Florbetapir (18F)

Identification

Summary

Florbetapir (18F) is a radiopharmaceutical diagnostic agent used during Positron Emission Tomography (PET) imaging of the brain to estimate β-amyloid neuritic plaque density in adult patients to diagnose the causes of cognitive impairment.

Brand Names
Amyvid
Generic Name
Florbetapir (18F)
DrugBank Accession Number
DB09149
Background

Florbetapir (18F) is a radiopharmaceutical compound containing the radionuclide fluorine-18 bound to the compound florbetapir, a molecule that binds with high affinity to beta amyloid plaque, a peptide that plays a key role in Alzheimer's Disease pathogenesis. Marketed as the product Amyvid, florbetapir 18F is indicated for positron emission tomography (PET) imaging of the brain to estimate β-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer's Disease (AD) and other causes of cognitive decline.

The radionucleide fluorine-18 was chosen as it has a half life of 110 minutes allowing it to accumulate sufficiently in the brain before undergoing positon emission decay.

Type
Small Molecule
Groups
Approved, Investigational
Structure
Thumb
Weight
Average: 359.432
Monoisotopic: 359.18745534
Chemical Formula
C20H25FN2O3
Synonyms
  • [18F]Florbetapir
  • 4-{(E)-2-[6-(2-{2-[2-(18F)fluoroethoxy]ethoxy}ethoxy)pyridin-3-yl]ethenyl}-N-methylaniline
  • Florbetapir (18F)
  • Florbetapir F-18
  • Florbetapir F18
  • florbetapir-fluorine-18
External IDs
  • (18F)AV-45
  • 18F-AV-45
  • 18FAV-45
  • 18FAV45
  • AV-45 F-18

Pharmacology

Indication

Florbetapir 18F is indicated for Positron Emission Tomography (PET) imaging of the brain to estimate β-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer's Disease (AD) and other causes of cognitive decline.

Pharmacology
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Associated Conditions
Contraindications & Blackbox Warnings
Contraindications
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Pharmacodynamics

Following intravenous injection, florbetapir F 18 diffuses across the human blood-brain barrier and produces a radioactivity signal detectable throughout the brain. Subsequently, cerebral perfusion decreases the brain florbetapir F 18 content, with differential retention of the drug in areas that contain β-amyloid aggregates compared to areas that lack the aggregates.

Mechanism of action

Florbetapir (18F) is a radiopharmaceutical compound containing the radionuclide fluorine-18 bound to the compound florbetapir, a molecule that binds with high affinity to beta amyloid plaque, a peptide that plays a key role in Alzheimer's Disease pathogenesis. The radionucleide fluorine-18 was chosen as it has a half life of 110 minutes allowing it to accumulate sufficiently in the brain before undergoing positon emission decay.

TargetActionsOrganism
AAmyloid beta A4 protein
binder
Humans
Absorption

The time-activity curves for florbetapir F 18 in the brain of subjects with positive scans show continual signal increases from time zero through 30 minutes post-administration, with stable values thereafter up to at least 90 minutes post-injection. Following the intravenous administration of 370 MBq (10 mCi) of florbetapir F 18 to healthy volunteers, the drug was distributed throughout the body with less than 5% of the injected F 18 radioactivity present in the blood by 20 minutes following administration, and less than 2% present by 45 minutes after administration.

Volume of distribution

Not Available

Protein binding

Not Available

Metabolism

The residual F 18 in circulation during the 30-90 minute imaging window was principally in the form of polar F 18 metabolites. Essentially all radioactivity collected in the urine was present as polar metabolites of florbetapir F 18. Three metabolites have been discovered and identified as [18F]AV-160 (desmethyl-[18F]AV-45), [18F]AV-267 (N-acetyl–[18F]AV-160), and an [18F]-Polar species, the identity of which has not been confirmed. Additionally, although metabolites may make some contribution to signal detection, particularly to the nontarget activity, it is concluded that there will be minimal interference from these radiolabeled metabolites to the amyloid target binding in the [18F]AV-45 brain PET image (Wong et al, 2010).

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Route of elimination

Whole body scanning following the intravenous injection showed accumulation of radioactivity in the liver within four minutes post-injection, followed by elimination of the radioactivity predominantly through the biliary/gastrointestinal tract with much lower radioactivity detected in the bladder. Essentially all radioactivity collected in the urine was present as polar metabolites of florbetapir F 18.

