Identification
- Summary
Serdexmethylphenidate is a prodrug of the CNS stimulant dexmethylphenidate used as a first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD).
- Brand Names
- Azstarys
- Generic Name
- Serdexmethylphenidate
- DrugBank Accession Number
- DB16629
- Background
Attention Deficit Hyperactivity Disorder (ADHD) is an early-onset neurodevelopmental disorder that often extends into adulthood and is characterized by developmentally inappropriate and impaired attention, impulsivity, and motor hyperactivity.1,2 The underlying cause of ADHD is unclear but likely involves dysfunction in dopaminergic and noradrenergic neurotransmission, as evidenced by the clear beneficial effect of CNS stimulants such as methylphenidate and amphetamine that increase extracellular dopamine and norepinephrine levels.1,3 Serdexmethylphenidate is a prodrug of the CNS stimulant dexmethylphenidate, a common first-line treatment for ADHD, that is combined with dexmethylphenidate to provide extended plasma concentrations and therapeutic benefit with once-daily dosing.11,12
Serdexmethylphenidate was granted FDA approval on March 2, 2021, and is currently marketed as a combination capsule with dexmethylphenidate under the trademark AZSTARYS™ by KemPharm, Inc.
- Type
- Small Molecule
- Groups
- Approved
- Structure
Structure for Serdexmethylphenidate (DB16629)
- Weight
- Average: 499.52
Monoisotopic: 499.195464906 - Chemical Formula
- C25H29N3O8
- Synonyms
- Serdexmethylphenidate
- External IDs
- KP-415 inner salt
Pharmacology
- Indication
Serdexmethylphenidate is a prodrug of dexmethylphenidate that is indicated in combination with dexmethylphenidate for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients aged six years and older.11
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Indication Type Indication Combined Product Details Approval Level Age Group Patient Characteristics Dose Form Used in combination to treat Attention deficit hyperactivity disorder (adhd) Combination Product in combination with: Dexmethylphenidate (DB06701) •••••••••••• ••••••• - Contraindications & Blackbox Warnings
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Serdexmethylphenidate is a prodrug of the CNS stimulant dexmethylphenidate, which increases extracellular levels of dopamine and norepinephrine in the CNS, leading to altered neurotransmission.3 As a CNS stimulant, serdexmethylphenidate carries a risk of abuse, misuse, and dependence, which should be monitored. Also, CNS stimulants are associated with increased blood pressure, heart rate, and risk of serious cardiovascular reactions, including stroke, myocardial infarction, and sudden death; patients should be assessed before starting therapy and monitored for cardiovascular abnormalities. Similarly, CNS stimulants may also result in peripheral vasculopathy, including Raynaud's phenomenon. Due to its ability to alter neurological function, serdexmethylphenidate may exacerbate pre-existing psychoses, induce manic episodes in patients with bipolar disorder, or result in newly diagnosable manic or psychotic symptoms. Frequent, sustained, and painful erections, which may require medical attention, have been observed in patients who have been treated for some time with serdexmethylphenidate, often associated with a dose increase. Finally, like other CNS stimulants, serdexmethylphenidate has been associated with weight loss and growth retardation, which may require treatment interruption in serious cases.11
- Mechanism of action
