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Technical details about Rilpivirine, learn more about the structure, uses, toxicity, action, side effects and more

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2D Structure
Also known as: 500287-72-9, Tmc278, Edurant, Rilpivirine free base, R278474, Tmc 278
Molecular Formula
C22H18N6
Molecular Weight
366.4  g/mol
InChI Key
YIBOMRUWOWDFLG-ONEGZZNKSA-N
FDA UNII
FI96A8X663

A diarylpyrimidine derivative and REVERSE TRANSCRIPTASE INHIBITOR with antiviral activity against HIV-1 that is used in the treatment of HIV INFECTIONS. It is also used in combination with other ANTI-HIV AGENTS, since ANTIVIRAL DRUG RESISTANCE emerges rapidly when it is used alone.
Rilpivirine is a Human Immunodeficiency Virus 1 Non-Nucleoside Analog Reverse Transcriptase Inhibitor. The mechanism of action of rilpivirine is as a Non-Nucleoside Reverse Transcriptase Inhibitor.
1 2D Structure

2D Structure

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
4-[[4-[4-[(E)-2-cyanoethenyl]-2,6-dimethylanilino]pyrimidin-2-yl]amino]benzonitrile
2.1.2 InChI
InChI=1S/C22H18N6/c1-15-12-18(4-3-10-23)13-16(2)21(15)27-20-9-11-25-22(28-20)26-19-7-5-17(14-24)6-8-19/h3-9,11-13H,1-2H3,(H2,25,26,27,28)/b4-3+
2.1.3 InChI Key
YIBOMRUWOWDFLG-ONEGZZNKSA-N
2.1.4 Canonical SMILES
CC1=CC(=CC(=C1NC2=NC(=NC=C2)NC3=CC=C(C=C3)C#N)C)C=CC#N
2.1.5 Isomeric SMILES
CC1=CC(=CC(=C1NC2=NC(=NC=C2)NC3=CC=C(C=C3)C#N)C)/C=C/C#N
2.2 Other Identifiers
2.2.1 UNII
FI96A8X663
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 278, Tmc

2. Hcl, Rilpivirine

3. Hydrochloride, Rilpivirine

4. R278474

5. Rilpivirine Hcl

6. Rilpivirine Hydrochloride

7. Tmc 278

8. Tmc-278

9. Tmc278

2.3.2 Depositor-Supplied Synonyms

1. 500287-72-9

2. Tmc278

3. Edurant

4. Rilpivirine Free Base

5. R278474

6. Tmc 278

7. Tmc-278

8. R 278474

9. (e)-4-((4-((4-(2-cyanovinyl)-2,6-dimethylphenyl)amino)pyrimidin-2-yl)amino)benzonitrile

10. (e)-4-(4-(4-(2-cyanovinyl)-2,6-dimethylphenylamino)pyrimidin-2-ylamino)benzonitrile

11. 4-{[4-({4-[(e)-2-cyanoethenyl]-2,6-dimethylphenyl}amino)pyrimidin-2-yl]amino}benzonitrile

12. 4-{[4-({4-[(e)-2-cyanovinyl]-2,6-dimethylphenyl}amino)pyrimidin-2-yl]amino}benzonitrile

13. Chebi:68606

14. Fi96a8x663

15. 500287-72-9 (free Base)

16. 4-[[4-[[4-[(e)-2-cyanoethenyl]-2,6-dimethyl-phenyl]amino]pyrimidin-2-yl]amino]benzonitrile

17. Db08864

18. R-278474

19. Rilpivirine [inn]

20. Rilpivirine [usan:inn]

21. Rilpivirina

22. Unii-fi96a8x663

23. Hsdb 8153

24. Edurant(tm)

25. 4-((4-((4-((1e)-2-cyanoethenyl)-2,6-dimethylphenyl)amino)-2-pyrimidinyl)amino)benzonitrile

26. 4-[[4-[[4-[(1e)-2-cyanoethenyl]-2,6-dimethylphenyl]amino]-2-pyrimidinyl]amino]benzonitrile

