methoxsalen
Regulatory sources consulted
Approved indications
- Symptomatic control of severe, recalcitrant, disabling psoriasis not adequately responsive to other treatments, together with controlled UVA and a biopsy-supported diagnosis.
Contraindications
Absolute
- Idiosyncratic psoralen reaction, photosensitive disease, current or prior melanoma, invasive squamous-cell carcinoma, or aphakia.
Clinical warnings
- Major warning · Use only by PUVA specialists. Major risks are severe burns, cataracts, photoaging, and skin cancer including melanoma. Do not sunbathe during the 24 hours before ingestion. During UVA exposure, shield unaffected male genitalia and protect sensitive areas until tanning occurs. Wear wraparound UVA-absorbing glasses for 24 hours, avoid sunlight for at least 8 hours, and do not sunbathe for 48 hours afterward; lifelong skin surveillance is required. — DailyMed methoxsalen capsules set ID a6ec8292-9189-4ebd-862a-e1725eb29eef
Drug interactions
- HighPhotosensitizing medicines
Mechanism: They may increase phototoxic reactions with PUVA.
Recommendation: Use special caution, adjust UVA dosimetry, and maintain close monitoring if anthralin, coal tar, griseofulvin, phenothiazines, quinolones, sulfonamides, tetracyclines, or thiazides are used.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a6ec8292-9189-4ebd-862a-e1725eb29eef
Adverse events
Common (≥1%)
Nausea · Itching with PUVA · Erythema after PUVA
Rare but serious
Severe phototoxic burn · Cataract or skin cancer
Pregnancy and lactation
Use during pregnancy only if clearly needed. During breastfeeding, stop either methoxsalen or breastfeeding.
Recent literature (PubMed)
Alzheimer's disease (AD) presents a growing global health concern. In recent decades, natural and synthetic chromenone have emerged as promising drug candidates due to their multi-target potential. Natural chromenone, quercetin, scopoletin, esculetin, coumestrol, umbelliferone, bergapten, and methoxsalen (xanthotoxin), and synthetic chromenone hybrids comprising structures like acridine, 4-aminophenyl, 3-arylcoumarins, quinoline, 1,3,4-oxadiazole, 1,2,3-triazole, and tacrine, have been explored for their potential to combat AD. Key reactions used for synthesis of chromenone hybrids include Perkin and Pechmann condensation. The activity of chromenone hybrids has been reported against several drug targets, including AChE, BuChE, BACE-1, and MAO-A/B. This review comprehensively explores natural, semisynthetic, and synthetic chromenone, elucidating their synthetic routes, possible mode of action/drug targets and structure-activity relationships (SAR). The acquired knowledge provides valuable insights for the development of new chromenone hybrids against AD.
We aimed to summarize the cancer risk among patients with indication of group I pharmaceuticals as stated in monographs presented by the International Agency for Research on Cancer working groups. Following the PRISMA guidelines, a comprehensive literature search was conducted using the PubMed database. Pharmaceuticals with few studies on cancer risk were identified in systematic reviews; those with two or more studies were subjected to meta-analysis. For the meta-analysis, a random-effects model was used to calculate the summary relative risks (SRRs) and 95% confidence intervals (95% CIs). Heterogeneity across studies was presented using the Higgins I square value from Cochran's Q test. Among the 12 group I pharmaceuticals selected, three involved a single study [etoposide, thiotepa, and mustargen + oncovin + procarbazine + prednisone (MOPP)], seven had two or more studies [busulfan, cyclosporine, azathioprine, cyclophosphamide, methoxsalen + ultraviolet (UV) radiation therapy, melphalan, and chlorambucil], and two did not have any studies [etoposide + bleomycin + cisplatin and treosulfan]. Cyclosporine and azathioprine reported increased skin cancer risk (SRR = 1.32, 95% CI 1.07-1.62; SRR = 1.56, 95% CI 1.25-1.93) compared to non-use. Cyclophosphamide increased bladder and hematologic cancer risk (SRR = 2.87, 95% CI 1.32-6.23; SRR = 2.43, 95% CI 1.65-3.58). Busulfan increased hematologic cancer risk (SRR = 6.71, 95% CI 2.49-18.08); melphalan was associated with hematologic cancer (SRR = 4.43, 95% CI 1.30-15.15). In the systematic review, methoxsalen + UV and MOPP were associated with an increased risk of skin and lung cancer, respectively. Our results can enhance persistent surveillance of group I pharmaceutical use, establish novel clinical strategies for patients with indications, and provide evidence for re-categorizing current group I pharmaceuticals into other groups.
Natural products have always served as an important source of drugs for treating various diseases. Among various privileged natural product scaffolds, the benzopyrone class of compounds has a substantial presence among biologically active compounds. One of the pioneering anticoagulant drugs, warfarin approved in 1954 bears a benzo-α-pyrone (coumarin) nucleus. The widely investigated psoriasis drugs, methoxsalen, and trioxsalen, also contain a benzo-α-pyrone nucleus. Benzo-γ-pyrone (chromone) containing drugs, cromoglic acid, and pranlukast were approved as treatments for asthma in 1982 and 2007, respectively. Numerous other small molecules with a benzopyrone core are under clinical investigation. The present review discusses the discovery, absorption, distribution, metabolism, excretion properties, and synthetic approaches for the Food and Drug Administration-approved and clinical-stage benzopyrone class of compounds. The role of the pyrone core in biological activity has also been discussed. The present review unravels the potential of benzopyrone core in medicinal chemistry and drug development.