Attention Deficit Hyperactivity Disorder (ADHD) is an early-onset neurodevelopmental disorder that often extends into adulthood and is characterized by developmentally inappropriate and impaired attention, impulsivity, and motor hyperactivity.1,2 Proper diagnosis is hindered by a lack of biological markers (based on symptoms alone), a spectrum of severity, and frequent comorbidities such as autism spectrum disorder, reading disabilities, developmental coordination disorders, and tic disorders.1 Although the underlying cause(s) is unclear, dopaminergic, noradrenergic, serotonergic, cholinergic, glutaminergic, and opioid neurotransmission likely plays a role.1,3
Serdexmethylphenidate is a prodrug of the CNS stimulant dexmethylphenidate(MPH), a common first-line treatment for ADHD.11 The main effect of MPH is to increase the extracellular levels of dopamine and norepinephrine, which has numerous potential downstream effects.2,3 This occurs mainly due to MPH's ability to inhibit the corresponding dopamine and norepinephrine monoamine transporters.2,3 Other studies have suggested additional possible MPH functions, including serotonin 5-HT1A receptor agonism,3,4 redistribution of vesicular monoamine transporter-2 (VMAT-2),3,5 and either direct or indirect activation of α2-adrenergic receptors.3,6,7 Overall, imaging studies reveal that MPH acts to alter brain activity in relevant regions associated with executive function, emotional regulation, reward processing, and working memory.3
Target Actions Organism ASodium-dependent dopamine transporter inhibitorHumans ASodium-dependent noradrenaline transporter inhibitorHumans U5-hydroxytryptamine receptor 1A agonistHumans - Absorption
Following a single dose of serdexmethylphenidate/dexmethylphenidate (52.3/10.4 mg) compared to extended-release dexmethylphenidate (40 mg) capsules in healthy volunteers under fasted conditions, the Cmax and AUC of dexmethylphenidate were 14.0 ng/mL and 186 ng*h/mL and 28.2 ng/mL and 248 ng*h/mL, respectively. The kinetics are approximately linear over a range of concentrations, with steady-state being reached after the third once-daily dose.11,14 Serdexmethylphenidate has a low oral bioavailability of 3%. The Tmax for both serdexmethylphenidate and dexmethylphenidate is approximately two hours under fasted conditions when coadministered. When serdexmethylphenidate is administered as a single entity, the dexmethylphenidate Tmax is approximately eight hours.11
Different ratios of serdexmethylphenidate to dexmethylphenidate, 64/8, 56/12, and 48/16 mg, each equivalent to 40 mg of dexmethylphenidate, were tested in healthy adult volunteers under fasted conditions. In each case, dexmethylphenidate reached peak plasma concentrations in roughly two hours (mean between 1.6-1.8 hours), which gradually decreased over 24 hours. The Cmax varied from 15.5 ± 3.7 to 23.8 ± 5.7 ng/mL while the AUC0-24h varied from 187.0 ± 41.0 to 207 ± 54.4 ng*h/mL.12 Another study investigated the pharmacokinetics of serdexmethylphenidate/dexmethylphenidate (28/6 or 56/12 mg) in patients aged between six and 17 years of age. In general, the Cmax and AUC varied between cohorts and dose but were roughly equivalent when normalized for both dose and body weight.13
- Volume of distribution
Serdexmethylphenidate has a mean apparent volume of distribution of 29.3 L/kg following serdexmethylphenidate/dexmethylphenidate administration.11 Serdexmethylphenidate/dexmethylphenidate (28/6 or 56/12 mg) administered orally in patients aged between six and 17 years of age produced an apparent volume of distribution of dexmethylphenidate of between 37.6 and 66 L/kg.13
- Protein binding
Plasma protein binding of serdexmethylphenidate and dexmethylphenidate is low at therapeutic doses, 56% and 47%, respectively, at 5 μM, a concentration roughly 60 times that achieved in therapeutic application.2,11
