Synthetic strategies and therapeutic insights into FDA-approved indole-containing drugs

Indole is a privileged heteroaromatic scaffold in medicinal chemistry, characterised by its unique physicochemical properties, hydrogen-bonding potential, and bioisosteric versatility. Over the past decades, numerous indole-containing drugs have been approved by the Food and Drug Administration (FDA), spanning diverse therapeutic areas including oncology, infectious diseases, gastrointestinal disorders, neurological conditions, and cardiovascular diseases. This review provides a comprehensive survey of FDA-approved indole-based drugs, with particular emphasis on those approved from 2013 to the present. Representative synthetic strategies are highlighted to illustrate the versatility of the indole framework in drug design. Furthermore, we systematically discuss each drug's pharmacology, mechanisms of action, and clinical applications. By integrating synthetic chemistry with clinical applications, this review aims to provide medicinal chemists and drug developers with guidance for leveraging indole scaffolds in next-generation therapeutic discovery and development.