Icatibant

Clinical data
Trade names	Firazyr
Other names	Hoe 140, JE 049[1]
AHFS/Drugs.com	Monograph
License data	EU EMA: by INN US DailyMed: Icatibant US FDA: Icatibant
Pregnancy category	AU: C
Routes of administration	Subcutaneous
ATC code	B06AC02 (WHO)
Legal status
Legal status	AU: S4 (Prescription only) US: ℞-only[2] EU: Rx-only[3] In general: ℞ (Prescription only)
Identifiers
IUPAC name (2S)-2-[[(2S,3aS,7aS)-1-[(3R)-2-[(2S)-2-[[(2S)-2-[[2-[[(2S,4R)-1-[(2S)-1-[(2S)-2-[[(2R)-2-amino-5-(diaminomethylideneamino)pentanoyl]amino]-5-(diaminomethylideneamino)pentanoyl]pyrrolidine-2-carbonyl]-4-hydroxypyrrolidine-2-carbonyl]amino]acetyl]amino]-3-thiophen-2-ylpropanoyl]amino]-3-hydroxypropanoyl]-3,4-dihydro-1H-isoquinoline-3-carbonyl]-2,3,3a,4,5,6,7,7a-octahydroindole-2-carbonyl]amino]-5-(diaminomethylideneamino)pentanoic acid
CAS Number	130308-48-4 N
PubChem CID	6918173
IUPHAR/BPS	667
DrugBank	DB06196 Y
ChemSpider	16736634 Y
UNII	7PG89G35Q7
KEGG	as salt: D04492
ChEBI	CHEBI:68556 N
ChEMBL	ChEMBL1743581 N
CompTox Dashboard (EPA)	DTXSID20903963
Chemical and physical data
Formula	C59H89N19O13S
Molar mass	1304.54 g·mol−1
3D model (JSmol)	Interactive image
SMILES C1CC[C@H]2[C@@H](C1)C[C@H](N2C(=O)[C@H]3CC4=CC=CC=C4CN3C(=O)[C@H](CO)NC(=O)[C@H](CC5=CC=CS5)NC(=O)CNC(=O)[C@@H]6C[C@H](CN6C(=O)[C@@H]7CCCN7C(=O)[C@H](CCCN=C(N)N)NC(=O)[C@@H](CCCN=C(N)N)N)O)C(=O)N[C@@H](CCCN=C(N)N)C(=O)O
InChI InChI=1S/C59H89N19O13S/c60-37(14-5-19-67-57(61)62)48(82)72-38(15-6-20-68-58(63)64)52(86)75-22-8-18-43(75)54(88)77-30-35(80)26-44(77)50(84)70-28-47(81)71-40(27-36-13-9-23-92-36)49(83)74-41(31-79)53(87)76-29-34-12-2-1-10-32(34)24-46(76)55(89)78-42-17-4-3-11-33(42)25-45(78)51(85)73-39(56(90)91)16-7-21-69-59(65)66/h1-2,9-10,12-13,23,33,35,37-46,79-80H,3-8,11,14-22,24-31,60H2,(H,70,84)(H,71,81)(H,72,82)(H,73,85)(H,74,83)(H,90,91)(H4,61,62,67)(H4,63,64,68)(H4,65,66,69)/t33-,35+,37+,38-,39-,40-,41-,42-,43-,44-,45-,46+/m0/s1 Y Key:QURWXBZNHXJZBE-SKXRKSCCSA-N Y
NY (what is this?)  (verify)

Icatibant, sold under the brand name Firazyr, is a medication for the symptomatic treatment of acute attacks of hereditary angioedema (HAE) in adults with C1-esterase-inhibitor deficiency.^[4][2][3] It is not effective in angioedema caused by medication from the ACE inhibitor class.^[5]

It is a peptidomimetic consisting of ten amino acids, which is a selective and specific antagonist of bradykinin B₂ receptors.

Mechanism of action

Bradykinin is a peptide-based hormone that is formed locally in tissues, very often in response to a trauma. It increases vessel permeability, dilates blood vessels and causes smooth muscle cells to contract. Bradykinin plays an important role as the mediator of pain. Surplus bradykinin is responsible for the typical symptoms of inflammation, such as swelling, redness, overheating and pain. These symptoms are mediated by activation of bradykinin B₂ receptors. Icatibant acts as a bradykinin inhibitor by blocking the binding of native bradykinin to the bradykinin B₂ receptor. Little is known about the effects of icatibant on the bradykinin B₁ receptor.

Society and culture

Legal status

Icatibant received orphan drug status in Australia, the EU, Switzerland, and the US for the treatment of hereditary angioedema (HAE).^[6]

In the EU, the approval by the European Commission (July 2008) allows Jerini to market Firazyr in the European Union's 27 member states, as well as Switzerland, Liechtenstein and Iceland, making it the first product to be approved in all EU countries for the treatment of HAE.^[4] In the US, the drug was granted FDA approval on August 25, 2011.^[7]