- Metabolism
Serdexmethylphenidate is converted to dexmethylphenidate in the lower gastrointestinal tract by as yet unknown enzymes. Following this, dexmethylphenidate is mainly converted to d-α-phenyl-piperidine acetic acid (d-ritalinic acid) in the liver by carboxylesterase 1A1.11,8 Other metabolites include the oxidation products 6-oxo-methylphenidate and p-hydroxy-methylphenidate, which are then de-esterified to oxo-ritalinic acid and p-hydroxy-ritalinic acid, respectively.9,10 Methylphenidate may also be trans-esterified to form ethylphenidate.10
Hover over products below to view reaction partners
- Route of elimination
Following oral serdexmethylphenidate dosing in humans, roughly 62% and 37% of the initial dose was recovered in the urine and feces, of which about 0.4% and 11% of the initial dose was recovered unchanged, respectively. Ritalinic acid accounted for approximately 63% of the recovered dose. When methylphenidate was administered orally as a racemate, about 90% of the dose was recovered in urine, of which racemic acid accounted for approximately 80% of the dose.11
- Half-life
Following a single oral dose of 52.3 mg/10.4 mg serdexmethylphenidate/dexmethylphenidate, the mean plasma terminal elimination half-lives of each component were roughly 5.7 and 11.7 hours, respectively.11 At steady-state in healthy adults under fasted conditions, serdexmethylphenidate/dexmethylphenidate at 64/8, 56/12, and 48/16 mg resulted in a dexmethylphenidate half-life of between 8.5 ± 2.3 and 9.2 ± 3.5 hours.12
- Clearance
Serdexmethylphenidate has a mean apparent clearance of about 3.6 L/h/kg following oral serdexmethylphenidate/dexmethylphenidate administration.11 In patients aged 6-17 years following oral administration of 28/6 or 56/12 mg serdexmethylphenidate/dexmethylphenidate, dexmethylphenidate has a mean apparent clearance of between 2.5 and 3.4 L/h/kg when normalized for dose.13
- Adverse Effects
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Serdexmethylphenidate/dexmethylphenidate overdose results in symptoms consistent with CNS overstimulation, including gastrointestinal complaints such as nausea and vomiting, neurological effects including anxiety, euphoria, confusion, and hallucinations/delirium, cardiovascular effects such as arrhythmias, hypertension/hypotension, and tachycardia, general effects such as agitation, restlessness, twitching, convulsions, sweating, flushing, mucous membrane dryness, tachypnea, mydriasis, and serious effects such as rhabdomyolysis, loss of consciousness, coma, and death. Overdose treatment should consist of appropriate symptomatic and supportive care.11
- 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.
Drug Interaction Integrate drug-drug
interactions in your softwareAcebutolol The therapeutic efficacy of Acebutolol can be decreased when used in combination with Serdexmethylphenidate. Aceclofenac The risk or severity of hypertension can be increased when Aceclofenac is combined with Serdexmethylphenidate. Acemetacin The risk or severity of hypertension can be increased when Acemetacin is combined with Serdexmethylphenidate. Acetylsalicylic acid The risk or severity of hypertension can be increased when Acetylsalicylic acid is combined with Serdexmethylphenidate. Albuterol The risk or severity of hypertension can be increased when Salbutamol is combined with Serdexmethylphenidate. - Food Interactions
- Take with or without food. Food does not exert a clinically meaningful effect on dexmethylphenidate exposure, though it does lengthen the time to reach maximum plasma concentration from two hours to approximately 4-4.5 hours.
