Benfluorex

Benfluorex
Clinical data

AHFS/Drugs.com	International Drug Names
Routes of administration	Oral
ATC code	A10BX06 (WHO)
Pharmacokinetic data
Excretion	Renal
Identifiers
IUPAC name (RS)-2-({1-[3-(trifluoromethyl)phenyl]propan- 2-yl}amino)ethyl benzoate
CAS Number	23602-78-0^Y
PubChem (CID)	2318
DrugBank	DB09022^N
ChemSpider	2228^Y
UNII	403FO0NQG3^Y
KEGG	D07192^Y
ChEMBL	CHEMBL400599^Y
Chemical and physical data
Formula	C₁₉H₂₀F₃NO₂
Molar mass	351.363 g/mol
3D model (Jmol)	Interactive image
Chirality	Racemic mixture
SMILES FC(F)(F)c1cccc(c1)CC(NCCOC(=O)c2ccccc2)C
InChI InChI=1S/C19H20F3NO2/c1-14(12-15-6-5-9-17(13-15)19(20,21)22)23-10-11-25-18(24)16-7-3-2-4-8-16/h2-9,13-14,23H,10-12H2,1H3^Y Key:CJAVTWRYCDNHSM-UHFFFAOYSA-N^Y
^NY (what is this?) (verify)

Benfluorex is an anorectic and hypolipidemic agent that is structurally related to fenfluramine patented and manufactured by a French pharmaceutical company Servier. Two clinical studies have shown it may improve glycemic control and decrease insulin resistance in people with poorly controlled type 2 diabetes.^[1]^[2] However, Servier is suspected of having marketed Mediator (benfluorex) at odds with the drug's medical properties.^[3]

Drug withdrawn

On 18 December 2009, the European Medicines Agency (EMA) recommended the withdrawal of all medicines containing benfluorex in the European Union, because their risks, particularly the risk of heart valve disease (fenfluramine-like cardiovascular side-effects), are greater than their benefits.^[4] Thus Frachon et al. showed a significantly higher prevalence of unexplained valvular heart disease in patients taking benfluorex compared to controls.^[5] and Weill et al. looked at over 1 million diabetic patients demonstrating a higher hospitalization rate in benfluorex takers for valvular heart disease.^[6]

In France the medication had been marketed as by Servier as an adjuvant antidiabetic under the name Mediator. The drug was on the market between 1976 and 2009 and is thought to have caused between 500 – 2,000 deaths.^[7] The drug was also used in Spain (trade name, Modulator), Portugal and Cyprus.

Fenfluramine, a related drug, had been withdrawn from the market in 1997 after reports of heart valve disease,^[8]^[9] pulmonary hypertension, and development of cardiac fibrosis. This side effect is mediated by the metabolite norfenfluramine on 5HT_2B receptors of heart valves (Rothman et al., Circulation 2000), leading to a characteristic pattern of heart failure following proliferation of cardiac fibroblasts on the tricuspid valve. Both fenfluramine and benfluorex form norfenfluramine as a metabolite. This side effect led to the withdrawal of fenfluramine as an anorectic drug worldwide, and later to the withdrawal of benfluorex in Europe.

