Emtricitabine

Emtricitabine
Clinical data
Trade names Emtriva
AHFS/Drugs.com Monograph
MedlinePlus a604004
License data
Pregnancy
category
  • AU: B1
  • US: B (No risk in non-human studies)
    Routes of
    administration    		 Oral
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Bioavailability 93%
    Protein binding Very low (less than 4%)
    Metabolism Hepatic oxidation and glucuronidation
    CYP system not involved
    Elimination half-life 10 hours
    Excretion Renal (86%) and fecal (14%)
    Identifiers
    CAS Number
    PubChem CID
    DrugBank
    ChemSpider
    UNII
    KEGG
    ChEBI
    ChEMBL
    NIAID ChemDB
    ECHA InfoCard 100.120.945 Edit this at Wikidata
    Chemical and physical data
    Formula C8H10FN3O3S
    Molar mass 247.248 g/mol
    3D model (JSmol)
      (verify)

    Emtricitabine (commonly called FTC, systematic name 2',3'-dideoxy-5-fluoro-3'-thiacytidine[1]), with trade name Emtriva (formerly Coviracil), is a nucleoside reverse transcriptase inhibitor (NRTI) for the prevention and treatment of HIV infection in adults and children.

    Emtricitabine is also marketed in a fixed-dose combination with tenofovir disoproxil (Viread) under the brand name Truvada, and with tenofovir alafenamide (Vemlidy) under the brand name Descovy.

    A fixed-dose triple combination of emtricitabine, tenofovir and efavirenz (Sustiva, marketed by Bristol-Myers Squibb) was approved by the U.S. Food and Drug Administration (FDA) on July 12, 2006 under the brand name Atripla.

    Emtricitabine makes up one fourth of the Quad pill (brand names: Stribild and Genvoya).

    It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.[2]

    Medical uses

    HIV infection

    Emtricitabine is indicated in combination with other antiretroviral agents for the prevention and treatment of HIV infection in adults. Emtricitabine is commercially available and is approved by the FDA for treatment of HIV infection.

    HBV infection

    Emtricitabine exhibits clinical activity against the hepatitis B virus (HBV), but is not approved by the FDA for the treatment of HBV infection. Among individuals with chronic HBV infection, emtricitabine treatment results in significant histologic, virologic, and biochemical improvement. The safety profile of emtricitabine during treatment is similar to that of a placebo. Emtricitabine, like all other FDA approved drugs, cures neither HIV nor HBV infection. In a study involving individuals with HBV infection, symptoms of infection returned in 23% of emtricitabine-treated individuals who were taken off therapy.[3] In studies involving individuals with chronic HIV infection, viral replication also resumes when study subjects are taken off therapy.[4] As with drugs used to treat HIV infection, drugs used to treat HBV infection may have to be used in combination to prevent the evolution of drug resistant strains. The effectiveness of emtricitabine in combination with other anti-HBV drugs has not been established.

    Side effects

    In clinical practice, toxicity with emtricitabine is unusual. The most common treatment-related adverse events are diarrhea, headache, nausea, and rash. These symptoms are generally mild to moderate in severity, but they caused 1% of clinical trial patients to give up treatment. Skin discoloration, which is typically reported as hyperpigmentation and usually affects either the palms of the hands or the soles of the feet, is reported in less than 2% of individuals and is almost exclusive to patients of African origin.

    Among the more severe side effects patients may experience are a hepatotoxicity or a lactic acidosis.

    Mechanism of action

    Emtricitabine is an analogue of cytidine. The drug works by inhibiting reverse transcriptase, the enzyme that copies HIV RNA into new viral DNA. By interfering with this process, which is central to the replication of HIV, emtricitabine can help to lower the amount of HIV, or "viral load", in a patient's body and can indirectly increase the number of immune system cells (namely T cells/CD4+ T-cells). Both of these changes are associated with healthier immune systems and decreased likelihood of serious illness.

    History

    Emtricitabine was discovered by Dr. Dennis C. Liotta, Dr. Raymond F. Schinazi, and Dr. Woo-Baeg Choi of Emory University and licensed to Triangle Pharmaceuticals by Emory in 1996.[5] Triangle Pharmaceuticals was acquired in 2003 by Gilead Sciences, who completed development and now market the product with the brand name Emtriva.

    It was approved by the FDA July 2, 2003. It is very similar to lamivudine (3TC) and cross-resistance between the two is near-universal.

    References

    1. ↑ http://www.google.co.uk/patents/US5814639
    2. ↑ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
    3. ↑ Lim SG; Ng TM; Kung N; et al. (January 2006). "A double-blind placebo-controlled study of emtricitabine in chronic hepatitis B". Arch. Intern. Med. 166 (1): 49–56. doi:10.1001/archinte.166.1.49. PMID 16401810.
    4. ↑ Oxenius A; Price DA; Günthard HF; et al. (October 2002). "Stimulation of HIV-specific cellular immunity by structured treatment interruption fails to enhance viral control in chronic HIV infection". Proc. Natl. Acad. Sci. U.S.A. 99 (21): 13747–52. doi:10.1073/pnas.202372199. PMC 129766. PMID 12370434.
    5. ↑ Leaf, Clifton (September 19, 2005). "The Law of Unintended Consequences". CNN.
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