Sofpironium

Identification

Summary

Sofpironium is a topical anticholinergic used to treat primary axillary hyperhidrosis.

Brand Names
Sofdra
Generic Name
Sofpironium
DrugBank Accession Number
DB19325
Background

Sofpironium is a "soft" anticholinergic analog of glycopyrronium that has been modified with a readily hydrolyzable ester moiety.6 Soft drugs are designed to reduce systemic toxicity while enhancing local efficacy by employing retrometabolic drug design, in which a molecule contains a metabolically sensitive moiety that promotes rapid metabolism to inactive metabolites after exerting activity at its target site.2 Sofpironium is rapidly converted to a less active metabolite, BBI-4010, after exerting its activity, thereby limiting the incidence and/or severity of systemic anticholinergic effects.5,6

Sofpironium bromide (Sofdra) was approved by the FDA in June 2024 for the topical treatment of primary axillary hyperhidrosis.4,5 It has also been available in Japan since 2020 under the brand name Ecclock.4

Type
Small Molecule
Groups
Approved, Investigational
Structure
Weight
Average: 390.499
Monoisotopic: 390.227499555
Chemical Formula
C22H32NO5
Synonyms
  • Pyrrolidinium, 3-(((2r)-2-cyclopentyl-2-hydroxy-2-phenylacetyl)oxy)-1-(2-ethoxy-2-oxoethyl)-1-methyl-, (3r)-
  • Sofpironium cation
  • Sofpironium ion
External IDs
  • BBI-4000 cation
  • BBI-4000 ion

Pharmacology

Indication

Sofpironium bromide is indicated for the treatment of primary axillary hyperhidrosis in patients ≥9 years of age.5

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Associated Conditions
Indication TypeIndicationCombined Product DetailsApproval LevelAge GroupPatient CharacteristicsDose Form
Treatment ofPrimary axillary hyperhidrosis•••••••••••••••••• ••••••••••••
Contraindications & Blackbox Warnings
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Pharmacodynamics

Binding studies at human muscarinic receptors (M1–M4) and guinea-pig ileum assays have found sofpironium bromide to have potency close to glycopyrronium with a shorter duration of action.6

Despite its topical application, sofpironium bromide exhibits some degree of systemic absorption that can result in anticholinergic adverse effects like urinary retention and heat illness.5 Patients with conditions that may be exacerbated by anticholinergic agents (e.g. myasthenia gravis, Sjögren’s syndrome) should not use sofpironium bromide, nor should it be used in patients already undergoing treatment with a systemic anticholinergic medication.5

Mechanism of action

Sofpironium is a competitive inhibitor of muscarinic acetylcholine receptors are located on certain peripheral tissues, including eccrine sweat glands.5 By inhibiting the activity of these receptors, sofpironium indirectly reduces the rate of sweating in patients with axillary hyperhidrosis.

TargetActionsOrganism
AMuscarinic acetylcholine receptor M3
inhibitor
Humans
AMuscarinic acetylcholine receptor
inhibitor
Humans
Absorption

Following a single topical administration of sofpironium in adult patients, the mean plasma Cmax was 2.71 ng/mL, the AUC0-t was 45.1 ng.hr/mL, and the tmax was 5.34 hours.5 Following a single topical administration of sofpironium in pediatric patients (9 to 16 years of age), the mean plasma Cmax was 1.30 ng/mL, the AUC0-t was 14.6 ng.hr/mL, and the tmax was 4.0 hours.5

Volume of distribution

Not Available

Protein binding

Plasma protein binding of sofpironium is approximately 34.8 - 37.8%.5 Plasma protein binding of BBI-4010 is significantly lower at approximately 2.3 - 3.7%.5

Metabolism

Sofpironium is metabolized by non-enzymatic hydrolysis, oxidative metabolism via CYP2D6 and CYP3A4, and glycine conjugation.5 As a product of retrometabolic drug design, sofpironium includes a metabolically labile ester moiety that is readily hydrolyzed (by plasma paraoxonase 1 (PON1))3 to produce BBI-4010, a less active anticholinergic agent, thereby limiting the risk of systemic adverse effects.6

