Alosetron

Identification

Summary

Alosetron is a 5-HT3 antagonist used to treat diarrhea-predominant IBS.

Brand Names
Lotronex
Generic Name
Alosetron
DrugBank Accession Number
DB00969
Background

Alosetron is a 5-HT3 antagonist used only for the management of severe diarrhoea-predominant irritable bowel syndrome (IBS) in women. Alosetron has an antagonist action on the 5-HT3 receptors and thus may modulate serotonin-sensitive gastrointestinal (GI) processes. Alosetron was voluntarily withdrawn from the US market in November 2000 by the manufacturer due to numerous reports of severe adverse effects including ischemic colitis, severely obstructed or ruptured bowel, and death. In June 2002, the FDA approved a supplemental new drug application allowing the remarketing of the drug under restricted conditions of use.

Type
Small Molecule
Groups
Approved, Withdrawn
Structure
Weight
Average: 294.351
Monoisotopic: 294.148061218
Chemical Formula
C17H18N4O
Synonyms
  • 2,3,4,5-Tetrahydro-5-methyl-2-((5-methyl-1H-imidazol-4-yl)methyl)-1H-pyrido(4,3-b)indol-1-one
  • Alosetron
External IDs
  • GR 68755
  • GR68755

Pharmacology

Indication

Only for the treatment of symptoms of severe diarrhea-predominant irritable bowel syndrome (IBS) in women with chronic symptoms (generally lasting greater than 6 months) who does not present with anatomic or biochemical GI abnormalities and have not responded to conventional therapy.

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Associated Conditions
Indication TypeIndicationCombined Product DetailsApproval LevelAge GroupPatient CharacteristicsDose Form
Management ofSevere diarrhea predominant irritable bowel syndrome••••••••••••
Contraindications & Blackbox Warnings
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Pharmacodynamics

Alosetron is a potent and selective antagonist of the serotonin 5-HT3 receptor type. Activation of these receptors and the resulting neuronal depolarization affects the regulation of visceral pain, colonic transit, and GI secretions processes that are related to IBS. By blocking these receptors, alosetron is able to effectively control IBS.

Mechanism of action

Alosetron is a potent and selective 5-HT3 receptor antagonist. 5-HT3 receptors are nonselective cation channels that are extensively distributed on enteric neurons in the human gastrointestinal tract, as well as other peripheral and central locations. Activation of these channels and the resulting neuronal depolarization affect the regulation of visceral pain, colonic transit and gastrointestinal secretions, processes that relate to the pathophysiology of irritable bowel syndrome (IBS). 5-HT3 receptor antagonists such as alosetron inhibit activation of non-selective cation channels which results in the modulation of serotonin-sensitive GI motor and sensory processes.

TargetActionsOrganism
A5-hydroxytryptamine receptor 3A
antagonist
Humans
Absorption

50-60 %

Volume of distribution
  • 65 to 95 L
Protein binding

82%

Metabolism

Hepatic, via microsomal cytochrome P450 (CYP)

Route of elimination

Renal elimination of unchanged alosetron accounts for only 6% of the dose. Alosetron is extensively metabolized in humans.

Half-life

1.5 hours

Clearance
  • 600 mL/min
Adverse Effects
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Toxicity

Not Available

Pathways
Not Available
Pharmacogenomic Effects/ADRs Browse all" title="About SNP Mediated Effects/ADRs" id="snp-actions-info" class="drug-info-popup" href="javascript:void(0);">
Not Available

Interactions

Drug Interactions Learn More" title="About Drug Interactions" id="structured-interactions-info" class="drug-info-popup" href="javascript:void(0);">
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
1,2-BenzodiazepineThe risk or severity of CNS depression can be increased when Alosetron is combined with 1,2-Benzodiazepine.
AbametapirThe serum concentration of Alosetron can be increased when it is combined with Abametapir.
AbataceptThe metabolism of Alosetron can be increased when combined with Abatacept.
AbirateroneThe serum concentration of Alosetron can be increased when it is combined with Abiraterone.
AbrocitinibThe metabolism of Abrocitinib can be decreased when combined with Alosetron.
Food Interactions
  • Take with or without food. The absorption is unaffected by food.

