(1S)-33-(4-amino-3,5-dihydroxy-6-methyloxan-2-yl)oxy-1,3,4,7,9,11,17,37-octahydroxy-15,16,18-trimethyl-13-oxo-14,39-dioxabicyclo[33.3.1]nonatriaconta-19,21,25,27,29,31-hexaene-36-carboxylic acid | 1400-61-9

• 物质功能分类: 原料药 - 抗生素类药物 - 多烯类药
• 分子结构分类: 有机化合物 - 苯丙烷和聚酮 - 大环内酯类和类似物
• 英文名称: (1S)-33-(4-amino-3,5-dihydroxy-6-methyloxan-2-yl)oxy-1,3,4,7,9,11,17,37-octahydroxy-15,16,18-trimethyl-13-oxo-14,39-dioxabicyclo[33.3.1]nonatriaconta-19,21,25,27,29,31-hexaene-36-carboxylic acid
• CAS: 1400-61-9
• 化学式: C₄₇H₇₅NO₁₇
• 分子量: 926.1
• InChiKey: VQOXZBDYSJBXMA-VSBJOVSVSA-N

物化性质

• 熔点：
  >155°C (dec.)
• 比旋光度：
  D25 -10° (glacial acetic acid); +21° (pyridine); +12° (DMF); -7° (0.1N HCl in methanol)
• 溶解度：
  不溶于水
• 颜色/状态：
  Light yellow powder
• 气味：
  Odor suggestive of cereals
• 蒸汽压力：
  8.7X10-7 mm Hg at 25 °C (est)
• 亨利常数：
  Henry's Law constant = 2.0X10-7 atm-cu m/mol at 25 °C (est)
• 稳定性/保质期：
  Solutions and aqueous suspensions begin to lose activity soon after preparation. Aqueous suspensions are stable for 10 minutes on heating to 100 °C at pH 7; also stable in moderately alkaline media, but labile at pH 9 and pH 2. Heat, light, and oxygen accelerate decomposition.
• 旋光度：
  Optical rotation at 25 °C/D: -10 deg (glacial acetic acid); +21 deg (pyridine); +12 deg (dimethylformamide); max absorption (ethanol): 290, 307 and 322 nm; optical rotation at 25 °C/D: -7 deg (0.1 N HCl in methanol)

计算性质

• 辛醇/水分配系数(LogP)：
  -0.2
• 重原子数：
  65
• 可旋转键数：
  3
• 环数：
  3.0
• sp3杂化的碳原子比例：
  0.7
• 拓扑面积：
  320
• 氢给体数：
  12
• 氢受体数：
  18

ADMET

毒理性

• 肝毒性

曲霉菌素治疗与血清酶异常的低发生率有关，尽管将这些升高归因于曲霉菌素一直很困难。尽管使用了数十年，但没有令人信服的案例表明急性肝损伤与曲霉菌素治疗有关。虽然曲霉菌素通常不被吸收，但在胃肠道炎症和损伤的患者中，低浓度的曲霉菌素可能会进入血液循环。尽管如此，曲霉菌素被认为非常安全，不太可能引起肝损伤。

Nystatin therapy has been associated with a low rate of serum enzyme abnormalities, although it has been difficult to attribute these elevations to nystatin. Despite its use for several decades, there have been no convincing cases of acute hepatic injury linked to nystatin therapy. While nystatin is usually is not normally absorbed, low concentrations may enter the circulation in patients with inflammation and damage to the gastrointestinal tract. Nevertheless, nystatin is considered very safe and is unlikely to cause hepatic injury.

来源:LiverTox

毒理性

• 解毒与急救

/SRP:/ 基本治疗：建立专利气道（如有需要，使用口咽或鼻咽气道）。如有必要，进行吸痰。密切观察呼吸不足的迹象，如有需要，进行辅助通气。通过非重复呼吸面罩以10至15升/分钟的速度给予氧气。监测肺水肿，并在必要时进行治疗……。监测休克，并在必要时进行治疗……。预防癫痫发作，并在必要时进行治疗……。对于眼睛污染，立即用水冲洗眼睛。在转运过程中，用0.9%的生理盐水（NS）持续冲洗每只眼睛……。不要使用催吐剂。对于摄入，如果患者能够吞咽、有强烈的干呕反射且不流口水，则用水冲洗口腔，并给予5毫升/千克，最多200毫升的水进行稀释……。在去污后，用干燥的无菌敷料覆盖皮肤烧伤……。/毒药A和B/

