Antimetabolites are synthetic analogues of normal metabolites and act by competition, i.e. they 'deceive' or 'defraud' bodily processes.

Methotrexate, for example, a folic acid antagonist, competitively inhibits dihydrofolate reductase, preventing the synthesis of tetrahydrofolic acid (the coenzyme that is important in synthesis of amino and nucleic acids). This drug also provides a cogent illustration of the need to exploit every possible

6 A metabolite, acrolein, of cyclophosphamide and ifosfamide causes haemorrhagic cystitis. A high urine volume plus use of mesna (sodium 2-mercapto-ethanesulphonate) which provides free thiol groups that bind acrolein, are used to prevent this serious complication.

M [mitosis'

Spindle poisons n

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