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Antimicrobial Agents and Chemotherapy, September 1998, p. 2410-2416, Vol. 42, No. 9
Department of Pharmacology and Therapeutics,
University of Liverpool, Liverpool L69 3GE, United Kingdom
Received 18 March 1997/Returned for modification 16 September
1997/Accepted 25 June 1998
The use of the antimalarial agent amodiaquine has been
curtailed due to drug-induced idiosyncratic reactions. These have
been attributed to the formation of a protein-reactive quinoneimine species via oxidation of the 4-aminophenol group. Therefore, the effects of chemical modifications on the disposition of
amodiaquine in relation to its metabolism, distribution,
and pharmacological activity have been investigated. The inclusion of a
group at the C-5' position of amodiaquine reduced or
eliminated bioactivation, as determined by glutathione
conjugate formation in vivo. This can be seen in two series of
C-5'-substituted compounds: the bis-Mannich antimalarial
agents, including cycloquine and pyronaridine, and mono-Mannich
antimalarial agents containing a 5'-chlorophenyl group (tebuquine and
5'-ClPAQ). Chemical substitution at the C-5' position also
resulted in compounds which underwent slower elimination (<5%
of the dose excreted into bile and urine, compared with 50% for
amodiaquine) and increased levels of accumulation in tissue (10% of the dose in the liver at 48 h compared with 1% with
amodiaquine). This may be due to an increase in either the
lipophilicity or the basicity of the analogs and may reflect the lack
of metabolic clearance for these compounds. The alteration in the
disposition following the introduction of the C-5' substituent resulted
in an increased duration of antimalarial activity in the mouse compared with that for amodiaquine. While this is desirable in
the treatment of malaria, repeated administration for
prophylaxis may induce toxicity through accumulation. Therefore, by
simple chemical modification it is possible to block the bioactivation
of amodiaquine while maintaining and in some cases
extending the duration of antimalarial activity.
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Effect of Disposition of Mannich Antimalarial
Agents on Their Pharmacology and Toxicology

*
Corresponding author. Present address: Department of
Pharmacology & Clinical Pharmacology, School of Medicine & Health
Sciences, University of Auckland, Private Bag 92019, Auckland, New
Zealand. Phone: (0064) 9 373 7599, ext. 4949. Fax: (0064) 9 373 7556. E-mail: m.tingle{at}auckland.ac.nz.
Present address: Fox Chase Cancer Center, Philadelphia, PA 19111.
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