Fumaric Acid

(BAN, USAN, rINN)
Fumaric Acid Chemical formula
Synonyms: Acidum Fumaricum; Allomalenic Acid; Boletic Acid; E297; Fumárico, ácido; Kwas fumarowy. trans-Butenedioic acid.
Cyrillic synonym: Фумаровая Кислота.

💊 Chemical information

Chemical formula: C2H2(CO2H)2 = 116.1.
CAS — 110-17-8 (fumaric acid); 624-49-7 (dimethyl fumarate).
ATC — D05AX01.
ATC Vet — QD05AX01.

Pharmacopoeias.

In Pol. Also in USNF.

USNF 26

(Fumaric Acid). White, odourless granules or crystalline powder. Slightly soluble in water and in ether; soluble in alcohol; very slightly soluble in chloroform.

💊 Profile

Fumaric acid and some of its derivatives have been used in the treatment of psoriasis and other skin disorders. Fumaric acid is also used as an acidifier and flavouring agent in foods.

Skin disorders.

Fumaric acid, its sodium salts, and derivatives such as dimethyl fumarate, monoethyl fumarate (ethyl hydrogen fumarate), and octil hydrogen fumarate have been used, both topically and systemically, in the treatment of psoriasis and other skin disorders. Dimethyl fumarate appears to be the most active compound given orally but combination with various salts of monoethyl fumarate has been claimed to improve efficacy.1-6 However, there have been reports of acute renal failure associated with treatment and the German Federal Office of Health has expressed the opinion that the available evidence did not establish the value of fumaric acid derivatives in psoriasis or other skin disorders.7 A subsequent retrospective analysis of 41 patients who received fumaric acid esters orally, for between 1 and 14 years, suggested that these drugs might be effective,8 and a later review suggested that they may be of value in refractory psoriasis.9 Reported adverse effects in the earlier analysis8 were generally mild, with only 1 case of elevated serum creatinine; however, lymphocytopenia was noted in 76% of patients and treatment consequently stopped in 4 patients. Other adverse effects with oral therapy have included disturbances of liver func tion,3,10 gastrointestinal effects,2-4,10,11 and flushing.2-4,10,11 There has been a report of exanthema in a patient receiving dimethyl fumarate for lichen planus.12
1. van Loenen AC, et al. Fumaarzuurtherapie: van fictie tot werkelijkheid? Pharm Weekbl 1989; 124: 894–900
2. Kolbach DN, Nieboer C. Fumaric acid therapy in psoriasis: a long-term retrospective study on the effect of fumaric acid combination (FAC-EC) therapy and dimethyl-fumaric acid ester (DMFAE) monotherapy. Br J Dermatol 1990; 123: 534–5
3. Nugteren-Huying WM, et al. Fumaric acid therapy for psoriasis: a randomized, double-blind, placebo-controlled study. J Am Acad Dermatol 1990; 22: 311–12
4. Altmeyer PJ, et al. Antipsoriatic effect of fumaric acid derivatives: results of a multicenter double-blind study in 100 patients. J Am Acad Dermatol 1994; 30: 977–81
5. Mrowietz U, et al. Treatment of severe psoriasis with fumaric acid esters: scientific background and guidelines for therapeutic use. Br J Dermatol 1999; 141: 424–9
6. Ständer H, et al. Efficacy of fumaric acid ester monotherapy in psoriasis pustulosa palmoplantaris. Br J Dermatol 2003; 149: 220–2
7. Anonymous. Fumaric acid derivatives and nephrotoxicity. WHO Drug Inf 1990; 4: 28
8. Hoefnagel JJ, et al. Long-term safety aspects of systemic therapy with fumaric acid esters in severe psoriasis. Br J Dermatol 2003; 149: 363–9
9. Harries MJ, et al. Fumaric acid esters for severe psoriasis: a retrospective review of 58 cases. Br J Dermatol 2005; 153: 549–51
10. Nieboer C, et al. Systemic therapy with fumaric acid derivates: new possibilities in the treatment of psoriasis. J Am Acad Dermatol 1989; 20: 601–8
11. Mrowietz U, et al. Treatment of psoriasis with fumaric acid esters: results of a prospective multicentre study. Br J Dermatol 1998; 138: 456–60
12. Guenther CH, et al. Macular exanthema due to fumaric acid esters. Ann Pharmacother 2003; 37: 234–6.

💊 Preparations

Proprietary Preparations

Arg.: Ingepsor; Ger.: Psoriasis-Solution†; Psoriasis-Tabletten†. Multi-ingredient: Arg.: Noquerat†; Austral.: Pro-PS†; Ger.: Fumaderm; Psoriasis-Bad†; Psoriasis-Salbe S†.
Published December 11, 2018.