Products
Drug product information from 10+ global regionsOur datasets provide approved product information including:dosage, form, labeller, route of administration, and marketing period.Access drug product information from over 10 global regions.- Product Ingredients
Ingredient UNII CAS InChI Key Serdexmethylphenidate chloride FN54BT298Y 1996626-30-2 GONQEUJYYMYNMN-HWAJWLCKSA-N - Active Moieties
Name Kind UNII CAS InChI Key Dexmethylphenidate prodrug M32RH9MFGP 40431-64-9 DUGOZIWVEXMGBE-CHWSQXEVSA-N - Mixture Products
Name Ingredients Dosage Route Labeller Marketing Start Marketing End Region Image Azstarys Serdexmethylphenidate chloride (26.1 mg/1) + Dexmethylphenidate hydrochloride (5.2 mg/1) Capsule Oral Corium, LLC. 2021-07-16 Not applicable US 
Azstarys Serdexmethylphenidate chloride (52.3 mg/1) + Dexmethylphenidate hydrochloride (10.4 mg/1) Capsule Oral Corium, LLC. 2021-07-16 Not applicable US Azstarys Serdexmethylphenidate chloride (39.2 mg/1) + Dexmethylphenidate hydrochloride (7.8 mg/1) Capsule Oral Corium, LLC. 2021-07-16 Not applicable US
Categories
- ATC Codes
- N06BA15 — Dexmethylphenidate and serdexmethylphenidate
- Drug Categories
- Agents that produce hypertension
- Central Nervous System Agents
- Central Nervous System Stimulants
- Central Nervous System Stimulation
- Centrally Acting Sympathomimetics
- Dopamine Agents
- Dopamine Uptake Inhibitors
- Membrane Transport Modulators
- Nervous System
- Neurotransmitter Agents
- Neurotransmitter Uptake Inhibitors
- Phenylacetates
- Piperidines
- Psychoanaleptics
- Psychostimulants, Agents Used for ADHD and Nootropics
- Classification
- Not classified
- Affected organisms
- Humans and other mammals
Chemical Identifiers
- UNII
- 0H8KZ470DW
- CAS number
- 1996626-29-9
- InChI Key
- UBZPNQRBUOBBLN-PWRODBHTSA-N
- InChI
- InChI=1S/C25H29N3O8/c1-35-24(33)21(17-8-3-2-4-9-17)20-11-5-6-13-28(20)25(34)36-16-27-12-7-10-18(14-27)22(30)26-19(15-29)23(31)32/h2-4,7-10,12,14,19-21,29H,5-6,11,13,15-16H2,1H3,(H-,26,30,31,32)/t19-,20+,21+/m0/s1
- IUPAC Name
- 3-{[(1S)-1-carboxylato-2-hydroxyethyl]carbamoyl}-1-{[(2R)-2-[(1R)-2-methoxy-2-oxo-1-phenylethyl]piperidine-1-carbonyloxy]methyl}pyridin-1-ium
- SMILES
- [H][C@@]1(CCCCN1C(=O)OC[N+]1=CC=CC(=C1)C(=O)N[C@@H](CO)C([O-])=O)[C@H](C(=O)OC)C1=CC=CC=C1
References
- Synthesis Reference
Travis Mickle, Sven M. Guenther, and Gouchen Chi, "Methylphenidate-prodrugs, processes of making and using the same." Patent WO2018107131A1, issued June 14, 2018.
- General References
- Thapar A, Cooper M: Attention deficit hyperactivity disorder. Lancet. 2016 Mar 19;387(10024):1240-50. doi: 10.1016/S0140-6736(15)00238-X. Epub 2015 Sep 17. [Article]
- Childress AC, Komolova M, Sallee FR: An update on the pharmacokinetic considerations in the treatment of ADHD with long-acting methylphenidate and amphetamine formulations. Expert Opin Drug Metab Toxicol. 2019 Nov;15(11):937-974. doi: 10.1080/17425255.2019.1675636. Epub 2019 Nov 8. [Article]
- Faraone SV: The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev. 2018 Apr;87:255-270. doi: 10.1016/j.neubiorev.2018.02.001. Epub 2018 Feb 8. [Article]
- Markowitz JS, DeVane CL, Ramamoorthy S, Zhu HJ: The psychostimulant d-threo-(R,R)-methylphenidate binds as an agonist to the 5HT(1A) receptor. Pharmazie. 2009 Feb;64(2):123-5. [Article]
- Riddle EL, Hanson GR, Fleckenstein AE: Therapeutic doses of amphetamine and methylphenidate selectively redistribute the vesicular monoamine transporter-2. Eur J Pharmacol. 2007 Sep 24;571(1):25-8. doi: 10.1016/j.ejphar.2007.05.044. Epub 2007 Jun 5. [Article]
