Split (1)

train · 17.4k rows

drugbank_id stringlengths 7 7	name stringlengths 3 226	description stringlengths 27 6.25k ⌀	state stringclasses 3 values	indication stringlengths 6 7.7k ⌀	pharmacodynamics stringlengths 6 9.4k ⌀	moa stringlengths 8 7.09k ⌀	absorption stringlengths 2 4k ⌀	metabolism stringlengths 4 2.83k ⌀	toxicity stringlengths 0 15.2k ⌀	half_life stringlengths 0 1.29k ⌀	protein_binding stringlengths 2 1.16k ⌀	route_elimination stringlengths 0 1.42k ⌀	volume_distribution stringlengths 4 1.28k ⌀	clearance stringlengths 3 1.38k ⌀	class_kingdom stringclasses 3 values	class_super stringclasses 24 values	class_class stringclasses 303 values	class_subclass stringclasses 511 values	groups listlengths 1 4	atc_codes listlengths 0 164	affected_organisms listlengths 0 41	prices listlengths 0 172	patents listlengths 0 155	synonyms stringlengths 0 36k	products listlengths 0 22.3k	int_brands listlengths 0 154	mixtures listlengths 0 13.7k	targets listlengths 0 304	enzymes listlengths 0 24	carriers listlengths 0 25	transporters listlengths 0 28
DB02552	Geranyl Diphosphate	null	solid	null	null	null	null	null	null	null	null	null	null	null	Organic compounds	Lipids and lipid-like molecules	Prenol lipids	Isoprenoid phosphates	[ "experimental" ]	[]	[]	[]	[]	(2E,6E)-farnesyl diphosphate synthase \| 2.5.1.10 \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| FPP synthase \| FPS \| Geranyltranstransferase \| KIAA1293 \| 4.6.1.12 \| MECDP-synthase \| mecS \| ygbB \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.- \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| Farnesyltranstransferase \| Geranylgeranyl diphosphate synthase \| Geranyltranstransferase \| GGPP synthase \| GGPPSase \| 2.5.1.68 \| Short-chain Z-isoprenyl diphosphate synthase \| Z-FPP synthase \| Z-FPPS \| Z-isoprenyl diphosphate synthase \| Z-Polyprenyl diphosphate synthase \| 2.5.1.86 \| DecaPP \| Decaprenyl pyrophosphate synthase \| Long-chain isoprenyl diphosphate synthase \| Trans,polycis-decaprenyl diphosphate synthase \| 4.6.1.12 \| MECDP-synthase \| 2.7.7.60 \| MECDP-synthase	[]	[]	[]	[ "P14324", "O95749" ]	[]	[]	[]
DB04714	ISOPENTENYL PYROPHOSPHATE	null	solid	null	null	null	null	null	null	null	null	null	null	null	Organic compounds	Lipids and lipid-like molecules	Prenol lipids	Isoprenoid phosphates	[ "experimental" ]	[]	[]	[]	[]	(2E,6E)-farnesyl diphosphate synthase \| 2.5.1.10 \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| FPP synthase \| FPS \| Geranyltranstransferase \| KIAA1293 \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.- \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| Farnesyltranstransferase \| Geranylgeranyl diphosphate synthase \| Geranyltranstransferase \| GGPP synthase \| GGPPSase \| 4.6.1.12 \| 2.5.1.86 \| DecaPP \| Decaprenyl pyrophosphate synthase \| Long-chain isoprenyl diphosphate synthase \| Trans,polycis-decaprenyl diphosphate synthase \| 1.17.1.2 \| lytB \| yaaE \| 2.5.1.31 \| Ditrans,polycis-undecaprenylcistransferase \| rth \| UDS \| Undecaprenyl diphosphate synthase \| Undecaprenyl pyrophosphate synthase \| UPP synthase \| uppS \| yaeS	[]	[]	[]	[ "P14324", "O95749" ]	[]	[]	[]
DB00439	Cerivastatin	On August 8, 2001 the U.S. Food and Drug Administration (FDA) announced that Bayer Pharmaceutical Division voluntarily withdrew Baycol from the U.S. market, due to reports of fatal rhabdomyolysis, a severe adverse reaction from this cholesterol-lowering (lipid-lowering) product. It has also been withdrawn from the Canadian market.[A669,L43942]	solid	Used as an adjunct to diet for the reduction of elevated total and LDL cholesterol levels in patients with primary hypercholesterolemia and mixed dyslipidemia (Fredrickson Types IIa and IIb) when the response to dietary restriction of saturated fat and cholesterol and other non-pharmacological measures alone has been inadequate.	Cerivastatin, a competitive HMG-CoA reductase inhibitor effective in lowering LDL cholesterol and triglycerides, is used to treat primary hypercholesterolemia and mixed dyslipidemia (Fredrickson types IIa and IIb).	Cerivastatin competitively inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, the hepatic enzyme responsible for converting HMG-CoA to mevalonate. As mevalonate is a precursor of sterols such as cholesterol, this results in a decrease in cholesterol in hepatic cells, upregulation of LDL-receptors, and an increase in hepatic uptake of LDL-cholesterol from the circulation.	The mean absolute oral bioavailability 60% (range 39 - 101%).	Hepatic. Biotransformation pathways for cerivastatin in humans include the following: demethylation of the benzylic methyl ether to form Ml and hydroxylation of the methyl group in the 6'-isopropyl moiety to form M23.	Rhabdomyolysis, liver concerns	2-3 hours	More than 99% of the circulating drug is bound to plasma proteins (80% to albumin).	null	null	null	Organic compounds	Organoheterocyclic compounds	Pyridines and derivatives	Phenylpyridines	[ "approved", "withdrawn" ]	[ "C10AA", "C10A", "C10", "C" ]	[ "Humans and other mammals" ]	[]	[ { "approved": "1993-01-05", "country": "United States", "expires": "2011-11-26", "number": "5177080" }, { "approved": "1999-10-26", "country": "Canada", "expires": "2016-10-26", "number": "1340798" }, { "approved": "1998-05-26", "country": "Canada", "expires": "2011-12-11", "number": "2057444" } ]	Cerivastatin \| 1.1.1.34 \| HMG-CoA reductase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 1 \| GNT1 \| hUG-BR1 \| UDP-glucuronosyltransferase 1-1 \| UDP-glucuronosyltransferase 1A isoform 1 \| UDPGT 1-1 \| UGT1 \| UGT1-01 \| UGT1.1 \| UGT1*1 \| UGT1A1 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2 \| 7.6.2.2 \| ABCP \| ATP-binding cassette sub-family G member 2 \| BCRP \| BCRP1 \| Breast cancer resistance protein \| CDw338 \| Mitoxantrone resistance-associated protein \| MXR \| Placenta-specific ATP-binding cassette transporter \| Urate exporter \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP	[ "Baycol", "Baycol", "Baycol (0.2mg)", "Baycol (0.3mg)" ]	[ "Lipobay", "Rivastatin" ]	[]	[ "P04035" ]	[ "P08684", "P20815", "P24462", "P10632", "P10635", "P11712", "P20813", "P22309" ]	[]	[ "P08183", "Q92887", "Q9UNQ0", "Q9Y6L6", "O95342" ]
DB00641	Simvastatin	Simvastatin, also known as the brand name product Zocor, is a lipid-lowering drug derived synthetically from a fermentation product of _Aspergillus terreus_. It belongs to the statin class of medications, which are used to lower the risk of cardiovascular disease and manage abnormal lipid levels by inhibiting the endogenous production of cholesterol in the liver. More specifically, statin medications competitively inhibit the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) Reductase,[A181421] which catalyzes the conversion of HMG-CoA to mevalonic acid and is the third step in a sequence of metabolic reactions involved in the production of several compounds involved in lipid metabolism and transport including cholesterol, low-density lipoprotein (LDL) (sometimes referred to as "bad cholesterol"), and very low-density lipoprotein (VLDL). Prescribing of statin medications is considered standard practice following any cardiovascular events and for people with a moderate to high risk of development of CVD, such as those with Type 2 Diabetes. The clear evidence of the benefit of statin use coupled with very minimal side effects or long term effects has resulted in this class becoming one of the most widely prescribed medications in North America.[A181087, A181406] Simvastatin and other drugs from the statin class of medications including [atorvastatin], [pravastatin], [rosuvastatin], [fluvastatin], and [lovastatin] are considered first-line options for the treatment of dyslipidemia.[A181087, A181406] Increasing use of the statin class of drugs is largely due to the fact that cardiovascular disease (CVD), which includes heart attack, atherosclerosis, angina, peripheral artery disease, and stroke, has become a leading cause of death in high-income countries and a major cause of morbidity around the world.[A181084] Elevated cholesterol levels, and in particular, elevated low-density lipoprotein (LDL) levels, are an important risk factor for the development of CVD.[A181087,A181553] Use of statins to target and reduce LDL levels has been shown in a number of landmark studies to significantly reduce the risk of development of CVD and all-cause mortality.[A181090,A181093,A181096,A181427,A181475,A181538] Statins are considered a cost-effective treatment option for CVD due to their evidence of reducing all-cause mortality including fatal and non-fatal CVD as well as the need for surgical revascularization or angioplasty following a heart attack.[A181087, A181406] Evidence has shown that even for low-risk individuals (with <10% risk of a major vascular event occurring within 5 years) statins cause a 20%-22% relative reduction in major cardiovascular events (heart attack, stroke, coronary revascularization, and coronary death) for every 1 mmol/L reduction in LDL without any significant side effects or risks.[A181397, A181403] While all statin medications are considered equally effective from a clinical standpoint, [rosuvastatin] is considered the most potent; doses of 10 to 40mg [rosuvastatin] per day were found in clinical studies to result in a 45.8% to 54.6% decrease in LDL cholesterol levels, while simvastatin has been found to have an average decrease in LDL-C of ~35%.[A181409,A181535,A181538,A1793] Potency is thought to correlate to tissue permeability as the more lipophilic statins such as simvastatin are thought to enter endothelial cells by passive diffusion, as opposed to hydrophilic statins such as [pravastatin] and [rosuvastatin] which are taken up into hepatocytes through OATP1B1 (organic anion transporter protein 1B1)-mediated transport.[A181424,A181460] Despite these differences in potency, several trials have demonstrated only minimal differences in terms of clinical outcomes between statins.[A181427]	solid	Simvastatin is indicated for the treatment of hyperlipidemia to reduce elevated total cholesterol (total-C), low-density lipoprotein cholesterol (LDL‑C), apolipoprotein B (Apo B), and triglycerides (TG), and to increase high-density lipoprotein cholesterol (HDL-C).[F4655, F4658] This includes the treatment of primary hyperlipidemia (Fredrickson type IIa, heterozygous familial and nonfamilial), mixed dyslipidemia (Fredrickson type IIb), hypertriglyceridemia (Fredrickson type IV hyperlipidemia), primary dysbetalipoproteinemia (Fredrickson type III hyperlipidemia), homozygous familial hypercholesterolemia (HoFH) as an adjunct to other lipid-lowering treatments, as well as adolescent patients with Heterozygous Familial Hypercholesterolemia (HeFH).[F4655, F4658] Simvastatin is also indicated to reduce the risk of cardiovascular morbidity and mortality including myocardial infarction, stroke, and the need for revascularization procedures. It is primarily used in patients at high risk of coronary events because of existing coronary heart disease, diabetes, peripheral vessel disease, history of stroke or other cerebrovascular disease.[F4655, F4658] Prescribing of statin medications is considered standard practice following any cardiovascular events and for people with a moderate to high risk of development of CVD. Statin-indicated conditions include diabetes mellitus, clinical atherosclerosis (including myocardial infarction, acute coronary syndromes, stable angina, documented coronary artery disease, stroke, trans ischemic attack (TIA), documented carotid disease, peripheral artery disease, and claudication), abdominal aortic aneurysm, chronic kidney disease, and severely elevated LDL-C levels.[A181087, A181406]	Simvastatin is an oral antilipemic agent which inhibits HMG-CoA reductase. It is used to lower total cholesterol, low density lipoprotein-cholesterol (LDL-C), apolipoprotein B (apoB), non-high density lipoprotein-cholesterol (non-HDL-C), and trigleride (TG) plasma concentrations while increasing HDL-C concentrations. High LDL-C, low HDL-C and high TG concentrations in the plasma are associated with increased risk of atherosclerosis and cardiovascular disease. The total cholesterol to HDL-C ratio is a strong predictor of coronary artery disease and high ratios are associated with higher risk of disease. Increased levels of HDL-C are associated with lower cardiovascular risk. By decreasing LDL-C and TG and increasing HDL-C, rosuvastatin reduces the risk of cardiovascular morbidity and mortality.[A181087, A181406] Elevated cholesterol levels, and in particular, elevated low-density lipoprotein (LDL) levels, are an important risk factor for the development of CVD.[A181087] Use of statins to target and reduce LDL levels has been shown in a number of landmark studies to significantly reduce the risk of development of CVD and all-cause mortality.[A181090,A181093,A181096,A181427,A181475] Statins are considered a cost-effective treatment option for CVD due to their evidence of reducing all-cause mortality including fatal and non-fatal CVD as well as the need for surgical revascularization or angioplasty following a heart attack.[A181087, A181406] Evidence has shown that even for low-risk individuals (with <10% risk of a major vascular event occurring within 5 years) statins cause a 20%-22% relative reduction in major cardiovascular events (heart attack, stroke, coronary revascularization, and coronary death) for every 1 mmol/L reduction in LDL without any significant side effects or risks.[A181397, A181403] Skeletal Muscle Effects Simvastatin occasionally causes myopathy manifested as muscle pain, tenderness or weakness with creatine kinase (CK) above ten times the upper limit of normal (ULN). Myopathy sometimes takes the form of rhabdomyolysis with or without acute renal failure secondary to myoglobinuria, and rare fatalities have occurred. Predisposing factors for myopathy include advanced age (≥65 years), female gender, uncontrolled hypothyroidism, and renal impairment. Chinese patients may also be at increased risk for myopathy. In most cases, muscle symptoms and CK increases resolved when treatment was promptly discontinued.[F4655, F4658] In a clinical trial database of 41,413 patients, the incidence of myopathy was approximately 0.03% and 0.08% at 20 and 40 mg/day, respectively, while the risk of myopathy with simvastatin 80 mg (0.61%) was disproportionately higher than that observed at the lower doses. It's therefore recommended that the 80mg dose of simvastatin should be used only in patients who have been taking simvastatin 80 mg chronically (e.g., for 12 months or more) without evidence of muscle toxicity. As well, patients already stabilized on simvastatin 80mg should be monitored closely for evidence of muscle toxicity; if they need to be initiated on an interacting drug that is contraindicated or is associated with a dose cap for simvastatin, that patient should be switched to an alternative statin with less potential for the drug-drug interaction.[F4655, F4658] The risk of myopathy during treatment with simvastatin may be increased with concurrent administration of interacting drugs such as [fenofibrate], [niacin], [gemfibrozil], [cyclosporine], and strong inhibitors of the CYP3A4 enzyme. Cases of myopathy, including rhabdomyolysis, have been reported with HMG-CoA reductase inhibitors coadministered with [colchicine], and caution should therefore be exercised when prescribing these two medications together.[F4655, F4658] Liver Enzyme Abnormalities Persistent increases (to more than 3X the ULN) in serum transaminases have occurred in approximately 1% of patients who received simvastatin in clinical studies. When drug treatment was interrupted or discontinued in these patients, the transaminase levels usually fell slowly to pretreatment levels. The increases were not associated with jaundice or other clinical signs or symptoms. [F4655, F4658] In the Scandinavian Simvastatin Survival Study (4S),[A181538] the number of patients with more than one transaminase elevation to >3 times the ULN, over the course of the study, was not significantly different between the simvastatin and placebo groups (14 [0.7%] vs. 12 [0.6%]). The frequency of single elevations of ALT to 3 times the ULN was significantly higher in the simvastatin group in the first year of the study (20 vs. 8, p=0.023), but not thereafter. In the HPS (Heart Protection Study),[A181475] in which 20,536 patients were randomized to receive simvastatin 40 mg/day or placebo, the incidences of elevated transaminases (>3X ULN confirmed by repeat test) were 0.21% (n=21) for patients treated with simvastatin and 0.09% (n=9) for patients treated with placebo.[F4655, F4658] Endocrine Effects Increases in HbA1c and fasting serum glucose levels have been reported with HMG-CoA reductase inhibitors, including simvastatin.[F4655] Although cholesterol is the precursor of all steroid hormones, studies with simvastatin have suggested that this agent has no clinical effect on steroidogenesis. Simvastatin caused no increase in biliary lithogenicity and, therefore, would not be expected to increase the incidence of gallstones.[F4658]	Simvastatin is a prodrug in which the 6-membered lactone ring of simvastatin is hydrolyzed <i>in vivo</i> to generate the beta,delta-dihydroxy acid, an active metabolite structurally similar to HMG-CoA (hydroxymethylglutaryl CoA). Once hydrolyzed, simvastatin competes with HMG-CoA for HMG-CoA reductase, a hepatic microsomal enzyme, which catalyzes the conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol biosynthesis.[A181421] Simvastatin acts primarily in the liver, where decreased hepatic cholesterol concentrations stimulate the upregulation of hepatic low density lipoprotein (LDL) receptors which increases hepatic uptake of LDL. Simvastatin also inhibits hepatic synthesis of very low density lipoprotein (VLDL).[F4655, F4658] The overall effect is a decrease in plasma LDL and VLDL. At therapeutic doses, the HMG-CoA enzyme is not completely blocked by simvastatin activity, thereby allowing biologically necessary amounts of mevalonate to remain available. As mevalonate is an early step in the biosynthetic pathway for cholesterol, therapy with simvastatin would also not be expected to cause any accumulation of potentially toxic sterols. In addition, HMG-CoA is metabolized readily back to acetyl-CoA, which participates in many biosynthetic processes in the body.[F4658] In vitro and in vivo animal studies also demonstrate that simvastatin exerts vasculoprotective effects independent of its lipid-lowering properties, also known as the pleiotropic effects of statins.[A181424] This includes improvement in endothelial function, enhanced stability of atherosclerotic plaques, reduced oxidative stress and inflammation, and inhibition of the thrombogenic response. Statins have also been found to bind allosterically to β2 integrin function-associated antigen-1 (LFA-1), which plays an important role in leukocyte trafficking and in T cell activation.[A181559]	Peak plasma concentrations of both active and total inhibitors were attained within 1.3 to 2.4 hours post-dose. While the recommended therapeutic dose range is 10 to 40 mg/day, there was no substantial deviation from linearity of AUC with an increase in dose to as high as 120 mg. Relative to the fasting state, the plasma profile of inhibitors was not affected when simvastatin was administered immediately before a test meal.[F4655,F4658] In a pharmacokinetic study of 17 healthy Chinese volunteers, the major PK parameters were as follows: Tmax 1.44 hours, Cmax 9.83 ug/L, t1/2 4.85 hours, and AUC 40.32ug·h/L.[A181571] Simvastatin undergoes extensive first-pass extraction in the liver, the target organ for the inhibition of HMG-CoA reductase and the primary site of action. This tissue selectivity (and consequent low systemic exposure) of orally administered simvastatin has been shown to be far greater than that observed when the drug is administered as the enzymatically active form, i.e. as the open hydroxyacid.[F4658] In animal studies, after oral dosing, simvastatin achieved substantially higher concentrations in the liver than in non-target tissues. However, because simvastatin undergoes extensive first-pass metabolism, the bioavailability of the drug in the systemic system is low. In a single-dose study in nine healthy subjects, it was estimated that less than 5% of an oral dose of simvastatin reached the general circulation in the form of active inhibitors.[F4658] Genetic differences in the OATP1B1 (Organic-Anion-Transporting Polypeptide 1B1) hepatic transporter encoded by the SCLCO1B1 gene (Solute Carrier Organic Anion Transporter family member 1B1) have been shown to impact simvastatin pharmacokinetics. Evidence from pharmacogenetic studies of the c.521T>C single nucleotide polymorphism (SNP) showed that simvastatin plasma concentrations were increased on average 3.2-fold for individuals homozygous for 521CC compared to homozygous 521TT individuals.[A34995,A181478] The 521CC genotype is also associated with a marked increase in the risk of developing myopathy, likely secondary to increased systemic exposure.[A34994] Other statin drugs impacted by this polymorphism include [rosuvastatin], [pitavastatin], [atorvastatin], [lovastatin], and [pravastatin].[A181460] For patients known to have the above-mentioned c.521CC OATP1B1 genotype, a maximum daily dose of 20mg of simvastatin is recommended to avoid adverse effects from the increased exposure to the drug, such as muscle pain and risk of rhabdomyolysis.[F4658] Evidence has also been obtained with other statins such as [rosuvastatin] that concurrent use of statins and inhibitors of Breast Cancer Resistance Protein (BCRP) such as elbasvir and grazoprevir increased the plasma concentration of these statins. Further evidence is needed, however a dose adjustment of simvastatin may be necessary. Other statin drugs impacted by this polymorphism include [fluvastatin] and [atorvastatin].[A181478]	Simvastatin is administered as the inactive lactone derivative that is then metabolically activated to its β-hydroxyacid form by a combination of spontaneous chemical conversion and enzyme-mediated hydrolysis by nonspecific carboxyesterases in the intestinal wall, liver, and plasma. Oxidative metabolism in the liver is primarily mediated by CYP3A4 and CYP3A5, with the remaining metabolism occurring through CYP2C8 and CYP2C9.[A181580] The major active metabolites of simvastatin are β-hydroxyacid metabolite and its 6'-hydroxy, 6'-hydroxymethyl, and 6'-exomethylene derivatives.[F4655,F4658] Polymorphisms in the CYP3A5 gene have been shown to affect the disposition of simvastatin and may provide a plausible explanation for interindividual variability of simvastatin disposition and pharmacokinetics.[A181577]	null	4.85 hours[A181571]	Both simvastatin and its β-hydroxyacid metabolite are highly bound (approximately 95%) to human plasma proteins.[F4655,F4658]	Following an oral dose of 14C-labeled simvastatin in man, 13% of the dose was excreted in urine and 60% in feces.[F4655,F4658]	Rat studies indicate that when radiolabeled simvastatin was administered, simvastatin-derived radioactivity crossed the blood-brain barrier.[F4655]	null	Organic compounds	Organoheterocyclic compounds	Lactones	Delta valerolactones	[ "approved" ]	[ "A10BH", "A10B", "A10", "A", "C10AA", "C10A", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BA", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BA", "C10B", "C10", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.17", "description": "Apo-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Co Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Jamp-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Mylan-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Novo-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Phl-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Pms-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Ran-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Ratio-Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Sandoz Simvastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Apo-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Apo-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Apo-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Co Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Co Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Co Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Jamp-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Jamp-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Jamp-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Mylan-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Mylan-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Mylan-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Novo-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Novo-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Novo-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Phl-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Phl-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Phl-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Pms-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Pms-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Pms-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Ran-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Ran-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Ran-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Ratio-Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Ratio-Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Ratio-Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Sandoz Simvastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Sandoz Simvastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.45", "description": "Sandoz Simvastatin 80 mg Tablet", "unit": "tablet" }, { "cost": "1.63", "description": "Simvastatin 5 mg tablet", "unit": "tablet" }, { "cost": "1.99", "description": "Zocor 5 mg tablet", "unit": "tablet" }, { "cost": "2.31", "description": "Simvastatin 10 mg tablet", "unit": "tablet" }, { "cost": "2.89", "description": "Zocor 10 mg tablet", "unit": "tablet" }, { "cost": "3.83", "description": "Simvastatin 20 mg tablet", "unit": "tablet" }, { "cost": "3.83", "description": "Simvastatin 40 mg tablet", "unit": "tablet" }, { "cost": "3.83", "description": "Simvastatin 80 mg tablet", "unit": "tablet" }, { "cost": "4.11", "description": "Zocor 40 mg tablet", "unit": "tablet" }, { "cost": "4.63", "description": "Vytorin 10-80 mg tablet", "unit": "tablet" }, { "cost": "4.69", "description": "Zocor 20 mg tablet", "unit": "tablet" }, { "cost": "4.69", "description": "Zocor 80 mg tablet", "unit": "tablet" }, { "cost": "4.97", "description": "Vytorin 10-10 mg tablet", "unit": "tablet" }, { "cost": "5.05", "description": "Vytorin 10-20 mg tablet", "unit": "tablet" }, { "cost": "5.05", "description": "Vytorin 10-40 mg tablet", "unit": "tablet" }, { "cost": "10.71", "description": "Simvastatin 100% powder", "unit": "g" }, { "cost": "525.16", "description": "Zocor 90 40 mg tablet Bottle", "unit": "bottle" }, { "cost": "0.59", "description": "Apo-Simvastatin 5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Co Simvastatin 5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Jamp-Simvastatin 5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Mylan-Simvastatin 5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Novo-Simvastatin 5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Phl-Simvastatin 5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Pms-Simvastatin 5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Ran-Simvastatin 5 mg Tablet", "unit": "tablet" } ]	[ { "approved": "1998-12-08", "country": "United States", "expires": "2013-09-21", "number": "5846966" }, { "approved": "2008-02-05", "country": "United States", "expires": "2027-05-24", "number": "7326708" }, { "approved": "2000-06-27", "country": "United States", "expires": "2017-05-27", "number": "6080428" }, { "approved": "2002-10-22", "country": "United States", "expires": "2018-03-15", "number": "6469035" }, { "approved": "2004-03-02", "country": "United States", "expires": "2023-01-26", "number": "6699871" }, { "approved": "2006-10-24", "country": "United States", "expires": "2023-01-26", "number": "7125873" }, { "approved": "2002-05-28", "country": "United States", "expires": "2017-04-25", "number": "RE37721" }, { "approved": "2011-06-14", "country": "United States", "expires": "2017-04-25", "number": "RE42461" }, { "approved": "2001-10-16", "country": "United States", "expires": "2017-04-24", "number": "6303661" }, { "approved": "2005-05-10", "country": "United States", "expires": "2019-02-02", "number": "6890898" }, { "approved": "2006-07-18", "country": "United States", "expires": "2019-02-02", "number": "7078381" }, { "approved": "2008-12-02", "country": "United States", "expires": "2019-02-02", "number": "7459428" }, { "approved": "2012-05-01", "country": "United States", "expires": "2022-06-26", "number": "8168637" }, { "approved": "2017-03-21", "country": "United States", "expires": "2030-02-23", "number": "9597289" }, { "approved": "2019-05-28", "country": "United States", "expires": "2027-04-26", "number": "10300041" } ]	2,2-dimethylbutyric acid, 8-ester with (4R,6R)-6-(2-((1S,2S,6R,8S,8aR)-1,2,6,7,8,8a-hexahydro-8-hydroxy-2,6-dimethyl-1-naphthyl)ethyl)tetrahydro-4-hydroxy-2H-pyran-2-one \| Simvastatin \| Simvastatina \| Simvastatine \| Simvastatinum \| 1.1.1.34 \| HMG-CoA reductase \| CD11 antigen-like family member A \| CD11A \| Leukocyte adhesion glycoprotein LFA-1 alpha chain \| Leukocyte function-associated molecule 1 alpha chain \| LFA-1A \| 3.5.1.98 \| HD2 \| Protein deacylase HDAC2 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 1 \| GNT1 \| hUG-BR1 \| UDP-glucuronosyltransferase 1-1 \| UDP-glucuronosyltransferase 1A isoform 1 \| UDPGT 1-1 \| UGT1 \| UGT1-01 \| UGT1.1 \| UGT11 \| UGT1A1 \| 2.4.1.17 \| GNT1 \| UDP-glucuronosyltransferase 1-3 \| UDP-glucuronosyltransferase 1-C \| UDP-glucuronosyltransferase 1A isoform 3 \| UDPGT 1-3 \| UGT-1C \| UGT1 \| UGT1-03 \| UGT1.3 \| UGT13 \| UGT1A3 \| UGT1C \| 2.4.1.17 \| 3,4-catechol estrogen-specific UDPGT \| UDP-glucuronosyltransferase 2B9 \| UDPGT 2B7 \| UDPGT 2B9 \| UDPGTh-2 \| UGT2B7 \| UGTB2B9 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 3.1.1.84 \| Carboxylesterase 2 \| CE-2 \| hCE-2 \| ICE \| Methylumbelliferyl-acetate deacetylase 2 \| ACAT \| Acyl-coenzyme A:cholesterol acyltransferase \| Brain carboxylesterase hBr1 \| Carboxylesterase 1 \| CE-1 \| CEH \| CES2 \| Cholesteryl ester hydrolase \| Cocaine carboxylesterase \| Egasyn \| hCE-1 \| HMSE \| Methylumbelliferyl-acetate deacetylase 1 \| Monocyte/macrophage serine esterase \| REH \| Retinyl ester hydrolase \| Serine esterase 1 \| SES1 \| TGH \| Triacylglycerol hydrolase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| OATP \| OATP-1 \| OATP-A \| OATP1 \| OATP1A2 \| Organic anion-transporting polypeptide 1 \| SLC21A3 \| Sodium-independent organic anion transporter \| Solute carrier family 21 member 3 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9 \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8	[ "Act Simvastatin", "Act Simvastatin", "Act Simvastatin", "Act Simvastatin", "Act Simvastatin", "Ag-simvastatin", "Ag-simvastatin", "Ag-simvastatin", "Ag-simvastatin", "Ag-simvastatin", "Apo-simvastatin", "Apo-simvastatin", "Apo-simvastatin", "Apo-simvastatin", "Apo-simvastatin", "Auro-simvastatin", "Auro-simvastatin", "Auro-simvastatin", "Auro-simvastatin", "Auro-simvastatin", "Ava-simvastatin", "Ava-simvastatin", "Ava-simvastatin", "Ava-simvastatin", "Ava-simvastatin", "Bci Simvastatin", "Bci Simvastatin", "Bci Simvastatin", "Bci Simvastatin", "Bci Simvastatin", "Bio-simvastatin", "Bio-simvastatin", "Bio-simvastatin", "Bio-simvastatin", "Bio-simvastatin", "Cholib", "Cholib", "Cholib", "Cholib", "Cholib", "Cholib", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Dom-simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe 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"Ntp-simvastatin", "Nu-simvastatin Tablets", "Nu-simvastatin Tablets", "Nu-simvastatin Tablets", "Nu-simvastatin Tablets", "Nu-simvastatin Tablets", "Pharma-simvastatin", "Pharma-simvastatin", "Pharma-simvastatin", "Pharma-simvastatin", "Pharma-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PHL-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "PMS-simvastatin", "Pmsc-simvastatin", "Pmsc-simvastatin", "Pmsc-simvastatin", "Pmsc-simvastatin", "Pmsc-simvastatin", "Priva-simvastatin", "Priva-simvastatin", "Priva-simvastatin", "Priva-simvastatin", "Priva-simvastatin", "Q-simvastatin", "Q-simvastatin", "Q-simvastatin", "Q-simvastatin", "Q-simvastatin", "Ratio-simvastatin", "Ratio-simvastatin", "Ratio-simvastatin", "Ratio-simvastatin", "Ratio-simvastatin", "Riva-simvastatin", "Riva-simvastatin", "Riva-simvastatin", "Riva-simvastatin", "Riva-simvastatin", "Sandoz Simvastatin", "Sandoz Simvastatin", "Sandoz Simvastatin", "Sandoz Simvastatin", "Sandoz Simvastatin", "Septa-simvastatin", "Septa-simvastatin", "Septa-simvastatin", "Septa-simvastatin", "Septa-simvastatin", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", 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"Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin", "Simvastatin Tablets", "Simvastatin Tablets", "Simvastatin Tablets", "Simvastatin Tablets", "Simvastatin Tablets", "Simvastatin Tablets 10mg", "Simvastatin Tablets 20mg", "Simvastatin Tablets 40mg", "Simvastatin Tablets 5mg", "Simvastatin Tablets 80mg", "Simvastatin-10", "Simvastatin-20", "Simvastatin-40", "Simvastatin-5", "Simvastatin-80", "Simvastatin-odan", "Simvastatin-odan", "Simvastatin-odan", "Simvastatin-odan", "Simvastatin-odan", "Taro-simvastatin", "Taro-simvastatin", "Taro-simvastatin", "Taro-simvastatin", "Taro-simvastatin", "Taro-simvastatin", "Taro-simvastatin", "Taro-simvastatin", "Teva-simvastatin", "Teva-simvastatin", "Teva-simvastatin", "Teva-simvastatin", "Teva-simvastatin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zocor", "Zym-simvastatin", "Zym-simvastatin", "Zym-simvastatin", "Zym-simvastatin", "Zym-simvastatin" ]	[ "Cholestat", "Colemin", "Labistatin", "Lipex", "Medipo", "Nivelipol", "Simovil", "Sinvacor", "Sivastin", "Sivatin", "Sivinar", "Sorfox", "Sotovastin", "Starezin", "Starstat", "Starzoko", "Stasiva", "Statex", "Staticor", "Statinal", "Stativer", "Synvinolin" ]	[ "Vytorin", "Vytorin", "Vytorin", "Simcor", "Simcor", "Simcor", "Simcor", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Simcor", "Juvisync", "Juvisync", "Juvisync", "Juvisync", "Juvisync", "Juvisync", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Vytorin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Ezetimibe and Simvastatin", "Cholib", "Cholib", "Cholib", "Cholib", "Cholib", "Cholib" ]	[ "P04035", "P20701", "Q92769" ]	[ "P08684", "P20815", "P10632", "P11712", "P10635", "P20813", "P22309", "P35503", "P16662", "P33261", "O00748", "P23141" ]	[]	[ "P08183", "P46721", "Q9Y6L6", "Q92887", "O95342", "O94956", "Q9NPD5" ]
DB00175	Pravastatin	Pravastatin is the 6-alpha-hydroxy acid form of [mevastatin].[T303] Pravastatin was firstly approved in 1991 becoming the second available statin in the United States. It was the first statin administered as the active form and not as a prodrug.[T274] This drug was developed by Sankyo Co. Ltd.; however, the first approved pravastatin product was developed by Bristol Myers Squibb and FDA approved in 1991.[L6142] Pravastatin is made through a fermentation process in which [mevastatin] is first obtained. The manufacturing process is followed by the hydrolysis of the lactone group and the biological hydroxylation with _Streptomyces carbophilus_ to introduce the allylic 6-alcohol group.[T239]	solid	Pravastatin is indicated for primary prevention of coronary events hypercholesterolemic patients without clinical evidence of coronary heart disease. Its use includes the reduction of risk on myocardial infarction, undergoing myocardial revascularization procedures and cardiovascular mortality.[T274] As well, pravastatin can be used as a secondary prevention agent for cardiovascular events in patients with clinically evident coronary heart disease. This indication includes the reduction of risk of total mortality by reducing coronary death, myocardial infarction, undergoing myocardial revascularization procedures, stroke, and stroke/transient ischemic attack as well as to slow the progression of coronary atherosclerosis.[T274] The term cardiovascular events correspond to all the incidents that can produce damage to the heart muscle including the interruption of blood flow.[L6028] As adjunctive therapy to diet, pravastatin is used in: - Patients with primary hypercholesterolemia and mixed dyslipidemias including hyperlipidemia type IIa and IIb. - Patients with elevated serum triglycerides including type IV hyperlipidemia. - Patients with heterozygous familial hypercholesterolemia in patients over 8 years of age with low-density lipoprotein (LDL) cholesterol higher than 190 mg/dl after diet modifications or LDL levels higher than 160 mg/dl and familial history of premature cardiovascular diseases or at least two cardiovascular risk factors.[T274] In patients that do not respond adequately to diet, pravastatin is used to treat patients with primary dysbetalipoproteinemia (type III hyperlipidemia).[T274] Dyslipidemia is defined as an elevation of plasma cholesterol, triglycerides or both as well as to the presence of low levels of high-density lipoprotein. This condition represents an increased risk for the development of atherosclerosis.[L6025]	The action of pravastatin on the 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase produces an increase in the expression of hepatic LDL receptors which in order decreases the plasma levels of LDL cholesterol.[T274] The effect of pravastatin has been shown to significantly reduce the circulating total cholesterol, LDL cholesterol, and apolipoprotein B. As well, it modestly reduces very low-density-lipoproteins (VLDL) cholesterol and triglycerides while increasing the level of high-density lipoprotein (HDL) cholesterol and apolipoprotein A.[F4603] In clinical trials with patients with a history of myocardial infarction or angina with high total cholesterol, pravastatin decreased the level of total cholesterol by 18%, decreased of LDL by 27%, decreased of triglycerides by 6% and increased of high-density lipoprotein (HDL) by 4%. As well, there was reported a decrease in risk of death due to coronary disease of 24%.[A177682] When coadministered with [cholestyramine], pravastatin can reduce by 50% the levels of LDL and slow the progression of atherosclerosis and the risk of myocardial infarction and death.[T274]	Pravastatin is a specific inhibitor of the hepatic HMG-CoA reductase in humans.[T274] The inhibition of this enzyme produces a reduction in cholesterol biosynthesis as HMG-CoA reductase activity is an early-limiting step in cholesterol biosynthesis.[A177397] The inhibitory mechanism of action produces a reduction in cholesterol synthesis which in order has been observed to increase the number of LDL receptors on cell surfaces and an enhancement in receptor-mediated metabolism of LDL and clearance.[A177415] On the other hand, pravastatin-driven inhibition of LDL production inhibits hepatic synthesis of VLDL as the LDL is the precursor for these molecules.[A177436]	Pravastatin is absorbed 60-90 min after oral administration and it presents a low bioavailability of 17%.[A34502] This low bioavailability can be presented due to the polar nature of pravastatin which produces a high range of first-pass metabolism and incomplete absorption.[T239] Pravastatin is rapidly absorbed from the upper part of the small intestine via proton-coupled carrier-mediated transport to be later taken up in the livery by the sodium-independent bile acid transporter.[A39676] The reported time to reach the peak serum concentration in the range of 30-55 mcg/L is of 1-1.5 hours with an AUC ranging from 60-90 mcg.h/L.[A177907]	After initial administration, pravastatin undergoes extensive first-pass extraction in the liver.[A34502] However, pravastatin's metabolism is not related to the activity of the cytochrome P-450 isoenzymes and its processing is performed in a minor extent in the liver. Therefore, this drug is highly exposed to peripheral tissues.[A177682] The metabolism of pravastatin is ruled mainly by the presence of glucuronidation reactions with very minimal intervention of CYP3A enzymes. After metabolism, pravastatin does not produce active metabolites.[A34502] This metabolism is mainly done in the stomach followed by a minor portion of renal and hepatic processing.[A39676] The major metabolite formed as part of pravastatin metabolism is the 3-alpha-hydroxy isomer. The activity of this metabolite is very clinically negligible.[F4603]	The reported oral LD50 of pravastatin in mice is of 8939 mg/kg.[MSDS] There haven't been significant overdosage reports however, in the case of overdosage, symptomatic treatment is recommended along with laboratory monitoring and supportive measures.[FDA label] In carcinogenic studies, high dose administration of pravastatin has been reported to increase the incidence of hepatocellular carcinomas in males and lung carcinomas in females. There is no evidence relating the administration of pravastatin with mutagenicity in different assays not to produce effects in fertility or reproductive potential.[FDA label]	The reported elimination half-life of pravastatin is reported to be of 1.8 hours.[A34502]	Due its polarity, pravastatin binding to plasma proteins is very limited and the bound form represents only about 43-48% of the administered dose. However, the activity of p-glycoprotein in luminal apical cells and OATP1B1 produce significant changes to pravastatin distribution and elimination.[A177682]	From the administered dose of pravastatin, about 70% is eliminated in the feces while about 20% is obtained in the urine.[T357] When pravastatin is administered intravenously, approximately 47% of the administered dose is eliminated via the urine with 53% of the dose eliminated either via biotransformation of biliary.[F4603]	The reported steady-state volume of distribution of pravastatin is reported to be of 0.5 L/kg.[A177913] This pharmacokinetic parameter in children was found to range from 31-37 ml/kg.[A177907]	The reported clearance rate of pravastatin ranges from 6.3-13.5 ml.min/kg in adults[A177913] while in children it has been reported to be of 4-11 L/min.[A177907]	Organic compounds	Organic acids and derivatives	Hydroxy acids and derivatives	Medium-chain hydroxy acids and derivatives	[ "approved" ]	[ "C10AA", "C10A", "C10", "C", "C10BA", "C10B", "C10", "C", "C10BA", "C10B", "C10", "C", "C10BA", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.0", "description": "Apo-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Co Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Jamp-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Mint-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Mylan-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Novo-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Pms-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Pravachol 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Ran-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Ratio-Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.0", "description": "Sandoz Pravastatin 10 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Apo-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Co Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Jamp-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Mint-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Mylan-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Novo-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Pms-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Pravachol 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Ran-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Ratio-Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.18", "description": "Sandoz Pravastatin 20 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Apo-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Co Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Jamp-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Mint-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Mylan-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Novo-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Pms-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Pravachol 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Ran-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Ratio-Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "1.42", "description": "Sandoz Pravastatin 40 mg Tablet", "unit": "tablet" }, { "cost": "3.28", "description": "Pravastatin sodium 10 mg tablet", "unit": "tablet" }, { "cost": "3.33", "description": "Pravastatin sodium 20 mg tablet", "unit": "tablet" }, { "cost": "4.38", "description": "Pravachol 10 mg tablet", "unit": "tablet" }, { "cost": "4.39", "description": "Pravachol 20 mg tablet", "unit": "tablet" }, { "cost": "4.89", "description": "Pravastatin sodium 40 mg tablet", "unit": "tablet" }, { "cost": "4.89", "description": "Pravastatin sodium 80 mg tablet", "unit": "tablet" }, { "cost": "6.53", "description": "Pravachol 40 mg tablet", "unit": "tablet" }, { "cost": "6.53", "description": "Pravachol 80 mg tablet", "unit": "tablet" } ]	[ { "approved": "1997-04-22", "country": "United States", "expires": "2014-10-22", "number": "5622985" }, { "approved": "1993-11-02", "country": "Canada", "expires": "2010-11-02", "number": "1323836" } ]	(+)-(3R,5R)-3,5-dihydroxy-7-[(1S,2S,6S,8S,8aR)-6-hydroxy-2-methyl-8-{[(S)-2-methylbutyryl]oxy}-1,2,6,7,8,8a-hexahydro-1-naphthyl]heptanoic acid \| Pravastatin \| Pravastatin acid \| Pravastatina \| Pravastatine \| Pravastatinum \| 1.1.1.34 \| HMG-CoA reductase \| 3.5.1.98 \| HD2 \| Protein deacylase HDAC2 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| OATP \| OATP-1 \| OATP-A \| OATP1 \| OATP1A2 \| Organic anion-transporting polypeptide 1 \| SLC21A3 \| Sodium-independent organic anion transporter \| Solute carrier family 21 member 3 \| hOAT1 \| hPAHT \| hROAT1 \| OAT1 \| Organic anion transporter 1 \| PAH transporter \| PAHT \| Renal organic anion transporter 1 \| hOAT3 \| OAT3 \| Organic anion/dicarboxylate exchanger \| Solute carrier family 22 member 8 \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2 \| OAT4 \| Organic anion transporter 4 \| Organic anion:dicarboxylate exchanger OAT4 \| 7.6.2.2 \| ABCP \| ATP-binding cassette sub-family G member 2 \| BCRP \| BCRP1 \| Breast cancer resistance protein \| CDw338 \| Mitoxantrone resistance-associated protein \| MXR \| Placenta-specific ATP-binding cassette transporter \| Urate exporter \| hOAT2 \| NLT \| Novel liver transporter \| OAT2 \| Organic anion transporter 2 \| MCT 1 \| MCT1 \| Solute carrier family 16 member 1 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8	[ "Ach-pravastatin", "Ach-pravastatin", "Ach-pravastatin", "Act Pravastatin", "Act Pravastatin", "Act Pravastatin", "Ag-pravastatin", "Ag-pravastatin", "Ag-pravastatin", "Apo-pravastatin", "Apo-pravastatin", "Apo-pravastatin", "Auro-pravastatin", "Auro-pravastatin", "Auro-pravastatin", "Ava-pravastatin", "Ava-pravastatin", "Ava-pravastatin", "Bio Pravastatin", "Bio Pravastatin", "Bio Pravastatin", "Bio-pravastatin", "Bio-pravastatin", "Bio-pravastatin", "Dom-pravastatin", "Dom-pravastatin", "Dom-pravastatin", "Ipg-pravastatin", "Ipg-pravastatin", "Ipg-pravastatin", "Jamp-pravastatin", "Jamp-pravastatin", "Jamp-pravastatin", "Lin-pravastatin", "Lin-pravastatin", "Lin-pravastatin", "M-pravastatin", "M-pravastatin", "M-pravastatin", "M-pravastatin", "M-pravastatin", "M-pravastatin", "Mar-pravastatin", "Mar-pravastatin", "Mar-pravastatin", "Mint-pravastatin", "Mint-pravastatin", "Mint-pravastatin", "Mylan-pravastatin", "Mylan-pravastatin", "Mylan-pravastatin", "Nra-pravastatin", "Nra-pravastatin", "Nra-pravastatin", "Ntp-pravastatin", "Ntp-pravastatin", "Ntp-pravastatin", "Nu-pravastatin Tablets", "Nu-pravastatin Tablets", "Nu-pravastatin Tablets", "Pal-pravastatin-asa", "Pal-pravastatin-asa", "Pal-pravastatin-asa", "Pendo-pravastatin", "Pendo-pravastatin", "PMS-pravastatin", "PMS-pravastatin", "PMS-pravastatin", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravachol", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin 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"Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Sodium", "Pravastatin Tablets", "Pravastatin Tablets", "Pravastatin Tablets", "Pravastatin-10", "Pravastatin-20", "Pravastatin-40", "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Priva-pravastatin", "Priva-pravastatin", "Priva-pravastatin", "Q-pravastatin", "Q-pravastatin", "Q-pravastatin", "Ratio-pravastatin", "Ratio-pravastatin", "Ratio-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Riva-pravastatin", "Sandoz Pravastatin", "Sandoz Pravastatin", "Sandoz Pravastatin", "Sandoz Pravastatin", "Sandoz Pravastatin", "Sandoz Pravastatin", "Sandoz Pravastatin Tablets", "Sandoz Pravastatin Tablets", "Sandoz Pravastatin Tablets", "Taro-pravastatin", "Taro-pravastatin", "Taro-pravastatin", "Teva-pravastatin", "Teva-pravastatin", "Teva-pravastatin" ]	[ "Elisor", "Lipostat", "Mevalotin", "Pravaselect", "Selipran" ]	[ "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Pravigard Pac", "Pal-pravastatin-asa", "Pal-pravastatin-asa", "Pal-pravastatin-asa", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix", "Pravafenix" ]	[ "P04035", "Q92769" ]	[]	[]	[ "Q9Y6L6", "O94956", "P08183", "P46721", "Q4U2R8", "Q8TCC7", "Q92887", "Q9NSA0", "Q9UNQ0", "Q9Y694", "P53985", "O95342", "Q9NPD5" ]
DB01098	Rosuvastatin	Rosuvastatin, also known as the brand name product Crestor, is a lipid-lowering drug that belongs to the statin class of medications, which are used to lower the risk of cardiovascular disease and manage elevated lipid levels by inhibiting the endogenous production of cholesterol in the liver. More specifically, statin medications competitively inhibit the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) Reductase,[A181421] which catalyzes the conversion of HMG-CoA to mevalonic acid and is the third step in a sequence of metabolic reactions involved in the production of several compounds involved in lipid metabolism and transport including cholesterol, low-density lipoprotein (LDL) (sometimes referred to as "bad cholesterol"), and very low-density lipoprotein (VLDL). Prescribing of statin medications is considered standard practice following any cardiovascular events and for people with a moderate to high risk of development of CVD, such as those with Type 2 Diabetes. The clear evidence of the benefit of statin use coupled with very minimal side effects or long term effects has resulted in this class becoming one of the most widely prescribed medications in North America.[A181087, A181406] Rosuvastatin and other drugs from the statin class of medications including [atorvastatin], [pravastatin], [simvastatin], [fluvastatin], and [lovastatin] are considered first-line options for the treatment of dyslipidemia.[A181087, A181406] This is largely due to the fact that cardiovascular disease (CVD), which includes heart attack, atherosclerosis, angina, peripheral artery disease, and stroke, has become a leading cause of death in high-income countries and a major cause of morbidity around the world.[A181084] Elevated cholesterol levels, and in particular, elevated low-density lipoprotein (LDL) levels, are an important risk factor for the development of CVD.[A181087,A181553] Use of statins to target and reduce LDL levels has been shown in a number of landmark studies to significantly reduce the risk of development of CVD and all-cause mortality.[A181090,A181093,A181096,A181427,A181475,A181538] Statins are considered a cost-effective treatment option for CVD due to their evidence of reducing all-cause mortality including fatal and non-fatal CVD as well as the need for surgical revascularization or angioplasty following a heart attack.[A181087, A181406] Evidence has shown that even for low-risk individuals (with <10% risk of a major vascular event occurring within 5 years) statins cause a 20%-22% relative reduction in major cardiovascular events (heart attack, stroke, coronary revascularization, and coronary death) for every 1 mmol/L reduction in LDL without any significant side effects or risks.[A181397, A181403] While all statin medications are considered equally effective from a clinical standpoint, rosuvastatin is considered the most potent; doses of 10 to 40mg rosuvastatin per day were found in clinical studies to result in a 45.8% to 54.6% decreases in LDL cholesterol levels, which is about three-fold more potent than [atorvastatin]'s effects on LDL cholesterol.[A181409,A1793] However, the results of the SATURN trial[A181427] concluded that despite this difference in potency, there was no difference in their effect on the progression of coronary atherosclerosis. Rosuvastatin is also a unique member of the class of statins due to its high hydrophilicity which increases hepatic uptake at the site of action, low bioavailability, and minimal metabolism via the Cytochrome P450 system.[A181523] This last point results in less risk of drug-drug interactions compared to [atorvastatin], [lovastatin], and [simvastatin], which are all extensively metabolized by Cytochrome P450 (CYP) 3A4, an enzyme involved in the metabolism of many commonly used drugs.[A181460] Drugs such as [ciclosporin], [gemfibrozil], and some antiretrovirals are more likely to interact with this statin through antagonism of OATP1B1 organic anion transporter protein 1B1-mediated hepatic uptake of rosuvastatin.[F4649, F4652]	solid	The FDA monograph states that rosuvastatin is indicated as an adjunct to diet in the treatment of triglyceridemia, Primary Dysbetalipoproteinemia (Type III Hyperlipoproteinemia), and Homozygous Familial Hypercholesterolemia.[F4649] The Health Canada monograph for rosuvastatin further specifies that rosuvastatin is indicated for the reduction of elevated total cholesterol (Total-C), LDL-C, ApoB, the Total-C/HDL-C ratio and triglycerides (TG) and for increasing HDL-C in hyperlipidemic and dyslipidemic conditions when response to diet and exercise alone has been inadequate. It is also indicated for the prevention of major cardiovascular events (including risk of myocardial infarction, nonfatal stroke, and coronary artery revascularization) in adult patients without documented history of cardiovascular or cerebrovascular events, but with at least two conventional risk factors for cardiovascular disease.[F4652] Prescribing of statin medications is considered standard practice following any cardiovascular events and for people with a moderate to high risk of development of CVD. Statin-indicated conditions include diabetes mellitus, clinical atherosclerosis (including myocardial infarction, acute coronary syndromes, stable angina, documented coronary artery disease, stroke, trans ischemic attack (TIA), documented carotid disease, peripheral artery disease, and claudication), abdominal aortic aneurysm, chronic kidney disease, and severely elevated LDL-C levels.[A181087, A181406]	Rosuvastatin is a synthetic, enantiomerically pure antilipemic agent. It is used to lower total cholesterol, low density lipoprotein-cholesterol (LDL-C), apolipoprotein B (apoB), non-high density lipoprotein-cholesterol (non-HDL-C), and trigleride (TG) plasma concentrations while increasing HDL-C concentrations. High LDL-C, low HDL-C and high TG concentrations in the plasma are associated with increased risk of atherosclerosis and cardiovascular disease. The total cholesterol to HDL-C ratio is a strong predictor of coronary artery disease and high ratios are associated with higher risk of disease. Increased levels of HDL-C are associated with lower cardiovascular risk. By decreasing LDL-C and TG and increasing HDL-C, rosuvastatin reduces the risk of cardiovascular morbidity and mortality.[A181087, A181406] Elevated cholesterol levels, and in particular, elevated low-density lipoprotein (LDL) levels, are an important risk factor for the development of CVD.[A181087] Use of statins to target and reduce LDL levels has been shown in a number of landmark studies to significantly reduce the risk of development of CVD and all-cause mortality.[A181090,A181093,A181096,A181427,A181475] Statins are considered a cost-effective treatment option for CVD due to their evidence of reducing all-cause mortality including fatal and non-fatal CVD as well as the need for surgical revascularization or angioplasty following a heart attack.[A181087, A181406] Evidence has shown that even for low-risk individuals (with <10% risk of a major vascular event occurring within 5 years) statins cause a 20%-22% relative reduction in major cardiovascular events (heart attack, stroke, coronary revascularization, and coronary death) for every 1 mmol/L reduction in LDL without any significant side effects or risks.[A181397, A181403] Skeletal Muscle Effects Cases of myopathy and rhabdomyolysis with acute renal failure secondary to myoglobinuria have been reported with HMG-CoA reductase inhibitors, including rosuvastatin. These risks can occur at any dose level, but are increased at the highest dose (40 mg). Rosuvastatin should be prescribed with caution in patients with predisposing factors for myopathy (e.g., age ≥ 65 years, inadequately treated hypothyroidism, renal impairment). The risk of myopathy during treatment with rosuvastatin may be increased with concurrent administration of some other lipid-lowering therapies (such as [fenofibrate] or [niacin]), [gemfibrozil], [cyclosporine], [atazanavir]/[ritonavir], [lopinavir]/ritonavir, or [simeprevir]. Cases of myopathy, including rhabdomyolysis, have been reported with HMG-CoA reductase inhibitors, including rosuvastatin, coadministered with [colchicine], and caution should therefore be exercised when prescribing these two medications together.[F4649] Real-world data from observational studies has suggested that 10-15% of people taking statins may experience muscle aches at some point during treatment.[A182258] Liver Enzyme Abnormalities Increases in serum transaminases have been reported with HMG-CoA reductase inhibitors, including rosuvastatin. In most cases, the elevations were transient and resolved or improved on continued therapy or after a brief interruption in therapy. There were two cases of jaundice, for which a relationship to rosuvastatin therapy could not be determined, which resolved after discontinuation of therapy. There were no cases of liver failure or irreversible liver disease in these trials.[F4649] Endocrine Effects Increases in HbA1c and fasting serum glucose levels have been reported with HMG-CoA reductase inhibitors, including rosuvastatin calcium tablets. Based on clinical trial data with rosuvastatin, in some instances these increases may exceed the threshold for the diagnosis of diabetes mellitus.[F4649] An in vitro study found that [atorvastatin], [pravastatin], [rosuvastatin], and [pitavastatin] exhibited a dose-dependent cytotoxic effect on human pancreas islet β cells, with reductions in cell viability of 32, 41, 34 and 29%, respectively, versus control]. Moreover, insulin secretion rates were decreased by 34, 30, 27 and 19%, respectively, relative to control.[A182012] HMG-CoA reductase inhibitors interfere with cholesterol synthesis and lower cholesterol levels and, as such, might theoretically blunt adrenal or gonadal steroid hormone production. Rosuvastatin demonstrated no effect upon nonstimulated cortisol levels and no effect on thyroid metabolism as assessed by TSH plasma concentration. In rosuvastatin treated patients, there was no impairment of adrenocortical reserve and no reduction in plasma cortisol concentrations. Clinical studies with other HMG-CoA reductase inhibitors have suggested that these agents do not reduce plasma testosterone concentration. The effects of HMG-CoA reductase inhibitors on male fertility have not been studied. The effects, if any, on the pituitarygonadal axis in premenopausal women are unknown.[F4652] Cardiovascular Ubiquinone levels were not measured in rosuvastatin clinical trials, however significant decreases in circulating ubiquinone levels in patients treated with other statins have been observed. The clinical significance of a potential long-term statin-induced deficiency of ubiquinone has not been established. It has been reported that a decrease in myocardial ubiquinone levels could lead to impaired cardiac function in patients with borderline congestive heart failure.[F4652] Lipoprotein A In some patients, the beneficial effect of lowered total cholesterol and LDL-C levels may be partly blunted by a concomitant increase in the Lipoprotein(a) [Lp(a)] concentrations. Present knowledge suggests the importance of high Lp(a) levels as an emerging risk factor for coronary heart disease. It is thus desirable to maintain and reinforce lifestyle changes in high-risk patients placed on rosuvastatin therapy.[F4652] Further studies have demonstrated statins affect Lp(a) levels differently in patients with dyslipidemia depending on their apo(a) phenotype; statins increase Lp(a) levels exclusively in patients with the low molecular weight apo(a) phenotype.[A181418]	Rosuvastatin is a statin medication and a competitive inhibitor of the enzyme HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase, which catalyzes the conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol biosynthesis.[A181421] Rosuvastatin acts primarily in the liver, where decreased hepatic cholesterol concentrations stimulate the upregulation of hepatic low density lipoprotein (LDL) receptors which increases hepatic uptake of LDL. Rosuvastatin also inhibits hepatic synthesis of very low density lipoprotein (VLDL).[F4649] The overall effect is a decrease in plasma LDL and VLDL. In vitro and in vivo animal studies also demonstrate that rosuvastatin exerts vasculoprotective effects independent of its lipid-lowering properties, also known as the pleiotropic effects of statins.[A181424] This includes improvement in endothelial function, enhanced stability of atherosclerotic plaques, reduced oxidative stress and inflammation, and inhibition of the thrombogenic response. Statins have also been found to bind allosterically to β2 integrin function-associated antigen-1 (LFA-1), which plays an important role in leukocyte trafficking and in T cell activation.[A181559] Rosuvastatin exerts an anti-inflammatory effect on rat mesenteric microvascular endothelium by attenuating leukocyte rolling, adherence and transmigration.[A1807] The drug also modulates nitric oxide synthase (NOS) expression and reduces ischemic-reperfusion injuries in rat hearts.[A1787] Rosuvastatin increases the bioavailability of nitric oxide[A1807,A1799,A1787] by upregulating NOS[A1791] and by increasing the stability of NOS through post-transcriptional polyadenylation.[A1796] It is unclear as to how rosuvastatin brings about these effects though they may be due to decreased concentrations of mevalonic acid.	In a study of healthy white male volunteers, the absolute oral bioavailability of rosuvastatin was found to be approximately 20% while absorption was estimated to be 50%, which is consistent with a substantial first-pass effect after oral dosing.[A181451, A181454] Another study in healthy volunteers found that the peak plasma concentration (Cmax) of rosuvastatin was 6.06ng/mL and was reached at a median of 5 hours following oral dosing.[A181463] Both Cmax and AUC increased in approximate proportion to dose. Neither food nor evening versus morning administration was shown to have an effect on the AUC of rosuvastatin.[F4649, F4652] Many statins are known to interact with hepatic uptake transporters and thus reach high concentrations at their site of action in the liver. Breast Cancer Resistance Protein (BCRP) is a membrane-bound protein that plays an important role in the absorption of rosuvastatin, particularly as CYP3A4 has minimal involvement in its metabolism.[A181460] Evidence from pharmacogenetic studies of c.421C>A single nucleotide polymorphisms (SNPs) in the gene for BCRP has demonstrated that individuals with the 421AA genotype have reduced functional activity and 2.4-fold higher AUC and Cmax values for rosuvastatin compared to study individuals with the control 421CC genotype. This has important implications for the variation in response to the drug in terms of efficacy and toxicity, particularly as the BCRP c.421C>A polymorphism occurs more frequently in Asian populations than in Caucasians.[A181478, A181487] Other statin drugs impacted by this polymorphism include [fluvastatin] and [atorvastatin].[A181478] Genetic differences in the OATP1B1 (organic-anion-transporting polypeptide 1B1) hepatic transporter have also been shown to impact rosuvastatin pharmacokinetics. Evidence from pharmacogenetic studies of the c.521T>C SNP showed that rosuvastatin AUC was increased 1.62-fold for individuals homozygous for 521CC compared to homozygous 521TT individuals.[A181493] Other statin drugs impacted by this polymorphism include [simvastatin], [pitavastatin], [atorvastatin], and [pravastatin].[A181460] For patients known to have the above-mentioned c.421AA BCRP or c.521CC OATP1B1 genotypes, a maximum daily dose of 20mg of rosuvastatin is recommended to avoid adverse effects from the increased exposure to the drug, such as muscle pain and risk of rhabdomyolysis.[F4652]	Rosuvastatin is not extensively metabolized, as demonstrated by the small amount of radiolabeled dose that is recovered as a metabolite (~10%). Cytochrome P450 (CYP) 2C9 is primarily responsible for the formation of rosuvastatin's major metabolite, N-desmethylrosuvastatin, which has approximately 20-50% of the pharmacological activity of its parent compound in vitro.[F4649, F4652] However, this metabolic pathway isn't deemed to be clinically significant as there were no observable effects found on rosuvastatin pharmacokinetics when rosuvastatin was coadministered with fluconazole, a potent CYP2C9 inhibitor.[A34483] In vitro and in vivo data indicate that rosuvastatin has no clinically significant cytochrome P450 interactions (as substrate, inhibitor or inducer). Consequently, there is little potential for drug-drug interactions upon coadministration with agents that are metabolized by cytochrome P450.[F4652]	Generally well-tolerated. Side effects may include myalgia, constipation, asthenia, abdominal pain, and nausea. Other possible side effects include myotoxicity (myopathy, myositis, rhabdomyolysis) and hepatotoxicity. To avoid toxicity in Asian patients, lower doses should be considered. Pharmacokinetic studies show an approximately two-fold increase in peak plasma concentration and AUC in Asian patients (Philippino, Chinese, Japanese, Korean, Vietnamese, or Asian-Indian descent) compared to Caucasian patients.	The elimination half-life (t½) of rosuvastatin is approximately 19 hours and does not increase with increasing doses.[F4649, F4652]	Rosuvastatin is 88% bound to plasma proteins, mostly albumin. This binding is reversible and independent of plasma concentrations.[F4649, F4652]	Rosuvastatin is not extensively metabolized; approximately 10% of a radiolabeled dose is recovered as metabolite. Following oral administration, rosuvastatin and its metabolites are primarily excreted in the feces (90%). After an intravenous dose, approximately 28% of total body clearance was via the renal route, and 72% by the hepatic route.[F4649, F4652, A181451] A study in healthy adult male volunteers found that approximately 90% of the rosuvastatin dose was recovered in feces within 72 hours after dose, while the remaining 10% was recovered in urine. The drug was completely excreted from the body after 10 days of dosing. They also found that approximately 76.8% of the excreted dose was unchanged from the parent compound, with the remaining dose recovered as the metabolites n-desmethyl rosuvastatin and rosuvastatin-5S-lactone.[A181463] Renal tubular secretion is responsible for >90% of total renal clearance, and is believed to be mediated primarily by the uptake transporter OAT3 (Organic anion transporter 1), while OAT1 had minimal involvement.[A181490]	Rosuvastatin undergoes first-pass extraction in the liver, which is the primary site of cholesterol synthesis and LDL-C clearance. The mean volume of distribution at steady-state of rosuvastatin is approximately 134 litres.[F4649, F4652]	null	Organic compounds	Organoheterocyclic compounds	Diazines	Pyrimidines and pyrimidine derivatives	[ "approved" ]	[ "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10AA", "C10A", "C10", "C", "A10BH", "A10B", "A10", "A", "G01AE", "G01A", "G01", "G", "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BA", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C10BA", "C10B", "C10", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.45", "description": "Crestor 5 mg Tablet", "unit": "tablet" }, { "cost": "1.53", "description": "Crestor 10 mg Tablet", "unit": "tablet" }, { "cost": "1.91", "description": "Crestor 20 mg Tablet", "unit": "tablet" }, { "cost": "2.24", "description": "Crestor 40 mg Tablet", "unit": "tablet" }, { "cost": "4.68", "description": "Crestor 10 mg tablet", "unit": "tablet" }, { "cost": "4.68", "description": "Crestor 5 mg tablet", "unit": "tablet" }, { "cost": "4.69", "description": "Crestor 20 mg tablet", "unit": "tablet" }, { "cost": "4.7", "description": "Crestor 40 mg tablet", "unit": "tablet" } ]	[ { "approved": "2009-08-18", "country": "Canada", "expires": "2020-08-04", "number": "2315141" }, { "approved": "2001-07-31", "country": "Canada", "expires": "2012-07-02", "number": "2072945" }, { "approved": "2005-02-22", "country": "United States", "expires": "2022-06-17", "number": "6858618" }, { "approved": "2006-04-18", "country": "United States", "expires": "2018-10-02", "number": "7030152" }, { "approved": "2011-06-21", "country": "United States", "expires": "2018-10-02", "number": "7964614" }, { "approved": "2001-11-13", "country": "United States", "expires": "2021-02-04", "number": "6316460" }, { "approved": "2001-08-07", "country": "United States", "expires": "2016-07-08", "number": "RE37314" }, { "approved": "2019-09-17", "country": "United States", "expires": "2036-02-12", "number": "10413543" }, { "approved": "2019-08-13", "country": "United States", "expires": "2033-05-01", "number": "10376470" }, { "approved": "2017-09-19", "country": "United States", "expires": "2033-05-01", "number": "9763885" } ]	(3R,5S,6E)-7-(4-(4-fluorophenyl)-6-(1-methylethyl)-2-(ethyl(methylsulfonyl)amino)-5-pyrimidinyl)-3,5-dihydroxy-6-heptenoic acid \| (3R,5S,6E)-7-{4-(4-fluorophenyl)-6-isopropyl-2-[methyl(methylsulfonyl)amino]pyrimidin-5-yl}-3,5-dihydroxyhept-6-enoic acid \| Rosuvastatin \| Rosuvastatina \| 1.1.1.34 \| HMG-CoA reductase \| CD11 antigen-like family member A \| CD11A \| Leukocyte adhesion glycoprotein LFA-1 alpha chain \| Leukocyte function-associated molecule 1 alpha chain \| LFA-1A \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| MOAT-B \| MOATB \| MRP/cMOAT-related ABC transporter \| MRP4 \| Multi-specific organic anion transporter B \| Multidrug resistance-associated protein 4 \| OATP \| OATP-1 \| OATP-A \| OATP1 \| OATP1A2 \| Organic anion-transporting polypeptide 1 \| SLC21A3 \| Sodium-independent organic anion transporter \| Solute carrier family 21 member 3 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9 \| Amino acid transport system xc- \| Calcium channel blocker resistance protein CCBR1 \| Solute carrier family 7 member 11 \| xCT \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP \| 7.6.2.2 \| ABCP \| ATP-binding cassette sub-family G member 2 \| BCRP \| BCRP1 \| Breast cancer resistance protein \| CDw338 \| Mitoxantrone resistance-associated protein \| MXR \| Placenta-specific ATP-binding cassette transporter \| Urate exporter \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2 \| hOAT3 \| OAT3 \| Organic anion/dicarboxylate exchanger \| Solute carrier family 22 member 8 \| Cell growth-inhibiting gene 29 protein \| Na(+)/bile acid cotransporter \| Na(+)/taurocholate transport protein \| NTCP \| SLC10A1 \| Sodium/taurocholate cotransporting polypeptide \| Solute carrier family 10 member 1	[ "Ach-rosuvastatin", "Ach-rosuvastatin", "Ach-rosuvastatin", "Ach-rosuvastatin", "Act Rosuvastatin", "Act Rosuvastatin", "Act Rosuvastatin", "Act Rosuvastatin", "Ag-rosuvastatin", "Ag-rosuvastatin", "Ag-rosuvastatin", "Ag-rosuvastatin", "Ag-rosuvastatin Calcium", "Ag-rosuvastatin Calcium", "Ag-rosuvastatin Calcium", "Ag-rosuvastatin Calcium", "Apo-rosuvastatin", "Apo-rosuvastatin", "Apo-rosuvastatin", "Apo-rosuvastatin", "Auro-rosuvastatin", "Auro-rosuvastatin", "Auro-rosuvastatin", "Auro-rosuvastatin", "Bio-rosuvastatin", "Bio-rosuvastatin", "Bio-rosuvastatin", "Bio-rosuvastatin", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor", "Crestor - 10mg", "Crestor - 20mg", "Crestor - 40mg", "Crestor - 5mg", "Dom-rosuvastatin", "Dom-rosuvastatin", "Dom-rosuvastatin", "Dom-rosuvastatin", "Ezallor Sprinkle", "Ezallor Sprinkle", "Ezallor Sprinkle", "Ezallor Sprinkle", "Ipg-rosuvastatin", "Ipg-rosuvastatin", "Ipg-rosuvastatin", "Ipg-rosuvastatin", "Jamp Rosuvastatin Calcium", "Jamp Rosuvastatin Calcium", "Jamp Rosuvastatin Calcium", "Jamp Rosuvastatin Calcium", "Jamp-rosuvastatin", "Jamp-rosuvastatin", "Jamp-rosuvastatin", "Jamp-rosuvastatin", "M-rosuvastatin", "M-rosuvastatin", "M-rosuvastatin", "M-rosuvastatin", "M-rosuvastatin", "M-rosuvastatin", "M-rosuvastatin", "M-rosuvastatin", "Mar-rosuvastatin", "Mar-rosuvastatin", "Mar-rosuvastatin", "Mar-rosuvastatin", "Med-rosuvastatin", "Med-rosuvastatin", "Med-rosuvastatin", "Med-rosuvastatin", "Mint-rosuvastatin", "Mint-rosuvastatin", "Mint-rosuvastatin", "Mint-rosuvastatin", "Mylan-rosuvastatin", "Mylan-rosuvastatin", "Mylan-rosuvastatin", "Mylan-rosuvastatin", "Novo-rosuvastatin", "Novo-rosuvastatin", "Novo-rosuvastatin", "Novo-rosuvastatin", "Nra-rosuvastatin", "Nra-rosuvastatin", "Nra-rosuvastatin", "Nra-rosuvastatin", "Nra-rosuvastatin Tablets", "Nra-rosuvastatin Tablets", "Nra-rosuvastatin Tablets", "Nra-rosuvastatin Tablets", "Ntp-rosuvastatin", "Ntp-rosuvastatin", "Ntp-rosuvastatin", "Ntp-rosuvastatin", "PMS-rosuvastatin", "PMS-rosuvastatin", "PMS-rosuvastatin", "PMS-rosuvastatin", "Priva-rosuvastatin", "Priva-rosuvastatin", "Priva-rosuvastatin", "Priva-rosuvastatin", "Prz-rosuvastatin", "Prz-rosuvastatin", "Prz-rosuvastatin", "Prz-rosuvastatin", "Q-rosuvastatin", "Q-rosuvastatin", "Q-rosuvastatin", "Q-rosuvastatin", "Riva-rosuvastatin", "Riva-rosuvastatin", "Riva-rosuvastatin", "Riva-rosuvastatin", "Rosuvastain Calcium", "Rosuvastain Calcium", "Rosuvastain Calcium", "Rosuvastain Calcium", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin", "Rosuvastatin and Ezetimibe", "Rosuvastatin and Ezetimibe", "Rosuvastatin and Ezetimibe", "Rosuvastatin and Ezetimibe", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin calcium", "Rosuvastatin calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Rosuvastatin Calcium", "Roszet", "Roszet", "Roszet", "Roszet", "Sandoz Rosuvastatin", "Sandoz Rosuvastatin", "Sandoz Rosuvastatin", "Sandoz Rosuvastatin", "Taro-rosuvastatin", "Taro-rosuvastatin", "Taro-rosuvastatin", "Taro-rosuvastatin", "Teva-rosuvastatin", "Teva-rosuvastatin", "Teva-rosuvastatin", "Teva-rosuvastatin" ]	[ "Astende", "Cirantan", "Cresadex", "Provisacor", "Razel", "Rosedex", "Rosimol", "Rosumed", "Rosustatin", "Rosuvas", "Rosuvast", "Rosvel", "Rovartal", "Simestat", "Sinlip", "Visacor", "Vivacor" ]	[ "Roszet", "Roszet", "Roszet", "Roszet", "Rosuvastatin and Ezetimibe", "Rosuvastatin and Ezetimibe", "Rosuvastatin and Ezetimibe", "Rosuvastatin and Ezetimibe" ]	[ "P04035", "P20701" ]	[ "P11712" ]	[ "P02768" ]	[ "O15439", "P46721", "Q9Y6L6", "Q9NPD5", "O94956", "Q9UPY5", "O95342", "Q9UNQ0", "Q92887", "Q8TCC7", "Q14973" ]
