molecular formula C17H16N2O3 B1671254 Eslicarbazepine acetate CAS No. 236395-14-5

Eslicarbazepine acetate

Cat. No.: B1671254
CAS No.: 236395-14-5
M. Wt: 296.32 g/mol
InChI Key: QIALRBLEEWJACW-INIZCTEOSA-N
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Description

  • Mechanism of Action

    Target of Action

    Eslicarbazepine acetate (ESL) is an anticonvulsant medication that primarily targets voltage-gated sodium channels . These channels play a crucial role in the generation and conduction of action potentials in neurons, which are fundamental to the functioning of the nervous system .

    Mode of Action

    ESL is a prodrug that is rapidly converted to eslicarbazepine, the primary active metabolite in the body . This prevents their return to the activated state, during which seizure activity can occur .

    Biochemical Pathways

    The primary biochemical pathway affected by ESL involves the modulation of voltage-gated sodium channels . By stabilizing the inactivated state of these channels, ESL reduces the ability of neurons to reach the threshold potential necessary for action potential generation . This effectively reduces the excitability of neurons, thereby suppressing seizure activity .

    Pharmacokinetics

    ESL exhibits favorable pharmacokinetic properties. It is rapidly and extensively metabolized to its major active metabolite, eslicarbazepine, via hydrolytic first-pass metabolism . Eslicarbazepine corresponds to about 92% of systemic exposure . The drug displays linear kinetics at doses of 400 mg to 1200 mg/day . ESL is predominantly eliminated by renal excretion, with 91% of the drug recovered in urine following an oral dose . The plasma elimination half-life of ESL is less than 2 hours, while the half-life values for eslicarbazepine are 10–20 hours .

    Result of Action

    The molecular and cellular effects of ESL’s action primarily involve the reduction of neuronal excitability. By inhibiting the activity of voltage-gated sodium channels, ESL suppresses the generation of action potentials in neurons . This results in a decrease in the frequency and severity of seizures in patients with epilepsy .

    Action Environment

    The action, efficacy, and stability of ESL can be influenced by various environmental factors. For instance, the presence of other antiepileptic drugs (AEDs) can affect the pharmacokinetics and pharmacodynamics of ESL . Several AEDs can induce enzymes that metabolize ESL, potentially leading to decreased plasma concentrations of eslicarbazepine . Therefore, the therapeutic efficacy of ESL may be affected by the concomitant use of other AEDs .

    Biochemical Analysis

    Biochemical Properties

    Eslicarbazepine acetate is converted to the active metabolite eslicarbazepine which carries out its anticonvulsant activity . This interaction with sodium channels inhibits repeated neuronal firing and stabilizes the inactivated state of these channels, thus preventing their return to the activated state during which seizure activity can occur .

    Cellular Effects

    This compound exerts its effects on various types of cells, primarily neurons. By inhibiting the activity of voltage-gated sodium channels, this compound reduces the excitability of neurons, thereby reducing the likelihood of seizure activity . This influence on cell function impacts cell signaling pathways and can affect gene expression and cellular metabolism .

    Molecular Mechanism

    The molecular mechanism of this compound involves its conversion to eslicarbazepine, which then interacts with voltage-gated sodium channels . By stabilizing the inactivated state of these channels, eslicarbazepine prevents the channels from returning to the activated state, thus inhibiting repeated neuronal firing and reducing seizure activity .

    Temporal Effects in Laboratory Settings

    The effects of this compound in laboratory settings can change over time. For instance, the drug’s anticonvulsant activity can be observed shortly after administration due to its rapid conversion to eslicarbazepine . Over time, the drug’s effects may diminish as it is metabolized and eliminated from the body .

    Dosage Effects in Animal Models

    The effects of this compound can vary with different dosages in animal models . At lower doses, the drug may exert its anticonvulsant effects without causing significant side effects. At higher doses, toxic or adverse effects may be observed .

    Metabolic Pathways

    This compound is rapidly and extensively metabolized to its major active metabolite, eslicarbazepine, via hydrolytic first-pass metabolism . Eslicarbazepine corresponds to about 92% of systemic exposure .

    Transport and Distribution

    After oral ingestion, this compound is rapidly absorbed and extensively metabolized to eslicarbazepine . Its volume of distribution is 2.7 L/kg, and plasma protein binding is somewhat less than 40% . These values relate to eslicarbazepine, the pharmacologically active metabolite of this compound .