Products

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Product Ingredients
IngredientUNIICASInChI Key
Alosetron hydrochloride2F5R1A46YW122852-69-1FNYQZOVOVDSGJH-UHFFFAOYSA-N
Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
LotronexTablet0.5 mg/1OralPrometheus Laboratories2009-02-09Not applicableUS flag
LotronexTablet0.5 mg/1OralSebela Pharmaceuticals Inc.2016-07-11Not applicableUS flag
LotronexTablet1 mg/1OralGlaxosmithkline Inc2000-02-092008-07-24US flag
LotronexTablet1.0 mg/1OralPrometheus Laboratories2009-02-09Not applicableUS flag
LotronexTablet0.5 mg/1OralGlaxosmithkline Inc2000-02-092009-09-24US flag
Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
AlosetronTablet1 mg/1OralLifestar Pharma Llc2020-09-14Not applicableUS flag
AlosetronTablet0.5 mg/1Oralbryant ranch prepack2020-09-14Not applicableUS flag
AlosetronTablet0.5 mg/1OralLifestar Pharma Llc2020-09-14Not applicableUS flag
AlosetronTablet1 mg/1Oralbryant ranch prepack2020-09-14Not applicableUS flag
Alosetron HydrochlorideTablet0.5 mg/1OralPar Pharmaceutical, Inc.2019-04-05Not applicableUS flag

Categories

ATC Codes
A03AE01 — Alosetron
Drug Categories
Chemical TaxonomyProvided by Classyfire
Description
This compound belongs to the class of organic compounds known as n-alkylindoles. These are compounds containing an indole moiety that carries an alkyl chain at the 1-position.
Kingdom
Organic compounds
Super Class
Organoheterocyclic compounds
Class
Indoles and derivatives
Sub Class
N-alkylindoles
Direct Parent
N-alkylindoles
Alternative Parents
Indoles / N-methylpyrroles / Benzenoids / Vinylogous amides / Tertiary carboxylic acid amides / Imidazoles / Heteroaromatic compounds / Lactams / Azacyclic compounds / Organopnictogen compounds
show 4 more
Substituents
Aromatic heteropolycyclic compound / Azacycle / Azole / Benzenoid / Carboxamide group / Carboxylic acid derivative / Heteroaromatic compound / Hydrocarbon derivative / Imidazole / Indole
show 13 more
Molecular Framework
Aromatic heteropolycyclic compounds
External Descriptors
imidazoles, pyridoindole (CHEBI:253342)
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
13Z9HTH115
CAS number
122852-42-0
InChI Key
JSWZEAMFRNKZNL-UHFFFAOYSA-N
InChI
InChI=1S/C17H18N4O/c1-11-13(19-10-18-11)9-21-8-7-15-16(17(21)22)12-5-3-4-6-14(12)20(15)2/h3-6,10H,7-9H2,1-2H3,(H,18,19)
IUPAC Name
5-methyl-2-[(5-methyl-1H-imidazol-4-yl)methyl]-1H,2H,3H,4H,5H-pyrido[4,3-b]indol-1-one
SMILES
CN1C2=C(C3=CC=CC=C13)C(=O)N(CC1=C(C)NC=N1)CC2

References

Synthesis Reference

Buchi Reddy REGURI, Sampathkumar UPPARAPALLI, Nilam SAHU, Karunakara Rao JAVVAJI, Brahma Reddy GADE, "PROCESS FOR THE PREPARATION OF ALOSETRON." U.S. Patent US20120178937, issued July 12, 2012.