DB00399	Zoledronic acid	Zoledronic acid, or CGP 42'446,[A203120] is a third generation, nitrogen containing bisphosphonate similar to [ibandronic acid], [minodronic acid], and [risedronic acid].[A203111] Zoledronic acid is used to treat and prevent multiple forms of osteoporosis, hypercalcemia of malignancy, multiple myeloma, bone metastases from solid tumors, and Paget’s disease of bone.[L13712,L13715,L13721] Zoledronic acid was first described in the literature in 1994.[A203120] Zoledronic acid was granted FDA approval on 20 August 2001.[L13712]	solid	Zoledronic acid is indicated to treat hypercalcemia of malignancy, multiple myeloma, bone metastases from solid tumors, osteoporosis in men and postmenopausal women, glucocorticoid induced osteoporosis, and Paget's disease of bone in men and women.[L13712,L13715,L13721] Zoledronic acid is also indicated for the prevention of osteoporosis in post menopausal women and glucocorticoid induced osteoporosis.[L13712,L13715,L13721]	Zoledronic acid is a third generation, nitrogen containing bisphosphonate that inhibits osteoclast function and prevents bone resorption.[A203111] The therapeutic window is wide as patients are unlikely to suffer severe effects from overdoses and the duration of action is long.[L13712,L13715,L13721] Patients should be counselled regarding the risk of electrolyte deficiencies, renal impairment, osteonecrosis of the jaw, atypical femoral fractures, bronchoconstriction, hepatic impairment, hypocalcemia, and embryo-fetal toxicity.[L13712,L13715,L13721]	Bisphosphonates are taken into the bone where they bind to hydroxyapatite. Bone resorption by osteoclasts causes local acidification, releasing the bisphosphonate, which is taken into the osteoclast by fluid-phase endocytosis.[A959] Endocytic vesicles become acidified, releasing bisphosphonates into the cytosol of osteoclasts where they act.[A959] Osteoclasts mediate resorption of bone.[A6366] When osteoclasts bind to bone they form podosomes, ring structures of F-actin.[A6366] Etidronic acid also inhibits V-ATPases in the osteoclast, though the exact subunits are unknown, preventing F-actin from forming podosomes.[A202229,A202247,A203360] Disruption of the podosomes causes osteoclasts to detach from bones, preventing bone resorption.[A6366] Nitrogen containing bisphosphonates such as zoledronate are known to induce apoptosis of hematopoietic tumor cells by inhibiting the components of the mevalonate pathway farnesyl diphosphate synthase, farnesyl diphosphate, and geranylgeranyl diphosphate.[A202769,A203123] These components are essential for post-translational prenylation of GTP-binding proteins like Rap1.[A202769,A203123] The lack of prenylation of these proteins interferes with their function, and in the case of Rap1, leads to apoptosis.[A202769,A203123] zoledronate also activated caspases which further contribute to apoptosis.[A202769,A203123]	A 4mg intravenous dose reaches a C<sub>max</sub> of 370±78.5ng/mL, with a T<sub>max</sub> of 0.317±0.014h, and an AUC of 788±181ng\h/mL.[A203099] A 5mg intravenous dose reaches a C<sub>max</sub> of 471±76.1ng/mL, with a T<sub>max</sub> of 0.368±0.005h, and an AUC of 917±226ng\h/mL.[A203099]	Zoledronic acid is not metabolized _in vivio_.[L13712,L13715,L13721]	Patients experiencing an overdose may present with renal impairment, hypocalcemia, hypophosphatemia, and hypomagnesemia.[L13712,L13715,L13721] Overdose should be managed through intravenous administration of the insufficient ions.[L13712,L13715,L13721]	Zoledronic acid has a terminal elimination half life of 146 hours.[L13712,L13715,L13721]	Zoledronic acid is 23-53% protein bound in plasma.[L13712,L13715,L13721]	Zoledronic acid is 39 ± 16% eliminated in the urine as the unmetabolized parent drug.[L13712,L13715,L13721]	null	Zoledronic acid has a renal clearance of 3.7 ± 2.0 L/h.[L13712,L13715,L13721]	Organic compounds	Organic acids and derivatives	Organic phosphonic acids and derivatives	Bisphosphonates	[ "approved" ]	[ "M05BB", "M05B", "M05", "M", "M05BA", "M05B", "M05", "M" ]	[ "Humans and other mammals" ]	[ { "cost": "12.88", "description": "Reclast 5 mg/100 ml solution", "unit": "ml" }, { "cost": "13.39", "description": "Reclast 5 mg/100ml Solution", "unit": "ml" }, { "cost": "1095.69", "description": "Zometa 4 mg/5ml Concentrate 5ml Vial", "unit": "vial" } ]	[ { "approved": "1990-07-03", "country": "United States", "expires": "2013-03-02", "number": "4939130" }, { "approved": "1997-02-25", "country": "Canada", "expires": "2014-02-25", "number": "1338937" }, { "approved": "1997-02-04", "country": "Canada", "expires": "2014-02-04", "number": "1338895" }, { "approved": "2012-12-04", "country": "United States", "expires": "2025-11-29", "number": "8324189" }, { "approved": "2011-04-26", "country": "United States", "expires": "2028-08-05", "number": "7932241" }, { "approved": "2011-11-08", "country": "United States", "expires": "2023-10-27", "number": "8052987" } ]	(1-hydroxy-2-(1H-imidazol-1-yl)ethylidene)bisphosphonic acid \| (1-hydroxy-2-imidazol-1-ylethylidene)diphosphonic acid \| ácido zoledrónico \| Anhydrous Zoledronic Acid \| Nanoparticles containing Zoledronic acid \| Zol \| Zoledronate \| Zoledronic acid \| Zoledronic Acid Anhydrous \| Zoledronic Acid, Anhydrous \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.- \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| Farnesyltranstransferase \| Geranylgeranyl diphosphate synthase \| Geranyltranstransferase \| GGPP synthase \| GGPPSase \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.10 \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| FPP synthase \| FPS \| Geranyltranstransferase \| KIAA1293 \| 7.6.2.2 \| ATP-binding cassette sub-family C member 1 \| Glutathione-S-conjugate-translocating ATPase ABCC1 \| Leukotriene C(4) transporter \| LTC4 transporter \| MRP \| MRP1	[ "Aclasta", "Aclasta", "Aclasta", "Act Zoledronic Acid", "Act Zoledronic Acid Concentrate", "Jamp-zoledronic Acid", "PMS-zoledronic Acid", "Reclast", "Reclast", "Taro-zoledronic Acid", "Taro-zoledronic Acid Concentrate", "Val-zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic Acid", "Zoledronic acid", "Zoledronic acid", "Zoledronic Acid - A", "Zoledronic Acid - Z", "Zoledronic Acid Accord", "Zoledronic Acid Accord", "Zoledronic Acid Accord Infusion", "Zoledronic Acid Actavis", "Zoledronic Acid Actavis", "Zoledronic Acid Actavis", "Zoledronic Acid Concentrate", "Zoledronic Acid Concentrate for Injection", "Zoledronic Acid for Injection", "Zoledronic Acid for Injection", "Zoledronic Acid for Injection", "Zoledronic Acid for Injection", "Zoledronic Acid for Injection", "Zoledronic Acid for Injection Concentrate", "Zoledronic Acid for Injection Concentrate", "Zoledronic Acid for Injection Concentrate", "Zoledronic Acid Hospira", "Zoledronic Acid Hospira", "Zoledronic Acid Hospira", "Zoledronic Acid Hospira", "Zoledronic Acid Injection", "Zoledronic Acid Injection", "Zoledronic Acid Injection", "Zoledronic Acid Injection A", "Zoledronic Acid Medac", "Zoledronic Acid Medac", "Zoledronic Acid Medac", "Zoledronic Acid Medac", "Zoledronic Acid Medac", "Zoledronic Acid Medac", "Zoledronic Acid Medac", "Zoledronic Acid Mylan", "Zoledronic Acid Mylan", "Zoledronic Acid Mylan", "Zoledronic Acid Mylan", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva", "Zoledronic Acid Teva Generics", "Zoledronic Acid Teva Generics", "Zoledronic Acid Teva Generics", "Zoledronic Acid Teva Generics", "Zoledronic Acid Teva Generics", "Zoledronic Acid Teva Pharma", "Zoledronic Acid Teva Pharma", "Zoledronic Acid Teva Pharma", "Zoledronic Acid Teva Pharma", "Zoledronic Acid Teva Pharma", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa", "Zometa Concentrate", "Zometa Lyophilized Powder" ]	[]	[]	[ "O95749", "P14324" ]	[]	[]	[ "P33527" ]
DB00282	Pamidronic acid	Pamidronic acid is a second generation, nitrogen containing bisphosphonate similar to [neridronic acid] and [alendronic acid].[A203111] Pamidronic acid was first described in the literature in 1977.[A203267] The second generation bisphosphonates are less common as third generation bisphosphonates, such as [ibandronic acid], [zoledronic acid], [minodronic acid], and [risedronic acid] are becoming more popular.[A203111] Pamidronic acid was granted FDA approval on 31 October 1991.[L13835]	solid	Pamidronate is indicated to treat moderate to severe hypercalcemia of malignancy, moderate to severe Paget's disease of bone, osteolytic bone metastases of breast cancer, and osteolytic lesions of multiple myeloma.[L13838]	Pamidronic acid is a second generation, nitrogen containing bisphosphonate that inhibits osteoclast mediated bone loss[A203111,A959,L13838] It has a wide therapeutic index and a long duration of action as it can be given every 3-4 weeks for certain indications.[L13838] Patients should be counselled regarding the risk of elevated blood urea nitrogen, renal tubular necrosis, and nephrotoxicity.[L13838]	Bisphosphonates are taken into the bone where they bind to hydroxyapatite. Bone resorption by osteoclasts causes local acidification, releasing the bisphosphonate, which is taken into the osteoclast by fluid-phase endocytosis.[A959] Endocytic vesicles become acidified, releasing bisphosphonates into the cytosol of osteoclasts where they act.[A959] Osteoclasts mediate resorption of bone.[A6366] When osteoclasts bind to bone they form podosomes, ring structures of F-actin.[A6366] Disruption of the podosomes causes osteoclasts to detach from bones, preventing bone resorption.[A6366] Nitrogen containing bisphosphonates such as pamidronate are known to induce apoptosis of hematopoietic tumor cells by inhibiting the components of the mevalonate pathway farnesyl diphosphate synthase, farnesyl diphosphate, and geranylgeranyl diphosphate.[A202769,A203123,A203111] These components are essential for post-translational prenylation of GTP-binding proteins like Rap1.[A202769,A203123] The lack of prenylation of these proteins interferes with their function, and in the case of Rap1, leads to apoptosis.[A202769,A203123] pamidronate also activated caspases 3 and 9 which further contribute to apoptosis.[A202769,A203123,A203177]	In patients with a creatinine clearance >90mL/min, a 90mg intravenous dose reached a C<sub>max</sub> of 1.92±1.08µg/mL, with a T<sub>max</sub> of 4h, and an AUC of 10.2±6.95µg\h/mL.[A203264] In patients with a creatinine clearance 61-90mL/min, a 90mg intravenous dose reached a C<sub>max</sub> of 1.86±0.50µg/mL, with a T<sub>max</sub> of 4h, and an AUC of 10.7—3.91µg\h/mL.[A203264 In patients with a creatinine clearance 30-60mL/min, a 90mg intravenous dose reached a C<sub>max</sub> of 1.84±0.58µg/mL, with a T<sub>max</sub> of 4h, and an AUC of 10.1±3.38µg\h/mL.[A203264] In patients with a creatinine clearance <30mL/min, a 90mg intravenous dose reached a C<sub>max</sub> of 1.93±0.53µg/mL, with a T<sub>max</sub> of 4h, and an AUC of 34.0±8.37µg\h/mL.[A203264]	Pamidronate is not metabolized _in vivo_.[L13838]	Patients experiencing and overdose may present with hypocalcemia, fever, hypotension, and taste perversion.[L13838] Overdose can be managed by symptomatic and supportive treatment which may include the administration of steroids and intravenous calcium.[L13838]	The mean elimination half life of pamidronate is 28±7 hours.[L13838]	Pamidronate is approximately 54% protein bound in serum.[L13892]	Pamidronate is exclusively eliminated in the urine.[L13838] By 120 hours after administration, 46±16% of the dose has been eliminated in the urine.[L13838]	null	The mean total clearance of pamidronate is 107±50mL/min and the mean renal clearance is 49±28mL/min.[L13838]	Organic compounds	Organic acids and derivatives	Organic phosphonic acids and derivatives	Bisphosphonates	[ "approved" ]	[ "M05BA", "M05B", "M05", "M" ]	[ "Humans and other mammals" ]	[ { "cost": "86.09", "description": "Pamidronate Disodium 30 mg/vial", "unit": "vial" }, { "cost": "86.09", "description": "Pamidronate Disodium Omega 30 mg/vial", "unit": "vial" }, { "cost": "111.94", "description": "Pamidronate disod 30 mg vial", "unit": "each" }, { "cost": "129.14", "description": "Pamidronate Disodium 60 mg/vial", "unit": "vial" }, { "cost": "182.69", "description": "Aredia 30 mg/vial", "unit": "vial" }, { "cost": "258.28", "description": "Pamidronate Disodium 90 mg/vial", "unit": "vial" }, { "cost": "258.28", "description": "Pamidronate Disodium Omega 90 mg/vial", "unit": "vial" }, { "cost": "258.28", "description": "Pms-Pamidronate 90 mg/vial", "unit": "vial" }, { "cost": "279.86", "description": "Aredia 30 mg vial", "unit": "each" }, { "cost": "548.05", "description": "Aredia 90 mg/vial", "unit": "vial" }, { "cost": "755.64", "description": "Pamidronate disod 90 mg vial", "unit": "each" }, { "cost": "839.59", "description": "Aredia 90 mg vial", "unit": "each" } ]	[]	Acide pamidronique \| Acido pamidronico \| Acidum pamidronicum \| Pamidronate \| Pamidronic acid \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.10 \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| FPP synthase \| FPS \| Geranyltranstransferase \| KIAA1293 \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.- \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| Farnesyltranstransferase \| Geranylgeranyl diphosphate synthase \| Geranyltranstransferase \| GGPP synthase \| GGPPSase \| 3.4.22.56 \| Apopain \| CASP-3 \| CPP-32 \| CPP32 \| Cysteine protease CPP32 \| Protein Yama \| SCA-1 \| SREBP cleavage activity 1 \| 3.4.22.62 \| APAF-3 \| Apoptotic protease Mch-6 \| Apoptotic protease-activating factor 3 \| CASP-9 \| ICE-LAP6 \| ICE-like apoptotic protease 6 \| MCH6	[ "Aredia", "Aredia", "Aredia", "Aredia 30mg", "Aredia 90mg", "Aredia Liq Inj 3mg/ml", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium for Injection", "Pamidronate Disodium Omega 3 mg/ml", "Pamidronate Disodium Omega 6 mg/ml", "Pamidronate Disodium Omega 9 mg/ml", "PMS-pamidronate", "PMS-pamidronate", "PMS-pamidronate", "PMS-pamidronate", "Val-pamidronate Disodium" ]	[ "Aminomux", "Pamimed", "Ribodroat" ]	[]	[ "P14324", "O95749", "P42574", "P55211" ]	[]	[]	[]
DB01095	Fluvastatin	Fluvastatin is an antilipemic agent that competitively inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase. HMG-CoA reductase catalyzes the conversion of HMG-CoA to mevalonic acid, the rate-limiting step in cholesterol biosynthesis. Fluvastatin belongs to a class of medications called statins and is used to reduce plasma cholesterol levels and prevent cardiovascular disease. It is also the first entirely synthetic HMG-CoA reductase inhibitor and is structurally distinct from the fungal derivatives of this therapeutic class. Fluvastatin is a racemate comprising equimolar amounts of (3R,5S)- and (3S,5R)-fluvastatin.	solid	To be used as an adjunct to dietary therapy to prevent cardiovascular events. May be used as secondary prevention in patients with coronary heart disease (CHD) to reduce the risk of requiring coronary revascularization procedures, for reducing progression of coronary atherosclerosis in hypercholesterolemic patients with CHD, and for the treatment of primary hypercholesterolemia and mixed dyslidipidemia.	Fluvastatin, the first synthetically-derived HMG-CoA reductase inhibitor, is a hydrophilic, acidic, antilipemic agent used to lower cholesterol and triglyceride levels associated with primary hypercholesterolemia and mixed dyslipidemia (Fredrickson types IIa and IIb), to slow the progression of coronary atherosclerosis in patients with CHD and as secondary prevention therapy in patients with CHD to reduce the risk of requiring coronary revascularization procedures. Although similar to lovastatin, simvastatin, and pravastatin, fluvastatin has a shorter half-life, no active metabolites, extensive protein binding, and minimal CSF penetration. Fluvastatin acts primarily in the liver. It is prepared as a racemate of two erythro enantiomers of which the 3R,5S enantiomer exerts the pharmacologic effect.	Fluvastatin selectively and competitively inhibits the hepatic enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase. HMG-CoA reductase is responsible for converting HMG-CoA to mevalonate, the rate-limiting step in cholesterol biosynthesis. Inhibition results in a decrease in hepatic cholesterol levels which stimulates the synthesis of LDL receptors and increases hepatic uptake of LDL cholesterol. The end result is decreased levels of plasma total and LDL cholesterol.	Rapidly and almost completely absorbed (> 90%), but undergoes extensive first pass metabolism. Bioavailability is 24% (range 9-50%) when a 10 mg dose is given. The mean relative bioavailability of the extended-release tablet is 29% (range: 9% to 66%) compared to an immediate-release capsule administered under fasting conditions. When given orally, fluvastatin reaches peak concentrations (Tmax) in less than one hour. Taking the extended release tablet with a high-fat meal will delay absorption (Tmax = 6 hours) and increase bioavailability by approximately 50%. However, the maximum concentration of fluvastatin sodium extended-release tablets seen after a high fat meal is less than the peak concentration following a single dose or twice daily dose of the 40 mg fluvastatin capsule.	Undergoes hepatic metabolism primarily via hydroxylation of the indole ring at the 5- and 6-positions to 5-hydroxy fluvastatin and 6-hydroxy fluvastatin, respectively. N-dealkylation to N-desisopropyl fluvastatin and beta-oxidation of the side chain also occurs. Metabolized primarily by the CYP2C9 isozyme system (75%), and to a lesser extent by CYP3A4 (~20%) and CYP2C8 (~5%). Hydroxylated metabolites retain some pharmcological activity, but are present as conjugates (glucuronides and sulfates) in the blood and are rapidly eliminated via bile into feces. Both enantiomers of fluvastatin are metabolized in a similar manner. Fluvastatin also undergoes glucuronidation via UGT enzymes.	Generally well-tolerated. May cause gastrointestinal upset (diarrhea, nausea, constipation, gas, abdominal pain), myotoxicity (mypothy, myositis, rhabdomyolysis), and hepatotoxicity.	3 hours	98% bound to plasma proteins. At therapeutic concentrations, the protein binding of fluvastatin is not affected by warfarin, salicylic acid and glyburide.	When orally administered, fluvastatin is primarily excreted in the faces ( ~90%) as metabolites, with less than 2% present as unchanged drug. Approximately 5% was recovered in the urine.	* 0.35 L/kg	* 0.8 L/h/kg * 107 ± 38.1 L/h [Hypercholesterolemia patients receiving a single dose of 20 mg] * 87.8 ± 45 L/h [Hypercholesterolemia patients receiving 20 mg twice daily] * 108 ± 44.7 L/h [Hypercholesterolemia patients receiving 40 mg single] * 64.2 ± 21.1 L/h [Hypercholesterolemia patients receiving 40 mg twice daily]	null	null	null	null	[ "approved" ]	[ "C10AA", "C10A", "C10", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.35", "description": "Lescol 40 mg Capsule", "unit": "capsule" }, { "cost": "1.62", "description": "Lescol Xl 80 mg Extended-Release Tablet", "unit": "tablet" }, { "cost": "3.37", "description": "Lescol 40 mg capsule", "unit": "capsule" }, { "cost": "3.38", "description": "Lescol 20 mg capsule", "unit": "capsule" }, { "cost": "3.66", "description": "Lescol xl 80 mg tablet sa", "unit": "tablet" }, { "cost": "4.24", "description": "Lescol xl 80 mg tablet", "unit": "tablet" }, { "cost": "4.25", "description": "Lescol XL 80 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "0.96", "description": "Lescol 20 mg Capsule", "unit": "capsule" } ]	[ { "approved": "1994-10-11", "country": "United States", "expires": "2011-10-11", "number": "5354772" }, { "approved": "2008-09-09", "country": "Canada", "expires": "2019-10-12", "number": "2346868" }, { "approved": "2000-11-28", "country": "Canada", "expires": "2012-12-10", "number": "2085037" }, { "approved": "2001-06-05", "country": "United States", "expires": "2020-10-13", "number": "6242003" } ]	Fluvastatin \| fluvastatina \| fluvastatine \| fluvastatinum \| 1.1.1.34 \| HMG-CoA reductase \| 3.5.1.98 \| HD2 \| Protein deacylase HDAC2 \| 1.14.14.1 \| CYPIA1 \| Cytochrome P450 form 6 \| Cytochrome P450-C \| Cytochrome P450-P1 \| Hydroperoxy icosatetraenoate dehydratase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 1 \| GNT1 \| hUG-BR1 \| UDP-glucuronosyltransferase 1-1 \| UDP-glucuronosyltransferase 1A isoform 1 \| UDPGT 1-1 \| UGT1 \| UGT1-01 \| UGT1.1 \| UGT11 \| UGT1A1 \| 2.4.1.17 \| GNT1 \| UDP-glucuronosyltransferase 1-3 \| UDP-glucuronosyltransferase 1-C \| UDP-glucuronosyltransferase 1A isoform 3 \| UDPGT 1-3 \| UGT-1C \| UGT1 \| UGT1-03 \| UGT1.3 \| UGT13 \| UGT1A3 \| UGT1C \| 2.4.1.17 \| 3,4-catechol estrogen-specific UDPGT \| UDP-glucuronosyltransferase 2B9 \| UDPGT 2B7 \| UDPGT 2B9 \| UDPGTh-2 \| UGT2B7 \| UGTB2B9 \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9 \| Intestinal H(+)/peptide cotransporter \| Oligopeptide transporter, small intestine isoform \| PEPT1 \| Peptide transporter 1 \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2	[ "Fluvastatin", "Fluvastatin", "Fluvastatin", "Fluvastatin", "Fluvastatin", "Fluvastatin Sodium", "Fluvastatin Sodium", "Fluvastatin Sodium", "Fluvastatin Sodium", "Fluvastatin Sodium", "Fluvastatin Sodium", "Fluvastatin Sodium", "Fluvastatin Sodium ER", "Fluvastatin Sodium ER", "Lescol", "Lescol", "Lescol", "Lescol", "Lescol 20mg", "Lescol 40mg", "Lescol XL", "Lescol XL", "Lescol XL", "Lescol XL", "Lescol XL", "Sandoz Fluvastatin", "Sandoz Fluvastatin", "Sandoz Fluvastatin XL", "Teva-fluvastatin", "Teva-fluvastatin" ]	[ "Canef", "Cranoc" ]	[]	[ "P04035", "Q92769" ]	[ "P04798", "P08684", "P20815", "P10632", "P11712", "P33261", "P10635", "P22309", "P35503", "P16662", "P20813" ]	[]	[ "Q9Y6L6", "Q9NPD5", "O94956", "P46059", "Q92887" ]
DB00710	Ibandronate	Ibandronate, or BM 21.0955, is a third generation, nitrogen containing bisphosphonate similar to [zoledronic acid], [minodronic acid], and [risedronic acid].[A203111,A203138] It is used to prevent and treat postmenopausal osteoporosis.[L13805,L13808] Ibandronate was first described in the literature in 1993 as a treatment for bone loss in dogs.[A203138] Ibandronate was granted FDA approval on 16 May 2003.[L13805]	solid	For the treatment and prevention of osteoporosis in postmenopausal women.[L13805,L13808]	Ibandronate is a nitrogen containing bisphosphonate used to treat and prevent osteoporosis in postmenopausal women.[L13805,L13808] The therapeutic index is wide as overdoses are not especially toxic, and the duration of action is long as the half life can be up to 157 hours.[L13805,L13808] Patients should be counselled regarding the risk of upper GI adverse reactions, hypocalcemia, musculoskeletal pain, osteonecrosis of the jaw, atypical fractures of the femur, and severe renal impairment.[L13805,L13808]	Bisphosphonates are taken into the bone where they bind to hydroxyapatite. Bone resorption by osteoclasts causes local acidification, releasing the bisphosphonate, which is taken into the osteoclast by fluid-phase endocytosis.[A959] Endocytic vesicles become acidified, releasing bisphosphonates into the cytosol of osteoclasts where they act.[A959] Osteoclasts mediate resorption of bone.[A6366] When osteoclasts bind to bone they form podosomes, ring structures of F-actin.[A6366] Disruption of the podosomes causes osteoclasts to detach from bones, preventing bone resorption.[A6366] Nitrogen containing bisphosphonates such as ibandronate are known to induce apoptosis of hematopoietic tumor cells by inhibiting the components of the mevalonate pathway farnesyl diphosphate synthase, farnesyl diphosphate, and geranylgeranyl diphosphate.[A202769,A203147] These components are essential for post-translational prenylation of GTP-binding proteins like Rap1.[A202769] The lack of prenylation of these proteins interferes with their function, and in the case of Rap1, leads to apoptosis.[A202769] ibandronate also activated caspase-3 which contribute to apoptosis.[A203150]	Oral ibandronate is 0.63% bioavailable.[A203153] In a study of healthy males, a 10mg oral dose had a T<sub>max</sub> of 1.1±0.6h and a C<sub>max</sub> of 4.1±2.6ng/mL.[A203162] The T<sub>max</sub> is approximately 1 hour, while C<sub>max</sub> varies depending on dose.[A203162] A 2mg intravenous dose of ibandronate has an AUC of 316ng\h/mL, a 4mg intravenous dose of ibandronate has an AUC of 581ng\h/mL, and a 6mg intravenous dose of ibandronate has an AUC of 908ng\*h/mL.[A203159]	Ibanronate is not metabolized in humans.[L13805,L13808]	Patients experiencing an overdose may present with hypocalcemia, hypophosphatemia, upset stomach, dyspepsia, esophagitis, and uclers.[L13805,L13808] Oral overdose can be managed by giving patients milk or antacids to bind excess unabsorbed ibandronate.[L13805] Overdoses can be managed by providing intravenous electrolytes and dialysis is not expected to remove excess drug from serum.[L13805,L13808]	The half life of ibandronate in postmenopausal women ranges from 37-157 hours.[L13805,L13808]	Ibandronate's protein binding in serum varies from 85.7-99.5% over a concentration of 0.5-10ng/mL,[L13805] but is generally 86% across a concentration range of 20-2000ng/mL.[L13808]	Ibandronate is predominantly eliminated in the urine and the unabsorbed drug is eliminated unchanged in the feces.[A203153,L13805,L13808]	The apparent terminal volume of distribution of ibandronate is 90-368L in headlthy subjects and 103L in postmenopausal women with osteopenia.[A203153,L13805,L13808]	The total clearance of ibandronate is 84-160mL/min.[L13805,L13808]	Organic compounds	Organic acids and derivatives	Organic phosphonic acids and derivatives	Bisphosphonates	[ "approved", "investigational" ]	[ "M05BA", "M05B", "M05", "M", "M05BB", "M05B", "M05", "M" ]	[ "Humans and other mammals" ]	[ { "cost": "4.16", "description": "Boniva 2.5 mg tablet", "unit": "tablet" }, { "cost": "124.66", "description": "Boniva 150 mg tablet", "unit": "tablet" }, { "cost": "388.93", "description": "Boniva 3 150 mg tablet Disp Pack", "unit": "disp" }, { "cost": "504.06", "description": "Boniva 3 mg/3 ml syringe", "unit": "syringe" }, { "cost": "524.22", "description": "Boniva 3 mg/3ml Kit Box", "unit": "box" } ]	[ { "approved": "1990-05-22", "country": "United States", "expires": "2012-03-17", "number": "4927814" }, { "approved": "2006-05-09", "country": "Canada", "expires": "2019-10-01", "number": "2346662" }, { "approved": "2007-03-20", "country": "United States", "expires": "2023-11-06", "number": "7192938" }, { "approved": "2010-05-18", "country": "United States", "expires": "2023-11-06", "number": "7718634" }, { "approved": "2008-08-12", "country": "United States", "expires": "2023-05-06", "number": "7410957" }, { "approved": "2001-09-25", "country": "United States", "expires": "2019-10-07", "number": "6294196" }, { "approved": "2000-11-07", "country": "United States", "expires": "2017-04-21", "number": "6143326" } ]	ácido ibandrónico \| Ibandronic acid \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.- \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| Farnesyltranstransferase \| Geranylgeranyl diphosphate synthase \| Geranyltranstransferase \| GGPP synthase \| GGPPSase \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.10 \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| FPP synthase \| FPS \| Geranyltranstransferase \| KIAA1293	[ "Bondenza", "Bondenza", "Bondenza", "Bondenza", "Bondronat", "Bondronat", "Bondronat", "Bondronat", "Bondronat", "Bondronat", "Bondronat", "Boniva", "Boniva", "Boniva", "Boniva", "Boniva", "Boniva", "Bonviva", "Bonviva", "Bonviva", "Bonviva", "Iasibon", "Iasibon", "Iasibon", "Iasibon", "Iasibon", "Iasibon", "Iasibon", "Iasibon", "Iasibon", "Iasibon", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronate sodium", "Ibandronate Sodium", "Ibandronate Sodium", "Ibandronic Acid Accord", "Ibandronic Acid Accord", "Ibandronic Acid Accord", "Ibandronic Acid Accord", "Ibandronic Acid Accord", "Ibandronic Acid Accord", "Ibandronic Acid Sandoz", "Ibandronic Acid Sandoz", "Ibandronic Acid Sandoz", "Ibandronic Acid Sandoz", "Ibandronic Acid Sandoz", "Ibandronic Acid Teva", "Ibandronic Acid Teva", "Ibandronic Acid Teva", "Ibandronic Acid Teva" ]	[ "ADRONiL" ]	[]	[ "O95749", "P14324" ]	[]	[]	[]
DB00630	Alendronic acid	Alendronic acid is a second generation bisphosphonate that is used for the treatment of some forms of osteoperosis and Paget's disease[FDA Label][A959,A203111]. It functions by preventing resorption of bone[FDA Label][A959].	solid	Alendronic acid is indicated for the treatment and prevention of osteoporosis in men and postmenopausal women, treatment of glucocorticoid-induced osteoporosis, and Paget's disease of bone[FDA Label][A959,A176750]. However, alendronic acid is not indicated for use in pediatric populations or patients with a creatinine clearance <35mL/min[FDA Label].	Alendronic acid tablets have a very low oral bioavialability[FDA Label][A176750]. After administration it distributes into soft tissue and bone or is excreted in the urine[FDA Label]. Alendronic acid does not undergo metabolism[FDA Label].	Alendronic acid binds to bone hydroxyapatite[FDA Label]. Bone resorption causes local acidification, releasing alendronic acid which is that taken into osteoclasts by fluid-phase endocytosis[A959]. Endocytic vesicles are acidified, releasing alendronic acid to the cytosol of osteoclasts where they induce apoptosis[A959]. Inhibition of osteoclasts results in decreased bone resorption which is shown through decreased urinary calcium, deoxypyridinoline and cross-linked N-telopeptidases of type I collagen[FDA Label].	Mean oral bioavailability of alendronic acid in women is 0.64% and in men is 0.59%[FDA Label][A176750]. Bioavailability of alendronic acid decreases by up to 40% if it is taken within an hour of a meal[FDA Label].	Urinary excretion is the sole method of elimination of alendronic acid and no metabolites are detected upon urine collection[A176750].	In clinical studies, ≥3% of patients experience abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, musculoskeletal pain, and nausea[FDA Label]. No information for treatment of overdose is available, however patients should be given milk or antacids to bind alendronic acid and vomiting should not be induced[FDA Label]. Patients may experience hypocalcemia, hypophosphatemia, and upper gastrointestinal events.[FDA Label]. There are currently no studies for safety and efficacy in pregnancy, though studies in pregnant rats show fetal and maternal complications at 4 times the clinical dose and pregnant rabbits do not show complications at as high as 10 times the clincal dose[FDA Label]. Excretion in breast milk, and therefore safety in lactation, is unknown[FDA Label]. Alendronic acid has been studied for use in pediatric patients[FDA Label]. The oral bioavailability is similar to that in adult patients, but an increase in the portion of patients experiencing vomiting[FDA Label]. There is no significant difference in efficacy or safety of alendronic acid in geriatric populations, though there is potential for even greater sensitivity in patients at a further advanced age than those in the study[FDA Label]. Alendronic acid is not recommended for patients with creatinine clearance <35mL/min, but no dosage adjustment is necessary in hepatic impairment[FDA Label].	Due to alendronic acid being incorporated into the skeleton, the terminal half life is estimated to be over 10 years[FDA Label].	78%[FDA Label]. Studies in rats show that plasma protein binding increases with decreasing alendronic acid plasma concentration[A176768] and increasing pH[A176771].	Administration of radiolabeled alendronic acid results in 50% recovery in urine within 72 hours[FDA Label][A176771]. No alendronic acid is recovered in the feces[FDA Label][A176750,A176768]. Men excrete less alendronic acid than women, though race and advanced age do not affect elimination[FDA Label].	28L[FDA Label].	71mL/min[FDA Label].	Organic compounds	Organic acids and derivatives	Organic phosphonic acids and derivatives	Bisphosphonates	[ "approved" ]	[ "M05BB", "M05B", "M05", "M", "M05BA", "M05B", "M05", "M", "M05BB", "M05B", "M05", "M", "M05BB", "M05B", "M05", "M" ]	[ "Humans and other mammals" ]	[ { "cost": "2.99", "description": "Alendronate sodium 10 mg tablet", "unit": "tablet" }, { "cost": "2.99", "description": "Alendronate sodium 5 mg tablet", "unit": "tablet" }, { "cost": "3.4", "description": "Fosamax 10 mg tablet", "unit": "tablet" }, { "cost": "3.4", "description": "Fosamax 5 mg tablet", "unit": "tablet" }, { "cost": "6.73", "description": "Alendronate sodium 40 mg tablet", "unit": "tablet" }, { "cost": "7.52", "description": "Fosamax 40 mg tablet", "unit": "tablet" }, { "cost": "20.49", "description": "Alendronate sodium 35 mg tablet", "unit": "tablet" }, { "cost": "20.49", "description": "Alendronate sodium 70 mg tablet", "unit": "tablet" }, { "cost": "21.85", "description": "Fosamax plus d 70 mg-2800 iu", "unit": "each" }, { "cost": "23.36", "description": "Fosamax 35 mg tablet", "unit": "tablet" }, { "cost": "24.51", "description": "Fosamax 70 mg tablet", "unit": "tablet" }, { "cost": "25.88", "description": "Fosamax plus d 70 mg-5600 iu", "unit": "each" }, { "cost": "34.75", "description": "Fosamax 70 mg/75ml Solution 75ml Bottle", "unit": "bottle" }, { "cost": "85.23", "description": "Alendronate Sodium 4 35 mg tablet Package", "unit": "package" }, { "cost": "85.23", "description": "Alendronate Sodium 4 70 mg tablet Package", "unit": "package" }, { "cost": "97.2", "description": "Fosamax 1 Package = 4 tablet (35 mg) Package", "unit": "package" }, { "cost": "101.96", "description": "Fosamax 1 Package = 4 tablet (70 mg) Package", "unit": "package" }, { "cost": "107.66", "description": "Fosamax Plus D 4 70-2800 mg-Unit tablet Disp Pack", "unit": "disp" }, { "cost": "107.66", "description": "Fosamax Plus D 4 70-5600 mg-Unit tablet Disp Pack", "unit": "disp" } ]	[ { "approved": "1994-10-25", "country": "United States", "expires": "2012-12-02", "number": "5358941" }, { "approved": "2006-02-14", "country": "Canada", "expires": "2015-05-12", "number": "2190148" }, { "approved": "2001-08-21", "country": "Canada", "expires": "2018-07-17", "number": "2294595" }, { "approved": "1999-11-30", "country": "United States", "expires": "2019-01-17", "number": "5994329" }, { "approved": "2000-01-18", "country": "United States", "expires": "2019-01-17", "number": "6015801" }, { "approved": "2001-05-01", "country": "United States", "expires": "2019-01-17", "number": "6225294" }, { "approved": "2011-06-21", "country": "United States", "expires": "2023-03-06", "number": "7964212" }, { "approved": "2009-02-10", "country": "United States", "expires": "2023-08-11", "number": "7488496" }, { "approved": "2017-03-14", "country": "United States", "expires": "2031-12-05", "number": "9592195" } ]	(4-amino-1-hydroxybutane-1,1-diyl)bis(phosphonic acid) \| (4-amino-1-hydroxybutylidene)bisphosphonic acid \| 4-amino-1-hydroxybutane-1,1-diphosphonic acid \| ABDP \| Acide Alendronique \| Acido Alendronico \| Acidum Alendronicum \| Alendronate \| Alendronic acid \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.10 \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| FPP synthase \| FPS \| Geranyltranstransferase \| KIAA1293 \| 3.1.3.48 \| MEG \| Protein-tyrosine phosphatase MEG1 \| PTPase-MEG1 \| 3.1.3.48 \| R-PTP-S \| R-PTP-sigma \| Receptor-type tyrosine-protein phosphatase sigma \| 3.1.3.48 \| Protein-tyrosine phosphatase epsilon \| R-PTP-epsilon \| 7.1.2.2 \| ATP6A1 \| ATP6V1A1 \| V-ATPase 69 kDa subunit \| V-ATPase subunit A \| Vacuolar ATPase isoform VA68 \| Vacuolar proton pump subunit alpha \| VPP2	[ "Accel-alendronate", "Accel-alendronate", "Accel-alendronate", "Ach-alendronate", "Ach-alendronate", "Ach-alendronate", "Act Alendronate", "Act Alendronate", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Ag-alendronate", "Ag-alendronate", "Ag-alendronate", "Ag-alendronate Sodium", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate Sodium", "Alendronate-10", "Alendronate-40", "Alendronate-5", "Alendronate-70", "Alendronate-cholecalciferol", "Alendronate-cholecalciferol", "Apo-alendronate", "Apo-alendronate", "Apo-alendronate", "Apo-alendronate", "Apo-alendronate/vitamin D3", "Apo-alendronate/vitamin D3", "Auro-alendronate", "Auro-alendronate", "Ava-alendronate", "Ava-alendronate", "Ava-alendronate", "Ava-alendronate", "Binosto", "Binosto", "Binosto", "Dom-alendronate", "Dom-alendronate-FC", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax", "Fosamax Plus D", "Fosamax Plus D", "Fosamax Plus D", "Fosamax Plus D", "Fosamax Plus D", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Gen-alendronate", "Jamp Alendronate / Vitamin D3", "Jamp Alendronate / Vitamin D3", "Jamp Alendronate Sodium", "Jamp-alendronate", "Jamp-alendronate", "Jamp-alendronate", "M-alendronate", "M-alendronate", "M-alendronate", "Mint-alendronate", "Mint-alendronate", "Mint-alendronate", "Mylan-alendronate", "Mylan-alendronate", "Nra-alendronate", "Nra-alendronate", "Nra-alendronate", "PHL-alendronate", "PMS-alendronate", "PMS-alendronate-FC", "Q-alendronate", "Ran-alendronate", "Ran-alendronate", "Ran-alendronate", "Ratio Alendronate", "Riva Alendronate", "Riva Alendronate", "Riva-alendronate", "Riva-alendronate", "Riva-alendronate Fc", "Sandoz Alendronate", "Sandoz Alendronate", "Sandoz Alendronate", "Sandoz Alendronate", "Sandoz Alendronate/cholecalciferol", "Teva-alendronate", "Teva-alendronate", "Teva-alendronate", "Teva-alendronate/cholecalciferol", "Teva-alendronate/cholecalciferol", "Van-alendronate", "Van-alendronate", "Van-alendronate", "Vantavo", "Vantavo", "Vantavo", "Vantavo", "Vantavo", "Vantavo", "Vantavo" ]	[ "Alenotop", "Alned", "Arendal", "Beenos", "Berlex", "Denfos", "Densidron", "Dronat", "Durost", "Fixopan", "Forosa", "Fosagen", "Fosalen", "Fosmin", "Fostolin", "Fosval", "Huesobone", "Lendrate", "Oseolen", "Ostemax" ]	[ "Fosamax Plus D", "Fosamax Plus D", "Fosamax Plus D", "Fosamax Plus D", "Fosamax Plus D", "Fosavance", "Fosavance", "Teva-alendronate/cholecalciferol", "Teva-alendronate/cholecalciferol", "Sandoz Alendronate/cholecalciferol", "Alendronate-cholecalciferol", "Alendronate-cholecalciferol", "Apo-alendronate/vitamin D3", "Apo-alendronate/vitamin D3", "Jamp Alendronate / Vitamin D3", "Jamp Alendronate / Vitamin D3", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Fosavance", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Adrovance", "Vantavo", "Vantavo", "Vantavo", "Vantavo", "Vantavo", "Vantavo", "Vantavo" ]	[ "P14324", "P29074", "Q13332", "P23469", "P38606" ]	[]	[]	[]
DB00884	Risedronic acid	Risedronic acid is a third generation bisphosphonate that is used for the treatment of some forms of osteoperosis and Paget's disease[FDA Label][A959,A203111]. It functions by preventing resorption of bone[FDA Label][A959].	solid	Risedronic acid is indicated for the treatment of osteoperosis in men, treatment of Paget's disease, treatment and prevention of osteoperosis in postmenopausal women, and treatment and prevention of glucocorticoid-induced osteoperosis[FDA Label].	Risedronate is a pyridine-based bisphosphonate that inhibits bone resorption caused by osteoclasts[FDA Label].	Risedronatic acid binds to bone hydroxyapatite[FDA Label]. Bone resorption causes local acidification, releasing risedronic acid which is that taken into osteoclasts by fluid-phase endocytosis[A959]. Endocytic vesicles are acidified, releasing risedronic acid to the cytosol of osteoclasts where they induce apoptosis through inhbition of farnesyl pyrophosphate synthase[A959]. Inhibition of osteoclasts results in decreased bone resorption[A959].	Oral bioavailability is 0.63% and maximum absorption is approximately 1 hour after dosing[FDA Label]. Administration half and hour before a meal reduces bioavailability by 55% compared to fasting and dosing 1 hour before a meal reduces bioavailability by 30%[FDA Label].	Risedronic acid is not likely not metabolized before elimination[FDA Label]. The P-C-P group of bisphosphonates is resistant to chemical and enzymatic hydrolysis preventing metabolism of the molecule[A959].	In clinical trials, over 10% of patients experienced back pain, arthralgia, abdominal pain, and dyspepsia[FDA Label]. Less commonly, patients experience angioedema, generalized rash, bullous skin reactions, iritis, and uveitis[FDA Label]. Patients experiencing an overdose may experience a decrease in serum calcium and phosphorus[FDA Label]. Patients can be given milk or antacids to bind the drug and reduce its absorption[FDA Label]. In more severe cases, patients may require gastric lavage and intravenous calcium[FDA Label]. A lethal dose in rats is equivalent to 320 to 620 times the human dose based on surface area[FDA Label].	The initial half life of risedronic acid is approximately 1.5 hours[T536], with a terminal half life of 561 hours[FDA Label].	~24%[FDA Label].	Risedronate is excreted by the kidneys and the unabsorbed dose is eliminated in the feces[FDA Label].	13.8 L/kg[FDA Label].	Mean renal clearance was 52mL/min and mean total clearance was 73mL/min[FDA Label].	Organic compounds	Organic acids and derivatives	Organic phosphonic acids and derivatives	Bisphosphonates	[ "approved", "investigational" ]	[ "M05BB", "M05B", "M05", "M", "M05BB", "M05B", "M05", "M", "M05BB", "M05B", "M05", "M", "M05BA", "M05B", "M05", "M" ]	[ "Humans and other mammals" ]	[ { "cost": "3.92", "description": "Actonel with calcium tablet", "unit": "tablet" }, { "cost": "4.13", "description": "Actonel 5 mg tablet", "unit": "tablet" }, { "cost": "28.75", "description": "Actonel 35 mg tablet", "unit": "tablet" }, { "cost": "29.32", "description": "Actonel 30 mg tablet", "unit": "tablet" }, { "cost": "54.83", "description": "Actonel 75 mg tablet", "unit": "tablet" }, { "cost": "119.43", "description": "Actonel 4 35 mg tablet Disp Pack", "unit": "disp" }, { "cost": "125.1", "description": "Actonel 150 mg tablet", "unit": "tablet" } ]	[ { "approved": "2000-08-01", "country": "United States", "expires": "2011-11-22", "number": "6096342" }, { "approved": "2001-08-21", "country": "Canada", "expires": "2018-07-17", "number": "2294595" }, { "approved": "2007-03-27", "country": "Canada", "expires": "2021-02-01", "number": "2399976" }, { "approved": "2007-03-20", "country": "United States", "expires": "2023-11-06", "number": "7192938" }, { "approved": "2010-05-18", "country": "United States", "expires": "2023-11-06", "number": "7718634" }, { "approved": "2000-12-26", "country": "United States", "expires": "2018-12-10", "number": "6165513" }, { "approved": "1999-11-30", "country": "United States", "expires": "2019-01-17", "number": "5994329" }, { "approved": "2000-01-18", "country": "United States", "expires": "2019-01-17", "number": "6015801" }, { "approved": "2002-08-13", "country": "United States", "expires": "2019-01-17", "number": "6432932" }, { "approved": "2002-10-15", "country": "United States", "expires": "2019-02-14", "number": "6465443" }, { "approved": "2010-01-12", "country": "United States", "expires": "2028-01-09", "number": "7645459" }, { "approved": "2010-01-12", "country": "United States", "expires": "2028-01-09", "number": "7645460" }, { "approved": "2012-08-21", "country": "United States", "expires": "2026-01-16", "number": "8246989" } ]	Acide risédroniqe \| Acido risedronico \| Acidum risedronicum \| Risedronate \| Risedronic acid \| Risedronsäure \| (2E,6E)-farnesyl diphosphate synthase \| 2.5.1.10 \| Dimethylallyltranstransferase \| Farnesyl diphosphate synthase \| FPP synthase \| FPS \| Geranyltranstransferase \| KIAA1293 \| 1.14.99.1 \| COX-2 \| COX2 \| Cyclooxygenase-2 \| PGH synthase 2 \| PGHS-2 \| PHS II \| Prostaglandin H2 synthase 2 \| Prostaglandin-endoperoxide synthase 2	[ "Aa-risedronate Dr", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel Dr", "Actonel Plus Calcium", "Actonel Sachet Kit", "Actonel With Calcium", "Actonel With Calcium", "Actonel with Calcium", "Actonel with Calcium", "Apo-risedronate", "Apo-risedronate", "Atelvia", "Atelvia", "Auro-risedronate", "Auro-risedronate", "Auro-risedronate", "Auro-risedronate", "Dom-risedronate", "Jamp-risedronate", "Mylan-risedronate", "Mylan-risedronate", "Ntp-risedronate", "Ntp-risedronate", "Ntp-risedronate", "Pendo-risedronate", "PHL-risedronate", "PMS-risedronate", "PMS-risedronate", "PMS-risedronate Plus Calcium", "Q-risedronate", "Ratio-risedronate", "Risedronate", "Risedronate", "Risedronate", "Risedronate", "Risedronate", "Risedronate", "Risedronate", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium Amorphous Fv2910cl", "Riva-risedronate", "Sandoz Risedronate", "Teva-risedronate", "Teva-risedronate", "Teva-risedronate", "Teva-risedronate", "Teva-risedronate/calcium" ]	[ "Benet", "Ridron" ]	[ "Actonel With Calcium", "Actonel With Calcium", "Actonel with Calcium", "Actonel with Calcium", "Atelvia", "Atelvia", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Risedronate Sodium", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Actonel", "Risedronate Sodium", "Risedronate Sodium", "PMS-risedronate Plus Calcium", "Actonel Plus Calcium", "Actonel Sachet Kit", "Teva-risedronate/calcium" ]	[ "P14324" ]	[ "P35354" ]	[]	[]
DB00170	Menadione	A synthetic naphthoquinone without the isoprenoid side chain and biological activity, but can be converted to active vitamin K2, menaquinone, after alkylation in vivo.	solid	The primary known function of vitamin K is to assist in the normal clotting of blood, but it may also play a role in normal bone calcification.	Menadione (Vitamin K3) is a fat-soluble vitamin precursor that is converted into menaquinone in the liver. Vitamin K1 and K2 are the naturally occurring types of vitamin K. The former, which is also known as phylloquinone, is synthesized by plants and can be found in such foods as spinach, broccoli, lettuce, and soybeans. The latter, sometimes alternatively referred to as menaquinone, is primarily produced by bacteria in the anterior part of the gut and the intestines. Vitamin K3, on the other hand, is one of the many manmade versions of vitamin K. Also called menadione, this yellowish, synthetic crystalline substance is converted into the active form of the K2 vitamin inside of the animal body. While a vitamin K deficiency can be dangerous, especially to infants that may easily suffer from extensive hemorrhaging, an overdose can be as equally detrimental. Newborns that are administered too great a dosage of vitamin K3 can suffer from kernicterus, a form of severe brain damage that may produce decreased movement, loss of appetite, seizures, deafness, mental retardation, and even death. This condition is associated with an abnormally high concentration of bilirubin, a bile pigment, in the tissues of the brain, which can be caused by the presence of K3. For this reason, K3 is less often utilized medically than it was in former times.	Menadione (vitamin K3) is involved as a cofactor in the posttranslational gamma-carboxylation of glutamic acid residues of certain proteins in the body. These proteins include the vitamin K-dependent coagulation factors II (prothrombin), VII (proconvertin), IX (Christmas factor), X (Stuart factor), protein C, protein S, protein Zv and a growth-arrest-specific factor (Gas6). In contrast to the other vitamin K-dependent proteins in the blood coagulation cascade, protein C and protein S serve anticoagulant roles. The two vitamin K-dependent proteins found in bone are osteocalcin, also known as bone G1a (gamma-carboxyglutamate) protein or BGP, and the matrix G1a protein or MGP. Gamma-carboxylation is catalyzed by the vitamin K-dependent gamma-carboxylases. The reduced form of vitamin K, vitamin K hydroquinone, is the actual cofactor for the gamma-carboxylases. Proteins containing gamma-carboxyglutamate are called G1a proteins.	Variable and ranges from 10% to 80%	Hepatic	Menadione (vitamin K3), which is not used as a nutritional supplemental form of vitamin K for humans, has been reported to cause adverse reactions, including hemolytic anemia. Large doses have also been reported to cause brain damage.	null	null	null	null	null	Organic compounds	Benzenoids	Naphthalenes	Naphthoquinones	[ "approved", "nutraceutical" ]	[ "B02BA", "B02B", "B02", "B" ]	[ "Humans and other mammals" ]	[ { "cost": "5.59", "description": "Menadione powder", "unit": "g" } ]	[]	2-Methyl-1,4-Naphthalenedione \| 2-Methyl-1,4-naphthochinon \| 2-Methyl-1,4-naphthoquinone \| Menadione \| Vitamin K 3 \| Vitamin K3 \| 1.2.3.1 \| Aldehyde oxidase 1 \| AO \| Azaheterocycle hydroxylase \| 4.1.1.90 \| Gamma-glutamyl carboxylase \| GC \| Peptidyl-glutamate 4-carboxylase \| Vitamin K gamma glutamyl carboxylase \| 1.17.4.4 \| Vitamin K1 2,3-epoxide reductase subunit 1 \| VKOR \| 1.17.4.4 \| VKORC1-like protein 1 \| 3.4.21.5 \| Coagulation factor II \| 3.4.21.22 \| Christmas factor \| Plasma thromboplastin component \| PTC \| 3.4.21.69 \| Anticoagulant protein C \| Autoprothrombin IIA \| Blood coagulation factor XIV \| PROS \| 1.10.5.1 \| NMOR2 \| NRH dehydrogenase [quinone] 2 \| NRH:quinone oxidoreductase 2 \| QR2 \| Quinone reductase 2 \| 1.6.5.2 \| Azoreductase \| DIA4 \| DT-diaphorase \| DTD \| Menadione reductase \| NAD(P)H:quinone oxidoreductase 1 \| NMOR1 \| Phylloquinone reductase \| QR1 \| Quinone reductase 1 \| BGP \| Bone Gla protein \| Gamma-carboxyglutamic acid-containing protein \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.14.- \| Coumarin 7-hydroxylase \| CYP2A3 \| CYPIIA6 \| Cytochrome P450 IIA3 \| Cytochrome P450(I) \| 1.14.14.1 \| CYPIB1 \| Hydroperoxy icosatetraenoate dehydratase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| XDHA \| 1.2.3.1 \| Aldehyde oxidase 1 \| AO \| Azaheterocycle hydroxylase \| 1.5.1.53 \| 1.14.14.1 \| CYPIA1 \| Cytochrome P450 form 6 \| Cytochrome P450-C \| Cytochrome P450-P1 \| Hydroperoxy icosatetraenoate dehydratase	[]	[ "Synkavite" ]	[]	[ "Q06278", "P38435", "Q9BQB6", "Q8N0U8", "P00734", "P00740", "P04070", "P07225", "P16083", "P15559", "P02818" ]	[ "P05177", "P11509", "Q16678", "P20813", "P10632", "P11712", "P33261", "P10635", "P05181", "P08684", "P20815", "P24462", "P47989", "Q06278", "P42898", "P04798" ]	[]	[]
DB01729	1D-myo-inositol 1,3,4-trisphosphate	null	solid	null	null	null	null	null	null	null	null	null	null	null	Organic compounds	Organic oxygen compounds	Organooxygen compounds	Alcohols and polyols	[ "experimental" ]	[]	[]	[]	[]	(1S,3S,4S)-1,3,4-triphospho-myo-inositol \| 1D-myo-inositol 1,3,4-trisphosphate \| D-myo-Inositol 1,3,4-trisphosphate \| Inositol 1,3,4-trisphosphate	[]	[]	[]	[]	[]	[]	[]