Half-life

Not Available

Clearance

Not Available

Adverse Effects
Adverseeffects
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Toxicity

The most common reported adverse reaction was headache, occurring in 2% of patients, followed by musculoskeletal pain, blood pressure increased, fatigue, nausea, and injection site reaction, all occurring in <1% of patients.

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
AbacavirAbacavir may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
AceclofenacAceclofenac may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
AcemetacinAcemetacin may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
AcetaminophenAcetaminophen may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
AcetazolamideAcetazolamide may increase the excretion rate of Florbetapir (18F) which could result in a lower serum level and potentially a reduction in efficacy.
Acetylsalicylic acidAcetylsalicylic acid may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
AclidiniumAclidinium may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
AcrivastineFlorbetapir (18F) may decrease the excretion rate of Acrivastine which could result in a higher serum level.
AcyclovirAcyclovir may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
Adefovir dipivoxilAdefovir dipivoxil may decrease the excretion rate of Florbetapir (18F) which could result in a higher serum level.
Interactions
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Food Interactions
No interactions found.

Products

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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
AmyvidInjection, solution800 MBq/mlIntravenousEli Lilly Nederland B.V.2016-09-08Not applicableEU flag
AmyvidInjection, solution1900 MBq/mlIntravenousEli Lilly Nederland B.V.2016-09-08Not applicableEU flag
AmyvidInjection, solution800 MBq/mlIntravenousEli Lilly Nederland B.V.2016-09-08Not applicableEU flag
AmyvidInjection, solution1900 MBq/mlIntravenousEli Lilly Nederland B.V.2016-09-08Not applicableEU flag
AmyvidInjection, solution51 mCi/1mLIntravenousEli Lilly and Company2012-06-01Not applicableUS flag

Categories

ATC Codes
V09AX05 — Florbetapir (18f)
Drug Categories
Chemical TaxonomyProvided by Classyfire
Description
This compound belongs to the class of organic compounds known as styrenes. These are organic compounds containing an ethenylbenzene moiety.
Kingdom
Organic compounds
Super Class
Benzenoids
Class
Benzene and substituted derivatives
Sub Class
Styrenes
Direct Parent
Styrenes
Alternative Parents
Phenylalkylamines / Aniline and substituted anilines / Secondary alkylarylamines / Alkyl aryl ethers / Pyridines and derivatives / Heteroaromatic compounds / Dialkyl ethers / Azacyclic compounds / Organopnictogen compounds / Organofluorides
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Substituents
Alkyl aryl ether / Alkyl fluoride / Alkyl halide / Amine / Aniline or substituted anilines / Aromatic heteromonocyclic compound / Azacycle / Dialkyl ether / Ether / Heteroaromatic compound
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Molecular Framework
Aromatic heteromonocyclic compounds
External Descriptors
organofluorine compound, aromatic ether, substituted aniline, pyridines, fluorine-18 radiopharmaceutical (CHEBI:66880)
Affected organisms
Not Available

Chemical Identifiers

UNII
6W15Z5R0RU
CAS number
956103-76-7
InChI Key
YNDIAUKFXKEXSV-CRYLGTRXSA-N
InChI
InChI=1S/C20H25FN2O3/c1-22-19-7-4-17(5-8-19)2-3-18-6-9-20(23-16-18)26-15-14-25-13-12-24-11-10-21/h2-9,16,22H,10-15H2,1H3/b3-2+/i21-1
IUPAC Name
4-[(E)-2-[6-(2-{2-[2-(¹⁸F)fluoroethoxy]ethoxy}ethoxy)pyridin-3-yl]ethenyl]-N-methylaniline
SMILES
[H]N(C1=C([H])C([H])=C(\C([H])=C(/[H])C2=C([H])N=C(OC([H])([H])C([H])([H])OC([H])([H])C([H])([H])OC([H])([H])C([H])([H])[18F])C([H])=C2[H])C([H])=C1[H])C([H])([H])[H]

