Drug/Small Molecule:
imatinib

2D structure

Overview

Generic Names: Imatinib Mesylate; Imatinib Methansulfonate
Trade Names: Gleevec; Glivec
PharmGKB Accession Id: PA10804

Description

Imatinib is a drug used to treat certain types of cancer. It is currently marketed by Novartis as Gleevec (USA) or Glivec (Europe/Australia) as its mesylate salt, imatinib mesilate (INN). It is occasionally referred to as CGP57148B or STI571 (especially in older publications). It is used in treating chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GISTs) and a number of other malignancies.
It is the first member of a new class of agents that act by inhibiting particular tyrosine kinase enzymes, instead of non-specifically inhibiting rapidly dividing cells. (source: Drug Bank)

Indication

For the treatment of newly diagnosed adult patients with Philadelphia chromosome positive chronic myeloid leukemia (CML). Also indicated for the treatment of pediatric patients with Ph+ chronic phase CML whose disease has recurred after stem cell transplant or who are resistant to interferon-alpha therapy. Also indicated with unresectable and/or metastatic malignant gastrointestinal stromal tumors (GIST). (source: Drug Bank)

ATC Therapeutic Category

  • L01XE:Protein kinase inhibitors

Pharmacology, Interactions, and Contraindications

Mechanism Of Action

Imatinib mesylate is a protein-tyrosine kinase inhibitor that inhibits the Bcr-Abl tyrosine kinase, the constitutive abnormal tyrosine kinase created by the Philadelphia chromosome abnormality in chronic myeloid leukemia (CML). It inhibits proliferation and induces apoptosis in Bcr-Abl positive cell lines as well as fresh leukemic cells from Philadelphia chromosome positive chronic myeloid leukemia. Imatinib also inhibits the receptor tyrosine kinases for platelet derived growth factor (PDGF) and stem cell factor (SCF) - called c-kit. Imatinib was identified in the late 1990s by Dr Brian J. Druker. Its development is an excellent example of rational drug design. Soon after identification of the bcr-abl target, the search for an inhibitor began. Chemists used a high-throughput screen of chemical libraries to identify the molecule 2-phenylaminopyrimidine. This lead compound was then tested and modified by the introduction of methyl and benzamide groups to give it enhanced binding properties, resulting in imatinib. (source: Drug Bank)

Pharmacology

Imatinib is an antineoplastic agent used to treat chronic myelogenous leukemia. Imatinib is a 2-phenylaminopyrimidine derivative that functions as a specific inhibitor of a number of tyrosine kinase enzymes. In chronic myelogenous leukemia, the Philadelphia chromosome leads to a fusion protein of Abl with Bcr (breakpoint cluster region), termed Bcr-Abl. As this is now a continuously active tyrosine kinase, Imatinib is used to decrease Bcr-Abl activity. (source: Drug Bank)

Food Interactions

Take with food to reduce the incidence of gastric irritation. Follow with a large glass of water. A lipid rich meal will slightly reduce and delay absorption. Avoid grapefruit and grapefruit juice throughout treatment, grapefruit can significantly increase serum levels of this product. (source: Drug Bank)

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Primarily hepatic via CYP3A4. Other cytochrome P450 enzymes, such as CYP1A2, CYP2D6, CYP2C9, and CYP2C19, play a minor role in its metabolism. The main circulating active metabolite in humans is the N-demethylated piperazine derivative, formed predominantly by CYP3A4. (source: Drug Bank)

Protein Binding

Very high (95%) (source: Drug Bank)

Absorption

Imatinib is well absorbed with mean absolute bioavailability is 98% with maximum levels achieved within 2-4 hours of dosing (source: Drug Bank)

Toxicity

Side effects include nausea, vomiting, diarrhea, loss of appetite, dry skin, hair loss, swelling (especially in the legs or around the eyes) and muscle cramps (source: Drug Bank)

Isomeric SMILES Code:

Cc1ccc(cc1Nc2nccc(n2)c3cccnc3)NC(=O)c4ccc(cc4)CN5CCN(CC5)C (source: Drug Bank)

Curated Annotations (Curated Annotation)

