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Ezetimibe is a once-daily orally active cholesterol absorption inhibitor, launched as a hypolipidemic agent. The one-step diastereo- and enantioselective formation of p-lactams starting from commercially available (3S)-hydroxy-y-lactone is the key point of the asymmetric synthesis of ezetimibe. The 2-azetidinone class was initially designed as acyl-coenzyme A: cholesterol acyltransferase (ACAT) inhibitors but experimental data suggest that this compound acts in the intestinal wall to inhibit cholesterol through a novel mechanism with an as yet undiscovered target. Orally administered ezetimibe inhibited increases in plasma cholesterol in four cholesterol-fed animals species (hamster, rats, dogs and rhesus monkeys). In rats cannulated in the intestine and bile duct, [3H]-ezetimibe inhibited cholesterol absorption by more than 95%. In cholesterol-fed LDL receptor+apoE knockout mice, treatment with ezetimibe reduced atherosclerotic lesion cross sectional area by 48% in the aorta and 20% in the carotid artery. Moreover, the plasma cholesterol levels were reduced and the progression of lesions was inhibited. Ezetimibe is highly protein bound and is metabolized by the liver to its glucuronide metabolite, which represents 80-90% of circulating ezetimibe. About 90% of ezetimibe and/or the glucuronide metabolite are excreted in the feces and 10% in the urine. The parent compound and its glucuronide metabolite undergo enterohepatic recirculation; in consequence, the drug is slowly eliminated. In hypercholesterolemic patients, ezetimibe (10 mg/day, 12 weeks) reduced LDL cholesterol by 18% and total cholesterol by 12%, with a similar safety profile to placebo. Co-administration of ezetimibe with statins or fenofibrate lowered LDL cholesterol levels more than either monotherapy. Ezetimibe was well tolerated and interaction studies provided evidence that ezetimibe had no significant effect on the activity of major CYP450 drug-metabolizing enzymes. Moreover, no pharmacokinetic/pharmacodynamic interactions were seen between ezetimibe and statins and others frequently administered drugs.

Fondaparinux sodium (antithrombotic) (60-63)

Fondaparinux sodium (antithrombotic) (60-63)

Country of Origin : Originator: First Introduction : Introduced by:

France

Sanofi-Synthelabo US

Akzo Nobel (Organon) and Sanofi-Synthelabo

Trade Name: Arixtra CAS Registry No. : 114870-03-0 Molecular Weight: 1728.08

Fondaparinux sodium was first introduced in the US for prophylaxis of deep vein thrombosis which may lead to pulmonary embolism following major orthopaedic surgery. Fondaparinux is the first of a new class of antithrombic agents distinct from low molecular weight heparin (LMWH) and heparin. This entirely synthetic molecule is a copy of the heparin pentasaccharide sequence, the shortest fragment able to catalyze antithrombin Ill-mediated inhibition of factor Xa thereby inhibiting thrombin generation without antithrombin action. Fondaparinux does not display significant effects on coagulation tests (such as activated partial thromboplastin time and prothrombin time), does not bind to platelet factor 4 or promote heparin-induced thrombocytopenia. In phase III studies, fondaparinux significantly reduced the incidence of thromboembolism following orthopedic surgery, with an overall risk reduction of 50% in comparison to the LMWH, enoxaparin. Following subcutaneous administration, fondaparinux has a nearly complete bioavailability, a rapid onset of action, a prolonged half-life (17.2 h) enabling once daily dosing and is not metabolized proceeding renal excretion. The drug appears to be generally safe, with haemoragic complications either comparable to or higher than those for LMWH.

Frovatriptan (antimigraine) (64-69)

Country of Origin Originator: First Introduction Introduced by: Trade Name: CAS Registry No :

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