DB13178	Inositol	Inositol is a collection of nine different stereoisomers but the name is usually used to describe only the most common type of inositol, myo-inositol. Myo-inositol is the cis-1,2,3,5-trans-4,6-cyclohexanehexol and it is prepared from an aqueous extract of corn kernels by precipitation and hydrolysis of crude phytate. These molecules have structural similarities to glucose and are involved in cellular signaling. It is considered a pseudovitamin as it is a molecule that does not qualify to be an essential vitamin because even though its presence is vital in the body, a deficiency in this molecule does not translate into disease conditions.[L2560] Inositol can be found as an ingredient of OTC products by Health Canada but all current product whose main ingredient is inositol are discontinued.[L1113] By the FDA, inositol is considered in the list of specific substances affirmed as generally recognized as safe (GRAS).[L2561]	solid	Inositol may be used in food without any limitation. As a drug, inositol is used as a nutrient supplement in special dietary foods and infant formula.[L2561] As it presents a relevant role in ensuring oocyte fertility, inositol has been studied for its use in the management of polycystic ovaries.[A32751] Inositol is also being researched for the treatment of diabetes,[A32766] prevention of metabolic syndrome,[A32768] aid agent for weight loss,[A32769] treatment of depression, psychiatric disorder and anxiety disorder[A32770] and for prevention of cancer.[A32771]	Inositol can stimulate glucose uptake in skeletal muscle cells which allows the decrease in blood sugar levels. This effect is later seen as a reduction in urine glucose concentration and indicates a decrease in high blood sugar levels.[A32776] In PCOS, the administration of inositol has produced the remission of symptoms as well as a reduction in male hormone secretion[A32777], a regulation of the cholesterol level,[A32768] and a more efficient fat breakdown which allow to a significant reduction on body mass and appetite.[A32779] In the cases of infertility, inositol has been proven to increase sperm count and motility,[A32794] as well as increase the overall quality of oocytes and embryos.[A32795] In the brain, inositol has been shown to produce an increase in serotonin receptor sensitivity. This activity produces an increase in GABA release.[A32781] Some of the effects observed in the brain produced a relief in symptoms of anxiety and obsessive-compulsive disorders.[A32783] In high doses, it has been shown to even reduce panic attacks.[A32784] In cancer research, inositol has gained interest as it can act as an antioxidant, anti-inflammatory and it seems to enhance immune properties.[A32771]	The mechanism of action of inositol in brain disorders is not fully understood but it is thought that it may be involved in neurotransmitter synthesis and it is a precursor to the phosphatidylinositol cycle. The change that occurs in the cycle simulates when the postsynaptic receptor is activated but without activating the receptor. This activity provokes a fake activation which regulated the activity of monoamines and other neurotransmitters.[T184] Reports have shown that insulin resistance plays a key role in the clinical development of PCOS. The presence of hyperinsulinemia can induce an excess in androgen production by stimulating ovaries to produce androgens and by reducing the sex hormone binding globulin serum levels. One of the mechanisms of insulin deficiency is thought to be related to a deficiency in inositol in the inositolphosphoglycans. The administration of inositol allows it to act as a direct messenger of the insulin signaling and improves glucose tissue uptake.[A32800] This mechanism is extrapolated to its functions in diabetes treatment, metabolic syndrome, and weight loss.[F17] In cancer, the mechanism of action of inositol is not fully understood. It is hypothesized that the administration of inositol increases the level of lower-phosphate inositol phosphates why can affect cycle regulation, growth, and differentiation of malignant cells. On the other hand, the formation of inositol hexaphosphate after administration of inositol presents antioxidant characteristics by the chelation of ferric ions and suppression of hydroxyl radicals.[A32801]	Inositol is absorbed from the small intestine.[T184] In patients with inositol deficiency, the maximal plasma concentration after oral administration of inositol is registered to be of 4 hours.[A32803] Inositol is taken up by the tissues via sodium-dependent inositol co-transporter which also mediates glucose uptake.[A32804] Oral ingestion of inositol is registered to generate a maximal plasma concentration of 36-45 mcg.[A32805]	It is thought that inositol is metabolized to phosphoinositol and then converted to phosphatylinositol-4,5-biphosphate which is a precursor of the second-messenger molecules.[T184] Inositol can be transformed to D-chiro-inositol via the actions of an epimerase. The normal modifications to inositol structure seem to be between all the different isomers.[A32806]	Consumption of high doses of inositol is reported to only cause some gastrointestinal effects.[A32811]	The pharmacokinetic profile of inositol was studied in preterm infants and the estimated elimination half-life was reported to be of 5.22 hours.[A32802]	It is thought that inositol can be found bound to plasma proteins.	Most of the administered dose is excreted in urine.[A32809]	The pharmacokinetic profile of inositol was studied in preterm infants and the estimated volume of distribution was reported to be 0.5115 L/kg.[A32802]	The pharmacokinetic profile of inositol was studied in preterm infants and the estimated clearance rate was reported to be 0.0679 L.kg/h.[A32802]	Organic compounds	Organic oxygen compounds	Organooxygen compounds	Alcohols and polyols	[ "approved", "investigational", "withdrawn" ]	[ "A11HA", "A11H", "A11", "A" ]	[ "Humans and other mammals" ]	[]	[]	1,2,3,5/4,6-cyclohexanehexol \| cis-1,2,3,5-trans-4,6-cyclohexanehexol \| Inositol \| L-myo-Inositol \| Meat sugar \| meso-Inositol \| myo-inositol \| Na(+)/myo-inositol cotransporter \| SMIT1 \| Sodium/myo-inositol transporter 1 \| Solute carrier family 5 member 3	[ "24 Multivitamins + Minerals", "50 Plus", "Advanced 2000 Capsules", "Alertonic", "Alertonic", "Alkadrenergy Tablets", "American Eagle Energizer Plus Vitamin Supplement Drink", "American Plus Energy & Vitamin Drink", "Amino-cerv", "B 50 Capsules", "B Complex 25mg Vitamin Supplement", "B Complex 50 Vitamin Cap", "B Complex 50+ Caplet", "B Compound 50mg Tab", "B-100 Caps", "B-100 Vitamin Supplement", "B-50 Complex", "B-50 Hi Potency B Vitamins Tab", "B-complex", "B-complex 100", "B-complex 50", "B-complex Tab", "B-complex With Vitamin C, Biotin, Folic Acid", "B-complex-50 Tab", "B-plex", "B-plus - Tab", "B50 Complex", "Balanced B 125 Srt", "Bev 29 Tab", "Bev B-150", "Bev-lipo-1000", "Biosculpt", "Body Rox", "Body Tropics Plus Tab", "C. Vit-min Formula", "C.A.G. Tab", "Calcium Magnesium Plus Vitamin D Liquid", "Card-floe II Tab", "Children's Chewable Multivitamins and Minerals", "Children's Chewable Vit and Min Tab", "Choline & Inositol Caps", "Choline and Inositol 250mg/250mg", "Choline Inositol Methionine", "Chromium and Vanadium Mineral Supplement", "Classic Swiss One 10 Multivitamin and Mineral Tab", "Complete Mega B", "Complete Mega B", "Complete Multivitamins and Minerals Tablets Timed Release", "Complete One A Day Tab", "Complete One-A-day - Tab", "Complexe B Compose 75", "Cyruta Tab", "Daily Energy Brand Vitamin & Mineral Drink Mix", "Deriton", "Derma-force", "Doctor's Choice Brand for Men", "Dp 2000", "Essential B Tablets", "Extra Once A Day", "For-2", "Formula 9 Tab", "Formula C.I. Tab", "Formula Cm", "Formula F L W", "Formula Gly", "Formula Hh", "Formula Lf", "Formula Pro-B", "Forty Plus Vitamin Supplement", "Fusion PM Formula Tab", "Gnc Choline/inositol 250mg Tablets", "Grand Master Formula Tab", "H.W. Children's Chewable Multi Vit & Mineral", "Harvest Of Values All B Complex Tab", "Hi Potency B Complex W Chelated Minerals", "Hi Potency B52 B Complex Tab", "Hi Potency Multi Tab", "Hi Potency Stress B Tension With C", "Hoa 1", "Hyporyl - Tab", "Innersource Tab", "Inositol 250mg - Tab", "Inositol 500mg", "Inositol Caps 500mg", "Inositol Ctr Srt 400mg", "Inositol Nicotinate Plus CR", "Inositol Tab 250mg", "Inositol Tab 250mg", "Inositol Tab 405mg", "Inositol-S Tab 400mg", "Inositolex 400mgms", "Insur-all Vitamin Supplement", "L Fac Tab", "L.C. Supplement", "Lip - Fac Formula", "Lipall Plus Tab", "Lipo Factors Plus B6", "Lipo-B-C Tab", "Lipotrope Tab", "Lipotrope-plus B6 Tab", "Lipotropic Adjunct", "Lipotropic Ctr", "Lipotropics 600 Tab", "Lipovite", "Liqui B Complex", "Liqui B Complex Plus", "Liqui Vita", "Liquid B Complex 50", "Low Potency B Complex Tab", "Magnum-75 Vitamin and Mineral Supplement", "Maintain Multiple Vitamin & Minerals", "Master Key Multi Vitamin Multi Mineral Formula 2", "Maximum Once A Day", "Maxine Vitamin and Mineral Supplement", "Maxum Multi-vite", "Mega 13 Multivitamin Formula", "Mega Balance", "Mega Capsules", "Mega Lipotropic Cap", "Mega Plex III - Pck", "Mega Plex III - Pck", "Mega Plex IV - Pck", "Mega Plex IV - Pck", "Mega Vitaminerals", "Mega-vim 75 With Beta-carotene - Tablets", "Men's 50+", "Men's Biomultiple Vitamin and Mineral Supplement", "Men's Multi Master Formula", "Mic B12", "Mini-B Tab", "Multi B", "Multi Flow Tablets", "Multi II IV Vi Tab", "Multi Plex I - Tab", "Multi Plex II - Tab", "Multi Spectrum - Tablet", "Multi Tabs", "Multi Vitamin-mineral Formula", "Multi-force for Adults Tab", "Multi-force for Women Tab", "Multi-phyto Capsules", "Multicaps", "Multipack II", "Multiple Vitamins and Minerals Capsules", "Multitabs", "Multivitamin & Minerals (iron Free)", "Multivitamin & Multimineral", "Multivitamine", "Multivitamins and Minerals for Men", "Multivitamins and Minerals for Women", "Multivitamins and Minerals for Young Men", "Multivitamins and Minerals for Young Women", "Multivitamins and Minerals With Betacarotene Tablets", "Multra Plex", "Multra With Iron", "My Favorite Niacin and Inositol Tab", "Natural Source Spectrum With Beta Carotene", "Neomultivite", "Neonatal Plus Vitamin", "Neonatal Vitamin", "New Chapter's D'adamo 4 Your Type Multiple for Type O", "Niacin 500 Mg and Inositol", "Nitro Vites - Tab", "Nrg Plus Liq", "Olympian Multi Vit Plus Minerals Tab", "Onccor", "One A Day Multiple Vit W Minerals", "One A Day Tab", "Only One - Tablet", "Orti B", "Palm Spring's PM Form Tab", "Phytopure", "Phytovim Cap", "Prenatal Formula Tab", "Prenatal Vi-min", "Prenatvite", "Prenatvite Plus", "Protect Plus SO 60", "Red American Eagle Vitamin Supplement Drink", "Revit Multi-vitamins and Minerals", "Revitalize Multi-vitamin and Mineral Complex", "Revitex Ampoules Et Comprimes", "Right Choice P.M. Multi Formula - Caplet", "Rocky Mountain Multiple Vit and Min Mega Tab", "Spectrum 2 Cap", "Stom #2", "Stress B & C Caplet", "Stress B Capsules With Vitamin C", "Stress B With 1000 Mg Vitamin C", "Stress B&c Tab", "Stress Ctr Srt", "Stress Formula B-comp + 500mg Vit C Tab", "Stress Formula Multi-B Comp + 500mg Vit C Cap", "Stress Formula Vit B With C Complex", "Stress Forte Plus Lipotropic Factors", "Stress Vitamin B With C Complex Tablets", "Stressmates", "Super B Compound W 500mg Vit C", "Super Daily No 2", "Super Multi", "Super Stress Capsules", "Super Stress Mega B Plus 1000mg Vit C Tab", "Super Vita Vim Multivitamins and Minerals", "Super Vita-vim With Beta-carotene - Tab", "Super-pote Vitamin Supplement", "Swiss One", "Swiss One Multi Vit & Chel Min Tab", "Swiss One Multivitamin and Mineral Caplet", "Swiss One Timed Release Tab", "Time Release B 100 Compound - Tablet", "Timed Release B Complex 100 Srt", "Timed Release B-complex 100", "Timed Release B-complex 50", "Timed Release Vita-vim Srt", "Twin G.F. Powder", "Twin G.F. Powder", "Twin G.F. Powder Vanilla Flavor", "Twin Opti Pwr", "Ultimate Tab", "Ultr F/b E.S. Mega Lipotropic Fmla W B6bet", "Ultra Hr", "Usana Megavitamin Tablets - Tab", "Vasula Tab", "Vege 1 Daily Tab", "Vege Swiss One Multivitamin W Chel Mins Tab", "Vit B Complex Ctr", "Vit-HA Multi Vitamin and Zinc Supplement", "Vita B Complex Tab", "Vita Balance 2000", "Vita Plex Tab", "Vita Vim Multivitamins and Minerals Tab", "Vita Vim With Beta Carotene-caplet", "Vita-B", "Vita-vim - Tab", "Vita-vim With Beta-carotene - Tab", "Vita-worth B-complex Tablets", "Vitachrom Gc", "Vitalife - Capsule", "Vitamin & Mineral Formula 1 Dietary Supplement", "Vitamin B + C Cap", "Vitamin B Complex 100 Tab", "Vitamin B Complex 50", "Vitamin B Complex Suppl", "Vitamin B Complex W C Tab", "Vitamin B Compound W C Tab 500mg", "Vitamin B Compound W Vit C 250mg Tab", "Vitamin B Tablets", "Vitaplex", "Wellness Formula", "Women's Biomultiple Vitamin and Mineral Supplement", "Women's Formula" ]	[]	[ "Lipovite", "Mic B12", "Neonatal Plus Vitamin", "Neomultivite", "Neonatal Vitamin", "Prenatvite", "Prenatvite Plus", "Vita Plex Tab", "One A Day Tab", "Olympian Multi Vit Plus Minerals Tab", "Mega Balance", "Vitaplex", "One A Day Multiple Vit W Minerals", "Right Choice P.M. Multi Formula - Caplet", "C. Vit-min Formula", "Alertonic", "Lipo-B-C Tab", "Super Stress Capsules", "Hi Potency Multi Tab", "Maxine Vitamin and Mineral Supplement", "Low Potency B Complex Tab", "Vitamin B + C Cap", "Swiss One Multivitamin and Mineral Caplet", "Vege Swiss One Multivitamin W Chel Mins Tab", "Cyruta Tab", "Lipotrope-plus B6 Tab", "Vasula Tab", "Rocky Mountain Multiple Vit and Min Mega Tab", "Extra Once A Day", "Stress B&c Tab", "Ultimate Tab", "Formula C.I. Tab", "Alertonic", "Multi Flow Tablets", "Fusion PM Formula Tab", "Palm Spring's PM Form Tab", "Lipotrope Tab", "Maximum Once A Day", "Timed Release B Complex 100 Srt", "Innersource Tab", "Prenatal Formula Tab", "Timed Release Vita-vim Srt", "Card-floe II Tab", "Vitamin B Complex 100 Tab", "B Complex 50 Vitamin Cap", "Body Tropics Plus Tab", "Super Vita Vim Multivitamins and Minerals", "Natural Source Spectrum With Beta Carotene", "Inositol Nicotinate Plus CR", "Stressmates", "Liqui B Complex", "Liqui Vita", "Twin Opti Pwr", "Mini-B Tab", "Liqui B Complex Plus", "Twin G.F. Powder", "Twin G.F. Powder Vanilla Flavor", "Twin G.F. Powder", "Only One - Tablet", "Vita Vim Multivitamins and Minerals Tab", "Mega-vim 75 With Beta-carotene - Tablets", "Formula Gly", "Prenatal Vi-min", "Harvest Of Values All B Complex Tab", "Grand Master Formula Tab", "B-50 Complex", "50 Plus", "My Favorite Niacin and Inositol Tab", "Amino-cerv", "Mega Capsules", "Vitalife - Capsule", "Multi Spectrum - Tablet", "24 Multivitamins + Minerals", "Essential B Tablets", "Vita-worth B-complex Tablets", "H.W. Children's Chewable Multi Vit & Mineral", "Time Release B 100 Compound - Tablet", "Calcium Magnesium Plus Vitamin D Liquid", "Dp 2000", "Vitamin B Compound W C Tab 500mg", "Complete One-A-day - Tab", "Vitamin B Complex W C Tab", "Multi-phyto Capsules", "Hyporyl - Tab", "Usana Megavitamin Tablets - Tab", "Vitamin B Compound W Vit C 250mg Tab", "Lipall Plus Tab", "Balanced B 125 Srt", "Lipotropics 600 Tab", "Hi Potency B52 B Complex Tab", "For-2", "Maxum Multi-vite", "Vita-vim - Tab", "Super Vita-vim With Beta-carotene - Tab", "Doctor's Choice Brand for Men", "Hi Potency Stress B Tension With C", "Master Key Multi Vitamin Multi Mineral Formula 2", "L Fac Tab", "Orti B", "Swiss One", "Complexe B Compose 75", "Lipotropic Adjunct", "Vita-B", "Mega Lipotropic Cap", "Hi Potency B Complex W Chelated Minerals", "Children's Chewable Multivitamins and Minerals", "B-complex-50 Tab", "Revitalize Multi-vitamin and Mineral Complex", "Complete Mega B", "Complete Multivitamins and Minerals Tablets Timed Release", "B Complex 25mg Vitamin Supplement", "B-100 Vitamin Supplement", "Vitamin & Mineral Formula 1 Dietary Supplement", "Revit Multi-vitamins and Minerals", "Vitamin B Complex Suppl", "Formula F L W", "L.C. Supplement", "B-plex", "Formula Lf", "Formula Pro-B", "Liquid B Complex 50", "Advanced 2000 Capsules", "Classic Swiss One 10 Multivitamin and Mineral Tab", "Vita B Complex Tab", "Multra Plex", "Chromium and Vanadium Mineral Supplement", "Vitachrom Gc", "Vitamin B Tablets", "Niacin 500 Mg and Inositol", "Complete Mega B", "Stress Formula Vit B With C Complex", "Deriton", "Multivitamins and Minerals for Men", "Multivitamins and Minerals for Women", "Bev-lipo-1000", "Multra With Iron", "Bev B-150", "Multitabs", "B-complex With Vitamin C, Biotin, Folic Acid", "Multipack II", "Biosculpt", "Multicaps", "Men's 50+", "Hoa 1", "Multivitamins and Minerals With Betacarotene Tablets", "Super Multi", "Stress Vitamin B With C Complex Tablets", "Super B Compound W 500mg Vit C", "Multi Tabs", "Stress B With 1000 Mg Vitamin C", "Multivitamin & Minerals (iron Free)", "Multivitamin & Multimineral", "Body Rox", "B50 Complex", "Daily Energy Brand Vitamin & Mineral Drink Mix", "Stress Formula B-comp + 500mg Vit C Tab", "Super Stress Mega B Plus 1000mg Vit C Tab", "Stress Formula Multi-B Comp + 500mg Vit C Cap", "Bev 29 Tab", "Swiss One Multi Vit & Chel Min Tab", "Vege 1 Daily Tab", "B Compound 50mg Tab", "B 50 Capsules", "Stress B Capsules With Vitamin C", "Maintain Multiple Vitamin & Minerals", "Choline Inositol Methionine", "Revitex Ampoules Et Comprimes", "Multi II IV Vi Tab", "B-complex Tab", "Mega 13 Multivitamin Formula", "Spectrum 2 Cap", "Multi B", "Men's Biomultiple Vitamin and Mineral Supplement", "Women's Biomultiple Vitamin and Mineral Supplement", "Complete One A Day Tab", "Ultr F/b E.S. Mega Lipotropic Fmla W B6bet", "Nitro Vites - Tab", "Multi Plex I - Tab", "Multi Plex II - Tab", "Mega Plex III - Pck", "Mega Plex III - Pck", "Mega Plex IV - Pck", "Mega Plex IV - Pck", "B-plus - Tab", "Lipotropic Ctr", "Vit B Complex Ctr", "Stress Ctr Srt", "Onccor", "Alkadrenergy Tablets", "American Eagle Energizer Plus Vitamin Supplement Drink", "Red American Eagle Vitamin Supplement Drink", "American Plus Energy & Vitamin Drink", "Vita Balance 2000", "Magnum-75 Vitamin and Mineral Supplement", "Formula Cm", "Formula Hh", "Children's Chewable Vit and Min Tab", "Super Daily No 2", "Formula 9 Tab", "Phytopure", "Multi-force for Women Tab", "Multi-force for Adults Tab", "Vit-HA Multi Vitamin and Zinc Supplement", "B Complex 50+ Caplet", "Stress Forte Plus Lipotropic Factors", "Vita Vim With Beta Carotene-caplet", "Choline & Inositol Caps", "Stress B & C Caplet", "B-50 Hi Potency B Vitamins Tab", "C.A.G. Tab", "Nrg Plus Liq", "Phytovim Cap", "Gnc Choline/inositol 250mg Tablets", "Swiss One Timed Release Tab", "Vita-vim With Beta-carotene - Tab", "Choline and Inositol 250mg/250mg", "B-complex 50", "Timed Release B-complex 50", "Timed Release B-complex 100", "B-complex 100", "Multi Vitamin-mineral Formula", "Lip - Fac Formula", "Men's Multi Master Formula", "Women's Formula", "Multivitamine", "B-complex", "Super-pote Vitamin Supplement", "Forty Plus Vitamin Supplement", "Insur-all Vitamin Supplement", "Stom #2", "Multivitamins and Minerals for Young Men", "Multivitamins and Minerals for Young Women", "Vitamin B Complex 50", "B-100 Caps", "Multiple Vitamins and Minerals Capsules", "Lipo Factors Plus B6", "Derma-force", "Mega Vitaminerals", "Ultra Hr", "Wellness Formula", "Protect Plus SO 60", "New Chapter's D'adamo 4 Your Type Multiple for Type O" ]	[]	[]	[]	[ "P53794" ]
DB04465	Lactose	A disaccharide of glucose and galactose in human and cow milk. It is used in pharmacy for tablets, in medicine as a nutrient, and in industry.	solid	null	null	null	null	null	null	null	null	null	null	null	Organic compounds	Organic oxygen compounds	Organooxygen compounds	Carbohydrates and carbohydrate conjugates	[ "approved", "experimental", "investigational" ]	[]	[]	[]	[]	35 kDa lectin \| Carbohydrate-binding protein 35 \| CBP 35 \| Gal-3 \| Galactose-specific lectin 3 \| Galactoside-binding protein \| GALBP \| IgE-binding protein \| L-31 \| Laminin-binding protein \| Lectin L-29 \| Mac-2 antigen \| MAC2 \| 3.2.1.18 \| Neuraminidase \| 3.2.1.23 \| Acid beta-galactosidase \| Elastin receptor 1 \| ELNR1 \| Lactase \| 3.2.1.23 \| Beta-gal \| Lactase \| 2.4.1.- \| Galactosyltransferase family 6 domain-containing 1 \| GLTDC1 \| GT6M7 \| GLTP \| 3.2.1.8 \| 1,4-beta-D-xylan xylanohydrolase A \| 3.2.1.8 \| Xylanase A	[ "Lac-tol Pwr 50gm/pck", "Lactol" ]	[]	[ "Lac-tol Pwr 50gm/pck", "Lactol" ]	[ "P17931", "P16278", "Q7Z4J2", "Q9NZD2" ]	[]	[]	[]
DB00176	Fluvoxamine	Fluvoxamine is an antidepressant which functions pharmacologically as a selective serotonin reuptake inhibitor. Though it is in the same class as other SSRI drugs, it is most often used to treat obsessive-compulsive disorder. Fluvoxamine has been in use in clinical practice since 1983 and has a clinical trial database comprised of approximately 35,000 patients. It was launched in the US in December 1994 and in Japan in June 1999. As of the end of 1995, more than 10 million patients worldwide have been treated with fluvoxamine.	solid	Indicated predominantly for the management of depression and for Obsessive Compulsive Disorder (OCD) [FDA Label]. Has also been used in the management of bulimia nervosa [A250].	Fluvoxamine, an aralkylketone-derivative agent [FDA Label], is one of a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) that differs structurally from other SSRIs [A249]. It is used to treat the depression associated with mood disorders. It is also used on occassion in the treatment of body dysmorphic disorder and anxiety [A249]. The antidepressant, antiobsessive-compulsive, and antibulimic actions of Fluvoxamine are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin [FDA Label, A249, A250]. <i>In vitro</i> studies show that Fluvoxamine is a potent and selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake [A250]. Moreover, apart from binding to σ1 receptors [A250], fluvoxamine has no significant affinity for adrenergic (alpha1, alpha2, beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT<sub>1A</sub>, 5HT<sub>1B</sub>, 5HT<sub>2</sub>), or benzodiazepine receptors; antagonism of such receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs [A249]. Furthermore, some studies have demonstrated that the chronic administration of Fluvoxamine was found to downregulate brain norepinephrine receptors (as has been observed with other drugs effective in the treatment of major depressive disorder), while others suggest the opposite [A31914].	The exact mechanism of action of fluvoxamine has not been fully determined, but appears to be linked to its inhibition of CNS neuronal uptake of serotonin [FDA Label, A249, A250]. Fluvoxamine blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT<sub>1A</sub> autoreceptors [FDA Label, A249, A250]. Studies have also demonstrated that fluvoxamine has virtually no affinity for α<sub>1</sub>- or α<sub>2</sub>-adrenergic, β-adrenergic, muscarinic, dopamine D<sub>2</sub>, histamine H<sub>1</sub>, GABA-benzodiazepine, opiate, 5-HT<sub>1</sub>, or 5-HT<sub>2</sub> receptors, despite having an affinity for binding to σ1 receptors [A250].	Well absorbed, bioavailability of fluvoxamine maleate is 53% [FDA Label].	Fluvoxamine is metabolized extensively by the liver [FDA Label].	Fluvoxamine is a member of antidepressants that possess an increased risk compared to placebo of suicidal thinking and behaviour (suicidality) in children, adolescents, and young adults (ages including and and below 24) in short-term studies of major depressive disorder and other psychiatric disorders [FDA Label]. Fluvoxamine maleate tablets are not approved for use in pediatric patients except for patients with obsessive compulsive disorder (OCD) [FDA Label]. Side effects include anorexia, constipation, dry mouth, headache, nausea, nervousness, skin rash, sleep problems, somnolence, liver toxicity, mania, increase urination, seizures, sweating increase, tremors, or Tourette's syndrome [FDA Label].	15.6 hours [FDA Label].	~77-80% (plasma protein) [FDA Label].	Nine metabolites were identified following a 5 mg radio labelled dose of fluvoxamine maleate, constituting approximately 85% of the urinary excretion products of fluvoxamine [FDA Label]. The main human metabolite was fluvoxamine acid which, together with its N-acetylated analog, accounted for about 60% of the urinary excretion products [FDA Label]. Approximately 2% of fluvoxamine was excreted in urine unchanged [FDA Label]. Following a 14C-labelled oral dose of fluvoxamine maleate (5 mg), an average of 94% of drug-related products was recovered in the urine within 71 hours [FDA Label].	* 25 L/kg [FDA Label].	null	null	null	null	null	[ "approved", "investigational" ]	[ "N06AB", "N06A", "N06", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.7", "description": "Luvox 100 mg Tablet", "unit": "tablet" }, { "cost": "2.34", "description": "Fluvoxamine maleate 25 mg tablet", "unit": "tablet" }, { "cost": "2.61", "description": "Fluvoxamine maleate 50 mg tablet", "unit": "tablet" }, { "cost": "2.63", "description": "Fluvoxamine mal 100 mg tablet", "unit": "tablet" }, { "cost": "2.69", "description": "Fluvoxamine maleate 100 mg tablet", "unit": "tablet" }, { "cost": "5.82", "description": "Luvox cr 100 mg capsule", "unit": "capsule" }, { "cost": "6.05", "description": "Luvox CR 100 mg 24 Hour Capsule", "unit": "capsule" }, { "cost": "6.24", "description": "Luvox cr 150 mg capsule", "unit": "capsule" }, { "cost": "6.34", "description": "Luvox CR 150 mg 24 Hour Capsule", "unit": "capsule" }, { "cost": "0.52", "description": "Apo-Fluvoxamine 50 mg Tablet", "unit": "tablet" }, { "cost": "0.52", "description": "Co Fluvoxamine 50 mg Tablet", "unit": "tablet" }, { "cost": "0.52", "description": "Novo-Fluvoxamine 50 mg Tablet", "unit": "tablet" }, { "cost": "0.52", "description": "Nu-Fluvoxamine 50 mg Tablet", "unit": "tablet" }, { "cost": "0.52", "description": "Pms-Fluvoxamine 50 mg Tablet", "unit": "tablet" }, { "cost": "0.52", "description": "Ratio-Fluvoxamine 50 mg Tablet", "unit": "tablet" }, { "cost": "0.52", "description": "Sandoz Fluvoxamine 50 mg Tablet", "unit": "tablet" }, { "cost": "0.93", "description": "Apo-Fluvoxamine 100 mg Tablet", "unit": "tablet" }, { "cost": "0.93", "description": "Co Fluvoxamine 100 mg Tablet", "unit": "tablet" }, { "cost": "0.93", "description": "Novo-Fluvoxamine 100 mg Tablet", "unit": "tablet" }, { "cost": "0.93", "description": "Nu-Fluvoxamine 100 mg Tablet", "unit": "tablet" }, { "cost": "0.93", "description": "Pms-Fluvoxamine 100 mg Tablet", "unit": "tablet" }, { "cost": "0.93", "description": "Ratio-Fluvoxamine 100 mg Tablet", "unit": "tablet" }, { "cost": "0.93", "description": "Sandoz Fluvoxamine 100 mg Tablet", "unit": "tablet" }, { "cost": "0.95", "description": "Luvox 50 mg Tablet", "unit": "tablet" } ]	[ { "approved": "2008-12-16", "country": "United States", "expires": "2020-05-10", "number": "7465462" } ]	Fluvoxamina \| Fluvoxamine \| Fluvoxaminum \| 5HT transporter \| 5HTT \| HTT \| SERT \| Solute carrier family 6 member 4 \| Eag homolog \| Eag-related protein 1 \| ERG \| ERG-1 \| ERG1 \| Ether-a-go-go-related gene potassium channel 1 \| Ether-a-go-go-related protein 1 \| H-ERG \| HERG \| hERG-1 \| hERG1 \| Potassium voltage-gated channel subfamily H member 2 \| Voltage-gated potassium channel subunit Kv11.1 \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| 1.14.14.1 \| CYPIA1 \| Cytochrome P450 form 6 \| Cytochrome P450-C \| Cytochrome P450-P1 \| Hydroperoxy icosatetraenoate dehydratase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP	[ "Apo-fluvoxamine", "Apo-fluvoxamine", "Ava-fluvoxamine", "Ava-fluvoxamine", "Bci Fluvoxamine Tablets", "Bci Fluvoxamine Tablets", "Dom-fluvoxamine", "Dom-fluvoxamine", "Fluvoxamine", "Fluvoxamine", "Fluvoxamine maleate", "Fluvoxamine maleate", "Fluvoxamine maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine maleate", "Fluvoxamine maleate", "Fluvoxamine maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine maleate", "Fluvoxamine maleate", "Fluvoxamine maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Maleate", "Fluvoxamine Tablets", "Fluvoxamine Tablets", "Fluvoxamine-100", "Fluvoxamine-50", "Gen-fluvoxamine 100mg", "Gen-fluvoxamine 50mg", "Luvox", "Luvox", "Luvox CR", "Luvox CR", "Novo-fluvoxamine", "Novo-fluvoxamine", "PHL-fluvoxamine", "PHL-fluvoxamine", "PMS-fluvoxamine", "PMS-fluvoxamine", "Ratio-fluvoxamine", "Ratio-fluvoxamine", "Riva-fluvox", "Riva-fluvox", "Riva-fluvox 100mg Tablets", "Riva-fluvox 50mg Tablets", "Sandoz Fluvoxamine", "Sandoz Fluvoxamine", "Teva-fluvoxamine", "Teva-fluvoxamine" ]	[ "Dumirox", "Faverin", "Fevarin", "Floxyfral", "Maveral" ]	[]	[ "P31645", "Q12809" ]	[ "P10635", "P05177", "P04798", "P08684", "P08684", "Q9HB55", "P20815", "P24462", "P11712", "P33261", "P20813" ]	[]	[ "P08183", "O95342" ]
DB00177	Valsartan	Valsartan belongs to the angiotensin II receptor blocker (ARB) family of drugs, which also includes [telmisartan], [candesartan], [losartan], [olmesartan], and [irbesartan]. ARBs selectively bind to angiotensin receptor 1 (AT1) and prevent the protein angiotensin II from binding and exerting its hypertensive effects, which include vasoconstriction, stimulation and synthesis of aldosterone and ADH, cardiac stimulation, and renal reabsorption of sodium, among others. Overall, valsartan's physiologic effects lead to reduced blood pressure, lower aldosterone levels, reduced cardiac activity, and increased excretion of sodium. Valsartan also affects the renin-angiotensin aldosterone system (RAAS), which plays an important role in hemostasis and regulation of kidney, vascular, and cardiac functions. Pharmacological blockade of RAAS via AT1 receptor blockade inhibits negative regulatory feedback within RAAS, which is a contributing factor to the pathogenesis and progression of cardiovascular disease, heart failure, and renal disease. In particular, heart failure is associated with chronic activation of RAAS, leading to inappropriate fluid retention, vasoconstriction, and ultimately a further decline in left ventricular function. ARBs have been shown to have a protective effect on the heart by improving cardiac function, reducing afterload, increasing cardiac output and preventing ventricular hypertrophy and remodelling.[A174154] By comparison, the angiotensin-converting enzyme inhibitor (ACEI) class of medications (which includes drugs such as [ramipril], [lisinopril], and [perindopril]) inhibit the conversion of angiotensin I to angiotensin II through inhibition of the ACE enzyme. However, this does not prevent the formation of all angiotensin II within the body. The angiotensin II receptor blocker (ARB) family of drugs unique in that it blocks all angiotensin II activity, regardless of where or how it was synthesized. Valsartan is commonly used for the management of hypertension, heart failure, and Type 2 Diabetes-associated nephropathy, particularly in patients who are unable to tolerate ACE inhibitors. ARBs such as valsartan have been shown in a number of large-scale clinical outcomes trials to improve cardiovascular outcomes including reducing risk of myocardial infarction, stroke, the progression of heart failure, and hospitalization.[A174124,A178153,A173869,A185324,A185327,A185333,A185342,A185345] Valsartan also slows the progression of diabetic nephropathy due to its renoprotective effects.[A174157,A174160,A174163] Improvements in chronic kidney disease with valsartan include both clinically and statistically significant decreases in urinary albumin and protein excretion in patients diagnosed with type 2 diabetes and in nondiabetic patients diagnosed with chronic kidney disease.[A174124,A173869] Valsartan was initially approved in 1996 in Europe for the treatment of hypertension in adults. Shortly after, in 1997, this drug was approved in the United States.[A174124] Valsartan is generally well-tolerated with a side-effect profile superior to that of other antihypertensive drugs.[A174130,A174133]	solid	Valsartan is indicated for the treatment of hypertension to reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It is also indicated for the treatment of heart failure (NYHA class II-IV) and for left ventricular dysfunction or failure after myocardial infarction when the use of an angiotensin-converting enzyme inhibitor (ACEI) is not appropriate.[F4703, L11305] It is also used in combination with [sacubitril].[L36445]	Valsartan inhibits the pressor effects of angiotensin II with oral doses of 80 mg inhibiting the pressor effect by about 80% at peak with approximately 30% inhibition persisting for 24 hours. Removal of the negative feedback of angiotensin II causes a 2- to 3-fold rise in plasma renin and consequent rise in angiotensin II plasma concentration in hypertensive patients. Minimal decreases in plasma aldosterone were observed after administration of valsartan. In multiple-dose studies in hypertensive patients, valsartan had no notable effects on total cholesterol, fasting triglycerides, fasting serum glucose, or uric acid.[L11305] Hypotension Excessive hypotension was rarely seen (0.1%) in patients with uncomplicated hypertension treated with valsartan alone. In patients with an activated renin-angiotensin system, such as volume- and/or salt-depleted patients receiving high doses of diuretics, symptomatic hypotension may occur. This condition should be corrected prior to administration of valsartan, or the treatment should start under close medical supervision. Caution should be observed when initiating therapy in patients with heart failure. Patients with heart failure given valsartan commonly have some reduction in blood pressure, but discontinuation of therapy because of continuing symptomatic hypotension usually is not necessary when dosing instructions are followed. In controlled trials in heart failure patients, the incidence of hypotension in valsartan-treated patients was 5.5% compared to 1.8% in placebo-treated patients. If excessive hypotension occurs, the patient should be placed in the supine position and, if necessary, given an intravenous infusion of normal saline. A transient hypotensive response is not a contraindication to further treatment, which usually can be continued without difficulty once the blood pressure has stabilized.[L11305] Impaired Renal Function Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system and by diuretics. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute renal failure on valsartan. Monitor renal function periodically in these patients. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function on valsartan.[L11305] Hyperkalemia Some patients with heart failure have developed increases in potassium. These effects are usually minor and transient, and they are more likely to occur in patients with pre-existing renal impairment. Dosage reduction and/or discontinuation of valsartan may be required.[L11305]	Valsartan belongs to the angiotensin II receptor blocker (ARB) family of drugs, which selectively bind to angiotensin receptor 1 (AT1) and prevent angiotensin II from binding and exerting its hypertensive effects. These include vasoconstriction, stimulation and synthesis of aldosterone and ADH, cardiac stimulation, and renal reabsorption of sodium among others. Overall, valsartan's physiologic effects lead to reduced blood pressure, lower aldosterone levels, reduced cardiac activity, and increased excretion of sodium. Valsartan also affects the renin-angiotensin aldosterone system (RAAS), which plays an important role in hemostasis and regulation of kidney, vascular, and cardiac functions. Pharmacological blockade of RAAS via AT1 receptor blockade inhibits negative regulatory feedback within RAAS which is a contributing factor to the pathogenesis and progression of cardiovascular disease, heart failure, and renal disease. In particular, heart failure is associated with chronic activation of RAAS, leading to inappropriate fluid retention, vasoconstriction, and ultimately a further decline in left ventricular function. ARBs have been shown to have a protective effect on the heart by improving cardiac function, reducing afterload, increasing cardiac output and prevent ventricular hypertrophy.[A174154] The angiotensin-converting enzyme inhibitor (ACEI) class of medications (which includes drugs such as [ramipril], [lisinopril], and [perindopril]) inhibits the conversion of angiotensin I to angiotensin II by inhibiting the ACE enzyme but does not prevent the formation of all angiotensin II. ARB activity is unique in that it blocks all angiotensin II activity, regardless of where or how it was synthesized. Valsartan is commonly used for the management of hypertension, heart failure, and type 2 diabetes-associated nephropathy, particularly in patients who are unable to tolerate ACE inhibitors. ARBs such as valsartan have been shown in a number of large-scale clinical outcomes trials to improve cardiovascular outcomes including reducing risk of myocardial infarction, stroke, the progression of heart failure, and hospitalization.[A174124,A178153,A173869,A185324,A185327,A185333,A185342,A185345] Valsartan also slows the progression of diabetic nephropathy due to its renoprotective effects.[A174157,A174160,A174163] Improvements in chronic kidney disease with valsartan include both clinically and statistically significant decreases in urinary albumin and protein excretion in patients diagnosed with type 2 diabetes and in nondiabetic patients diagnosed with chronic kidney disease.[A174124,A173869] Valsartan also binds to the AT2 receptor, however AT2 is not known to be associated with cardiovascular homeostasis like AT1. Valsartan has about 20,000-fold higher affinity for the AT1 receptor than for the AT2 receptor. The increased plasma levels of angiotensin II following AT1 receptor blockade with valsartan may stimulate the unblocked AT2 receptor.[L11305]	After one oral dose, the antihypertensive activity of valsartan begins within approximately 2 hours and peaks within 4-6 hours in most patients.[L40064] Food decreases the exposure to orally administered valsartan by approximately 40% and peak plasma concentration by approximately 50%. AUC and Cmax values of valsartan generally increase linearly with increasing dose over the therapeutic dose range. Valsartan does not accumulate appreciably in plasma following repetitive administration.[L11305]	Valsartan undergoes minimal liver metabolism and is not biotransformed to a high degree, as only approximately 20% of a single dose is recovered as metabolites.[A174124,L40064] The primary metabolite, accounting for about 9% of dose, is valeryl 4-hydroxy valsartan. In vitro metabolism studies involving recombinant CYP 450 enzymes indicated that the CYP 2C9 isoenzyme is responsible for the formation of valeryl-4-hydroxy valsartan. Valsartan does not inhibit CYP 450 isozymes at clinically relevant concentrations. CYP 450 mediated drug interaction between valsartan and coadministered drugs are unlikely because of the low extent of metabolism.[L11305]	Approximate LD50 >2000 mg/kg (Gavage, rat) [L40064] Reproductive Toxicology Studies No teratogenic effects were seen when valsartan was given to pregnant mice and rats at oral doses up to 600 mg/kg/day and to pregnant rabbits at oral doses reaching up to 10 mg/kg/day. Despite this, marked decreases in fetal weight, pup birth weight, pup survival rate, and delays in developmental milestones were noted in studies in which parental rats were treated with valsartan at oral, maternally toxic doses of 600 mg/kg/day during the organogenesis period or during late gestation and lactation.[L11305] Pregnancy When used in pregnancy, drugs that act directly on the renin-angiotensin system (RAAS) can cause injury and death to the developing fetus. When pregnancy is detected, valsartan should be discontinued as soon as possible.[L11305]	After intravenous (IV) administration, valsartan demonstrates bi-exponential decay kinetics, with an average elimination half-life of about 6 hours.[L11305]	Valsartan is highly bound to serum proteins (95%), mainly serum albumin.[L11305]	Valsartan, when administered as an oral solution, is primarily recovered in feces (about 83% of dose) and urine (about 13% of dose). The recovery is mainly as unchanged drug, with only about 20% of dose recovered as metabolites.[L11305]	The steady-state volume of distribution of valsartan after intravenous administration is small (17 L), indicating that valsartan does not distribute into tissues extensively.[L40064]	Following intravenous administration, plasma clearance of valsartan is approximately 2 L/hour and its renal clearance is 0.62 L/hour (about 30% of total clearance).[L11305]	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved", "investigational" ]	[ "C09DX", "C09D", "C09", "C", "C10BX", "C10B", "C10", "C", "C09DA", "C09D", "C09", "C", "C09CA", "C09C", "C09", "C", "C09DX", "C09D", "C09", "C", "C09DX", "C09D", "C09", "C", "C09DB", "C09D", "C09", "C", "C09DB", "C09D", "C09", "C", "C09DX", "C09D", "C09", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "2.32", "description": "Diovan 40 mg tablet", "unit": "tablet" }, { "cost": "2.33", "description": "Diovan 80 mg tablet", "unit": "tablet" }, { "cost": "2.42", "description": "Diovan 160 mg tablet", "unit": "tablet" }, { "cost": "3.0", "description": "Diovan hct 80-12.5 mg tablet", "unit": "tablet" }, { "cost": "3.17", "description": "Diovan 320 mg tablet", "unit": "tablet" }, { "cost": "3.27", "description": "Diovan hct 160-12.5 mg tablet", "unit": "tablet" }, { "cost": "3.66", "description": "Diovan hct 160-25 mg tablet", "unit": "tablet" }, { "cost": "4.1", "description": "Diovan hct 320-12.5 mg tablet", "unit": "tablet" }, { "cost": "4.63", "description": "Diovan hct 320-25 mg tablet", "unit": "tablet" } ]	[ { "approved": "1995-03-21", "country": "United States", "expires": "2012-03-21", "number": "5399578" }, { "approved": "2009-09-29", "country": "Canada", "expires": "2017-06-18", "number": "2259148" }, { "approved": "1998-12-29", "country": "Canada", "expires": "2011-02-15", "number": "2036427" }, { "approved": "2001-09-25", "country": "United States", "expires": "2017-12-18", "number": "6294197" }, { "approved": "1996-09-24", "country": "United States", "expires": "2019-01-21", "number": "5559111" }, { "approved": "2002-05-28", "country": "United States", "expires": "2019-07-08", "number": "6395728" }, { "approved": "1999-10-26", "country": "United States", "expires": "2017-04-26", "number": "5972990" }, { "approved": "2012-05-01", "country": "United States", "expires": "2026-07-03", "number": "8168616" }, { "approved": "2012-01-24", "country": "United States", "expires": "2023-05-16", "number": "8101599" }, { "approved": "2013-07-02", "country": "United States", "expires": "2023-11-16", "number": "8475839" }, { "approved": "2014-08-05", "country": "United States", "expires": "2023-07-14", "number": "8796331" }, { "approved": "2012-01-24", "country": "United States", "expires": "2023-07-14", "number": "8101659" }, { "approved": "2008-12-23", "country": "United States", "expires": "2024-05-27", "number": "7468390" }, { "approved": "2013-03-26", "country": "United States", "expires": "2023-07-14", "number": "8404744" }, { "approved": "2014-11-04", "country": "United States", "expires": "2027-11-27", "number": "8877938" }, { "approved": "2010-09-28", "country": "United States", "expires": "2026-08-29", "number": "7803838" }, { "approved": "2010-11-23", "country": "United States", "expires": "2027-10-04", "number": "7838552" }, { "approved": "2016-07-12", "country": "United States", "expires": "2027-05-08", "number": "9388134" }, { "approved": "2016-12-13", "country": "United States", "expires": "2033-08-22", "number": "9517226" }, { "approved": "2018-04-10", "country": "United States", "expires": "2033-08-22", "number": "9937143" }, { "approved": "2021-07-13", "country": "United States", "expires": "2036-05-09", "number": "11058667" }, { "approved": "2021-10-05", "country": "United States", "expires": "2033-08-22", "number": "11135192" }, { "approved": "2017-02-02", "country": "United States", "expires": "2037-02-02", "number": "10722471" } ]	(S)-N-Valeryl-N-{[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]-methyl}-valine \| N-(P-(O-1H-Tetrazol-5-ylphenyl)benzyl)-N-valeryl-L-valine \| N-pentanoyl-N-{[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl}-L-valine \| Valsartan \| AGTR1A \| AGTR1B \| Angiotensin II type-1 receptor \| AT1 receptor \| AT1AR \| AT1BR \| AT2R1 \| AT2R1B \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2	[ "Act Valsartan", "Act Valsartan", "Act Valsartan", "Act Valsartan", "AMLODIPINE and VALSARTAN", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and valsartan", "Amlodipine and valsartan", "Amlodipine and valsartan", "Amlodipine and valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Apo-valsartan", "Apo-valsartan", "Apo-valsartan", "Apo-valsartan", "Apo-valsartan/hctz", "Apo-valsartan/hctz", "Apo-valsartan/hctz", "Apo-valsartan/hctz", "Apo-valsartan/hctz", "Auro-valsartan", "Auro-valsartan", "Auro-valsartan", "Auro-valsartan", "Auro-valsartan HCT", "Auro-valsartan HCT", "Auro-valsartan HCT", "Auro-valsartan HCT", "Auro-valsartan HCT", "Ava-valsartan", "Ava-valsartan", "Ava-valsartan", "Ava-valsartan", "Ava-valsartan HCT", "Ava-valsartan HCT", "Ava-valsartan HCT", "Ava-valsartan HCT", "Ava-valsartan HCT", "Byvalson", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan", "Diovan 160mg", "Diovan 160mg Tablets", "Diovan 80mg", "Diovan 80mg Tablets", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan-hct", "Diovan-hct", "Diovan-hct", "Diovan-hct", "Diovan-hct", "Dom-valsartan", "Dom-valsartan", "Dom-valsartan", "Dom-valsartan", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "M-valsartan", "M-valsartan", "M-valsartan", "M-valsartan", "M-valsartan", "M-valsartan", "Mylan-valsartan", "Mylan-valsartan", "Mylan-valsartan", "Mylan-valsartan", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Novo-valsartan", "Novo-valsartan", "Novo-valsartan", "Novo-valsartan", "Novo-valsartan/hctz", "Novo-valsartan/hctz", "Novo-valsartan/hctz", "PMS-valsartan", "PMS-valsartan", "PMS-valsartan", "PMS-valsartan", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "Prexxartan", "Q-valsartan", "Q-valsartan", "Q-valsartan", "Q-valsartan", "Q-valsartan Hctz", "Q-valsartan Hctz", "Q-valsartan Hctz", "Q-valsartan Hctz", "Q-valsartan Hctz", "Reddy-valsartan", "Reddy-valsartan", "Reddy-valsartan", "Riva-valsartan", "Riva-valsartan", "Riva-valsartan", "Riva-valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril-valsartan", "Sacubitril-valsartan", "Sacubitril-valsartan", "Sandoz Valsartan", "Sandoz Valsartan", "Sandoz Valsartan", "Sandoz Valsartan", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Taro-valsartan", "Taro-valsartan", "Taro-valsartan", "Teva-valsartan", "Teva-valsartan", "Teva-valsartan", "Teva-valsartan", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCTZ", "Valsartan-hctz", "Valsartan-hctz", "Valsartan-hctz", "Valsartan-hctz", "Valsartan-hctz", "Valsartan/htcz", "Valturna", "Valturna" ]	[]	[ "Diovan HCT", "Exforge HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Valturna", "Valturna", "Exforge", "Exforge", "Exforge", "Exforge", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan HCTZ", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "AMLODIPINE and VALSARTAN", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Exforge HCT", "Exforge", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Diovan HCT", "Diovan HCT", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Diovan HCT", "Valsartan and Hydrochlorothiazide", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine and valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine, Valsartan, and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan/htcz", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and valsartan", "Amlodipine and valsartan", "Amlodipine and valsartan", "Amlodipine and valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Diovan HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge", "Exforge", "Exforge", "Exforge", "Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Entresto", "Entresto", "Entresto", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Valsartan and hydrochlorothiazide", "Byvalson", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Diovan HCT", "Diovan HCT", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Diovan-hct", "Diovan-hct", "Diovan-hct", "Diovan-hct", "Diovan-hct", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Teva-valsartan/hctz", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan-hctz", "Valsartan-hctz", "Valsartan-hctz", "Apo-valsartan/hctz", "Apo-valsartan/hctz", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Valsartan HCT", "Auro-valsartan HCT", "Auro-valsartan HCT", "Auro-valsartan HCT", "Auro-valsartan HCT", "Auro-valsartan HCT", "Ava-valsartan HCT", "Ava-valsartan HCT", "Ava-valsartan HCT", "Ava-valsartan HCT", "Ava-valsartan HCT", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "PMS-valsartan-hctz", "Novo-valsartan/hctz", "Novo-valsartan/hctz", "Novo-valsartan/hctz", "Q-valsartan Hctz", "Q-valsartan Hctz", "Q-valsartan Hctz", "Q-valsartan Hctz", "Q-valsartan Hctz", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Sandoz Valsartan HCT", "Entresto", "Entresto", "Entresto", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Mylan-valsartan Hctz", "Apo-valsartan/hctz", "Apo-valsartan/hctz", "Apo-valsartan/hctz", "Valsartan-hctz", "Valsartan-hctz", "Entresto", "Entresto", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Amlodipine, Valsartan, Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Valsartan and Hydrochlorothiazide", "Sacubitril-valsartan", "Sacubitril-valsartan", "Sacubitril-valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Valsartan and Hydrochlorothiazide", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Imprida HCT", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Neparvis", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Dafiro", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Entresto", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine-valsartan Mylan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Amlodipine and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Sacubitril and Valsartan", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Copalia HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Dafiro HCT", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Imprida", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge HCT", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge", "Exforge" ]	[ "P30556" ]	[ "P11712" ]	[]	[ "Q9NPD5", "Q9Y6L6", "Q92887" ]
DB00178	Ramipril	Ramipril is a prodrug belonging to the angiotensin-converting enzyme (ACE) inhibitor class of medications. It is metabolized to ramiprilat in the liver and, to a lesser extent, kidneys. Ramiprilat is a potent, competitive inhibitor of ACE, the enzyme responsible for the conversion of angiotensin I (ATI) to angiotensin II (ATII). ATII regulates blood pressure and is a key component of the renin-angiotensin-aldosterone system (RAAS). Ramipril may be used in the treatment of hypertension, congestive heart failure, nephropathy, and to reduce the rate of death, myocardial infarction and stroke in individuals at high risk of cardiovascular events.	solid	For the management of mild to severe hypertension. May be used to reduce cardiovascular mortality following myocardial infarction in hemodynamically stable individuals who develop clinical signs of congestive heart failure within a few days following myocardial infarction. [FDA Label] To reduce the rate of death, myocardial infarction and stroke in individuals at high risk of cardiovascular events. May be used to slow the progression of renal disease in individuals with hypertension, diabetes mellitus and microalubinuria or overt nephropathy. [T116]	Ramipril is an ACE inhibitor similar to benazepril, fosinopril and quinapril. [T116] It is an inactive prodrug that is converted to ramiprilat in the liver, the main site of activation, and kidneys. Ramiprilat confers blood pressure lowing effects by antagonizing the effect of the RAAS. The RAAS is a homeostatic mechanism for regulating hemodynamics, water and electrolyte balance. During sympathetic stimulation or when renal blood pressure or blood flow is reduced, renin is released from the granular cells of the juxtaglomerular apparatus in the kidneys. In the blood stream, renin cleaves circulating angiotensinogen to ATI, which is subsequently cleaved to ATII by ACE. ATII increases blood pressure using a number of mechanisms. First, it stimulates the secretion of aldosterone from the adrenal cortex. Aldosterone travels to the distal convoluted tubule (DCT) and collecting tubule of nephrons where it increases sodium and water reabsorption by increasing the number of sodium channels and sodium-potassium ATPases on cell membranes. Second, ATII stimulates the secretion of vasopressin (also known as antidiuretic hormone or ADH) from the posterior pituitary gland. ADH stimulates further water reabsorption from the kidneys via insertion of aquaporin-2 channels on the apical surface of cells of the DCT and collecting tubules. Third, ATII increases blood pressure through direct arterial vasoconstriction. Stimulation of the Type 1 ATII receptor on vascular smooth muscle cells leads to a cascade of events resulting in myocyte contraction and vasoconstriction. In addition to these major effects, ATII induces the thirst response via stimulation of hypothalamic neurons. ACE inhibitors inhibit the rapid conversion of ATI to ATII and antagonize RAAS-induced increases in blood pressure. ACE (also known as kininase II) is also involved in the enzymatic deactivation of bradykinin, a vasodilator. Inhibiting the deactivation of bradykinin increases bradykinin levels and may sustain the effects of ramiprilat by causing increased vasodilation and decreased blood pressure.	Ramipril inhibits the RAAS system by binding to and inhibiting ACE thereby preventing the conversion of angiotensin I to angiotensin II. [T116] As plasma levels of angiotensin II fall, less activation of the G-protein coupled receptors angiotensin receptor I (AT<sub>1</sub>R) and angiotensin receptor II (AT<sub>2</sub>R) occurs. AT<sub>1</sub>R mediates vasoconstriction, inflammation, fibrosis, and oxidative stress through a variety of signaling pathways. [T116] These include G<sub>q</sub> coupling to the inositol triphosphate pathway, activation of phospholipases C, A<sub>2</sub>, and D which contribute to eicosanoid production, activation of Ca<sup>2+</sup>-dependent and MAP kinases, G<sub>i</sub> and G<sub>12/13</sub>, and eventual activation of the Jak/STAT pathway leading to cell growth and production of extracellular matrix components. AT<sub>1</sub>R activation also leads to increased activity of membrane-bound NADH/NADPH oxidase which contributes to production of reactive oxygen species. Decreased activation of this receptor mediates the renoprotective, antihypertensive, and cardioprotective effects of ramipril by reducing inflammation and vasoconstriction. AT<sub>2</sub>R acts in opposition to the effects of AT<sub>1</sub>R by activating phosphotyrosine phosphatases which inhibit MAP kinases, inhibiting Ca<sup>2+</sup> channel opening, and stimulating cGMP and nitric oxide production leading to vasodilation. [T116] These counteracting effects are shared by the Mas receptor which is activated by Ang(1-7), a subtype of angiotensin produced by plasma esterases from AngI or by ACE2 from AngII produced through a secondary pathway by tonin and cathepsin G. Ang(1-7) also activates AT<sub>2</sub>R although the bulk of its effect is mediated by MasR. ACE is also responsible for the breakdown of bradykinin. [T116] The resulting buildup of bradykinin due to ACE inhibition is thought to mediate the characteristic dry-cough as a side effect of ACE inhibitor medications.	The extent of absorption is at least 50-60%.[FDA Label]. Food decreases the rate of absorption from the GI tract without affecting the extent of absorption. The absolute bioavailabilities of ramipril and ramiprilat were 28% and 44%, respectively, when oral administration was compared to intravenous administration. The serum concentration of ramiprilat was unchanged when capsules were opened and the contents dissolved in water, dissolved in apple juice, or suspended in apple sauce.	Hepatic metabolism accounts for 75% of total ramipril metabolism.[FDA Label] 25% of hepatic metabolism produces the active metabolite ramiprilat via liver esterase enzymes. 100% of renal metabolism converts ramipril to ramiprilat. Other metabolites, diketopiperazine ester, the diketopiperazine acid, and the glucuronides of ramipril and ramiprilat, are inactive.	Symptoms of overdose may include excessive peripheral vasodilation (with marked hypotension and shock), bradycardia, electrolyte disturbances, and renal failure. Cases of ACE inhibitor induced hepatotoxicity have been reported in humans and presented as acute jaundice and elevated liver enzymes.[A174280] Removal of the ACE inhbitor resulted in a decline in liver enzymes and re-challenge produced a subsequent increase. There were no observed tumerogenic effects at chronic doses up to 500mg/kg/day to rats for 24 months or at doses up to 1000mg/kg/day to mice for 18 months. For both species doses were administered by gavage and equivalent to 200 time the maximum recommended human exposure based on body surface area. No mutagenic activity was detected in the Ames test in bacteria, the micronucleus test in mice, unscheduled DNA synthesis in a human cell line, or a forward gene-mutation assay in a Chinese hamster ovary cell line. Several metabolites of ramipril also produced negative results in the Ames test. No effects on fertility were seen in rats at doses up to 500mg/kg/day. No teratogenicity was observed in rats and cynomolgus monkeys at doses 400 times the maximum recommended human exposure nor in rabbites at 2 times the maximum recommended human exposure. LD<sub>50</sub> 10 g/kg (rat).[MSDS] LD<sub>50</sub> 10.5 g/kg (mouse).[MSDS] LD<sub>50</sub> 1 g/kg (dog).[MSDS]	Plasma concentrations of ramiprilat decline in a triphasic manner.[FDA Label] Initial rapid decline represents distribution into tissues and has a half life of 2-4 hours. The half life of the apparent elimination phase is 9-18 hours, which is thought to represent clearance of free drug. The half-life of the terminal elimination phase is > 50 hours and thought to represent clearance of drug bound to ACE due to its slow dissociation. The half life of ramiprilat after multiple daily doses (MDDs) is dose-dependent, ranging from 13-17 hours with 5-10 mg MDDs to 27-36 hours for 2.5 mg MDDs.	Protein binding of ramipril is about 73% and that of ramiprilat about 56%.[FDA Label] Protein binding is independent of concentration over the range of 0.1μg/mL-10μg/mL	Following oral administration, about 60% of the dose is eliminated in the urine as unchanged ramipril (<2%) and its metabolites. About 40% of the dose is found in the feces, representing both unabsorbed drug and drugs and metabolites eliminated via biliary excretion. The urinary excretion of ramipril may be reduced in patients with impaired renal function.[L12798]	null	The renal clearance of ramipril and ramiprilat was reported to be 7.2 and 77.4 mL/min/1.73m<sup>2</sup>. [A174595] The mean renal clearance of ramipril and ramiprilat is reported to be 10.7 and 126.8 mL/min in healthy elderly patients with normal renal function, additionally the Cmax of ramiprilat is approximately 20% higher in this population. While the pharmacokinetics of ramipril appear unaffected by reduced renal function, the plasma concentration and half-life of ramiprilat are increased. In patient's with hepatic failure the concentration of ramipril is initially increased while the tmax of ramiprilat is prolonged due to a reduced ability to metabolize the drug. However, steady state concentrations of ramiprilat are the same in hepatic failure as in healthy patients.	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved" ]	[ "C09BX", "C09B", "C09", "C", "C10BX", "C10B", "C10", "C", "C09BB", "C09B", "C09", "C", "C09AA", "C09A", "C09", "C", "C10BX", "C10B", "C10", "C", "C10BX", "C10B", "C10", "C", "C09BB", "C09B", "C09", "C", "C09BX", "C09B", "C09", "C", "C10BX", "C10B", "C10", "C", "C09BA", "C09B", "C09", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.14", "description": "Altace 10 mg Tablet", "unit": "tablet" }, { "cost": "1.59", "description": "Ramipril 1.25 mg capsule", "unit": "capsule" }, { "cost": "1.63", "description": "Altace 1.25 mg tablet", "unit": "tablet" }, { "cost": "1.78", "description": "Ramipril 2.5 mg capsule", "unit": "capsule" }, { "cost": "1.87", "description": "Ramipril 5 mg capsule", "unit": "capsule" }, { "cost": "1.93", "description": "Altace 2.5 mg tablet", "unit": "tablet" }, { "cost": "2.02", "description": "Altace 5 mg tablet", "unit": "tablet" }, { "cost": "2.19", "description": "Ramipril 10 mg capsule", "unit": "capsule" }, { "cost": "2.2", "description": "Altace 1.25 mg capsule", "unit": "capsule" }, { "cost": "2.37", "description": "Altace 10 mg tablet", "unit": "tablet" }, { "cost": "2.53", "description": "Altace 5 mg capsule", "unit": "capsule" }, { "cost": "2.54", "description": "Altace 2.5 mg capsule", "unit": "capsule" }, { "cost": "2.87", "description": "Altace 10 mg capsule", "unit": "capsule" }, { "cost": "0.44", "description": "Apo-Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Co Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Jamp-Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Mylan-Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Pms-Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Ran-Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Ratio-Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.44", "description": "Sandoz Ramipril 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Apo-Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Apo-Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Co Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Co Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Jamp-Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Jamp-Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Mylan-Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Mylan-Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Novo-Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Novo-Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Pms-Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Pms-Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Ran-Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Ran-Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Ratio-Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Ratio-Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Sandoz Ramipril 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.5", "description": "Sandoz Ramipril 5 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Apo-Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Co Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Jamp-Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Mylan-Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Novo-Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Pms-Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Ran-Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Ratio-Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.64", "description": "Sandoz Ramipril 10 mg Tablet", "unit": "tablet" }, { "cost": "0.78", "description": "Altace 1.25 mg Tablet", "unit": "tablet" }, { "cost": "0.9", "description": "Altace 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.9", "description": "Altace 5 mg Tablet", "unit": "tablet" } ]	[ { "approved": "1995-04-04", "country": "United States", "expires": "2012-04-04", "number": "5403856" }, { "approved": "2005-06-21", "country": "Canada", "expires": "2020-08-25", "number": "2382387" }, { "approved": "1996-05-21", "country": "Canada", "expires": "2013-05-21", "number": "1338344" }, { "approved": "2008-05-06", "country": "United States", "expires": "2020-08-30", "number": "7368469" } ]	(2S-(1(R(R)),2alpha,3abeta,6abeta))-1-(2-((1-(Ethoxycarbonyl)-3-phenylpropyl)amino)-1-oxopropyl)octahydrocyclopenta(b)pyrrole-2-carboxylic acid \| Ramipril \| Ramiprilum \| 3.4.15.1 \| ACE \| DCP \| DCP1 \| Dipeptidyl carboxypeptidase I \| Kininase II \| B1R \| BK-1 receptor \| BRADYB1 \| 3.1.1.8 \| Acylcholine acylhydrolase \| Butyrylcholine esterase \| CHE1 \| Choline esterase II \| Pseudocholinesterase \| Intestinal H(+)/peptide cotransporter \| Oligopeptide transporter, small intestine isoform \| PEPT1 \| Peptide transporter 1 \| Kidney H(+)/peptide cotransporter \| Oligopeptide transporter, kidney isoform \| PEPT2 \| Peptide transporter 2	[ "Ach-ramipril", "Ach-ramipril", "Ach-ramipril", "Ach-ramipril", "Ach-ramipril", "Act Ramipril", "Act Ramipril", "Act Ramipril", "Act Ramipril", "Ag-ramipril", "Ag-ramipril", "Ag-ramipril", "Ag-ramipril", "Ag-ramipril", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace", "Altace Cap 1.25mg", "Altace Cap 10mg", "Altace Cap 2.5mg", "Altace Cap 5mg", "Altace HCT", "Altace HCT", "Altace HCT", "Altace HCT", "Altace HCT", "Altace Plus Felodipine 2.5mg + 2.5mg", "Altace Plus Felodipine 5mg + 5mg", "Apo-ramipril", "Apo-ramipril", "Apo-ramipril", "Apo-ramipril", "Apo-ramipril", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Auro-ramipril", "Auro-ramipril", "Auro-ramipril", "Auro-ramipril", "Ava-ramipril", "Ava-ramipril", "Ava-ramipril", "Ava-ramipril", "Bio-ramipril", "Bio-ramipril", "Bio-ramipril", "Dom-ramipril", "Dom-ramipril", "Dom-ramipril", "Dom-ramipril", "Ipg-ramipril", "Ipg-ramipril", "Ipg-ramipril", "Ipg-ramipril", "Ipg-ramipril", "Jamp-ramipril", "Jamp-ramipril", "Jamp-ramipril", "Jamp-ramipril", "Jamp-ramipril", "Mar-ramipril", "Mar-ramipril", "Mar-ramipril", "Mar-ramipril", "Mar-ramipril", "Mint-ramipril", "Mint-ramipril", "Mint-ramipril", "Mint-ramipril", "Mint-ramipril", "Mylan-ramipril", "Mylan-ramipril", "Mylan-ramipril", "Mylan-ramipril", "Nra-ramipril", "Nra-ramipril", "Nra-ramipril", "Nra-ramipril", "Nra-ramipril", "Ntp-ramipril", "Ntp-ramipril", "Ntp-ramipril", "Pharma-ramipril", "Pharma-ramipril", "Pharma-ramipril", "Pharma-ramipril", "PMS-ramipril", "PMS-ramipril", "PMS-ramipril", "PMS-ramipril", "PMS-ramipril", "PMS-ramipril-hctz", "PMS-ramipril-hctz", "PMS-ramipril-hctz", "PMS-ramipril-hctz", "PMS-ramipril-hctz", "Pmsc-ramipril", "Pmsc-ramipril", "Pmsc-ramipril", "Pmsc-ramipril", "Priva-ramipril", "Priva-ramipril", "Priva-ramipril", "Priva-ramipril", "Priva-ramipril", "Priva-ramipril", "Priva-ramipril", "Priva-ramipril", "Pro-ramipril - 1.25", "Pro-ramipril - 10", "Pro-ramipril - 2.5", "Pro-ramipril - 5", "Prv-ramipril", "Prv-ramipril", "Prv-ramipril", "Ramace", "Ramace", "Ramace", "Ramace", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril", "Ramipril Capsules", "Ramipril Capsules", "Ramipril Capsules", "Ramipril Capsules", "Ramipril-10", "Ramipril-2.5", "Ramipril-5", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Ratio-ramipril", "Ratio-ramipril", "Ratio-ramipril", "Ratio-ramipril", "Ratio-ramipril", "Rbx-ramipril", "Rbx-ramipril", "Rbx-ramipril", "Rbx-ramipril", "Sandoz Ramipril", "Sandoz Ramipril", "Sandoz Ramipril", "Sandoz Ramipril", "Sandoz Ramipril", "Sandoz Ramipril", "Sandoz Ramipril", "Sandoz Ramipril", "Taro-ramipril", "Taro-ramipril", "Taro-ramipril", "Taro-ramipril", "Taro-ramipril", "Taro-ramipril Hctz", "Taro-ramipril Hctz", "Taro-ramipril Hctz", "Taro-ramipril Hctz", "Taro-ramipril Hctz", "Teva-ramipril", "Teva-ramipril", "Teva-ramipril", "Teva-ramipril", "Teva-ramipril", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Van-ramipril", "Van-ramipril", "Van-ramipril", "Van-ramipril", "Van-ramipril" ]	[ "Acovil", "Carasel", "Cardace", "Delix", "Hypren", "Lostapres", "Pramace", "Quark", "Triatec", "Tritace", "Vesdil" ]	[ "PMS-ramipril-hctz", "PMS-ramipril-hctz", "PMS-ramipril-hctz", "PMS-ramipril-hctz", "PMS-ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Altace Plus Felodipine 5mg + 5mg", "Altace Plus Felodipine 2.5mg + 2.5mg", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Apo-ramipril/hctz", "Altace HCT", "Altace HCT", "Altace HCT", "Altace HCT", "Altace HCT", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Teva-ramipril/hctz", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Ramipril-hctz", "Taro-ramipril Hctz", "Taro-ramipril Hctz", "Taro-ramipril Hctz", "Taro-ramipril Hctz", "Taro-ramipril Hctz" ]	[ "P12821", "P46663" ]	[ "P06276" ]	[]	[ "P46059", "Q16348" ]
DB00179	Masoprocol	A potent lipoxygenase inhibitor that interferes with arachidonic acid metabolism. The compound also inhibits formyltetrahydrofolate synthetase, carboxylesterase, and cyclooxygenase to a lesser extent. It also serves as an antioxidant in fats and oils. [PubChem]	solid	Used for the treatment of actinic keratoses (precancerous skin growths that can become malignant if left untreated).	Masoprocol is a novel antineoplastic agent. It is not known exactly how masoprocol works. Laboratory experiments have shown that masoprocol prevents cells similar to the ones found in actinic keratoses from multiplying. Masoprocol was withdrawn from the U.S. market in June 1996.	Although the exact mechanism of action is not known, studies have shown that masoprocol is a potent 5-lipoxygenase inhibitor and has antiproliferative activity against keratinocytes in tissue culture, but the relationship between this activity and its effectiveness in actinic keratoses is unknown. Masoprocol also inhibits prostaglandins but the significance of this action is not yet known.	Less than 1%-2% is absorbed through the skin over a 4-day period following application.	null	Symptoms of overdose or allergic reaction include bluish coloration of skin, dizziness, severe, or feeling faint, wheezing or trouble in breathing.	null	null	null	null	null	Organic compounds	Lignans, neolignans and related compounds	Dibenzylbutane lignans	null	[ "approved", "investigational" ]	[ "L01XX", "L01X", "L01", "L" ]	[ "Humans and other mammals" ]	[]	[]	erythro-nordihydroguaiaretic acid \| Masoprocol \| Masoprocolum \| meso-1,4-bis(3,4-dihydroxyphenyl)-2,3-dimethylbutane \| meso-2,3-bis(3,4-dihydroxyphenylmethyl)butane \| meso-4-[4-(3,4-dihydroxyphenyl)-2,3-dimethylbutyl]benzene-1,2-diol \| meso-4,4'-(2,3-dimethyl-1,4-butanediyl)bis(pyrocatechol) \| meso-4,4'-(2,3-dimethyltetramethylene)dipyrocatechol \| meso-NDGA \| meso-nordihydroguaiaretic acid \| meso-β,γ-dimethyl-α,δ-bis(3,4-dihydroxyphenyl)butan \| Nordihydroguaiaretic acid \| 1.13.11.- \| 5-lipoxygenase \| 5-LO \| Arachidonate 5-lipoxygenase \| LOG5 \| 2.7.10.1 \| HER2 \| Metastatic lymph node gene 19 protein \| MLN 19 \| MLN19 \| NEU \| NGL \| p185erbB2 \| Proto-oncogene c-ErbB-2 \| Proto-oncogene Neu \| Tyrosine kinase-type cell surface receptor HER2 \| 2.7.11.1 \| CHAK1 \| Channel-kinase 1 \| Long transient receptor potential channel 7 \| LTrpC-7 \| LTRPC7 \| ABP \| SBP \| Sex steroid-binding protein \| SHBG \| TeBG \| Testis-specific androgen-binding protein \| Testosterone-estradiol-binding globulin \| Testosterone-estrogen-binding globulin	[]	[ "Actinex" ]	[]	[ "P09917", "P04626", "Q96QT4", "P04278" ]	[]	[]	[]
DB00180	Flunisolide	Flunisolide (marketed as AeroBid, Nasalide, Nasarel) is a corticosteroid with anti-inflammatory actions. It is often prescribed as treatment for allergic rhinitis and its principle mechanism of action involves activation of glucocorticoid receptors.	solid	For the maintenance treatment of asthma as a prophylactic therapy.	Flunisolide is a synthetic corticosteroid. It is administered either as an oral metered-dose inhaler for the treatment of asthma or as a nasal spray for treating allergic rhinitis. Corticosteroids are naturally occurring hormones that prevent or suppress inflammation and immune responses. When given as an intranasal spray, flunisolide reduces watery nasal discharge (rhinorrhea), nasal congestion, postnasal drip, sneezing, and itching oat the back of the throat that are common allergic symptoms.	Flunisolide is a glucocorticoid receptor agonist. The antiinflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins which, through inhibition arachidonic acid, control the biosynthesis of prostaglandins and leukotrienes. The immune system is suppressed by corticosteroids due to a decrease in the function of the lymphatic system, a reduction in immunoglobulin and complement concentrations, the precipitation of lymphocytopenia, and interference with antigen-antibody binding. Flunisolide binds to plasma transcortin, and it becomes active when it is not bound to transcortin.	Absorbed rapidly	Primarily hepatic, converted to the S beta-OH metabolite.	null	1.8 hours	Approximately 40% after oral inhalation	null	null	null	Organic compounds	Lipids and lipid-like molecules	Steroids and steroid derivatives	Hydroxysteroids	[ "approved", "investigational" ]	[ "R01AD", "R01A", "R01", "R", "R03BA", "R03B", "R03", "R" ]	[ "Humans and other mammals" ]	[ { "cost": "1.98", "description": "Nasarel 29 mcg-0.025% spray", "unit": "ml" }, { "cost": "2.2", "description": "Flunisolide 29 mcg-0.025% spray", "unit": "ml" }, { "cost": "14.0", "description": "Aerobid aerosol with adapter", "unit": "g" }, { "cost": "14.0", "description": "Aerobid-m aerosol with adapter", "unit": "g" }, { "cost": "48.35", "description": "Flunisolide 0.025% Solution 25ml Bottle", "unit": "bottle" }, { "cost": "57.16", "description": "Flunisolide 29 mcg/act Solution 25ml Bottle", "unit": "bottle" }, { "cost": "101.95", "description": "Aerobid 250 mcg/act Aerosol 7 gm Inhaler", "unit": "inhaler" }, { "cost": "101.95", "description": "Aerobid-M 250 mcg/act Aerosol 7 gm Inhaler", "unit": "inhaler" }, { "cost": "0.62", "description": "Apo-Flunisolide 0.025 % Spray", "unit": "ml" } ]	[ { "approved": "1998-07-07", "country": "United States", "expires": "2015-07-07", "number": "5776433" } ]	Flunisolida \| Flunisolide \| Flunisolide anhydrous \| Flunisolidum \| GR \| GRL \| Nuclear receptor subfamily 3 group C member 1 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| CBG \| Serpin A6 \| Transcortin	[ "Aerobid", "Aerobid", "Aerobid", "Aerobid-M", "Aerospan", "Aerospan", "Aerospan", "Apo-flunisolide Nasal Spray", "Bronalide Inhal 250mcg/aem", "Flunisolide", "Flunisolide", "Flunisolide", "Flunisolide", "Flunisolide", "Flunisolide", "Flunisolide", "Flunisolide", "Nasarel", "Novo-flunisolide", "PMS-flunisolide", "Ratio-flunisolide", "Rhinalar", "Rhinalar Nasal Mist" ]	[ "Bronalide", "Nasalide", "Syntaris" ]	[]	[ "P04150" ]	[ "P08684" ]	[ "P08185" ]	[]