/SRP:/ Basic treatment: Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if needed. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary ... . Monitor for shock and treat if necessary ... . Anticipate seizures and treat if necessary ... . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with 0.9% saline (NS) during transport ... . Do not use emetics. For ingestion, rinse mouth and administer 5 ml/kg up to 200 ml of water for dilution if the patient can swallow, has a strong gag reflex, and does not drool ... . Cover skin burns with dry sterile dressings after decontamination ... . /Poisons A and B/

来源:Hazardous Substances Data Bank (HSDB)

毒理性

• 解毒与急救

/SRP:/ 高级治疗：对于昏迷、严重肺水肿或严重呼吸困难的病人，考虑进行口咽或鼻咽气管插管以控制气道。使用气囊面罩装置的正压通气技术可能有益。考虑使用药物治疗肺水肿...。对于严重的支气管痉挛，考虑给予β激动剂，如沙丁胺醇...。监测心率和必要时治疗心律失常...。开始静脉输注5%葡萄糖水（D5W）/SRP: "保持开放"，最低流量/。如果出现低血容量的迹象，使用0.9%盐水（NS）或乳酸林格液。对于伴有低血容量迹象的低血压，谨慎给予液体。注意液体过载的迹象...。使用地西泮或劳拉西泮治疗癫痫...。使用丙美卡因氢氯化物协助眼部冲洗...。/Poisons A and B/

/SRP:/ Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Positive-pressure ventilation techniques with a bag valve mask device may be beneficial. Consider drug therapy for pulmonary edema ... . Consider administering a beta agonist such as albuterol for severe bronchospasm ... . Monitor cardiac rhythm and treat arrhythmias as necessary ... . Start IV administration of D5W /SRP: "To keep open", minimal flow rate/. Use 0.9% saline (NS) or lactated Ringer's if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. Watch for signs of fluid overload ... . Treat seizures with diazepam or lorazepam ... . Use proparacaine hydrochloride to assist eye irrigation ... . /Poisons A and B/

来源:Hazardous Substances Data Bank (HSDB)

毒理性

• 人类毒性摘录

/病例报告/ ...已报告了几例局部过敏反应的病例。

/CASE REPORTS/ ...Few cases of local allergic reactions have been reported.

来源:Hazardous Substances Data Bank (HSDB)

毒理性

• 人类毒性摘录

/流行病学研究/ 比较了在第一孕期间涉及先天性异常分娩和不涉及先天性异常分娩之前，咪康唑、克霉唑、制霉菌素、杀念菌素、氨基acrine化合物和甲硝唑的处方频率。自发性流产前的处方与第一孕期间分娩的处方以及合法流产前的处方进行了比较。观察到任何这些药物与出生缺陷的总频率或分析特定出生缺陷（心血管缺陷、口裂和脊柱裂）之间没有统计学上的显著关联。在4264次自发性流产中有250次咪康唑暴露，与55,736次分娩第一孕期间的2236次相比，估计相对风险为1.4（95%置信区间1.2-1.5）。在自发性流产中有112次使用克霉唑治疗，与分娩中的1086次相比，相对风险为1.4（95%置信区间1.1-1.6）。相比之下，大量暴露于制霉菌素和氨基acrine化合物并未显示出这种关联，这表明自发性流产是由咪唑类药物咪康唑和克霉唑引起的，而不是由所治疗的情况引起的。由于许多关联是在没有先前假设的情况下进行的检查，并且数据不足以显示在比较自发性流产与合法流产暴露时克霉唑的风险升高，这些发现被视为进一步研究的信号，而不是本身具有决定性。

/EPIDEMIOLOGY STUDIES/ Prescription frequencies in the first trimester were compared for miconazole, clotrimazole, nystatin, candicidin, aminacrine compounds, and metronidazole before deliveries involving congenital anomalies versus those not linked to congenital anomalies. Prescriptions before spontaneous abortions were compared with those in the first trimester of deliveries and with those before legal abortions. No statistically significant association was observed with any of these agents for the overall frequency of birth defects or for specific birth defects analyzed (cardiovascular defects, oral clefts, and spina bifida). Two hundred fifty miconazole exposures among 4264 spontaneous abortions, compared with 2236 in the first trimester of 55,736 deliveries, provided an estimated relative risk of 1.4 (95% confidence limits 1.2-1.5). One hundred twelve treatments with clotrimazole among the spontaneous abortions, compared with 1086 among the deliveries, provided a relative risk of 1.4 (95% confidence limits 1.1-1.6). In contrast, large numbers of exposures to nystatin and aminacrine compounds did not show this association, suggesting that spontaneous abortions are caused by the imidazole agents miconazole and clotrimazole rather than the condition being treated. Because many associations were examined without previous hypotheses, and because the data were inadequate to show an elevated risk for clotrimazole when comparing spontaneous with legal abortion exposures, these findings are considered to be a signal for further studies rather than definitive in themselves.