In plasma, the major component was sofpironium (38%) followed by BBI-4010 (20%).5

Hover over products below to view reaction partners

Route of elimination

Urinary excretion of sofpironium and BBI-4010 were less than 0.5% of the applied dose.5

Half-life

The in vitro half-life sofpironium in human plasma has been measured at 3.86 hours.6

Clearance

Not Available

Adverse Effects
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Toxicity

In the event of an overdose via overapplication of sofpironium bromide topical gel, prescribing information recommends washing the area with soap and water.5 Patients experiencing an overdose are likely to exhibit anticholinergic toxicities, including mydriasis (pupil dilation), blurred vision, urinary retention, and temperature dysregulation. Symptoms attributed to sofpironium overdose should be treated symptomatically.5

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
AclidiniumSofpironium may increase the anticholinergic activities of Aclidinium.
AmantadineSofpironium may increase the anticholinergic activities of Amantadine.
AmitriptylineSofpironium may increase the anticholinergic activities of Amitriptyline.
AmobarbitalSofpironium may increase the anticholinergic activities of Amobarbital.
AmoxapineSofpironium may increase the anticholinergic activities of Amoxapine.
Food Interactions
No interactions found.

Products

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Product Ingredients
IngredientUNIICASInChI Key
Sofpironium bromide7B2Y1932XU1628106-94-4FIAFMTCUJCWADZ-JOFREBOKSA-M
Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
SofdraGel87 mg/0.67mLTopicalBotanix SB Inc.2024-08-06Not applicableUS flag

Categories

Drug Categories
Classification
Not classified
Affected organisms
  • Humans

Chemical Identifiers

UNII
00Y6A5AJU6
CAS number
1628251-49-9
InChI Key
SEVCTUCCZYBJER-BSJAROSPSA-N
InChI
InChI=1S/C22H32NO5/c1-3-27-20(24)16-23(2)14-13-19(15-23)28-21(25)22(26,18-11-7-8-12-18)17-9-5-4-6-10-17/h4-6,9-10,18-19,26H,3,7-8,11-16H2,1-2H3/q+1/t19-,22-,23?/m1/s1
IUPAC Name
SMILES
CCOC(=O)C[N+]1(C)CC[C@H](C1)OC(=O)[C@@](O)(C1CCCC1)C1=CC=CC=C1

References

Synthesis Reference

Marubayashi K, Watanabe M, & Brinkman HR. (2021). Crystalline form of sofpironium bromide and preparation method thereof. (US Patent No. US11584715B2). U.S. Patent and Trademark Office.

General References
  1. Yokozeki H, Fujimoto T, Abe Y, Igarashi M, Ishikoh A, Omi T, Kanda H, Kitahara H, Kinoshita M, Nakasu I, Hattori N, Horiuchi Y, Maruyama R, Mizutani H, Murakami Y, Watanabe C, Kume A, Hanafusa T, Hamaguchi M, Yoshioka A, Egami Y, Matsuo K, Matsuda T, Akamatsu M, Yorozuya T, Takayama S: A phase 3, multicenter, randomized, double-blind, vehicle-controlled, parallel-group study of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis. J Dermatol. 2021 Mar;48(3):279-288. doi: 10.1111/1346-8138.15668. Epub 2021 Jan 7. [Article]
  2. Armstrong A, Reddy R, Chadha D, Kircik L: SUPPLEMENT ARTICLE: A Novel Drug Delivery Method: Retrometabolic Drug Design. J Drugs Dermatol. 2022 Apr 1;21(4):s5-s10. [Article]
  3. Samir A, Ohura K, Bodor N, Imai T: Identification of Major Esterase Involved in Hydrolysis of Soft Anticholinergic (2R3'R-SGM) Designed From Glycopyrrolate in Human and Rat Tissues. J Pharm Sci. 2019 Aug;108(8):2791-2797. doi: 10.1016/j.xphs.2019.03.030. Epub 2019 Apr 5. [Article]
  4. Dermatology Times: FDA Approves Sofpironium (Sofdra) as First and Only Chemical Entity for Primary Axillary Hyperhidrosis [Link]
  5. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]
  6. 2021 Fall Clinical Dermatology Conference: Investigating Treatment of Primary Axillary Hyperhidrosis With a Topical Retrometabolic Anticholinergic Drug [Link]
RxNav
2689322
ChEMBL
CHEMBL3707224
Wikipedia
Sofpironium_bromide