DB00181	Baclofen	Baclofen is a gamma-aminobutyric acid (GABA) agonist used as a skeletal muscle relaxant. Although originally designed in 1962 to treat epilepsy, baclofen was not effective in treating this condition but instead was shown to reduce spasticity in selected patients.[A245338] Baclofen was reintroduced in 1971 as a treatment for spasticity and was later approved by the FDA in 1977.[A245323, A245338] Baclofen is used to manage severe muscle spasms of cerebral or spinal cord origins, including multiple sclerosis and traumatic brain injury.[L39429] Baclofen was investigated for use in alcohol dependence and withdrawal; however, evidence is limited and there is inconsistent evidence to suggest its clinical efficacy in managing alcohol dependence or withdrawal symptoms.[A173905, A173908, A245338]	solid	Oral baclofen is indicated for the treatment of spasticity resulting from multiple sclerosis and is particularly useful for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. It may also be used to treat patients with spinal cord injuries and other spinal cord diseases. Baclofen should not be used to treat skeletal muscle spasms resulting from rheumatic disorders.[L39434] Intrathecal baclofen is also indicated for the management of severe spasticity of the cerebral or spinal original in patients 4 years of age and older. It is reserved for patients unresponsive to oral baclofen therapy, or those who experience intolerable central nervous system side effects at effective doses. For use in spasticity due to traumatic brain injury, baclofen should be considered after at least one year of injury.[L39429]	Baclofen is an antispasmodic agent that induces muscle relaxation. It reduces the release of excitatory neurotransmitters in the pre-synaptic neurons and stimulates inhibitory neuronal signals in the post-synaptic neurons.[A245323] Oral formulations of baclofen are the most commonly used form of the drug. In one cross-section study, intrathecal baclofen was more effective than oral baclofen in relieving spasticity directly at the level of the spinal cord.[A245338] Baclofen has CNS depression properties and can cause sedation with tolerance, somnolence, ataxia, and respiratory and cardiovascular depression.[L40134] Baclofen also mediates some antinociceptive effects and stimulates gastric acid secretion.[L40278] Baclofen exhibits anti-inflammatory and neuroprotective activities: it inhibits the release of pro-inflammatory cytokines from microglia and astrocytes, and decreases oxidative stress in rats.[A173938]	The exact mechanism of action of baclofen is unclear. Baclofen is an agonist at the beta subunit of gamma-aminobutyric acid (GABA) receptors expressed on pre- and post-synaptic neurons.[A173923] Upon binding to GABA<sub>B</sub> receptors, baclofen causes an influx of potassium into the neuron, leading to hyperpolarization of the neuronal membrane and decreased calcium influx at presynaptic nerve terminals. This results in a decreased rate of action potential threshold being reached by presynaptic neurons and reduced action potential of postsynaptic motor neurons that innervate the muscle spindles. Baclofen thereby inhibits the transmission of both mono- and polysynaptic reflexes at the spinal cord, relaxing spasticity.[A245338] Baclofen may act on some voltage-gated calcium channels; however, the clinical significance of this is unclear.[A245323]	Baclofen has an oral bioavailability of 70% to 85%. Following oral administration, it is rapidly absorbed through the gastrointestinal tract with peak plasma concentrations being reached two to three hours after ingestion.[A245323] Peak effect is observed about four hours after intrathecal administration.[A245338] The absorption is dose-dependent and increases with higher doses.[A245323] There is intersubject variation in absorption.[L40134] Administration of oral baclofen suspension with a high-fat meal resulted in 9% decrease in AUC and 33% decrease in C<sub>max</sub> compared to the fasted state.[L40134]	Approximately 15% of the oral dose is metabolized in the liver, mainly by deamination.[A245338] Deamination yields the main metabolite, β-(p-chlorophenyl)-4-hydroxybutyric acid, which is pharmacologically inactive.[L40278]	The oral LD<sub>50</sub> in rats is 145 mg/kg.[L40273] Baclofen withdrawal symptoms typically occur within hours to days following interruption of either oral or intrathecal drug formulations.[A245338] Abrupt discontinuation of baclofen is not advised.[L39429] Clinical manifestations of baclofen overdose may include altered mental status, somnolence, seizure, hypothermia, respiratory depression, and coma. Overdose from baclofen oral tablets resulted in vomiting, lightheadedness, drowsiness, muscular hypotonia, accommodation disorders, coma, respiratory depression, and seizures.[A245323, L40134] Most overdose symptoms are neurological but uncommon cardiovascular effects such as hypertension, bradycardia, and tachycardia may be observed.[A37219] In case of overdose, symptomatic treatment and gastric decontamination should be initiated. When the patient is alert, gastric emptying should be performed by inducing emesis and then performing lavage while maintaining an adequate airway and respiration. Emesis should not be induced in unconscious patients.[A245323, L40134]	The half-life is 2-6 hours after oral administration and 1-5 hours following intrathecal administration.[A245338] The apparent elimination half-life of baclofen oral suspension or granules is about 5.6 hours.[L40134]	The protein binding is approximately 30%.[L40278]	About 70-80% of baclofen is eliminated in an unchanged form by renal excretion [A245323, A245338] within 72 hours of administration. About 5% of the dose is excreted via the kidneys as metabolites.[L40278] There is intersubject variation in elimination.[L40134]	The volume of distribution of baclofen is 0.7 L/kg.[L40278] As baclofen is mainly water-soluble, it does not readily cross the blood-brain barrier.[A245333] Drug concentrations of baclofen in the cerebrospinal fluid are approximately 8.5 times lower than in the plasma.[L40278]	The systemic clearance (CL/F) was 180 mL/min and the renal clearance was 103 mL/min following oral administration.[A245343]	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved" ]	[ "M03BX", "M03B", "M03", "M" ]	[ "Humans and other mammals" ]	[ { "cost": "1.4", "description": "Lioresal D.S. 20 mg Tablet", "unit": "tablet" }, { "cost": "11.16", "description": "Lioresal Intrathecal 0.5 mg/ml", "unit": "ml" }, { "cost": "12.9", "description": "Lioresal it 10 mg/20 ml kit", "unit": "ml" }, { "cost": "14.38", "description": "Baclofen powder", "unit": "g" }, { "cost": "14.89", "description": "Lioresal Intrathecal 0.05 mg/ml", "unit": "ml" }, { "cost": "44.64", "description": "Lioresal Intrathecal 2 mg/ml", "unit": "ml" }, { "cost": "51.6", "description": "Lioresal it 10 mg/5 ml kit", "unit": "ml" }, { "cost": "84.0", "description": "Lioresal it 0.05 mg/1 ml amp", "unit": "ml" }, { "cost": "0.3", "description": "Apo-Baclofen 10 mg Tablet", "unit": "tablet" }, { "cost": "0.3", "description": "Mylan-Baclofen 10 mg Tablet", "unit": "tablet" }, { "cost": "0.3", "description": "Nu-Baclo 10 mg Tablet", "unit": "tablet" }, { "cost": "0.3", "description": "Phl-Baclofen 10 mg Tablet", "unit": "tablet" }, { "cost": "0.3", "description": "Pms-Baclofen 10 mg Tablet", "unit": "tablet" }, { "cost": "0.3", "description": "Ratio-Baclofen 10 mg Tablet", "unit": "tablet" }, { "cost": "0.51", "description": "Baclofen 10 mg tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Apo-Baclofen 20 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Mylan-Baclofen 20 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Nu-Baclo 20 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Phl-Baclofen 20 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Pms-Baclofen 20 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Ratio-Baclofen 20 mg Tablet", "unit": "tablet" }, { "cost": "0.72", "description": "Lioresal 10 mg Tablet", "unit": "tablet" }, { "cost": "0.92", "description": "Baclofen 20 mg tablet", "unit": "tablet" } ]	[ { "approved": "2001-04-24", "country": "United States", "expires": "2018-04-09", "number": "6221392" }, { "approved": "2000-02-15", "country": "United States", "expires": "2018-04-09", "number": "6024981" }, { "approved": "2020-04-07", "country": "United States", "expires": "2039-08-30", "number": "10610502" }, { "approved": "2020-10-06", "country": "United States", "expires": "2039-07-29", "number": "10792262" }, { "approved": "2017-09-29", "country": "United States", "expires": "2037-09-29", "number": "11324696" }, { "approved": "2017-09-08", "country": "United States", "expires": "2037-09-08", "number": "11446246" }, { "approved": "2021-09-29", "country": "United States", "expires": "2041-09-29", "number": "11491125" }, { "approved": "2019-07-29", "country": "United States", "expires": "2039-07-29", "number": "11654124" }, { "approved": "2021-09-29", "country": "United States", "expires": "2041-09-29", "number": "11850225" }, { "approved": "2019-07-29", "country": "United States", "expires": "2039-07-29", "number": "11931328" } ]	(+-)-Baclofen \| 4-Amino-3-(4-chlorophenyl)butyric acid \| Baclofen \| Baclofène \| Baclofeno \| Baclofenum \| beta-(4-Chlorophenyl)gaba \| beta-(Aminomethyl)-4-chlorobenzenepropanoic acid \| beta-(Aminomethyl)-p-chlorohydrocinnamic acid \| beta-(p-Chlorophenyl)-gamma-aminobutyric acid \| DL-4-Amino-3-p-chlorophenylbutanoic acid \| DL-Baclofen \| gamma-Amino-beta-(p-chlorophenyl)butyric acid \| G-protein coupled receptor 51 \| GABA-B receptor 2 \| GABA-B-R2 \| GABA-BR2 \| GABABR2 \| Gb2 \| GPR51 \| GPRC3B \| HG20 \| CXC-R4 \| CXCR-4 \| FB22 \| Fusin \| HM89 \| LAP-3 \| LCR1 \| LESTR \| Leukocyte-derived seven transmembrane domain receptor \| Lipopolysaccharide-associated protein 3 \| LPS-associated protein 3 \| NPYRL \| SDF-1 receptor \| Stromal cell-derived factor 1 receptor \| GABA-B receptor 1 \| GABA-B-R1 \| GABA-BR1 \| GABABR1 \| Gb1 \| GPRC3A	[ "Apo-baclofen", "Apo-baclofen", "Ava-baclofen", "Ava-baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen", "Baclofen (intrathecal)", "Baclofen (intrathecal)", "Baclofen (intrathecal)", "Baclofen (Intrathecal)", "Baclofen (Intrathecal)", "Baclofen Injection", "Baclofen Injection", "Baclofen Injection", "Baclofen Injection", "Baclofen Injection", "Baclofen Injection", "Baclofen Injection USP", "Baclofen Intrathecal", "Baclofen Intrathecal", "Baclofen Intrathecal", "Baclofen Tablets - 10mg", "Baclofen Tablets - 20mg", "Baclofen Tablets 10mg", "Baclofen Tablets 20mg", "Baclofen-10", "Baclofen-20", "Bacolfen", "Bacolfen", "Co Baclofen Tablets 10mg", "Co Baclofen Tablets 20mg", "Dom-baclofen-tab 10mg", "Dom-baclofen-tab 20mg", "Equipto - Baclofen External Cream Compounding Kit", "Fleqsuvy", "Ftp-baclofen", "Ftp-baclofen", "Gablofen", "Gablofen", "Gablofen", "Gablofen", "Gablofen", "Gablofen", "Gablofen", "Gablofen", "Gapeam Budibac", "Innoprax-5", "Jamp Baclofen", "Jamp Baclofen", "Kemstro", "Kemstro", "Lioresal", "Lioresal", "Lioresal", "Lioresal", "Lioresal", "Lioresal", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal (baclofen)", "Lioresal D.S. Tab 20mg", "Lioresal Intrathecal 0.05mg/ml", "Lioresal Intrathecal 0.5mg/ml", "Lioresal Intrathecal 2mg/ml", "Lioresal Tab 10mg", "Lyvispah", "Lyvispah", "Lyvispah", "Lyvispah", "Lyvispah", "Lyvispah", "Med Baclofen Tab 10mg", "Med Baclofen Tab 20mg", "Mint-baclofen", "Mint-baclofen", "Mylan-baclofen", "Mylan-baclofen", "Novo-baclofen", "Novo-baclofen", "Ozobax", "Ozobax DS", "Penta-baclofen Tablets", "Penta-baclofen Tablets", "PHL-baclofen", "PHL-baclofen", "PMS-baclofen", "PMS-baclofen", "Ratio-baclofen", "Ratio-baclofen", "Riva-baclofen", "Riva-baclofen", "Sandoz Baclofen", "Sandoz Baclofen" ]	[ "Baclon", "Lioresal Intrathecal", "Nu-Baclofen" ]	[ "Innoprax-5", "Gapeam Budibac" ]	[ "O75899", "P61073", "Q9UBS5" ]	[]	[]	[]
DB00182	Amphetamine	Amphetamine, a compound discovered over 100 years ago, is one of the more restricted controlled drugs. It was previously used for a large variety of conditions and this changed until this point where its use is highly restricted. Amphetamine, with the chemical formula alpha-methylphenethylamine, was discovered in 1910 and first synthesized by 1927. After being proven to reduce drug-induced anesthesia and produce arousal and insomnia, amphetamine racemic mix was registered by Smith, Kline and French in 1935. Amphetamine structure presents one chiral center and it exists in the form of dextro- and levo-isomers.[A18540] The first product of Smith, Kline and French was approved by the FDA on 1976.[L5194] During World War II, amphetamine was used to promote wakefulness in the soldiers. This use derived into a large overproduction of amphetamine and all the surplus after the war finalized ended up in the black market, producing the initiation of the illicit abuse.[A18540]	liquid	Amphetamine is indicated for the treatment of attention-deficit/hyperactivity disorders (ADHD) as well as for the treatment of central nervous system disorders such as narcolepsy.[A18540] ADHD is a complex disorder associated with the substantial heterogeneity in etiology, clinical presentation, and treatment outcome. ADHD comes from a complex interplay between interdependent genetic and non-genetic factors which cause complex mental disorders in children and teenagers.[A174271] On the other hand, narcolepsy is a chronic sleep disorder typically resenting during adolescence and characterized by excessive daytime sleepiness.[A174274] Amphetamine is also being used nowadays off-label for the treatment of obesity, depression and chronic pain.[A174268, A174283]	From its mechanism of action, it has been demonstrated that amphetamine augments the concentration of noradrenaline in the prefrontal cortex and dopamine in the striatum on a dose and time-dependent manner. The indistinct release of neurotransmitters which include adrenaline is known to produce cardiovascular side effects.[A174214] There are old reports of a cognitive enhancement related to the administration of amphetamine in which improvements in intelligence test scores were reported.[A174196] In ADHD, amphetamine has been largely showed to produce remarkable improvements in school performance, behavior, and demeanor.[A18540] The effect was shown to be produced through both racemic forms and to this date, the use of racemic forms 3:1 (D:L) is very common.[A174199] The therapeutic effect of amphetamine on serotonin does not seem to have a significant clinical effect on ADHD as observed on comparative studies with amphetamine and fenfluramine, a powerful serotonin releasing factor. However, the indirect effect on serotonin might have an effect on the depression and anxiety profile of ADHD.[A174241] Studies regarding the illicit use of amphetamine in which heavy consumers were studied proved the generation of a paranoid state which flagged this drug as a psychiatric danger compound.[L5197] This observation was supported by the continuous reports of misuse in patients under depression.[A18540]	It is important to consider that amphetamine has a very similar structure to the catecholamine neurotransmitters mainly on the presence of a long planar conformation, the presence of an aromatic ring and nitrogen in the aryl side chain. Amphetamine, as well as other catecholamines, is taken into presynaptic nerve terminals by the association with two sodium ions and one chloride ion. The complex of the amphetamine with the ions is actively transported by monoamine reuptake transporters. As amphetamine acts competitively with the endogenous monoamines, the greater the number of amphetamines the more internalized amphetamine will be found.[A18540] Once inside the presynaptic terminal, amphetamine displaces other monoamines to be stored by VMAT2 which produces the pumping of the neurotransmitters into the synapse by a process called retro-transport.[A174211] This process of release of neurotransmitters is approximately fourfold more potent in the d-isomer for the release of dopamine.[A174214] The mechanism of action of amphetamine is complemented by the inhibition of the reuptake and of monoamine oxidase which acts synergistically to produce a significant increase the monoamine concentration.[A18540] This activity is not done as an inhibitor per se but more as a competitive substrate and thus, amphetamine is known to be a weak dopamine reuptake inhibitor, moderate noradrenaline reuptake inhibitor and very weak serotonin reuptake inhibitor. From this specific action, the l-isomer is known to be significantly less potent.[A174214] Lastly, amphetamine is known to be an inhibitor of the mitochondrial-bound enzyme MAO which is the catalytic enzyme in charge of degrading all the excess of neurotransmitters. This mechanism of action is often overpassed as amphetamine is a weak MAO inhibitor but this mechanism cannot be dismissed.[A18540]	Amphetamine is well absorbed in the gut and as it is a weak base hence the more basic the environment the more of the drug is found in a lipid-soluble form and the absorption through lipid-rich cell membranes is highly favored.[A174292] The peak response of amphetamine occurs 1-3 hours after oral administration and approximately 15 minutes after injection and it presents a bioavailability of over 75%.[L5206] Complete amphetamine absorption is usually done after 4-6 hours.[L5209]	Amphetamine is known to be metabolized by the liver under the action of the CYP2D6. The metabolic pathway of amphetamine is mainly defined by aromatic hydroxylation, aliphatic hydroxylation, and n-dealkylation.[L5212] The formed metabolites in this pathway are 4-hydroxyamphetamine, 4-hydroxynorephedrine, hippuric acid, benzoic acid, benzyl methyl ketone, and p-hydroxyamphetamine which is known to be a potent hallucinogen.[L5206] However, a significant part of the original compound remains unchanged.[A174292]	The mean lethal serum concentration is reported to be of 6.4 mg/l. Acute amphetamine overdose can lead to hyperthermia, respiratory depression, seizures, metabolic acidosis, renal failure, hepatic injury, and coma. Some of the neurologic effects have been shown to be agitation, aggressive behavior, irritability, headache, and hallucinations. In the cardiovascular site, there have been reports of arrhythmia, cardiomyopathy, myocardial infarction or ischemic stroke. Lastly, in the GI tract, there are reports if abdominal pain, vomiting, diarrhea, cramps, anorexia and GI hemorrhage. A dose of 1-2 g of amphetamine is known to cause severe intoxication but some chronic abusers can report usage of even 5-15 g per day.[L5212] In animal studies, there is no evidence of carcinogenic potential, not clastogenic or to affect fertility or early embryonic development.[FDA label]	The half-life of amphetamine highly depends on the isomer. For d-amphetamine, the reported half-life is of approximately 9-11 hours while for l-amphetamine the half-life is reported to be of 11-14 hours. The urine pH can modify this pharmacokinetic parameter which can vary from 7 hours in acid urine to 34 hours for alkaline urine.[A174292]	The reported protein binding of amphetamine is relatively low and register to be of 20%.[A174292]	The elimination of amphetamine is mainly via the urine from which about 40% of the excreted dose is found as unchanged amphetamine. About 90% of the administered amphetamine is eliminated 3 days after oral administration.[A174292] The rate of elimination of amphetamine highly depends on the urine pH in which acidic pH will produce a higher excretion of amphetamine and basic pH produces a lower excretion.[L5206]	Amphetamine is reported to have a high volume of distribution of 4 L/kg.[A174292]	The reported normal clearance rate is of 0.7 L.h/kg. This clearance has been shown to get significantly reduced in patients with renal impairment reaching a value of 0.4 L.h/kg.[F3244]	Organic compounds	Benzenoids	Benzene and substituted derivatives	Phenethylamines	[ "approved", "illicit", "investigational" ]	[ "N06BA", "N06B", "N06", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.3", "description": "Amphetamine Salt Combo 7.5 mg tablet", "unit": "tablet" }, { "cost": "1.37", "description": "Amphetamine salts 10 mg tablet", "unit": "tablet" }, { "cost": "1.37", "description": "Amphetamine salts 20 mg tablet", "unit": "tablet" }, { "cost": "1.37", "description": "Amphetamine salts 30 mg tablet", "unit": "tablet" }, { "cost": "1.37", "description": "Amphetamine salts 5 mg tablet", "unit": "tablet" }, { "cost": "1.43", "description": "Amphetamine salts 12.5 mg tablet", "unit": "tablet" }, { "cost": "1.43", "description": "Amphetamine salts 15 mg tablet", "unit": "tablet" }, { "cost": "1.43", "description": "Amphetamine salts 7.5 mg tablet", "unit": "tablet" }, { "cost": "1.91", "description": "Dexedrine spansule 10 mg", "unit": "each" }, { "cost": "1.91", "description": "Dexedrine spansule 5 mg", "unit": "each" }, { "cost": "2.45", "description": "Dexedrine spansule 15 mg", "unit": "each" }, { "cost": "3.0", "description": "Dexedrine 5 mg 24 Hour Capsule", "unit": "capsule" }, { "cost": "3.23", "description": "Dexedrine 10 mg 24 Hour Capsule", "unit": "capsule" }, { "cost": "4.22", "description": "Dexedrine 15 mg 24 Hour Capsule", "unit": "capsule" }, { "cost": "5.1", "description": "Desoxyn 5 mg tablet", "unit": "tablet" } ]	[ { "approved": "2002-05-07", "country": "United States", "expires": "2021-01-06", "number": "6384020" }, { "approved": "2011-02-01", "country": "United States", "expires": "2019-04-21", "number": "RE42096" }, { "approved": "2003-08-12", "country": "United States", "expires": "2019-04-21", "number": "6605300" }, { "approved": "2001-11-27", "country": "United States", "expires": "2019-04-21", "number": "6322819" }, { "approved": "2010-02-23", "country": "United States", "expires": "2019-04-21", "number": "RE41148" }, { "approved": "2011-11-22", "country": "United States", "expires": "2029-03-29", "number": "8062667" }, { "approved": "2014-09-23", "country": "United States", "expires": "2026-06-05", "number": "8840924" }, { "approved": "2015-04-28", "country": "United States", "expires": "2032-06-28", "number": "9017731" }, { "approved": "2014-04-29", "country": "United States", "expires": "2032-06-28", "number": "8709491" }, { "approved": "2016-02-23", "country": "United States", "expires": "2032-06-28", "number": "9265737" }, { "approved": "2014-06-10", "country": "United States", "expires": "2027-03-15", "number": "8747902" }, { "approved": "2013-12-03", "country": "United States", "expires": "2027-03-15", "number": "8597684" }, { "approved": "2014-11-11", "country": "United States", "expires": "2027-03-15", "number": "8883217" }, { "approved": "2017-06-13", "country": "United States", "expires": "2027-03-15", "number": "9675703" }, { "approved": "2015-11-03", "country": "United States", "expires": "2026-05-12", "number": "9173857" }, { "approved": "2005-07-05", "country": "United States", "expires": "2023-05-24", "number": "6913768" }, { "approved": "2014-09-30", "country": "United States", "expires": "2029-08-24", "number": "8846100" }, { "approved": "2018-10-02", "country": "United States", "expires": "2027-03-15", "number": "10086087" }, { "approved": "2018-11-20", "country": "United States", "expires": "2024-04-19", "number": "10130580" }, { "approved": "2019-10-15", "country": "United States", "expires": "2037-03-10", "number": "10441554" }, { "approved": "2012-12-25", "country": "United States", "expires": "2027-04-17", "number": "8337890" }, { "approved": "2017-06-13", "country": "United States", "expires": "2027-03-15", "number": "9675704" }, { "approved": "2021-11-02", "country": "United States", "expires": "2037-03-10", "number": "11160772" }, { "approved": "2018-09-24", "country": "United States", "expires": "2038-09-24", "number": "11590081" }, { "approved": "2016-09-07", "country": "United States", "expires": "2036-09-07", "number": "11590228" }, { "approved": "2017-03-10", "country": "United States", "expires": "2037-03-10", "number": "11896562" }, { "approved": "2012-06-28", "country": "United States", "expires": "2032-06-28", "number": "9839619" } ]	(+-)-alpha-Methylphenylethylamine \| 1-phenyl-2-aminopropane \| alpha-Methylbenzeneethaneamine \| Amfetamina \| Amfetamine \| Amfetaminum \| Amphetamine \| beta-Aminopropylbenzene \| beta-Phenylisopropylamin \| Desoxynorephedrine \| rac-(2R)-1-phenylpropan-2-amine \| rac-amphetamine \| α-methylbenzeneethaneamine \| α-methylphenethylamine \| β-aminopropylbenzene \| β-phenylisopropylamine \| Solute carrier family 18 member 2 \| SVMT \| VAT2 \| Vesicular amine transporter 2 \| Vesicular monoamine transporter 2 \| VMAT2 \| DA transporter \| DAT \| DAT1 \| Solute carrier family 6 member 3 \| CART \| TA1 \| TaR-1 \| TAR1 \| Trace amine receptor 1 \| TRAR1 \| 1.4.3.21 \| 1.4.3.4 \| MAO-A \| Monoamine oxidase type A \| 1.4.3.21 \| 1.4.3.4 \| MAO-B \| Monoamine oxidase type B \| NAT1 \| NET \| NET1 \| Norepinephrine transporter \| SLC6A5 \| Solute carrier family 6 member 2 \| ADRA1C \| Alpha-1A adrenoceptor \| Alpha-1A adrenoreceptor \| Alpha-1C adrenergic receptor \| Alpha-adrenergic receptor 1c \| Alpha-1B adrenoceptor \| Alpha-1B adrenoreceptor \| ADRA1A \| Alpha-1A adrenergic receptor \| Alpha-1D adrenoceptor \| Alpha-1D adrenoreceptor \| Alpha-adrenergic receptor 1a \| ADRA2R \| ADRAR \| Alpha-2 adrenergic receptor subtype C10 \| Alpha-2A adrenoceptor \| Alpha-2A adrenoreceptor \| Alpha-2AAR \| ADRA2L1 \| ADRA2RL1 \| Alpha-2 adrenergic receptor subtype C2 \| Alpha-2B adrenoceptor \| Alpha-2B adrenoreceptor \| Alpha-2BAR \| ADRA2L2 \| ADRA2RL2 \| Alpha-2 adrenergic receptor subtype C4 \| Alpha-2C adrenoceptor \| Alpha-2C adrenoreceptor \| Alpha-2CAR \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ADRB2R \| B2AR \| Beta-2 adrenoceptor \| Beta-2 adrenoreceptor \| ADRB3R \| B3AR \| Beta-3 adrenoceptor \| Beta-3 adrenoreceptor \| Dopamine D2 receptor \| 1.4.3.21 \| 1.4.3.4 \| MAO-B \| Monoamine oxidase type B \| 5HT transporter \| 5HTT \| HTT \| SERT \| Solute carrier family 6 member 4 \| 1,4-cineole 2-exo-monooxygenase \| 1.14.14.- \| Coumarin 7-hydroxylase \| CYP2A3 \| CYPIIA6 \| Cytochrome P450 IIA3 \| Cytochrome P450(I) \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| EMT \| EMTH \| Extraneuronal monoamine transporter \| OCT3 \| Organic cation transporter 3 \| High-affinity sodium-dependent carnitine cotransporter \| OCTN2 \| Solute carrier family 22 member 5	[ "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adderall XR", "Adzenys ER", "Adzenys XR-ODT", "Adzenys XR-ODT", "Adzenys XR-ODT", "Adzenys XR-ODT", "Adzenys XR-ODT", "Adzenys XR-ODT", "Amphetamine Extended-Release Oral Suspension", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine sulfate", "Amphetamine sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Amphetamine Sulfate", "Apo-amphetamine XR", "Apo-amphetamine XR", "Apo-amphetamine XR", "Apo-amphetamine XR", "Apo-amphetamine XR", "Apo-amphetamine XR", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate and Amphetamine Aspartate and Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate (monohydrate), Dextroamphetamine Sulfate, Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate (monohydrate), Dextroamphetamine Sulfate, Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate (monohydrate), Dextroamphetamine Sulfate, Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate (monohydrate), Dextroamphetamine Sulfate, Amphetamine Sulfate", 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Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate", "Dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Dyanavel XR", "Evekeo", "Evekeo", "Evekeo", "Evekeo", "Evekeo ODT", "Evekeo ODT", "Evekeo ODT", "Evekeo ODT", "Evekeo ODT", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single Entity Amphetamine Product XR", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mydayis", "Mydayis", "Mydayis", "Mydayis", "Mydayis", "Mydayis", "Mydayis", "Mydayis", "PMS-amphetamines XR", "PMS-amphetamines XR", "PMS-amphetamines XR", "PMS-amphetamines XR", "PMS-amphetamines XR", "PMS-amphetamines XR", "Sandoz Amphetamine XR", "Sandoz Amphetamine XR", "Sandoz Amphetamine XR", "Sandoz Amphetamine XR", "Sandoz Amphetamine XR", "Sandoz Amphetamine XR", "Taro-amphetamine XR", "Taro-amphetamine XR", "Taro-amphetamine XR", "Taro-amphetamine XR", "Taro-amphetamine XR", "Taro-amphetamine XR", "Teva-amphetamine XR", "Teva-amphetamine XR", "Teva-amphetamine XR", "Teva-amphetamine XR", "Teva-amphetamine XR", "Teva-amphetamine XR" ]	[]	[ "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine 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"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate Extended-Release", "Dextroamphetamine Saccharate, Amphetamine 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and Amphetamine Sulfate", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Mixed Salts of a Single-Entity Amphetamine Product", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate", "Dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, amphetamine sulfate", 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"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate", "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate" ]	[ "Q05940", "Q01959", "Q16568", "Q96RJ0", "P21397", "P27338", "P23975", "P35348", "P35368", "P25100", "P08913", "P18089", "P18825", "P08588", "P07550", "P13945", "P14416", "P27338", "P31645" ]	[ "P11509", "P10635" ]	[]	[ "O75751", "O76082" ]
DB00183	Pentagastrin	A synthetic pentapeptide that mimics the actions of endogenous gastrin when given parenterally. It works by stimulating the secretion of gastric acid, pepsin, and intrinsic factor. It has also been used as a diagnostic aid.	solid	Used as a diagnostic aid for evaluation of gastric acid secretory function	Pentagastrin is indicated as a diagnostic aid for evaluation of gastric acid secretory function. It is effective in testing for anacidity (achlorhydria) in patients with suspected pernicious anemia, atrophic gastritis, or gastric carcinoma. It is also effective in determining the reduction in acid output after operations for peptic ulcer, such as vagotomy or gastric resection.	The exact mechanism by which pentagastrin stimulates gastric acid, pepsin, and intrinsic factor secretion is unknown; however, since pentagastrin is an analogue of natural gastrin, it is believed that it excites the oxyntic cells of the stomach to secrete to their maximum capacity. Pentagastrin stimulates pancreatic secretion, especially when administered in large intramuscular doses. Pentagastrin also increases gastrointestinal motility by a direct effect on the intestinal smooth muscle. However, it delays gastric emptying time probably by stimulation of terminal antral contractions, which enhance retropulsion.	Rapidly absorbed after parenteral administration.	Primarily hepatic	null	10 minutes or less	null	null	null	null	Organic compounds	Organic acids and derivatives	Peptidomimetics	Hybrid peptides	[ "approved" ]	[ "V04CG", "V04C", "V04", "V" ]	[ "Humans and other mammals" ]	[]	[]	Pentagastrin \| CCK-B receptor \| CCK-BR \| CCK2-R \| CCKRB \| Cholecystokinin-2 receptor \| 3.1.1.8 \| Acylcholine acylhydrolase \| Butyrylcholine esterase \| CHE1 \| Choline esterase II \| Pseudocholinesterase	[ "Pentagastrin", "Peptavlon Liq Inj 0.25mg/ml" ]	[ "Peptavlon" ]	[]	[ "P32239" ]	[ "P06276" ]	[]	[]
DB00184	Nicotine	Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke.	liquid	For the relief of nicotine withdrawal symptoms and as an aid to smoking cessation.	Nicotine, the primary alkaloid in tobacco products binds stereo-selectively to nicotinic-cholinergic receptors on autonomic ganglia, the adrenal medulla, neuromuscular junctions and in the brain. Nicotine exerts two effects, a stimulant effect exerted at the locus ceruleus and a reward effect in the limbic system. Itranvenous administration of nicotine causes release of acetylcholine, norepinephrine, dopamine, serotonine, vasopressin, beta-endorphin and ACTH. Nicotine is a highly addictive substance. Nicotine also induces peripheral vasoconstriction, tachycardia and elevated blood pressure. Nicotine inhalers and patches are used to treat smoking withdrawl syndrome. Nicotine is classified as a stimulant of autonomic ganglia.	Nicotine is a stimulant drug that acts as an agonist at nicotinic acetylcholine receptors. These are ionotropic receptors composed up of five homomeric or heteromeric subunits. In the brain, nicotine binds to nicotinic acetylcholine receptors on dopaminergic neurons in the cortico-limbic pathways. This causes the channel to open and allow conductance of multiple cations including sodium, calcium, and potassium. This leads to depolarization, which activates voltage-gated calcium channels and allows more calcium to enter the axon terminal. Calcium stimulates vesicle trafficking towards the plasma membrane and the release of dopamine into the synapse. Dopamine binding to its receptors is responsible the euphoric and addictive properties of nicotine. Nicotine also binds to nicotinic acetylcholine receptors on the chromaffin cells in the adrenal medulla. Binding opens the ion channel allowing influx of sodium, causing depolarization of the cell, which activates voltage-gated calcium channels. Calcium triggers the release of epinephrine from intracellular vesicles into the bloodstream, which causes vasoconstriction, increased blood pressure, increased heart rate, and increased blood sugar.	Absorption of nicotine through the buccal mucosa is relatively slow and the high and rapid rise followed by the decline in nicotine arterial plasma concentrations seen with cigarette smoking are not achieved with the inhaler. About 10% of absorbed nicotine is excreted unchanged in urine.	Primarily hepatic, cotinine is the primary metabolite.	Symptoms of overdose include nausea, abdominal pain, vomiting, diarrhea, diaphoresis, flushing, dizziness, disturbed hearing and vision, confusion, weakness, palpitations, altered respiration and hypotension. LD<sub>50</sub>= 24 mg/kg (orally in mice).	Cotinine has a half life of 15-20 hours, while nicotine has a half life of 1-3 hours	Less than 5%	About 10% of the nicotine absorbed is excreted unchanged in the urine.	* 2 to 3 L/kg	* 1.2 L/min [healthy adult smoker]	Organic compounds	Organoheterocyclic compounds	Pyridines and derivatives	Pyrrolidinylpyridines	[ "approved" ]	[ "N07BA", "N07B", "N07", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.28", "description": "Nicotrol cartridge inhaler", "unit": "each" }, { "cost": "1.83", "description": "Nicotine transdermal system", "unit": "each" }, { "cost": "3.14", "description": "Nicotine 11 mg/24hr patch", "unit": "patch" }, { "cost": "3.14", "description": "Nicotine 22 mg/24hr patch", "unit": "patch" }, { "cost": "3.52", "description": "Nicoderm cq 14 mg/24hr patch", "unit": "patch" }, { "cost": "3.52", "description": "Nicoderm cq 7 mg/24hr patch", "unit": "patch" }, { "cost": "4.08", "description": "Nicoderm cq 21 mg/24hr patch", "unit": "patch" }, { "cost": "5.37", "description": "Nicotrol ns 10 mg/ml spray", "unit": "ml" }, { "cost": "11.25", "description": "Nicotine polacrilex powder", "unit": "g" }, { "cost": "55.88", "description": "Nicotrol NS 10 mg/ml Solution 10ml Bottle", "unit": "bottle" }, { "cost": "196.27", "description": "Nicotine 30 14 mg/24hr Patches Box", "unit": "box" }, { "cost": "206.52", "description": "Nicotine 30 21 mg/24hr Patches Box", "unit": "box" }, { "cost": "223.5", "description": "Nicotrol 168 10 mg Inhalant Inhaler", "unit": "inhaler" }, { "cost": "0.25", "description": "Nicotine 2 mg chewing gum", "unit": "each" }, { "cost": "0.3", "description": "Nicotine 4 mg chewing gum", "unit": "each" }, { "cost": "0.34", "description": "CVS Pharmacy nicotine 2 mg chewing gum", "unit": "each" }, { "cost": "0.38", "description": "CVS Pharmacy nicotine 4 mg chewing gum", "unit": "each" }, { "cost": "0.42", "description": "Thrive nicotine 2 mg gum", "unit": "each" }, { "cost": "0.42", "description": "Thrive nicotine 4 mg gum", "unit": "each" }, { "cost": "0.45", "description": "Nicorette 2 mg chewing gum", "unit": "each" }, { "cost": "0.52", "description": "Nicorette 4 mg chewing gum", "unit": "each" }, { "cost": "0.55", "description": "Commit 2 mg lozenge", "unit": "lozenge" }, { "cost": "0.55", "description": "Commit 4 mg lozenge", "unit": "lozenge" } ]	[ { "approved": "1997-08-12", "country": "United States", "expires": "2014-08-12", "number": "5656255" }, { "approved": "1996-03-26", "country": "United States", "expires": "2010-06-08", "number": "5501236" }, { "approved": "1994-11-15", "country": "Canada", "expires": "2011-11-15", "number": "1333051" }, { "approved": "2012-12-04", "country": "United States", "expires": "2028-04-30", "number": "8323683" }, { "approved": "2015-04-07", "country": "United States", "expires": "2020-02-13", "number": "8999379" }, { "approved": "2015-12-08", "country": "United States", "expires": "2019-12-15", "number": "9205059" }, { "approved": "2011-12-13", "country": "United States", "expires": "2021-05-22", "number": "8075911" }, { "approved": "2014-03-04", "country": "United States", "expires": "2020-02-13", "number": "8663680" }, { "approved": "2013-08-06", "country": "United States", "expires": "2029-06-14", "number": "8501164" }, { "approved": "2015-01-27", "country": "United States", "expires": "2029-04-30", "number": "8940772" } ]	(−)-nicotine \| (S)-(−)-nicotine \| (S)-3-(1-methylpyrrolidin-2-yl)pyridine \| (S)-3-(N-methylpyrrolidin-2-yl)pyridine \| (S)-Nicotine \| 3-(2-(N-methylpyrrolidinyl))pyridine \| 3-(N-methylpyrollidino)pyridine \| L(−)-nicotine \| Nicotina \| Nicotine \| Nicotine betadex \| Nicotine polacrilex \| Nikotin \| Nikotyna \| NACRA4 \| NACHRA7 \| NACHRA3 \| NACHRA5 \| NACHR alpha-9 \| NACHRA9 \| Nicotinic acetylcholine receptor subunit alpha-9 \| NACHR alpha-10 \| NACHRA10 \| Nicotinic acetylcholine receptor subunit alpha-10 \| 1.14.14.14 \| ARO1 \| CYAR \| CYP19 \| CYPXIX \| Cytochrome P-450AROM \| Cytochrome P450 19A1 \| Estrogen synthase \| 2.3.1.6 \| ChAT \| CHOACTase \| Choline acetylase \| 1.14.14.1 \| CYPIA1 \| Cytochrome P450 form 6 \| Cytochrome P450-C \| Cytochrome P450-P1 \| Hydroperoxy icosatetraenoate dehydratase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.4.3.21 \| 1.4.3.4 \| MAO-A \| Monoamine oxidase type A \| 1.4.3.21 \| 1.4.3.4 \| MAO-B \| Monoamine oxidase type B \| 1,4-cineole 2-exo-monooxygenase \| 1.14.14.- \| Coumarin 7-hydroxylase \| CYP2A3 \| CYPIIA6 \| Cytochrome P450 IIA3 \| Cytochrome P450(I) \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J \| 1.14.14.1 \| CYPIIA13 \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| hOCT2 \| OCT2 \| Organic cation transporter 2 \| hOCT1 \| OCT1 \| Organic cation transporter 1 \| EMT \| EMTH \| Extraneuronal monoamine transporter \| OCT3 \| Organic cation transporter 3 \| High-affinity sodium-dependent carnitine cotransporter \| OCTN2 \| Solute carrier family 22 member 5 \| Ergothioneine transporter \| ET transporter \| ETT \| ETTh \| OCTN1 \| Organic cation/carnitine transporter 1 \| UT2H	[ "Amazon Basic Care Nicotine Polacrilex", "Amazon Basic Care Nicotine Polacrilex", "Amazon Basic Care Nicotine Polacrilex", "Amazon Basic Care Nicotine Polacrilex", "American Fare Nicotine Transdermal System", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care nicotine", "Basic Care Nicotine", "Basic Care Nicotine", "Basic Care nicotine", "Basic 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Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine transdermal system", "Nicotine transdermal system", "Nicotine transdermal system", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "NICOTINE Transdermal System Step 1", "Nicotine Transdermal System Step 1", "Nicotine Transdermal System Step 1", "Nicotine Transdermal System Step 1", "Nicotine transdermal system step 1", "Nicotine Transdermal System Step 1", "Nicotine transdermal system step 1", "Nicotine transdermal system step 1", "Nicotine Transdermal System Step 1", "Nicotine Transdermal System Step 1", "Nicotine transdermal system step 1", "Nicotine transdermal system step 1", "Nicotine transdermal system step 1", "Nicotine transdermal system step 1", "Nicotine transdermal system step 1", "Nicotine transdermal system step 1", "Nicotine Transdermal System Step 1", "Nicotine Transdermal System Step 1", "Nicotine Transdermal System Step 1", "Nicotine Transdermal System Step 1", "Nicotine transdermal system step 1", "Nicotine transdermal system step 1", "NICOTINE Transdermal System Step 2", "Nicotine Transdermal System Step 2", "Nicotine Transdermal System Step 2", "Nicotine Transdermal System Step 2", "Nicotine transdermal system step 2", "Nicotine Transdermal System Step 2", "Nicotine transdermal system step 2", "Nicotine Transdermal System Step 2", "Nicotine Transdermal System Step 2", "Nicotine transdermal system step 2", "Nicotine transdermal system step 2", "Nicotine transdermal system step 2", "Nicotine transdermal system step 2", "Nicotine transdermal system step 2", "Nicotine transdermal system step 2", "Nicotine Transdermal System Step 2", "Nicotine Transdermal System Step 2", "Nicotine transdermal system step 2", "Nicotine transdermal system step 2", "NICOTINE Transdermal System Step 3", "Nicotine Transdermal System Step 3", "Nicotine transdermal system step 3", "Nicotine transdermal system step 3", "Nicotine Transdermal System Step 3", "Nicotine Transdermal System Step 3", "Nicotine transdermal system step 3", "Nicotine transdermal system step 3", "Nicotine transdermal system step 3", "Nicotine transdermal system step 3", "Nicotine transdermal system step 3", "Nicotine transdermal system step 3", "Nicotine Transdermal System Step 3", "Nicotine Transdermal System Step 3", "Nicotine transdermal system step 3", "Nicotine transdermal system step 3", "Nicotine UN1654", "Nicotrol", "Nicotrol", "Nicotrol", "Nicotrol", "Nicotrol", "Nicotrol (Professional Sample)", "Nicotrol (Professional Sample)", "Nictoine Gum", "NiEnjoy Nicotine Transdermal System", "Preferred Plus Nicotine", "Preferred Plus Nicotine", "Preferred Plus Nicotine Polacrilex Gum, Original Flavor", "Quitine Nicotine", "Quitine Nicotine", "Quitine Nicotine", "Quitine Nicotine", "Quitine Nicotine", "Quitine Nicotine", "Rexall Nicotine", "Rexall Nicotine", "Rexall Nicotine", "Rite Aid Nicotine Transdermal System Step 1", "Rite Aid Nicotine Transdermal System Step 2", "Rite Aid Nicotine Transdermal System Step 3", "Rugby Nicotine", "Rugby Nicotine", "Rugby Nicotine Polacrilex Gum, Coated Fruit Flavor", "Rugby Nicotine Polacrilex Gum, Coated Fruit Flavor", "Rugby Nicotine Polacrilex Gum, Coated Mint Flavor", "Rugby Nicotine Polacrilex Gum, Coated Mint Flavor", "Rugby Nicotine Polacrilex Gum, Mint Flavor", "Rugby Nicotine Polacrilex Gum, Mint Flavor", "Rugby Nicotine Polacrilex Gum, Mint Flavor", "Rugby Nicotine Polacrilex Gum, Mint Flavor", "Rugby Nicotine Polacrilex Gum, Mint Flavor", "Rugby Nicotine Polacrilex Gum, Mint Flavor", "Rugby Nicotine Polacrilex Gum, Original Flavor", "Rugby Nicotine Polacrilex Gum, Original Flavor", "Rugby Nicotine Polacrilex Gum, Original Flavor", "Safeway Nicotine Transdermal System Step 1", "Safeway Nicotine Transdermal System Step 2", "Safeway Nicotine Transdermal System Step 3", "Sielkin QUIT SMOKING NICOTINE PATCHES", "Sielkin QUIT SMOKING NICOTINE PATCHES 14mg", "Sielkin QUIT SMOKING NICOTINE PATCHES 21mg", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Signature Care Nicotine", "Simply Right Nicotine", "Simply Right Nicotine", "Simply Right Nicotine", "Simply Right Nicotine", "Simply Right Nicotine", "Simply Right Nicotine", "Simply Right Nicotine", "Simply Right Nicotine", "Smart Sense Nicotine", "Smart Sense Nicotine", "Smart Sense Nicotine", "Smart Sense Nicotine", "Smart Sense Nicotine", "Smart Sense Nicotine", "Smart Sense Nicotine", "Smart Sense Nicotine Mint", "Smart Sense Nicotine Polacrilex", "Smart Sense Nicotine Polacrilex", "Sound Body Nicotine", "Stop Smoking Aid", "Stop Smoking Aid", "Stop Smoking Aid", "Stop Smoking Aid", "Stop Smoking Aid", "Stop Smoking Aid Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine", "Sunmark Nicotine Transdermal System Step 1", "Sunmark Nicotine Transdermal System Step 2", "Sunmark Nicotine Transdermal System Step 2", "Sunmark Nicotine Transdermal System Step 3", "Thrive", "Thrive", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "TopCare Nicotine", "Topcare nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine", "Topcare Nicotine Gum", "Topcare Nicotine Polacrilex", "Topcare Nicotine Polacrilex", "Topcare nicotine stop smoking aid", "Tru Relief Nicotine", "Tru Relief Nicotine", "Up and Up Cherry Ice Nicotine", "Up and Up Cherry Nicotine", "Up and Up Cherry Nicotine", "Up and Up Citrus Mini Nicotine", "Up and Up Citrus Mini Nicotine", "Up and Up Coated Cool Mint Nicotine", "Up and Up Coated Mint Freeze Nicotine", "Up and Up Mini Nicotine", "Up and Up Mini Nicotine", "Up and Up Mini Nicotine", "Up and Up Mini Nicotine", "Up and Up Mini Nicotine Polacrilex", "Up and Up Mint Mini Nicotine", "Up and Up Mint Nicotine", "Up and Up Mint Nicotine", "Up and Up Mint Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine", "Up and Up Nicotine Mini Mint", "Up and Up Nicotine Polacrilex", "Up and Up Nicotine Polacrilex", "Up and Up Nicotine Polacrilex", "Up and Up Nicotine Polacrilex", "Up and Up Uncoated Nicotine", "Up and Up Uncoated Original Nicotine", "Zonnic", "Zonnic Nicotine", "Zonnic Nicotine", "Zonnic nicotine", "Zonnic Nicotine", "Zonnic Nicotine Mini", "Zonnic Nicotine Polacrilex", "Zonnic Nicotine Polacrilex", "Zonnic Nicotine Polacrilex", "Zonnic Nicotine Polacrilex" ]	[ "Habitrol", "Nicoderm" ]	[ "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Basic Care Nicotine", "Basic Care Nicotine", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine", "Nicotine", "Nicotine", "Nicotine", "Nicotine transdermal system", "Nicotine transdermal system", "Nicotine transdermal system", "Nicotine transdermal", "Nicotine transdermal", "Nicotine transdermal", "Nicorette and Aquafresh Fruit Chill and Extreme Clean Whitening", "Nicotine Transdermal", "Nicotine Transdermal", "Nicotine Transdermal", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal System", "Nicotine Transdermal Patches", "Nicotine Transdermal Patches", "Nicotine Transdermal Patches", "Nicotine Transdermal Patches" ]	[ "P43681", "P36544", "P17787", "Q15822", "P32297", "P30532", "Q15825", "Q9UGM1", "Q9GZZ6", "Q05901", "P30926", "P11511", "P28329" ]	[ "P04798", "P05177", "P33261", "P10632", "P11712", "P10635", "P08684", "P21397", "P27338", "P11509", "P05181", "Q16696", "P20813" ]	[]	[ "O15244", "O15245", "O75751", "O76082", "Q9H015" ]
DB00185	Cevimeline	Cevimeline is a parasympathomimetic agent that act as an agonist at the muscarinic acetylcholine receptors M1 and M3. It is indicated by the Food and Drug Administration for the treatment of dry mouth associated with Sjögren's syndrome.	solid	For the treatment of symptoms of dry mouth in patients with Sjögren's Syndrome.	Cevimeline is a cholinergic agonist which binds to muscarinic receptors. Muscarinic agonists in sufficient dosage can increase secretion of exocrine glands, such as salivary and sweat glands and increase tone of the smooth muscle in the gastrointestinal and urinary tracts.	Muscarinic agonists such as cevimeline bind and activate the muscarinic M1 and M3 receptors. The M1 receptors are common in secretory glands (exocrine glands such as salivary and sweat glands), and their activation results in an increase in secretion from the secretory glands. The M3 receptors are found on smooth muscles and in many glands which help to stimulate secretion in salivary glands, and their activation generally results in smooth muscle contraction and increased glandular secretions. Therefore, as saliva excretion is increased, the symptoms of dry mouth are relieved.	Rapidly absorbed with peak concentration after 1.5 to 2 hours	Primarily hepatic, isozymes CYP2D6 and CYP3A4 are responsible for the metabolism of cevimeline. Approximately 44.5% of the drug is converted to cis and trans-sulfoxide, 22.3% to glucuronic acid conjugate, and 4% to N-oxide of cevimeline. Approximately 8% of the trans-sulfoxide metabolite is then converted into the corresponding glucuronic acid conjugate.	null	5 ± 1 hours	< 20%	After 24 hours, 84% of a 30 mg dose of cevimeline was excreted in urine.	* 6 L/kg	null	Organic compounds	Organoheterocyclic compounds	Azaspirodecane derivatives	null	[ "approved" ]	[ "N07AX", "N07A", "N07", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "2.69", "description": "Evoxac 30 mg capsule", "unit": "capsule" } ]	[ { "approved": "1994-08-23", "country": "United States", "expires": "2013-07-07", "number": "5340821" }, { "approved": "1989-08-08", "country": "United States", "expires": "2009-08-30", "number": "4855290" } ]	2-Methyspiro(1,3-oxathiolane-5,3)quinuclidine \| Cevimelina \| Cévimèline \| Cevimeline \| Cevimelinum \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.13.148 \| 1.14.13.8 \| Dimethylaniline monooxygenase [N-oxide-forming] 1 \| Dimethylaniline oxidase 1 \| Fetal hepatic flavin-containing monooxygenase 1 \| FMO 1 \| Trimethylamine monooxygenase	[ "Cevimeline", "Cevimeline", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Cevimeline Hydrochloride", "Evoxac", "Evoxac", "Evoxac" ]	[ "Saligren" ]	[]	[ "P20309", "P11229" ]	[ "P10635", "P08684", "Q01740" ]	[]	[]
DB00186	Lorazepam	Lorazepam is a short-acting and rapidly cleared benzodiazepine used commonly as a sedative and anxiolytic.[A957] It was developed by DJ Richards, presented and marketed initially by Wyeth Pharmaceuticals in the USA in 1977. The first historic FDA label approval is reported in 1985 by the company Mutual Pharm.[L5095]	solid	Lorazepam is FDA-approved for the short-term relief of anxiety symptoms related to anxiety disorders and anxiety associated with depressive symptoms such as anxiety-associated insomnia. It is as well used as an anesthesia premedication in adults to relieve anxiety or to produce sedation/amnesia and for the treatment of status epilepticus.[T385] Some off-label indications of lorazepam include rapid tranquilization of an agitated patient, alcohol withdrawal delirium, alcohol withdrawal syndrome, muscle spasms, insomnia, panic disorder, delirium, chemotherapy-associated anticipatory nausea and vomiting, and psychogenic catatonia.[T385]	The effect of lorazepam in GABA-A receptors produces an increase in the frequency of opening of the chloride ion channel. However, for its effect to generate, the neurotransmitter is required.[A5415] The anticonvulsant properties of lorazepam are thought to be related to the binding to voltage-dependent sodium channels in which the sustained repetitive firing gets limited by the slow recovery of sodium channels due to the benzodiazepine effect.[A1240] The effect of lorazepam seems to be very compartmental which was observed with a different generation of sleepiness and a dizziness effect.[A173920]	Lorazepam allosterically binds on the benzodiazepine receptors in the post-synaptic GABA-A ligand-gated chloride channel in different sites of the central nervous system (CNS). This binding will result in an increase on the GABA inhibitory effects which is translated as an increase in the flow of chloride ions into the cell causing hyperpolarization and stabilization of the cellular plasma membrane.[T385] According to the binding site of lorazepam, we can observe different activities as the binding in the amygdala is known to help mainly in anxiety disorders while the binding in the cerebral cortex helps in seizure disorders.[T385]	Readily absorbed with an absolute bioavailability of 90% when given orally. When intramuscularly administered a dose of 4 mg, lorazepam is completely and rapidly absorbed and achieves a maximal serum concentration of 48 ng/ml in 15-30 minutes. When administered orally, the time to attained maximum concentration is observed to be of 2 hours.[T385]	Lorazepam is hepatically metabolized by CYP450 isoenzymes and extensively conjugated to the 3-0-phenolic glucuronide.[T385] This is an inactive metabolite and is eliminated mainly by the kidneys.	The LD50 observed by oral administration in a mouse is of 1850 mg/kg.[L6403] When an overdose administration is registered, signs of CNS and respiratory depression are rapidly observed. An overdose stage can result in profound sedation, deep respiratory depression, coma, and death.[T385] When overdose is observed, it is recommended to administer emergency symptomatic medical support with attention to produce an increase in lorazepam elimination.[T388] There is no evidence of carcinogenicity nor mutagenicity. At doses higher than 40 mg/kg there is evidence of fetal resorption and increase in fetal loss.[FDA label]	When administered parentally, the registered half-life of lorazepam is of 14 hours.[T385] Following the administration of 1 mg of lorazepam in healthy adult male volunteers and using a multi-doses equation based on a one-compartment model, the average elimination half-life of lorazepam was estimated to be 11 hours and 8 hours for sublingual and oral doses respectively.[A251115] The absorption half-life was calculated to be 55 minutes for oral doses and 15 minutes for sublingual doses.[A251115]	Reports indicate that 85% of lorazepam administered dose is protein bound.[T388]	When a single 2 mg oral dose is given to healthy subjects, 88% of the administered dose is recovered in urine and 7% was recovered in feces. From the excreted dose in urine, the major form is the glucuronide version that represents 74% while only 0.3% of the dose is recovered as unchanged lorazepam.[T388]	The reported volume of distribution of lorazepam is 1.3 L/kg.[T388] It is important to mention that due to the lipophilicity of lorazepam, it does not redistribute as fast in the brain.[T391]	_In vivo_ studies with lorazepam have shown a clearance rate of 5.8 ml.min/kg.[A173914]	Organic compounds	Organoheterocyclic compounds	Benzodiazepines	1,4-benzodiazepines	[ "approved" ]	[ "N05BA", "N05B", "N05", "N", "N05BA", "N05B", "N05", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.01", "description": "Lorazepam 2 mg tablet", "unit": "tablet" }, { "cost": "1.16", "description": "Lorazepam-d5w 100 mg/100 ml", "unit": "ml" }, { "cost": "1.16", "description": "Lorazepam-ns 100 mg/100 ml bag", "unit": "ml" }, { "cost": "1.37", "description": "Ativan 0.5 mg tablet", "unit": "tablet" }, { "cost": "1.53", "description": "Lorazepam-ns 60 mg/60 ml bag", "unit": "ml" }, { "cost": "1.6", "description": "Lorazepam intensol 2 mg/ml", "unit": "ml" }, { "cost": "1.96", "description": "Ativan 1 mg tablet", "unit": "tablet" }, { "cost": "2.16", "description": "Ativan 4 mg/ml vial", "unit": "ml" }, { "cost": "2.3", "description": "Ativan 2 mg tablet", "unit": "tablet" }, { "cost": "2.5", "description": "Lorazepam 2 mg/ml vial", "unit": "ml" }, { "cost": "9.59", "description": "Lorazepam 4 mg/ml vial", "unit": "ml" }, { "cost": "20.81", "description": "Lorazepam powder", "unit": "g" }, { "cost": "44.99", "description": "LORazepam Intensol 2 mg/ml Concentrate 30ml Bottle", "unit": "bottle" }, { "cost": "0.04", "description": "Apo-Lorazepam 0.5 mg Tablet", "unit": "tablet" }, { "cost": "0.04", "description": "Novo-Lorazem 0.5 mg Tablet", "unit": "tablet" }, { "cost": "0.04", "description": "Pms-Lorazepam 0.5 mg Tablet", "unit": "tablet" }, { "cost": "0.05", "description": "Apo-Lorazepam 1 mg Tablet", "unit": "tablet" }, { "cost": "0.05", "description": "Novo-Lorazem 1 mg Tablet", "unit": "tablet" }, { "cost": "0.05", "description": "Pms-Lorazepam 1 mg Tablet", "unit": "tablet" }, { "cost": "0.07", "description": "Apo-Lorazepam 2 mg Tablet", "unit": "tablet" }, { "cost": "0.07", "description": "Novo-Lorazem 2 mg Tablet", "unit": "tablet" }, { "cost": "0.07", "description": "Pms-Lorazepam 2 mg Tablet", "unit": "tablet" }, { "cost": "0.12", "description": "Ativan 0.5 mg Sublingual Tablet", "unit": "tablet" }, { "cost": "0.15", "description": "Ativan 1 mg Sublingual Tablet", "unit": "tablet" }, { "cost": "0.24", "description": "Ativan 2 mg Sublingual Tablet", "unit": "tablet" }, { "cost": "0.55", "description": "Lorazepam 0.5 mg tablet", "unit": "tablet" }, { "cost": "0.69", "description": "Lorazepam 1 mg tablet", "unit": "tablet" }, { "cost": "0.9", "description": "Ativan 2 mg/ml vial", "unit": "ml" } ]	[ { "approved": "2015-04-07", "country": "United States", "expires": "2034-01-08", "number": "8999393" } ]	Loracepam \| Lorazepam \| o-Chlorooxazepam \| o-Chloroxazepam \| BZRP \| MBR \| Mitochondrial benzodiazepine receptor \| PBR \| Peripheral-type benzodiazepine receptor \| PKBS \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-4 \| GABAAR subunit alpha-4 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit alpha-6 \| GABAAR subunit alpha-6 \| GABA(A) receptor subunit beta-1 \| GABAAR subunit beta-1 \| GABA(A) receptor subunit beta-2 \| GABAAR subunit beta-2 \| GABA(A) receptor subunit beta-3 \| GABAAR subunit beta-3 \| GABA(A) receptor subunit delta \| GABAAR subunit delta \| GABA(A) receptor subunit epsilon \| GABAAR subunit epsilon \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| GABA(A) receptor subunit pi \| GABAAR subunit pi \| GABA(A) receptor subunit theta \| GABAAR subunit theta \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| 2.4.1.17 \| HLUG4 \| UDP-glucuronosyltransferase 2B8 \| UDPGT 2B15 \| UDPGT 2B8 \| UDPGTh-3 \| UGT2B15 \| UGT2B8	[ "Apo-lorazepam", "Apo-lorazepam", "Apo-lorazepam", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan", "Ativan Inj 4mg/ml", "Ativan Injection Liq 4mg/ml", "Ativan Subl Tab 0.5mg", "Ativan Subl Tab 1mg", "Ativan Tab 0.5mg", "Ativan Tab 1mg", "Ativan Tab 2mg", "Dom-lorazepam", "Dom-lorazepam", "Dom-lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam", "Lorazepam Injection USP", "Lorazepam Injection USP", "Lorazepam Injection USP", "Lorazepam Injection, USP", "Lorazepam Sublingual", "Lorazepam Sublingual", "Lorazepam Sublingual", "Loreev XR", "Loreev XR", "Loreev XR", "Loreev XR", "Ntp-lorazepam", "Ntp-lorazepam", "Ntp-lorazepam", "Nu-loraz Tab 0.5mg", "Nu-loraz Tab 1mg", "Nu-loraz Tab 2mg", "PHL-lorazepam", "PHL-lorazepam", "PHL-lorazepam", "PMS-lorazepam", "PMS-lorazepam", "PMS-lorazepam", "Pro-lorazepam", "Pro-lorazepam", "Pro-lorazepam", "Riva-lorazepam 0.5 Mg Tablets", "Riva-lorazepam 1 Mg Tablets", "Riva-lorazepam 2mg Tablets", "Teva-lorazepam", "Teva-lorazepam", "Teva-lorazepam" ]	[ "Almazine", "Anxiedin", "Idalprem", "Lorabenz", "Lorsilan", "Somagerol", "Temesta", "Wypax" ]	[]	[ "P30536", "P14867", "P47869", "P34903", "P48169", "P31644", "Q16445", "P18505", "P47870", "P28472", "O14764", "P78334", "Q8N1C3", "P18507", "Q99928", "O00591", "Q9UN88", "P14867", "P47869", "P34903", "P31644", "Q8N1C3", "P18507", "Q99928" ]	[ "P54855" ]	[]	[]
DB00187	Esmolol	Esmolol, commonly marketed under the trade name Brevibloc, is a cardioselective beta-1 receptor blocker. It has a rapid onset but short duration of action without causing significant intrinsic sympathomimetic or membrane stabilizing activities at recommended therapeutic doses. It works by blocking beta-adrenergic receptors in the heart, which leads to decreased force and rate of heart contractions. Esmolol prevents the action of two naturally occurring substances: epinephrine and norepinephrine. The FDA withdrew its approval for the use of all parenteral dosage form drug products containing esmolol hydrochloride that supply 250 milligrams/milliliter of concentrated esmolol per 10-milliliter ampule. Other esmolol formulations are still available for use.[L43942]	solid	For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short term control of ventricular rate with a short-acting agent is desirable. Also used in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention.	null	Similar to other beta-blockers, esmolol blocks the agonistic effect of the sympathetic neurotransmitters by competing for receptor binding sites. Because it predominantly blocks the beta-1 receptors in cardiac tissue, it is said to be cardioselective. In general, so-called cardioselective beta-blockers are relatively cardioselective; at lower doses they block beta-1 receptors only but begin to block beta-2 receptors as the dose increases. At therapeutic dosages, esmolol does not have intrinsic sympathomimetic activity (ISA) or membrane-stabilizing (quinidine-like) activity. Antiarrhythmic activity is due to blockade of adrenergic stimulation of cardiac pacemaker potentials. In the Vaughan Williams classification of antiarrhythmics, beta-blockers are considered to be class II agents.	Rapidly absorbed, steady-state blood levels for dosages from 50-300 µg/kg/min (0.05-0.3 mg/kg/mm) are obtained within five minutes.	Esmolol undergoes rapid hydrolysis of ester linkage which is catalyzed by esterases found in the cytosol of red blood cells (RBCs). The plasma cholinersterases or RBC membrane acetylcholinesterases are not involved in this metabolic reaction. Metabolism of the drug occurs mainly in RBCs to form a free acid metabolite (with 1/1500 the activity of esmolol) and methanol.	Symptoms of overdose include cardiac arrest, bradycardia, hypotension, electromechanical dissociation and loss of consciousness.	Rapid distribution half-life of about 2 minutes and an elimination half-life of about 9 minutes. The acid metabolite has an elimination half-life of about 3.7 hours.	55% bound to human plasma protein, while the acid metabolite is 10% bound.	Consistent with the high rate of blood-based metabolism of esmolol hydrochloride, less than 2% of the drug is excreted unchanged in the urine. The acid metabolite has an elimination half-life of about 3.7 hours and is excreted in the urine with a clearance approximately equivalent to the glomerular filtration rate. Excretion of the acid metabolite is significantly decreased in patients with renal disease, with the elimination half-life increased to about ten-fold that of normals, and plasma levels considerably elevated.	null	* 20 L/kg/hr [Men]	Organic compounds	Benzenoids	Phenol ethers	null	[ "approved", "withdrawn" ]	[ "C07AB", "C07A", "C07", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.26", "description": "Esmolol hcl 10 mg/ml vial", "unit": "ml" }, { "cost": "1.54", "description": "Brevibloc 20 mg/ml iv bag", "unit": "ml" }, { "cost": "2.21", "description": "Brevibloc 10 mg/ml vial", "unit": "ml" }, { "cost": "13.21", "description": "Brevibloc 250 mg/ml ampul", "unit": "ml" } ]	[ { "approved": "2008-08-26", "country": "Canada", "expires": "2022-01-02", "number": "2410446" }, { "approved": "2003-03-04", "country": "United States", "expires": "2021-07-12", "number": "6528540" }, { "approved": "2001-10-30", "country": "United States", "expires": "2021-07-12", "number": "6310094" }, { "approved": "2014-09-16", "country": "United States", "expires": "2033-03-15", "number": "8835505" }, { "approved": "2014-09-09", "country": "United States", "expires": "2033-03-15", "number": "8829054" } ]	(±)-esmolol \| (±)-methyl p-(2-hydroxy-3-(isopropylamino)propoxy)hydrocinnamate \| 3-[4-(2-Hydroxy-3-isopropylamino-propoxy)-phenyl]-propionic acid methyl ester \| Esmolol \| Methyl 4-(2-hydroxy-3-((1-methylethyl)amino)propoxy)benzenepropanoate \| methyl p-(2-hydroxy-3-(isopropylamino)propoxy)hydrocinnamate \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase	[ "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc", "Brevibloc Injection 10mg/ml", "Brevibloc Injection 250mg/ml", "Brevibloc Liq IV 10mg/ml", "Brevibloc Liq IV 250mg/ml", "Brevibloc Premixed Injection", "Esmolol", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride", "Esmolol Hydrochloride In Sodium Chloride", "Esmolol Hydrochloride In Sodium Chloride", "Esmolol Hydrochloride in Water", "Esmolol Hydrochloride in Water" ]	[]	[]	[ "P08588" ]	[ "P10635" ]	[]	[]
