2,4-Diaminothieno[2,3-d]pyrimidine analogues of trimetrexate and piritrexim as potential inhibitors of Pneumocystis carinii and Toxoplasma gondii dihydrofolate reductase.

A series of eight previously undescribed 2,4-diaminothieno[2,3-d]pyrimidine analogues of the potent dihydrofolate reductase (DHFR) inhibitors trimetrexate (TMQ) and piritrexim (PTX) were synthesized as potential drugs against Pneumocystis carinii and Toxoplasma gondii, which are major causes of severe opportunistic infections in AIDS patients. 2,4-Diamino-5-methyl-6-(aryl/aralkyl)thieno[2,3-d]pyrimidines with 3,4,5-trimethoxy or 2,5-dimethoxy substitution in the aryl/aralkyl moiety and 2,4-diamino-5-(aryl/aralkyl)thieno[2,3-d]pyrimidines with 2,5-dimethoxy substitution in the aryl/aralkyl moiety were obtained by reaction of the corresponding 2-amino-3-cyanothiophenes with chloroformamidine hydrochloride. The aryl group in the 5,6-disubstituted analogues was either attached directly to the hetero ring or was separated from it by one or two carbons, whereas the aryl group in the 5-monosubstituted analogues was separated from the hetero ring by two or three carbons. 2-Amino-3-cyano-5-methyl-6-(aryl/alkyl)thiophene intermediates for the preparation of the 5,6-disubstituted analogues were prepared from omega-aryl-2-alkylidene-malononitriles and sulfur in the presence of a secondary amine, and 2-amino-3-cyano-4-(aryl/aralkyl)thiophene intermediates for the preparation of the 5-monosubstituted analogues were obtained from omega-aryl-1-chloro-2-alkylidenemalononitriles and sodium hydrosulfide. Synthetic routes to the heretofore unknown ylidenemalononitriles, and the ketone precursors thereof, were developed. The final products were tested in vitro as inhibitors of DHFR from Pneumocystis carinii, Toxoplasma gondii, rat liver, beef liver, and Lactobacillus casei. A selected number of previously known 2,4-diaminothieno[2,3-d]pyrimidines lacking the 3,4,5-trimethoxyphenyl and 2,5-dimethoxyphenyl substitution pattern of TMQ and PTX, respectively, were also tested for comparison. None of the compounds was as potent as TMQ or PTX, and while some of them showed some selectivity in their binding to Pneumocystis carinii and Toxoplasma gondii versus rat liver DHFR, this effect was not deemed large enough to warrant further preclinical evaluation.

Comparison of equal-weight oral dosages of verapamil hydrochloride and diltiazem hydrochloride in patients with mild to moderate hypertension.

The clinical efficacy, safety, and tolerability of oral verapamil and diltiazem, at total daily dosages of equal weight, were evaluated in a placebo-controlled, double-blind crossover study. Thirty-six ambulatory patients with chronic, stable, mild to moderate hypertension (supine diastolic blood pressure of 94-116 mm Hg) received a dosage of either verapamil or diltiazem 80 mg t.i.d. as the hydrochloride salt for one week after an antihypertensive-drug washout period. Each then received 120 mg of the same drug t.i.d. for one week. After another two-week washout period, the patients were crossed over to the other drug. Each patient had a 12-lead electrocardiogram and measurement of supine and standing blood pressure weekly. In the 32 patients completing the study, low-dose verapamil reduced supine diastolic blood pressure (DBP) from a mean of 101.5 +/- 5.2 to 95.3 +/- 9.5 mm Hg; high dose verapamil reduced DBP to 90.9 +/- 7.4 mm Hg. Standing DBP was reduced to a similar degree. Diltiazem showed an almost identical effect: Supine DBP was reduced from a mean of 101.7 +/- 5.3 to 94.0 +/- 10.1 mm Hg with the low dose and to 91.0 +/- 8.6 mm Hg with the high dose, with similar effects on standing DBP. The high dose of both drugs significantly increased the QTc interval, and both doses of diltiazem significantly increased the PR interval compared with baseline. Both drugs exhibited consistent efficacy with minimal adverse effects. The electrophysiologic safety profile of verapamil was superior to that of diltiazem.