- Andrews GD, Lavin A: Methylphenidate increases cortical excitability via activation of alpha-2 noradrenergic receptors. Neuropsychopharmacology. 2006 Mar;31(3):594-601. doi: 10.1038/sj.npp.1300818. [Article]
- Gamo NJ, Wang M, Arnsten AF: Methylphenidate and atomoxetine enhance prefrontal function through alpha2-adrenergic and dopamine D1 receptors. J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):1011-23. doi: 10.1016/j.jaac.2010.06.015. Epub 2010 Sep 1. [Article]
- Sun Z, Murry DJ, Sanghani SP, Davis WI, Kedishvili NY, Zou Q, Hurley TD, Bosron WF: Methylphenidate is stereoselectively hydrolyzed by human carboxylesterase CES1A1. J Pharmacol Exp Ther. 2004 Aug;310(2):469-76. doi: 10.1124/jpet.104.067116. Epub 2004 Apr 13. [Article]
- Loureiro-Vieira S, Costa VM, de Lourdes Bastos M, Carvalho F, Capela JP: Methylphenidate effects in the young brain: friend or foe? Int J Dev Neurosci. 2017 Aug;60:34-47. doi: 10.1016/j.ijdevneu.2017.04.002. Epub 2017 Apr 13. [Article]
- Markowitz JS, Straughn AB, Patrick KS: Advances in the pharmacotherapy of attention-deficit-hyperactivity disorder: focus on methylphenidate formulations. Pharmacotherapy. 2003 Oct;23(10):1281-99. doi: 10.1592/phco.23.12.1281.32697. [Article]
- FDA Approved Drug Products: AZSTARYS (serdexmethylphenidate and dexmethylphenidate) capsules [Link]
- KemPharm Poster: Braeckman, et al. (2018) American Professional Society for ADHD and Related Disorders [Link]
- KemPharm Poster: Braeckman, et al. (2019) American Professional Society for ADHD and Related Disorders [Link]
- KemPharm Poster: Braeckman, et al. poster 2 (2019) American Professional Society for ADHD and Related Disorders [Link]
- External Links
- ChemSpider
- 81367537
- 2562176
- Wikipedia
- Serdexmethylphenidate
Clinical Trials
- Clinical Trials
Phase Status Purpose Conditions Count 4 Recruiting Treatment Adult Attention Deficit Hyperactivity Disorder (ADHD) 1 4 Recruiting Treatment Attention Deficit Hyperactivity Disorder (ADHD) 2 3 Completed Treatment Attention Deficit Hyperactivity Disorder (ADHD) 1 3 Not Yet Recruiting Treatment Attention Deficit Hyperactivity Disorder (ADHD) 1 2 Active Not Recruiting Treatment Idiopathic Hypersomnia 1
Pharmacoeconomics
- Manufacturers
- Not Available
- Packagers
- Not Available
- Dosage Forms
Form Route Strength Capsule Oral - Prices
- Not Available
- Patents
Patent Number Pediatric Extension Approved Expires (estimated) Region US10858341 No 2020-12-08 2037-12-09 US US10954213 No 2021-03-23 2037-12-09 US US10584112 No 2020-03-10 2037-12-09 US US9079928 No 2015-07-14 2032-07-27 US US10584113 No 2020-03-10 2037-12-09 US US10759778 No 2020-09-01 2037-12-09 US
Properties
- State
- Solid
- Experimental Properties
- Not Available
- Predicted Properties
Property Value Source logP -2.7 Chemaxon pKa (Strongest Acidic) 2.56 Chemaxon pKa (Strongest Basic) -2.4 Chemaxon Physiological Charge 0 Chemaxon Hydrogen Acceptor Count 6 Chemaxon Hydrogen Donor Count 2 Chemaxon Polar Surface Area 149.18 Å2 Chemaxon Rotatable Bond Count 11 Chemaxon Refractivity 137.75 m3·mol-1 Chemaxon Polarizability 50.9 Å3 Chemaxon Number of Rings 3 Chemaxon Bioavailability 1 Chemaxon Rule of Five Yes Chemaxon Ghose Filter No Chemaxon Veber's Rule No Chemaxon MDDR-like Rule Yes Chemaxon - Predicted ADMET Features
- Not Available
Spectra
- Mass Spec (NIST)
- Not Available
- Spectra
Spectrum Spectrum Type Splash Key Predicted 1H NMR Spectrum 1D NMR Not Applicable Predicted 13C NMR Spectrum 1D NMR Not Applicable - Chromatographic Properties
Collision Cross Sections (CCS)
Not Available
Targets
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Yes
- Actions
- Inhibitor
- Curator comments
- This action is mediated by the active moiety dexmethylphenidate following prodrug conversion.