  1. rs2231142 at chr4:89271347 in ABCG2
    studied allele=A; study size=46 (30 children; 16 adults);PK=significantly lower clearance (-23%) of imatinib and major metabolite in heterozygous versus wild-type homozygous patients when genotype considered with body weight, albuminemia and alpha1-acid glycoprotein covariates; significance= P < 0.05; genotype alone not associated with increased clearance
    Variant Name:
    ABCG2:421C>A; ABCG2:Q141K;
    Related Drugs:
    imatinib
    Evidence:
    PMID:18981009
  2. rs2290573 at chr15:72916647 in ULK3
    A significant association between major cytogenetic response (MCyR) and the rs2290573 polymorphism mapped to 15q22.33 was observed in imatinib-treated patients (P = 0.00037, Bonferroni corrected P = 0.025). Individuals with a CC genotype had a MCyR rate of 52% compared with individuals with a CT or TT genotype that had a MCyR rate of 89% (odds ratio, 6.72; 95% confidence interval, 1.51-29.91). CO: The time to progression at 18 months was significantly different between CC and CT/TT genotype using log-rank test or Wilcoxon test (P < 0.03): Six of 29 imatinib-treated patients (21%) with a CC genotype experienced progression events vs five of 84 patients (6%) with a CT or TT genotype. Study size=113
    Related Drugs:
    imatinib
    Related Diseases:
    Leukemia, Myelogenous, Chronic, BCR-ABL Positive
    Evidence:
    PMID:15073101
Variant names are different names that have been used in the literature and other resources to refer to the same variant.

The following genes are in curated knowledge about this drug.

  Gene Relationship Evidence
Phenotype data available Genotype Data Available Literature annotations available Has annotations
ABCB1
  • CO
  •   
  • PK
  • FA
  • GN
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
ABCC1
  • CO
  •   
  •   
  • FA
  • GN
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
ABCC2
  • CO
  •   
  •   
  •   
  • GN
Publications
No phenotype data Genotype Data Available Literature annotations available Not annotated
ABCC6
  • CO
  •   
  •   
  •   
  • GN
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
ABCG2
  • CO
  •   
  • PK
  • FA
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
ABL1
  • CO
  • PD
  •   
  • FA
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
BLK
  •   
  • PD
  •   
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
CSF1R
  •   
  • PD
  •   
  •   
  •   
Publications
No phenotype data Genotype Data Available Literature annotations available Not annotated
CYP1A2
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP2C19
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP2C9
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP2D6
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP3A4
  •   
  •   
  • PK
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
CYP3A5
  •   
  •   
  • PK
  •   
  • GN
Publications
Phenotype data available No genotype data Literature annotations available Not annotated
DCK
  • CO
  •   
  •   
  •   
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
DDR1
  •   
  • PD
  •   
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
DDR2
  •   
  • PD
  •   
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
FLT3
  • CO
  •   
  •   
  •   
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
KIT
  • CO
  • PD
  •   
  • FA
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
LCK
  •   
  • PD
  •   
  •   
  •   
Publications
Phenotype data available No genotype data Literature annotations available Not annotated
MYC
  • CO
  •   
  •   
  • FA
  •   
Publications
Phenotype data available No genotype data Literature annotations available Not annotated
NPM1
  • CO
  •   
  •   
  •   
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
NQO2
  •   
  •   
  •   
  • FA
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
PDGFRA
  • CO
  • PD
  •   
  • FA
  • GN
Publications
Phenotype data available No genotype data Literature annotations available Not annotated
PDGFRB
  • CO
  • PD
  •   
  • FA
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
SLC22A1
  • CO
  •   
  •   
  • FA
  •   
Publications
No phenotype data Genotype Data Available Literature annotations available Not annotated
SLCO1A2
  •   
  •   
  • PK
  •   
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
SYK
  •   
  • PD
  •   
  •   
  •   
Publications
No phenotype data No genotype data No literature annotations Not annotated
ULK3
  •   
  •   
  •   
  •   
  •   
Variants

A list of non-curated publications that mention this drug along with other genes is available.

Drug Targets

Gene Description
ABCB1 Uncurated Annotation (source: Drug Bank)
ABCG2 Uncurated Annotation (source: Drug Bank)
ABL1 Uncurated Annotation (source: Drug Bank)
CSF1R Uncurated Annotation (source: Drug Bank)
DDR1 Uncurated Annotation (source: Drug Bank)
NTRK1 Uncurated Annotation (source: Drug Bank)
PDGFRA Uncurated Annotation (source: Drug Bank)
PDGFRB Uncurated Annotation (source: Drug Bank)
RET Uncurated Annotation (source: Drug Bank)
KIT Uncurated Annotation (source: Drug Bank)

A list of non-curated publications that mention this drug along with other drugs is available.