DB00188	Bortezomib	Bortezomib is a dipeptide boronic acid derivative and proteasome inhibitor used to treat multiple myeloma and mantle cell lymphoma.[A204083] The 26S proteasome is a protein complex that degrades ubiquitinated proteins in the ubiquitin-proteasome pathway: reversible inhibition of the 26S proteasome, leading to cell cycle arrest and apoptosis of cancer cells, is thought to be the main mechanism of action of bortezomib.[L14180] However, multiple mechanisms may be involved in the anticancer activity of bortezomib.[A204083] Bortezomib was first synthesized in 1995.[A204083] In May 2003, bortezomib became the first anticancer proteasome inhibitor that was approved by the FDA under the trade name VELCADE.[A204146] Phase I, II, III, and IV clinical trials are undergoing to investigate the therapeutic efficacy of bortezomib in leukemia, myasthenia gravis, systemic lupus erythematosus, rheumatoid arthritis, and solid tumours.[A214307]	solid	Bortezomib is indicated for the treatment of adults with multiple myeloma or mantle cell lymphoma.[L44341]	Bortezomib works to target the ubiquitin-proteasome pathway, an essential molecular pathway that regulates intracellular concentrations of proteins and promotes protein degradation.[A272] The ubiquitin-proteasome pathway is often dysregulated in pathological conditions, leading to aberrant pathway signalling and the formation of malignant cells. In one study, patient-derived chronic lymphocytic leukemia (CLL) cells contained 3-fold higher levels of chymotrypsin-like proteasome activity than normal lymphocytes.[A272] By reversibly inhibiting proteasome, bortezomib prevents proteasome-mediated proteolysis. Bortezomib exerts a cytotoxic effect on various cancer cell types _in vitro_ and delays tumour growth _in vivo_ in nonclinical tumour models.[L14177] Bortezomib inhibits the proteasome activity in a dose-dependent manner. In one pharmacodynamic study, more than 75% of proteasome inhibition was observed in whole blood samples within one hour after dosing of bortezomib.[A204083]	The ubiquitin-proteasome pathway is a homeostatic proteolytic pathway for intracellular protein degradation: proteins marked with a poly-ubiquitin chain are degraded to small peptides and free ubiquitin by the proteasome, which is a large multimeric protease.[A18508] Aberrant proteasome-dependent proteolysis, as seen in some malignancies, can lead to uncontrolled cell division, leading to tumorigenesis, cancer growth, and spread.[A18508, A204083] Bortezomib is a reversible inhibitor of the 26S proteasome, which is made up of a 20S core complexed with a 19S regulatory complex. Individual β-subunits allow specific catalytic action of the 20S core.[A18509, A204083] In mammalian cells, bortezomib is a potent inhibitor of the proteasome’s chymotryptic-like activity, which is attributed to the β5-subunit of the 20S core particle.[A18509] Bortezomib binds to the active site of the threonine hydroxyl group in the β5-subunit.[A204083] A probing study showed bortezomib also binding to and inhibiting the β1-subunit, which mediates the caspase-like activity of the proteasome, and β1i-subunit, which is an altered subunit that is expressed to form immunoproteasomes in response to cell stress or inflammation.[A18509] By inhibiting the proteasome-mediated degradation of key proteins that promote cell apoptosis,[A18508] bortezomib induces a cell cycle arrest during the G2-M phase.[L14180] It is believed that multiple mechanisms, other than proteasome inhibition, may be involved in the anticancer activity of bortezomib.[A204083] The anticancer activity of bortezomib was largely associated with suppression of the NF-κB signalling pathway, resulting in the downregulation of anti-apoptotic target genes and expression of anti-apoptic proteins. This may be explained by bortezomib preventing uncontrolled degradation of IκB, which is an inhibitory protein of NF-κB. NOXA, which is a pro-apoptotic factor, induced by bortezomib selectively in cancer cells; thus, it is suggested to be another key mechanism of bortezomib.[A204083]	Following intravenous administration of 1 mg/m<sup>2</sup> and 1.3 mg/m<sup>2</sup> doses, the mean C<sub>max</sub> of bortezomib were 57 and 112 ng/mL, respectively. In a twice-weekly dosing regimen, the C<sub>max</sub> ranged from 67 to 106 ng/mL at the dose of 1 mg/m<sup>2</sup> and 89 to 120 ng/mL for the 1.3 mg/m<sup>2</sup> dose. In patients with multiple myeloma, the C<sub>max</sub> of bortezomib followig subcutaneous administration was lower than that of intravenously-administered dose; however, the total systemic exposure of the drug was equivalent for both routes of administration.[L14177] There is a wide interpatient variability in drug plasma concentrations.[L14180]	Bortezomib is primarily metabolized by CYP3A4, CYP2C19, and CYP1A2. CYP2D6 and CYP2C9 are also involved in drug metabolism, but to a smaller extent.[L14177] Oxidative deboronation, which involves the removal of boronic acid from the parent compound, is the main metabolic pathway. Metabolites of bortezomib are pharmacologically inactive and more than 30 metabolites have been identified in human and animal studies.[A204146]	The Lowest published toxic dose (TD<sub>Lo</sub>) in mouse was 5 mg/kg/14D following intraperitoneal administration of an intermittent dose and 1.6 mg/kg/12D following subcutaneous administration of a continuous dose.[L14198] The therapeutic dose of bortezomib is individualized in each patient to prevent overdose. Fatal outcomes occurred in humans following the administration of more than twice the recommended therapeutic dose of bortezomib. The symptoms from overdose included the acute onset of symptomatic hypotension and thrombocytopenia. As there is no known antidote for bortezomib overdosage, monitoring of vital signs and appropriate supportive care should be initiated when drug overdosage is suspected. In monkeys and dogs, increased heart rate, decreased contractility, hypotension, and death were observed with the intravenous dose as low as two times the recommended clinical dose on a mg/m2 basis. A case of a slight increase in the corrected QT interval leading to death occurred in dog studies.[L14177]	The mean elimination half-life of bortezomib ranged from 40 to 193 hours following a multiple dosing regimen at a 1 mg/m<sup>2</sup> dose. The half-life ranged from 76 to 108 hours after multiple dosing of 1.3 mg/m<sup>2</sup> bortezomib.[L14177]	Over the concentration range of 100 to 1000 ng/mL, bortezomib is about 83% bound to human plasma proteins.[L14177]	Bortezomib is eliminated by both renal and hepatic routes.[A204146]	The mean distribution volume of bortezomib ranged from approximately 498 to 1884 L/m<sup>2</sup> in patients with multiple myeloma receiving a single- or repeat-dose of 1 mg/m<sup>2</sup> or 1.3 mg/m<sup>2</sup>.[L14177] Bortezomib distributes into nearly all tissues, except for the adipose and brain tissue.[A204083]	Following the administration of a first dose of 1 mg/m<sup>2</sup> and 1.3 mg/m<sup>2</sup>, the mean mean total body clearances were 102 and 112 L/h, respectively. The clearances were 15 and 32 L/h after the subsequent dose of 1 and 1.3 mg/m<sup>2</sup>, respectively.[L14177]	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved", "investigational" ]	[ "L01XG", "L01X", "L01", "L" ]	[ "Humans and other mammals" ]	[ { "cost": "1590.0", "description": "Velcade 3.5 mg vial", "unit": "vial" } ]	[ { "approved": "2000-07-04", "country": "United States", "expires": "2014-10-28", "number": "6083903" }, { "approved": "2005-04-12", "country": "Canada", "expires": "2015-10-27", "number": "2203936" }, { "approved": "1998-07-14", "country": "United States", "expires": "2017-11-03", "number": "5780454" }, { "approved": "2005-10-25", "country": "United States", "expires": "2022-07-25", "number": "6958319" }, { "approved": "2004-03-30", "country": "United States", "expires": "2022-07-25", "number": "6713446" }, { "approved": "2015-02-24", "country": "United States", "expires": "2032-11-03", "number": "8962572" }, { "approved": "2022-09-23", "country": "United States", "expires": "2042-09-23", "number": "11679119" }, { "approved": "2022-09-23", "country": "United States", "expires": "2042-09-23", "number": "11752164" }, { "approved": "2022-09-23", "country": "United States", "expires": "2042-09-23", "number": "12005069" } ]	[(1R)-3-methyl-1-({(2S)-3-phenyl-2-[(pyrazin-2-ylcarbonyl)amino]propanoyl}amino)butyl]boronic acid \| Bortezomib \| N-[(1R)-1-(DIHYDROXYBORYL)-3-methylbutyl]-N-(pyrazin-2-ylcarbonyl)-L-phenylalaninamide \| 3.4.25.1 \| beta-5 \| LMPX \| Macropain epsilon chain \| MB1 \| Multicatalytic endopeptidase complex epsilon chain \| Proteasome chain 6 \| Proteasome epsilon chain \| Proteasome subunit beta-5 \| Proteasome subunit MB1 \| Proteasome subunit X \| X \| 3.4.21.4 \| Anionic trypsin I \| Anionic trypsin-I \| Beta-trypsin \| Cationic trypsinogen \| Pretrypsinogen I \| TRP1 \| TRY1 \| TRYP1 \| Trypsin I \| Trypsin-1 \| beta-6 \| Macropain subunit C5 \| Multicatalytic endopeptidase complex subunit C5 \| Proteasome component C5 \| Proteasome gamma chain \| Proteasome subunit beta-6 \| PSC5 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8	[ "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib", "Bortezomib Accord", "Bortezomib Accord", "Bortezomib Accord", "Bortezomib Accord", "Bortezomib Accord", "Bortezomib Accord", "Bortezomib Fresenius Kabi", "Bortezomib Fresenius Kabi", "Bortezomib Fresenius Kabi", "Bortezomib Hospira", "Bortezomib Hospira", "Bortezomib Hospira", "Bortezomib Hospira", "Bortezomib Sun", "Boruzu", "Velcade", "Velcade", "Velcade" ]	[]	[]	[ "P28074", "P07477", "P20618" ]	[ "P08684", "P33261", "P10635", "P05177", "P11712" ]	[]	[ "P08183", "Q9NPD5" ]
DB00189	Ethchlorvynol	Ethchlorvynol is a sedative and hypnotic drug. It has been used to treat insomnia, but has been largely superseded and is only offered where an intolerance or allergy to other drugs exists.	liquid	Used for short-term hypnotic therapy in the management of insomnia for periods of up to one week in duration; however, this medication generally has been replaced by other sedative-hypnotic agents.	Ethchlorvynol is a sedative drug and schedule IV (USA) controlled substance. It produces cerebral depression, however the exact mechanism of action is not known.	Although the exact mechanism of action is unknown, ethchlorvynol appears to depress the central nervous system in a manner similar to that of barbiturates. Barbiturates bind at a distinct binding sites associated with a Cl<sup>-</sup> ionopore at the GABA<sub>A</sub> receptor, increasing the duration of time for which the Cl<sup>-</sup> ionopore is open. The post-synaptic inhibitory effect of GABA in the thalamus is, therefore, prolonged.	Rapidly absorbed from gastrointestinal tract.	About 90% of a dose is metabolized in the liver. Some ethchlorvynol may also be metabolized in the kidneys. Ethchlorvynol and metabolites undergo extensive enterohepatic recirculation.	Symptoms of overdose include thrombocytopenia.	Plasma half-life is approximately 10 to 20 hours, terminal half-life is 21-100 hours.	35-50%	null	null	null	Organic compounds	Organic oxygen compounds	Organooxygen compounds	Carbonyl compounds	[ "approved", "illicit", "withdrawn" ]	[ "N05CM", "N05C", "N05", "N" ]	[ "Humans and other mammals" ]	[]	[]	1-chloro-3-ethyl-1-penten-4-yn-3-ol \| 1-Chloro-3-ethyl-pent-1-en-4-yn-3-ol \| 3-(beta-chlorovinyl)-1-pentyn-3-ol \| 3-(β-chlorovinyl)-1-pentyn-3-ol \| etclorvinol \| Ethchlorvynol \| ethyl β-chlorovinyl ethynyl carbinol \| β-chlorovinyl ethyl ethynyl carbinol \| GABA(A) receptor subunit beta-2 \| GABAAR subunit beta-2 \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-4 \| GABAAR subunit alpha-4 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit alpha-6 \| GABAAR subunit alpha-6 \| GABA(A) receptor subunit beta-1 \| GABAAR subunit beta-1 \| GABA(A) receptor subunit beta-2 \| GABAAR subunit beta-2 \| GABA(A) receptor subunit beta-3 \| GABAAR subunit beta-3 \| GABA(A) receptor subunit delta \| GABAAR subunit delta \| GABA(A) receptor subunit epsilon \| GABAAR subunit epsilon \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| GABA(A) receptor subunit pi \| GABAAR subunit pi \| GABA(A) receptor subunit theta \| GABAAR subunit theta	[ "Placidyl Cap 200mg", "Placidyl Cap 500mg", "Placidyl Cap 750mg" ]	[ "Arvynol", "Nostel", "Placidyl", "Roeridorm", "Serenesil" ]	[]	[ "P47870", "P14867", "P14867", "P47869", "P34903", "P48169", "P31644", "Q16445", "P18505", "P47870", "P28472", "O14764", "P78334", "Q8N1C3", "P18507", "Q99928", "O00591", "Q9UN88" ]	[]	[]	[]
DB00190	Carbidopa	Carbidopa presents a chemical denomination of N-amino-alpha-methyl-3-hydroxy-L-tyrosine monohydrate. It potently inhibits aromatic amino acid decarboxylase (DDC) and due to its chemical properties, it does not cross the blood-brain barrier. Due to its activity, carbidopa is always administered concomitantly with [levodopa]. An individual formulation containing solely carbidopa was generated to treat nausea in patients where the combination therapy [levodopa]/carbidopa is not efficient reducing nausea.[T394] The first approved product by the FDA containing only carbidopa was developed by Amerigens Pharmaceuticals Ltd and approved on 2014.[L5110] On the other hand, the combination treatment of carbidopa/levodopa was originally developed by Watson Labs but the historical information by the FDA brings back to the approval of this combination therapy developed by Mayne Pharma in 1992.[L5113]	solid	Carbidopa is indicated with [levodopa] for the treatment of symptoms of idiopathic Parkinson disease, postencephalitic parkinsonism and symptomatic parkinsonism followed by carbon monoxide or manganese intoxication.[FDA label] The combination therapy is administered for the reduction of [levodopa]-driven nausea and vomiting.[FDA label] The product of carbidopa should be used in patients where the combination therapy of carbidopa/[levodopa] provide less than the adequate daily dosage.[FDA label] As well carbidopa can be used in patients where the dosages of carbidopa and [levodopa] require individual titration.[FDA label]	When mixed with [levodopa], carbidopa inhibits the peripheral conversion of [levodopa] to dopamine and the decarboxylation of [oxitriptan] to serotonin by aromatic L-amino acid decarboxylase. This results in an increased amount of [levodopa] and [oxitriptan] available for transport to the central nervous system. Carbidopa also inhibits the metabolism of [levodopa] in the GI tract, thus, increasing the bioavailability of [levodopa].[A13607] The presence of additional units of circulating [levodopa] can increase the effectiveness of the still functional dopaminergic neurons and it has been shown to alleviate symptoms for a time. The action of carbidopa is very important as [levodopa] is able to cross the blood-brain barrier while dopamine cannot.[T28] Hence the administration of carbidopa is essential to prevent the transformation of external [levodopa] to dopamine before reaching the main action site in the brain. The coadministration of carbidopa with [levodopa] has been shown to increase the half-life of [levodopa] more than 1.5 times while increasing the plasma level and decreasing clearance. The combination therapy has also shown an increase of the recovery of [levodopa] in urine instead of dopamine which proves a reduced metabolism. This effect has been highly observed by a significant reduction in [levodopa] requirements and a significant reduction in the presence of side effects such as nausea. It has been observed that the effect of carbidopa is not dose-dependent.[T394]	Carbidopa is an inhibitor of the DDC which in order, inhibits the peripheral metabolism of levodopa.[A173935] DDC is very important in the biosynthesis of L-tryptophan to serotonin and the modification of L-DOPA to dopamine.[A13607] DDC can be found in the body periphery and in the blood-brain barrier.[A13607] The action of carbidopa is focused on peripheral DDC as this drug cannot cross the blood-brain barrier.[T28] Hence, it will prevent the metabolism of [levodopa] in the periphery but it will not have any activity on the generation of dopamine in the brain.	When [levodopa]/carbidopa is administered orally, 40-70% of the administered dose is absorbed.[L5116] Once absorbed, carbidopa shows bioavailability of 58%.[A173941] A maximum concentration of 0.085 mcg/ml was achieved after 143 min with an AUC of 19.28 mcg.min/ml.[A173944]	The loss of the hydrazine functional group (probably as molecular nitrogen) represents the major metabolic pathway for carbidopa. There are several metabolites of carbidopa metabolism including 3-(3,4-dihydroxyphenyl)-2-methylpropionic acid, 3-(4-hydroxy-3-methoxyphenyl)-2-methylpropionic acid, 3-(3-hydroxyphenyl)-2-methylpropionic acid, 3-(4-hydroxy-3-methoxyphenyl)-2-methyllactic acid, 3-(3-hydroxyphenyl)-2-methyllactic acid, and 3,4-dihydroxyphenylacetone (1,2).[A274]	The LD50 of carbidopa is reported to be in the rat of 4810 mg/kg.[MSDS] In animal studies, carbidopa showed no incidences on neoplasia and showed no effect on the fertility status and development.[FDA label] No reports of overdosage have been registered with the carbidopa-only product. In the event of overdosage, immediate gastric lavage is recommended as well as intravenous fluid administration. Continuous electrocardiographic monitoring is required.[FDA label]	The reported half-life of carbidopa is of approximately 107 minutes.[A173944]	It is widely accepted that the protein binding of carbidopa is 76%. However, more studies are required or the presentation of the source of this information.	In animal studies, 66% of the administered dose of carbidopa was eliminated via the urine while 11% was found in feces. These studies were performed in humans and it was observed a urine excretion covering 50% of the administered dose.[A274]	The volume of distribution reported for the combination therapy of carbidopa/[levodopa] is of 3.6 L/kg.[A173947] However, carbidopa is widely distributed in the tissues, except in the brain.[L5116] After one hour, carbidopa is found mainly in the kidney, lungs, small intestine and liver.[A274]	The reported clearance rate for the combination therapy of [levodopa]/carbidopa is 51.7 L/h.[A173947]	Organic compounds	Phenylpropanoids and polyketides	Phenylpropanoic acids	null	[ "approved" ]	[]	[ "Humans and other mammals" ]	[ { "cost": "2.53", "description": "Lodosyn 25 mg tablet", "unit": "tablet" }, { "cost": "27.54", "description": "Carbidopa powder", "unit": "g" } ]	[ { "approved": "2002-12-31", "country": "United States", "expires": "2020-06-29", "number": "6500867" }, { "approved": "2004-09-28", "country": "United States", "expires": "2020-06-29", "number": "6797732" }, { "approved": "2015-07-28", "country": "United States", "expires": "2028-12-26", "number": "9089607" }, { "approved": "2013-02-19", "country": "United States", "expires": "2028-12-26", "number": "8377474" }, { "approved": "2013-06-04", "country": "United States", "expires": "2028-12-26", "number": "8454998" }, { "approved": "2006-08-22", "country": "United States", "expires": "2022-05-29", "number": "7094427" }, { "approved": "2013-10-15", "country": "United States", "expires": "2028-12-26", "number": "8557283" }, { "approved": "2015-07-28", "country": "United States", "expires": "2028-12-26", "number": "9089608" }, { "approved": "2016-10-11", "country": "United States", "expires": "2028-12-26", "number": "9463246" }, { "approved": "2017-01-03", "country": "United States", "expires": "2028-12-26", "number": "9533046" }, { "approved": "2018-02-27", "country": "United States", "expires": "2028-12-26", "number": "9901640" }, { "approved": "2021-06-15", "country": "United States", "expires": "2039-03-28", "number": "11033521" }, { "approved": "2019-03-28", "country": "United States", "expires": "2039-03-28", "number": "11439613" }, { "approved": "2019-03-28", "country": "United States", "expires": "2039-03-28", "number": "11819485" }, { "approved": "2021-12-21", "country": "United States", "expires": "2041-12-21", "number": "11986449" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "11666538" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "10987313" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "10973769" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "10688058" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "10292935" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "10098845" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "11622941" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "12064521" }, { "approved": "2014-10-07", "country": "United States", "expires": "2034-10-07", "number": "11357733" }, { "approved": "2021-12-21", "country": "United States", "expires": "2041-12-21", "number": "12109185" } ]	(-)-L-alpha-Hydrazino-3,4-dihydroxy-alpha-methylhydrocinnamic acid monohydrate \| (S)-(−)-carbidopa \| (S)-carbidopa \| (αS)-α-hydrazino-3,4-dihydroxy-α-methylbenzenepropanoic acid \| Carbidopa \| Carbidopa (anhydrous) \| Carbidopa anhydrous \| Carbidopum \| L-3-(3,4-dihydroxyphenyl)-2-methyl-2-hydrazinopropionic acid \| L-α-methyldopahydrazine \| 4.1.1.28 \| AADC \| DDC \| DOPA decarboxylase	[ "Aa-levocarb CR", "Aa-levocarb CR", "Ag-levocarb", "Ag-levocarb", "Ag-levocarb", "Apo-levocarb", "Apo-levocarb", "Apo-levocarb", "Auro-levocarb", "Auro-levocarb", "Auro-levocarb", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa Tablets, 25 mg", "Carbidopa Tablets, 25 mg", "Carbidopa Tablets, 25 mg", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Crexont", "Crexont", "Crexont", "Crexont", "Dhivy", "Dom-levo-carbidopa", "Duodopa", "Duopa", "Jamp Levocarb", "Jamp Levocarb", "Jamp Levocarb", "Levodopa-carbidopa", "Levodopa-carbidopa", "Levodopa-carbidopa", "Levodopa-carbidopa CR", "Levodopa-carbidopa CR", "Levodopa, Carbidopa and Entacapone Tablets", "Levodopa, Carbidopa and Entacapone Tablets", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Lodosyn", "Lodosyn", "Lodosyn", "Lodosyn", "Mint-levocarb", "Mint-levocarb", "Mint-levocarb", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Parcopa", "Parcopa", "Parcopa", "Parcopa", "Parcopa", "Parcopa", "PMS-levodopa-carbidopa", "PMS-levodopa-carbidopa", "PMS-levodopa-carbidopa", "Pro-lecarb-100/10 - Tab", "Pro-lecarb-100/25 - Tab", "Pro-levocarb - 100/25", "Ratio-levodopa/carbidopa", "Ratio-levodopa/carbidopa", "Ratio-levodopa/carbidopa", "Rytary", "Rytary", "Rytary", "Rytary", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet 100/10", "Sinemet CR", "Sinemet CR", "Sinemet CR", "Sinemet CR", "Sinemet CR", "Sinemet CR 100/25", "Sinemet CR 200/50", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Teva-levocarbidopa", "Teva-levocarbidopa", "Teva-levocarbidopa" ]	[]	[ "Parcopa", "Parcopa", "Parcopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Sinemet CR", "Sinemet CR", "Sinemet CR", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Parcopa", "Parcopa", "Parcopa", "Carbidopa and Levodopa", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa, levodopa and entacapone", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Sinemet CR", "Sinemet CR", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Rytary", "Rytary", "Rytary", "Rytary", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa, Levodopa, and Entacapone", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Sinemet", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Duopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Sinemet", "Sinemet", "Sinemet", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Sinemet CR 200/50", "Sinemet CR 100/25", "Apo-levocarb", "Apo-levocarb", "Apo-levocarb", "Sinemet", "Sinemet", "Teva-levocarbidopa", "Teva-levocarbidopa", "Teva-levocarbidopa", "Aa-levocarb CR", "Aa-levocarb CR", "Stalevo", "Stalevo", "Stalevo", "Pro-levocarb - 100/25", "Stalevo", "Stalevo", "Levodopa-carbidopa CR", "Levodopa-carbidopa CR", "Ratio-levodopa/carbidopa", "Ratio-levodopa/carbidopa", "Ratio-levodopa/carbidopa", "Levodopa-carbidopa", "Levodopa-carbidopa", "Levodopa-carbidopa", "Pro-lecarb-100/10 - Tab", "Pro-lecarb-100/25 - Tab", "Mint-levocarb", "Sinemet 100/10", "Dom-levo-carbidopa", "Mint-levocarb", "Mint-levocarb", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Sandoz Levodopa-carbidopa-entacapone", "Levodopa, Carbidopa and Entacapone Tablets", "Levodopa, Carbidopa and Entacapone Tablets", "Duodopa", "Dhivy", "Carbidopa and Levodopa", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa, Levodopa and Entacapone", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa and levodopa", "Auro-levocarb", "Auro-levocarb", "Auro-levocarb", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa-levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and Levodopa", "Jamp Levocarb", "Jamp Levocarb", "Jamp Levocarb", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and levodopa", "Carbidopa and levodopa", "PMS-levodopa-carbidopa", "PMS-levodopa-carbidopa", "PMS-levodopa-carbidopa", "Crexont", "Crexont", "Crexont", "Crexont", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Ag-levocarb", "Ag-levocarb", "Ag-levocarb", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Carbidopa and Levodopa", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Corbilta", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Numient", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Stalevo", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Levodopa/carbidopa/entacapone Orion", "Carbidopa and Levodopa", "Carbidopa and Levodopa" ]	[ "P20711" ]	[]	[]	[]
DB00191	Phentermine	Phentermine is a sympathomimetic amine anorectic agent and it was introduced in 1959 as part of an anti-obesity combination drug.[A174361, A174364] It is chemically related to amphetamine and it is commonly referred to as an atypical amphetamine.[A174370] Phentermine has not been reported an addictive potential which allows this agent to be classified under the Schedule IV drugs (low abuse potential).[A174367] Phentermine was FDA approved for short-term weight management in 1959 and it became widely used in 1960. This initial product, formed by the combination of phentermine with [fenfluramine] and [dexfenfluramine] was discontinued after finding several reports of abnormal valves in nearly 30% of the consumers.[A174376, T403] Later on, phentermine was approved alone and in combination with topiramate in 2012 as a new alternative that required lower doses of phentermine to obtain the desired effect.[A174373]	solid	Phentermine is indicated, alone or in combination with topiramate, as a short-term adjunct, not pass a few weeks, in a regimen of weight reduction based on exercise, behavioral modifications and caloric restriction in the management of exogenous obesity for patients with an initial body mass index (BMI) greater than 30 kg/m2 or greater than 27 kg/m2 in presence of other risk factors such as controller hypertension, diabetes or hyperlipidemia.[FDA label] Exogenous obesity is considered when the overweight is caused by consuming more food than the person activity level warrants. This condition commonly causes an increase in fat storage. It is an epidemic condition in the United States where over two-thirds of adults are overweight or obese and one in three Americans is obese. In the world, the incidence of obesity has nearly doubled.[A174391]	It is reported that the main mechanism of action of phentermine is the generation of appetite suppression, maybe due to the increase in leptin, but it is considered that other mechanisms should be involved.[A174370] Some reports have indicated that the weight loss effect is mainly due to the increase in resting energy expenditure.[A174367] In clinical studies where phentermine was used as a monotherapy and as combination therapy, this drug has shown an average weight loss of 3.6 kg when compared with the placebo in 2-24 weeks. Patients treated with phentermine also showed increased maintenance of the weight after treatment discontinuation.[A174367] As well, even though it is a derivative of the amphetamines, it has not been registered to produce any of the effects of amphetamine such as central nervous system stimulation, elevation of blood pressure, tachyphylaxis or QTc prolongation.[A174370]	Phentermine is an indirect-acting sympathomimetic agent that acts by releasing noradrenaline from the presynaptic vesicles in the lateral hypothalamus. This increase in noradrenaline concentration in the synaptic cleft results in the stimulation of beta2-adrenergic receptors.[A174367] Phentermine is classified as an indirect sympathomimetic due to the increase in the level of norepinephrine, dopamine and its indirect effect towards serotonin.[L5233] Some reports have indicated that phentermine inhibits the neuropeptide Y which is a principal signaling pathway for the induction of hunger.[T403] This combined effect produces a continuous flight-or-fight response in the body which reduces the hunger signal as this state is on the immediate need for energy.[T403] Lastly, some reports have indicated that phentermine is a weak inhibitor of monoamine oxidase but this mechanism does not tend to produce a clinically significant response.[T49]	Phentermine shows a dose-dependent pharmacokinetic profile. After oral administration of a dose of 15 mg, the maximal concentration was achieved after 6 hours and its bioavailability was not affected by the consumption of high-fat meals.[A174370] The reported plasma concentration at steady-state is of around 200 ng/ml as observed in clinical trials.[T49]	Phentermine undergoes minimal p-hydroxylation, N-oxidation and N-hydroxylation followed by conjugation. The total proportion of the drug that goes under metabolism only represents about 6% of the administered dose where about 5% is represented by the N-oxidized and N-Hydroxylated metabolites.[T49]	The reported LD50 after oral administration of phentermine in rats is reported to be of 151 mg/kg.[L5239] Reports of acute overdose include restlessness, tremors, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations and panic state followed by fatigue, and depression. In the cardiovascular system, there are reports of tachycardia, arrhythmia, hypertension, hypotension, circulatory collapse. In the GI tract, there are symptoms of nausea, vomiting, diarrhea and abdominal cramps. The management of acute overdosage includes symptomatic treatment as well as lavage and sedation with barbiturates.[FDA label] On the other hand, chronic overdosage is marked by dermatoses, insomnia, irritability, hyperactivity and personality changes. In severe cases, it can derive into a schizophrenia-like psychosis.[FDA label] Studies regarding the carcinogenic potential have not been performed. On the case of mutagenic assays, phentermine was shown to not be mutagenic nor clastogenic.[FDA label]	The mean terminal half-life of phentermine is reported to be of approximately 20 hours.[A174370] In conditions where there is acidic urine (pH <5), the elimination half-life is of 7-8 hours.[T49]	The protein binding of phentermine is determined to be of 17.5%.[A174370]	Phentermine is excreted mainly in the urine from which about 70-80% of the administered dose can be found as the unchanged drug.[A174370]	The reported volume of distribution for phentermine is reported to be of 5 L/kg.[L5236]	The reported clearance when administered orally is 8.79 L/h as observed in pharmacokinetic population studies.[F3283]	Organic compounds	Benzenoids	Benzene and substituted derivatives	Phenethylamines	[ "approved", "illicit" ]	[ "A08AA", "A08A", "A08", "A", "A08AA", "A08A", "A08", "A" ]	[ "Humans and other mammals" ]	[ { "cost": "1.0", "description": "Phentermine HCl 37.5 mg capsule", "unit": "capsule" }, { "cost": "1.0", "description": "Phentermine HCl 37.5 mg tablet", "unit": "tablet" }, { "cost": "1.15", "description": "Ionamin 15 mg capsule sa", "unit": "capsule" }, { "cost": "1.17", "description": "Phentermine HCl 30 mg capsule", "unit": "capsule" }, { "cost": "1.18", "description": "Phentermine HCl 15 mg capsule", "unit": "capsule" }, { "cost": "1.54", "description": "Phentermine 37.5 mg tablet", "unit": "tablet" }, { "cost": "2.15", "description": "Adipex-p 37.5 mg tablet", "unit": "tablet" }, { "cost": "2.2", "description": "Adipex-P 37.5 mg capsule", "unit": "capsule" }, { "cost": "2.87", "description": "Ionamin 30 mg capsule sa", "unit": "capsule" }, { "cost": "10.71", "description": "Phentermine hcl powder", "unit": "g" }, { "cost": "0.54", "description": "Phentermine 8 mg tablet", "unit": "tablet" } ]	[ { "approved": "2000-06-06", "country": "United States", "expires": "2017-06-23", "number": "6071537" }, { "approved": "2014-11-25", "country": "United States", "expires": "2028-06-09", "number": "8895057" }, { "approved": "2006-06-06", "country": "United States", "expires": "2020-06-14", "number": "7056890" }, { "approved": "2009-06-30", "country": "United States", "expires": "2020-06-14", "number": "7553818" }, { "approved": "2010-02-09", "country": "United States", "expires": "2020-06-14", "number": "7659256" }, { "approved": "2010-03-09", "country": "United States", "expires": "2020-06-14", "number": "7674776" }, { "approved": "2013-11-12", "country": "United States", "expires": "2029-06-14", "number": "8580299" }, { "approved": "2015-04-21", "country": "United States", "expires": "2028-06-09", "number": "9011906" }, { "approved": "2015-04-21", "country": "United States", "expires": "2028-06-09", "number": "9011905" }, { "approved": "2014-11-25", "country": "United States", "expires": "2028-06-09", "number": "8895058" }, { "approved": "2013-11-12", "country": "United States", "expires": "2029-05-15", "number": "8580298" }, { "approved": "2000-11-21", "country": "United States", "expires": "2018-07-23", "number": "6149938" }, { "approved": "2013-05-14", "country": "United States", "expires": "2029-03-14", "number": "8440170" } ]	alpha,alpha-Dimethylphenethylamine \| Fentermina \| Phentermine \| Phentermine resin \| Phenterminum \| NAT1 \| NET \| NET1 \| Norepinephrine transporter \| SLC6A5 \| Solute carrier family 6 member 2 \| 5HT transporter \| 5HTT \| HTT \| SERT \| Solute carrier family 6 member 4 \| DA transporter \| DAT \| DAT1 \| Solute carrier family 6 member 3 \| 1.4.3.21 \| 1.4.3.4 \| MAO-A \| Monoamine oxidase type A \| 1.4.3.21 \| 1.4.3.4 \| MAO-B \| Monoamine oxidase type B \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase	[ "Adipex-P", "Adipex-P", "Adipex-P", "Adipex-P", "Adipex-P", "Adipex-P", "Adipex-P", "Adipex-P", "Fastin Cap 30mg", "Ionamin", "Ionamin", "Ionamin", "Ionamin", "Lomaira", "Lomaira", "Lomaira", "Phentermine", "Phentermine", "Phentermine", "Phentermine", "Phentermine", "Phentermine", "Phentermine HCl", "Phentermine HCl", "Phentermine HCl", "Phentermine HCL", "Phentermine HCL", "Phentermine HCl C-IV", "Phentermine HCL C-IV", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine hydrochloride", "Phentermine hydrochloride", "Phentermine Hydrochloride", "Phentermine hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine 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Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine hydrochloride", "Phentermine hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine hydrochloride", "Phentermine hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Hydrochloride", "Phentermine Resin ER", "Phentermine Resin ER", "Phetermine Hydrochloride", "Qsymia", "Qsymia", "Qsymia", "Qsymia", "Suprenza", "Suprenza", "Suprenza" ]	[ "Dapex", "Duromine", "Fastin", "Obenix", "Obestin-30", "Oby-trim", "Phentercot", "Phentride", "Umi-Pex" ]	[ "Qsymia", "Qsymia", "Qsymia", "Qsymia" ]	[ "P23975", "P31645", "Q01959", "P21397", "P27338", "P01303" ]	[ "P08684" ]	[]	[]
DB00192	Indecainide	Indecainide is a rarely used antidysrhythmic. Indecainide has local anesthetic activity and belongs to the membrane stabilizing (Class 1) group of antiarrhythmic agents; it has electrophysiologic effects characteristic of the IC class of antiarrhythmics.	solid	For the treatment of life-threatening dysrhythmias and sustained ventricular tachycardia.	Indecainide is a rarely used antidysrhythmic. Indecainide has local anesthetic activity and belongs to the membrane stabilizing (Class 1) group of antiarrhythmic agents; it has electrophysiologic effects characteristic of the IC class of antiarrhythmics.	Indecainide acts on sodium channels on the neuronal cell membrane, limiting the spread of seizure activity and reducing seizure propagation. The antiarrhythmic actions are mediated through effects on sodium channels in Purkinje fibers.	Nearly complete following oral administration.	null	When given orally to either young adult rats or mice, the LD50 was 100 mg/kg. Symptoms of overdose include nausea and vomiting, convulsions, hypotension, bradycardia, syncope, extreme widening of the QRS complex, widening of the QT interval, widening of the PR interval, ventricular tachycardia, AV nodal block, asystole, bundle branch block, cardiac failure, and cardiac arrest.	null	null	null	null	null	Organic compounds	Benzenoids	Fluorenes	null	[ "approved" ]	[]	[ "Humans and other mammals" ]	[]	[]	Indecainida \| Indecainide \| Indecainidum \| hH1 \| Sodium channel protein cardiac muscle subunit alpha \| Sodium channel protein type V subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.5	[]	[ "Decabid" ]	[]	[ "Q14524" ]	[]	[]	[]
DB00193	Tramadol	Tramadol is a centrally acting synthetic opioid analgesic and SNRI (serotonin/norepinephrine reuptake-inhibitor) that is structurally related to [codeine] and [morphine]. Due to its good tolerability profile and multimodal mechanism of action, tramadol is generally considered a lower-risk opioid option for the treatment of moderate to severe pain. It is considered a Step 2 option on the World Health Organization's pain ladder and has about 1/10th of the potency of [morphine]. Tramadol differs from other traditional opioid medications in that it doesn't just act as a μ-opioid agonist, but also affects monoamines by modulating the effects of neurotransmitters involved in the modulation of pain such as serotonin and norepinpehrine which activate descending pain inhibitory pathways.[A182279] Tramadol's effects on serotonin and norepinephrine mimic the effects of other SNRI antidepressants such as [duloxetine] and [venlafaxine]. Tramadol exists as a racemic mixture consisting of two pharmacologically active enantiomers that both contribute to its analgesic property through different mechanisms and are also themselves metabolized into active metabolites: (+)-tramadol and its primary metabolite (+)-O-desmethyl-tramadol (M1) are agonists of the μ opioid receptor while (+)-tramadol inhibits serotonin reuptake and (-)-tramadol inhibits norepinephrine reuptake. These pathways are complementary and synergistic, improving tramadol's ability to modulate the perception of and response to pain.[A4269,A183842] Tramadol has also been shown to affect a number of other pain modulators within the central nervous system as well as non-neuronal inflammatory markers and immune mediators.[A183728,A183734,A183761,A17159,A182300] Due to the broad spectrum of targets involved in pain and inflammation, it's not surprising that the evidence has shown that tramadol is effective for a number of pain types including neuropathic pain, post-operative pain, lower back pain, as well as pain associated with labour, osteoarthritis, fibromyalgia, and cancer. Due to its SNRI activity, tramadol also has anxiolytic, antidepressant, and anti-shivering effects which are all frequently found as comorbidities with pain.[A182300] Similar to other opioid medications, tramadol poses a risk for development of tolerance, dependence and abuse. If used in higher doses, or with other opioids, there is a dose-related risk of overdose, respiratory depression, and death.[A183830,F4679] However, unlike other opioid medications, tramadol use also carries a risk of seizure and serotonin syndrome, particularly if used with other serotonergic medications.[A183836,A179926]	solid	Tramadol is approved for the management of moderate to severe pain in adults.[L9257,F4679] Tramadol is also used off-label in the treatment of premature ejaculation.[A173986]	Tramadol modulates the descending pain pathways within the central nervous system through the binding of parent and M1 metabolite to μ-opioid receptors and the weak inhibition of the reuptake of norepinephrine and serotonin.[A173983,A173980] Apart from analgesia, tramadol may produce a constellation of symptoms (including dizziness, somnolence, nausea, constipation, sweating and pruritus) similar to that of other opioids. Central Nervous System In contrast to [morphine], tramadol has not been shown to cause histamine release. At therapeutic doses, tramadol has no effect on heart rate, left-ventricular function or cardiac index. Orthostatic hypotension has been observed.[L9257] Tramadol produces respiratory depression by direct action on brain stem respiratory centres. The respiratory depression involves both a reduction in the responsiveness of the brain stem centres to increases in CO2 tension and to electrical stimulation. Tramadol depresses the cough reflex by a direct effect on the cough centre in the medulla. Antitussive effects may occur with doses lower than those usually required for analgesia. Tramadol causes miosis, even in total darkness. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origin may produce similar findings). Marked mydriasis rather than miosis may be seen with hypoxia in the setting of oxycodone overdose.[F4679] Seizures have been reported in patients receiving tramadol within the recommended dosage range. Spontaneous post-marketing reports indicate that seizure risk is increased with doses of tramadol above the recommended range. Risk of convulsions may also increase in patients with epilepsy, those with a history of seizures or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections), or with concomitant use of other drugs known to reduce the seizure threshold.[F4679] Tramadol can cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs (e.g., anti-depressants, migraine medications). Treatment with the serotoninergic drug should be discontinued if such events (characterized by clusters of symptoms such as hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, mental status changes including confusion, irritability, extreme agitation progressing to delirium and coma) occur and supportive symptomatic treatment should be initiated. Tramadol should not be used in combination with MAO inhibitors or serotonin-precursors (such as L-tryptophan, oxitriptan) and should be used with caution in combination with other serotonergic drugs (triptans, certain tricyclic antidepressants, lithium, St. John’s Wort) due to the risk of serotonin syndrome.[F4679] Gastrointestinal Tract and Other Smooth Muscle Tramadol causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum. Digestion of food in the small intestine is delayed and propulsive contractions are decreased. Propulsive peristaltic waves in the colon are decreased, while tone may be increased to the point of spasm resulting in constipation. Other opioid-induced effects may include a reduction in gastric, biliary and pancreatic secretions, spasm of the sphincter of Oddi, and transient elevations in serum amylase.[F4679] Endocrine System Opioids may influence the hypothalamic-pituitary-adrenal or -gonadal axes. Some changes that can be seen include an increase in serum prolactin and decreases in plasma cortisol and testosterone. Clinical signs and symptoms may be manifest from these hormonal changes.[F4679] Hyponatremia has been reported very rarely with the use of tramadol, usually in patients with predisposing risk factors, such as elderly patients and/or patients using concomitant medications that may cause hyponatremia (e.g., antidepressants, benzodiazepines, diuretics). In some reports, hyponatremia appeared to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and resolved with discontinuation of tramadol and appropriate treatment (e.g., fluid restriction). During tramadol treatment, monitoring for signs and symptoms of hyponatremia is recommended for patients with predisposing risk factors.[F4679] Cardiovascular Tramadol administration may result in severe hypotension in patients whose ability to maintain adequate blood pressure is compromised by reduced blood volume, or concurrent administration of drugs such as phenothiazines and other tranquillizers, sedative/hypnotics, tricyclic antidepressants or general anesthetics. These patients should be monitored for signs of hypotension after initiating or titrating the dose of tramadol.[F4679] QTc-Interval Prolongation The maximum placebo-adjusted mean change from baseline in the QTcF interval was 5.5 ms in the 400 mg/day treatment arm and 6.5 ms in the 600 mg/day mg treatment arm, both occurring at the 8h time point. Both treatment groups were within the 10 ms threshold for QT prolongation. Post-marketing experience with the use of tramadol containing products included rare reports of QT prolongation reported with an overdose. Particular care should be exercised when administering tramadol to patients who are suspected to be at an increased risk of experiencing torsade de pointes during treatment with a QTc-prolonging drug.[F4679] Abuse and Misuse Like all opioids, tramadol has the potential for abuse and misuse, which can lead to overdose and death. Therefore, tramadol should be prescribed and handled with caution.[F4679] Dependence/Tolerance Physical dependence and tolerance reflect the neuroadaptation of the opioid receptors to chronic exposure to an opioid and are separate and distinct from abuse and addiction. Tolerance, as well as physical dependence, may develop upon repeated administration of opioids, and are not by themselves evidence of an addictive disorder or abuse. Patients on prolonged therapy should be tapered gradually from the drug if it is no longer required for pain control. Withdrawal symptoms may occur following abrupt discontinuation of therapy or upon administration of an opioid antagonist. Some of the symptoms that may be associated with abrupt withdrawal of an opioid analgesic include body aches, diarrhea, gooseflesh, loss of appetite, nausea, nervousness or restlessness, anxiety, runny nose, sneezing, tremors or shivering, stomach cramps, tachycardia, trouble with sleeping, unusual increase in sweating, palpitations, unexplained fever, weakness and yawning.[F4679]	Tramadol is a centrally acting μ-opioid receptor agonist and SNRI (serotonin/norepinephrine reuptake-inhibitor) that is structurally related to [codeine] and [morphine]. Tramadol binds weakly to κ- and δ-opioid receptors and to the μ-opioid receptor with 6000-fold less affinity than morphine.[A182300] Tramadol exists as a racemic mixture consisting of two pharmacologically active enantiomers that both contribute to its analgesic property through different mechanisms: (+)-tramadol and its primary metabolite (+)-O-desmethyl-tramadol (M1) are agonists of the μ opioid receptor while (+)-tramadol inhibits serotonin reuptake and (-)-tramadol inhibits norepinephrine reuptake. These pathways are complementary and synergistic, improving tramadol's ability to modulate the perception of and response to pain.[A4269] In animal models, M1 is up to 6 times more potent than tramadol in producing analgesia and 200 times more potent in μ-opioid binding.[L9257] Tramadol has also been shown to affect a number of pain modulators including alpha2-adrenoreceptors, neurokinin 1 receptors, the voltage-gated sodium channel type II alpha subunit[A183728], transient receptor potential cation channel subfamily V member 1 (TRPV1 - also known as the capsaicin receptor)[A183734], muscarinic receptors (M1 and M3), N-methyl-D-aspartate receptor (also known as the NMDA receptor or glutamate receptor)[A17158], Adenosine A1 receptors[A183761], and nicotinic acetylcholine receptor.[A17159] In addition to the above neuronal targets, tramadol has a number of effects on inflammatory and immune mediators involved in the pain response. This includes inhibitory effects on cytokines, prostaglandin E2 (PGE2), nuclear factor-κB, and glial cells as well as a change in the polarization state of M1 macrophages.[A182300]	Oral Administration Tramadol is administered as a racemate, with both the [-] and [+] forms of both tramadol and the M1 metabolite detected in circulation. Following administration, racemic tramadol is rapidly and almost completely absorbed, with a bioavailability of 75%. This difference in absorption and bioavailability can be attributed to the 20-30% first-pass metabolism. Peak plasma concentrations of tramadol and the primary metabolite M1 occur at two and three hours, respectively.[F4679] Following a single oral dose of 100mg of tramadol, the Cmax was found to be approximately 300μg/L with a Tmax of 1.6-1.9 hours, while metabolite M1 was found to have a Cmax of 55μg/L with a Tmax of 3 hours.[A4269,L9257] Steady-state plasma concentrations of both tramadol and M1 are achieved within two days of dosing. There is no evidence of self-induction.[F4679] Following multiple oral doses, Cmax is 16% higher and AUC is 36% higher than after a single dose, demonstrating a potential role of saturable first-pass hepatic metabolism in increasing bioavailability.[A4269] Intramuscular Administration Tramadol is rapidly and almost completely absorbed following intramuscular administration. Following injection of 50mg of tramadol, Cmax of 166μg/L was found with a Tmax of 0.75 hours.[A4269] Rectal Administration Following rectal administration with suppositories containing 100mg of tramadol, Cmax of 294μg/L was found with a Tmax of 3.3 hours. The absolute bioavailability was found to be higher than oral administration (77% vs 75%), likely due to reduced first-pass metabolism with rectal administration compared to oral administration.[A4269]	Tramadol undergoes extensive first-pass metabolism in the liver by N- and O- demethylation and conjugation. From the extensive metabolism, there have been identified at least 23 metabolites. There are two main metabolic pathways: the O-demethylation of tramadol to produce O-desmethyl-tramadol (M1) catalyzed by CYP2D6 and the N-demethylation to N-desmethyl-tramadol (M2) catalyzed by CYP3A4 and CYP2B6.[A4269,L9257,F4679] The wide variability in the pharmacokinetic properties between patients can partly be ascribed to polymorphisms within the gene for CYP2D6 that determine its enzymatic activity. CYP2D6\1 is considered the wild-type allele associated with normal enzyme activity and the "extensive metabolizer" phenotype; 90-95% of Caucasians are considered "extensive metabolizers" (with normal CYP2D6 function) while the remaining 5-10% are considered "poor metabolizers" with reduced or non-functioning enzyme.[A182294] CYP2D6 alleles associated with non-functioning enzyme include 3, 4, 5, and 6 while alleles associated with reduced activity include 9, 10, 17, and 41.[A183812] Poor metabolizers have reduced activity of the CYP2D6 enzyme and therefore less production of tramadol metabolites M1 and M2, which ultimately results in a reduced analgesic effect as tramadol interacts with the μ-opioid receptor primarily via M1.[A4269] There are also large differences in the frequency of these alleles between different ethnicities: \3, \4, \5, \6, and \41 are more common among Caucasians while \17 is more common in Africans for example.[A183812] Compared to 5-10% of Caucasians, only ~1% of Asians are considered poor metabolizers, however Asian populations carry a much higher frequency (51%) of the CYP2D6\10 allele, which is relatively rare in Caucasian populations and results in higher exposure to tramadol.[A182294] Some individuals are considered "ultra-rapid metabolizers", such as those carrying CYP2D6 gene duplications (CYP2D6*DUP) or multiplications. These individuals are at risk of intoxication or exaggerated effects of tramadol due to higher concentrations of its active metabolite (M1).[A182297] The occurrence of this phenotype is seen in approximately 1% to 2% of East Asians (Chinese, Japanese, Korean), 1% to 10% of Caucasians, 3% to 4% of African-Americans, and may be >10% in certain racial/ethnic groups (ie, Oceanian, Northern African, Middle Eastern, Ashkenazi Jews, Puerto Rican). The FDA label recommends avoiding the use of tramadol in these individuals.[L9257,F4679]	The reported LD50 for tramadol, when administered orally in mice, is 350 mg/kg.[A174010] In carcinogenic studies, there are reports of murine tumors which cannot be concluded to be carcinogenic in humans. On the other hand, tramadol showed no evidence to be mutagenic in different assays and does not have effects on fertility. However, there are clear reports of embryotoxicity and fetotoxicity.[L9257,F4679]	Tramadol reported a half-life of 5-6 hours while the M1 metabolite presents a half-life of 8 hours.[A173980]	About 20% of the administered dose is found to bind to plasma proteins. Protein binding appears to be independent of concentrations up to 10μg/mL. Saturation only occurs at concentrations outside of the clinical range.[F4679]	Tramadol is eliminated primarily through metabolism by the liver and the metabolites are excreted primarily by the kidneys, accounting for 90% of the excretion while the remaining 10% is excreted through feces.[L9257,F4679,A173980] Approximately 30% of the dose is excreted in the urine as unchanged drug, whereas 60% of the dose is excreted as metabolites.[A174010] The mean terminal plasma elimination half-lives of racemic tramadol and racemic M1 are 6.3 ± 1.4 and 7.4 ± 1.4 hours, respectively. The plasma elimination half-life of racemic tramadol increased from approximately six hours to seven hours upon multiple dosing.[L9257,F4679]	The volume of distribution of tramadol is reported to be in the range of 2.6-2.9 L/kg.[L9257,F4679] Tramadol has high tissue affinity; the total volume of distribution after oral administration was 306L and 203L after parenteral administration.[A182300] Tramadol crosses the blood-brain barrier with peak brain concentrations occurring 10 minutes following oral administration. It also crosses the placental barrier with umbilical concentrations being found to be ~80% of maternal concentrations.[A4269]	In clinical trials, the clearance rate of tramadol ranged from 3.73 ml/min/kg in renal impairment patients to 8.50 ml/min/kg in healthy adults.[L9257,F4679]	null	null	null	null	[ "approved", "investigational" ]	[ "N02AJ", "N02A", "N02", "N", "N02AJ", "N02A", "N02", "N", "N02AJ", "N02A", "N02", "N", "N02AX", "N02A", "N02", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.07", "description": "Tramadol-Acetaminophen 37.5-325 mg tablet", "unit": "tablet" }, { "cost": "1.99", "description": "Ultram 50 mg tablet", "unit": "tablet" }, { "cost": "3.78", "description": "TraMADol HCl 100 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "4.44", "description": "Ultram er 100 mg tablet", "unit": "tablet" }, { "cost": "4.62", "description": "Ultram ER 100 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "6.25", "description": "TraMADol HCl 200 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "7.35", "description": "Ultram er 200 mg tablet", "unit": "tablet" }, { "cost": "7.64", "description": "Ultram ER 200 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "10.25", "description": "Ultram er 300 mg tablet", "unit": "tablet" }, { "cost": "10.66", "description": "Ultram ER 300 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "29.08", "description": "Tramadol hcl powder", "unit": "g" }, { "cost": "0.7", "description": "Tramadol hcl 50 mg tablet", "unit": "tablet" } ]	[ { "approved": "1995-11-07", "country": "United States", "expires": "2013-03-22", "number": "5464632" }, { "approved": "2009-09-01", "country": "Canada", "expires": "2023-02-21", "number": "2476201" }, { "approved": "2003-04-29", "country": "Canada", "expires": "2014-05-09", "number": "2123160" }, { "approved": "2002-01-15", "country": "United States", "expires": "2020-04-12", "number": "6339105" }, { "approved": "2000-08-22", "country": "United States", "expires": "2017-12-05", "number": "6106861" }, { "approved": "2003-08-19", "country": "United States", "expires": "2020-06-29", "number": "6607748" }, { "approved": "2011-08-02", "country": "United States", "expires": "2023-10-27", "number": "7988998" }, { "approved": "2010-12-28", "country": "United States", "expires": "2022-04-11", "number": "7858118" }, { "approved": "2021-08-31", "country": "United States", "expires": "2040-09-01", "number": "11103452" }, { "approved": "2019-03-26", "country": "United States", "expires": "2030-04-19", "number": "10238668" }, { "approved": "2020-02-04", "country": "United States", "expires": "2030-04-19", "number": "10548909" }, { "approved": "2015-04-21", "country": "United States", "expires": "2030-04-19", "number": "9012440" }, { "approved": "2014-09-30", "country": "United States", "expires": "2031-06-03", "number": "8846744" }, { "approved": "2013-12-03", "country": "United States", "expires": "2030-04-19", "number": "8598152" }, { "approved": "2019-04-02", "country": "United States", "expires": "2030-04-19", "number": "10245276" }, { "approved": "2010-04-19", "country": "United States", "expires": "2030-04-19", "number": "11478488" }, { "approved": "2020-09-01", "country": "United States", "expires": "2040-09-01", "number": "11752103" } ]	Tramadol \| Tramadolum \| hMOP \| M-OR-1 \| MOP \| MOR-1 \| MOR1 \| Mu opiate receptor \| Mu opioid receptor \| NAT1 \| NET \| NET1 \| Norepinephrine transporter \| SLC6A5 \| Solute carrier family 6 member 2 \| 5HT transporter \| 5HTT \| HTT \| SERT \| Solute carrier family 6 member 4 \| HBA \| HBSC II \| NAC2 \| SCN2A1 \| SCN2A2 \| Sodium channel protein brain II subunit alpha \| Sodium channel protein type II subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.2 \| GluN1 \| Glutamate [NMDA] receptor subunit zeta-1 \| hNR1 \| N-methyl-D-aspartate receptor subunit NR1 \| NMD-R1 \| NMDAR1 \| GluN2A \| Glutamate [NMDA] receptor subunit epsilon-1 \| hNR2A \| N-methyl D-aspartate receptor subtype 2A \| NMDAR2A \| NR2A \| GluN2B \| Glutamate [NMDA] receptor subunit epsilon-2 \| hNR3 \| N-methyl D-aspartate receptor subtype 2B \| N-methyl-D-aspartate receptor subunit 3 \| NMDAR2B \| NR2B \| NR3 \| GluN2C \| Glutamate [NMDA] receptor subunit epsilon-3 \| N-methyl D-aspartate receptor subtype 2C \| NMDAR2C \| NR2C \| EB11 \| GluN2D \| Glutamate [NMDA] receptor subunit epsilon-4 \| N-methyl D-aspartate receptor subtype 2D \| NMDAR2D \| NR2D \| GluN3A \| KIAA1973 \| N-methyl-D-aspartate receptor subtype 3A \| NMDAR-L \| NMDAR3A \| NR3A \| GluN3B \| N-methyl-D-aspartate receptor subtype 3B \| NMDAR3B \| NR3B \| ADRA2R \| ADRAR \| Alpha-2 adrenergic receptor subtype C10 \| Alpha-2A adrenoceptor \| Alpha-2A adrenoreceptor \| Alpha-2AAR \| ADRA2L1 \| ADRA2RL1 \| Alpha-2 adrenergic receptor subtype C2 \| Alpha-2B adrenoceptor \| Alpha-2B adrenoreceptor \| Alpha-2BAR \| ADRA2L2 \| ADRA2RL2 \| Alpha-2 adrenergic receptor subtype C4 \| Alpha-2C adrenoceptor \| Alpha-2C adrenoreceptor \| Alpha-2CAR \| 5-HT-1C \| 5-HT-2C \| 5-HT1C \| 5-HT2C \| 5-HTR2C \| 5-hydroxytryptamine receptor 1C \| HTR1C \| Serotonin receptor 2C \| K-OR-1 \| KOR-1 \| OPRK \| D-OR-1 \| DOR-1 \| OPRD \| NACHRA7 \| NK-1 receptor \| NK-1R \| NK1R \| SPR \| TAC1R \| Tachykinin receptor 1 \| Capsaicin receptor \| Osm-9-like TRP channel 1 \| OTRPC1 \| TrpV1 \| Vanilloid receptor 1 \| VR1 \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 1 \| GNT1 \| hUG-BR1 \| UDP-glucuronosyltransferase 1-1 \| UDP-glucuronosyltransferase 1A isoform 1 \| UDPGT 1-1 \| UGT1 \| UGT1-01 \| UGT1.1 \| UGT1*1 \| UGT1A1 \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase	[ "Act Tramadol/acet", "Ag-acet-tramadol", "Apo-tramadol", "Apo-tramadol/acet", "Auro-tramadol", "Auro-tramadol/acetaminophen", "Bio-tramadol/acet", "ConZip", "ConZip", "ConZip", "ConZip", "ConZip", "ConZip", "Durela", "Durela", "Durela", "Durela", "Durela", "Durela", "Ipg-tramadol/acet", "Jamp Tramadol", "Jamp Tramadol HCl", "Jamp-acet-tramadol", "Lupin-tramadol/acet", "Mar-tramadol", "Mar-tramadol/acet", "Mint-tramadol/acet", "Mylan-tramadol/acet", "Nra-tramadol/acet", "Pat-tramadol/acet", "PMS-tramadol-acet", "Priva-tramadol/acet", "Prz-tramadol/acet", "Qdolo", "Ralivia", "Ralivia", "Ralivia", "Riva-tramadol/acet", "Rybix ODT", "Rybix ODT", "Ryzolt", "Ryzolt", "Ryzolt", "Ryzolt", "Ryzolt", "Ryzolt", "Ryzolt", "Ryzolt", "Sandoz Tramadol", "Seglentis", "Synapryn", "Synapryn", "Taro-tramadol ER", "Taro-tramadol ER", "Taro-tramadol ER", "Taro-tramadol/acet", "Teva-tramadol/acetaminophen", "Theratramadol-60", "Theratramadol-90", "Topical Pain", "Tramacet", "Tramadol", "Tramadol / Acetaminophen", "Tramadol Acetaminophen", "Tramadol ER", "Tramadol HCl", "Tramadol HCl", "Tramadol HCL", "Tramadol HCL", "Tramadol HCL", "Tramadol HCl and Acetaminophen", "Tramadol HCl and Acetaminophen", "Tramadol HCl ER", "Tramadol HCL ER", "Tramadol HCL ER", "Tramadol HCL ER", "Tramadol HCL ER", "Tramadol HCL ER", "Tramadol HCL ER", "Tramadol HCL ER", "Tramadol Hydrchloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", 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Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride ER", "Tramadol Hydrochloride ER", "Tramadol Hydrochloride Extended Release", "Tramadol Hydrochloride Extended Release", "Tramadol Hydrochloride Extended Release", "Tramadol Hydrochloride Extended Release", "Tramadol Hydrochloride Extended-Release", "Tramadol Hydrochloride Extended-Release", "Tramadol Hydrochloride Extended-Release", "Tramadol Hydrochloride Extended-Release", "Tramadol Hydrochloride Extended-Release", "Tramadol Hydrochloride Extended-Release", "Tramadol-acet", "Tramadol/acet", "Tramapap", "Tramaphen-odan", "Tridural", "Tridural", "Tridural", "Ultracet", "Ultracet", "Ultracet", "Ultracet", "Ultracet", "Ultracet", "Ultracet", "Ultracet", "Ultram", "Ultram", "Ultram", "Ultram", "Ultram", "Ultram", "Ultram", "Ultram", "Ultram", "Ultram", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Ultram ER", "Zytram XL", "Zytram XL", "Zytram XL", "Zytram XL", "Zytram XL", "Zytram XL" ]	[ "Rybix", "Tramal" ]	[ "Tramapap", "Ultracet", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Theratramadol-90", "Theratramadol-60", "Tramadol Hydrochloride and Acetaminophen", "Ultracet", "Tramadol Hydrochloride and Acetaminophen", "Ultracet", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Ultracet", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol HCl and Acetaminophen", "Tramadol Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol hydrochloride and acetaminophen", "Ultracet", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Ultracet", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Ultracet", "Tramadol hydrochloride and acetaminophen", "Tramadol hydrochloride and acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Topical Pain", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Ultracet", "Tramadol Hydrochloride and Acetaminophen", "Tramadol HCl and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramacet", "Apo-tramadol/acet", "Teva-tramadol/acetaminophen", "Taro-tramadol/acet", "Jamp-acet-tramadol", "PMS-tramadol-acet", "Tramadol-acet", "Tramadol/acet", "Tramadol / Acetaminophen", "Auro-tramadol/acetaminophen", "Tramaphen-odan", "Pat-tramadol/acet", "Riva-tramadol/acet", "Ipg-tramadol/acet", "Lupin-tramadol/acet", "Mylan-tramadol/acet", "Act Tramadol/acet", "Mar-tramadol/acet", "Mint-tramadol/acet", "Nra-tramadol/acet", "Priva-tramadol/acet", "Bio-tramadol/acet", "Ag-acet-tramadol", "Tramadol Hydrochloride and Acetaminophen", "Seglentis", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Tramadol Hydrochloride and Acetaminophen", "Prz-tramadol/acet" ]	[ "P35372", "P23975", "P31645", "Q99250", "Q05586", "Q12879", "Q13224", "Q14957", "O15399", "Q8TCU5", "O60391", "P30542", "P08913", "P18089", "P18825", "P28335", "P41145", "P41143", "P36544", "P20309", "P11229", "P25103", "Q8NER1" ]	[ "P20813", "P22309", "P10635", "P08684" ]	[]	[]
DB00194	Vidarabine	A nucleoside antibiotic isolated from Streptomyces antibioticus. It has some antineoplastic properties and has broad spectrum activity against DNA viruses in cell cultures and significant antiviral activity against infections caused by a variety of viruses such as the herpes viruses, the vaccinia VIRUS and varicella zoster virus.	solid	For treatment of chickenpox - varicella, herpes zoster and herpes simplex	Vidarabine is a synthetic purine nucleoside analogue with <i>in vitro</i> and <i>in vivo</i> inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV-2), and varicella-zoster virus (VZV). The inhibitory activity of Vidarabine is highly selective due to its affinity for the enzyme thymidine kinase (TK) encoded by HSV and VZV. This viral enzyme converts Vidarabine into Vidarabine monophosphate, a nucleotide analogue. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular enzymes. <i>In vitro</i>, Vidarabine triphosphate stops the DNA replication of herpes virus by being incorporated into the DNA strand and preventing the formation of phosphodiester bridges between bases. This ultimately leads to destabilization of the viral DNA strands.	Vidarabine stops replication of herpes viral DNA in 2 ways: 1) competitive inhibition of viral DNA polymerase, and consequently 2) incorporation into and termination of the growing viral DNA chain. Vidarabine is sequentially phosphorylated by kinases to the triphosphate ara-ATP, which is the active form of vidarabine that acts as both an inhibitor and a substrate of viral DNA polymerase. By acting as a substrate for viral DNA polymerase, ara-ATP competitively inhibits dATP leading to the formation of ‘faulty’ DNA. Ara-ATP can also be incorporated into the DNA strand to replace many of the adenosine bases, resulting in the disruption of DNA synthesis.	Systemetic absorption of vidarabine should not be expected to occur following ocular administration and swallowing lacrimal secretions.	In laboratory animals, vidarabine is rapidly deaminated in the gastrointestinal tract to Ara-Hx.	Acute massive overdosage by oral ingestion of the ophthalmic ointment has not occurred. However, the rapid deamination to arabinosylhypoxanthine should preclude any difficulty. The oral LD<sub>50</sub> for vidarabine is greater than 5020 mg/kg in mice and rats. No untoward effects should result from ingestion of the entire contents of the tube. Overdosage by ocular instillation is unlikely because any excess should be quickly expelled from the conjunctival sac.	null	24-38%	null	null	null	Organic compounds	Nucleosides, nucleotides, and analogues	Purine nucleosides	null	[ "approved", "investigational" ]	[ "J05AB", "J05A", "J05", "J", "S01AD", "S01A", "S01", "S" ]	[ "Human Herpes Virus" ]	[ { "cost": "366.59", "description": "Vidarabine powder", "unit": "g" }, { "cost": "687.0", "description": "Vidarabine monohydrate powder", "unit": "g" } ]	[]	9-beta-D-arabinofuranosyl-9H-purin-6-amine \| 9-beta-D-arabinofuranosyl-adenine \| 9-beta-D-Arabinofuranosyladenine \| 9-β-D-arabinofuranosyl-9H-purin-6-amine \| 9-β-D-arabinofuranosyladenine \| Spongoadenosine \| Vidarabine \| Vidarabinum \| 2.7.7.7 \| 2.7.1.21 \| 2.7.1.21 \| UL23 \| 3.5.4.4 \| ADA1 \| Adenosine aminohydrolase	[ "Vira-A" ]	[ "Arasena-A" ]	[]	[ "P29275", "P09250" ]	[ "P00813" ]	[]	[]