- General Function
- Monoamine transmembrane transporter activity
- Specific Function
- Amine transporter. Terminates the action of dopamine by its high affinity sodium-dependent reuptake into presynaptic terminals.
- Gene Name
- SLC6A3
- Uniprot ID
- Q01959
- Uniprot Name
- Sodium-dependent dopamine transporter
- Molecular Weight
- 68494.255 Da
References
- Childress AC, Komolova M, Sallee FR: An update on the pharmacokinetic considerations in the treatment of ADHD with long-acting methylphenidate and amphetamine formulations. Expert Opin Drug Metab Toxicol. 2019 Nov;15(11):937-974. doi: 10.1080/17425255.2019.1675636. Epub 2019 Nov 8. [Article]
- Faraone SV: The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev. 2018 Apr;87:255-270. doi: 10.1016/j.neubiorev.2018.02.001. Epub 2018 Feb 8. [Article]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Yes
- Actions
- Inhibitor
- Curator comments
- This action is mediated by the active moiety dexmethylphenidate following prodrug conversion.
- General Function
- Norepinephrine:sodium symporter activity
- Specific Function
- Amine transporter. Terminates the action of noradrenaline by its high affinity sodium-dependent reuptake into presynaptic terminals.
- Gene Name
- SLC6A2
- Uniprot ID
- P23975
- Uniprot Name
- Sodium-dependent noradrenaline transporter
- Molecular Weight
- 69331.42 Da
References
- Childress AC, Komolova M, Sallee FR: An update on the pharmacokinetic considerations in the treatment of ADHD with long-acting methylphenidate and amphetamine formulations. Expert Opin Drug Metab Toxicol. 2019 Nov;15(11):937-974. doi: 10.1080/17425255.2019.1675636. Epub 2019 Nov 8. [Article]
- Faraone SV: The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev. 2018 Apr;87:255-270. doi: 10.1016/j.neubiorev.2018.02.001. Epub 2018 Feb 8. [Article]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Agonist
- Curator comments
- This action is mediated by the active moiety dexmethylphenidate following prodrug conversion. The relevance of 5-HT1A agonism on the pharmacological effects of dexmethylphenidate is not fully understood.
- General Function
- Serotonin receptor activity
- Specific Function
- G-protein coupled receptor for 5-hydroxytryptamine (serotonin). Also functions as a receptor for various drugs and psychoactive substances. Ligand binding causes a conformation change that triggers...
- Gene Name
- HTR1A
- Uniprot ID
- P08908
- Uniprot Name
- 5-hydroxytryptamine receptor 1A
- Molecular Weight
- 46106.335 Da
References
- Faraone SV: The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev. 2018 Apr;87:255-270. doi: 10.1016/j.neubiorev.2018.02.001. Epub 2018 Feb 8. [Article]
- Markowitz JS, DeVane CL, Ramamoorthy S, Zhu HJ: The psychostimulant d-threo-(R,R)-methylphenidate binds as an agonist to the 5HT(1A) receptor. Pharmazie. 2009 Feb;64(2):123-5. [Article]
Enzymes
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- Curator comments
- Serdexmethylphenidate is hydrolyzed by an unknown enzyme(s) to dexmethylphenidate, which is a substrate for the CES1A1 liver carboxylesterase.
- General Function
- Carboxylic ester hydrolase activity
- Specific Function
- Not Available
- Gene Name
- CES1A1a
- Uniprot ID
- Q6LAP9
- Uniprot Name
- Carboxylesterase
- Molecular Weight
- 1908.25 Da
References
- Sun Z, Murry DJ, Sanghani SP, Davis WI, Kedishvili NY, Zou Q, Hurley TD, Bosron WF: Methylphenidate is stereoselectively hydrolyzed by human carboxylesterase CES1A1. J Pharmacol Exp Ther. 2004 Aug;310(2):469-76. doi: 10.1124/jpet.104.067116. Epub 2004 Apr 13. [Article]
Drug created at March 04, 2021 04:54 / Updated at March 09, 2021 02:59