27. T27

28. Rilpivirine [mi]

29. Rilpivirine [jan]

30. Rilpivirine [usan]

31. Rilpivirine [vandf]

32. Rilpivirine [mart.]

33. Rilpivirine [who-dd]

34. Schembl384696

35. Schembl385113

36. Rilpivirine (jan/usan/inn)

37. Chembl175691

38. Gtpl11387

39. Dtxsid10198189

40. Ex-a245

41. Rilpivirine [orange Book]

42. Bdbm222178

43. Bcp03563

44. Zinc1554274

45. Cabenuva Component Rilpivirine

46. Mfcd11046372

47. S7303

48. Stl484047

49. Akos015901680

50. Bcp9000016

51. Ccg-268241

52. Cs-0440

53. Ke-0036

54. R278474;tmc278

55. 4-[[4-[4-[(e)-2-cyanovinyl]-2,6-dimethyl-anilino]pyrimidin-2-yl]amino]benzonitrile

56. Rilpivirine Component Of Cabenuva

57. Ncgc00319175-03

58. Ncgc00319175-08

59. Rilpivirine(r 278474, Tmc 278)

60. Ac-30619

61. Hy-10574

62. Bcp0726000192

63. Sw220232-1

64. D09720

65. A827939

66. Q421547

67. W-202888

68. 4-[[4-[[4-(2-cyanoethenyl)-2,6-dimethylphenyl]amino]pyrimidine-2-yl]amino]benzonitrile

69. 4-[[4-[4-[(e)-2-cyanoethenyl]-2,6-dimethylanilino]-2-pyrimidinyl]amino]benzonitrile

70. 4-{4-[4-((e)-2-cyano-vinyl)-2,6-dimethyl-phenylamino]-pyrimidin-2-ylamino}-benzonitrile

71. (e)-3-{4-[2-(p-cyanophenylamino)-4-pyrimidinylamino]-3,5-xylyl}acrylonitrile; 4-[[4-[[4-[(1e)-2-cyanoethenyl]-2,6-dimethylphenyl]amino]-2-pyrimidinyl]amino]benzonitrile

72. 4-((4-((4-((1e)-2-cyanoethenyl)-2,6-dimethylphenyl)amino)pyrimidin-2-yl)amino)benzonitrile

73. 4-[[4-[[4-[(e)-2-cyanoethenyl]-2,6-dimethyl-phenyl]amino]pyrimidin-2-yl]amino]benzenecarbonitrile

74. Benzonitrile, 4-((4-((4-((1e)-2-cyanoethenyl)-2,6-dimethylphenyl)amino)-2- Pyrimidinyl)amino)-

75. Benzonitrile, 4-((4-((4-((1e)-2-cyanoethenyl)-2,6-dimethylphenyl)amino)-2-pyrimidinyl)amino)-

2.4 Create Date
2006-04-29
3 Chemical and Physical Properties
Molecular Weight 366.4 g/mol
Molecular Formula C22H18N6
XLogP34.5
Hydrogen Bond Donor Count2
Hydrogen Bond Acceptor Count6
Rotatable Bond Count5
Exact Mass366.15929460 g/mol
Monoisotopic Mass366.15929460 g/mol
Topological Polar Surface Area97.4 Ų
Heavy Atom Count28
Formal Charge0
Complexity607
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count1
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 2  
Drug NameEdurant
PubMed HealthRilpivirine (By mouth)
Drug ClassesAntiretroviral Agent
Active IngredientRilpivirine hydrochloride
Dosage FormTablet
RouteOral
Strengtheq 25mg base
Market StatusPrescription
CompanyJanssen Prods

2 of 2  
Drug NameEdurant
PubMed HealthRilpivirine (By mouth)
Drug ClassesAntiretroviral Agent
Active IngredientRilpivirine hydrochloride
Dosage FormTablet
RouteOral
Strengtheq 25mg base
Market StatusPrescription
CompanyJanssen Prods

4.2 Therapeutic Uses

HIV Reverse Transcriptase/antagonists & inhibitors

National Library of Medicine's Medical Subject Headings. Rilpivirine. Online file (MeSH, 2014). Available from, as of November 19, 2013: https://www.nlm.nih.gov/mesh/2014/mesh_browser/MBrowser.html