    Subcellular Localization

    The subcellular localization of eslicarbazepine, the active metabolite of this compound, is primarily at the cellular membrane where it interacts with voltage-gated sodium channels . This interaction inhibits repeated neuronal firing and stabilizes the inactivated state of these channels, thus preventing their return to the activated state during which seizure activity can occur .

    Preparation Methods

      Synthetic Routes: Eslicarbazepine acetate is synthesized from carbamazepine via acetylation. The acetoxy group is introduced at position 10 of the dibenzazepine ring.

      Reaction Conditions: Specific synthetic conditions and reaction parameters are proprietary, but the overall process involves chemical modifications of carbamazepine.

      Industrial Production: Details on industrial-scale production methods are not widely available in the public domain.

  • Chemical Reactions Analysis

      Reactivity: Eslicarbazepine acetate undergoes various chemical reactions, including oxidation, reduction, and substitution.

      Common Reagents and Conditions:

      Major Products: The primary product of these reactions is the active metabolite, .

  • Scientific Research Applications

    Adjunctive Therapy for Partial-Onset Seizures

    Eslicarbazepine acetate is indicated as adjunctive therapy for adults and children aged four years and older with partial-onset seizures. Clinical trials have demonstrated significant reductions in seizure frequency when eslicarbazepine is added to existing antiepileptic regimens. For instance, a pooled analysis from three phase III studies involving 1,049 patients showed that doses of 800 mg and 1,200 mg resulted in median relative reductions in seizure frequency of 35% and 39%, respectively, compared to a placebo reduction of only 15% .

    Long-Term Efficacy and Safety

    Long-term studies have confirmed the sustained efficacy of this compound over extended periods. A retrospective observational study in Norway indicated a retention rate of 83% after one year of treatment, suggesting good tolerability and effectiveness in patients with refractory epilepsy . Common side effects reported include dizziness, somnolence, and headache; however, these were generally manageable and did not lead to significant discontinuation rates .

    Pharmacokinetics

    The pharmacokinetic profile of this compound reveals high bioavailability and rapid absorption, with peak serum concentrations reached within 1-4 hours post-administration. The drug exhibits a wide volume of distribution (approximately 61.3 L) and is primarily eliminated through hepatic metabolism . Notably, inter-patient variability in drug concentration has been observed, emphasizing the potential need for therapeutic drug monitoring in clinical practice .

    Comparative Effectiveness

    When compared to other antiepileptic drugs such as carbamazepine and oxcarbazepine, this compound demonstrates several advantages:

    • Once-Daily Dosing : Unlike many traditional antiepileptic medications that require multiple doses per day, eslicarbazepine can be administered once daily, improving patient compliance .
    • Fewer Drug Interactions : Eslicarbazepine has a more favorable drug interaction profile than carbamazepine, being a weaker enzyme inducer and affecting fewer cytochrome P450 enzymes .

    Case Study 1: Efficacy in Refractory Epilepsy

    A study involving patients with refractory focal seizures showed significant improvements in seizure control after initiating treatment with this compound. Patients previously on multiple antiepileptic drugs experienced notable reductions in seizure frequency within weeks of starting therapy.

    Case Study 2: Long-Term Tolerability

    In a cohort study following patients over five years, eslicarbazepine was well tolerated with minimal adverse events reported. Patients who switched from other treatments noted improved quality of life metrics alongside reduced seizure frequency.

    Comparison with Similar Compounds

      Similar Compounds: Eslicarbazepine shares similarities with oxcarbazepine, which also behaves as a prodrug to licarbazepine.

      Uniqueness: Unlike carbamazepine, eslicarbazepine has a modified side chain, leading to differences in metabolism and pharmacokinetics.

    Biological Activity

    Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug primarily utilized as an adjunctive therapy for adults with focal seizures. Its biological activity is primarily attributed to its active metabolite, eslicarbazepine, which demonstrates a complex mechanism of action involving the modulation of ion channels and neurotransmitter systems. This article delves into the pharmacological properties, efficacy, safety, and case studies related to ESL.

    The exact mechanism of action of eslicarbazepine is not fully understood; however, several key actions have been identified:

    • Voltage-Gated Sodium Channel Inhibition : ESL stabilizes the inactivated state of voltage-gated sodium channels, thereby inhibiting repetitive neuronal firing. This action is crucial in preventing seizure propagation .
    • T-Type Calcium Channel Modulation : In vitro studies suggest that eslicarbazepine also inhibits T-type calcium channels, which may contribute to its anticonvulsant effects .
    • Neurotransmitter Interaction : ESL may influence neurotransmitter release and receptor activity indirectly through its effects on ion channels.