DB00195	Betaxolol	A cardioselective beta-1-adrenergic antagonist with no partial agonist activity.	solid	For the management of hypertension.	Betaxolol is a competitive, beta(1)-selective (cardioselective) adrenergic antagonist. Betaxolol is used to treat hypertension, arrhythmias, coronary heart disease, glaucoma, and is also used to reduce non-fatal cardiac events in patients with heart failure. Activation of beta(1)-receptors (located mainly in the heart) by epinephrine increases the heart rate and the blood pressure, and the heart consumes more oxygen. Drugs such as betaxolol that block these receptors therefore have the reverse effect: they lower the heart rate and blood pressure and hence are used in conditions when the heart itself is deprived of oxygen. They are routinely prescribed in patients with ischemic heart disease. In addition, beta(1)-selective blockers prevent the release of renin, which is a hormone produced by the kidneys which leads to constriction of blood vessels. Betaxolol is lipophilic and exhibits no intrinsic sympathomimetic activity (ISA) or membrane stabilizing activity.	Betaxolol selectively blocks catecholamine stimulation of beta(1)-adrenergic receptors in the heart and vascular smooth muscle. This results in a reduction of heart rate, cardiac output, systolic and diastolic blood pressure, and possibly reflex orthostatic hypotension. Betaxolol can also competitively block beta(2)-adrenergic responses in the bronchial and vascular smooth muscles, causing bronchospasm.	Absorption of an oral dose is complete. There is a small and consistent first-pass effect resulting in an absolute bioavailability of 89% ± 5% that is unaffected by the concomitant ingestion of food or alcohol.	Primarily hepatic. Approximately 15% of the dose administered is excreted as unchanged drug, the remainder being metabolites whose contribution to the clinical effect is negligible.	Oral LD<sub>50</sub>s are 350 to 400 mg betaxolol/kg in mice and 860 to 980 mg/kg in rats. Predicted symptoms of overdose include bradycardia, congestive heart failure, hypotension, bronchospasm, and hypoglycemia.	14-22 hours	50%	null	null	null	Organic compounds	Benzenoids	Phenols	Tyrosols and derivatives	[ "approved", "investigational" ]	[ "S01ED", "S01E", "S01", "S", "C07AB", "C07A", "C07", "C", "S01ED", "S01E", "S01", "S" ]	[ "Humans and other mammals" ]	[ { "cost": "1.24", "description": "Betaxolol 10 mg tablet", "unit": "tablet" }, { "cost": "1.29", "description": "Betaxolol HCl 10 mg tablet", "unit": "tablet" }, { "cost": "1.63", "description": "Kerlone 10 mg tablet", "unit": "tablet" }, { "cost": "1.86", "description": "Betaxolol 20 mg tablet", "unit": "tablet" }, { "cost": "2.35", "description": "Kerlone 20 mg tablet", "unit": "tablet" }, { "cost": "2.54", "description": "Betoptic S 0.25 % Suspension", "unit": "ml" }, { "cost": "6.82", "description": "Betaxolol hcl 0.5% eye drop", "unit": "ml" }, { "cost": "9.79", "description": "Betoptic s 0.25% eye drops", "unit": "ml" }, { "cost": "51.99", "description": "Betoptic-S 0.25% Suspension 5ml Bottle", "unit": "bottle" }, { "cost": "104.31", "description": "Betaxolol HCl 0.5% Solution 15ml Bottle", "unit": "bottle" }, { "cost": "130.29", "description": "Betoptic-S 0.25% Suspension 10ml Bottle", "unit": "bottle" }, { "cost": "195.44", "description": "Betoptic-S 0.25% Suspension 15ml Bottle", "unit": "bottle" } ]	[ { "approved": "1996-07-30", "country": "United States", "expires": "2014-01-30", "number": "5540918" } ]	1-(4-(2-(cyclopropylmethoxy)ethyl)phenoxy)-3-((1-methylethyl)amino)-2-propanol \| 1-(isopropylamino)-3-[p-(cyclopropylmethoxyethyl)phenoxy]-2-propanol \| Betaxolol \| Bétaxolol \| Betaxololum \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ADRB2R \| B2AR \| Beta-2 adrenoceptor \| Beta-2 adrenoreceptor \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase	[ "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol", "Betaxolol Hydrochloride", "Betaxolol Hydrochloride", "Betaxolol Hydrochloride", "Betoptic", "Betoptic Liq", "Betoptic Pilo", "Betoptic S", "Betoptic S", "Betoptic S", "Betoptic/pilo", "Kerlone", "Kerlone", "Novo-betaxolol", "Sandoz Betaxolol" ]	[ "Betaxon" ]	[ "Betoptic Pilo", "Betoptic/pilo" ]	[ "P08588", "P07550" ]	[ "P10635", "P05177" ]	[]	[]
DB00196	Fluconazole	Fluconazole, commonly known as _Diflucan_, is an antifungal drug used for the treatment of both systemic and superficial fungal infections in a variety of tissues. It was initially approved by the FDA in 1990. This drug is an _azole_ antifungal, in the same drug family as [ketoconazole] and [itraconazole]. Fluconazole has many advantages over the other antifungal drugs including the option of oral administration. The side effect profile of this drug is minimal. It has been demonstrated as an efficacious treatment for vaginal yeast infections in one single dose.[A174325]	solid	Fluconazole can be administered in the treatment of the following fungal infections[L11043]: 1) Vaginal yeast infections caused by Candida 2) Systemic Candida infections 3) Both esophageal and oropharyngeal candidiasis 4) Cryptococcal meningitis 5) UTI (urinary tract infection) by Candida 6) Peritonitis (inflammation of the peritoneum) caused by Candida A note on fungal infection prophylaxis Patients receiving bone marrow transplantation who are treated with cytotoxic chemotherapy and/or radiation therapy may be predisposed to candida infections, and may receive fluconazole as prophylactic therapy.[L11043] A note on laboratory testing Obtaining specimens for fungal culture and other important laboratory studies such as serology or pathology is advised before starting fluconazole therapy in order to isolate the organisms to be eliminated through treatment. It is permissible to start therapy before the results are available, however, adjusting the therapy once laboratory results confirm the causative organism may be necessary.[L11043]	Fluconazole has been demonstrated to show fungistatic activity against the majority of strains of the following microorganisms, curing fungal infections[L11043]: _Candida albicans, Candida glabrata (Many strains are intermediately susceptible), Candida parapsilosis, Candida tropicalis, Cryptococcus neoformans_ This is achieved through steroidal inhibition in fungal cells, interfering with cell wall synthesis and growth as well as cell adhesion, thereby treating fungal infections and their symptoms.[L11043,A174325,A174343] The fungistatic activity of fluconazole has also been shown in normal and immunocompromised animal models with both systemic and intracranial fungal infections caused by _Cryptococcus neoformans_ and for systemic infections caused by Candida albicans.[L11043] It is important to note that resistant organisms have been found against various strains of organisms treated with fluconazole.[A178759,A178762,A178765] This further substantiates the need to perform susceptibility testing when fluconazole is considered as an antifungal therapy.[A178768,A178786] A note on steroidal effects of fluconazole There has been some concern that fluconazole may interfere with and inactivate human steroids/hormones due to the inhibition of hepatic cytochrome enzymes.[L11034] Fluconazole has demonstrated to be more selective for _fungal_ cytochrome P-450 enzymes than for a variety of mammalian cytochrome P-450 enzymes. Fluconazole 50 mg administered daily for up to 28 days in individuals of reproductive age has been show to have no effect on testosterone plasma concentrations of males and plasma concentrations of steroids in females. A 200-400 mg dose of fluconazole showed no clinically relevant effect on steroid levels or on ACTH-stimulated steroid response in healthy males, in one clinical study mentioned on the European Medicines Agency label.[L11034] Other studies have shown no significant effects of fluconazole on steroid levels, further confirming these data.[A174358,A178780]	Fluconazole is a very selective inhibitor of fungal cytochrome P450 dependent enzyme _lanosterol 14-α-demethylase_. This enzyme normally works to convert _lanosterol_ to _ergosterol_, which is necessary for fungal cell wall synthesis. The free nitrogen atom located on the azole ring of fluconazole binds with a single iron atom located in the heme group of lanosterol 14-α-demethylase.[A178774] This prevents oxygen activation and, as a result, inhibits the demethylation of lanosterol, halting the process of ergosterol biosynthesis.[A178777] Methylated sterols are then found to accumulate in the fungal cellular membrane, leading to an arrest of fungal growth.[A178774] These accumulated sterols negatively affect the structure and function of the fungal cell plasma membrane.[A16632] Fluconazole resistance may arise from an alteration in the amount or function of the target enzyme (lanosterol 14-α-demethylase), altered access to this enzyme, or a combination of the above.[A16632] Other mechanisms may also be implicated, and studies are ongoing.[A178783]	The pharmacokinetic properties of fluconazole are comparable after administration by the intravenous (IV) and oral (PO) routes. In healthy volunteers, the bioavailability of orally administered fluconazole is measured to be above 90%.[L11043] It is extensively absorbed in the gastrointestinal tract when an oral dose is taken.[A178813] Oral absorption is not affected by food intake with fluconazole but may increase the time until the maximum concentration is reached.[L11034,A178792] Tmax (or the time taken to achieve the maximum concentration) in one clinical study of healthy patients receiving 50 mg/kg of fluconazole was 3 hours.[A178792] Peak plasma concentrations (Cmax) in fasting and healthy volunteers occur between 1-2 hours post-dose.[L11043] Steady-state concentrations are achieved within 5 to 10 days after oral doses of 50-400 mg administered once daily. Administration of a loading dose on the first day of fluconazole treatment, or twice the usual daily dose, leads to plasma concentrations close to steady-state by the second day.[L11043] Mean AUC (area under the curve) was 20.3 in healthy volunteers receiving 25 mg of fluconazole.[A178792] A note on the capsule and powder form and malabsorption syndromes The capsule forms of fluconazole often contain lactose and should not be administered with hereditary galactose intolerance, _Lapp lactase enzyme_ deficiency, or malabsorption of glucose/galactose.[L11043] The powder form, used for the oral suspension, lists sucrose as an ingredient and should not be used in patients who have been diagnosed with fructose, glucose/galactose malabsorption, and _sucrase-isomaltase_ enzyme deficiency.[L11043]	Fluconazole is metabolized minimally in the liver. Fluconazole is an inhibitor of CYP2C9, CYP3A4 and CYP2C19.[L11034,L11043] Two metabolites were detected in the urine of healthy volunteers taking a 50 mg radiolabeled dose of fluconazole; a glucuronidated metabolite on the hydroxyl moiety (6.5%) and a fluconazole N-oxide metabolite (2%).[A178813] The same study indicated that no signs of metabolic cleavage of fluconazole were observed, suggesting a difference in metabolism when compared to other agents in the same drug class, which are heavily metabolized in the liver.[A178813,A178834]	Acute oral toxicity (LD50): 1271 mg/kg (rat) [MSDS] Overdose information Fluconazole overdoses have been associated with hallucination and paranoia, sometimes in combination.[L11043] In cases of overdose, employ supportive treatment. Gastric lavage may be necessary.[L11043] Other modalities such as forced diuresis or hemodialysis may also be used.[L11043] A note on liver toxicity The FDA label warns that this drug carries a risk of hepatotoxicity. Rare but serious cases of serious hepatic toxicity have been reported, especially in patients with serious underlying medical conditions using fluconazole. This group of patients has an increased risk of fatality when using fluconazole.[L11043] In patients with existing liver dysfunction, use caution during fluconazole therapy. Those who are found to have abnormal liver function tests during therapy should be carefully monitored for the development of increasingly severe injury to the liver. Fluconazole should be stopped if its use is likely to be the underlying cause of liver injury, and medical attention should be sought.[L11043,L6505] Fluconazole induced hepatotoxicity is usually reversible.[L11043] Carcinogenesis, mutagenesis, and impairment of fertility Fluconazole demonstrated no evidence of carcinogenic risk in mice and rats treated orally for 24 months at doses equivalent to approximately 2-7 time the recommended human dose). Male rats given fluconazole at doses equivalent to supratherapeutic human doses showed an increased incidence of hepatocellular adenomas. Cytogenetic studies in vivo and in vitro demonstrated no sign of chromosomal mutation. The significance of these findings for humans is unknown.[L11043] Use in pregnancy There are no sufficient and well-controlled studies of fluconazole use in pregnant women. Available human data do not show an increased risk of congenital anomalies after pregnant women were treated with standard doses (<200 mg/day) of fluconazole, either in a single dose or multiple doses in the first trimester did not appear to impact the fetus negatively.[L11043] Several case reports describe rare but striking congenital anomalies observed in infants who were exposed to fluconazole at high doses reaching 400-800 mg/day, primarily in the first trimester of pregnancy. Similar findings were observed in animal studies. If this drug is administered during pregnancy, or if the patient becomes pregnant while taking fluconazole, the risk should be discussed thoroughly.[L11043] Use in nursing Fluconazole is secreted in breastmilk at high concentrations. Exercise caution if this drug is used during nursing.[L11043]	The terminal elimination half-life in the plasma is approximately 30 hours (range: 20-50 hours) after oral administration.[L11043] The long plasma elimination half-life supports a single-dose therapy for vaginal candidiasis, once daily and once weekly dosing for other indications.[L11034] Patients with renal failure may require dosage adjustment, and half-life can be significantly increased in these patients.[A178792]	The protein binding of fluconazole is low and estimated to be 11 to 12%.[L11043,A178792]	In normal volunteers, fluconazole is cleared primarily by renal excretion, with approximately 80% of the administered dose measured in the urine as unchanged drug.[L11043] About 11% of the dose is excreted in the urine as metabolites.[L11043]. A study of a 50mg radiolabeled dose of fluconazole revealed that 93.3% of the dose was found excreted in the urine.[A178813] A note on renal failure The pharmacokinetics of fluconazole are significantly affected by renal dysfunction. The dose of fluconazole may need to be reduced in patients with decreased renal function. A 3-hour hemodialysis treatment lowers plasma fluconazole concentrations by about 50%.[L11043]	The apparent volume of distribution is said to be similar to the volume of distribution of total body water.[L11043] One clinical study of healthy volunteers administered 50 mg/kg of fluconazole was 39L, based on a body weight of 60kg.[A178792] Fluconazole shows substantial penetration in many body fluids, which is a property that renders it an ideal treatment for systemic fungal infections, especially when administered over a longer time.[A178792,L11043] Fluconazole is found in high concentrations in the stratum corneum and dermis-epidermis of skin, in addition to eccrine sweat. Fluconazole is found to accumulate especially well in the stratum corneum, which is beneficial in superficial fungal infections.[L11034] Saliva and sputum concentrations of fluconazole are found to be similar to the plasma concentrations.[L6505] In patients diagnosed with fungal meningitis, fluconazole CSF (cerebrospinal fluid) levels are measured to be about 80% of the corresponding plasma levels. Therefore, fluconazole crosses the blood-brain barrier.[L11034] The meninges are increasingly permeable to fluconazole in states of inflammation, facilitating treatment in meningitis.[A178801]	This drug is mainly eliminated by the kidneys and the mean body clearance in adults is reported to be 0.23 mL/min/kg.[L11043] One clinical study of healthy subjects showed total clearance of 19.5 ± 4.7 mL/min and renal clearance of 14.7 ± 3.7 mL/min (1.17 ± 0.28 and 0.88 ± 0.22 L/h).[A178792] Clearance in the pediatric population varies according to age, as does clearance in patients with renal failure.[L11043]	Organic compounds	Benzenoids	Benzene and substituted derivatives	Halobenzenes	[ "approved", "investigational" ]	[ "J01RA", "J01R", "J01", "J", "J02AC", "J02A", "J02", "J", "D01AC", "D01A", "D01", "D" ]	[ "Fungi" ]	[ { "cost": "1.28", "description": "Diflucan-dextr 200 mg/100 ml", "unit": "ml" }, { "cost": "1.28", "description": "Diflucan-saline 200 mg/100 ml", "unit": "ml" }, { "cost": "3.06", "description": "Co Fluconazole 50 mg Tablet", "unit": "tablet" }, { "cost": "3.06", "description": "Novo-Fluconazole 50 mg Tablet", "unit": "tablet" }, { "cost": "3.06", "description": "Pms-Fluconazole 50 mg Tablet", "unit": "tablet" }, { "cost": "3.28", "description": "Apo-Fluconazole 50 mg Tablet", "unit": "tablet" }, { "cost": "3.28", "description": "Mylan-Fluconazole 50 mg Tablet", "unit": "tablet" }, { "cost": "5.42", "description": "Co Fluconazole 100 mg Tablet", "unit": "tablet" }, { "cost": "5.42", "description": "Novo-Fluconazole 100 mg Tablet", "unit": "tablet" }, { "cost": "5.42", "description": "Pms-Fluconazole 100 mg Tablet", "unit": "tablet" }, { "cost": "5.7", "description": "Fluconazole 50 mg tablet", "unit": "tablet" }, { "cost": "5.81", "description": "Apo-Fluconazole 100 mg Tablet", "unit": "tablet" }, { "cost": "5.81", "description": "Mylan-Fluconazole 100 mg Tablet", "unit": "tablet" }, { "cost": "8.05", "description": "Diflucan 50 mg tablet", "unit": "tablet" }, { "cost": "8.95", "description": "Fluconazole 100 mg tablet", "unit": "tablet" }, { "cost": "9.18", "description": "Apo-Fluconazole-150 150 mg Capsule", "unit": "capsule" }, { "cost": "9.18", "description": "Co Fluconazole 150 mg Capsule", "unit": "capsule" }, { "cost": "9.18", "description": "Mylan-Fluconazole 150 mg Capsule", "unit": "capsule" }, { "cost": "9.18", "description": "Pms-Fluconazole 150 mg Capsule", "unit": "capsule" }, { "cost": "12.61", "description": "Diflucan 100 mg tablet", "unit": "tablet" }, { "cost": "13.93", "description": "Fluconazole 150 mg tablet", "unit": "tablet" }, { "cost": "14.08", "description": "Fluconazole powder", "unit": "g" }, { "cost": "14.26", "description": "Fluconazole 200 mg tablet", "unit": "tablet" }, { "cost": "16.44", "description": "Diflucan 150 mg Capsule", "unit": "capsule" }, { "cost": "20.82", "description": "Diflucan 200 mg tablet", "unit": "tablet" }, { "cost": "24.71", "description": "Diflucan 150 mg tablet", "unit": "tablet" }, { "cost": "35.94", "description": "Fluconazole 10 mg/ml Suspension 35ml Bottle", "unit": "bottle" }, { "cost": "56.06", "description": "Diflucan 10 mg/ml Suspension 35ml Bottle", "unit": "bottle" }, { "cost": "135.99", "description": "Fluconazole 40 mg/ml Suspension 35ml Bottle", "unit": "bottle" }, { "cost": "203.65", "description": "Diflucan 40 mg/ml Suspension 35ml Bottle", "unit": "bottle" }, { "cost": "0.19", "description": "Fluconazole-ns 200 mg/100 ml", "unit": "ml" }, { "cost": "0.32", "description": "Fluconazole-dext 200 mg/100 ml", "unit": "ml" }, { "cost": "0.33", "description": "Fluconazole 2 mg/ml", "unit": "ml" }, { "cost": "0.33", "description": "Fluconazole Omega 2 mg/ml", "unit": "ml" }, { "cost": "0.6", "description": "Diflucan 2 mg/ml", "unit": "ml" } ]	[]	Diflucan \| Difluconazole \| Fluconazol \| Fluconazole \| Fluconazolum \| Triflucan \| 1.14.13.70 \| CYP51 \| CYPLI \| Cytochrome P450 51 \| Cytochrome P450-14DM \| Cytochrome P450-LIA1 \| ERG16 \| Sterol 14-alpha demethylase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1	[ "Act Fluconazole", "Act Fluconazole", "Apo-fluconazole", "Apo-fluconazole", "Apo-fluconazole", "Apo-fluconazole-150", "Bio-fluconazole", "Canesoral", "Canesoral Combi", "Canesoral Combi 1 Day", "Ciclopirox 8% / Fluconazole 1% / Terbinafine HCl 1%", "Clotrimaderm-fluconazole Combi-pack", "Clotrimazole-fluconazole Combi", "Co Fluconazole-150", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan", "Diflucan One", "Direct Rx", "Dom-fluconazole", "Dom-fluconazole", "Dom-fluconazole", "Extra Strength Clotrimazole Extra Fort -fluconazole Combi", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole", "Fluconazole 150", "Fluconazole 150", "Fluconazole 4% / Ibuprofen 2% / Itraconazole 1% / Terbinafine HCl 4%", "Fluconazole in Dextrose", "Fluconazole in Sodium Chloride", "Fluconazole in Sodium Chloride", "Fluconazole in Sodium Chloride", "Fluconazole in Sodium Chloride", "Fluconazole in Sodium Chloride", "Fluconazole in Sodium Chloride", "Fluconazole In Sodium Chloride Injection USP", "Fluconazole Injection", "Fluconazole Injection", "Fluconazole Injection", "Fluconazole Injection Sdz", "Fluconazole Omega", "Fluconazole Tablets", "Fluconazole Tablets", "Fluconazole Tablets", "Fluconazole-150", "Fluconazole-150", "Jamp Fluconazole 150 mg", "Jamp-fluconazole", "Mar-fluconazole-150", "Monicure", "Monicure Combo", "Mylan-fluconazole", "Mylan-fluconazole", "Mylan-fluconazole", "Novo-fluconazole", "Novo-fluconazole-150", "Nu-fluconazole-150", "PHL-fluconazole", "PHL-fluconazole", "PMS-fluconazole", "PMS-fluconazole", "PMS-fluconazole", "PMS-fluconazole-150", "Priva-fluconazole", "Pro-fluconazole", "Pro-fluconazole", "Riva-fluconazole", "Riva-fluconazole", "Taro-fluconazole", "Taro-fluconazole", "Taro-fluconazole", "Teva-fluconazole", "Teva-fluconazole" ]	[ "Elazor", "Flucazol", "Flucostat", "Flunizol", "Pritenzol", "Trican", "Triflucan" ]	[ "Fluconazole 4% / Ibuprofen 2% / Itraconazole 1% / Terbinafine HCl 4%", "Ciclopirox 8% / Fluconazole 1% / Terbinafine HCl 1%", "Monicure Combo", "Clotrimaderm-fluconazole Combi-pack", "Clotrimazole-fluconazole Combi", "Canesoral Combi", "Canesoral Combi 1 Day", "Extra Strength Clotrimazole Extra Fort -fluconazole Combi" ]	[]	[ "P20815", "P08684", "P11712", "P33261" ]	[]	[ "P08183" ]
DB00197	Troglitazone	Troglitazone was withdrawn in 2000 due to risk of hepatotoxicity. It was superseded by [pioglitazone] and [rosiglitazone].	solid	For the treatment of Type II diabetes mellitus. It is used alone or in combination with a sulfonylurea, metformin, or insulin as an adjunct to diet and exercise.	Troglitazone is an oral antihyperglycemic agent which acts primarily by decreasing insulin resistance. Troglitazone is used in the management of type II diabetes (noninsulin-dependent diabetes mellitus (NIDDM) also known as adult-onset diabetes). It improves sensitivity to insulin in muscle and adipose tissue and inhibits hepatic gluconeogenesis. Troglitazone is not chemically or functionally related to either the sulfonylureas, the biguanides, or the g-glucosidase inhibitors. Troglitazone may be used concomitantly with a sulfonylurea or insulin to improve glycemic control.	Troglitazone is a thiazolidinedione antidiabetic agent that lowers blood glucose by improving target cell response to insulin. It has a unique mechanism of action that is dependent on the presence of insulin for activity. Troglitazone decreases hepatic glucose output and increases insulin dependent glucose disposal in skeletal muscle. Its mechanism of action is thought to involve binding to nuclear receptors (PPAR) that regulate the transcription of a number of insulin responsive genes critical for the control of glucose and lipid metabolism. Troglitazone is a ligand to both PPARα and PPARγ, with a highter affinity for PPARγ. The drug also contains an α-tocopheroyl moiety, potentially giving it vitamin E-like activity. Troglitazone has been shown to reduce inflammation, and is associated with a decrase in nuclear factor kappa-B (NF-κB) and a concomitant increase in its inhibitor (IκB). Unlike sulfonylureas, troglitazone is not an insulin secretagogue.	Absorbed rapidly. Food increases the extent of absorption by 30% to 85%.	A sulfate conjugate metabolite (Metabolite 1) and a quinone metabolite (Metabolite 3) have been detected in the plasma of healthy males. A glucuronide conjugate (Metabolite 2) has been detected in the urine and also in negligible amounts in the plasma. In healthy volunteers and in patients with type 2 diabetes, the steady-state concentration of Metabolite 1 is six to seven times that of troglitazone and Metabolite 3. In in vivo drug interaction studies, troglitazone has been shown to induce cytochrome P450 CYP3A4 at clinically relevant doses.	null	16-34 hours	> 99% (primarily to serum albumin)	null	null	null	Organic compounds	Organoheterocyclic compounds	Benzopyrans	1-benzopyrans	[ "approved", "investigational", "withdrawn" ]	[ "A10BG", "A10B", "A10", "A" ]	[ "Humans and other mammals" ]	[]	[ { "approved": "1997-02-11", "country": "United States", "expires": "2013-09-15", "number": "5602133" }, { "approved": "1999-01-12", "country": "United States", "expires": "2017-11-13", "number": "5859037" }, { "approved": "2000-01-04", "country": "United States", "expires": "2017-11-13", "number": "6011049" } ]	Troglitazona \| Troglitazone \| NR1C3 \| Nuclear receptor subfamily 1 group C member 3 \| PPAR-gamma \| ERR gamma-2 \| ERR3 \| ERRG2 \| Estrogen receptor-related protein 3 \| KIAA0832 \| NR3B3 \| Nuclear receptor subfamily 3 group B member 3 \| ERR-alpha \| ERR1 \| ESRL1 \| Estrogen receptor-like 1 \| Estrogen-related receptor alpha \| NR3B1 \| Nuclear receptor subfamily 3 group B member 1 \| NR1C2 \| NUC1 \| NUCI \| Nuclear hormone receptor 1 \| Nuclear receptor subfamily 1 group C member 2 \| Peroxisome proliferator-activated receptor beta \| PPAR-beta \| PPAR-delta \| PPARB \| NR1C1 \| Nuclear receptor subfamily 1 group C member 1 \| PPAR \| PPAR-alpha \| 2.5.1.18 \| FAEES3 \| GST class-pi \| GST3 \| GSTP1-1 \| 6.2.1.3 \| ACS4 \| Arachidonate--CoA ligase \| FACL4 \| LACS 4 \| LACS4 \| Long-chain acyl-CoA synthetase 4 \| Endothelial plasminogen activator inhibitor \| PAI \| PAI-1 \| PAI1 \| PLANH1 \| Serpin E1 \| ENT1 \| Equilibrative NBMPR-sensitive nucleoside transporter \| Equilibrative nitrobenzylmercaptopurine riboside-sensitive nucleoside transporter \| es nucleoside transporter \| hENT1 \| Nucleoside transporter, es-type \| Solute carrier family 29 member 1 \| 1.14.14.14 \| ARO1 \| CYAR \| CYP19 \| CYPXIX \| Cytochrome P-450AROM \| Cytochrome P450 19A1 \| Estrogen synthase \| 1.14.14.1 \| CYPIA1 \| Cytochrome P450 form 6 \| Cytochrome P450-C \| Cytochrome P450-P1 \| Hydroperoxy icosatetraenoate dehydratase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| 2.4.1.17 \| GNT1 \| UDP-glucuronosyltransferase 1-3 \| UDP-glucuronosyltransferase 1-C \| UDP-glucuronosyltransferase 1A isoform 3 \| UDPGT 1-3 \| UGT-1C \| UGT1 \| UGT1-03 \| UGT1.3 \| UGT13 \| UGT1A3 \| UGT1C \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 2 \| GNT1 \| hUG-BR2 \| UDP-glucuronosyltransferase 1-4 \| UDP-glucuronosyltransferase 1-D \| UDPGT 1-4 \| UGT-1D \| UGT1 \| UGT1-04 \| UGT1.4 \| UGT14 \| UGT1A4 \| UGT1D \| 2.4.1.17 \| GNT1 \| Phenol-metabolizing UDP-glucuronosyltransferase \| UDP-glucuronosyltransferase 1-F \| UDP-glucuronosyltransferase 1A6 \| UDPGT 1-6 \| UGT-1F \| UGT1 \| UGT1-06 \| UGT1.6 \| UGT16 \| UGT1F \| 2.4.1.17 \| GNT1 \| UDP-glucuronosyltransferase 1-7 \| UDP-glucuronosyltransferase 1-G \| UDPGT 1-7 \| UGT-1G \| UGT1 \| UGT1-07 \| UGT1.7 \| UGT17 \| UGT1A7 \| UGT1G \| 2.4.1.17 \| GNT1 \| UDP-glucuronosyltransferase 1-8 \| UDP-glucuronosyltransferase 1-H \| UDPGT 1-8 \| UGT-1H \| UGT1 \| UGT1-08 \| UGT1.8 \| UGT18 \| UGT1A8 \| UGT1H \| 2.4.1.17 \| GNT1 \| lugP4 \| UDP-glucuronosyltransferase 1-9 \| UDP-glucuronosyltransferase 1-I \| UDPGT 1-9 \| UGT-1I \| UGT1 \| UGT1-09 \| UGT1.9 \| UGT19 \| UGT1A9 \| UGT1I \| 2.4.1.17 \| GNT1 \| UDP-glucuronosyltransferase 1-10 \| UDP-glucuronosyltransferase 1-J \| UDPGT 1-10 \| UGT-1J \| UGT1 \| UGT1-10 \| UGT1.10 \| UGT110 \| UGT1A10 \| UGT1J \| 2.4.1.17 \| 3,4-catechol estrogen-specific UDPGT \| UDP-glucuronosyltransferase 2B9 \| UDPGT 2B7 \| UDPGT 2B9 \| UDPGTh-2 \| UGT2B7 \| UGTB2B9 \| 2.4.1.17 \| HLUG4 \| UDP-glucuronosyltransferase 2B8 \| UDPGT 2B15 \| UDPGT 2B8 \| UDPGTh-3 \| UGT2B15 \| UGT2B8 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 1 \| GNT1 \| hUG-BR1 \| UDP-glucuronosyltransferase 1-1 \| UDP-glucuronosyltransferase 1A isoform 1 \| UDPGT 1-1 \| UGT1 \| UGT1-01 \| UGT1.1 \| UGT11 \| UGT1A1 \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6	[]	[ "Noscal", "Resulin", "Rezulin", "Romozin" ]	[]	[ "P37231", "P62508", "P11474", "Q03181", "Q07869", "P09211", "O60488", "P05121", "Q99808" ]	[ "P11511", "P04798", "P20813", "P11712", "P20815", "P24462", "P35503", "P22310", "P19224", "Q9HAW7", "Q9HAW9", "O60656", "Q9HAW8", "P16662", "P54855", "P08684", "P33261", "P22309", "P10632" ]	[]	[ "O95342", "Q9Y6L6" ]
DB00198	Oseltamivir	Oseltamivir (marketed as the product TamifluⓇ), is an antiviral neuraminidase inhibitor used for the treatment and prophylaxis of infection with influenza viruses A (including pandemic H1N1) and B. Oseltamivir exerts its antiviral activity by inhibiting the activity of the viral neuraminidase enzyme found on the surface of the virus, which prevents budding from the host cell, viral replication, and infectivity. The clinical benefit of use of oseltamivir is greatest when administered within 48 hours of the onset of influenza symptoms since effectiveness decreases significantly after that point in time; there is generally no benefit in use beyond 48 hours for healthy, low-risk individuals as influenza is a self-limiting illness.[A180574, L7267, A180580] However, antiviral treatment might be beneficial when initiated after 48 hours for patients with severe, complicated or progressive illness or for hospitalized patients.[A180583] According to the CDC, data from clinical trials and observational studies have demonstrated that early antiviral treatment can shorten the duration of fever and illness symptoms, and may reduce the risk of some complications (including pneumonia and respiratory failure). They recommend the use of oseltamivir in people with a higher risk of developing complications including children younger than 2 years, people over 65 years, people with some chronic conditions or immunosuppression, pregnant women, residents of long term care facilities, and indigenous communities for example.[L7264] The benefits of oseltamivir use are controversial; a 2014 Cochrane Review of the evidence found that oseltamivir treatment had limited benefit. The authors concluded that oseltamivir use in healthy adults had small, non-specific effects on symptoms (where the time to first alleviation of symptoms was only reduced from 7 to 6.3 days), it had no effect on hospitalizations, and that there was no evidence for any reductions in complications of influenza such as pneumonia.[A179962, A179965, A179968] Due to the risk of adverse effects such as nausea, vomiting, psychiatric effects and renal adverse events in adults and vomiting in children, the harms are generally considered to outweigh the small clinical benefit of use of oseltamivir. Notably, in 2017, the World Health Organization downgraded oseltamivir from its essential medicines list from a "core" drug to a "complementary" drug, due to limited cost-effectiveness.[A179086] Yearly vaccination with the influenza vaccine is still considered the best preventative measure.	solid	According to FDA prescribing information, oseltamivir is indicated for the treatment of acute, uncomplicated illness due to influenza A and B infection in patients 2 weeks of age and older who have been symptomatic for no more than 48 hours [F3094]. In particular, this agent is indicated in adults and children including full-term neonates who present with symptoms typical of influenza when influenza virus is circulating in the community. Efficacy has been demonstrated when treatment is initiated within two days of the first onset of symptoms.[F3097] Oseltamivir is also indicated for the prophylaxis of influenza in patients one year and older [F3094]. Specifically, post-exposure prevention in individuals one year of age or older following contact with a clinically diagnosed influenza case when influenza virus is circulating in the community qualifies for such prophylactic therapy. Oseltamivir would only be indicated for post-exposure prevention of influenza in infants less than 1 year of age during a pandemic influenza outbreak. [F3097]	There have been postmarketing reports of delirium and abnormal behavior leading to injury, and in some cases resulting in fatal outcomes, in patients with influenza who were receiving oseltamivir. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made but they appear to be uncommon based on oseltamivir. These events were reported primarily among pediatric patients and often had an abrupt onset and rapid resolution. The contribution of oseltamivir to these events has not been established. Influenza can be associated with a variety of neurologic and behavioral symptoms that can include events such as hallucinations, delirium, and abnormal behavior, in some cases resulting in fatal outcomes. These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease.[F3097, A180586, A180589]	Oseltamivir phosphate is a pro-drug of the active metabolite (oseltamivir carboxylate) which is a potent and selective inhibitor of influenza virus neuraminidase enzymes, which are glycoproteins found on the virion surface. Viral neuraminidase enzyme activity is important for viral entry into uninfected cells, for the release of recently formed virus particles from infected cells, and for the further spread of the infectious virus in the body.[F3097, L5161, F3115] Oseltamivir activity reduces viral shedding and infectivity. Oseltamivir is effective agaisnt viral neuraminidases of influenza A (including pandemic H1N1) and influenza B.[F3097, L5161, F3115]	Oseltamivir is readily absorbed from the gastrointestinal tract after oral administration of oseltamivir phosphate and is extensively converted by predominantly hepatic esterases to the active metabolite oseltamivir carboxylate. At least 75 % of an oral dose reaches the systemic circulation as the active metabolite. Exposure to the pro-drug is less than 5 % relative to the active metabolite. Plasma concentrations of both pro-drug and active metabolite are proportional to dose and are unaffected by co-administration with food.[F3094, F3097, L5161, F3115] Pharmacokinetic parameters following twice daily dosing of oseltamivir 75mg capsules are as follows: Cmax of oseltamivir and oseltamivir carboxylate were found to be 65ng/mL and 348ng/mL, respectively, while AUC (0-12h) of oseltamivir and oseltamivir carboxylate were found to be 112ng·h/mL and 2719ng·h/mL, respectively.[F3097]	Oseltamivir is extensively converted to the active metabolite, oseltamivir carboxylate, by esterases located predominantly in the liver. Oseltamivir carboxylate is not further metabolized. Neither oseltamivir nor oseltamivir carboxylate is a substrate for, or inhibitor of, cytochrome P450 isoforms. No phase 2 conjugates of either compound have been identified in vivo.[F3094, F3097, L5161, F3115]	Reports of overdoses with oseltamivir have been received from clinical trials and during postmarketing experience. In the majority of cases reporting overdose, no adverse reactions were reported. Adverse reactions reported following overdose were similar in nature to those observed with therapeutic doses of oseltamivir.	Plasma concentrations of oseltamivir declined with a half-life of 1 to 3 hours in most subjects after oral administration, although plasma concentrations of oseltamivir carboxylate declined with a half-life of 6 to 10 hours in most subjects after oral administration.[F3094, F3097]	The binding of the active oseltamivir carboxylate metabolite to human plasma protein is negligible at approximately 3 % while the binding of oseltamivir to human plasma protein is 42%, which is insufficient to cause significant displacement-based drug interactions.[F3094]	Following absorption, oseltamivir is more than 90 % eliminated through conversion to oseltamivir carboxylate and subsequent elimination entirely through renal excretion. During clinical studies, less than 20 % of oral radiolabelled dose was found to be eliminated in faeces.[F3094, F3097, L5161, F3115]	The mean volume of distribution at steady state of the oseltamivir carboxylate ranges approximately between 23 and 26 liters in humans, a volume that is roughly equivalent to extracellular body fluid. Since neuraminidase activity is extracellular, oseltamivir carboxylate distributes to all sites of influenza virus spread.[F3094, F3097, L5161, F3115]	Renal clearance (18.8 l/h) of the drug exceeds glomerular filtration rate (7.5 l/h) indicating that tubular secretion occurs in addition to glomerular filtration.[F3097]	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved" ]	[ "J05AH", "J05A", "J05", "J" ]	[ "Influenza A virus", "Influenza B virus" ]	[ { "cost": "9.76", "description": "Tamiflu 30 mg gel capsule", "unit": "gel capsule" }, { "cost": "9.76", "description": "Tamiflu 45 mg gel capsule", "unit": "gel capsule" }, { "cost": "9.76", "description": "Tamiflu 75 mg gel capsule", "unit": "gel capsule" }, { "cost": "51.0", "description": "Tamiflu 12 mg/ml Suspension", "unit": "bottle" }, { "cost": "101.54", "description": "Tamiflu 10 30 mg capsule Box", "unit": "box" }, { "cost": "101.54", "description": "Tamiflu 10 45 mg capsule Box", "unit": "box" }, { "cost": "101.54", "description": "Tamiflu 10 75 mg capsule Disp Pack", "unit": "disp" } ]	[ { "approved": "2006-08-08", "country": "Canada", "expires": "2016-02-26", "number": "2188835" }, { "approved": "1998-06-09", "country": "United States", "expires": "2017-02-23", "number": "5763483" }, { "approved": "1999-02-02", "country": "United States", "expires": "2016-08-02", "number": "5866601" }, { "approved": "1999-09-14", "country": "United States", "expires": "2015-08-27", "number": "5952375" } ]	(−)-oseltamivir \| 1-Cyclohexene-1-carboxylic acid, 4-(acetylamino)-5-amino-3-(1-ethylpropoxy)-, ethyl ester, (3R-(3alpha,4beta,5alpha))- \| Ethyl (3R,4R,5S)-4-acetamido-5-amino-3-(1-ethylpropoxy)-1-cyclohexene-1-carboxylate \| Oseltamivir \| Oséltamivir \| Oseltamivirum \| 3.2.1.18 \| 3.2.1.18 \| Acetylneuraminyl hydrolase \| G9 sialidase \| Lysosomal sialidase \| N-acetyl-alpha-neuraminidase 1 \| NANH \| 3.2.1.18 \| Cytosolic sialidase \| N-acetyl-alpha-neuraminidase 2 \| ACAT \| Acyl-coenzyme A:cholesterol acyltransferase \| Brain carboxylesterase hBr1 \| Carboxylesterase 1 \| CE-1 \| CEH \| CES2 \| Cholesteryl ester hydrolase \| Cocaine carboxylesterase \| Egasyn \| hCE-1 \| HMSE \| Methylumbelliferyl-acetate deacetylase 1 \| Monocyte/macrophage serine esterase \| REH \| Retinyl ester hydrolase \| Serine esterase 1 \| SES1 \| TGH \| Triacylglycerol hydrolase \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| MOAT-B \| MOATB \| MRP/cMOAT-related ABC transporter \| MRP4 \| Multi-specific organic anion transporter B \| Multidrug resistance-associated protein 4 \| Intestinal H(+)/peptide cotransporter \| Oligopeptide transporter, small intestine isoform \| PEPT1 \| Peptide transporter 1 \| hOAT3 \| OAT3 \| Organic anion/dicarboxylate exchanger \| Solute carrier family 22 member 8	[ "Ach-oseltamivir Phosphate", "Ach-oseltamivir Phosphate", "Ach-oseltamivir Phosphate", "Ag-oseltamivir", "Ag-oseltamivir", "Ag-oseltamivir", "Ebilfumin", "Ebilfumin", "Ebilfumin", "Ebilfumin", "Ebilfumin", "Ebilfumin", "Jamp Oseltamivir", "Jamp Oseltamivir", "Jamp Oseltamivir", "Mar-oseltamivir", "Mar-oseltamivir", "Mar-oseltamivir", "Mint-oseltamivir", "Mint-oseltamivir", "Mint-oseltamivir", "Mylan-oseltamivir", "Mylan-oseltamivir", "Mylan-oseltamivir", "Nat-oseltamivir", "Nat-oseltamivir", "Nat-oseltamivir", "Nat-oseltamivir", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamavir Phosphate", "Oseltamivir", "Oseltamivir", "Oseltamivir", "Oseltamivir", "Oseltamivir", "Oseltamivir", "Oseltamivir", "Oseltamivir", "Oseltamivir", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate", "Oseltamivir Phosphate for Oral Suspension", "Oseltamivir Phosphate for Oral Suspension", "Oseltamivir Phosphate for Oral Suspension", "Oseltamivir Phosphate for Oral Suspension", "Oseltamivir Powder for Oral Suspension", "Sandoz Oseltamivir", "Sandoz Oseltamivir", "Sandoz Oseltamivir", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu", "Tamiflu Oral Suspension" ]	[ "Tamiflu" ]	[]	[ "Q99519", "Q9Y3R4" ]	[ "P23141" ]	[]	[ "O15439", "P46059", "Q8TCC7" ]
DB00200	Hydroxocobalamin	Hydroxocobalamin, also known as vitamin B12a and hydroxycobalamin, is an injectable form of vitamin B 12 that has been used therapeutically to treat vitamin B 12 deficiency. It is also used in cyanide poisoning, Leber's optic atrophy, and toxic amblyopia.	solid	For treatment of pernicious anemia and the prevention and treatment of vitamin B12 deficiency arising from alcoholism, malabsorption, tapeworm infestation, celiac, hyperthyroidism, hepatic-biliary tract disease, persistent diarrhea, ileal resection, pancreatic cancer, renal disease, prolonged stress, vegan diets, macrobiotic diets or other restrictive diets. Also for the treatment of known or suspected cyanide poisoning.	Hydroxocobalamin is a synthetic, injectable form of Vitamin B12. Hydroxocobalamin is actually a precursor of two cofactors or vitamins (Vitamin B12 and Methylcobalamin) which are involved in various biological systems in man. Vitamin B12 is required for the conversion of methylmalonate to succinate. Deficiency of this enzyme could therefore interfere with the production of lipoprotein in myelin sheath tissue and so give rise to neurological lesions. The second cofactor, Methylcobalamin, is necessary for the conversion of homocysteine to methionine which is essential for the metabolism of folic acid. Deficiency of tetrahydrafolate leads to reduced synthesis of thymidylate resulting in reduced synthesis of DNA which is essential for cell maturation. Vitamin B12 is also concerned in the maintenance of sulphydryl groups in reduced form, deficiency leading to decreased amounts of reduced SH content of erythrocytes and liver cells. Overall, vitamin B12 acts as a coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis. It is necessary for growth, cell replication, hematopoiesis, and nucleoprotein as well as myelin synthesis. This is largely due to its effects on metabolism of methionine folic acid, and malonic acid.	Vitamin B12 exists in four major forms referred to collectively as cobalamins; deoxyadenosylcobalamin, methylcobalamin, hydroxocobalamin, and cyanocobalamin. Two of these, methylcobalamin and 5-deoxyadenosyl cobalamin, are primarily used by the body. Methionine synthase needs methylcobalamin as a cofactor. This enzyme is involved in the conversion of the amino acid homocysteine into methionine. Methionine in turn is required for DNA methylation. 5-Deoxyadenosyl cobalamin is a cofactor needed by the enzyme that converts L-methylmalonyl-CoA to succinyl-CoA. This conversion is an important step in the extraction of energy from proteins and fats. Furthermore, succinyl CoA is necessary for the production of hemoglobin, the substances that carries oxygen in red blood cells.	Readily absorbed from the gastrointestinal tract, except in malabsorption syndromes. Vitamin B12 is absorbed in the lower half of the ileum.	Primarily hepatic. Cobalamins are absorbed in the ileum and stored in the liver. They continuously undergo enterohepatic recycling via secretion in the bile. Part of a dose is excreted in the urine, most of it in the first 8 hours.	null	Approximately 6 days (peak plasma concentration after 8-12 hours from oral administration)	Very high (90%). Cobalamins are extensively bound to two specific plasma proteins called transcobalamin 1 and 2; 70% to transcobalamin 1, 5% to transcobalamin 2.	Each hydroxocobalamin molecule can bind one cyanide ion by substituting it for the hydroxo ligand linked to the trivalent cobalt ion, to form cyanocobalamin, which is then excreted in the urine.	null	null	Organic compounds	Organoheterocyclic compounds	Tetrapyrroles and derivatives	Corrinoids	[ "approved" ]	[ "B03BA", "B03B", "B03", "B", "V03AB", "V03A", "V03", "V", "B03BA", "B03B", "B03", "B" ]	[ "Humans and other mammals" ]	[ { "cost": "1.28", "description": "Hydroxocobalamin 1000 mcg/ml", "unit": "ml" }, { "cost": "812.5", "description": "Cyanokit 5 g kit", "unit": "kit" } ]	[ { "approved": "1998-11-10", "country": "United States", "expires": "2016-11-14", "number": "5834448" } ]	Hydroxocobalamin \| Hydroxocobalamin anhydrous \| Hydroxocobalamine \| Hydroxocobalaminum anhydrous \| Hydroxycobalamin \| OH-Cbl \| Vitamin B-12b \| 2.1.1.13 \| 5-methyltetrahydrofolate--homocysteine methyltransferase \| Cobalamin-dependent methionine synthase \| MS \| Vitamin-B12 dependent methionine synthase \| 5.4.99.2 \| MCM \| Methylmalonyl-CoA isomerase \| MUT \| 3.6.-.- \| Haptocorrin \| HC \| Protein R \| TC I \| TC-1 \| TC1 \| TCI \| Transcobalamin I \| 460 kDa receptor \| IFCR \| Intestinal intrinsic factor receptor \| Intrinsic factor-cobalamin receptor \| Intrinsic factor-vitamin B12 receptor \| Alkylcobalamin:glutathione S-alkyltransferase \| CblC \| Cyanocobalamin reductase (cyanide-eliminating) \| Methylmalonic aciduria and homocystinuria type C protein \| MMACHC \| TC II \| TC-2 \| TC2 \| TCII \| Transcobalamin II	[ "Aronamin Gold", "Cyanokit", "Cyanokit", "Cyanokit", "Cyanokit", "Cyanokit", "Cyanokit", "Cyanokit", "Cyanokit", "DermaNIC", "Escavite D", "Hydro Cobex Inj 1000mcg/ml", "Hydroxocobalamin", "Hydroxocobalamin", "Hydroxocobalamin", "Hydroxocobalamin Inj 1000mcg/ml", "Hydroxy Cobal Inj 1000mcg/ml" ]	[ "Alpha-Redisol", "Hydrocobamine" ]	[ "DermaNIC", "Aronamin Gold", "Escavite D" ]	[ "Q99707", "P22033", "Q8IVH4", "P20061", "Q9BXJ7", "O60494", "Q9Y4U1" ]	[]	[ "P20062" ]	[]
DB00202	Succinylcholine	Succinylcholine is a depolarizing skeletal muscle relaxant consisting of two molecules of the endogenous neurotransmitter [acetylcholine] (ACh) linked by their acetyl groups.[A19054] It has been widely used for over 50 years,[A299] most commonly in its chloride salt form, as a means of neuromuscular blockade during intubation and surgical procedures. Its rapid onset and offset, with effects beginning within 60 seconds of intravenous administration and lasting between four to six minutes, make succinylcholine particularly useful in the setting of short medical procedures requiring brief periods of muscle relaxation.[L9004]	solid	Succinylcholine is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.[L9004]	Succinylcholine's neuromuscular blockade takes effect within 60 seconds of intravenous administration and lasts between four to six minutes.[A19054] Similar to acetylcholine, it binds to cholinergic receptors of the motor endplate to induce membrane depolarization and, eventually, muscle paralysis, which may be maintained for as long as an adequate concentration of succinylcholine remains at the receptor site.[L32828] Succinylcholine has no direct action on smooth or cardiac muscle, nor does it appear to act on pre-synaptic or ganglionic acetylcholine receptors.[A34369] The paralysis induced by succinylcholine has been described as "progressive", first involving the muscles of the face and glottis, then the intercostals and diaphragm, then followed by other skeletal muscles.[L32828] Succinylcholine has no effect on consciousness or pain threshold, and must therefore be used in conjunction with adequate anesthesia.[L9004] There have been rare reports of the development of acute rhabdomyolysis with hyperkalemia - resulting in ventricular dysrhythmias, cardiac arrest, and death - after the intravenous administration of succinylcholine to apparently healthy pediatric patients who were subsequently found to have undiagnosed skeletal myopathy (most frequently Duchenne's muscular dystrophy).[L9004] Infants or children experiencing seemingly idiopathic cardiac arrest soon after the administration of succinylcholine should therefore be treated immediately for hyperkalemia. Given that patients may not present with any apparent risk factors, the use of succinylcholine in pediatric patients should be restricted to emergency intubation or other situations in which a suitable alternative is unavailable.[L9004]	Succinylcholine is a depolarizing neuromuscular blocker, meaning it causes a prolonged period of membrane depolarization in order to exert its therapeutic effects. It binds to the post-synaptic cholinergic receptors found on motor endplates, thereby inducing first transient fasciculations followed by skeletal muscle paralysis.[A233250]	null	Succinylcholine is rapidly metabolized by plasma cholinesterase in the bloodstream to succinylmonocholine, which is then further hydrolyzed (albeit more slowly) to succinic acid and choline.[L32828]	Overdosage of succinylcholine is likely to extend the neuromuscular blockade beyond the time needed for surgery. Symptoms are likely to be consistent with its therapeutic effects, although more pronounced, and may therefore include skeletal muscle weakness, decreased respiratory reserve, low tidal volume, or apnea. Treatment of succinylcholine overdose involves airway and respiratory support until recovery of normal respiration is assured.[L9004] Depending on the extent of the overdose, the characteristic depolarizing (i.e. Phase I) neuromuscular blockade may switch to resemble more closely a non-depolarizing (i.e. Phase II) neuromuscular blockade.[L9004] This occurs primarily when succinylcholine is given over a prolonged period of time or with particularly large doses, and may result in significant respiratory muscle paralysis or weakness.	The mean half-life of elimination following intravenous administration is 47 seconds.[A233225]	null	Approximately 10% of an administered dose is excreted unchanged in the urine.[L32828]	At intravenous doses of 1 mg/kg and 2 mg/kg in 14 patients, the mean apparent volumes of distribution were 16.4 ± 14.7 and 5.6 ± 6.8 mL/kg, respectively.[A233235]	The mean _in vivo_ plasma clearance of succinylcholine following an intravenous dose of 1 mg/kg in 18 patients was approximately 4.17 ± 2.37 L/min.[A233220]	Organic compounds	Organic nitrogen compounds	Organonitrogen compounds	Quaternary ammonium salts	[ "approved" ]	[ "M03AB", "M03A", "M03", "M" ]	[ "Humans and other mammals" ]	[ { "cost": "1.2", "description": "Quelicin 100 mg/ml vial", "unit": "ml" }, { "cost": "2.08", "description": "Succinylcholine-ns 140 mg/7 ml", "unit": "ml" }, { "cost": "0.22", "description": "Quelicin 20 mg/ml vial", "unit": "ml" } ]	[]	2,2'-[(1,4-dioxobutane-1,4-diyl)bis(oxy)]bis(N,N,N-trimethylethanaminium) \| Dicholine succinate \| Succinocholine \| Succinoylcholine \| Succinylbischoline \| Succinyldicholine \| Suxamethonium \| NACHR alpha-10 \| NACHRA10 \| Nicotinic acetylcholine receptor subunit alpha-10 \| NACHRA3 \| NACRA4 \| NACHRA5 \| NACHRA7 \| NACHR alpha-9 \| NACHRA9 \| Nicotinic acetylcholine receptor subunit alpha-9 \| 3.1.1.8 \| Acylcholine acylhydrolase \| Butyrylcholine esterase \| CHE1 \| Choline esterase II \| Pseudocholinesterase	[ "Anectine", "Anectine", "Anectine", "Anectine", "Anectine", "Anectine Civ", "Anectine Flopack 500mg", "Anectine Inj 20mg/ml", "Anectine Nov", "Quelicin", "Quelicin", "Quelicin", "Quelicin", "Quelicin", "Quelicin", "Quelicin", "Quelicin", "Quelicin Inj 20mg/ml USP", "Succinylcholine", "Succinylcholine", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride", "Succinylcholine Chloride Injection USP", "Succinylcholine Chloride Injection USP", "Succinylcholine Chloride Injection, USP", "Succinylcholine Chloride Injection, USP 20mg/ml" ]	[ "Scoline", "Sucostrin" ]	[]	[ "Q9GZZ6", "Q15822", "P32297", "P43681", "P30532", "Q15825", "P36544", "Q9UGM1", "P17787", "Q05901", "P30926", "P08172", "P20309" ]	[ "P06276" ]	[]	[]
DB00203	Sildenafil	In eliciting its mechanism of action, sildenafil ultimately prevents or minimizes the breakdown of cyclic guanosine monophosphate (cGMP) by inhibiting cGMP specific phosphodiesterase type 5 (PDE5) [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. The result of doing so allows cGMP present in both the penis and pulmonary vasculature to elicit smooth muscle relaxation and vasodilation that subsequently facilitates relief in pulmonary arterial hypertension and the increased flow of blood into the spongy erectile tissue of the penis that consequently allows it to grow in size and become erect and rigid [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Interestingly enough, it is precisely via this mechanism why sildenafil was at first researched as a potential treatment for angina - or chest pain associated with inadequate blood flow to the heart - before being serendipitously indicated for treating erectile dysfunction in the late 1980s [A175732]. Nevertheless, it is because of this mechanism that sildenafil is also indicated for treating pulmonary arterial hypertension but is also additionally notorious for interacting with various anti-anginal or anti-hypertensive agents to develop potentially rapid, excessive, and/or fatal hypotensive crises [A175579, A175582, A175654]. Regardless, sildenafil, among a variety of other similar or related PDE5 inhibitors, has become a common and effective treatment for erectile dysfunction and since its formal approval for medical use in the public in 1998 [A175732], continues to see millions of prescriptions written for it internationally. Although the medication has historically been most popularly recognized as Pfizer's brand name Viagra, sildenafil is currently available generically and even as a non-prescription over the counter medication in some countries [L5656].	solid	Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor that is predominantly employed for two primary indications: (1) the treatment of erectile dysfunction [A175582, L5611, F3853, F3856, F3886]; and (2) treatment of pulmonary hypertension, where: a) the US FDA specifically indicates sildenafil for the treatment of pulmonary arterial hypertension (PAH) (WHO Group I) in adults to improve exercise ability and delay clinical worsening [F3850]. The delay in clinical worsening was demonstrated when sildenafil was added to background epoprostenol therapy [F3850]. Studies establishing effectiveness were short-term (12 to 16 weeks), and included predominately patients with New York Heart Association (NYHA) Functional Class II-III symptoms and idiopathic etiology (71%) or associated with connective tissue disease (CTD) (25%) [F3850]; b) the Canadian product monograph specifically indicates sildenafil for the treatment of primary pulmonary arterial hypertension (PPH) or pulmonary hypertension secondary to connective tissue disease (CTD) in adult patients with WHO functional class II or III who have not responded to conventional therapy [F3859]. In addition, improvement in exercise ability and delay in clinical worsening was demonstrated in adult patients who were already stabilized on background epoprostenol therapy [F3859]; and c) the EMA product information specifically indicates sildenafil for the treatment of adult patients with pulmonary arterial hypertension classified as WHO functional class II and III, to improve exercise capacity [F3883]. Efficacy has been shown in primary pulmonary hypertension and pulmonary hypertension associated with connective tissue disease [F3883]. The EMA label also indicates sildenafil for the treatment of pediatric patients aged 1 year to 17 years old with pulmonary arterial hypertension [F3883]. Efficacy in terms of improvement of exercise capacity or pulmonary hemodynamics has been shown in primary pulmonary hypertension and pulmonary hypertension associated with congenital heart disease [F3883].	In vitro studies have shown that sildenafil is selective for phosphodiesterase-5 (PDE5) [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Its effect is more potent on PDE5 than on other known phosphodiesterases [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. In particular, there is a 10-times selectivity over PDE6 which is involved in the phototransduction pathway in the retina [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. There is an 80-times selectivity over PDE1, and over 700-times over PDE 2, 3, 4, 7, 8, 9, 10 and 11 [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. And finally, sildenafil has greater than 4,000-times selectivity for PDE5 over PDE3, the cAMP-specific phosphodiesterase isoform involved in the control of cardiac contractility [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. In eight double-blind, placebo-controlled crossover studies of patients with either organic or psychogenic erectile dysfunction, sexual stimulation resulted in improved erections, as assessed by an objective measurement of hardness and duration of erections (via the use of RigiScan®), after sildenafil administration compared with placebo [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Most studies assessed the efficacy of sildenafil approximately 60 minutes post-dose [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. The erectile response, as assessed by RigiScan®, generally increased with increasing sildenafil dose and plasma concentration [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. The time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Sildenafil causes mild and transient decreases in systemic blood pressure which, in the majority of cases, do not translate into clinical effects [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. After chronic dosing of 80 mg, three times a day to patients with systemic hypertension the mean change from baseline in systolic and diastolic blood pressure was a decrease of 9.4 mmHg and 9.1 mmHg respectively [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. After chronic dosing of 80 mg, three times a day to patients with pulmonary arterial hypertension lesser effects in blood pressure reduction were observed (a reduction in both systolic and diastolic pressure of 2 mmHg)[F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614] . At the recommended dose of 20 mg three times a day no reductions in systolic or diastolic pressure were seen [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Single oral doses of sildenafil up to 100 mg in healthy volunteers produced no clinically relevant effects on ECG [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. After chronic dosing of 80 mg three times a day to patients with pulmonary arterial hypertension no clinically relevant effects on the ECG were reported either [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. In a study of the hemodynamic effects of a single oral 100 mg dose of sildenafil in 14 patients with severe coronary artery disease (CAD) (> 70 % stenosis of at least one coronary artery), the mean resting systolic and diastolic blood pressures decreased by 7 % and 6 % respectively compared to baseline [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Mean pulmonary systolic blood pressure decreased by 9% [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Sildenafil showed no effect on cardiac output and did not impair blood flow through the stenosed coronary arteries [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Mild and transient differences in color discrimination (blue/green) were detected in some subjects using the Farnsworth-Munsell 100 hue test at 1 hour following a 100 mg dose, with no effects evident after 2 hours post-dose [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. The postulated mechanism for this change in color discrimination is related to inhibition of PDE6, which is involved in the phototransduction cascade of the retina [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Sildenafil has no effect on visual acuity or contrast sensitivity. In a small size placebo-controlled study of patients with documented early age-related macular degeneration (n = 9), sildenafil (single dose, 100 mg) demonstrated no significant changes in visual tests conducted (which included visual acuity, Amsler grid, color discrimination simulated traffic light, and the Humphrey perimeter and photostress test) [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	Sildenafil is an oral therapy for erectile dysfunction [A175582, F3853, F3856, F3886, L5611]. In the natural setting, i.e. with sexual stimulation, it restores impaired erectile function by increasing blood flow to the penis [A175582, F3853, F3856, F3886, L5611]. The physiological mechanism responsible for the erection of the penis involves the release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation [A175582, F3853, F3856, F3886, L5611]. Nitric oxide then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood [A175582, F3853, F3856, F3886, L5611]. Sildenafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) in the corpus cavernosum, where PDE5 is responsible for degradation of cGMP [A175582, F3853, F3856, F3886, L5611]. Sildenafil has a peripheral site of action on erections [A175582, F3853, F3856, F3886, L5611]. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum but potently enhances the relaxant effect of NO on this tissue [A175582, F3853, F3856, F3886, L5611]. When the NO/cGMP pathway is activated, as occurs with sexual stimulation, inhibition of PDE5 by sildenafil results in increased corpus cavernosum levels of cGMP [A175582, F3853, F3856, F3886, L5611]. Therefore sexual stimulation is required in order for sildenafil to produce its intended beneficial pharmacological effects [A175582, F3853, F3856, F3886, L5611]. Moreover, apart from the presence of PDE5 in the corpus cavernosum of the penis, PDE5 is also present in the pulmonary vasculature [A175579, F3850, F3859, F3883, L5614]. Sildenafil, therefore, increases cGMP within pulmonary vascular smooth muscle cells resulting in relaxation [A175579, F3850, F3859, F3883, L5614]. In patients with pulmonary arterial hypertension, this can lead to vasodilation of the pulmonary vascular bed and, to a lesser degree, vasodilatation in the systemic circulation [A175579, F3850, F3859, F3883, L5614].	Sildenafil is known to be quickly absorbed, with maximum plasma concentrations being observed within 30-120 minutes (with a median of 60 minutes) of oral administration in a fasting patient [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Moreover, the mean absolute bioavailability observed for sildenafil is about 41% (from a range of 25-63%) [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. In particular, after oral three times a day dosing of sildenafil, the AUC and Cmax increase in proportion with dose over the recommended dosage range of 25-100 mg [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. When used in pulmonary arterial hypertension patients, however, the oral bioavailability of sildenafil after a dosing regimen of 80 mg three times a day, was on average 43% greater than compared to the lower doses [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Finally, if sildenafil is administered orally with food, the rate of absorption is observed to be decreased with a mean delay in Tmax of about 60 minutes and a mean decrease in Cmax of approximately 29% [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Regardless, the extent of absorption is not observed to be significantly affected as the recorded AUC decreased by only about 11 % [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	The metabolism of sildenafil is facilitated primarily by the CYP3A4 hepatic microsomal isoenzymes and to a minor extent, via the CYP2C9 hepatic isoenzymes [A175654, F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. The predominant circulating metabolite results from the N-demethylation of sildenafil [A175654, F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. This particular resultant metabolite possesses a phosphodiesterase selectivity that is similar to the parent sildenafil molecule and a corresponding in vitro potency for PDE5 that is approximately 50% that of the parent drug [A175654, F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Moreover, plasma concentrations of the metabolite are about 40% of those recorded for sildenafil, a percentage that accounts for about 20% of sildenafil’s pharmacologic effects [A175654, F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. This primary N-desmethyl metabolite of sildenafil also undergoes further metabolism, with a terminal half-life of about 4 hours [A175654, F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. In patients with pulmonary arterial hypertension, plasma concentrations of the primary N-desmethyl metabolite are about 72% those of the original parent sildenafil molecule after a regimen of 20 mg three times a day - which is consequently responsible for about a 36% contribution to sildenafil’s overall pharmacological effects [A175654, F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	In single-dose volunteer studies of doses up to 800 mg, adverse reactions were similar to those seen at lower doses, but the incidence rates and severities were increased [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Doses of 200 mg did not result in increased efficacy but the incidence of adverse reaction (headache, flushing, dizziness, dyspepsia, nasal congestion, altered vision) was increased [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Due to the lack of data on the effect of sildenafil indicated for the treatment of pulmonary arterial hypertension (PAH) in pregnant women, sildenafil is not recommended for women of childbearing potential unless also using appropriate contraceptive measures [F3850, F3859, F3883, L5614]. The safety and efficacy of sildenafil indicated for treating PAH in a woman during labor and delivery have not been studied [F3850, F3859, F3883, L5614]. Caution should ultimately be exercised when sildenafil is administered to nursing women as it is not known if sildenafil or its metabolites are excreted in human breast milk [F3850, F3859, F3883, L5614]. The safety and efficacy of sildenafil for the treatment of PAH in children below 1 year of age has not been established as no data is available [F3883]. Clinical experience with the elderly population in the use of sildenafil for the treatment of PAH has been varied. Some reports suggest that there are no identified differences in responses between elderly and younger patients [F3850] while others have documented that clinical efficacy as measured by 6-minute walk distance could be less in elderly patients [L5614]. In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy [F3850]. Conversely, when sildenafil was used to treat erectile dysfunction in healthy elderly volunteers (65 years or over), a reduced clearance of sildenafil was observed [F3853, L5611]. This reduction resulted in about 90% higher plasma concentrations of sildenafil and the active N-desmethyl metabolite compared to those seen in healthy younger volunteers (18-45 years) [F3853, L5611]. Due to age-differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40% [F3853, L5611]. Sildenafil was not carcinogenic when administered to rats for 24 months at a dose resulting in total systemic drug exposure (AUCs) for unbound sildenafil and its major metabolite of 29- and 42- times, for male and female rats, respectively, the exposures observed in human males given the Maximum Recommended Human Dose (MRHD) of 100 mg [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Sildenafil was not carcinogenic when administered to mice for 18-21 months at dosages up to the Maximum Tolerated Dose (MTD) of 10 mg/kg/day, approximately 0.6 times the MRHD on a mg/m2 basis [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Sildenafil was negative in in vitro bacterial and Chinese hamster ovary cell assays to detect mutagenicity, and in vitro human lymphocytes and in vivo mouse micronucleus assays to detect clastogenicity [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. There was no impairment of fertility in rats given sildenafil up to 60 mg/kg/day for 36 days to females and 102 days to males, a dose producing an AUC value of more than 25 times the human male AUC [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	The terminal phase half-life observed for sildenafil is approximately 3 to 5 hours [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	It is generally observed that sildenafil and its main circulating N-desmethyl metabolite are both estimated to be about 96% bound to plasma proteins [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614]. Nevertheless, it has been determined that protein binding for sildenafil is independent of total drug concentrations [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	After either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the feces (approximately 80% of the administered oral dose) and to a lesser extent in the urine (approximately 13% of the administered oral dose) [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	The mean steady-state volume of distribution documented for sildenafil is approximately 105 L - a value which suggests the medication undergoes distribution into the tissues [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	The total body clearance documented for sildenafil is 41 L/h [F3850, F3853, F3856, F3859, F3883, F3886, L5611, L5614].	Organic compounds	Benzenoids	Benzene and substituted derivatives	Benzenesulfonamides	[ "approved", "investigational" ]	[ "G01AE", "G01A", "G01", "G", "G04BE", "G04B", "G04", "G" ]	[ "Humans and other mammals" ]	[ { "cost": "9.33", "description": "Revatio 10 mg/12.5 ml vial", "unit": "ml" }, { "cost": "17.5", "description": "Revatio 20 mg tablet", "unit": "tablet" }, { "cost": "19.45", "description": "Viagra 100 mg tablet", "unit": "tablet" }, { "cost": "19.45", "description": "Viagra 25 mg tablet", "unit": "tablet" }, { "cost": "19.45", "description": "Viagra 50 mg tablet", "unit": "tablet" }, { "cost": "24.38", "description": "Sildenafil citrate powder", "unit": "g" } ]	[ { "approved": "1993-10-05", "country": "United States", "expires": "2012-03-27", "number": "5250534" }, { "approved": "2005-12-20", "country": "Canada", "expires": "2020-10-26", "number": "2324324" }, { "approved": "1998-02-03", "country": "Canada", "expires": "2011-06-17", "number": "2044748" }, { "approved": "2002-10-22", "country": "United States", "expires": "2020-04-22", "number": "6469012" }, { "approved": "2018-12-24", "country": "United States", "expires": "2038-12-24", "number": "11337979" }, { "approved": "2018-12-24", "country": "United States", "expires": "2038-12-24", "number": "11464778" }, { "approved": "2018-12-24", "country": "United States", "expires": "2038-12-24", "number": "11759468" }, { "approved": "2018-12-24", "country": "United States", "expires": "2038-12-24", "number": "12005062" } ]	1-((3-(4,7-Dihydro-1-methyl-7-oxo-3-propyl-1H-pyrazolo(4,3-d)pyrimidin-5-yl)-4-ethoxyphenyl)sulfonyl)-4-methylpiperazine \| Sildenafil \| Sildenafilo \| C1 esterase inhibitor \| C1 Inh \| C1-inhibiting factor \| C1IN \| C1Inh \| C1NH \| Serpin G1 \| 3.1.4.35 \| CGB-PDE \| cGMP-binding cGMP-specific phosphodiesterase \| PDE5 \| 3.1.4.35 \| GMP-PDE gamma \| PDEG \| 3.1.4.35 \| GMP-PDE gamma \| 4.1.1.17 \| ODC \| B7 homolog 1 \| B7-H1 \| B7H1 \| hPD-L1 \| PD-L1 \| PDCD1 ligand 1 \| PDCD1L1 \| PDCD1LG1 \| PDL1 \| Programmed death ligand 1 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| MOAT-B \| MOATB \| MRP/cMOAT-related ABC transporter \| MRP4 \| Multi-specific organic anion transporter B \| Multidrug resistance-associated protein 4 \| 7.6.2.- \| 7.6.2.2 \| MOAT-C \| MRP5 \| Multi-specific organic anion transporter C \| Multidrug resistance-associated protein 5 \| pABC11 \| SMRP \| 7.6.2.2 \| 7.6.2.3 \| MRP7 \| Multidrug resistance-associated protein 7 \| SIMRP7 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1	[ "Accel-sildenafil", "Accel-sildenafil", "Accel-sildenafil", "Act Sildenafil", "Act Sildenafil", "Act Sildenafil", "Ag-sildenafil", "Ag-sildenafil", "Ag-sildenafil", "Ag-sildenafil Tablets", "Ag-sildenafil Tablets", "Ag-sildenafil Tablets", "Apo-sildenafil", "Apo-sildenafil", "Apo-sildenafil", "Apo-sildenafil R", "Auro-sildenafil", "Auro-sildenafil", "Auro-sildenafil", "Bio-sildenafil", "Bio-sildenafil", "Bio-sildenafil", "Dom-sildenafil", "Dom-sildenafil", "Dom-sildenafil", "Gd-sildenafil", "Gd-sildenafil", "Gd-sildenafil", "Granpidam", "Granpidam", "Granpidam", "Granpidam", "Granpidam", "Ipg-sildenafil", "Ipg-sildenafil", "Ipg-sildenafil", "Jamp Sildenafil Tablets", "Jamp Sildenafil Tablets", "Jamp Sildenafil Tablets", "Jamp-sildenafil", "Jamp-sildenafil", "Jamp-sildenafil", "Jamp-sildenafil R", "Liqrev", "M-sildenafil", "M-sildenafil", "M-sildenafil", "Mar-sildenafil", "Mar-sildenafil", "Mar-sildenafil", "Mint-sildenafil", "Mint-sildenafil", "Mint-sildenafil", "Myl-sildenafil", "Myl-sildenafil", "Myl-sildenafil", "Mylan-sildenafil", "Mylan-sildenafil", "Mylan-sildenafil", "Mysildecard", "Mysildecard", "Mysildecard", "Nra-sildenafil", "Nra-sildenafil", "Nra-sildenafil", "Pb-sildenafil", "Pb-sildenafil", "Pb-sildenafil", "PMS-sildenafil", "PMS-sildenafil", "PMS-sildenafil", "PMS-sildenafil R", "Priva-sildenafil", "Priva-sildenafil", "Priva-sildenafil", "Prv-sildenafil", "Prv-sildenafil", "Prv-sildenafil", "Prz-sildenafil", "Prz-sildenafil", "Prz-sildenafil", "Ratio-sildenafil", "Ratio-sildenafil", "Ratio-sildenafil", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Revatio", "Riva-sildenafil", "Riva-sildenafil", "Riva-sildenafil", "Riva-sildenafil", "Riva-sildenafil", "Riva-sildenafil", "Sandoz Sildenafil", "Sandoz Sildenafil", "Sandoz Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Actavis", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil citrate", "Sildenafil citrate", "Sildenafil citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "sildenafil CITRATE", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil Citrate", "Sildenafil citrate", "Sildenafil for Oral Suspension", "Sildenafil for Oral Suspension", "Sildenafil R", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Ratiopharm", "Sildenafil Tablets", "Sildenafil Tablets", "Sildenafil Tablets", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Sildenafil Teva", "Taro-sildenafil", "Taro-sildenafil", "Taro-sildenafil", "Teva-sildenafil", "Teva-sildenafil", "Teva-sildenafil", "Teva-sildenafil R", "Uph-sildenafil", "Uph-sildenafil", "Uph-sildenafil", "Van-sildenafil", "Van-sildenafil", "Van-sildenafil", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Viagra", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin", "Vizarsin" ]	[]	[]	[ "P05155", "O76074", "P18545", "Q13956", "P11926", "Q9NZQ7" ]	[ "P08684", "P20815", "P24462", "P11712", "P33261", "P10635", "P05181" ]	[]	[ "O15439", "O15440", "Q5T3U5", "Q9Y6L6", "P08183" ]
