The use of deuteration
in medicinal chemistry has exploded in the
past years, and the FDA has recently approved the first deuterium-labeled
drug. Precision deuteration goes beyond the pure and simple amelioration
of the pharmacokinetic parameters of a drug and might provide an opportunity
when facing problems in terms of metabolism-mediated toxicity, drug
interactions, and low bioactivation. The use of deuterium is even
broader, offering the opportunity to lower the degree of epimerization,
reduce the dose of coadministered boosters, and discover compounds
where deuterium is the basis for the mechanism of action. Nevertheless,
designing, synthesizing, and developing a successful deuterated drug
is far from straightforward, and the translation from concept to practice
is often unpredictable. This Perspective provides an overview of the
recent developments of deuteration, with a focus on deuterated clinical
candidates, and highlights both opportunities and challenges of this
strategy.