    Pharmacokinetics

    This compound undergoes rapid metabolism to its active form, eslicarbazepine, via hydrolytic first-pass metabolism. Here are some pharmacokinetic parameters:

    ParameterValue
    BioavailabilityHigh
    Peak Serum Concentration1-4 hours post-dose
    Volume of Distribution61.3 L (for a 70 kg individual)
    Protein Binding<40%
    Half-Life10-20 hours (healthy subjects)
    ClearanceRenal excretion

    The pharmacokinetic profile suggests that ESL reaches steady-state plasma concentrations after 4-5 days of once-daily dosing .

    Clinical Trials and Studies

    • Efficacy in Drug-Resistant Focal Epilepsy : A systematic review including seven clinical trials with 2,185 participants indicated that ESL significantly reduces seizure frequency in adults with drug-resistant focal epilepsy. The responder rate was notably higher compared to placebo groups .
    • Real-World Data : A prospective study (EPOS) provided real-world evidence supporting the efficacy and tolerability of ESL in patients with uncontrolled partial-onset seizures. The study highlighted a retention rate of 69% and a seizure-free rate of 24.1% after one year .
    • Elderly Patients : A retrospective survey involving elderly patients (>65 years) found ESL to be well-tolerated with a mean dose of approximately 850 mg/day. Adverse effects were reported in 55.2% of patients, but many experienced improved tolerability compared to previous treatments with carbamazepine or oxcarbazepine .

    Case Study 1: Efficacy in Elderly Patients

    In a study involving 29 elderly patients with focal seizures, ESL was administered as an adjunctive therapy. After one year, the majority reported improved seizure control and tolerability compared to prior therapies. Adverse effects such as dizziness and nausea were common but manageable .

    Case Study 2: Long-Term Use

    A long-term follow-up study demonstrated sustained efficacy over five years for patients on ESL, with no unexpected safety signals emerging during this period. Patients switching from other antiepileptic medications reported better tolerability and fewer side effects .

    Properties

    IUPAC Name

    [(5S)-11-carbamoyl-5,6-dihydrobenzo[b][1]benzazepin-5-yl] acetate
    Source PubChem
    URL https://pubchem.ncbi.nlm.nih.gov
    Description Data deposited in or computed by PubChem

    InChI

    InChI=1S/C17H16N2O3/c1-11(20)22-16-10-12-6-2-4-8-14(12)19(17(18)21)15-9-5-3-7-13(15)16/h2-9,16H,10H2,1H3,(H2,18,21)/t16-/m0/s1
    Source PubChem
    URL https://pubchem.ncbi.nlm.nih.gov
    Description Data deposited in or computed by PubChem

    InChI Key

    QIALRBLEEWJACW-INIZCTEOSA-N
    Source PubChem
    URL https://pubchem.ncbi.nlm.nih.gov
    Description Data deposited in or computed by PubChem

    Canonical SMILES

    CC(=O)OC1CC2=CC=CC=C2N(C3=CC=CC=C13)C(=O)N
    Source PubChem
    URL https://pubchem.ncbi.nlm.nih.gov
    Description Data deposited in or computed by PubChem

    Isomeric SMILES

    CC(=O)O[C@H]1CC2=CC=CC=C2N(C3=CC=CC=C13)C(=O)N
    Source PubChem
    URL https://pubchem.ncbi.nlm.nih.gov
    Description Data deposited in or computed by PubChem

    Molecular Formula

    C17H16N2O3
    Source PubChem
    URL https://pubchem.ncbi.nlm.nih.gov
    Description Data deposited in or computed by PubChem

    DSSTOX Substance ID

    DTXSID90178308
    Record name Eslicarbazepine acetate
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    Description DSSTox provides a high quality public chemistry resource for supporting improved predictive toxicology.