Drug Interactions

Drug Description
acenocoumarol Uncurated Annotation Imatinib increases the anticoagulant effect (source: Drug Bank)
acetaminophen Uncurated Annotation Increased hepatic toxicity of both agents (source: Drug Bank)
atorvastatin Uncurated Annotation Increases the effect and toxicity of atorvastatin (source: Drug Bank)
carbamazepine Uncurated Annotation Carbamazepine decreases levels of imatinib (source: Drug Bank)
cerivastatin Uncurated Annotation Imatinib increases the effect and toxicity of statin (source: Drug Bank)
clarithromycin Uncurated Annotation The macrolide increases levels of imatinib (source: Drug Bank)
cyclosporine Uncurated Annotation Imatinib increases the effect and toxicity of cyclosporine (source: Drug Bank)
dexamethasone Uncurated Annotation Dexamethasone decreases levels of imatinib (source: Drug Bank)
dicumarol Uncurated Annotation Imatinib increases the anticoagulant effect (source: Drug Bank)
erythromycin Uncurated Annotation The macrolide increases levels of imatinib (source: Drug Bank)
itraconazole Uncurated Annotation The imidazole increases the levels of imatinib (source: Drug Bank)
ketoconazole Uncurated Annotation The imidazole increases the levels of imatinib (source: Drug Bank)
lovastatin Uncurated Annotation Imatinib increases the effect and toxicity of statin (source: Drug Bank)
mephenytoin Uncurated Annotation The hydantoin decreases the levels of imatinib (source: Drug Bank)
nifedipine Uncurated Annotation Imatinib increases the effect and toxicity of nifedipine (source: Drug Bank)
phenobarbital Uncurated Annotation Phenobarbital decreases levels of imatinib (source: Drug Bank)
phenytoin Uncurated Annotation The hydantoin decreases the levels of imatinib (source: Drug Bank)
pimozide Uncurated Annotation Increases the effect and toxicity of pimozide (source: Drug Bank)
rifampin Uncurated Annotation Rifampin decreases levels of imatinib (source: Drug Bank)
simvastatin Uncurated Annotation Imatinib increases the effect and toxicity of statin (source: Drug Bank)
warfarin Uncurated Annotation Imatinib increases the anticoagulant effect (source: Drug Bank)

Curated Information

The following diseases are in curated knowledge about this drug.

  Disease Relationship Evidence
No phenotype data No genotype data Literature annotations available Not annotated
Cytomegalovirus Infections
  •   
  •   
  •   
  • FA
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Diabetes Mellitus, Type 2
  • CO
  • PD
  •   
  •   
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Gastrointestinal Stromal Tumors
  • CO
  • PD
  • PK
  • FA
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Glioma
  • CO
  •   
  •   
  • FA
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Heart Failure
  • CO
  • PD
  •   
  •   
  •   
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
Leukemia
  •   
  •   
  •   
  •   
  • GN
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
  • CO
  • PD
  • PK
  • FA
  • GN
Publications, Variants
No phenotype data No genotype data Literature annotations available Not annotated
Leukemia, Myeloid
  • CO
  •   
  •   
  • FA
  •   
Publications
No phenotype data No genotype data Literature annotations available Not annotated
Leukemia, Myeloid, Acute
  • CO
  •   
  •   
  •   
  • GN
Publications
Phenotype data available Genotype Data Available Literature annotations available Not annotated
Neoplasms
  •   
  •   
  • PK
  •   
  • GN
Publications

Non-Curated Information

A list of non-curated publications that mention this drug along with other diseases is available.

LinkOuts

Web Resource:
Wikipedia
DrugBank:
DB00619
KEGG Drug ID:
D01441
PubChem Compound ID:
5291
PubChem Substance ID:
841977

Common Searches

Search PubMed
Search Medline Plus
Search PubChem
Search CTD

Non-Curated Publications

A list of non-curated publications that mention this drug is available.

PharmGKB integrates drug information from different sources: DrugBank, Open Eye Scientific Software.
Add New Alternate Name
Add New ATC Term
Add Cross Reference
Add a metabolite
Add a text annotation
Add a drug target
hint: enter a gene
    Add a drug interaction
    hint: enter a drug
    PharmGKB® is a registered trademark of HHS and is financially supported by NIH/NIGMS. It is managed at Stanford University (GM61374).
    ©2001-2010 PharmGKB.