Prescription Medicine which isn't fully understood?

ChocolateSauce

Of course, all prescription medicine has gone though several phases of clinical trials to test is efficacy and safety, but I was wondering is the mode of activity unknown or poorly understood for some, or is it a requirement for all that the biochemistry is specifically understood?

SomeDose

No, it's not a requirement of the licensing process that the exact biochemical or pharmacodynamic mechanism of action has to be fully understood.

anotherlostie

But modern drug development such as of the mabs tends to involve a targeted approach to specific receptor sites, so the scattergun approach of old (synthesise a compound and screen it in the hope it will work) is less common. I always remember learning that Eli Lilly (I think) synthesised Propranalol but didn't find out its beta blocking action so let it pass and then ICI (AstraZeneca today) discovered what it did and patented it. This made them a lot of money and Sir James Black whose research it was, was awarded the Nobel Prize in Medicine (impressively, he also discovered Cimetidine - quite the CV!)

I reckon there will be further Sildenafil/ Finasteride discoveries though where drugs are found to have totally unexpected 'side effects' for which a therapeutic indication can be licensed.

Vorsprung

Propofol's mechanism of action isn't completely understood as far as I know.

bythewoods

Digoxin's MOA isn't fully understood either, is it? And that's used quite a bit.
I recall learning as much anyway.

Vorsprung

bythewoods wrote: »

Digoxin's MOA isn't fully understood either, is it? And that's used quite a bit.
I recall learning as much anyway.

Fairly well understood I thought (currently studying).

opinion guy

Hell paracetamol is not even fully understood

Tree

sure about that, i thought paracetomol had something to do with the COX that the NSAIDs didnt hang out with as much. Pretty sure it's well established (as are the NSAIDs)

SomeDose

Tree wrote: »

sure about that, i thought paracetomol had something to do with the COX that the NSAIDs didnt hang out with as much. Pretty sure it's well established (as are the NSAIDs)

The mechanism of paracetamol's analgesic effect (and antipyretic effect, to a lesser extent) is still far from definitive, relatively speaking.

In any case, what's more important in practice is the actual effect rather than how it is achieved. The biochemical theory behind it is obviously a good starting point in the drug discovery process, the MAbs alluded to above being a good example of this, and is becoming more relevant in modern medicine.

opinion guy

Tree wrote: »

sure about that, i thought paracetomol had something to do with the COX that the NSAIDs didnt hang out with as much. Pretty sure it's well established (as are the NSAIDs)

Note I said not fully understood. Yes there is something about it having action at the 'other' COX, but that's about the height of it. AS SomeDose points out (hmmm apt username for this thread), paracetamol does stuff other than that explainable by its COX activity.



Here's another one for you - alcohol. Everyone knows alcohol has analgesic effects. Can anyone tell me how ? I have tried to find out before and even started a thread on it here but could find nothing and nobody else could tell me anything.