Pimecrolimus

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Pimecrolimus
Systematic (IUPAC) name
(3S,4R,5S,8R,9E,12S,14S,15R,16S,18R,19R,26aS) -3-{(E)-2-[(1R,3R,4S)-4-Chloro-3 -methoxycyclohexyl]-1-methylvinyl} -8-ethyl-5,6,8,11,12,13,14,15,16,17,18 ,19,24,25,26,26a-hexadecahydro -5,19-dihydroxy-14,16-dimethoxy -4,10,12,18-tetramethyl-15,19-epoxy -3H-pyrido[2,1-c][1,4]oxaazacyclotricosine -1,7,20,21(4H,23H)-tetrone
Identifiers
CAS number	137071-32-0
ATC code	D11 AX15
PubChem	6447131
DrugBank	APRD01182
Chemical data
Formula	C₄₃H₆₈ClNO₁₁
Mol. weight	810.453 g/mol
Pharmacokinetic data
Bioavailability	low systemic absorption
Protein binding	74%-87%
Metabolism	Hepatic CYP3A
Half life	?
Excretion	?
Therapeutic considerations
Pregnancy cat.	?
Legal status
Routes	topical

Pimecrolimus is an immunomodulating agent used in the treatment of atopic dermatitis (eczema). It is currently available as a topical cream, marketed by Novartis, under the trade name Elidel.

1 Pharmacology
2 Side effects
3 Footnotes
4 External links

[edit] Pharmacology

Pimecrolimus is an ascomycin macrolactam derivative. It has been shown in vitro that pimecrolimus binds to macrophilin-12 and inhibits calcineurin. Thus pimecrolimus inhibits T-cell activation by inhibiting the synthesis and release of cytokines from T-cells. Pimecrolimus also prevents the release of inflammatory cytokines and mediators from mast cells.

[edit] Side effects

Further information: Eczema#Immunomodulators

In January 2006, the United States Food and Drug Administration (FDA) announced that Elidel packaging would be required to carry a black box warning regarding the potential increased risk of lymph node or skin malignancy, as for the similar drug tacrolimus. Whereas current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of such new drugs.^[1]

Dermatologists agree that the drug should be used as a second-line remedy only after conventional methods of treatment have failed.

[edit] Footnotes

^ N H Cox and Catherine H Smith (December 2002). Advice to dermatologists re topical tacrolimus (DOC). Therapy Guidelines Committee. British Association of Dermatologists.