Notes

↑ Moulin, P.; Andre, M.; Alawi, H.; dos Santos, L. C.; Khalid, A. K.; Koev, D.; Moore, R.; Serban, V.; et al. (2006). "Efficacy of Benfluorex in Combination with Sulfonylurea in Type 2 Diabetic Patients: An 18-Week, Randomized, Double-Blind Study". Diabetes Care. 29 (3): 515–520. doi:10.2337/diacare.29.03.06.dc05-1439. PMID 16505498.
↑ Roger, P.; Auclair, J.; Drain, P. (1999). "Addition of Benfluorex to Biguanide Improves Glycemic Control in Obese Non-Insulin-Dependent Diabetes: A Double-Blind Study versus Placebo". Journal of Diabetes and its Complications. 13 (2): 62–67. doi:10.1016/S1056-8727(98)00004-X. PMID 10432168.
↑ Mullard, A. (2011). "Mediator Scandal Rocks French Medical Community" (pdf). Lancet. 377 (9769): 890–892. doi:10.1016/s0140-6736(11)60334-6. PMID 21409784.
↑ "European Medicines Agency recommends withdrawal of benfluorex from the market in European Union" (pdf). European Medicines Agency. 2009-12-18.
↑ Frachon, I. N.; Etienne, Y.; Jobic, Y.; Le Gal, G. G.; Humbert, M.; Leroyer, C.; Lexchin, J. (2010). Lexchin, J., ed. "Benfluorex and Unexplained Valvular Heart Disease: A Case-Control Study". PLoS ONE. 5 (4): e10128. Bibcode:2010PLoSO...510128F. doi:10.1371/journal.pone.0010128. PMC 2853566. PMID 20405030.
↑ Weill, A.; Païta, M.; Tuppin, P.; Fagot, J. P.; Neumann, A.; Simon, D.; Ricordeau, P.; Montastruc, J. L.; Allemand, H. (2010). "Benfluorex and Valvular Heart Disease: A Cohort Study of a Million People with Diabetes Mellitus". Pharmacoepidemiology and Drug Safety. 19 (12): 1256–1262. doi:10.1002/pds.2044. PMID 20945504.
↑ "France braced for diabetic drug scandal report". BBC News. 2011-01-11.
↑ Connolly, H. M.; Crary, J. L.; McGoon, M. D.; Hensrud, D. D.; Edwards, B. S.; Edwards, W. D.; Schaff, H. V. (1997). "Valvular Heart Disease Associated with Fenfluramine-Phentermine". New England Journal of Medicine. 337 (9): 581–588. doi:10.1056/NEJM199708283370901. PMID 9271479.
↑ Weissman, N. J. (2001). "Appetite Suppressants and Valvular Heart Disease". American Journal of the Medical Sciences. 321 (4): 285–291. doi:10.1097/00000441-200104000-00008. PMID 11307869.

References

Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL.(2000). "Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications." Circulation 102(23):2836-41. PMID 11104741

Antiobesity agents/Anorectics (A08)

Central

Stimulants	4-Methylamphetamine^‡ Amfecloral Amfepentorex Amfepramone Aminorex^‡ Amphetamine Amphetaminil Atomoxetine Benfluorex^‡ Benzphetamine Bupropion (+naltrexone; +zonisamide^†) Cathine Cathinone Chlorphentermine Ciclazindol Clobenzorex Cloforex Clominorex Clortermine Dexfenfluramine^‡ Dextroamphetamine Dexmethylphenidate Difemetorex^‡ Dimethylcathinone Diphemethoxidine Ephedrine Ephedra^‡ Etilamfetamine Etolorex Fenbutrazate Fencamfamine Fenethylline Fenfluramine^‡ (+phentermine^‡) Fenproporex Fludorex Fluminorex Furfenorex^‡ Indanorex Khat Levopropylhexedrine Lisdexamfetamine Manifaxine Mazindol Mefenorex Methamphetamine Methylphenidate Norfenfluramine Pemoline Pentorex Phendimetrazine Phenethylamine Phenmetrazine Phentermine (+topiramate) Phenylpropanolamine Picilorex Pipradrol Prolintane Propylhexedrine Pseudoephedrine Pyrovalerone Radafaxine Reboxetine Setazindol Sibutramine^‡ Synephrine Tesofensine Viloxazine Xylopropamine Zylofuramine

Cannabinoid receptor antagonists	Drinabant^§ Ibipinabant^§ Otenabant^§ Rimonabant^‡ Rosonabant^§ Surinabant^§ Taranabant^§

Others	5-HTP Galactomannan Guar gum Glucomannan L-DOPA L-Phenylalanine L-Tryptophan L-Tyrosine Lorcaserin Lu AA-33810 Metformin Naltrexone Naloxone Oxyntomodulin P57 Peptide YY Topiramate Yohimbine (Yohimbe) Zonisamide Water

Peripheral

^#WHO-EM
^‡Withdrawn from market
Clinical trials:
- ^†Phase III
- ^§Never to phase III

Oral anti-diabetic drugs, insulins and insulin analogs, and other drugs used in diabetes (A10)

Insulin

Sensitizers

Biguanides	Buformin^‡ Metformin^# Phenformin^‡

TZDs/"glitazones" (PPAR)	Ciglitazone^§ Darglitazone^§ Englitazone^§ Lobeglitazone Netoglitazone^§ Pioglitazone Rivoglitazone^† Rosiglitazone Troglitazone^‡