Clinical Trials

Clinical Trials
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Explore 4,000+ rare diseases, orphan drugs & condition pairs, clinical trial why stopped data, & more. Preview package
PhaseStatusPurposeConditionsCountStart DateWhy Stopped100+ additional columns
3CompletedTreatmentAxillary Hyperhidrosis2somestatusstop reasonjust information to hide
3CompletedTreatmentPrimary Axillary Hyperhidrosis1somestatusstop reasonjust information to hide
2CompletedTreatmentHyperhidrosis3somestatusstop reasonjust information to hide
2CompletedTreatmentPrimary Axillary Hyperhidrosis1somestatusstop reasonjust information to hide
1CompletedTreatmentHyperhidrosis1somestatusstop reasonjust information to hide

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
GelTopical87 mg/0.67mL
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
PropertyValueSource
water solubilityFreely solublehttps://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217347s000lbl.pdf
Predicted Properties
PropertyValueSource
Predicted ADMET Features
Not Available

Spectra

Mass Spec (NIST)
Not Available
Spectra
Not Available
Chromatographic Properties
Collision Cross Sections (CCS)
Not Available

Targets

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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
The muscarinic acetylcholine receptor mediates various cellular responses, including inhibition of adenylate cyclase, breakdown of phosphoinositides and modulation of potassium channels through the action of G proteins. Primary transducing effect is Pi turnover
Specific Function
Acetylcholine binding
Gene Name
CHRM3
Uniprot ID
P20309
Uniprot Name
Muscarinic acetylcholine receptor M3
Molecular Weight
66127.445 Da
References
  1. Yokozeki H, Fujimoto T, Abe Y, Igarashi M, Ishikoh A, Omi T, Kanda H, Kitahara H, Kinoshita M, Nakasu I, Hattori N, Horiuchi Y, Maruyama R, Mizutani H, Murakami Y, Watanabe C, Kume A, Hanafusa T, Hamaguchi M, Yoshioka A, Egami Y, Matsuo K, Matsuda T, Akamatsu M, Yorozuya T, Takayama S: A phase 3, multicenter, randomized, double-blind, vehicle-controlled, parallel-group study of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis. J Dermatol. 2021 Mar;48(3):279-288. doi: 10.1111/1346-8138.15668. Epub 2021 Jan 7. [Article]
  2. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]
Kind
Protein group
Organism
Humans
Pharmacological action
Yes
Actions
Inhibitor
General Function
The muscarinic acetylcholine receptor mediates various cellular responses, including inhibition of adenylate cyclase, breakdown of phosphoinositides and modulation of potassium channels through the action of G proteins. Primary transducing effect is Pi turnover
Specific Function
G protein-coupled acetylcholine receptor activity

Components:
References
  1. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]