Effect of chronically administered ketoconazole on the elimination of theophylline in man.

Ketoconazole, a nitrogen-substituted imidazole, has been shown to be a potent in vitro inhibitor of cytochrome P-450-mediated metabolic processes. Conflicting reports exist concerning the in vivo effect of ketoconazole on concomitantly administered drugs that require these metabolic processes for clearance. Therefore, the effect of multiple-dose ketoconazole on the elimination of theophylline, a drug metabolized by cytochrome P-450, in ten healthy, nonsmoking males (aged 18-40 years) was evaluated. Each subject received aminophylline 6 mg/kg iv before and at the end of seven days of ketoconazole 200 mg/d po. Theophylline serum concentrations were determined by fluorescence polarization immunoassay (TDx) at 12 time points over the 24-hour period following each infusion. No statistical difference (two-tailed t-test) in half-life (mean +/- SD 7.8 +/- 1.8 vs. 8.2 +/- 1.9 h) or clearance (0.797 +/- 0.201 vs. 0.722 +/- 0.133 ml/min/kg) could be demonstrated for theophylline before or after ketoconazole administration. Theophylline dosage adjustment is probably not necessary for concomitant theophylline and ketoconazole drug therapy.

Inhibition of metabolism of the 'nonclassical' antifolate, trimetrexate (2,4-diamino-5-methyl-6-[(3,4,5-trimethoxyanilino)methyl]quinazoline) by drugs containing an imidazole moiety.

2,4-Diamino-5-methyl-6-[(3,4,5-trimethoxyanilino)methyl]quinazoline (TMQ; NSC No. 249008) is a 'nonclassical' antifolate which is advocated as an alternative to methotrexate. TMQ is rapidly and extensively demethylated by a cytochrome P-450-mediated oxidation to a weakly cytotoxic compound of increased polarity. In this study, the effects of clinically used imidazole drugs ketoconazole, miconazole, clotrimazole, cimetidine, etintidine, clonidine and cibenzoline on the rat hepatic microsomal demethylation of TMQ in vitro was investigated. The nitrogen-substituted imidazole drugs (ketoconazole, miconazole, and clotrimazole) were potent non-competitive inhibitors of TMQ metabolism with IC50 values obtainable at therapeutic doses (less than 2 microM). Cimetidine and etintidine were comparatively weak, competitive inhibitors of TMQ metabolism (IC50 greater than 300 microM) and clonidine and cibenzoline were even less inhibitory (IC50 greater than 1 mM). The nitrogen-substituted imidazole drugs have the potential to dramatically alter the pharmacokinetic and pharmacodynamic profile of TMQ as well as other drugs in vivo.

Enzymatic assays for 2,4-diamino-5-methyl-6-[(3,4,5-trimethoxyanilino)methyl]quinazoline, a promising new "nonclassical" antifolate.

2,4-Diamino-5-methyl-6-[(3,4,5-trimethoxyanilino)-methyl]quinazoline (I) is a promising new "nonclassical" antifolate. Inhibition of dihydrofolate reductase from bacterial (Lactobacillus casei)and mammalian (beef liver) sources was employed to develop useful enzymatic assays for this compound. A linear relationship was obtained by plotting the I concentration versus 1/V. The resultant standard curves maintained linearity particularly well between the 30 and 70% control range, with a correlation coefficient of 0.99 for both enzyme systems. The two enzyme systems are characterized by differences in sensitivity, stability, and day-to-day variation. The ID50 for the beef liver reductase system was 1.6 X 10(-9) M (+/-0.03); for the L. casei system, it was 1.35 X 10(-8) M (+/- 0.2). The apparent advantage for the beef liver enzyme was offset somewhat by its relative instability and its higher day-to-day variability. Studies in mice demonstrated that these assays are suitable for pharmacokinetic studies in vivo. Such studies indicated that I has a serum t1/2 of 45 min in mice; a similar serum t1/2 (50 min) was estimated in studies with 14C-labeled I in position 6.