Dual PPAR agonists	Aleglitazar^† Muraglitazar^§ Saroglitazar Tesaglitazar^§

Secretagogues

K⁺_ATP

Sulfonylureas	1st generation: Acetohexamide Carbutamide Chlorpropamide Glycyclamide Metahexamide Tolazamide Tolbutamide 2nd generation: Glibenclamide (glyburide)^# Glibornuride Glicaramide Gliclazide Glimepiride Glipizide Gliquidone Glisoxepide Glyclopyramide

Meglitinides/"glinides"	Mitiglinide Nateglinide Repaglinide

GLP-1 agonists

DPP-4 inhibitors/"gliptins"

Free fatty acid receptor 1 (GPR40)

Fasiglifam^†

Analogs/other insulins

fast-acting (Insulin aspart
Insulin glulisine
Insulin lispro)
short-acting (Regular insulin)
long-acting (Insulin detemir
Insulin glargine
NPH insulin)
ultra-long-acting (Insulin degludec)
inhalable (Exubera^‡
Afrezza)

Other

Aldose reductase inhibitors	Epalrestat Fidarestat^§ Ranirestat^† Tolrestat^‡ Zenarestat^§

Alpha-glucosidase inhibitors	Acarbose Miglitol Voglibose

Amylin analog	Pramlintide

Sodium glucose transporter (SGLT2) inhibitors/"gliflozins"	Canagliflozin Dapagliflozin Empagliflozin Ipragliflozin Remogliflozin^§ Sergliflozin^§ Tofogliflozin^†

Other	Benfluorex^‡ Bromocriptine

^#WHO-EM
^‡Withdrawn from market
Clinical trials:
- ^†Phase III
- ^§Never to phase III

Lipid modifying agents (C10)

GI tract

Cholesterol absorption inhibitors, NPC1L1	Ezetimibe SCH-48461

Bile acid sequestrants/resins (LDL)	Colestyramine Colestipol Colestilan Colextran Colesevelam

Liver

Statins (HMG-CoA reductase, LDL)	Simvastatin^# Atorvastatin Fluvastatin Lovastatin Mevastatin Pitavastatin Pravastatin Rosuvastatin Cerivastatin^‡

Niacin and derivatives (HDL and LDL)	Niceritrol Niacin Nicofuranose Aluminium nicotinate Nicotinyl alcohol Acipimox

MTTP inhibitors (VLDL)	Dirlotapide Lomitapide Mitratapide

Blood vessels

Fibrates (PPAR)	Clofibrate^‡ Bezafibrate Aluminium clofibrate Gemfibrozil Fenofibrate Simfibrate Ronifibrate Ciprofibrate Etofibrate Clofibride Clinofibrate

CETP inhibitors (HDL)	Anacetrapib^† Dalcetrapib^§ Evacetrapib^§ Torcetrapib^§

Combinations

Other

^#WHO-EM
^‡Withdrawn from market
Clinical trials:
- ^†Phase III
- ^§Never to phase III

Phenethylamines

Phenethylamines	Psychedelics: 25B-NBOMe 25C-NBOMe 25D-NBOMe 25I-NBOMe 25N-NBOMe 2C-B 2C-B-AN 2C-B-FLY βk-2C-B 2C-C 2C-D 2C-E 2C-EF 2C-F 2C-G 2C-I 2C-N 2C-P 2C-SE 2C-T 2C-T-2 2C-T-4 2C-T-7 2C-T-8 2C-T-9 2C-T-13 2C-T-15 2C-T-16 2C-T-17 2C-T-21 2C-TFM 2C-YN Allylescaline DESOXY Escaline Isoproscaline Jimscaline Macromerine MEPEA Mescaline Metaescaline Methallylescaline Proscaline Psi-2C-T-4 TCB-2 Stimulants: Phenylethanolamine Hordenine Phenethylamine α-Methylphenethylamine (amphetamine) β-Methylphenethylamine m-Methylphenethylamine N-Methylphenethylamine o-Methylphenethylamine p-Methylphenethylamine Entactogens: Lophophine MDPEA MDMPEA Others: BOH DMPEA