DB00204	Dofetilide	Dofetilide is a class III antiarrhythmic agent that is approved by the Food and Drug Administration (FDA) for the maintenance of sinus rhythm in individuals prone to the formation of atrial fibrillation and flutter, and for the chemical cardioversion to sinus rhythm from atrial fibrillation and flutter.	solid	For the maintenance of normal sinus rhythm (delay in time to recurrence of atrial fibrillation/atrial flutter [AF/AFl]) in patients with atrial fibrillation/atrial flutter of greater than one week duration who have been converted to normal sinus rhythm	Dofetilide is an antiarrhythmic drug with Class III (cardiac action potential duration prolonging) properties and is indicated for the maintenance of normal sinus rhythm. Dofetilide increases the monophasic action potential duration in a predictable, concentration-dependent manner, primarily due to delayed repolarization. At concentrations covering several orders of magnitude, Dofetilide blocks only IKr with no relevant block of the other repolarizing potassium currents (e.g., IKs, IK1). At clinically relevant concentrations, Dofetilide has no effect on sodium channels (associated with Class I effect), adrenergic alpha-receptors, or adrenergic beta-receptors.	The mechanism of action of Dofetilide is a blockade of the cardiac ion channel carrying the rapid component of the delayed rectifier potassium current, IKr. This inhibition of potassium channels results in a prolongation of action potential duration and the effective refractory period of accessory pathways (both anterograde and retrograde conduction in the accessory pathway).	>90%	Hepatic	null	10 hours	60% -70%	null	* 3 L/kg	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	Sulfanilides	[ "approved", "investigational" ]	[ "C01BD", "C01B", "C01", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "3.61", "description": "Tikosyn 500 mcg capsule", "unit": "capsule" }, { "cost": "3.63", "description": "Tikosyn 125 mcg capsule", "unit": "capsule" }, { "cost": "3.64", "description": "Tikosyn 250 mcg capsule", "unit": "capsule" } ]	[ { "approved": "1990-09-25", "country": "United States", "expires": "2012-09-25", "number": "4959366" }, { "approved": "2000-09-26", "country": "United States", "expires": "2018-10-09", "number": "6124363" } ]	beta-((p-Methanesulfonamidophenethyl)methylamino)methanesulfono-p-phenetidide \| Dofetilida \| Dofetilide \| Dofetilidum \| Eag homolog \| Eag-related protein 1 \| ERG \| ERG-1 \| ERG1 \| Ether-a-go-go-related gene potassium channel 1 \| Ether-a-go-go-related protein 1 \| H-ERG \| HERG \| hERG-1 \| hERG1 \| Potassium voltage-gated channel subfamily H member 2 \| Voltage-gated potassium channel subunit Kv11.1 \| K2P2.1 \| Outward rectifying potassium channel protein TREK-1 \| TREK \| TREK-1 K(+) channel subunit \| TREK1 \| Two pore domain potassium channel TREK1 \| Two pore potassium channel TPKC1 \| Inward rectifier K(+) channel Kir2.2 \| Inward rectifier K(+) channel Kir2.2v \| IRK-2 \| IRK2 \| KCNJN1 \| Potassium channel, inwardly rectifying subfamily J member 12 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| hOCT2 \| OCT2 \| Organic cation transporter 2	[ "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide", "Dofetilide 0.125mg", "Dofetilide 0.25mg", "Dofetilide 0.5mg", "Tikosyn", "Tikosyn", "Tikosyn", "Tikosyn", "Tikosyn", "Tikosyn" ]	[]	[]	[ "Q12809", "O95069", "Q14500" ]	[ "P08684" ]	[]	[ "O15244" ]
DB00205	Pyrimethamine	One of the folic acid antagonists that is used as an antimalarial or with a sulfonamide to treat toxoplasmosis.	solid	For the treatment of toxoplasmosis and acute malaria; For the prevention of malaria in areas non-resistant to pyrimethamine	Pyrimethamine is an antiparasitic compound commonly used as an adjunct in the treatment of uncomplicated, chloroquine resistant, P. falciparum malaria. Pyrimethamine is a folic acid antagonist and the rationale for its therapeutic action is based on the differential requirement between host and parasite for nucleic acid precursors involved in growth. This activity is highly selective against plasmodia and Toxoplasma gondii. Pyrimethamine possesses blood schizonticidal and some tissue schizonticidal activity against malaria parasites of humans. However, the 4-amino-quinoline compounds are more effective against the erythrocytic schizonts. It does not destroy gametocytes, but arrests sporogony in the mosquito. The action of pyrimethamine against Toxoplasma gondii is greatly enhanced when used in conjunction with sulfonamides.	Pyrimethamine inhibits the dihydrofolate reductase of plasmodia and thereby blocks the biosynthesis of purines and pyrimidines, which are essential for DNA synthesis and cell multiplication. This leads to failure of nuclear division at the time of schizont formation in erythrocytes and liver.	Well absorbed with peak levels occurring between 2 to 6 hours following administration	Hepatic	null	96 hours	87%	null	null	null	Organic compounds	Organoheterocyclic compounds	Diazines	Pyrimidines and pyrimidine derivatives	[ "approved", "investigational", "vet_approved" ]	[ "P01BF", "P01B", "P01", "P", "P01BD", "P01B", "P01", "P", "P01BD", "P01B", "P01", "P", "P01BF", "P01B", "P01", "P" ]	[ "Plasmodium" ]	[ { "cost": "8.88", "description": "Pyrimethamine powder", "unit": "g" }, { "cost": "0.98", "description": "Daraprim 25 mg tablet", "unit": "tablet" } ]	[]	2,4-Diamino-5-(4-chlorophenyl)-6-ethylpyrimidine \| 2,4-Diamino-5-(P-chlorophenyl)-6-ethylpyrimidine \| 2,4-Diamino-5-chlorophenyl-6-ethylpyrimidine \| 5-(4-Chlorophenyl)-6-ethyl-2,4-diaminopyrimidine \| 5-(4-Chlorophenyl)-6-ethyl-2,4-pyrimidinediamine \| 5-(4'-Chlorophenyl)-2,4-diamino-6-ethylpyrimidine \| CD \| Chloridine \| Chloridyn \| Diaminopyritamin \| Ethylpyrimidine \| Pirimetamina \| Primethamine \| Pyrimethamine \| Pyriméthamine \| Pyrimethaminum \| 1.5.1.3 \| Adult folate-binding protein \| FBP \| Folate receptor 1 \| Folate receptor, adult \| FOLR \| FR-alpha \| KB cells FBP \| Ovarian tumor-associated antigen MOv18 \| DHFR-TS \| 3.2.1.52 \| Beta-N-acetylhexosaminidase subunit beta \| Cervical cancer proto-oncogene 7 protein \| HCC-7 \| Hexosaminidase subunit B \| N-acetyl-beta-glucosaminidase subunit beta \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| hMATE-1 \| MATE-1 \| MATE1 \| Solute carrier family 47 member 1 \| hMATE-2 \| Kidney-specific H(+)/organic cation antiporter \| MATE-2 \| MATE2 \| Solute carrier family 47 member 2	[ "Daraprim", "Daraprim", "Daraprim", "Daraprim", "Daraprim", "Daraprim", "Daraprim", "Daraprim", "Fansidar", "Fansidar Tablets", "Pyrimethamine", "Pyrimethamine", "Pyrimethamine", "Pyrimethamine", "Pyrimethamine", "Pyrimethamine", "Pyrimethamine", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin" ]	[]	[ "Fansidar", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Pyrimethamine Leucovorin", "Fansidar Tablets" ]	[ "P00374", "P15328", "P07686" ]	[ "P10632" ]	[]	[ "Q96FL8", "Q86VL8" ]
DB00206	Reserpine	An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse effects limit its clinical use. The FDA withdrew its approval for the use of all oral dosage form drug products containing more than 1 mg of reserpine.[L43942]	solid	For the treatment of hypertension	Reserpine is an adrenergic blocking agent used to treat mild to moderate hypertension via the disruption of norepinephrine vesicular storage. The antihypertensive actions of Reserpine are a result of its ability to deplete catecholamines from peripheral sympathetic nerve endings. These substances are normally involved in controlling heart rate, force of cardiac contraction and peripheral resistance.	Reserpine's mechanism of action is through inhibition of the ATP/Mg<sup>2+</sup> pump responsible for the sequestering of neurotransmitters into storage vesicles located in the presynaptic neuron. The neurotransmitters that are not sequestered in the storage vesicle are readily metabolized by monoamine oxidase (MAO) causing a reduction in catecholamines.	null	null	Possible human carcinogen. May cause reproductive harm. ORL-RAT LD<sub>50</sub> 420 mg/kg; IPR-RAT LD<sub>50</sub> 44 mg/kg; IVN-RAT LD<sub>50</sub> 15 mg/kg; ORL-MUS LD<sub>50</sub> 200 mg/kg; SCU-MUS LD<sub>50</sub> 52 mg/kg; IPR-RBT LD<sub>50</sub> 7 mg/kg	null	62%	Reserpine is extensively metabolized to inactive compounds. It is slowly excreted via the urine and feces.	null	null	Organic compounds	Alkaloids and derivatives	Yohimbine alkaloids	null	[ "approved", "investigational", "withdrawn" ]	[ "C02LA", "C02L", "C02", "C", "C02AA", "C02A", "C02", "C", "C02LA", "C02L", "C02", "C", "C02LA", "C02L", "C02", "C", "C02AA", "C02A", "C02", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.52", "description": "Reserpine 0.25 mg tablet", "unit": "tablet" }, { "cost": "0.83", "description": "Reserpine 0.1 mg tablet", "unit": "tablet" } ]	[]	(−)-reserpine \| (3beta,16beta,17alpha,18beta,20alpha)-11,17-Dimethoxy-18-[(3,4,5-trimethoxybenzoyl)oxy]yohimban-16-carboxylic acid methyl ester \| 3,4,5-trimethoxybenzoyl methyl reserpate \| Reserpin \| Reserpine \| Solute carrier family 18 member 2 \| SVMT \| VAT2 \| Vesicular amine transporter 2 \| Vesicular monoamine transporter 2 \| VMAT2 \| Solute carrier family 18 member 1 \| VAT1 \| Vesicular amine transporter 1 \| VMAT1 \| API4 \| Apoptosis inhibitor 4 \| Apoptosis inhibitor survivin \| IAP4 \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| hOCT1 \| OCT1 \| Organic cation transporter 1 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2 \| hOCT2 \| OCT2 \| Organic cation transporter 2 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9	[ "Diupres", "Diupres", "Hydropres 25 Tab", "Hydropres 50 Tab", "Novo-reserpine Tab 0.25mg", "Renese-R", "Reserpine", "Reserpine", "Reserpine", "Reserpine", "Ser-Ap-Es", "Ser-AP-ES Tab", "Serpasil 0.25mg" ]	[ "Apoplon", "Hiserpia", "Novoreserpine", "Reserfia", "Serpalan", "Serpanray", "Serpasil" ]	[ "Diupres", "Diupres", "Renese-R", "Ser-Ap-Es", "Ser-AP-ES Tab", "Hydropres 25 Tab", "Hydropres 50 Tab" ]	[ "Q05940", "P54219", "O15392" ]	[ "P20815" ]	[]	[ "P08183", "O15245", "O95342", "Q92887", "O15244", "Q9Y6L6", "O94956" ]
DB00208	Ticlopidine	Ticlopidine is an effective inhibitor of platelet aggregation. It is a prodrug that is metabolised to an active form, which blocks the ADP receptor that is involved in GPIIb/IIIa receptor activation leading to platelet aggregation. Ticlopidine is marketed under the brand name Ticlid and is indicated for patients who cannot take aspirin or in whom aspirin has not worked to prevent a thrombotic stroke. The FDA label includes a black-box warning of neutropenia, aplastic anemia, thrombotic thrombocytopenia purpura, and agranulocytosis, so it is necessary to monitor patients' WBC and platelets when they are taking ticlopidine.	solid	Used in patients, who have had a stroke or stroke precursors and who cannot take aspirin or aspirin has not worked, to try to prevent another thrombotic stroke.	Ticlopidine is a prodrug that is metabolised to an as yet undetermined metabolite that acts as a platelet aggregation inhibitor. Inhibition of platelet aggregation causes a prolongation of bleeding time. In its prodrug form, ticlopidine has no significant in vitro activity at the concentrations attained in vivo.	The active metabolite of ticlopidine prevents binding of adenosine diphosphate (ADP) to its platelet receptor, impairing the ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. It is proposed that the inhibition involves a defect in the mobilization from the storage sites of the platelet granules to the outer membrane. No direct interference occurs with the GPIIb/IIIa receptor. As the glycoprotein GPIIb/IIIa complex is the major receptor for fibrinogen, its impaired activation prevents fibrinogen binding to platelets and inhibits platelet aggregation. By blocking the amplification of platelet activation by released ADP, platelet aggregation induced by agonists other than ADP is also inhibited by the active metabolite of ticlopidine.	Absorption is greater than 80%. Food increases absorption by approximately 20%.	Ticlopidine is metabolized extensively by the liver with only trace amounts of intact drug detected. At least 20 metabolites have been identified.	Single oral doses of ticlopidine at 1600 mg/kg and 500 mg/kg were lethal to rats and mice, respectively. Symptoms of acute toxicity were GI hemorrhage, convulsions, hypothermia, dyspnea, loss of equilibrium and abnormal gait. The FDA label includes a black-box warning of neutropenia, aplastic anemia, thrombotic thrombocytopenia purpura, and agranulocytosis, so it is necessary to monitor patients' WBC and platelets when they are taking ticlopidine.	Half-life following a single 250-mg dose is approximately 7.9 hours in subjects 20 to 43 years of age and 12.6 hours in subjects 65 to 76 years of age. With repeated dosing (250 mg twice a day), half-life is about 4 days in subjects 20 to 43 years of age and about 5 days in subjects 65 to 76 years of age.	Binds reversibly (98%) to plasma proteins, mainly to serum albumin and lipoproteins. The binding to albumin and lipoproteins is nonsaturable over a wide concentration range. Ticlopidine also binds to alpha-1 acid glycoprotein (about 15% or less).	Ticlopidine is eliminated mostly in the urine (60%) and somewhat in the feces (23%).	The volume of distribution was not quantified.	Ticlopidine clearance was not quantified, but clearance decreases with age.	Organic compounds	Organoheterocyclic compounds	Thienopyridines	null	[ "approved" ]	[ "B01AC", "B01A", "B01", "B" ]	[ "Humans and other mammals" ]	[ { "cost": "1.86", "description": "Ticlopidine 250 mg tablet", "unit": "tablet" }, { "cost": "2.1", "description": "Ticlopidine HCl 250 mg tablet", "unit": "tablet" }, { "cost": "2.61", "description": "Ticlid 250 mg tablet", "unit": "tablet" }, { "cost": "87.36", "description": "Ticlid 30 250 mg tablet Bottle", "unit": "bottle" }, { "cost": "0.72", "description": "Apo-Ticlopidine 250 mg Tablet", "unit": "tablet" }, { "cost": "0.72", "description": "Mylan-Ticlopidine 250 mg Tablet", "unit": "tablet" }, { "cost": "0.72", "description": "Novo-Ticlopidine 250 mg Tablet", "unit": "tablet" }, { "cost": "0.72", "description": "Nu-Ticlopidine 250 mg Tablet", "unit": "tablet" }, { "cost": "0.72", "description": "Sandoz Ticlopidine 250 mg Tablet", "unit": "tablet" }, { "cost": "0.72", "description": "Ticlopidine 250 mg Tablet", "unit": "tablet" } ]	[]	Ticlopidina \| Ticlopidine \| Ticlopidinum \| PAF-R \| PAFR \| ADP-glucose receptor \| ADPG-R \| HORK3 \| P2T(AC) \| P2Y(AC) \| P2Y(ADP) \| P2Y(cyc) \| P2Y12 \| P2Y12 platelet ADP receptor \| SP1999 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.11.2.2 \| MPO \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J	[ "Alti-ticlopidine - Tab 250mg", "Dom-ticlopidine", "Mylan-ticlopidine", "PMS-ticlopidine", "Sandoz Ticlopidine", "Teva-ticlopidine", "Ticlid", "Ticlid", "Ticlid 250mg Tablets", "Ticlid Tab 250mg", "Ticlopidine", "Ticlopidine", "Ticlopidine", "Ticlopidine Hydrochloride", "Ticlopidine Hydrochloride", "Ticlopidine Hydrochloride", "Ticlopidine Hydrochloride", "Ticlopidine Hydrochloride", "Ticlopidine hydrochloride", "Ticlopidine Hydrochloride", "Ticlopidine-250" ]	[]	[]	[ "P25105", "Q9H244" ]	[ "P33261", "P10635", "P05164", "P11712", "P10632", "P05177", "P20813", "P05181" ]	[]	[]
DB00209	Trospium	Trospium is an antispasmodic agent used to treat the symptoms of overactive bladder, a condition that causes the bladder muscles to contract uncontrollably.[L6208] An overactive bladder leads to an increased urge to urinate, frequent urination, and sometimes, loss of control over urination.[L6208] Trospium is manufactured by _Indevus Pharmaceutical Inc._ and was granted FDA approval in 2007.[L6211]	solid	Trospium is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.[L36823] It is also indicated in combination with [xanomeline] for the treatment of adult patients with schizophrenia.[L51629]	Trospium is an antispasmodic, antimuscarinic agent indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. According to receptor assays, it displays higher affinity towards muscarininc receptors compared to nicotinic receptors at therapeutic concentrations.	Trospium antagonizes the effect of acetylcholine on muscarinic receptors in cholinergically innervated organs. Its parasympatholytic action reduces the tonus of smooth muscle in the bladder.	The mean absolute bioavailability of an orally administered immediate-release dose of trospium is approximately 9.6%.[L36823]	Trospium is likely metabolized via ester hydrolysis and glucuronic acid conjugation, although its metabolic fate has not been fully characterized.[L51629]	Overdosage with trospium is likely to result in anticholinergic adverse effects, which may include delirium, agitation, garbled speech, dizziness, hypertension, tachycardia, dry mouth, dry eyes, ileus, blurred vision, and urinary retention.[L51629]	The half-life of trospium in patients receiving the extended-release formulation is approximately 35 hours,[L36823] whereas the half-life of immediate-release trospium is approximately 6 hours.[L51629]	Trospium is approximately 80% protein bound in plasma.[L51629]	After administration of oral 14C-trospium chloride, the majority of the dose (85.2%) was recovered in feces and a smaller amount (5.8% of the dose) was recovered in urine; 60% of the radioactivity excreted in urine was unchanged trospium. Trospium mainly undergoes elimination via active tubular secretion, as indicated by the mean renal clearance of 29.07 L/hour, which is about 4-fold higher than average glomerular filtration rate. Trospium is metabolized by ester hydrolysis and excreted by the kidneys by a combination of tubular secretion and glomerular filtration.	The volume of distribution of orally administered trospium is approximately 531 liters.[L51629]	The total apparent clearance of trospium is 796 L/hour.[L51629] The renal clearance of trospium is 21 L/hour.[L51629]	Organic compounds	Benzenoids	Benzene and substituted derivatives	Diphenylmethanes	[ "approved" ]	[ "A03DA", "A03D", "A03", "A", "G04BD", "G04B", "G04", "G" ]	[ "Humans" ]	[ { "cost": "3.12", "description": "Sanctura 20 mg tablet", "unit": "tablet" }, { "cost": "5.02", "description": "Sanctura xr 60 mg capsule", "unit": "capsule" }, { "cost": "5.17", "description": "Sanctura XR 60 mg 24 Hour Capsule", "unit": "capsule" } ]	[ { "approved": "2010-01-19", "country": "Canada", "expires": "2024-11-04", "number": "2537103" }, { "approved": "2010-07-20", "country": "United States", "expires": "2024-11-04", "number": "7759359" }, { "approved": "2010-07-27", "country": "United States", "expires": "2024-11-04", "number": "7763635" }, { "approved": "2010-08-24", "country": "United States", "expires": "2024-11-04", "number": "7781448" }, { "approved": "2010-08-24", "country": "United States", "expires": "2024-11-04", "number": "7781449" }, { "approved": "2008-08-12", "country": "United States", "expires": "2025-02-01", "number": "7410978" }, { "approved": "2019-09-27", "country": "United States", "expires": "2039-09-27", "number": "11890378" }, { "approved": "2019-09-27", "country": "United States", "expires": "2039-09-27", "number": "11471413" }, { "approved": "2019-09-27", "country": "United States", "expires": "2039-09-27", "number": "11452692" }, { "approved": "2019-09-27", "country": "United States", "expires": "2039-09-27", "number": "10933020" }, { "approved": "2010-07-21", "country": "United States", "expires": "2030-07-21", "number": "10695339" }, { "approved": "2010-07-21", "country": "United States", "expires": "2030-07-21", "number": "10369144" }, { "approved": "2010-07-21", "country": "United States", "expires": "2030-07-21", "number": "10369143" }, { "approved": "2010-07-21", "country": "United States", "expires": "2030-07-21", "number": "10265311" }, { "approved": "2010-07-21", "country": "United States", "expires": "2030-07-21", "number": "10238643" }, { "approved": "2019-09-27", "country": "United States", "expires": "2039-09-27", "number": "10925832" } ]	1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase	[ "Accel-trospium", "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy", "Jamp Trospium", "Mar-trospium", "Sanctura", "Sanctura XR", "Sanctura XR", "Sanctura XR", "Sanctura XR", "Trosec", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride", "Trospium Chloride ER", "Trospium Chloride ER", "Trospium Chloride ER", "Trospium Chloride ER" ]	[ "Flotros", "Regurin", "Spasmex", "Spasmolyt", "Spasmoplex", "Tropez OD" ]	[ "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy", "Cobenfy" ]	[ "P08912", "P20309", "P11229" ]	[ "P10635" ]	[]	[]
DB00210	Adapalene	Acne vulgaris is a multifactorial disorder of the pilosebaceous unit involving increased sebum production, inflammation, and hyperproliferation/hyperkeratinization of the follicular infundibulum. It is also associated with _Cutibacterium acnes_ (also known as _Propionibacterium acnes_). Adapalene is a third-generation topical retinoid used for the treatment of acne vulgaris.[A193518] Adapalene has similar efficacy but a superior safety profile compared to tretinoin.[A193521] [Tazarotene] is more efficacious than adapalene but is designated as pregnancy category X and hence is contraindicated in pregnant women.[A193518] Adapalene can also be combined with benzoyl peroxide (BPO), which possesses bactericidal properties[A193524], and either adapalene alone, or adapalene BPO combination products, are commonly used to treat mild-to-severe acne.[A193518] Differin®, produced by Galderma Labs, was first granted FDA approval on May 31st, 1996, as a 0.1% adapalene topical solution. Differin was later made available as 0.1% gel, cream, or lotion, or 0.3% gel products. On December 8th, 2008, Galderma Labs gained FDA approval for Epiduo®, a 0.1% adapalene, 2.5% BPO combination gel.[L12873]	solid	Adapalene is indicated for the topical treatment of acne vulgaris in patients aged 12 and over.[L12873] It is also indicated for acne vulgaris in combination with [benzoyl peroxide][L12930] and in a triple combination therapy with benzoyl peroxide and [clindamycin].[L48666]	Adapalene is anticomedogenic, preventing the formation of new comedones and inflammatory lesions, and also acts to reduce inflammation by modulating the innate immune response.[A193512] Like other retinoid compounds, adapalene is chemically stable but photosensitive; use with sunscreen is recommended. Minor skin irritations, including erythema, scaling, dryness, and stinging/burning, have been reported.[L12873]	Adapalene is used for the treatment/maintenance of mild-to-severe acne (acne vulgaris). Acne is a multifactorial condition, and evidence exists to support multiple mechanisms of action for adapalene. Adapalene binds to retinoic acid receptor (RAR)-beta and RAR-gamma; this complex subsequently binds to one of three retinoid X receptors (RXRs), which as a complex is capable of binding DNA to modulate transcriptional activity.[A193509] Although the full extent of transcriptional modulation is not described, retinoid activation is generally known to affect cellular proliferation and differentiation[A193527], and adapalene has been shown to inhibit HeLa cell proliferation and human keratinocyte differentiation.[A193515] These effects primarily account for adapalene's comedolytic and anticomedogenic properties. In addition, adapalene modulates the immune response by down-regulating toll-like receptor 2 (TLR-2) expression and inhibiting the transcription factor activator protein 1 (AP-1). TLR-2 recognizes _Cutibacterium acnes_ (formerly _Propionibacterium acnes_), the bacterium primarily associated with acne. TLR-2 activation causes nuclear translocation of AP-1 and downstream pro-inflammatory gene regulation. Therefore, adapalene has a general anti-inflammatory effect, which reduces inflammation-mediated acne symptoms.[A193512] When used with benzoyl peroxide, which possesses free radical-mediated bactericidal effects, the combination acts synergistically to reduced comedones and inflammatory lesions.[A193512]	Adapalene is applied topically and absorbed through the skin. In one clinical study treating patients once per day with 2g of 0.3% gel applied to 2 mg/cm<sup>2</sup> of skin, 15 patients had detectable blood plasma adapalene levels (0.1 ng/ml) resulting in a mean C<sub>max</sub> of 0.553 ± 0.466 ng/ml and a mean AUC of 8.37 ± 8.46 ng\*h/ml on day 10.[L12873]	Extensive information regarding adapalene metabolism in humans is unavailable, although it is known to accumulate in the liver and GI-tract. In human, mouse, rat, rabbit, and dog cultured hepatocytes, metabolism appears to affect the methoxybenzene moiety but remains incompletely characterized. The major products of metabolism are glucuronides. Approximately 25% of the drug is metabolized; the rest is excreted as parent drug.[L12897]	Toxicity information regarding adapalene is not readily available. Patients experiencing an overdose are at an increased risk of severe adverse effects such as redness, scaling, and skin discomfort. Symptomatic and supportive measures are recommended.[L12873] Adapalene has an acute oral LD<sub>50</sub> in S-D rats and CD-1 mice of over 5000 mg/kg. The LD<sub>50</sub> of 0.3% applied topically to Credo OF1 mice is over 10 ml/kg (30 mg/kg). No systemic or local toxicity was observed in rats treated topically with 6 mg/kg/day of 0.3% adapalene.[L12897]	In one clinical study, after ten days of treatment with 2g of 0.3% cream or gel, the terminal half-life was between 7 and 51 hours, with a mean of 17.2 ± 10.2.[L12873]	null	Adapalene is primarily excreted by the biliary route at about 30 ng/g of the topically applied amount. Approximately 75% of the drug remains unchanged.[A193509]	null	Adapalene is rapidly cleared from blood plasma, typically undetectable after 72 hours following topical application.[L12873]	Organic compounds	Lipids and lipid-like molecules	Prenol lipids	Retinoids	[ "approved" ]	[ "D10AD", "D10A", "D10", "D", "D10AD", "D10A", "D10", "D" ]	[ "Humans and other mammals" ]	[ { "cost": "4.85", "description": "Differin 0.1% cream", "unit": "g" }, { "cost": "219.65", "description": "Differin 0.3% Gel 45 gm Tube", "unit": "tube" }, { "cost": "227.13", "description": "Differin 0.1% Cream 45 gm Tube", "unit": "tube" }, { "cost": "227.13", "description": "Differin 0.1% Gel 45 gm Tube", "unit": "tube" } ]	[ { "approved": "1988-01-05", "country": "United States", "expires": "2010-05-31", "number": "4717720" }, { "approved": "2014-12-09", "country": "United States", "expires": "2022-12-23", "number": "8909305" }, { "approved": "2009-08-25", "country": "United States", "expires": "2025-02-23", "number": "7579377" }, { "approved": "2010-11-16", "country": "United States", "expires": "2023-03-12", "number": "7834060" }, { "approved": "2011-01-11", "country": "United States", "expires": "2023-03-12", "number": "7868044" }, { "approved": "2014-04-22", "country": "United States", "expires": "2023-03-12", "number": "8703820" }, { "approved": "2010-11-23", "country": "United States", "expires": "2023-03-12", "number": "7838558" }, { "approved": "2010-06-15", "country": "United States", "expires": "2024-08-29", "number": "7737181" }, { "approved": "2011-06-21", "country": "United States", "expires": "2024-09-01", "number": "7964202" }, { "approved": "2011-12-06", "country": "United States", "expires": "2027-07-18", "number": "8071644" }, { "approved": "2011-12-20", "country": "United States", "expires": "2027-07-18", "number": "8080537" }, { "approved": "2012-01-31", "country": "United States", "expires": "2022-12-23", "number": "8105618" }, { "approved": "2012-03-06", "country": "United States", "expires": "2027-07-18", "number": "8129362" }, { "approved": "2013-05-21", "country": "United States", "expires": "2027-07-12", "number": "8445543" }, { "approved": "2014-08-19", "country": "United States", "expires": "2022-12-23", "number": "8809305" }, { "approved": "2015-01-20", "country": "United States", "expires": "2022-12-23", "number": "8936800" }, { "approved": "2012-08-14", "country": "United States", "expires": "2022-12-23", "number": "8241649" }, { "approved": "2010-10-26", "country": "United States", "expires": "2025-11-23", "number": "7820186" }, { "approved": "2011-08-16", "country": "United States", "expires": "2028-05-31", "number": "7998467" }, { "approved": "2013-05-07", "country": "United States", "expires": "2026-09-15", "number": "8435502" }, { "approved": "2014-04-29", "country": "United States", "expires": "2026-09-15", "number": "8709392" }, { "approved": "2014-07-22", "country": "United States", "expires": "2022-12-23", "number": "8785420" }, { "approved": "2014-05-20", "country": "United States", "expires": "2023-03-12", "number": "8729127" }, { "approved": "2016-07-05", "country": "United States", "expires": "2023-03-12", "number": "9381179" }, { "approved": "2016-07-12", "country": "United States", "expires": "2023-03-12", "number": "9387187" }, { "approved": "2017-11-14", "country": "United States", "expires": "2022-12-23", "number": "9814690" }, { "approved": "2012-10-16", "country": "United States", "expires": "2029-08-05", "number": "8288434" }, { "approved": "2017-02-07", "country": "United States", "expires": "2029-06-03", "number": "9561208" }, { "approved": "2019-03-05", "country": "United States", "expires": "2029-06-03", "number": "10220049" }, { "approved": "2020-04-21", "country": "United States", "expires": "2029-06-03", "number": "10624918" }, { "approved": "2020-12-28", "country": "United States", "expires": "2040-12-28", "number": "11389467" } ]	6-(3-(1-Adamantyl)-4-methoxyphenyl)-2-naphthoic acid \| Adapalene \| Adapalène \| Adapaleno \| Adapalenum \| HAP \| HBV-activated protein \| NR1B2 \| Nuclear receptor subfamily 1 group B member 2 \| RAR-beta \| RAR-epsilon \| NR1B3 \| Nuclear receptor subfamily 1 group B member 3 \| RAR-gamma \| NR2B2 \| Nuclear receptor subfamily 2 group B member 2 \| Retinoid X receptor beta \| NR2B3 \| Nuclear receptor subfamily 2 group B member 3 \| Retinoid X receptor gamma \| NR2B1 \| Nuclear receptor subfamily 2 group B member 1 \| Retinoid X receptor alpha \| Activator protein 1 \| AP1 \| p39 \| Proto-oncogene c-Jun \| Transcription factor AP-1 subunit Jun \| V-jun avian sarcoma virus 17 oncogene homolog \| TIL4 \| Toll/interleukin-1 receptor-like protein 4 \| NR1B1 \| Nuclear receptor subfamily 1 group B member 1 \| RAR-alpha \| 2.6.1.1 \| 2.6.1.3 \| cAspAT \| cCAT \| Cysteine aminotransferase, cytoplasmic \| Cysteine transaminase, cytoplasmic \| Glutamate oxaloacetate transaminase 1 \| Transaminase A	[ "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene", "Adapalene 0.1% / Benzoyl Peroxide 2.5% / Clindamycin 1%", "Adapalene 0.1% / Benzoyl Peroxide 2.5% / Niacinamide 4%", "Adapalene 0.3% / Benzoyl Peroxide 2.5% / Clindamycin 1%", "Adapalene 0.3% / Benzoyl Peroxide 2.5% / Niacinamide 4%", "Adapalene 0.3% / Niacinamide 4%", "Adapalene and Benzoyl Peroxide", "ADAPALENE and BENZOYL PEROXIDE", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and benzoyl peroxide", "Adapalene and benzoyl peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and benzoyl peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide 0.1%/2.5% Gel Pad", "Adapalene and Benzoyl Peroxide Gel, 0.1%/2.5%", "Adapalene and Benzoyl Peroxide Gel, 0.1%/2.5%", "Adapalene and Benzoyl Peroxide Gel, 0.1%/2.5%", "Adapalene and Benzoyl Peroxide Swab", "Adapalene Gel", "Adapalene Gel 0.1%", "Adapalene Gel USP, 0.3%", "Adapalene Gel USP, 0.3%", "Adapalene Gel USP, 0.3%", "Adapalene Topical Solution", "Adapalene Topical Solution", "Adapalene Topical Solution", "Cabtreo", "Cabtreo", "Clindap-T", "Curist Acne Relief", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin", "Differin Xp", "Effaclar", "Epiduo", "Epiduo", "Epiduo Forte", "Neutrogena Adapalene 0.1% Acne Treatment", "Nuvya", "PanOxyl", "Proactiv MD Adapalene Acne Treatment", "Proactiv MD Adapalene Acne Treatment", "Sandoz Adapalene / Benzoyl Peroxide", "Sandoz Adapalene / Benzoyl Peroxide Forte", "Tactupump", "Tactupump Forte", "Taro-adapalene/benzoyl Peroxide", "Taro-adapalene/benzoyl Peroxide Forte" ]	[ "Adaferin", "Differine" ]	[ "Epiduo", "Clindap-T", "Nuvya", "Adapalene and Benzoyl Peroxide", "ADAPALENE and BENZOYL PEROXIDE", "Epiduo", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene 0.3% / Niacinamide 4%", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Epiduo Forte", "Adapalene and Benzoyl Peroxide", "Adapalene 0.3% / Benzoyl Peroxide 2.5% / Niacinamide 4%", "Adapalene 0.1% / Benzoyl Peroxide 2.5% / Niacinamide 4%", "Adapalene 0.3% / Benzoyl Peroxide 2.5% / Clindamycin 1%", "Adapalene 0.1% / Benzoyl Peroxide 2.5% / Clindamycin 1%", "Adapalene and Benzoyl Peroxide Swab", "Adapalene and Benzoyl Peroxide", "Tactupump", "Tactupump Forte", "Sandoz Adapalene / Benzoyl Peroxide", "Taro-adapalene/benzoyl Peroxide", "Sandoz Adapalene / Benzoyl Peroxide Forte", "Taro-adapalene/benzoyl Peroxide Forte", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and benzoyl peroxide", "Adapalene and benzoyl peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide 0.1%/2.5% Gel Pad", "Adapalene and benzoyl peroxide", "Adapalene and Benzoyl Peroxide Gel, 0.1%/2.5%", "Cabtreo", "Adapalene and Benzoyl Peroxide Gel, 0.1%/2.5%", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide", "Adapalene and Benzoyl Peroxide Gel, 0.1%/2.5%", "Cabtreo" ]	[ "P10826", "P13631", "P28702", "P48443", "P19793", "P05412", "O60603", "P10276", "P17174" ]	[]	[]	[]
DB00211	Midodrine	An ethanolamine derivative that is an adrenergic alpha agonist. It is used as a vasoconstrictor agent in the treatment of hypotension.	solid	For the treatment of symptomatic orthostatic hypotension (OH).	Midodrine is a prodrug, i.e., the therapeutic effect of orally administered midodrine is due to the major metabolite desglymidodrine formed by deglycination of midodrine. Administration of midodrine results in a rise in standing, sitting, and supine systolic and diastolic blood pressure in patients with orthostatic hypotension of various etiologies. Standing systolic blood pressure is elevated by approximately 15 to 30 mmHg at 1 hour after a 10-mg dose of midodrine, with some effect persisting for 2 to 3 hours. Midodrine has no clinically significant effect on standing or supine pulse rates in patients with autonomic failure.	Midodrine undergoes metabolism to form its pharmacologically active metabolite, desglymidodrine. Desglymidodrine acts as an agonist at the alpha<sub>1</sub>-adrenergic receptors expressed in the arteriolar and venous vasculature. Activation of alpha<sub>1</sub>-adrenergic receptor signaling pathways lead to an increase in the vascular tone and elevation of blood pressure. Desglymidodrine is reported to have negligible effect on the cardiac beta-adrenergic receptors.	Rapidly absorbed following oral administration. The peak plasma concentrations of the prodrug, desglymidodrine, is reached about half an hour following drug administration. The metabolites reach their peak plasma concentrations at about 1 to 2 hours following drug administration. The absolute bioavailability of midodrine (measured as desglymidodrine) is 93% and is not affected by food. As desglymidodrine displays poor diffusibility across the blood-brain barrier, it is expected to have minimal effects on the central nervous system.	Thorough metabolic studies have not been conducted, but it appears that deglycination of midodrine to desglymidodrine takes place in many tissues, and both compounds are metabolized in part by the liver.	Symptoms of overdose could include hypertension, piloerection (goosebumps), a sensation of coldness and urinary retention. The single doses that would be associated with symptoms of overdosage or would be potentially life- threatening are unknown. The oral LD<sub>50</sub> is approximately 30 to 50 mg/kg in rats, 675 mg/kg in mice, and 125 to 160 mg/kg in dogs. Desglymidodrine is dialyzable.	The metabolites display a half-life of about 3 to 4 hours.	null	null	null	* Renal cl=385 mL/minute	Organic compounds	Benzenoids	Benzene and substituted derivatives	Methoxybenzenes	[ "approved" ]	[ "C01CA", "C01C", "C01", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.23", "description": "Midodrine hcl 2.5 mg tablet", "unit": "tablet" }, { "cost": "1.53", "description": "Proamatine 2.5 mg tablet", "unit": "tablet" }, { "cost": "2.47", "description": "Midodrine hcl 5 mg tablet", "unit": "tablet" }, { "cost": "3.08", "description": "Proamatine 5 mg tablet", "unit": "tablet" }, { "cost": "4.93", "description": "Midodrine hcl 10 mg tablet", "unit": "tablet" }, { "cost": "5.91", "description": "Proamatine 10 mg tablet", "unit": "tablet" }, { "cost": "0.35", "description": "Apo-Midodrine 2.5 mg Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Apo-Midodrine 5 mg Tablet", "unit": "tablet" } ]	[]	(±)-2-amino-N-(β-hydroxy-2,5-dimethoxyphenethyl)acetamide \| 1-(2',5'-Dimethoxyphenyl)-2-glycinamidoethanol \| 2-Amino-N-(2,5-dimethoxy-beta-hydroxyphenethyl)acetamide \| DL-N1-(beta-Hydroxy-2,5-dimethoxyphenethyl)glycinamid \| Midodrin \| Midodrina \| Midodrine \| Midodrinum \| ADRA1C \| Alpha-1A adrenoceptor \| Alpha-1A adrenoreceptor \| Alpha-1C adrenergic receptor \| Alpha-adrenergic receptor 1c \| Alpha-1B adrenoceptor \| Alpha-1B adrenoreceptor \| ADRA1A \| Alpha-1A adrenergic receptor \| Alpha-1D adrenoceptor \| Alpha-1D adrenoreceptor \| Alpha-adrenergic receptor 1a \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| Intestinal H(+)/peptide cotransporter \| Oligopeptide transporter, small intestine isoform \| PEPT1 \| Peptide transporter 1	[ "Amatine", "Amatine", "Apo-midodrine", "Apo-midodrine", "Jamp Midodrine", "Jamp Midodrine", "M-midodrine", "M-midodrine", "Mar-midodrine", "Mar-midodrine", "Midodrine", "Midodrine", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine HCl", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine hydrochloride", "Midodrine hydrochloride", "Midodrine hydrochloride", "Midodrine hydrochloride", "Midodrine hydrochloride", "Midodrine hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "Midodrine Hydrochloride", "ProAmatine", "ProAmatine", "ProAmatine", "ProAmatine" ]	[]	[]	[ "P35348", "P35368", "P25100" ]	[ "P10635" ]	[]	[ "P46059" ]
DB00212	Remikiren	Remikiren is an orally active, high specificity renin inhibitor.	solid	For the treatment of hypertension and heart failure	Remikiren is an orally available renin inhibitor with an established blood pressure-lowering effect in patients with essential hypertension. No data are available on the renal effects of remikiren in humans. In patients with essential hypertension, a single oral dose of remikiren can induce a renal vasodilation, without affecting the GFR and despite a significant decrease in blood pressure. This systemic and renal hemodynamic response is more pronounced in case of a more activated renin-angiotensin system.	Several in vivo experiments have shown that remikiren is specific for renin and does not decrease arterial pressure by an unrelated mechanism.	Absorbed following oral administration.	null	null	null	83%	null	null	null	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "experimental" ]	[ "C09XA", "C09X", "C09", "C" ]	[ "Humans and other mammals" ]	[]	[]	Remikiren \| 3.4.23.15 \| Angiotensinogenase	[]	[]	[]	[ "P00797" ]	[]	[]	[]
DB00213	Pantoprazole	Pantoprazole is a first-generation proton pump inhibitor (PPI) used for the management of gastroesophageal reflux disease (GERD), for gastric protection to prevent recurrence of stomach ulcers or gastric damage from chronic use of NSAIDs, and for the treatment of pathological hypersecretory conditions including Zollinger-Ellison (ZE) Syndrome. It can also be found in quadruple regimens for the treatment of _H. pylori_ infections along with other antibiotics including [amoxicillin], [clarithromycin], and [metronidazole], for example.[A177271][F4498] Its efficacy is considered similar to other medications within the PPI class including [omeprazole], [esomeprazole], [lansoprazole], [dexlansoprazole], and [rabeprazole]. Pantoprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cell. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. As the binding of pantoprazole to the (H+, K+)-ATPase enzyme is irreversible and new enzyme needs to be expressed in order to resume acid secretion, pantoprazole's duration of antisecretory effect persists longer than 24 hours.[FDA Label] Due to their good safety profile and as several PPIs are available over the counter without a prescription, their current use in North America is widespread. Long term use of PPIs such as pantoprazole have been associated with possible adverse effects, however, including increased susceptibility to bacterial infections (including gastrointestinal _C. difficile_), reduced absorption of micronutrients including iron and B12, and an increased risk of developing hypomagnesemia and hypocalcemia which may contribute to osteoporosis and bone fractures later in life.[A177571] PPIs such as pantoprazole have also been shown to inhibit the activity of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme necessary for cardiovascular health. DDAH inhibition causes a consequent accumulation of the nitric oxide synthase inhibitor asymmetric dimethylarginie (ADMA), which is thought to cause the association of PPIs with increased risk of cardiovascular events in patients with unstable coronary syndromes.[A177577, A177580] Pantoprazole doses should be slowly lowered, or tapered, before discontinuing as rapid discontinuation of PPIs such as pantoprazole may cause a rebound effect and a short term increase in hypersecretion.[A177574]	solid	Pantoprazole Injection: Treatment of gastroesophageal reflux disease associated with a history of erosive esophagitis Pantoprazole for injection is indicated for short-term treatment (7-10 days) of patients having gastroesophageal reflux disease (GERD) with a history of erosive esophagitis, as an alternative to oral medication in patients who are unable to continue taking pantoprazole delayed-release tablets. _Safety and efficacy of pantoprazole injection as the initial treatment of patients having GERD with a history of erosive esophagitis have not been demonstrated at this time_.[FDA label] Pathological Hypersecretion Associated with Zollinger-Ellison Syndrome Pantoprazole for injection is indicated for the treatment of pathological hypersecretory conditions associated with Zollinger-Ellison Syndrome or other neoplastic conditions.[FDA label] Pantoprazole delayed-release oral suspension: Short-Term Treatment of erosive esophagitis associated with gastroesophageal reflux disease (GERD) Indicated in adults and pediatric patients five years of age and above for the short-term treatment (up to 8 weeks) in the healing and symptomatic relief of erosive esophagitis. For adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of pantoprazole may be considered. Safety of treatment beyond 8 weeks in pediatric patients has not been determined.[F3202] Maintenance of healing of erosive esophagitis Indicated for maintenance of healing of erosive esophagitis and reduction in relapse rates of daytime and nighttime heartburn symptoms in adult patients with GERD.[F3202] Pathological hypersecretory conditions including Zollinger-Ellison syndrome Indicated for the long-term treatment of the above conditions.[F3202]	This drug acts to decrease gastric acid secretion, which reduces stomach acidity. Pantoprazole administration leads to long-lasting inhibition of gastric acid secretion.[F3193] General Effects Pantoprazole has been shown to reduce acid reflux-related symptoms, heal inflammation of the esophagus, and improve patient quality of life more effectively than histamine-2 receptor antagonists (H2 blockers). This drug has an excellent safety profile and a low incidence of drug interactions. It can be used safely in various high-risk patient populations, including the elderly and those with renal failure or moderate hepatic dysfunction.[A174226] Due to their good safety profile and as several PPIs are available over the counter without a prescription, their current use in North America is widespread. Long term use of PPIs such as pantoprazole have been associated with possible adverse effects, however, including increased susceptibility to bacterial infections (including gastrointestinal _C. difficile_), reduced absorption of micronutrients including iron and B12, and an increased risk of developing hypomagnesemia and hypocalcemia which may contribute to osteoporosis and bone fractures later in life.[A177571] PPIs such as pantoprazole have also been shown to inhibit the activity of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme necessary for cardiovascular health. DDAH inhibition causes a consequent accumulation of the nitric oxide synthase inhibitor asymmetric dimethylarginie (ADMA), which is thought to cause the association of PPIs with increased risk of cardiovascular events in patients with unstable coronary syndromes [A177577, A177580]. A note on laboratory testing abnormalities During treatment with antisecretory medicinal products such as pantoprazole, serum gastrin (a peptide hormone that stimulates secretion of gastric acid) increases in response to the decreased acid secretion caused by proton pump inhibition. The increased gastrin level may interfere with investigations for neuroendocrine tumors. Published evidence suggests that proton pump inhibitors should be stopped 14 days before chromogranin A (CgA) measurements. This permits chromogranin A levels, that might be falsely elevated after proton pump inhibitor treatment, to return to the normal reference range.[F3217] Reports have been made of false-positive results in urine screening tests for tetrahydrocannabinol (THC) in patients receiving the majority of proton pump inhibitors, including pantoprazole. A confirmatory method should be used.[F3217]	Hydrochloric acid (HCl) secretion into the gastric lumen is a process regulated mainly by the H(+)/K(+)-ATPase of the proton pump, expressed in high quantities by the parietal cells of the stomach.[A174295] ATPase is an enzyme on the parietal cell membrane that facilitates hydrogen and potassium exchange through the cell, which normally results in the extrusion of potassium and formation of HCl (gastric acid). Proton pump inhibitors such as pantoprazole are substituted _benzimidazole_ derivatives, weak bases, which accumulate in the acidic space of the parietal cell before being converted in the _canaliculi_ (small canal) of the gastric parietal cell, an acidic environment, to active _sulfenamide_ derivatives. This active form then makes disulfide bonds with important cysteines on the gastric acid pump, inhibiting its function.[A174247] Specifically, pantoprazole binds to the _sulfhydryl group_ of H+, K+-ATPase, which is an enzyme implicated in accelerating the final step in the acid secretion pathway. The enzyme is inactivated, inhibiting gastric acid secretion.[A174253] The inhibition of gastric acid secretion is stronger with proton pump inhibitors such as pantoprazole and lasts longer than with the H(2) antagonists.[A174295]	Pantoprazole is absorbed after oral administration as an enteric-coated tablet with maximum plasma concentrations attained within 2 – 3 hours and a bioavailability of 77% that does not change with multiple dosing [A174247]. Following an oral dose of 40mg, the Cmax is approximately 2.5 μg/mL with a tmax of 2 to 3 hours. The AUC is approximately 5 μg.h/mL. There is no food effect on AUC (bioavailability) and Cmax.[F4486] Delayed-release tablets are prepared as enteric-coated tablets so that absorption of pantoprazole begins only after the tablet leaves the stomach.	Pantoprazole is heavily metabolized in the liver by the cytochrome P450 (CYP) system. Pantoprazole metabolism is independent of the route of administration (intravenous or oral). The main metabolic pathway is _demethylation_, by _CYP2C19_ hepatic cytochrome enzyme, followed by sulfation; other metabolic pathways include oxidation by CYP3A4. There is no evidence that any of the pantoprazole metabolites are pharmacologically active.[F3202] After hepatic metabolism, almost 80% of an oral or intravenous dose is excreted as metabolites in urine; the remainder is found in feces and originates from biliary secretion.[A174256]	Rat Oral LD 50 747 mg/kg[F3196] Tumorigenicity Because of the chronic nature of GERD, there may be a potential for long-term administration of pantoprazole. In long-term rodent studies, pantoprazole was carcinogenic and its administration lead to rare types of gastrointestinal tumors. The relevance of these findings to tumor development in humans is unknown at this time.[F3202] Teratogenic Effects This drug falls under pregnancy category B category. Reproduction studies have been performed in rats at oral doses up to 88 times the recommended human dose (RHD), as well as in rabbits at oral doses up to 16 times the RHD, and have shown no evidence of impaired fertility or harm to the fetus caused by pantoprazole. No adequate and well-controlled studies in pregnant women have been completed. Because animal reproduction studies are not always predictive of human response, this drug should only be used during pregnancy if clearly required.[F3202] Nursing Mothers Pantoprazole and its metabolites have been found to be excreted in the milk of rats. Pantoprazole excretion in human milk has been found in a study performed with a single nursing mother after one 40 mg oral dose. The clinical relevance of this finding is not known, however, it is advisable to take note of this finding when considering pantoprazole use during nursing. Many drugs excreted in human breastmilk have a risk for serious adverse effects in nursing infants.[F3202]	About 1 hour[F3202]	Approximately 98%[FDA label]	After a single oral or intravenous (IV) dose of 14C-labeled pantoprazole to healthy, normal metabolizing subjects, about 71% of the dose was excreted in the urine, with 18% excreted in the feces by biliary excretion. There was no kidney excretion of unchanged pantoprazole.[F3202]	The apparent volume of distribution of pantoprazole is approximately 11.0-23.6 L, distributing mainly in the extracellular fluid.[FDA label]	Adults: With intravenous administration of pantoprazole to extensive metabolizers, total clearance is 7.6-14.0 L/h.[F3193] In a population pharmacokinetic analysis, the total clearance increased with increasing body weight in a non-linear fashion.[F3193] Children: clearance values in the children 1 to 5 years old with endoscopically proven GERD had a median value of 2.4 L/h.[F3202]	Organic compounds	Organoheterocyclic compounds	Benzimidazoles	Sulfinylbenzimidazoles	[ "approved" ]	[ "A02BD", "A02B", "A02", "A", "A02BD", "A02B", "A02", "A", "A02BC", "A02B", "A02", "A" ]	[ "Humans and other mammals" ]	[ { "cost": "1.27", "description": "Apo-Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Co Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Mylan-Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Novo-Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Phl-Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Pms-Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Ran-Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Ratio-Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.27", "description": "Sandoz Pantoprazole 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "2.28", "description": "Pantoloc 40 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "3.93", "description": "Pantoprazole sod dr 20 mg tablet", "unit": "tablet" }, { "cost": "3.93", "description": "Pantoprazole sod dr 40 mg tablet", "unit": "tablet" }, { "cost": "4.26", "description": "Pantoprazole Sodium 20 mg Enteric Coated Tabs", "unit": "tab" }, { "cost": "4.26", "description": "Pantoprazole Sodium 40 mg Enteric Coated Tabs", "unit": "tab" }, { "cost": "5.22", "description": "Protonix dr 20 mg tablet", "unit": "tablet" }, { "cost": "5.22", "description": "Protonix dr 40 mg tablet", "unit": "tablet" }, { "cost": "5.43", "description": "Protonix 20 mg tablet", "unit": "tab" }, { "cost": "5.43", "description": "Protonix 40 mg Enteric Coated Tabs", "unit": "tab" }, { "cost": "8.91", "description": "Protonix 40 mg tablet dr", "unit": "tablet" }, { "cost": "14.4", "description": "Protonix iv 40 mg vial", "unit": "vial" } ]	[ { "approved": "1988-07-19", "country": "United States", "expires": "2010-07-19", "number": "4758579" }, { "approved": "2006-05-23", "country": "Canada", "expires": "2021-11-17", "number": "2428870" }, { "approved": "2005-04-05", "country": "Canada", "expires": "2011-09-06", "number": "2092694" }, { "approved": "2006-04-04", "country": "Canada", "expires": "2019-08-12", "number": "2341031" }, { "approved": "1999-12-07", "country": "United States", "expires": "2017-06-07", "number": "5997903" }, { "approved": "2014-06-17", "country": "United States", "expires": "2022-05-17", "number": "8754108" }, { "approved": "2004-08-24", "country": "United States", "expires": "2022-05-17", "number": "6780881" }, { "approved": "2008-04-01", "country": "United States", "expires": "2022-05-17", "number": "7351723" }, { "approved": "2009-06-23", "country": "United States", "expires": "2025-03-30", "number": "7550153" }, { "approved": "2009-06-30", "country": "United States", "expires": "2025-03-30", "number": "7553498" }, { "approved": "2010-11-23", "country": "United States", "expires": "2025-03-30", "number": "7838027" }, { "approved": "2009-06-09", "country": "United States", "expires": "2026-12-07", "number": "7544370" } ]	Pantoprazol \| Pantoprazole \| Pantoprazolum \| 7.2.2.19 \| Gastric H(+)/K(+) ATPase subunit alpha \| Proton pump \| Gastric H(+)/K(+) ATPase subunit beta \| Proton pump beta chain \| 3.5.3.18 \| DDAH \| DDAH-1 \| DDAHI \| Dimethylargininase-1 \| Dimethylarginine dimethylaminohydrolase 1 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| 7.6.2.2 \| ABCP \| ATP-binding cassette sub-family G member 2 \| BCRP \| BCRP1 \| Breast cancer resistance protein \| CDw338 \| Mitoxantrone resistance-associated protein \| MXR \| Placenta-specific ATP-binding cassette transporter \| Urate exporter \| hOAT3 \| OAT3 \| Organic anion/dicarboxylate exchanger \| Solute carrier family 22 member 8	[ "Abbott-pantoprazole", "Abbott-pantoprazole", "Act Pantoprazole", "Ag-pantoprazole", "Ag-pantoprazole", "Ag-pantoprazole Sodium", "Ag-pantoprazole Sodium", "Apo-pantoprazole", "Apo-pantoprazole", "Auro-pantoprazole", "Ava-pantoprazole", "Ava-pantoprazole", "Bio-pantoprazole", "Bio-pantoprazole", "Controloc Control", "Controloc Control", "Controloc Control", "Controloc Control", "Dom-pantoprazole", "Dom-pantoprazole", "Dom-pantoprazole", "Ipg-pantoprazole", "Ipg-pantoprazole", "Jamp Pantoprazole Sodium", "Jamp Pantoprazole Sodium", "Jamp-pantoprazole", "Jamp-pantoprazole", "M-pantoprazole", "M-pantoprazole", "Mar-pantoprazole", "Mar-pantoprazole", "Mint-pantoprazole", "Mint-pantoprazole", "Mylan-pantoprazole", "Mylan-pantoprazole T", "Nra-pantoprazole", "Nra-pantoprazole", "Ntp-pantoprazole", "Ntp-pantoprazole", "Pantecta Control", "Pantecta Control", "Pantecta Control", "Pantecta Control", "Panto IV", "Panto-byk", "Panto-byk", "Pantoloc", "Pantoloc", "Pantoloc Control", "Pantoloc Control", "Pantoloc Control", "Pantoloc Control", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole", "Pantoprazole for Injection", "Pantoprazole for Injection", "Pantoprazole for Injection", "Pantoprazole for Injection", "Pantoprazole Magnesium", "Pantoprazole Magnesium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole sodium", "Pantoprazole sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole sodium", "Pantoprazole sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole sodium", "Pantoprazole sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium", "Pantoprazole Sodium D/r", "Pantoprazole Sodium Delayed Release", "PANTOPRAZOLE SODIUM Delayed Release", "Pantoprazole Sodium Delayed Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole Sodium Delayed-Release", "Pantoprazole sodium delayed-release", "Pantoprazole sodium delayed-release", "Pantoprazole sodium delayed-release", "Pantoprazole Sodium Delayed-Release Delayed-Release", "Pantoprazole Sodium DR", "Pantoprazole Sodium Dr", "Pantoprazole Sodium Dr", "Pantoprazole Sodium DR", "Pantoprazole Sodium DR", "Pantoprazole Sodium DR", "Pantoprazole Sodium DR", "Pantoprazole Sodium DR", "Pantoprazole Sodium DR", "Pantoprazole Sodium DR", "Pantoprazole Sodium for Injection", "Pantoprazole Sodium for Injection", "Pantoprazole Sodium for Injection", "Pantoprazole Sodium for Injection", "Pantoprazole Sodium for Injection", "Pantoprazole Sodium I.V.", "Pantoprazole T", "Pantoprazole Tablets", "Pantozol Control", "Pantozol Control", "Pantozol Control", "Pantozol Control", "PHL-pantoprazole", "PMS-pantoprazole", "PMS-pantoprazole", "PMS-pantoprazole", "Protonix", "Protonix Delayed-release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix Delayed-Release", "Protonix I.V.", "Protonix I.V.", "Protonix I.V.", "Protonix I.V.", "Protonix I.V.", "Protonix I.V.", "Protonix I.V.", "Q-pantoprazole", "Ratio-pantoprazole", "Ratio-pantoprazole", "Rbx-pantoprazole", "Rbx-pantoprazole", "Riva-pantoprazole", "Riva-pantoprazole", "Sandoz Pantoprazole", "Sandoz Pantoprazole", "Somac Control", "Somac Control", "Somac Control", "Somac Control", "Taro-pantoprazole", "Taro-pantoprazole", "Tecta", "Teva-pantoprazole", "Teva-pantoprazole", "Teva-pantoprazole Magnesium", "Van-pantoprazole" ]	[ "Pantozol" ]	[]	[ "P20648", "P51164", "O94760" ]	[ "P33261", "P08684" ]	[]	[ "P08183", "Q9UNQ0", "Q8TCC7" ]
DB03128	Acetylcholine	A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications.	solid	Used to obtain miosis of the iris in seconds after delivery of the lens in cataract surgery, in penetrating keratoplasty, iridectomy and other anterior segment surgery where rapid miosis may be required.	null	null	null	null	null	null	null	null	null	null	Organic compounds	Organic nitrogen compounds	Organonitrogen compounds	Quaternary ammonium salts	[ "approved", "investigational" ]	[ "S01EB", "S01E", "S01", "S" ]	[]	[]	[ { "approved": "2001-07-17", "country": "United States", "expires": "2019-04-29", "number": "6261546" } ]	Acetylcholine \| ACh \| Choline acetate \| O-Acetylcholine \| NACHRA7 \| 3.1.1.7 \| AChE \| 3.1.1.8 \| Acylcholine acylhydrolase \| Butyrylcholine esterase \| CHE1 \| Choline esterase II \| Pseudocholinesterase \| High-affinity sodium-dependent carnitine cotransporter \| OCTN2 \| Solute carrier family 22 member 5 \| hOCT1 \| OCT1 \| Organic cation transporter 1	[ "Miochol E", "Miochol E", "Miochol E Acetylcholine Chloride Oph Soln", "Miochol-E", "Miogan Pws 20mg/vial" ]	[]	[ "Miochol E", "Miochol E", "Miochol-E", "Miogan Pws 20mg/vial", "Miochol E Acetylcholine Chloride Oph Soln" ]	[ "P11229", "P08172", "P20309", "P08173", "P36544" ]	[ "P22303", "P06276" ]	[]	[ "O76082", "O15245" ]