US20120178937
General References
  1. Andresen V, Hollerbach S: Reassessing the benefits and risks of alosetron: what is its place in the treatment of irritable bowel syndrome? Drug Saf. 2004;27(5):283-92. [Article]
  2. Camilleri M: Pharmacology and clinical experience with alosetron. Expert Opin Investig Drugs. 2000 Jan;9(1):147-59. [Article]
  3. Mayer EA, Bradesi S: Alosetron and irritable bowel syndrome. Expert Opin Pharmacother. 2003 Nov;4(11):2089-98. [Article]
  4. Rahimi R, Nikfar S, Abdollahi M: Efficacy and tolerability of alosetron for the treatment of irritable bowel syndrome in women and men: a meta-analysis of eight randomized, placebo-controlled, 12-week trials. Clin Ther. 2008 May;30(5):884-901. doi: 10.1016/j.clinthera.2008.05.002. [Article]
  5. Lewis JH: Alosetron for severe diarrhea-predominant irritable bowel syndrome: safety and efficacy in perspective. Expert Rev Gastroenterol Hepatol. 2010 Feb;4(1):13-29. doi: 10.1586/egh.09.72. [Article]
Human Metabolome Database
HMDB0015104
KEGG Drug
D07129
PubChem Compound
2099
PubChem Substance
46506274
ChemSpider
2015
BindingDB
50014558
RxNav
85248
ChEBI
253342
ChEMBL
CHEMBL1110
ZINC
ZINC000013537284
Therapeutic Targets Database
DAP000369
PharmGKB
PA164745502
Guide to Pharmacology
GtP Drug Page
PDBe Ligand
S7Y
RxList
RxList Drug Page
Drugs.com
Drugs.com Drug Page
Wikipedia
Alosetron
PDB Entries
6w1j
FDA label
Download (208 KB)

Clinical Trials

Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">
PhaseStatusPurposeConditionsCount
4CompletedTreatmentIrritable Bowel Syndrome (IBS)1
3CompletedTreatmentIrritable Bowel Syndrome (IBS)2
2CompletedTreatmentIrritable Bowel Syndrome (IBS)1

Pharmacoeconomics

Manufacturers
  • Prometheus laboratories inc
Packagers
  • GlaxoSmithKline Inc.
  • Prometheus Laboratories Inc.
Dosage Forms
FormRouteStrength
Tablet, film coatedOral0.5 mg/1
Tablet, film coatedOral1 mg/1
TabletOral0.5 mg/1
TabletOral1 mg/1
TabletOral1.0 mg/1
Prices
Unit descriptionCostUnit
Lotronex 1 mg tablet19.47USD tablet
Lotronex 0.5 mg tablet14.3USD tablet
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
US5360800No1994-11-012013-01-13US flag
US6284770No2001-09-042018-10-05US flag

Properties

State
Solid
Experimental Properties
PropertyValueSource
logP2Not Available
Predicted Properties
PropertyValueSource
Water Solubility0.438 mg/mLALOGPS
logP1.85ALOGPS
logP1.21Chemaxon
logS-2.8ALOGPS
pKa (Strongest Acidic)13.32Chemaxon
pKa (Strongest Basic)6.81Chemaxon
Physiological Charge0Chemaxon
Hydrogen Acceptor Count2Chemaxon
Hydrogen Donor Count1Chemaxon
Polar Surface Area53.92 Å2Chemaxon
Rotatable Bond Count2Chemaxon
Refractivity86.41 m3·mol-1Chemaxon
Polarizability32.52 Å3Chemaxon
Number of Rings4Chemaxon
Bioavailability1Chemaxon
Rule of FiveYesChemaxon
Ghose FilterYesChemaxon
Veber's RuleNoChemaxon
MDDR-like RuleNoChemaxon
Predicted ADMET Features
PropertyValueProbability
Human Intestinal Absorption+0.9745
Blood Brain Barrier+0.9139
Caco-2 permeable+0.6511
P-glycoprotein substrateSubstrate0.8033
P-glycoprotein inhibitor IInhibitor0.7435
P-glycoprotein inhibitor IINon-inhibitor0.5707
Renal organic cation transporterInhibitor0.7795
CYP450 2C9 substrateNon-substrate0.7501
CYP450 2D6 substrateNon-substrate0.9116
CYP450 3A4 substrateSubstrate0.7672
CYP450 1A2 substrateNon-inhibitor0.5781
CYP450 2C9 inhibitorNon-inhibitor0.8878
CYP450 2D6 inhibitorInhibitor0.6507
CYP450 2C19 inhibitorNon-inhibitor0.9239
CYP450 3A4 inhibitorNon-inhibitor0.8274
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.6424
Ames testNon AMES toxic0.6156
CarcinogenicityNon-carcinogens0.967
BiodegradationNot ready biodegradable0.981
Rat acute toxicity2.7709 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.8334
hERG inhibition (predictor II)Inhibitor0.8554
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