Due to ongoing neuropsychiatric adverse events in some efavirenz (EFV)-treated patients, a switch to an alternative non-nucleoside reverse transcriptase inhibitor may be considered. Rilpivirine (RPV) has been coformulated as a single-tablet regimen (STR) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF), and the components have demonstrated noninferior efficacy to EFV+FTC/TDF, good tolerability profile, and high adherence. After discontinuation, EFV has an extended inductive effect on cytochrome P450 (CYP) 3A4 that, after switching, may reduce RPV exposures and adversely impact clinical outcomes. This study examines the clinical implications of reduced RPV exposures with concomitant FTC/TDF and declining EFV exposures when patients, intolerant to EFV, switch from EFV/FTC/TDF to RPV/FTC/TDF. This 48-week, phase 2b, open-label, multicenter study evaluated the efficacy and safety of switching from EFV/FTC/TDF (>/= 3 months duration) to RPV/FTC/TDF. Virologic suppression (HIV-1 RNA <50 copies/mL), safety, and EFV and RPV pharmacokinetics were assessed. At weeks 12 and 24, all 49 dosed subjects remained suppressed on RPV/FTC/TDF. At week 48, 46 (93.9%) subjects remained suppressed and virologic failure occurred in 2/49 (4.1%) subjects with no emergence of resistance. EFV concentrations were above the 90th percentile for inhibitory concentration (IC90) for several weeks after EFV discontinuation, and RPV exposures were in the range observed in phase 3 studies by approximately 2 weeks post switch. No subjects discontinued the study due to an adverse event. Switching from EFV/FTC/TDF to RPV/FTC/ TDF was a safe, efficacious option for virologically suppressed HIV-infected patients with EFV intolerance wishing to remain on an STR.

PMID:24144898 Mills AM et al; HIV Clin Trials 14 (5): 216-23 (2013)


4.3 Drug Warning

Adverse effects of moderate or severe intensity and reported in 2% or more of patients receiving rilpivirine include depressive disorders, insomnia, headache, and rash. Increased serum AST and/or ALT concentrations (more than 2.5 times the upper limit of normal (ULN) were reported in 3-4% of patients receiving rilpivirine.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 680


Rilpivirine should be used with caution and with increased monitoring for adverse effects in patients with severe renal impairment or end-stage renal disease since concentrations of the drug may be increased due to alterations in absorption, distribution, or metabolism.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 680


Rilpivirine and the fixed combination containing rilpivirine, emtricitabine, and tenofovir (Complera) have not been studied in patients with severe hepatic impairment (Child-Pugh class C).

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 680


Experience in those 65 years of age and older is insufficient to determine whether they respond differently than younger adults. Dosage should be selected with caution because of age-related decreases in hepatic and/or renal function and potential for concomitant disease and drug therapy.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 680


For more Drug Warnings (Complete) data for Rilpivirine (13 total), please visit the HSDB record page.


4.4 Drug Indication

Rilpivirine, in combination with other agents, is indicated for the treatment of HIV-1 infections in antiretroviral treatment-naive patients with HIV-1 RNA 100,000 copies/mL and CD4+ cell count >200 cells/mm3. The FDA combination therapy approval of rilpivirine and dolutegravir is indicated for adults with HIV-1 infections whose virus is currently suppressed (< 50 copies/ml) on a stable regimen for at least six months, without history of treatment failure and no known substitutions associated to resistance to any of the two components of the therapy.


FDA Label


Edurant, in combination with other antiretroviral medicinal products, is indicated for the treatment of human immunodeficiency virus type 1 (HIV1) infection in antiretroviral treatmentnave patients 12 years of age and older with a viral load 100,000 HIV1 RNA copies/ml.

As with other antiretroviral medicinal products, genotypic resistance testing should guide the use of Edurant.


Treatment of human immunodeficiency virus (HIV-1) infection


Rekambys is indicated, in combination with cabotegravir injection, for the treatment of human immunodeficiency virus type 1 (HIV 1) infection in adults who are virologically suppressed (HIV-1 RNA < 50 copies/mL) on a stable antiretroviral regimen without present or past evidence of viral resistance to, and no prior virological failure with, agents of the NNRTI and INI class.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Rilpivirine is a non-nucleoside reverse transcriptase inhibitor that inhibits the replication of HIV-1. It has a long duration of action as the oral tablet is given daily and the intramuscular suspension is given monthly. Patients should be counselled regarding the risk of hypersensitivity reactions, hepatotoxicity, depressive disorders, and the redistribution or accumulation of body fat.


