Validated (UNII)
Record Version