Spectra

Mass Spec (NIST)
Not Available
Spectra
SpectrumSpectrum TypeSplash Key
Predicted GC-MS Spectrum - GC-MSPredicted GC-MSsplash10-054p-9640000000-36ec950b2b5a4de0d766
MS/MS Spectrum - , positiveLC-MS/MSsplash10-0udi-0390000000-3b813a9458d2bce7516f
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSsplash10-0006-0290000000-15bddd47f373eb667d36
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSsplash10-0002-0090000000-ea8da26c53a0e796404d
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSsplash10-0002-0090000000-ae47caffe1cf52321d57
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSsplash10-0007-1190000000-de5347291a022e684281
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSsplash10-03ed-4790000000-f8cd452d5238f9e29fdb
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSsplash10-05al-2950000000-19fb31d533c50402f31b
Predicted 1H NMR Spectrum1D NMRNot Applicable
Predicted 13C NMR Spectrum1D NMRNot Applicable
Chromatographic Properties
Collision Cross Sections (CCS)
AdductCCS Value (Å2)Source typeSource
[M-H]-180.1968973
predicted
DarkChem Lite v0.1.0
[M-H]-181.2782973
predicted
DarkChem Lite v0.1.0
[M-H]-164.76216
predicted
DeepCCS 1.0 (2019)
[M+H]+180.8015973
predicted
DarkChem Lite v0.1.0
[M+H]+180.7651973
predicted
DarkChem Lite v0.1.0
[M+H]+167.12016
predicted
DeepCCS 1.0 (2019)
[M+Na]+179.9657973
predicted
DarkChem Lite v0.1.0
[M+Na]+181.2261973
predicted
DarkChem Lite v0.1.0
[M+Na]+173.21332
predicted
DeepCCS 1.0 (2019)

Targets

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insights and accelerate drug research.
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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Antagonist
General Function
Voltage-gated potassium channel activity
Specific Function
This is one of the several different receptors for 5-hydroxytryptamine (serotonin), a biogenic hormone that functions as a neurotransmitter, a hormone, and a mitogen. This receptor is a ligand-gate...
Gene Name
HTR3A
Uniprot ID
P46098
Uniprot Name
5-hydroxytryptamine receptor 3A
Molecular Weight
55279.835 Da
References
  1. Clayton NM, Sargent R, Butler A, Gale J, Maxwell MP, Hunt AA, Barrett VJ, Cambridge D, Bountra C, Humphrey PP: The pharmacological properties of the novel selective 5-HT3 receptor antagonist, alosetron, and its effects on normal and perturbed small intestinal transit in the fasted rat. Neurogastroenterol Motil. 1999 Jun;11(3):207-17. [Article]
  2. Mayer EA, Bradesi S: Alosetron and irritable bowel syndrome. Expert Opin Pharmacother. 2003 Nov;4(11):2089-98. [Article]
  3. Coldwell JR, Phillis BD, Sutherland K, Howarth GS, Blackshaw LA: Increased responsiveness of rat colonic splanchnic afferents to 5-HT after inflammation and recovery. J Physiol. 2007 Feb 15;579(Pt 1):203-13. Epub 2006 Nov 30. [Article]
  4. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [Article]
  5. Houghton LA, Foster JM, Whorwell PJ: Alosetron, a 5-HT3 receptor antagonist, delays colonic transit in patients with irritable bowel syndrome and healthy volunteers. Aliment Pharmacol Ther. 2000 Jun;14(6):775-82. [Article]
  6. Gunput MD: Review article: clinical pharmacology of alosetron. Aliment Pharmacol Ther. 1999 May;13 Suppl 2:70-6. [Article]
  7. Balfour JA, Goa KL, Perry CM: Alosetron. Drugs. 2000 Mar;59(3):511-8; discussion 519-20. [Article]
  8. Camilleri M: Pharmacology and clinical experience with alosetron. Expert Opin Investig Drugs. 2000 Jan;9(1):147-59. [Article]
  9. Rahimi R, Nikfar S, Abdollahi M: Efficacy and tolerability of alosetron for the treatment of irritable bowel syndrome in women and men: a meta-analysis of eight randomized, placebo-controlled, 12-week trials. Clin Ther. 2008 May;30(5):884-901. doi: 10.1016/j.clinthera.2008.05.002. [Article]
  10. Lewis JH: Alosetron for severe diarrhea-predominant irritable bowel syndrome: safety and efficacy in perspective. Expert Rev Gastroenterol Hepatol. 2010 Feb;4(1):13-29. doi: 10.1586/egh.09.72. [Article]
  11. Andresen V, Hollerbach S: Reassessing the benefits and risks of alosetron: what is its place in the treatment of irritable bowel syndrome? Drug Saf. 2004;27(5):283-92. [Article]