Enzymes

Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
Inhibitor
General Function
A cytochrome P450 monooxygenase involved in the metabolism of fatty acids, steroids and retinoids (PubMed:18698000, PubMed:19965576, PubMed:20972997, PubMed:21289075, PubMed:21576599). Mechanistically, uses molecular oxygen inserting one oxygen atom into a substrate, and reducing the second into a water molecule, with two electrons provided by NADPH via cytochrome P450 reductase (NADPH--hemoprotein reductase) (PubMed:18698000, PubMed:19965576, PubMed:20972997, PubMed:21289075, PubMed:21576599). Catalyzes the epoxidation of double bonds of polyunsaturated fatty acids (PUFA) (PubMed:19965576, PubMed:20972997). Metabolizes endocannabinoid arachidonoylethanolamide (anandamide) to 20-hydroxyeicosatetraenoic acid ethanolamide (20-HETE-EA) and 8,9-, 11,12-, and 14,15-epoxyeicosatrienoic acid ethanolamides (EpETrE-EAs), potentially modulating endocannabinoid system signaling (PubMed:18698000, PubMed:21289075). Catalyzes the hydroxylation of carbon-hydrogen bonds. Metabolizes cholesterol toward 25-hydroxycholesterol, a physiological regulator of cellular cholesterol homeostasis (PubMed:21576599). Catalyzes the oxidative transformations of all-trans retinol to all-trans retinal, a precursor for the active form all-trans-retinoic acid (PubMed:10681376). Also involved in the oxidative metabolism of drugs such as antiarrhythmics, adrenoceptor antagonists, and tricyclic antidepressants
Specific Function
Anandamide 11,12 epoxidase activity
Gene Name
CYP2D6
Uniprot ID
P10635
Uniprot Name
Cytochrome P450 2D6
Molecular Weight
55768.94 Da
References
  1. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
Inhibitor
General Function
A cytochrome P450 monooxygenase involved in the metabolism of sterols, steroid hormones, retinoids and fatty acids (PubMed:10681376, PubMed:11093772, PubMed:11555828, PubMed:12865317, PubMed:14559847, PubMed:15373842, PubMed:15764715, PubMed:19965576, PubMed:20702771, PubMed:21490593, PubMed:21576599). Mechanistically, uses molecular oxygen inserting one oxygen atom into a substrate, and reducing the second into a water molecule, with two electrons provided by NADPH via cytochrome P450 reductase (NADPH--hemoprotein reductase). Catalyzes the hydroxylation of carbon-hydrogen bonds (PubMed:12865317, PubMed:14559847, PubMed:15373842, PubMed:15764715, PubMed:21490593, PubMed:21576599, PubMed:2732228). Exhibits high catalytic activity for the formation of hydroxyestrogens from estrone (E1) and 17beta-estradiol (E2), namely 2-hydroxy E1 and E2, as well as D-ring hydroxylated E1 and E2 at the C-16 position (PubMed:11555828, PubMed:12865317, PubMed:14559847). Plays a role in the metabolism of androgens, particularly in oxidative deactivation of testosterone (PubMed:15373842, PubMed:15764715, PubMed:22773874, PubMed:2732228). Metabolizes testosterone to less biologically active 2beta- and 6beta-hydroxytestosterones (PubMed:15373842, PubMed:15764715, PubMed:2732228). Contributes to the formation of hydroxycholesterols (oxysterols), particularly A-ring hydroxylated cholesterol at the C-4beta position, and side chain hydroxylated cholesterol at the C-25 position, likely contributing to cholesterol degradation and bile acid biosynthesis (PubMed:21576599). Catalyzes bisallylic hydroxylation of polyunsaturated fatty acids (PUFA) (PubMed:9435160). Catalyzes the epoxidation of double bonds of PUFA with a preference for the last double bond (PubMed:19965576). Metabolizes endocannabinoid arachidonoylethanolamide (anandamide) to 8,9-, 11,12-, and 14,15-epoxyeicosatrienoic acid ethanolamides (EpETrE-EAs), potentially modulating endocannabinoid system signaling (PubMed:20702771). Plays a role in the metabolism of retinoids. Displays high catalytic activity for oxidation of all-trans-retinol to all-trans-retinal, a rate-limiting step for the biosynthesis of all-trans-retinoic acid (atRA) (PubMed:10681376). Further metabolizes atRA toward 4-hydroxyretinoate and may play a role in hepatic atRA clearance (PubMed:11093772). Responsible for oxidative metabolism of xenobiotics. Acts as a 2-exo-monooxygenase for plant lipid 1,8-cineole (eucalyptol) (PubMed:11159812). Metabolizes the majority of the administered drugs. Catalyzes sulfoxidation of the anthelmintics albendazole and fenbendazole (PubMed:10759686). Hydroxylates antimalarial drug quinine (PubMed:8968357). Acts as a 1,4-cineole 2-exo-monooxygenase (PubMed:11695850). Also involved in vitamin D catabolism and calcium homeostasis. Catalyzes the inactivation of the active hormone calcitriol (1-alpha,25-dihydroxyvitamin D(3)) (PubMed:29461981)
Specific Function
1,8-cineole 2-exo-monooxygenase activity
Gene Name
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]

