Mutual prodrug concept: Fundamentals and applications

A therapeutically significant drug may have limited utilization in clinical practice because of poor organoleptic properties, poor bioavailability, short duration of action, nonspecificity, incomplete absorption, poor aqueous solubility, high first-pass metabolism or other adverse effects. There is a great emphasis on research to discover methods aimed at improving their therapeutic efficacy by minimizing or eliminating these undesirable properties. Sometimes, an adequate pharmaceutical formulation can overcome these drawbacks, but often the galenic formulation is inoperant and a chemical modification of active molecule is necessary to correct its pharmacokinetic insufficiencies. This chemical formulation process, whose objective is to convert an interesting active molecule into a clinically acceptable drug, often involves the so-called ‘Prodrug design.’ Mutual prodrug is a type of carrier-linked prodrug, where the carrier used is another biologically active drug instead of some inert molecule. A mutual prodrug consists of two pharmacologically active agents coupled together so that each acts as a promoiety for the other agent and vice versa. Mutual prodrug design is really no different from the general drug discovery process, in which a unique substance is observed to have desirable pharmacological effects, and studies of its properties lead to the design of better drugs. It is a very fruitful area of research, and its introduction in human therapy has given successful results in improving the clinical and therapeutic effectiveness of drugs suffering from some undesirable properties that otherwise hinder their clinical usefulness. The present article takes a review of various applications of mutual prodrugs and the developments in this field during the last few decades.