Twelve Principles for Drug Optimization

3. Improving the Physicochemical Properties with the Help of Analogues
Benzylpenicillin (penicillin G) was a pioneer antibiotic molecule, which could be administered only by intramuscular injection because of its acid-sensitivity. Through analogues, stable molecules were obtained and they could be given orally (e.g., ampicillin).

4. Decreasing Resistance to Anti-Infective Drugs
Resistance to anti-infective drugs has become an increasing problem all over the world. The widespread use of penicillin G led to an alarming increase of penicillin-G resistant Staphylococcus aureus infections in 1960. A solution to the problem was the design of penicillinase-resistant penicillins. Several examples show that analogues can also overcome the resistance to antifungal and antiviral drugs.

5 .Decreasing Resistance to Anticancer Agents
Imatinib is the pioneer drug for the treatment of chronic myelogenous leukemia. However, a significant number of patients develop resistance to imatinib. New analogues, such as dasatinib and nilotinib, have been introduced recently and it is hoped that these analogues will be effective in imatinib-resistant cases.

6. Improving Oral Bioavailability
A good oral bioavailability is necessary in most cases because the oral application of a drug is preferred to an injection therapy. Enalaprilat is an angiotensin-converting enzyme inhibitor which is used in intravenous administration for the treatment of hypertensive emergencies. Its ester prodrug has an excellent oral bioavailability, but it requires hydrolysis by esterases. Analogue-

7. Long-Acting Drugs for Chronic Diseases
Quaternary antimuscarinics are important drugs for the treatment of chronic obstructive pulmonary disease. Ipratropium bromide is a very active bronchodilator that is used several times daily. Its analogue is tiotropium with a longer duration of action which enables a once-daily dosing.

8. Ultrashort-Acting Drugs in Emergency Cases
Esmolol is an adrenergic β1-selective blocker with a very short duration of action. It is used when β-blockade of very short duration is desired in emergency situations.

9. Decreasing Interindividual Pharmacokinetic Differences
Omeprazole is a pioneer proton pump inhibitor that shows interindividual variability. Analogue-based drug discovery afforded pantoprazole with a linear, highly predictable pharmacokinetic property.

10. Decreasing Systemic Activities
For intranasal and inhalation applications of corticosteroids in the treatment of asthma and rhinitis, it is important to decrease the systemic availability of these drugs to avoid their adverse effects. Analogue research afforded budenoside and fluticasone with a low oral bioavailability.

11. Decreasing Drug Interactions with the Help of Analogues
Cimetidine inhibits CYPs, an important class of drug-metabolizing enzymes. This interaction inhibits the metabolism of certain drugs, such as propranolol, warfarin, diazepam, thus producing effects equivalent to an overdose of these medicines. These effects are avoided by analogues such as ranitidine and famotidine.

12. Synergistic Interactions between Analogues
Analogue-based drug research starting from ritonavir, which is an HIV-1 protease inhibitor, afforded the more potent lopinavir. However, it has a low plasma half- life. A combination of ritonavir and lopinavir is very successful, because ritonavir inhibits the P-450-mediated metabiolism of lopinavir.