Transporters

Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Inhibitor
General Function
Electrogenic voltage-dependent transporter that mediates the transport of a variety of organic cations such as endogenous bioactive amines, cationic drugs and xenobiotics (PubMed:11388889, PubMed:11408531, PubMed:12439218, PubMed:12719534, PubMed:15389554, PubMed:16263091, PubMed:16272756, PubMed:16581093, PubMed:19536068, PubMed:21128598, PubMed:23680637, PubMed:24961373, PubMed:34040533, PubMed:9187257, PubMed:9260930, PubMed:9655880). Functions as a pH- and Na(+)-independent, bidirectional transporter (By similarity). Cation cellular uptake or release is driven by the electrochemical potential (i.e. membrane potential and concentration gradient) and substrate selectivity (By similarity). Hydrophobicity is a major requirement for recognition in polyvalent substrates and inhibitors (By similarity). Primarily expressed at the basolateral membrane of hepatocytes and proximal tubules and involved in the uptake and disposition of cationic compounds by hepatic and renal clearance from the blood flow (By similarity). Most likely functions as an uptake carrier in enterocytes contributing to the intestinal elimination of organic cations from the systemic circulation (PubMed:16263091). Transports endogenous monoamines such as N-1-methylnicotinamide (NMN), guanidine, histamine, neurotransmitters dopamine, serotonin and adrenaline (PubMed:12439218, PubMed:24961373, PubMed:35469921, PubMed:9260930). Also transports natural polyamines such as spermidine, agmatine and putrescine at low affinity, but relatively high turnover (PubMed:21128598). Involved in the hepatic uptake of vitamin B1/thiamine, hence regulating hepatic lipid and energy metabolism (PubMed:24961373). Mediates the bidirectional transport of acetylcholine (ACh) at the apical membrane of ciliated cell in airway epithelium, thereby playing a role in luminal release of ACh from bronchial epithelium (PubMed:15817714). Transports dopaminergic neuromodulators cyclo(his-pro) and salsolinol with lower efficency (PubMed:17460754). Also capable of transporting non-amine endogenous compounds such as prostaglandin E2 (PGE2) and prostaglandin F2-alpha (PGF2-alpha) (PubMed:11907186). May contribute to the transport of cationic compounds in testes across the blood-testis-barrier (Probable). Also involved in the uptake of xenobiotics tributylmethylammonium (TBuMA), quinidine, N-methyl-quinine (NMQ), N-methyl-quinidine (NMQD) N-(4,4-azo-n-pentyl)-quinuclidine (APQ), azidoprocainamide methoiodide (AMP), N-(4,4-azo-n-pentyl)-21-deoxyajmalinium (APDA) and 4-(4-(dimethylamino)styryl)-N-methylpyridinium (ASP) (PubMed:11408531, PubMed:15389554, PubMed:35469921, PubMed:9260930)
Specific Function
(r)-carnitine transmembrane transporter activity
Gene Name
SLC22A1
Uniprot ID
O15245
Uniprot Name
Solute carrier family 22 member 1
Molecular Weight
61153.345 Da
References
  1. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Inhibitor
General Function
