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Sildenafil (Viagra) University of California of San Diego By Trang Nguyen and Elissa Min Author’s Note This group final paper was written for Dr. James Whitesell’s Chemistry 151: Molecules that Changed the World, Winter 2013. Abstract/Introduction It was 1995, Charles Hancock, a 65 years old with diabetes, had recently begun experiencing difficulties in the bedroom. That is, he could not get it up. He explained to his wife and the doctor that he was still very sexually aroused by the love of his life for 30 years, Mary, but could not seem to produce an erection. Three years later, After Sildenafil became available to the general public, Charles’ sex life, unbeknownst to him, would return to normal. Sildenafil Citrate, popularly known for its trade name Viagra and Revatio, was synthesized at Pfizer in England. Initially, Sildenafil was studied for its effects in hypertension (high blood pressure) and angina pectoris (chest pain due to ischemic heart disease). During the phase 1 clinical trials, it was observed that Sildenafil did not have any significant effects on angina; however, it was noted that it induced penile erections. It is now recognized as a drug used to treat various conditions including pulmonary arterial hypertension, high blood pressure, and high-altitude pulmonary edema known as altitude sickness, jet lag, vasculogenic impotence and most importantly sexually dysfunction. Viagra is available through prescription but is only effective with sexual arousal and does not increase sexual drive. Some sources of erectile dysfunction caused by diabetes, drug use (antidepressant), vascular disease, hormone disorders, neurologic disorders, pelvic trauma, radiation exposure, venous sleep, psychological problems and /or Pyrenees disease and not just impotence. People who were taking antidepressant would also experience sexual dysfunction may also be benefit by this drug. This breakthrough for erectile dysfunction led to Pzifer’s patent and approval in the United States in 1996. In recent statistics, approximately 30 million males in the United States of America are battling different severities of erectile dysfunction. Women alike can suffer the same condition as men resulting in an insufficient blood flow to the clitoris. But treated with Sildenafil, women too could rectify the dysfunction. Some side effects of Sildenafil include flushing, congestion, headache, blurred vision, priapism of up to seven hours, and in rare cases some users claimed of loss of vision. Thus, this accidental miracle drug began a multi-billion dollar market. Next the Commercial Synthesis of Sildenafil will be explained. The preparation steps for synthesis of sildenafil are as follows: Peter J. Dunn* Chemical Research and DeVelopment, Pfizer Global Research and DeVelopment, Sandwich, CT13 9NJ Kent, UK The nitro pyrazole 4 can be prepared by a number of routes (see section 2.4). The sulphonamide 5 is prepared by chlorosulphonation chemistry. The two halves of the molecule, 4 and 5, are put together by a hydrogenation, activation, and acylation sequence in which the three reactions are telescoped into a single process using ethyl acetate as solvent. The overall isolated yield of compound 6 for this three step reaction sequence is 96%. In the cyclisation reaction of 6 to give sildenafil, a potential problem is that the ethoxygroup is doubly activated to nucleophilic substitu- tion by the sulphonamide and amide groups; side reactions can be reduced by careful choice of reaction conditions. The isolated yield for this reaction is 95%, though the reaction yield is around 99%. Finally the synthesis is completed by converting the sildenafil base to the citrate salt in 100% yield. The very high yields late in the synthesis and the use of a single solvent (ethyl acetate) for the three telescoped steps (allowing easy solvent recovery without the to fraction- ally separate different solvents) ensure the environmental profile of the process is very clean. need that In addition, the synthesis of pyrazole labeled 4 starts from 2-pentanone, and the first stage is the condensation reaction with the diester of oxalic acid.With the regiochemistry in the condensation reaction optimised, the next stage is to form the pyrazole. This can be done by reaction with hydrazine followed by methylation17 or alternatively by reaction with methylhydrazine (see later). For the alkylation reaction there is a tendency to obtain the desired N-1 isomer under acidic or neutral conditions17 and the undesired N-2 isomer under basic conditions. The N-1 isomer, formed under acidic or neutral conditions, can then be converted into pyrazole 4 by hydrolysis, nitration, and amide formation. The schematic synthesis of the pyrazole is depicted in the illustration below. Peter J. Dunn*Chemical Research and DeVelopment, Pfizer Global Research and DeVelopment, Sandwich, CT13 9NJ Kent, UK Next the biological mechanism will be explained and how Viagra works in vivo. On a normal physiological scale, an erection would start with sexual stimulation that would trigger a release of neurotransmitters from the cavernous nerve in the endothelial cell. And this would allow relaxation of smooth muscles from the release of nitric oxide causing a dilation of arteries to increase the blood flow through the penile walls. The following are a detailed account for what was happening in the endothelial cell: 1. Dilatation of the arterioles and arteries by increased blood flow in both the diastolic and the systolic phases 2. Trapping of the incoming blood by the expanding sinusoids 3. Compression of the subtunical venular plexuses between the tunica albuginea and the peripheral sinusoids, reducing the venous outflow 4. Stretching of the tunica to its capacity, which Robert C. Dean, Tom F. Lue occludes the Urol Clin North Am. Author manuscript; available in PMC 2006 January 25. Published in final edited form as: Urol Clin North Am. 2005 November; 32(4): 379– emissary veins v. doi: 10.1016/j.ucl.2005.08.007 between the inner PMCID: PMC1351051 circular and the outer longitudinal layers and further decreases the venous outflow to a minimum 5. Full-erection phase: An increase in PO2 (to about 90 mmHg) and intracavernous pressure (around 100 mm Hg), which raises the penis from the dependent position to the erect state 6. rigid-erection phase: A further pressure increase (to several hundred millimeters of mercury) with contraction of the ischiocavernosus muscles Smooth muscle contraction and relaxation are regulated by cytosolic (sarcoplasmic) free Ca2+. Norepinephrine from the nerve endings as well as endothelins and prostaglandin F2α from endothelium activated the receptors on smooth muscle cells to increase inositol triphosphate and diacylglycerol. As the result, calcium molecules are released from the intracellular stores such as sarcoplasmic reticulum and opens calcium channels on the smooth muscle cell membrane leading to an influx of calcium from extracellular space. This triggers a transient increase in cytosolic free Ca2+ from a resting level of 120 to 270 to the excited level of 500 to 700 nM.32At the elevated level, Ca2+ binds to calmodulin and changes the latter’s conformation to expose sites of interaction with myosin lightchain kinase. The resultant activation catalyzes phosphorylation of myosin light chains and triggers cycling of myosin crossbridges (heads) along actin filaments and the development of force. In addition, more ATP can be hydrolyzed by phosphorylation of the light chain which has the ability to activate mysosin ATPase. Free Ca2+ continues the erection state until natural dissipation through an enzymatic breakdown by phosphodiesterase type 5 from cGMP into GMP. Sildenafil has a structure resemblance as the cGMP, and the molecules have the ability to bind to the receptors for cGMP, which would delay the breakdown of cGMP, As the result blood flow would increase to the penis and prolong the erection stage. Viagra acts on this mechanism by blocking the phosphodiesterase type 5 allowing the free Ca2+ to continue the muscles relaxation for longer until the effect of Sildenafil faded away. Charles Hancock now sleeps with a bottle of Viagra on the nightstand and a satisfaction he has not felt for years. References Dean, Richard. "Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction." Http://www.ncbi.nlm.nih.gov/. Urologic Clinics of North America, 25 Jan. 2006. Web. 7 Feb. 2014. Dunn, Peter J. "Synthesis of Commercial Phosphodiesterase(V) Inhibitors." Organic Process Research & Development 9.1 (2005): 88-97.