    Molecular Weight

    296.32 g/mol
    Source PubChem
    URL https://pubchem.ncbi.nlm.nih.gov
    Description Data deposited in or computed by PubChem

    Solubility

    Water solubility of eslicarbazepine acetate is low at less than 1 mg/mL including at different pH values. Its main metabolite eslicarbazepine has a greater water solubility of 4.2 mg/mL.
    Record name Eslicarbazepine acetate
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    Mechanism of Action

    Eslicarbazepine acetate is converted to the active metabolite eslicarbazepine which carries out its anticonvulsant activity. The exact mechanism of action is unknown, but it is thought to involve the inhibition of voltage-gated sodium channels. In in vitro electrophysiological studies, eslicarbazepine was shown to inhibit repeated neuronal firing by stabilizing the inactivated state of voltage-gated sodium channels and preventing their return to the activated state. In vitro studies also showed eslicarbazepine inhibiting T-type calcium channels, which likely also has a role in anticonvulsant activity.
    Record name Eslicarbazepine acetate
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    CAS No.

    236395-14-5
    Record name Eslicarbazepine acetate
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    Record name Eslicarbazepine acetate [USAN]
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    Record name Eslicarbazepine acetate
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    Record name Eslicarbazepine acetate
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    Record name S-(-)-10-Acetoxy-10,11-dihydro-5H-dibenz[b,f]azepine-5-carboxamide
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    Record name ESLICARBAZEPINE ACETATE
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    Retrosynthesis Analysis

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    Feasible Synthetic Routes

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    Customer
    Q & A

    A: Eslicarbazepine acetate itself is a prodrug, meaning it is inactive until metabolized in the body. Its major active metabolite, Eslicarbazepine, exerts its antiepileptic effects primarily by stabilizing the inactivated state of voltage-gated sodium channels (VGSCs) []. This prevents the channels from returning to their active state, thereby inhibiting the repetitive firing of neurons that underlies epileptic seizures.

    A: Yes, research suggests that ESL exhibits maintained use-dependent blocking effects in both human and experimental epilepsy models. Furthermore, it demonstrates significant add-on effects when used with Carbamazepine in human epilepsy [].

    A: Studies have shown that ESL also inhibits Cav3.2 T-type Ca2+ channels. These channels are thought to play a crucial role in the process of epileptogenesis, which is the development of epilepsy [].

    ANone: this compound has the molecular formula C18H18N2O3 and a molecular weight of 310.34 g/mol.

    A: Yes, various spectroscopic techniques, including Fourier-transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRPD), and differential scanning calorimetry (DSC) have been used to characterize ESL and its formulations [, , ]. These techniques provide information about the drug's structural properties, crystallinity, and thermal behavior.

    ANone: this compound is not known to possess catalytic properties and is not used for catalytic applications. Its primary function is as a pharmaceutical drug.

    A: Yes, computational studies, including molecular docking simulations, have been employed to investigate the interactions of ESL with its molecular targets, such as VGSCs and BACE1 []. These studies can provide insights into the binding affinities and molecular mechanisms of action.

    A: ESL shares structural similarities with other dibenzazepine antiepileptic drugs like Carbamazepine and Oxcarbazepine. The S (+) enantiomer of licarbazepine, the active metabolite of ESL, is thought to be responsible for its enhanced efficacy and reduced side effects compared to the racemic mixture found in Oxcarbazepine []. The absence of the 10,11-epoxide group in ESL, unlike Carbamazepine, contributes to its lower drug interaction potential and improved neurological tolerability [].

    A: Researchers have investigated various formulation strategies for ESL, including tablet formulations [, ], oral suspensions [, ], and formulations suitable for delivery via enteral feeding tubes []. These formulations aim to optimize drug solubility, dissolution rate, and bioavailability.

    A: Studies indicate that ESL oral suspensions prepared with specific vehicles, such as a 50:50 v/v mixture of Ora-Sweet or Ora-Sweet SF with Ora-Plus, demonstrate good stability for up to two months when stored at room temperature or under refrigeration [, ].

    ANone: Information about specific SHE regulations related to ESL research and manufacturing is not directly addressed in the provided research papers.

    A: ESL is rapidly and extensively metabolized in the liver, primarily by esterases, into its major active metabolite, Eslicarbazepine (S-licarbazepine) [, , , ]. Minor metabolic pathways include oxidation to Oxcarbazepine and formation of R-licarbazepine [].

    A: Studies indicate that food does not significantly impact the pharmacokinetics of ESL, making it convenient for once-daily dosing [, , ].

    A: Research has identified that the enzyme AADAC plays a significant role in the hydrolysis of ESL to its active metabolite Eslicarbazepine in the human liver and intestines []. Notably, genetic variations (polymorphisms) in the AADAC gene can influence enzyme activity and potentially impact drug response [].

