Definition
ChEBI: A phosphate monoester resulting from the formal condensation of equimolar amounts of phosphoric acid with the hydroxy group of tedizolid . It is a prodrug of tedizolid, used for the treatment of acute bacterial skin infections caused by certain susceptibl
bacteria, including Staphylococcus aureus (including methicillin-resistant strains (MRSA) and methicillin-susceptible strains), various Streptococcus species, and Enterococcus faecalis.
Description
Tedizolid phosphate was approved by the US FDA in June 2014
for treatment of acute bacterial skin and skin structure infections
caused by susceptible gram-positive pathogens, including
MRSA. Tedizolid phosphate was discovered by Dong-A Pharmaceuticals
in South Korea and developed in the USA by Cubist
Pharmaceuticals (acquired from Trius Therapeutics in 2013,
became a wholly owned subsidiary of Merck in 2015). The
worldwide commercialization rights for tedizolid phosphate are
divided between Cubist in the USA, Canada, and EU, and Bayer in
Asia–Pacific, Latin America, and Africa. This second-generation
oxazolidinone prodrug is rapidly converted to the active form tedizolid
in the presence of endogenous phosphatases. It inhibits
bacterial protein synthesis by binding to the 23S ribosomal RNA
of the 50S subunit of the ribosome, preventing formation of the
70S ribosomal initiation complex, and is 4-fold to 16-fold more
potent against staphylococci and enterococci compared to linezolid.
251 With high oral bioavailability (approximately 90%) and
long half-life (approximately 12 hours), tedizolid phosphate is
the first oxazolidinone antibiotic which can be dosed once daily
either orally or intravenously.
Uses
Tedizolid, known as TR-700, is an oral and i.v administered intracellular antibacterial drug.
Clinical Use
Reversible non-selective MAO inhibitor:
Antibacterial agent
Synthesis
Commercial 5-bromo-2-cyanopyridine (260) was
treated with sodium azide and ammonium chloride in DMF to produce
tetrazole 261, which was isolated by precipitation of the
tetrazole ammonium salt. Subsequent methylation with methyl
iodide in THF/DMF (3:1) afforded a 3.85:1 mixture of 262 and
the corresponding N1-regioisomer. Acidification with 6 M HCl followed
by treatment with 50% aqueous NaOH (to pH 10.6) enabled
isolation of 262 in 96% isomeric purity; crude 262 was further purified
by recrystallization from isopropyl acetate and obtained in
33% yield from 261. A Suzuki reaction of 262 with boronic acid
263 (which was prepared from commercial 4-bromo-3-fluoroaniline
(267) as described in Scheme, via carboxybenzyl (Cbz) protection
and lithiation/borylation) followed by recrystallization
from ethyl acetate produced triaryl system 264. Deprotonation of
the carbamate within 264 using lithium hexamethyldisilazide
(LiHMDS) followed by reaction with R-(-)-glycidyl butyrate
(265) in the presence of 1,3-dimethyl tetrahydropyrimidin-2
(1H)-one (DMPU) generated tedizolide 266 in 85% yield. Reaction
with POCl3 in THF at 1¨C2 ?? followed by subjection to sodium
hydroxide and subsequent acidification furnished tedizolid phosphate
(XXXIII) in 76% yield across the three steps.
Drug interactions
Potentially hazardous interactions with other drugs
Alcohol: some alcoholic and de-alcoholised drinks
contain tyramine which can cause hypertensive crisis.
Alpha-blockers: avoid concomitant use with
indoramin; enhanced hypotensive effect.
Analgesics: CNS excitation or depression with
pethidine, other opioids and nefopam - avoid;
increased risk of serotonergic effects and convulsions
with tramadol - avoid.
Antidepressants: enhancement of CNS effects and
toxicity; avoid MAOIs, SSRIs and vortioxetine for 2
weeks after use; care with all antidepressants.
Antiepileptics: antagonism of anticonvulsant effect;
avoid carbamazepine with or within 2 weeks of
MAOIs.
Antimalarials: avoid concomitant use with
artemether/lumefantrine and piperaquine with
artenimol.
Antipsychotics: effects enhanced by clozapine.
Atomoxetine: possible increased risk of convulsions
- avoid concomitant use and for 2 weeks after use.
Bupropion: avoid with or for 2 weeks after MAOIs.
Dapoxetine: increased risk of serotonergic effects,
avoid with or for 2 weeks after MAOIs.
Dexamfetamine and lisdexamfetamine: risk of
hypertensive crisis, avoid with or for 2 weeks after
MAOIs.
Dopaminergics: avoid concomitant use with
entacapone and tolcapone; hypertensive crisis with
levodopa and rasagiline - avoid for at least 2 weeks
after stopping MAOI; hypotension with selegiline.
5HT1
agonist: risk of CNS toxicity with
sumatriptan, rizatriptan and zolmitriptan - avoid
sumatriptan and rizatriptan for 2 weeks after MAOI.
Metaraminol: risk of hypertensive crisis, avoid with
or for 2 weeks after MAOIs.
Methyldopa: avoid concomitant use.
Opicapone: avoid concomitant use.
Sympathomimetics: hypertensive crisis with
sympathomimetics - avoid.
Tetrabenazine: risk of CNS excitation and
hypertension - avoid.
Metabolism
Tedizolid phosphate is converted by endogenous plasma
and tissue phosphatases to the microbiologically active
moiety, tedizolid.
Tedizolid is eliminated in excreta, primarily as a noncirculating sulfate conjugate. Following single oral
administration of [14C]-labelled tedizolid under fasted
conditions, the majority of elimination occurred via the
liver with 81.5% of the radioactive dose recovered in
faeces and 18% in urine.