References

Synthesis Reference
  • Wong DF, Rosenberg PB, Zhou Y, Kumar A, Raymont V, Ravert HT, Dannals RF, Nandi A, Brasic JR, Ye W, Hilton J, Lyketsos C, Kung HF, Joshi AD, Skovronsky DM, Pontecorvo MJ: In vivo imaging of amyloid deposition in Alzheimer disease using the radioligand 18F-AV-45 (florbetapir [corrected] F 18). J Nucl Med. 2010 Jun;51(6):913-20. doi: 10.2967/jnumed.109.069088.
  • Fowler J. S. and Wolf A. P. (1982) The synthesis of carbon-11, fluorine-18 and nitrogen-13 labeled radiotracers for biomedical applications. Nucl. Sci. Ser. Natl Acad. Sci. Natl Res. Council Monogr. 1982.
General References
  1. Wong DF, Rosenberg PB, Zhou Y, Kumar A, Raymont V, Ravert HT, Dannals RF, Nandi A, Brasic JR, Ye W, Hilton J, Lyketsos C, Kung HF, Joshi AD, Skovronsky DM, Pontecorvo MJ: In vivo imaging of amyloid deposition in Alzheimer disease using the radioligand 18F-AV-45 (florbetapir [corrected] F 18). J Nucl Med. 2010 Jun;51(6):913-20. doi: 10.2967/jnumed.109.069088. [Article]
  2. Choi SR, Golding G, Zhuang Z, Zhang W, Lim N, Hefti F, Benedum TE, Kilbourn MR, Skovronsky D, Kung HF: Preclinical properties of 18F-AV-45: a PET agent for Abeta plaques in the brain. J Nucl Med. 2009 Nov;50(11):1887-94. doi: 10.2967/jnumed.109.065284. Epub 2009 Oct 16. [Article]
  3. FDA Approved Drug Products: AMYVID (florbetapir F18) injection [Link]
KEGG Drug
D09617
PubChem Compound
24822371
PubChem Substance
310265062
ChemSpider
26348452
BindingDB
50484946
RxNav
1427224
ChEBI
66880
ChEMBL
CHEMBL1774461
ZINC
ZINC000100090643
RxList
RxList Drug Page
Drugs.com
Drugs.com Drug Page
Wikipedia
Florbetapir_(18F)
FDA label
Download (4.31 MB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
4CompletedDiagnosticAlzheimer's Disease (AD)4
4CompletedOtherMultiple Sclerosis1
4Enrolling by InvitationDiagnosticDementia of the Alzheimer's Type1
4RecruitingDiagnosticCardiac Amyloidosis2
4RecruitingDiagnosticPOCD - Postoperative Cognitive Dysfunction1
4TerminatedDiagnosticCardiac Amyloidosis1
3Active Not RecruitingDiagnosticAlzheimer's Disease (AD) and Related Disorders1
3CompletedDiagnosticAlzheimer's Disease (AD)2
3CompletedDiagnosticProgressive Cognitive Decline1
3RecruitingDiagnosticCognition Disorders / Dementia1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Injection, solutionIntravenous1900 MBQ/ml
Injection, solutionIntravenous51 mCi/1mL
Injection, solutionIntravenous800 MBQ/ml
Prices
Not Available
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
US8506929No2013-08-132027-04-30US flag
US7687052No2010-03-302027-04-30US flag

Properties

State
Solid
Experimental Properties
Not Available
Predicted Properties
PropertyValueSource
Water Solubility0.0058 mg/mLALOGPS
logP3.61ALOGPS
logP3.11ChemAxon
logS-4.8ALOGPS
pKa (Strongest Basic)4.62ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count5ChemAxon
Hydrogen Donor Count1ChemAxon
Polar Surface Area52.61 Å2ChemAxon
Rotatable Bond Count12ChemAxon
Refractivity103.01 m3·mol-1ChemAxon
Polarizability40.43 Å3ChemAxon
Number of Rings2ChemAxon
Bioavailability1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted ADMET Features
Not Available

Spectra

Mass Spec (NIST)
Not Available
Spectra
SpectrumSpectrum TypeSplash Key
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available

Targets

Drugtargets2
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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Binder
General Function
Transition metal ion binding
Specific Function
Functions as a cell surface receptor and performs physiological functions on the surface of neurons relevant to neurite growth, neuronal adhesion and axonogenesis. Involved in cell mobility and tra...
Gene Name
APP
Uniprot ID
P05067
Uniprot Name
Amyloid beta A4 protein
Molecular Weight
86942.715 Da
References
  1. Choi SR, Golding G, Zhuang Z, Zhang W, Lim N, Hefti F, Benedum TE, Kilbourn MR, Skovronsky D, Kung HF: Preclinical properties of 18F-AV-45: a PET agent for Abeta plaques in the brain. J Nucl Med. 2009 Nov;50(11):1887-94. doi: 10.2967/jnumed.109.065284. Epub 2009 Oct 16. [Article]

Drug created on October 01, 2015 17:14 / Updated on August 13, 2021 04:44