Enzymes

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
Inhibitor
General Function
Oxidoreductase activity, acting on paired donors, with incorporation or reduction of molecular oxygen, reduced flavin or flavoprotein as one donor, and incorporation of one atom of oxygen
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP1A2
Uniprot ID
P05177
Uniprot Name
Cytochrome P450 1A2
Molecular Weight
58293.76 Da
References
  1. Wang B, Zhou SF: Synthetic and natural compounds that interact with human cytochrome P450 1A2 and implications in drug development. Curr Med Chem. 2009;16(31):4066-218. [Article]
  2. Koch KM, Corrigan BW, Manzo J, James CD, Scott RJ, Stead AG, Kersey KE: Alosetron repeat dose pharmacokinetics, effects on enzyme activities, and influence of demographic factors. Aliment Pharmacol Ther. 2004 Jul 15;20(2):223-30. doi: 10.1111/j.1365-2036.2004.02031.x. [Article]
  3. Lucak SL: Optimizing outcomes with alosetron hydrochloride in severe diarrhea-predominant irritable bowel syndrome. Therap Adv Gastroenterol. 2010 May;3(3):165-72. doi: 10.1177/1756283X10362277. [Article]
  4. Alosteron [Link]
  5. Alosteron FDA label [File]
  6. CTEP CYP1A2 document, NIH [File]
Details
2. Cytochrome P450 3A4
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. D'Souza DL, Levasseur LM, Nezamis J, Robbins DK, Simms L, Koch KM: Effect of alosetron on the pharmacokinetics of alprazolam. J Clin Pharmacol. 2001 Apr;41(4):452-4. [Article]
  2. Alosetron FDA label [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
General Function
Steroid hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP2C9
Uniprot ID
P11712
Uniprot Name
Cytochrome P450 2C9
Molecular Weight
55627.365 Da
References
  1. D'Souza DL, Dimmitt DC, Robbins DK, Nezamis J, Simms L, Koch KM: Effect of alosetron on the pharmacokinetics of fluoxetine. J Clin Pharmacol. 2001 Apr;41(4):455-8. [Article]
  2. D'Souza DL, Levasseur LM, Nezamis J, Robbins DK, Simms L, Koch KM: Effect of alosetron on the pharmacokinetics of alprazolam. J Clin Pharmacol. 2001 Apr;41(4):452-4. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Inhibitor
General Function
Steroid hydroxylase activity
Specific Function
Metabolizes several precarcinogens, drugs, and solvents to reactive metabolites. Inactivates a number of drugs and xenobiotics and also bioactivates many xenobiotic substrates to their hepatotoxic ...
Gene Name
CYP2E1
Uniprot ID
P05181
Uniprot Name
Cytochrome P450 2E1
Molecular Weight
56848.42 Da
References
  1. LOTRONEX (alosetron hydrochloride) Tablets - FDA Label [Link]
  2. List of drugs that may have potential CYP2E1 interactions [File]

Drug created at June 13, 2005 13:24 / Updated at February 02, 2024 22:46