Additionally, the use of a prodrug strategy increases the selectivity of the drug for its intended target. An example of this can be seen in many chemotherapy treatments, in which the reduction of adverse effects is always of paramount importance. Drugs used to target hypoxic cancer cells, through the use of redox-activation, utilise the large quantities of reductase enzyme present in the hypoxic cell to convert the drug into its cytotoxic form, essentially activating it. As the prodrug has low cytotoxicity prior to this activation, there is a markedly lower chance of it "attacking" healthy, non-cancerous cells which reduces the side-effects associated with these chemotherapeutic agents.
In rational drug design, the knowledge of chemical properties likely to improve absorption and the major metabolic pathways in the body allows the modification of the structure of new chemical entities for improved bioavailability. Sometimes the use of a prodrug is unintentional, however, especially in the case of serendipitous drug discoveries, and the drug is only identified as a prodrug after extensive drug metabolism studies. Some prodrugs, such as Codeine and Psilocybin, also occur naturally.
Prodrugs can be classified into two types based on their sites of conversion into the final active drug form: Type I, those that are converted intracellularly (e.g., anti-viral nucleoside analogs, lipid-lowering statins, antibody-directed/gene-directed enzyme prodrugs [ADEP/GDEP] for chemotherapy), and Type II, those that are converted extracellularly, especially in digestive fluids or the systemic circulation (e.g., etoposide phosphate, valganciclovir, fosamprenavir). Both types can be further categorized into subtype A or B, based on additional criteria. Those for the Type IA and IB are whether or not the cellular converting location is the site of therapeutic action. For the Type IIA and IIB, they are categorized depending on whether the conversion occurs in the gastrointestinal (GI) fluids or systemic circulation (see Table 1; Wu and Farrelly, Toxicology 236:1-6, 2007).
|Type||Converting site||Subtype||Tissue location of conversion||Examples|
|Type I||Intracellular||Type IA||Therapeutic target tissues/cells||Zidovudine, 5-Flurouracil|
|Type I||Intracellular||Type IB||Metabolic tissues (liver/lung etc)||Captopril, Cyclophosphamide|
|Type II||Extracellular||Type IIA||GI fluid||Sulfasalazine, Loperamide oxide|
|Type II||Extracellular||Type IIB||Systemic circulation||Fosphenytoin, Bambuterol|
A prodrug can belong to both a Type IA and IB category when the site of the therapeutic target and conversion are the same (e.g., HMG Co-A reductase inhibitors).