来源:Hazardous Substances Data Bank (HSDB)

吸收、分配和排泄

制霉菌素很难渗透眼部。

Nystatin penetrates eye poorly.

来源:Hazardous Substances Data Bank (HSDB)

吸收、分配和排泄

制霉菌素从胃肠道吸收不良，常规剂量后无法获得可检测的血药浓度。口服给药后，制霉菌素几乎全部以未改变的形式随粪便排出。

Nystatin is poorly absorbed from the GI tract, and detectable blood concentrations are not obtained after usual doses. Following oral administration, nystatin is excreted almost entirely in feces as unchanged drug.

来源:Hazardous Substances Data Bank (HSDB)

吸收、分配和排泄

在健康的个体中，服用两片溶菌酶含片（400,000单位）后，唾液中制霉菌素的平均浓度超过体外抑制临床重要念珠菌生长所需的浓度，持续时间大约为2小时。

In healthy individuals, mean salivary nystatin concentrations in excess of those required in vitro for growth inhibition of clinically important Candida persist for approximately 2 hours after the beginning of oral dissolution of two nystatin lozenges (400,000 units) administered simultaneously.

来源:Hazardous Substances Data Bank (HSDB)

吸收、分配和排泄

未通过完整皮肤或粘膜的局部应用被吸收。

Not absorbed following topical application to intact skin or mucous membranes.

来源:Hazardous Substances Data Bank (HSDB)

安全信息

• 危险等级：
  3
• 危险品标志：
  F,C
• 安全说明：
  S22,S24/25
• 危险类别码：
  R11
• WGK Germany：
  2,3
• 海关编码：
  2942000000
• 危险品运输编号：
  NONH for all modes of transport
• RTECS号：
  RF5950000
• 危险类别：
  3

制备方法与用途

多烯类抗真菌素——制霉菌素

制霉菌素简介 制霉菌素是一种多烯类抗真菌素，具有共轭多烯大环内酯结构。它能有效抑制真菌的活性，但对细菌没有抑制作用。该物质通过与真菌细胞膜上的甾醇结合，导致细胞膜通透性的改变，进而使得重要细胞内容物泄露，从而发挥其抗真菌作用。

应用 制霉菌素被广泛应用于多个领域，如防止细胞培养污染，并能诱导白细胞介素（IL）-1、IL-8以及TLR2在THP1细胞中表达。它还用作真菌膜（麦角甾醇结合）的造孔剂，在脂质双层中创建离子通道。

作为真菌抑制剂 制霉菌素常用于配置选择性培养基，特别是在防止细胞培养污染方面表现优异。推荐的工作浓度为0.05mg/ml，37℃下可稳定3天。可制备50mg/ml的悬液作为储存液，并在-20℃下保存。

抗菌谱 制霉菌素对念珠菌属具有强大的抗菌活性，对新型隐球菌、曲霉菌、毛癣菌、球孢子菌、荚膜组织胞浆菌、皮炎芽生菌以及皮肤癣菌等也表现出敏感性。

理化性质 制霉菌素为黄色或黄棕色粉末，带有特殊气味且具有吸湿性。该物质微溶于水和甲醇，但不溶于丙酮、乙醚及氯仿。它对空气、光、热、水、酸或碱均不稳定。

作用机制 通过与真菌细胞膜上的固醇结合，制霉菌素可以改变细胞膜的通透性，导致重要细胞内物质外泄，从而发挥其抗真菌效果。

应用范围 制霉菌素（又称米可定）为一种白色念珠菌、新型隐球菌、曲霉菌、毛霉菌和小孢子菌等敏感的抗真菌药物。建议遵医嘱使用该药物。它广泛应用于皮肤粘膜、口腔、阴道以及肠道的白色念珠菌感染治疗，尤其在高浓度时表现出杀菌作用。

药动学 口服后制霉菌素不会被胃肠道吸收，局部外用也不被皮肤和黏膜吸收。几乎全部服药量以原形形式从粪便中排出。局部给药用于念珠菌病的治疗，在用药后的24-72小时内达到最大效果。