Amphetamines	Psychedelics: 3C-BZ 3C-E 3C-P Aleph Beatrice Bromo-DragonFLY D-Deprenyl DMA DMCPA DMMDA DOB DOC DOEF DOET DOI DOM DON DOPR DOTFM Ganesha MMDA MMDA-2 Psi-DOM TMA TeMA Stimulants: 2-FA 2-FMA 3-FA 3-FMA Acridorex Alfetamine Amfecloral Amfepentorex Amphetamine (Dextroamphetamine, Levoamphetamine) Amphetaminil Benfluorex Benzphetamine Cathine Clobenzorex Dimethylamphetamine Ephedrine Etilamfetamine Fencamfamine Fencamine Fenethylline Fenfluramine (Dexfenfluramine, Levofenfluramine) Fenproporex Flucetorex Fludorex Formetorex Furfenorex Gepefrine 4-Hydroxyamphetamine Iofetamine Isopropylamphetamine Lefetamine Lisdexamfetamine Mefenorex Metaraminol Methamphetamine (Dextromethamphetamine, Levomethamphetamine) Methoxyphenamine MMA Morforex Norfenfluramine L -Norpseudoephedrine N,alpha-Diethylphenylethylamine Oxifentorex Oxilofrine Ortetamine PBA PCA Phenpromethamine PFA PFMA PIA PMA PMEA PMMA Phenylpropanolamine Pholedrine Prenylamine Propylamphetamine Pseudoephedrine Sibutramine Tiflorex Tranylcypromine Xylopropamine Zylofuramine Entactogens: 4-FA 4-FMA 4-MA 4-MMA 4-MTA 5-APB 5-APDB 5-EAPB 5-IT 5-MAPB 5-MAPDB 6-APB 6-APDB 6-Chloro-MDMA 6-EAPB 6-IT 6-MAPB 6-MAPDB EDA IAP 2,3-MDA 3,4-MDA MDEA MDHMA MDMA MDOH Methamnetamine MMDMA Naphthylaminopropane TAP Others: 3,4-DCA Amiflamine DFMDA Selegiline (also D -Deprenyl)

Phentermines	Stimulants: Chlorphentermine Cloforex Clortermine Etolorex Mephentermine Pentorex Phentermine Entactogens: MDPH MDMPH Others: Cericlamine

Cathinones	Stimulants: 3-FMC 4-MC 4-BMC 4-CMC 4-EMC 4-FMC 4-MEC 4-MeMABP 4-MPD Amfepramone Benzedrone Brephedrone Buphedrone Bupropion Cathinone Dimethylcathinone Ethcathinone Eutylone Hydroxybupropion Methcathinone Methedrone NEB Pentedrone Pentylone Radafaxine Entactogens: 3,4-DMMC 3-MMC Butylone Ethylone Methylone Methylenedioxycathinone Mephedrone

Phenylisobutylamines	Entactogens: 4-CAB 4-MAB Ariadne BDB Butylone EBDB Eutylone MBDB Stimulants: Phenylisobutylamine

Phenylalkylpyrrolidines	Stimulants: α-PBP α-PHP α-PPP α-PVP MDPBP MDPPP MDPV 4-MePBP 4-MePHP 4-MePPP MOPPP MOPVP MPBP MPHP MPPP Naphyrone PEP Prolintane Pyrovalerone

Catecholamines (and close relatives)	6-FNE 6-OHDA a-Me-DA a-Me-TRA Adrenochrome Ciladopa D -DOPA (Dextrodopa) Dimetofrine Dopamine Epinephrine Epinine Etilefrine Ethylnorepinephrine Fenclonine Ibopamine Isoprenaline Isoetarine L -DOPA (Levodopa) L -DOPS (Droxidopa) L -Phenylalanine L -Tyrosine m-Tyramine Metanephrine Metaraminol Metaterol Metirosine Methyldopa N,N-Dimethyldopamine Nordefrin (Levonordefrin) Norepinephrine Norfenefrine (m-Octopamine) Normetanephrine Orciprenaline p-Octopamine p-Tyramine Phenylephrine Synephrine

Miscellaneous	AL-LAD Amidephrine Arbutamine Cafedrine Denopamine Desvenlafaxine Diphenidine Dizocilpine Dobutamine Dopexamine Ephenidine Etafedrine ETH-LAD Famprofazone Fluorolintane Hexapradol IP-LAD Lysergic acid amide Lysergic acid 2-butyl amide Lysergic acid 2,4-dimethylazetidide Lysergic acid diethylamide Methoxamine Methoxphenidine MT-45 PARGY-LAD Phenibut PRO-LAD Pronethalol Salbutamol (Levosalbutamol) Theodrenaline Thiamphenicol UWA-101

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