Metiamide
Metiamide is a histamine H receptor antagonist developed from another H antagonist, burimamide. It was an intermediate compound in the development of the successful anti-ulcer drug cimetidine (Tagamet). Development of metiamide from burimamide. After discovering that burimamide is largely inactive at physiological pH, due to the presence of its electron-donating side chain, the following steps were undertaken to stabilize burimamide: These changes increased the bioavailability metiamide so that it is ten times more potent than burimamide in inhibiting histamine-stimulated release of gastric acid. The clinical trials that began in 1973 demonstrated the ability of metiamide to  provide symptomatic relief for ulcerous patients by increasing healing rate of peptic ulcers. However, during these trials, an unacceptable number of patients dosed with metiamide developed agranulocytosis (decreased white blood cell count). Modification of metiamide to cimetidine. It was determined that the thiourea group was the cause of the agranulocytosis. Therefore, replacement of the thiocarbonyl in the thiourea group was suggested: The nitro and cyano groups are sufficiently electronegative to reduce the pK of the neighboring nitrogens to the same acidity of the thiourea group, hence preserving the activity of the drug in a physiological environment. Synthesis. Reacting ethyl 2 -chloroacetoacetate (1) with 2 molar equivalents of formamide (2) gives 4-carboethoxy-5-methylimidazole (3). Reduction of the carboxylic ester (3) with sodium in liquid ammonia via Birch reduction gives the corresponding alcohol (4). Reaction of that with cysteamine (mercaptoethylamine), as its hydrochloride, leads to intermediate 5. In the strongly acid medium, the amine is completely protonated; this allows the thiol to express its nucleophilicity without competition and the acid also activates the alcoholic function toward displacement. Finally, condensation of the amine with methyl isothiocyanate gives metiamide (6).