Electrogenic voltage-dependent transporter that mediates the transport of a variety of organic cations such as endogenous bioactive amines, cationic drugs and xenobiotics (PubMed:9260930, PubMed:9687576). Functions as a Na(+)-independent, bidirectional uniporter (PubMed:21128598, PubMed:9687576). Cation cellular uptake or release is driven by the electrochemical potential, i.e. membrane potential and concentration gradient (PubMed:15212162, PubMed:9260930, PubMed:9687576). However, may also engage electroneutral cation exchange when saturating concentrations of cation substrates are reached (By similarity). Predominantly expressed at the basolateral membrane of hepatocytes and proximal tubules and involved in the uptake and disposition of cationic compounds by hepatic and renal clearance from the blood flow (PubMed:15783073). Implicated in monoamine neurotransmitters uptake such as histamine, dopamine, adrenaline/epinephrine, noradrenaline/norepinephrine, serotonin and tyramine, thereby supporting a physiological role in the central nervous system by regulating interstitial concentrations of neurotransmitters (PubMed:16581093, PubMed:17460754, PubMed:9687576). Also capable of transporting dopaminergic neuromodulators cyclo(his-pro), salsolinol and N-methyl-salsolinol, thereby involved in the maintenance of dopaminergic cell integrity in the central nervous system (PubMed:17460754). Mediates the bidirectional transport of acetylcholine (ACh) at the apical membrane of ciliated cell in airway epithelium, thereby playing a role in luminal release of ACh from bronchial epithelium (PubMed:15817714). Also transports guanidine and endogenous monoamines such as vitamin B1/thiamine, creatinine and N-1-methylnicotinamide (NMN) (PubMed:12089365, PubMed:15212162, PubMed:17072098, PubMed:24961373, PubMed:9260930). Mediates the uptake and efflux of quaternary ammonium compound choline (PubMed:9260930). Mediates the bidirectional transport of polyamine agmatine and the uptake of polyamines putrescine and spermidine (PubMed:12538837, PubMed:21128598). Able to transport non-amine endogenous compounds such as prostaglandin E2 (PGE2) and prostaglandin F2-alpha (PGF2-alpha) (PubMed:11907186). Also involved in the uptake of xenobiotic 4-(4-(dimethylamino)styryl)-N-methylpyridinium (ASP) (PubMed:12395288, PubMed:16394027). May contribute to regulate the transport of organic compounds in testis across the blood-testis-barrier (Probable)
Specific Function
Acetylcholine transmembrane transporter activity
Gene Name
SLC22A2
Uniprot ID
O15244
Uniprot Name
Solute carrier family 22 member 2
Molecular Weight
62579.99 Da
References
  1. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Inhibitor
General Function
Multidrug efflux pump that functions as a H(+)/organic cation antiporter (PubMed:16330770, PubMed:17509534). Plays a physiological role in the excretion of cationic compounds including endogenous metabolites, drugs, toxins through the kidney and liver, into urine and bile respectively (PubMed:16330770, PubMed:17495125, PubMed:17509534, PubMed:17582384, PubMed:18305230, PubMed:19158817, PubMed:21128598, PubMed:24961373). Mediates the efflux of endogenous compounds such as creatinine, vitamin B1/thiamine, agmatine and estrone-3-sulfate (PubMed:16330770, PubMed:17495125, PubMed:17509534, PubMed:17582384, PubMed:18305230, PubMed:19158817, PubMed:21128598, PubMed:24961373). May also contribute to regulate the transport of cationic compounds in testis across the blood-testis-barrier (Probable)
Specific Function
Antiporter activity
Gene Name
SLC47A1
Uniprot ID
Q96FL8
Uniprot Name
Multidrug and toxin extrusion protein 1
Molecular Weight
61921.585 Da
References
  1. FDA Approved Drug Products: Sofdra (sofpironium bromide) topical gel [Link]

Drug created at August 12, 2024 18:33 / Updated at September 11, 2024 23:10