    A: Yes, numerous clinical trials have demonstrated the efficacy of ESL as adjunctive therapy in adults with refractory focal-onset seizures. Significant reductions in seizure frequency and improved responder rates were observed compared to placebo, particularly at doses of 800mg and 1200mg once daily [, , , , , ].

    A: Clinical trials have shown promising results for ESL monotherapy in adults with newly diagnosed focal-onset seizures, demonstrating good tolerability and effectiveness over the long term [, ]. Additionally, patients transitioning from controlled-release Carbamazepine monotherapy to ESL monotherapy showed comparable efficacy and safety profiles [].

    A: Preliminary research suggests that ESL might hold promise in treating other neurological disorders, such as neuropathic pain, including diabetic neuropathic pain and postherpetic neuralgia. This is based on its similarities in structure and mechanism of action to Carbamazepine and Oxcarbazepine, which are known to be effective in these conditions [].

    ANone: The provided research papers do not extensively discuss specific resistance mechanisms to ESL or cross-resistance with other antiepileptic drugs.

    ANone: Information regarding the toxicology and safety profile of ESL is not included in this scientific Q&A, as the focus is on the scientific aspects of the compound.

    ANone: The provided research papers primarily focus on conventional oral administration of ESL. Targeted drug delivery approaches are not discussed within the scope of these studies.

    ANone: The provided research papers do not mention any specific biomarkers associated with ESL treatment response or adverse effects.

    A: High-performance liquid chromatography (HPLC) coupled with ultraviolet detection (HPLC-UV) is commonly used for the quantification of ESL and its metabolites in biological samples, particularly plasma [, , , ].

    A: Yes, enantioselective HPLC methods utilizing chiral stationary phases, such as beta-cyclodextrin columns, are employed to separate and quantify the individual enantiomers of ESL's metabolites, particularly S-licarbazepine and R-licarbazepine [].

    ANone: The provided research papers do not delve into the environmental impact or degradation pathways of ESL.

    A: ESL is known to have poor aqueous solubility, which can limit its dissolution rate and, consequently, its oral bioavailability []. Therefore, various formulation strategies, such as particle size reduction and the use of solubility enhancers, have been explored to improve its dissolution characteristics and enhance its therapeutic effectiveness [].

    A: Yes, studies have investigated techniques like co-grinding ESL with other compounds such as tartaric acid or citric acid to form eutectic systems []. These eutectic mixtures exhibit lower melting points and enhanced dissolution rates compared to the pure drug, leading to improved bioavailability [].

    A: Several research articles highlight the development and validation of analytical methods, particularly HPLC-UV methods, for the quantification of ESL and its metabolites in various matrices, including bulk drug substance, pharmaceutical formulations, and biological samples [, , , ]. The validation processes typically involve assessing parameters such as linearity, accuracy, precision, specificity, sensitivity, and robustness to ensure the reliability and reproducibility of the analytical data [, , , ].

    ANone: The specifics of quality control and assurance measures implemented during the development, manufacturing, and distribution of ESL are not elaborated upon in the provided research papers.

    ANone: The provided research papers do not delve into the immunogenicity or potential for immunological responses associated with ESL.

    ANone: Specific details regarding ESL's interactions with drug transporters are not discussed in the provided research papers.

    A: ESL exhibits a low potential for inducing or inhibiting major drug-metabolizing enzymes, particularly cytochrome P450 enzymes [, , ]. This characteristic contributes to its favorable drug interaction profile, making it a suitable option for patients on multiple medications [, , ].

    ANone: The provided research papers do not provide specific details regarding the biocompatibility or biodegradability of ESL.

    A: ESL is often compared to other antiepileptic drugs, such as Carbamazepine, Oxcarbazepine, lacosamide, levetiracetam, and pregabalin, in terms of efficacy, tolerability, and safety [, , , , , ]. The choice of one drug over another is influenced by factors such as the patient's individual characteristics, seizure type, potential for drug interactions, and tolerability profile [, , , , , ].

    ANone: The provided research papers do not address the aspects of recycling or waste management specific to ESL.

    ANone: The research papers do not explicitly discuss specific research infrastructure or resources used in ESL studies.

    A: ESL, under the brand name Zebinix®, received approval from the European Medicines Agency (EMA) in 2009 for use as adjunctive therapy in adults with partial-onset seizures [, ]. Subsequently, it gained approval from the US Food and Drug Administration (FDA) in 2013 under the brand name Aptiom™ for the same indication [].

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