5.2 MeSH Pharmacological Classification

Anti-HIV Agents

Agents used to treat AIDS and/or stop the spread of the HIV infection. These do not include drugs used to treat symptoms or opportunistic infections associated with AIDS. (See all compounds classified as Anti-HIV Agents.)


Reverse Transcriptase Inhibitors

Inhibitors of reverse transcriptase (RNA-DIRECTED DNA POLYMERASE), an enzyme that synthesizes DNA on an RNA template. (See all compounds classified as Reverse Transcriptase Inhibitors.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
RILPIVIRINE
5.3.2 FDA UNII
FI96A8X663
5.3.3 Pharmacological Classes
Non-Nucleoside Analog [EXT]
5.4 ATC Code

J05AG05


J05AG05


J05AG05

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355


J - Antiinfectives for systemic use

J05 - Antivirals for systemic use

J05A - Direct acting antivirals

J05AG - Non-nucleoside reverse transcriptase inhibitors

J05AG05 - Rilpivirine


5.5 Absorption, Distribution and Excretion

Absorption

Rilpivirine has a Tmax of 3-4 hours and has a mean AUC of 2235 851 ng\*h/mL. A 25mg dose reaches a Cmax of 247 ng/mL in healthy subjects and 138.6 ng/mL in patients with HIV-1.


Route of Elimination

Rilpivirine is 85% eliminated in the feces and 6.1% eliminated in the urine. 25% of a dose is recovered in the feces as the unchanged parent drug, while <1% of a dose is recovered in the urine as the unchanged parent drug.


Volume of Distribution

In HIV-1 patients, the apparent volume of distribution in the central compartment was 152-173 L.


Clearance

In HIV-1 patients, the apparent total clearance is estimated to be 6.89-8.66 L/h.


After a single oral dose, an average of 85% of the dose is eliminated in feces (75% as metabolites) and 6% is eliminated in urine (only trace amounts as unchanged rilpivirine).

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 681


It is not known whether rilpivirine is distributed into human milk; however, the drug is distributed into milk in rats.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 680


5.6 Metabolism/Metabolites

Rilpivirine is predominantly metabolized by CYP3A4 and CYP3A5 to the hydroxylated metabolites M1, M2, M3, and M4. UGT1A1 glucuronidates the M2 metabolite to form M6, UGT1A4 glucuronidates rilpivirine to form M5, and an unknown UGT glucuronidates the M4 metabolite to form M7.


Rilpivirine is metabolized by the cytochrome P-450 (CYP) isoenzyme 3A.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 680


5.7 Biological Half-Life

Rilpivirine has a terminal half-life of 34-55 hours.


The terminal elimination half-life of rilpivirine is approximately 50 hours.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 681


5.8 Mechanism of Action

Rilpivirine is a non-competitive NNRTI that binds to reverse transcriptase. Its binding results in the blockage of RNA and DNA- dependent DNA polymerase activities, like HIV-1 replication. It does not present activity against human DNA polymerases , and . Rilpivirine's flexible structure around the aromatic rings allows the adaptation to changes in the non-nucleoside RT binding pocket, reducing the likelihood of viral mutations conferring resistance.


Rilpivirine, a diarylpyrimidine nonnucleoside reverse transcriptase inhibitor (NNRTI), inhibits replication of human immunodeficiency virus type 1 (HIV-1) by interfering with viral RNA- and DNA-directed polymerase activities of reverse transcriptase. Diarylpyrimidine NNRTIs (e.g., rilpivirine, etravirine) are capable of adapting to mutations in HIV-1 reverse transcriptase because of structural flexibility that allows for binding to the allosteric NNRTI binding pocket in a variety of conformations. Unlike other currently available NNRTIs, rilpivirine contains a cyanovinyl group that contributes to potency and maintains the drug's binding ability, despite the emergence of some resistance mutations.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 681


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