DB00214	Torasemide	Torasemide is a high-ceiling loop diuretic.[A174463] Structurally, it is a pyridine-sulfonylurea used as an antihypertensive agent.[A319] Torasemide was first approved for clinical use by the FDA in 1993.[L5257]	solid	Torasemide is indicated for the treatment of edema associated with congestive heart failure, renal or hepatic diseases. From this condition, it has been observed that torasemide is very effective in cases of kidney failure.[FDA label] As well, torasemide is approved to be used as an antihypertensive agent either alone or in combination with other antihypertensives.[FDA label]	It is widely known that administration of torasemide can attenuate renal injury and reduce the severity of acute renal failure. This effect is obtained by increasing urine output and hence, facilitating fluid, acid-base and potassium control.[A174466] This effect is obtained by the increase in the excretion of urinary sodium and chloride.[A174472] Several reports have indicated that torasemide presents a long-lasting diuresis and less potassium excretion which can be explained by the effect that torasemide has on the renin-angiotensin-aldosterone system. This effect is very similar to the effect observed with the administration of combination therapy with [furosemide] and [spironolactone] and it is characterized by a decrease in plasma brain natriuretic peptide and improved measurements of left ventricular function.[A174472] Above the aforementioned effect, torasemide presents a dual effect .in which the inhibition of aldosterone which donates torasemide with a potassium-sparing action.[A174466] Torasemide has been shown to reduce extracellular fluid volume and blood pressure in hypertensive patients suffering from chronic kidney disease. As well, some reports have indicated that torasemide can reduce myocardial fibrosis by reducing the collagen accumulation. This effect is suggested to be related to the decrease in aldosterone which in order has been shown to reduce the production of the enzyme procollagen type I carboxy-terminal proteinase which is known to be overexpressed in heart failure patients.[A174463]	As mentioned above, torasemide is part of the loop diuretics and thus, it acts by reducing the oxygen demand in the medullary thick ascending loop of Henle by inhibiting the Na+/K+/Cl- pump on the luminal cell membrane surface.[A174466] This action is obtained by the binding of torasemide to a chloride ion-binding site of the transport molecule.[L5257] Torasemide is known to have an effect in the renin-angiotensin-aldosterone system by inhibiting the downstream cascade after the activation of angiotensin II. This inhibition will produce a secondary effect marked by the reduction of the expression of aldosterone synthase, TGF-B1 and thromboxane A2 and a reduction on the aldosterone receptor binding.[A174466, A174472]	Torasemide is the diuretic with the highest oral bioavailability even in advanced stages of chronic kidney disease.[A174463] This bioavailability tends to be higher than 80% regardless of the patient condition. The maximal serum concentration is reported to be of 1 hour and the absorption parameters are not affected by its use concomitantly with food.[A174472]	Torasemide is extensively metabolized in the liver and only 20% of the dose remains unchanged and it is recovered in the urine.[A174475] Metabolized via the hepatic CYP2C8 and CYP2C9 mainly by reactions of hydroxylation, oxidation and reduction to 5 metabolites.[A174514] The major metabolite, M5, is pharmacologically inactive. There are 2 minor metabolites, M1, possessing one-tenth the activity of torasemide, and M3, equal in activity to torasemide. Overall, torasemide appears to account for 80% of the total diuretic activity, while metabolites M1 and M3 account for 9% and 11%, respectively.[A174508]	The oral LD50 of torasemide in the rat is 5 g/kg. When overdose occurs, there is a marked diuresis with the danger of loss of fluid and electrolytes which has been seen to lead to somnolence, confusion, hypotension, hyponatremia, hypokalemia, hypochloremic alkalosis, hemoconcentration dehydration and circulatory collapse. This effects can include some gastrointestinal disturbances.[L5260] There is no increase in tumor incidence with torasemide and it is proven to not be mutagenic, not fetotoxic or teratogenic.[FDA label]	The average half-life of torasemide is 3.5 hours.[A174472]	Torasemide is found to be highly bound to plasma proteins, representing over 99% of the administered dose.[A174475]	Torasemide is mainly hepatically processed and excreted in the feces from which about 70-80% of the administered dose is excreted by this pathway. On the other hand, about 20-30% of the administered dose is found in the urine.[L5257]	The volume of distribution of torasemide is 0.2 L/kg.[A174475]	The clearance rate of torasemide is considerably reduced by the presence of renal disorders.[A174475]	Organic compounds	Organoheterocyclic compounds	Pyridines and derivatives	Pyridinesulfonamides	[ "approved" ]	[ "C03CA", "C03C", "C03", "C", "G01AE", "G01A", "G01", "G" ]	[ "Humans and other mammals" ]	[ { "cost": "1.28", "description": "Demadex 5 mg tablet", "unit": "tablet" }, { "cost": "1.39", "description": "Demadex 10 mg tablet", "unit": "tablet" }, { "cost": "1.59", "description": "Demadex 20 mg tablet", "unit": "tablet" }, { "cost": "3.16", "description": "Torsemide 100 mg tablet", "unit": "tablet" }, { "cost": "5.69", "description": "Demadex 100 mg tablet", "unit": "tablet" }, { "cost": "0.66", "description": "Torsemide 5 mg tablet", "unit": "tablet" }, { "cost": "0.73", "description": "Torsemide 10 mg tablet", "unit": "tablet" }, { "cost": "0.85", "description": "Torsemide 20 mg tablet", "unit": "tablet" } ]	[ { "approved": "2018-12-18", "country": "United States", "expires": "2033-10-06", "number": "10154963" } ]	1-Isopropyl-3-((4-m-toluidino-3-pyridyl)sulfonyl)urea \| N-(((1-Methylethyl)amino)carbonyl)-4-((3-methylphenyl)amino)-3-pyridinesulfonamide \| Torasemida \| Torasemide \| Torasémide \| Torasemidum \| Torsemide \| Basolateral Na-K-Cl symporter \| BSC2 \| Bumetanide-sensitive sodium-(potassium)-chloride cotransporter 2 \| hNKCC1 \| Na-K-2Cl cotransporter 1 \| NKCC1 \| BSC1 \| Bumetanide-sensitive sodium-(potassium)-chloride cotransporter 1 \| Kidney-specific Na-K-Cl symporter \| Na-K-2Cl cotransporter 2 \| NKCC2 \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6	[ "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex", "Demadex Injection - 10mg/ml", "Demadex Tablets - 100mg", "Demadex Tablets - 10mg", "Demadex Tablets - 20mg", "Demadex Tablets - 5mg", "Soaanz", "Soaanz", "Soaanz", "Soaanz", "Soaanz", "Soaanz", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide", "Torsemide" ]	[ "Britomar", "Diuver", "Examide", "Luprac", "Soaanz", "Torem", "Trifas" ]	[]	[ "P55011", "Q13621" ]	[ "P10632", "P11712" ]	[ "P02768" ]	[ "Q9Y6L6" ]
DB00215	Citalopram	Citalopram is an antidepressant belonging to the class of selective _serotonin-reuptake inhibitors_ (SSRIs) widely used to treat the symptoms of depression. It is a racemic bicyclic phthalate derivate and is the only compound with a tertiary amine and 2 nitrogen-containing metabolites among all SSRIs.[A261316,A14720] Citalopram enhances serotonergic transmission through the inhibition of serotonin reuptake, and among all the SSRIs, citalopram appears to be the most selective toward serotonin reuptake inhibition.[A261316,A14720] Specifically, it has a very minimal effect on dopamine and norepinephrine transportation and virtually no affinity for muscarinic, histaminergic, or GABAergic receptors.[A261316] Citalopram was approved by the FDA in 1998 for the treatment of depression in adults 18 years or older.[L5230]	solid	Citalopram is approved by the FDA for treating adults with major depressive disorder.[L47941] It has also been used off-label to treat various diseases, including but not limited to sexual dysfunction, ethanol abuse, psychiatric conditions such as obsessive-compulsive disorder (OCD), social anxiety disorder, panic disorder, and diabetic neuropathy.[L5224,A321,A322,A261296]	Citalopram belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It has been found to relieve or manage symptoms of depression, anxiety, eating disorders and obsessive-compulsive disorder among other mood disorders. The antidepressant, anti-anxiety, and other actions of citalopram are linked to its inhibition of CNS central uptake of serotonin.[L47941] Serotonergic abnormalities have been reported in patients with mood disorders. Behavioral and neuropsychological effects of serotonin include the regulation of mood, perception, reward, anger, aggression, appetite, memory, sexuality, and attention, as examples. The onset of action for depression is approximately 1 to 4 weeks. The complete response may take 8-12 weeks after initiation of citalopram.[L5224] <i>In vitro</i> studies demonstrate that citalopram is a strong and selective inhibitor of neuronal serotonin reuptake and has weak effects on norepinephrine and dopamine central reuptake. The chronic administration of citalopram has been shown to downregulate central norepinephrine receptors, similar to other drugs effective in the treatment of major depressive disorder. Citalopram does not inhibit monoamine oxidase.[A325]	The mechanism of action of citalopram is unclear but is presumed to be related to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT), potentially through the inhibition of the serotonin transporter (solute carrier family 6 member 4, _SLC6A4_).[L47941,A37688] Citalopram binds with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs. Particularly, citalopram has no or very low affinity for 5-HT<sub>1A</sub>, 5-HT<sub>2A</sub>, dopamine D<sub>1</sub> and D<sub>2</sub>, α<sub>1</sub>-, α<sub>2</sub>-, and β-adrenergic, histamine H<sub>1</sub>, gamma aminobutyric acid (GABA), muscarinic cholinergic, and benzodiazepine receptors.[L47941]	The single- and multiple-dose pharmacokinetics of citalopram are linear and dose-proportional in a dose range of 10 to 40 mg/day. Biotransformation of citalopram is mainly hepatic, with a mean terminal half-life of about 35 hours. With once daily dosing, steady state plasma concentrations are achieved within approximately one week. At steady state, the extent of accumulation of citalopram in plasma, based on the half-life, is expected to be 2.5 times the plasma concentrations observed after a single dose.[L47941] Following a single oral dose (40 mg tablet) of citalopram, peak blood levels occur at about 4 hours. The absolute bioavailability of citalopram was about 80% relative to an intravenous dose, and absorption is not affected by food.[L47941]	Citalopram is metabolized mainly in the liver via <i>N</i>-demethylation to its main metabolite, _demethylcitalopram_ by CYP2C19 and CYP3A4. [A174382,A37688,L47941] Other metabolites include _didemethylcitalopram_ via CYP2D6 metabolism, _citalopram <i>N</i>-oxide_ and propionic acid derivative via monoamine oxidase enzymes A and B and aldehyde oxidase.[A174382,L47941] Citalopram metabolites exert little pharmacologic activity in comparison to the parent drug and are not likely to contribute to the clinical effect of citalopram.[A325]	Based on data from published observational studies, exposure to SSRIs, particularly in the month before delivery, has been associated with a less than 2-fold increase in the risk of postpartum hemorrhage.[L47941] Available data from published epidemiologic studies and postmarketing reports with citalopram use in pregnancy have not established an increased risk of major birth defects or miscarriage. Published studies demonstrated that citalopram levels in both cord blood and amniotic fluid are similar to those observed in maternal serum. There are risks of persistent pulmonary hypertension of the newborn (PPHN) and/or poor neonatal adaptation with exposure to selective serotonin reuptake inhibitors (SSRIs), including citalopram, during pregnancy. There also are risks associated with untreated depression in pregnancy.[L47941] Citalopram was administered orally to pregnant rats during the period of organogenesis at doses of 32, 56, and 112 mg/kg/day, which are approximately 8, 14, and 27 times the Maximum Recommended Human Dose (MRHD) of 40 mg, based on mg/m2 body surface area. Citalopram caused maternal toxicity of CNS clinical signs and decreased weight gain at 112 mg/kg/day, which is 27 times the MRHD. At this maternally toxic dose, citalopram decreased embryo/fetal growth and survival and increased fetal abnormalities (including cardiovascular and skeletal defects). The no observed adverse effect level (NOAEL) for maternal and embryofetal toxicity is 56 mg/kg/day, which is approximately 14 times the MRHD.[L47941] Citalopram was administered orally to pregnant rabbits during the period of organogenesis at doses up to 16 mg/kg/day, which is approximately 8 times the MRHD of 40 mg, based on mg/m2 body surface area. No maternal or embryofetal toxicity was observed. The NOAEL for maternal and embryofetal toxicity is 16 mg/kg/day, which is approximately 8 times the MRHD.[L47941] Citalopram was administered orally to pregnant rats during late gestation and lactation periods at doses of 4.8, 12.8, and 32 mg/kg/day, which are approximately 1, 3, and 8 times the MRHD of 40 mg, based on mg/m2 body surface area. Citalopram increased offspring mortality during the first 4 days of birth and decreased offspring growth at 32 mg/kg/day, which is approximately 8 times the MRHD. The NOAEL for developmental toxicity is 12.8 mg/kg/day, which is approximately 3 times the MRHD. In a separate study, similar effects on offspring mortality and growth were seen when dams were treated throughout gestation and early lactation at doses ≥ 24 mg/kg/day, which is approximately 6 times the MRHD. A NOAEL was not determined in that study.[L47941] SSRIs, including citalopram, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse reaction.[L47941] The following have been reported with citalopram tablet overdosage: • Seizures, which may be delayed, and altered mental status including coma.[L47941] • Cardiovascular toxicity, which may be delayed, including QRS and QTc interval prolongation, wide complex tachyarrhythmias, and torsade de pointes. Hypertension is most commonly seen, but hypotension can rarely be seen alone or with co‐ingestants including alcohol.[L47941] • Serotonin syndrome (patients with a multiple drug overdosage with other pro-serotonergic drugs may have a higher risk).[L47941] Prolonged cardiac monitoring is recommended in citalopram overdosage ingestions due to the arrhythmia risk. Gastrointestinal decontamination with activated charcoal should be considered in patients who present early after a citalopram overdose. Consider contacting a Poison Center (1‐800‐221‐2222) or a medical toxicologist for additional overdosage management recommendations.[L47941] Citalopram increased the incidence of small intestine carcinoma in rats treated for 24 months at doses of 8 and 24 mg/kg/day in the diet, which are approximately 2 and 6 times the Maximum Recommended Human Dose (MRHD) of 40 mg, respectively, based on mg/m2 body surface area. A no-effect level (NOEL) for this finding was not established. Citalopram did not increase the incidence of tumors in mice treated for 18 months at doses up to 240 mg/kg/day in the diet, which is approximately 30 times the MRDH of 40 mg based on mg/m2 body surface area.[L47941] Citalopram was mutagenic in the in vitro bacterial reverse mutation assay (Ames test) in 2 of 5 bacterial strains (Salmonella TA98 and TA1537) in the absence of metabolic activation. It was clastogenic in the in vitro Chinese hamster lung cell assay for chromosomal aberrations in the presence and absence of metabolic activation. Citalopram was not mutagenic in the in vitro mammalian forward gene mutation assay (HPRT) in mouse lymphoma cells or in in vitro/in vivo unscheduled DNA synthesis (UDS) assay in rat liver. It was not clastogenic in the in vitro chromosomal aberration assay in human lymphocytes or in two in vivo mouse micronucleus assays.[L47941] Citalopram was administered orally to female and male rats at doses of 32, 48, and 72 mg/kg/day prior to and throughout mating and continuing to gestation. These doses are approximately 8, 12, and 17 times the MRHD of 40 mg based on mg/m2 body surface area. Mating and fertility were decreased at doses ≥ 32 mg/kg/day, which is approximately 8 times the MRHD. Gestation duration was increased to 48 mg/kg/day, which is approximately 12 times the MRHD.[L47941]	The mean terminal half-life of citalopram is about 35 hours.[L8126]	The binding of citalopram (CT), demethylcitalopram (DCT) and didemethylcitalopram (DDCT) to human plasma proteins is about 80%.[L47941]	Approximately 12 to 23% of an oral dose of citalopram is found unchanged in the urine, while 10% is found in feces.[A37688] Following intravenous administrations of citalopram, the fraction of the drug recovered in the urine as citalopram and DCT was about 10% and 5%, respectively.[L47941]	The volume of distribution of citalopram is about 12 L/kg.[L47941]	The systemic clearance of citalopram was 330 mL/min, with approximately 20% of that due to renal clearance.[L47941]	Organic compounds	Benzenoids	Benzene and substituted derivatives	Phenylbutylamines	[ "approved" ]	[ "N06AB", "N06A", "N06", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.47", "description": "Celexa 20 mg Tablet", "unit": "tablet" }, { "cost": "1.47", "description": "Celexa 40 mg Tablet", "unit": "tablet" }, { "cost": "2.33", "description": "Citalopram hbr 10 mg tablet", "unit": "tablet" }, { "cost": "2.43", "description": "Citalopram hbr 20 mg tablet", "unit": "tablet" }, { "cost": "2.53", "description": "Citalopram hbr 40 mg tablet", "unit": "tablet" }, { "cost": "2.68", "description": "Citalopram Hydrobromide 10 mg tablet", "unit": "tablet" }, { "cost": "2.8", "description": "Citalopram Hydrobromide 20 mg tablet", "unit": "tablet" }, { "cost": "2.89", "description": "Citalopram Hydrobromide 40 mg tablet", "unit": "tablet" }, { "cost": "3.57", "description": "Celexa 10 mg tablet", "unit": "tablet" }, { "cost": "3.72", "description": "Celexa 20 mg tablet", "unit": "tablet" }, { "cost": "3.88", "description": "Celexa 40 mg tablet", "unit": "tablet" }, { "cost": "122.28", "description": "Citalopram Hydrobromide 10 mg/5ml Solution 240ml Bottle", "unit": "bottle" }, { "cost": "0.47", "description": "Pms-Citalopram 10 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Apo-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Apo-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Citalopram-Odan 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Citalopram-Odan 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Co Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Co Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Jamp-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Jamp-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Mint-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Mint-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Mylan-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Mylan-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ng Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ng Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Novo-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Novo-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Phl-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Phl-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Pms-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Pms-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ran-Citalo 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ran-Citalo 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ran-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ran-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ratio-Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Ratio-Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Sandoz Citalopram 20 mg Tablet", "unit": "tablet" }, { "cost": "0.82", "description": "Sandoz Citalopram 40 mg Tablet", "unit": "tablet" }, { "cost": "0.99", "description": "Ctp 30 30 mg Tablet", "unit": "tablet" } ]	[ { "approved": "2003-07-22", "country": "Canada", "expires": "2021-07-24", "number": "2353693" }, { "approved": "2001-10-23", "country": "Canada", "expires": "2011-08-16", "number": "2049368" } ]	Citalopram \| Citalopramum \| Nitalapram \| 5HT transporter \| 5HTT \| HTT \| SERT \| Solute carrier family 6 member 4 \| H1-R \| H1R \| HH1R \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| 1.4.3.21 \| 1.4.3.4 \| MAO-A \| Monoamine oxidase type A \| 1.4.3.21 \| 1.4.3.4 \| MAO-B \| Monoamine oxidase type B \| 1.2.3.1 \| Aldehyde oxidase 1 \| AO \| Azaheterocycle hydroxylase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1	[ "Abbott-citalopram", "Abbott-citalopram", "Abbott-citalopram", "Accel-citalopram Tablets", "Accel-citalopram Tablets", "Accel-citalopram Tablets", "Act Citalopram", "Act Citalopram", "Act Citalopram", "Ag-citalopram", "Ag-citalopram", "Ag-citalopram", "Ag-citalopram Tablets", "Ag-citalopram Tablets", "Ag-citalopram Tablets", "Ag-citalopram Tablets", "Apo-citalopram", "Apo-citalopram", "Auro-citalopram", "Auro-citalopram", "Ava-citalopram", "Ava-citalopram", "Ava-citalopram", "Bio-citalopram", "Bio-citalopram", "Bio-citalopram", "Ccp-citalopram", "Ccp-citalopram", "Celexa", "Celexa", "Celexa", "Celexa", "Celexa", "Celexa", "Celexa", "Celexa", "Celexa 10 mg", "Celexa 20 mg", "Celexa 40 mg", "Citalopram", "Citalopram", "Citalopram", "Citalopram", 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"Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Hydrobromide", "Citalopram Tablets", "Citalopram Tablets", "Citalopram Tablets USP", "Citalopram Tablets USP", "Citalopram Tablets USP", "Citalopram-odan", "Citalopram-odan", "Ctp 30", "Dom-citalopram", "Dom-citalopram", "Dom-citalopram", "Ecl-citalopram", "Ecl-citalopram", "Ecl-citalopram", "Ipg-citalopram", "Ipg-citalopram", "Ipg-citalopram", "Jamp Citalopram Tablets", "Jamp-citalopram", "Jamp-citalopram", "Jamp-citalopram", "M-citalopram", "M-citalopram", "M-citalopram", "Manda-citalopram", "Manda-citalopram", "Manda-citalopram", "Mar-citalopram", "Mar-citalopram", "Mar-citalopram", "Mint-citalopram", "Mint-citalopram", "Mint-citalopram", "Mint-citalopram", "Mint-citalopram", "Mint-citalopram", "Mylan-citalopram", "Mylan-citalopram", "Mylan-citalopram", "Nat-citalopram", "Nat-citalopram", "Natco-citalopram", "Natco-citalopram", "Natco-citalopram", "Ng Citalopram", "Ng Citalopram", "Novo-citalopram", "Novo-citalopram", "Nra-citalopram", "Nra-citalopram", "Nra-citalopram", "Ntp-citalopram", "Ntp-citalopram", "Ntp-citalopram", "Nu-citalopram", "Nu-citalopram", "Pendo-citalopram", "Perrigo Citalopram", "Perrigo Citalopram", "Perrigo Citalopram", "Perrigo Citalopram", "PHL-citalopram", "PHL-citalopram", "PHL-citalopram", "PMS-citalopram", "PMS-citalopram", "PMS-citalopram", "Priva-citalopram", "Priva-citalopram", "Priva-citalopram", "Q-citalopram", "Q-citalopram", "Q-citalopram", "Ran-citalo", "Ran-citalo", "Ran-citalopram", "Ran-citalopram", "Ratio-citalopram", "Ratio-citalopram", "Riva-citalopram", "Riva-citalopram", "Riva-citalopram", "Riva-citalopram", "Riva-citalopram", "Riva-citalopram", "Sandoz Citalopram", "Sandoz Citalopram", "Sentralopram AM-10", "Septa-citalopram", "Septa-citalopram", "Septa-citalopram", "Sig-citalopram", "Sig-citalopram", "Teva-citalopram", "Teva-citalopram", "Teva-citalopram", "Van-citalopram", "Van-citalopram", "Van-citalopram" ]	[ "Akarin", "Celapram", "Ciazil", "Cilift", "Cipram", "Cipramil", "Ciprapine", "Citabax", "Citadur", "Citalec", "Citol", "Citopam", "Citox", "Citrol", "Dalsan", "Elopram", "Humorup", "Oropram", "Pramcit", "Recital", "Seropram", "Talam", "Talohexal", "Temperax", "Vodelax", "Zentius", "Zetalo" ]	[ "Sentralopram AM-10" ]	[ "P31645", "P35367" ]	[ "P08684", "P33261", "P10635", "P05177", "P21397", "P27338", "Q06278" ]	[]	[ "P08183" ]
DB00216	Eletriptan	Eletriptan is a second generation triptan drug developed by Pfizer Inc for the treatment of migraine headaches.	solid	For the acute treatment of migraine with or without aura in adults.	Eletriptan is a selective 5-hydroxytryptamine 1B/1D receptor agonist. In the anesthetized dog, eletriptan has been shown to reduce carotid arterial blood flow, with only a small increase in arterial blood pressure at high doses. While the effect on blood flow was selective for the carotid arterial bed, decreases in coronary artery diameter were observed. Eletriptan has also been shown to inhibit trigeminal nerve activity in the rat.	Eletriptan binds with high affinity to 5-HT1B, 5-HT1D and 5-HT1F receptors, has modest affinity for 5-HT1A, 5-HT1E, 5-HT2B and 5-HT7 receptors, and little or no affinity for 5-HT2A, 5-HT2C, 5-HT3, 5-HT4, 5-HT5A and 5-HT6 receptors. In contrast, eletriptan displays insignificant pharmacological activity at adrenergic alpha1, alpha2, or beta; dopaminergic D1 or D2; muscarinic; or opioid receptors. While the full mechanism of action of 5-HT receptor agonists in relieving migrains is not fully elucidated, it is proposed that the activation of 5-HT1 receptors located on intracranial blood vessels leads to vasoconstriction that correlates with the relief of migraine headaches. It is also proposed that the activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system leads to the inhibition of release of pro-inflammatory neuropeptides.	Well absorbed after oral administration with a mean absolute bioavailability of approximately 50%.	In vitro studies indicate that eletriptan is primarily metabolized by cytochrome P-450 enzyme CYP3A4. The N-demethylated metabolite of eletriptan is the only known active metabolite.	Based on the pharmacology of the 5-HT1B/1D agonists, hypertension or other more serious cardiovascular symptoms could occur on overdose.	The terminal elimination half-life of eletriptan is approximately 4 hours.	Plasma protein binding is moderate and approximately 85%.	null	* 138 L	* Renal cl=3.9 L/h	Organic compounds	Organoheterocyclic compounds	Indoles and derivatives	Indoles	[ "approved", "investigational" ]	[ "N02CC", "N02C", "N02", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "25.01", "description": "Relpax 20 mg tablet", "unit": "tablet" }, { "cost": "25.01", "description": "Relpax 40 mg tablet", "unit": "tablet" }, { "cost": "156.05", "description": "Relpax 6 20 mg tablet Box", "unit": "box" }, { "cost": "156.05", "description": "Relpax 6 40 mg tablet Box", "unit": "box" } ]	[ { "approved": "2006-01-24", "country": "Canada", "expires": "2019-11-01", "number": "2352392" }, { "approved": "2000-06-06", "country": "Canada", "expires": "2015-05-17", "number": "2198599" }, { "approved": "1996-08-13", "country": "United States", "expires": "2016-12-26", "number": "5545644" }, { "approved": "2000-08-29", "country": "United States", "expires": "2017-08-29", "number": "6110940" } ]	Eletriptan \| élétriptan \| Eletriptán \| Eletriptanum \| 5-HT-1D \| 5-HT-1D-alpha \| 5-HT1D \| HTR1DA \| HTRL \| Serotonin 1D alpha receptor \| Serotonin receptor 1D \| 5-HT-1B \| 5-HT-1D-beta \| 5-HT1B \| HTR1DB \| S12 \| Serotonin 1D beta receptor \| Serotonin receptor 1B \| 5-HT-1F \| 5-HT1F \| HTR1EL \| Serotonin receptor 1F \| 5-HT-1A \| 5-HT1A \| ADRB2RL1 \| ADRBRL1 \| G-21 \| Serotonin receptor 1A \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.14.- \| Coumarin 7-hydroxylase \| CYP2A3 \| CYPIIA6 \| Cytochrome P450 IIA3 \| Cytochrome P450(I) \| 1.14.99.1 \| COX-1 \| COX1 \| Cyclooxygenase-1 \| PGH synthase 1 \| PGHS-1 \| PHS 1 \| Prostaglandin H2 synthase 1 \| Prostaglandin-endoperoxide synthase 1 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1	[ "Apo-eletriptan", "Apo-eletriptan", "Apo-eletriptan Tablets", "Apo-eletriptan Tablets", "Auro-eletriptan", "Auro-eletriptan", "Eletriptan", "Eletriptan", "Eletriptan", "Eletriptan", "Eletriptan", "Eletriptan", "Eletriptan HBR", "Eletriptan HBR", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan hydrobromide", "Eletriptan hydrobromide", "Eletriptan hydrobromide", "Eletriptan hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Eletriptan Hydrobromide", "Jamp Eletriptan", "Jamp Eletriptan", "Mylan-eletriptan", "Mylan-eletriptan", "PMS-eletriptan", "PMS-eletriptan", "Relpax", "Relpax", "Relpax", "Relpax", "Relpax", "Relpax", "Relpax", "Relpax", "Relpax", "Relpax", "Teva-eletriptan", "Teva-eletriptan" ]	[]	[]	[ "P28221", "P28222", "P30939", "P08908" ]	[ "P10635", "P11712", "P33261", "P11509", "P23219", "P08684" ]	[]	[ "P08183" ]
DB00217	Bethanidine	A guanidinium antihypertensive agent that acts by blocking adrenergic transmission.	solid	For the treatment of hypertension.	Bethanidine is a guanidinium antihypertensive agent that acts by blocking adrenergic transmission. The precise mode of action is not clear. Although bethanidine may produce adverse effects, they are beneficial in severe hypertension and produce fewer side effects than guanethidine.	Bethanidine, a guanidine derivative, is a peripherally acting antiadrenergic agent which primarily acts as an alpha2a adrenergic agonist. Bethanidine effectively decreases blood pressure by suppressing renin secretion or interfering with function of the sympathetic nervous system.	Absorbed rapidly in the gastrointestinal tract following oral administration.	null	null	9 hours (range 7 to 11 hours)	null	null	null	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	null	[ "approved" ]	[ "C02CC", "C02C", "C02", "C" ]	[ "Humans and other mammals" ]	[]	[]	Betanidina \| Betanidine \| Bétanidine \| Betanidinum \| Bethanidine \| N,N'-dimethyl-N''-(phenylmethyl)-guanidine \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ATP-regulated potassium channel ROM-K \| Inward rectifier K(+) channel Kir1.1 \| Potassium channel, inwardly rectifying subfamily J member 1 \| ROMK1 \| ADRA2R \| ADRAR \| Alpha-2 adrenergic receptor subtype C10 \| Alpha-2A adrenoceptor \| Alpha-2A adrenoreceptor \| Alpha-2AAR \| ADRA2L1 \| ADRA2RL1 \| Alpha-2 adrenergic receptor subtype C2 \| Alpha-2B adrenoceptor \| Alpha-2B adrenoreceptor \| Alpha-2BAR \| ADRA2L2 \| ADRA2RL2 \| Alpha-2 adrenergic receptor subtype C4 \| Alpha-2C adrenoceptor \| Alpha-2C adrenoreceptor \| Alpha-2CAR \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ADRB2R \| B2AR \| Beta-2 adrenoceptor \| Beta-2 adrenoreceptor \| ADRB3R \| B3AR \| Beta-3 adrenoceptor \| Beta-3 adrenoreceptor	[]	[ "Esbatal" ]	[]	[ "P08588", "P48048", "P08913", "P18089", "P18825", "P08588", "P07550", "P13945" ]	[]	[]	[]
DB00218	Moxifloxacin	Moxifloxacin is a synthetic fluoroquinolone antibiotic agent. Bayer AG developed the drug (initially called BAY 12-8039) and it is marketed worldwide (as the hydrochloride) under the brand name Avelox (in some countries also Avalox) for oral treatment.	solid	For the treatment of sinus and lung infections such as sinusitis, pneumonia, and secondary infections in chronic bronchitis. Also for the treatment of bacterial conjunctivitis (pinkeye).	Moxifloxacin is a quinolone/fluoroquinolone antibiotic. Moxifloxacin can be used to treat infections caused by the following bacteria: Aerobic Gram-positive microorganisms: _Corynebacterium_ species, _Micrococcus luteus_, _Staphylococcus aureus_, _Staphylococcus epidermidis_, _Staphylococcus haemolyticus_, _Staphylococcus hominis_, _Staphylococcus warneri_, _Streptococcus pneumoniae_, and _Streptococcus viridans_ group. Aerobic Gram-negative microorganisms: _Acinetobacter lwoffii_, _Haemophilus influenzae_, and _Haemophilus parainfluenzae_. Other microorganisms: _Chlamydia trachomatis_. Moxifloxacin is bactericidal and its mode of action depends on blocking of bacterial DNA replication by binding itself to an enzyme called DNA gyrase, which allows the untwisting required to replicate one DNA double helix into two. Notably the drug has 100 times higher affinity for bacterial DNA gyrase than for mammalian. Moxifloxacin is a broad-spectrum antibiotic that is active against both Gram-positive and Gram-negative bacteria.	The bactericidal action of moxifloxacin results from inhibition of the enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. DNA gyrase is an essential enzyme that is involved in the replication, transcription and repair of bacterial DNA. Topoisomerase IV is an enzyme known to play a key role in the partitioning of the chromosomal DNA during bacterial cell division.	Well absorbed from the gastrointestinal tract. Absolute oral bioavailability is approximately 90%. Food has little effect on absorption.	Approximately 52% or oral or intravenous dose is metabolized via glucuronide and sulphate conjugation. The cytochrome P450 system is not involved in metabolism. The sulphate conjugate accounts for 38% of the dose, and the glucuronide conjugate accounts for 14% of the dose.	Symptoms of overdose include CNS and gastrointestinal effects such as decreased activity, somnolence, tremor, convulsions, vomiting, and diarrhea. The minimal lethal intravenous dose in mice and rats is 100 mg/kg.	11.5-15.6 hours (single dose, oral)	50% bound to serum proteins, independent of drug concentration.	Approximately 45% of an oral or intravenous dose of moxifloxacin is excreted as unchanged drug (~20% in urine and ~25% in feces).	* 1.7 to 2.7 L/kg	* 12 +/- 2 L/hr	Organic compounds	Organoheterocyclic compounds	Quinolines and derivatives	Quinoline carboxylic acids	[ "approved", "investigational" ]	[ "S01AE", "S01A", "S01", "S", "J01MA", "J01M", "J01", "J" ]	[ "Enteric bacteria and other eubacteria" ]	[ { "cost": "16.35", "description": "Avelox abc pack 400 mg tablet", "unit": "tablet" }, { "cost": "16.68", "description": "Avelox 400 mg tablet", "unit": "tablet" }, { "cost": "27.22", "description": "Vigamox 0.5% eye drops", "unit": "ml" }, { "cost": "90.72", "description": "Vigamox 0.5% Solution 3ml Bottle", "unit": "bottle" }, { "cost": "0.17", "description": "Avelox iv 400 mg/250 ml", "unit": "ml" } ]	[ { "approved": "1991-02-05", "country": "United States", "expires": "2011-12-08", "number": "4990517" }, { "approved": "2009-05-26", "country": "Canada", "expires": "2019-09-29", "number": "2342211" }, { "approved": "1998-11-03", "country": "Canada", "expires": "2015-11-03", "number": "1340114" }, { "approved": "1998-12-15", "country": "United States", "expires": "2016-12-05", "number": "5849752" }, { "approved": "2003-08-26", "country": "United States", "expires": "2019-10-29", "number": "6610327" }, { "approved": "2003-04-15", "country": "United States", "expires": "2020-07-25", "number": "6548079" }, { "approved": "2010-03-02", "country": "United States", "expires": "2020-03-29", "number": "7671070" }, { "approved": "2004-04-06", "country": "United States", "expires": "2020-03-29", "number": "6716830" }, { "approved": "2013-05-28", "country": "United States", "expires": "2029-05-29", "number": "8450311" }, { "approved": "2015-08-25", "country": "United States", "expires": "2029-05-29", "number": "9114168" } ]	1-Cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-((4as,7as)-octahydro-6H-pyrrolo(3,4-b)pyridin-6-yl)-4-oxo-3-quinolinecarboxylic acid \| Moxifloxacin \| Moxifloxacino \| 5.99.1.3 \| 5.99.1.3 \| 5.99.1.3 \| 5.99.1.3 \| Topoisomerase IV subunit A \| 5.6.2.2 \| DNA topoisomerase II, alpha isozyme \| TOP2 \| 3.1.1.2 \| 3.1.1.81 \| 3.1.8.1 \| A-esterase 1 \| Aromatic esterase 1 \| K-45 \| PON \| PON 1 \| Serum aryldialkylphosphatase 1 \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase	[ "Act Moxifloxacin", "Ag-moxifloxacin", "Ag-moxifloxacin", "Apo-moxifloxacin", "Apo-moxifloxacin", "Apo-moxifloxacin Hydrochloride", "Auro-moxifloxacin", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox", "Avelox ABC Pack", "Avelox I.V.", "Bio-moxifloxacin", "Dex-Moxi", "Dex-Moxi PF", "Dex-Moxi-Ketor", "DexMoxiKetor PF", "Dom-moxifloxacin", "Ipg-moxifloxacin", "Ixoba M", "Jamp-moxifloxacin", "Jamp-moxifloxacin", "Jamp-moxifloxacin Tablets", "M-moxifloxacin", "Mar-moxifloxacin", "Med-moxifloxacin", "Moxeza", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride", "Moxifloxacin Hydrochloride Tablets, 400 mg", "Moxifloxacin Hydrochloride Tablets, 400 mg", "Moxifloxacin Hydrochloride Tablets, 400 mg", "Moxifloxacin Injection", "Moxifloxacin Ophthalmic", "Moxifloxacin ophthalmic solution", "Moxifloxacin Ophthalmic Solution", "Moxifloxacin Ophthalmic Solution", "Moxifloxacin ophthalmic solution", "Moxifloxacin Ophthalmic Solution", "Moxifloxacin ophthalmic solution", "Moxifloxacin ophthalmic solution", "Moxifloxacin ophthalmic solution", "Moxifloxacin PF", "Moxifloxacin PF", "Moxifloxacin PF", "Mylan-moxifloxacin", "Mylan-moxifloxacin HCl Ophthalmic Solution", "PHL-moxifloxacin", "PMS-moxifloxacin", "PMS-moxifloxacin", "Priva-moxifloxacin", "Riva-moxifloxacin", "Sandoz Moxifloxacin", "Sandoz Moxifloxacin", "Strenza", "Teva-moxifloxacin", "Teva-moxifloxacin", "Torrent-moxifloxacin", "Triamcinolone-Moxifloxacin PF", "Triamcinolone-Moxifloxacin PF", "Vigamox", "Vigamox", "Vigamox", "Vigamox", "Vigamox", "Vigamox", "Vigamox", "Vigamox", "Vigamox" ]	[]	[ "Triamcinolone-Moxifloxacin PF", "Dex-Moxi PF", "DexMoxiKetor PF", "Triamcinolone-Moxifloxacin PF", "Dex-Moxi", "Dex-Moxi-Ketor", "Ixoba M", "Strenza" ]	[ "P11388", "P27169" ]	[ "P05177" ]	[]	[]
DB00219	Oxyphenonium	A quaternary ammonium anticholinergic agent with peripheral side effects similar to those of atropine. It is used as an adjunct in the treatment of gastric and duodenal ulcer, and to relieve visceral spasms. The drug has also been used in the form of eye drops for mydriatic effect. [PubChem]	solid	For the treatment of visceral spasms	Oxyphenonium is an anticholinergic drug, a medication that reduces the effect of acetylcholine, a chemical released from nerves that stimulates muscles, by blocking the receptors for acetylcholine on smooth muscle (a type of muscle). It also has a direct relaxing effect on smooth muscle. Oxyphenonium is used to treat or prevent spasm in the muscles of the gastrointestinal tract in the irritable bowel syndrome. In addition, Oxyphenonium inhibits gastrointestinal propulsive motility and decreases gastric acid secretion and controls excessive pharyngeal, tracheal and bronchial secretions.	Action is achieved via a dual mechanism: (1) a specific anticholinergic effect (antimuscarinic) at the acetylcholine-receptor sites and (2) a direct effect upon smooth muscle (musculotropic).	null	null	null	null	93% bound to albumin	null	null	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	null	[ "approved" ]	[ "A03AB", "A03A", "A03", "A", "A03AB", "A03A", "A03", "A" ]	[ "Humans and other mammals" ]	[]	[]	Oxyphenonium cation \| Oxyphenonium ion	[]	[ "A-Spasm", "Antispasmin", "Antrenex", "Antrenyl", "Atrenex", "Spasmophen" ]	[]	[ "P11229" ]	[]	[]	[]
DB00220	Nelfinavir	Nelfinavir is a potent HIV-1 protease inhibitor. It is used in combination with other antiviral drugs in the treatment of HIV in both adults and children. Nelfinavir inhibits the HIV viral proteinase enzyme which prevents cleavage of the gag-pol polyprotein, resulting in noninfectious, immature viral particles.[L36485]	solid	Used in combination with other antiviral drugs in the treatment of HIV in both adults and children.[L36485]	Nelfinavir is a protease inhibitor with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Protease inhibitors block the part of HIV called protease. HIV-1 protease is an enzyme required for the proteolytic cleavage of the viral polyprotein precursors into the individual functional proteins found in infectious HIV-1. Nelfinavir binds to the protease active site and inhibits the activity of the enzyme. This inhibition prevents cleavage of the viral polyproteins resulting in the formation of immature non-infectious viral particles. Protease inhibitors are almost always used in combination with at least two other anti-HIV drugs.	HIV viral protease is an important enzyme for HIV maturation and pathogenicity since HIV produces its structural and key proteins in the form of a polyprotein that needs to be cleaved by a protease.[A246853] HIV protease is synthesized as part of the Gag-pol polyprotein, where Gag encodes for the capsid and matrix protein to form the outer protein shell, and Pol encodes for the reverse transcriptase and integrase protein to synthesize and incorporate its genome into host cells.[A246853, A246858] The Gag-pol polyprotein undergoes proteolytic cleavage by HIV protease to produce 66 molecular species which will assume conformational changes to become fully active.[A246853] Inhibition of protease, therefore, prevents HIV virion from fully maturing and becoming infective.[A246853] Nelfinavir is a competitive inhibitor of the HIV protease by reversibly binding to the active site of the enzyme, preventing it from interacting with its substrate to produce mature and infectious viral particles.[L36485, L41608]	Well absorbed following oral administration.	Unchanged nelfinavir comprised 82-86% of the total plasma radioactivity after a single oral 750 mg dose of 14C-nelfinavir. In vitro, multiple cytochrome P-450 enzymes including CYP3A and CYP2C19 are responsible for the metabolism of nelfinavir. One major and several minor oxidative metabolites were found in plasma. The major oxidative metabolite has in vitro antiviral activity comparable to the parent drug.[L36485]	Carcinogenicity studies in mice and rats were conducted with nelfinavir at oral doses up to 1000 mg/kg/day. No evidence of a tumorigenic effect was noted in mice at systemic exposures (Cmax) up to 9-fold those measured in humans at the recommended therapeutic dose (750 mg TID or 1250 mg BID). In rats, thyroid follicular cell adenomas and carcinomas were increased in males at 300 mg/kg/day and higher and in females at 1000 mg/kg/day. Systemic exposures (Cmax) at 300 and 1000 mg/kg/day were 1- to 3-fold, respectively, those measured in humans at the recommended therapeutic dose. Repeated administration of nelfinavir to rats produced effects consistent with hepatic microsomal enzyme induction and increased thyroid hormone deposition; these effects predispose rats, but not humans, to thyroid follicular cell neoplasms. Nelfinavir showed no evidence of mutagenic or clastogenic activity in a battery of in vitro and in vivo genetic toxicology assays. These studies included bacterial mutation assays in S. typhimurium and E. coli, a mouse lymphoma tyrosine kinase assay, a chromosomal aberration assay in human lymphocytes, and an in vivo mouse bone marrow micronucleus assay.[L36485] Nelfinavir produced no effects on either male or female mating and fertility or embryo survival in rats at systemic exposures comparable to the human therapeutic exposure.[L36485] Human experience of acute overdose with nelfinavir is limited. There is no specific antidote for overdose with VIRACEPT. If indicated, elimination of unabsorbed drug should be achieved by emesis or gastric lavage. Administration of activated charcoal may also be used to aid the removal of unabsorbed drug. Since nelfinavir is highly protein-bound, dialysis is unlikely to significantly remove the drug from blood.[L36485]	The terminal half-life in plasma was typically 3.5 to 5 hours.[L36485]	Nelfinavir in serum is extensively protein-bound (>98%).[L36485]	The majority (87%) of an oral 750 mg dose containing 14C-nelfinavir was recovered in the feces; fecal radioactivity consisted of numerous oxidative metabolites (78%) and unchanged nelfinavir (22%). Only 1–2% of the dose was recovered in urine, of which unchanged nelfinavir was the major component.[L36485]	The apparent volume of distribution following oral administration of nelfinavir was 2-7 L/kg.[L36485]	Oral clearance estimates after single doses (24-33 L/h) and multiple doses (26-61 L/h) indicate that nelfinavir is a drug with medium to high hepatic bioavailability.[L41608]	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved" ]	[ "J05AE", "J05A", "J05", "J" ]	[ "Human Immunodeficiency Virus" ]	[ { "cost": "3.46", "description": "Viracept 250 mg tablet", "unit": "tablet" }, { "cost": "11.24", "description": "Viracept 625 mg tablet", "unit": "tablet" }, { "cost": "0.54", "description": "Viracept 50 mg/gm Powder", "unit": "gm" } ]	[ { "approved": "1996-01-16", "country": "United States", "expires": "2014-04-07", "number": "5484926" }, { "approved": "1999-08-31", "country": "Canada", "expires": "2014-10-07", "number": "2173328" } ]	Nelfinavir \| Fragment \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 1 \| GNT1 \| hUG-BR1 \| UDP-glucuronosyltransferase 1-1 \| UDP-glucuronosyltransferase 1A isoform 1 \| UDPGT 1-1 \| UGT1 \| UGT1-01 \| UGT1.1 \| UGT1*1 \| UGT1A1 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| AGP 1 \| AGP1 \| OMD 1 \| Orosomucoid-1 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| hOCT1 \| OCT1 \| Organic cation transporter 1 \| OATP \| OATP-1 \| OATP-A \| OATP1 \| OATP1A2 \| Organic anion-transporting polypeptide 1 \| SLC21A3 \| Sodium-independent organic anion transporter \| Solute carrier family 21 member 3 \| 7.6.2.2 \| ABCP \| ATP-binding cassette sub-family G member 2 \| BCRP \| BCRP1 \| Breast cancer resistance protein \| CDw338 \| Mitoxantrone resistance-associated protein \| MXR \| Placenta-specific ATP-binding cassette transporter \| Urate exporter \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP	[ "Viracept", "Viracept", "Viracept", "Viracept", "Viracept", "Viracept", "Viracept", "Viracept", "Viracept", "Viracept -250mg", "Viracept -50mg" ]	[]	[]	[]	[ "P08684", "P24462", "P20815", "P20813", "P33261", "P22309", "P11712", "P10635" ]	[ "P02768", "P02763" ]	[ "P08183", "O15245", "P46721", "Q9UNQ0", "Q9Y6L6", "Q9NPD5", "O94956", "O95342" ]
DB00221	Isoetharine	Isoetharine is a relatively selective beta-2 adrenergic agonist. It is a catechol-like agent. Isoetharine is a fast-acting bronchodilator used for emphysema, bronchitis and asthma.[A330]	solid	For the treatment of asthma, wheezing, and chronic asthmatic bronchitis.	Isoetharine is a beta-adrenergic receptor agonist. While it is reported to demonstrate more selectivity towards beta-2 adrenergic receptors,[A259681] isoetharine still binds to beta-1 adrenergic receptors and thus may be associated with beta-1-mediated adverse events.[A330, A259686] Isoetharine produces maximal bronchodilation within 15 minutes of inhalation.[A330]	Isoetharine-induced bronchodilator occurs from an increased activity of adenyl cyclase, which augments the formation of cyclic AMP (cAMP). Increased levels of cAMP result in the relaxation of bronchial smooth muscle, stimulation of ciliary activity, and potential improvement in capillary integrity.[A259681]	null	Isoetharine is rapidly metabolized once inhaled.[A330]	Signs of overdose include tachycardia, palpitations, nausea, headache, and epinephrine-like side effects.	null	null	null	null	null	Organic compounds	Benzenoids	Phenols	Benzenediols	[ "approved" ]	[ "R03CC", "R03C", "R03", "R", "R03AC", "R03A", "R03", "R" ]	[ "Humans and other mammals" ]	[]	[]	Isoetarina \| Isoetarine \| Isoetarinum \| Isoetharine \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ADRB2R \| B2AR \| Beta-2 adrenoceptor \| Beta-2 adrenoreceptor	[]	[ "Bronkometer", "Bronkosol" ]	[]	[ "P08588", "P07550" ]	[]	[]	[]
DB00222	Glimepiride	First introduced in 1995, glimepiride is a member of the second-generation sulfonylurea (SU) drug class used for the management of type 2 diabetes mellitus (T2DM) to improve glycemic control. Type 2 diabetes is a metabolic disorder with increasing prevalences worldwide; it is characterized by insulin resistance in accordance with progressive β cell failure and long-term microvascular and macrovascular complications that lead to co-morbidities and mortalities. Sulfonylureas are one of the insulin secretagogues widely used for the management of type 2 diabetes to lower blood glucose levels. The main effect of SUs is thought to be effective when residual pancreatic β-cells are present,[A177715] as they work by stimulating the release of insulin from the pancreatic beta cells and they are also thought to exert extra-pancreatic effects, such as increasing the insulin-mediated peripheral glucose uptake.[A177709] Glimepiride works by stimulating the secretion of insulin granules from pancreatic islet beta cells by blocking ATP-sensitive potassium channels (K<SUB>ATP</SUB> channels) and causing depolarization of the beta cells. Compared to [glipizide], another second SU drug, glimepiride has a longer duration of action. It is sometimes classified as a third-generation SU because it has larger substitutions than other second-generation SUs.[A177703] Compared to other SUs, glimepiride was associated with a lower risk of developing hypoglycemia and weight gain in clinical trials [A177709] as well as fewer cardiovascular effects than other SUs due to minimal effects on ischemic preconditioning of cardiac myocytes.[A177703] It is effective in reducing fasting plasma glucose, postprandial glucose, and glycosylated hemoglobin levels and is considered to be a useful, cost-effective treatment option for managing type 2 diabetes mellitus.[A177703] Glimepiride was approved by the Food and Drug Administration (FDA) in the United States in 1995 for the treatment of T2DM. It is commonly marketed under the brand name Amaryl as oral tablets and is typically administered once daily.	solid	Glimepiride is indicated for the management of type 2 diabetes in adults as an adjunct to diet and exercise to improve glycemic control as monotherapy. It may also be indicated for use in combination with metformin or insulin to lower blood glucose in patients with type 2 diabetes whose high blood sugar levels cannot be controlled by diet and exercise in conjunction with an oral hypoglycemic (a drug used to lower blood sugar levels) agent alone.[L10322]	Glimepiride stimulates the secretion of insulin granules from the pancreatic beta cells and improves the sensitivity of peripheral tissues to insulin to increase peripheral glucose uptake, thus reducing plasma blood glucose levels and glycated hemoglobin (HbA1C) levels. A multi-center, randomized, placebo-controlled clinical trial evaluated the efficacy of glimepiride (1–8 mg) as monotherapy titrated over 10 weeks compared with placebo in T2DM subjects who were not controlled by diet alone.[A177703] In this study, there was a reduction in fasting plasma glucose (FPG) by 46 mg/dL, post-prandial glucose (PPG) by 72 mg/dL, and HbA1c by 1.4% more than the placebo.[A177703] In another randomized study comprising of patients with T2DM receiving either placebo or one of the three doses (1, 4, or 8 mg) of glimepiride during a 14-week study period, all glimepiride regimens significantly reduced FPG, PPG, and HbA1c values (P < 0.001) compared to placebo by the end of the study period.[A177703] The 4- and 8-mg doses of glimepiride were more effective than the 1-mg dose; however, the 4-mg dose provided a nearly maximal antihyperglycemic effect.[A177703]	ATP-sensitive potassium channels on pancreatic beta cells that are gated by intracellular ATP and ADP. The hetero-octomeric complex of the channel is composed of four pore-forming Kir6.2 subunits and four regulatory sulfonylurea receptor (SUR) subunits. Alternative splicing allows the formation of channels composed of varying subunit isoforms expressed at different concentrations in different tissues.[A177730] In pancreatic beta cells, ATP-sensitive potassium channels play a role as essential metabolic sensors and regulators that couple membrane excitability with glucose-stimulated insulin secretion (GSIS).[A177727] When there is a decrease in the ATP:ADP ratio, the channels are activated and open, leading to K+ efflux from the cell, membrane hyperpolarization, and suppression of insulin secretion.[A177727] In contrast, increased uptake of glucose into the cell leads to elevated intracellular ATP:ADP ratio, leading to the closure of channels and membrane depolarization. Depolarization leads to activation and opening of the voltage-dependent Ca2+ channels and consequently an influx of calcium ions into the cell.[A177727] Elevated intracellular calcium levels causes the contraction of the filaments of actomyosin responsible for the exocytosis of insulin granules stored in vesicles.[A177715] Glimepiride blocks the ATP-sensitive potassium channel by binding non-specifically to the B sites of both sulfonylurea receptor-1 (SUR1) and sulfonylurea receptor-2A (SUR2A) subunits as well as the A site of SUR1 subunit of the channel to promote insulin secretion from the beta cell.[A177715]	Glimepiride is completely absorbed after oral administration within 1 hour of administration with a linear pharmacokinetics profile.[A177703] Following administration of a single oral dose of glimepiride in healthy subjects and with multiple oral doses with type 2 diabetes, the peak plasma concentrations (Cmax) were reached after 2 to 3 hours post-dose.[L10319] Accumulation does not occur after multiple doses.[A177703] When glimepiride was given with meals, the time to reach Cmax was increased by 12% while the mean and AUC (area under the curve) were decreased by 8 to 9%, respectively.[L10322] In a pharmacokinetic study of Japanese patients with T2DM, Cmax value in once-daily dose was higher than those in twice-daily doses.[A177724] The absolute bioavailability of glimepiride is reported to be complete following oral administration.[A177721]	Glimepiride is reported to undergo hepatic metabolism. Following either an intravenous or oral dose, glimepiride undergoes oxidative biotransformation mediated by CYP2C9 enzyme to form a major metabolite, cyclohexyl hydroxymethyl derivative (M1), that is pharmacologically active. M1 can be further metabolized to the inactive metabolite carboxyl derivative (M2) by one or several cytosolic enzymes. M1 retained approximately one third of the pharmacologic activity of its parent in an animal model, with a half-life of 3-6 hours.[A177715] However, whether the glucose-lowering effect of M1 is clinically significant is not clear.	The oral LD50 value in rats is > 10000 mg/kg.[MSDS] The intraperitoneal LD50 value in rats is reported to be 3950 mg/kg [MSDS]. Although glimepiride is reported to have fewer risks of hypoglycemia compared to other sulfonylureas such as glyburide, overdosage of glimepiride may result in severe hypoglycemia with coma, seizure, or other neurological impairment may occur. This can be treated with glucagon or intravenous glucose. Continued observation and additional carbohydrate intake may be necessary since hypoglycemia may recur after apparent clinical recovery.[L10319] In a study of rats given doses of up to 5000 parts per million (ppm) in complete feed for 30 months, there were no signs of carcinogenesis. Meanwhile, the administration of glimepiride at a dose much higher than the maximum human recommended dose for 24 months in mice resulted in an increase in benign pancreatic adenoma formation in a dose-related manner, which was thought to be the result of chronic pancreatic stimulation.[L10319] Glimepiride was non-mutagenic in _in vitro_ and _in vivo_ mutagenicity studies. In male and female rat studies, glimepiride was shown to have no effects on fertility.[L10319]	The elimination half-life of glimepiride is approximately 5 to 8 hours,[A177715] which can increase up to 9 hours following multiple doses.[A177709]	Plasma protein binding of glimepiride is greater than 99.5%.[L10319]	Following oral administration of glimepiride in healthy male subjects, approximately 60% of the total radioactivity was recovered in the urine in 7 days, with M1 and M2 accounting for 80-90% of the total radioactivity recovered in the urine. The ratio of M1 to M2 was approximately 3:2 in two subjects and 4:1 in one subject.[L10319] Approximately 40% of the total radioactivity was recovered in feces where M1 and M2 accounted for about 70% of the radioactivity and a ratio of M1 to M2 being 1:3. No parent drug was recovered from urine or feces.[L10319]	Following intravenous dosing in healthy subjects, the volume of distribution was 8.8 L (113 mL/kg).[L10319]	A single-dose, crossover, dose-proportionality (1, 2, 4, and 8 mg) study in normal subjects and from a single- and multiple-dose, parallel, dose proportionality (4 and 8 mg) study in patients with type 2 diabetes (T2D) were performed. In these studies, the total body clearance was 52.1 +/- 16.0 mL/min, 48.5 +/- 29.3 mL/min in patients with T2D given a single oral dose, and 52.7 +/- 40.3 mL/min in patients with T2D given multiple oral doses.[L10322] Following intravenous dosing in healthy subjects, the total body clearance was 47.8 mL/min.[L10319]	Organic compounds	Benzenoids	Benzene and substituted derivatives	Benzenesulfonamides	[ "approved" ]	[ "A10BD", "A10B", "A10", "A", "A10BB", "A10B", "A10", "A", "A10BD", "A10B", "A10", "A" ]	[ "Humans and other mammals" ]	[ { "cost": "1.25", "description": "Amaryl 2 mg tablet", "unit": "tablet" }, { "cost": "1.25", "description": "Glimepiride 4 mg tablet", "unit": "tablet" }, { "cost": "2.11", "description": "Amaryl 4 mg tablet", "unit": "tablet" }, { "cost": "0.42", "description": "Glimepiride 1 mg tablet", "unit": "tablet" }, { "cost": "0.67", "description": "Glimepiride 2 mg tablet", "unit": "tablet" }, { "cost": "0.88", "description": "Amaryl 1 mg tablet", "unit": "tablet" } ]	[ { "approved": "2000-11-21", "country": "United States", "expires": "2016-06-19", "number": "6150383" }, { "approved": "2001-04-03", "country": "United States", "expires": "2016-06-19", "number": "6211205" }, { "approved": "2001-10-16", "country": "United States", "expires": "2016-08-09", "number": "6303640" }, { "approved": "2001-12-11", "country": "United States", "expires": "2016-06-19", "number": "6329404" }, { "approved": "2011-12-06", "country": "United States", "expires": "2028-06-08", "number": "8071130" }, { "approved": "2009-05-26", "country": "United States", "expires": "2016-06-19", "number": "7538125" }, { "approved": "2010-04-20", "country": "United States", "expires": "2027-01-30", "number": "7700128" }, { "approved": "2008-04-15", "country": "United States", "expires": "2020-10-19", "number": "7358366" } ]	Glimepirida \| Glimepiride \| Glimépiride \| Glimepiridum \| Sulfonylurea receptor 2 \| SUR2 \| IKATP \| Inward rectifier K(+) channel Kir6.2 \| Potassium channel, inwardly rectifying subfamily J member 11 \| ATP-regulated potassium channel ROM-K \| Inward rectifier K(+) channel Kir1.1 \| Potassium channel, inwardly rectifying subfamily J member 1 \| ROMK1 \| HRINS \| Sulfonylurea receptor 1 \| SUR \| SUR1 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP	[ "Amaryl", "Amaryl", "Amaryl", "Amaryl", "Amaryl", "Amaryl", "Amaryl", "Amaryl", "Amaryl", "Apo-glimepiride", "Apo-glimepiride", "Apo-glimepiride", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Co Glimepiride", "Co Glimepiride", "Co Glimepiride", "Duetact", "Duetact", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride", "Glimepiride 3 mg", "Novo-glimepiride", "Novo-glimepiride", "Novo-glimepiride", "Pioglitazone and Glimepiride", "Pioglitazone and Glimepiride", "Pioglitazone hydrochloride and glimepiride", "Pioglitazone hydrochloride and glimepiride", "PMS-glimepiride", "PMS-glimepiride", "PMS-glimepiride", "Ratio-glimepiride", "Ratio-glimepiride", "Ratio-glimepiride", "Sandoz Glimepiride", "Sandoz Glimepiride", "Sandoz Glimepiride", "Sandoz Glimepiride", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact" ]	[ "GLIMPID", "GLIMY" ]	[ "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Avandaryl", "Duetact", "Duetact", "Pioglitazone and Glimepiride", "Pioglitazone and Glimepiride", "Pioglitazone hydrochloride and glimepiride", "Pioglitazone hydrochloride and glimepiride", "Avandaryl", "Avandaryl", "Avandaryl", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Avaglim", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact", "Tandemact" ]	[ "O60706", "Q14654", "P48048", "Q09428" ]	[ "P11712" ]	[]	[ "O95342" ]
DB00223	Diflorasone	Diflorasone is a topical corticosteroid used to treat itching and inflammation of the skin.	solid	For relief of the inflammatory and pruritic manifestations of corticosteroid responsive dermatoses.	Like other topical corticosteroids, diflorasone has anti-inflammatory, antipruritic, and vasoconstrictive properties. Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. Diflorasone is a potent topical corticosteroid that should not be used with occlusive dressings. It is recommended that treatment should be limited to 2 consecutive weeks and therapy should be discontinued when adequate results have been achieved.	The precise mechanism of the antiinflammatory activity of topical steroids in the treatment of steroid-responsive dermatoses, in general, is uncertain. However, corticosteroids are thought to act by the induction of phospholipase A<sub>2</sub> inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A<sub>2</sub>.	Topical corticosteroids can be absorbed from intact healthy skin. The extent of percutaneous absorption of topical corticosteroids is determined by many factors, including the vehicle and the integrity of the epidermal barrier. Occlusion, inflammation and/or other disease processes in the skin may also increase percutaneous absorption.	Metabolized, primarily in the liver, and then excreted by the kidneys.	Topically applied diflorasone can be absorbed in sufficient amounts to produce systemic effects. Symptoms of overdose include thinning of skin and suppression of adrenal cortex (decreased ability to respond to stress).	null	Bound to plasma proteins in varying degrees.	null	null	null	Organic compounds	Lipids and lipid-like molecules	Steroids and steroid derivatives	Hydroxysteroids	[ "approved" ]	[ "D07AC", "D07A", "D07", "D" ]	[ "Humans and other mammals" ]	[ { "cost": "1.5", "description": "Diflorasone 0.05% cream", "unit": "g" }, { "cost": "3.45", "description": "Psorcon 0.05% cream", "unit": "g" }, { "cost": "38.05", "description": "Diflorasone Diacetate 0.05% Ointment 15 gm Tube", "unit": "tube" }, { "cost": "38.25", "description": "Diflorasone Diacetate 0.05% Cream 15 gm Tube", "unit": "tube" }, { "cost": "52.29", "description": "Diflorasone Diacetate 0.05% Ointment 30 gm Tube", "unit": "tube" }, { "cost": "52.81", "description": "Diflorasone Diacetate 0.05% Cream 30 gm Tube", "unit": "tube" }, { "cost": "100.5", "description": "Diflorasone Diacetate 0.05% Ointment 60 gm Tube", "unit": "tube" }, { "cost": "101.11", "description": "Diflorasone Diacetate 0.05% Cream 60 gm Tube", "unit": "tube" }, { "cost": "137.58", "description": "Psorcon 0.05% Cream 60 gm Tube", "unit": "tube" }, { "cost": "145.75", "description": "Psorcon 0.05% Ointment 60 gm Tube", "unit": "tube" } ]	[]	(6α,11β,16β)-6,9-difluoro-11,17,21-trihydroxy-16-methylpregna-1,4-diene-3,20-dione \| Diflorasona \| Diflorasone \| Diflorasonum \| 3.1.1.4 \| Group IB phospholipase A2 \| Phosphatidylcholine 2-acylhydrolase 1B \| PLA2 \| PLA2A \| PPLA2 \| GR \| GRL \| Nuclear receptor subfamily 3 group C member 1	[ "ApexiCon", "ApexiCon E", "ApexiCon E", "ApexiCon E", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate", "Diflorasone Diacetate Oint", "Florone", "Florone Crm 0.05%", "Florone Ont 0.05%", "Psorcon", "Psorcon", "Psorcon", "Psorcon", "Psorcon E", "Psorcon E" ]	[ "Florone E", "Maxiflor" ]	[]	[ "P04054", "P04150" ]	[]	[]	[]
DB00224	Indinavir	A potent and specific HIV protease inhibitor that appears to have good oral bioavailability. [PubChem]	solid	Indinavir is an antiretroviral drug for the treatment of HIV infection.	Indinavir is a protease inhibitor with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Protease inhibitors block the part of HIV called protease. HIV-1 protease is an enzyme required for the proteolytic cleavage of the viral polyprotein precursors into the individual functional proteins found in infectious HIV-1. Indinavir binds to the protease active site and inhibits the activity of the enzyme. This inhibition prevents cleavage of the viral polyproteins resulting in the formation of immature non-infectious viral particles. Protease inhibitors are almost always used in combination with at least two other anti-HIV drugs.	Indinavir inhibits the HIV viral protease enzyme which prevents cleavage of the gag-pol polyprotein, resulting in noninfectious, immature viral particles.	Rapidly absorbed	Hepatic. Seven metabolites have been identified, one glucuronide conjugate and six oxidative metabolites. In vitro studies indicate that cytochrome P-450 3A4 (CYP3A4) is the major enzyme responsible for formation of the oxidative metabolites.	Symptoms of overdose include myocardial infarction and angina pectoris.	1.8 (± 0.4) hours	60%	Less than 20% of indinavir is excreted unchanged in the urine.	null	null	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved" ]	[ "J05AE", "J05A", "J05", "J" ]	[ "Human Immunodeficiency Virus" ]	[ { "cost": "1.52", "description": "Crixivan 200 mg capsule", "unit": "each" }, { "cost": "2.54", "description": "Crixivan 333 mg capsule", "unit": "each" }, { "cost": "2.86", "description": "Crixivan 400 mg capsule", "unit": "each" }, { "cost": "570.02", "description": "Crixivan 360 200 mg capsule Bottle", "unit": "bottle" }, { "cost": "0.76", "description": "Crixivan 100 mg capsule", "unit": "each" } ]	[ { "approved": "1995-05-09", "country": "United States", "expires": "2012-05-09", "number": "5413999" }, { "approved": "1997-07-08", "country": "Canada", "expires": "2012-11-02", "number": "2081970" }, { "approved": "2004-02-10", "country": "United States", "expires": "2021-02-10", "number": "6689761" }, { "approved": "2003-11-11", "country": "United States", "expires": "2018-03-04", "number": "6645961" } ]	(1(1S,2R),5(S))-2,3,5-Trideoxy-N-(2,3-dihydro-2-hydroxy-1H-inden-1-yl)-5-(2-(((1,1-dimethylethyl)amino)carbonyl)-4-(3-pyridinylmethyl)-1-piperazinyl)-2-(phenylmethyl)-D-erythro-pentonamide \| Indinavir \| Indinavir anhydrous \| Pr160Gag-Pol \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 2.4.1.17 \| Bilirubin-specific UDPGT isozyme 1 \| GNT1 \| hUG-BR1 \| UDP-glucuronosyltransferase 1-1 \| UDP-glucuronosyltransferase 1A isoform 1 \| UDPGT 1-1 \| UGT1 \| UGT1-01 \| UGT1.1 \| UGT1*1 \| UGT1A1 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| hOCT1 \| OCT1 \| Organic cation transporter 1 \| 7.6.2.2 \| ATP-binding cassette sub-family C member 1 \| Glutathione-S-conjugate-translocating ATPase ABCC1 \| Leukotriene C(4) transporter \| LTC4 transporter \| MRP \| MRP1 \| OATP \| OATP-1 \| OATP-A \| OATP1 \| OATP1A2 \| Organic anion-transporting polypeptide 1 \| SLC21A3 \| Sodium-independent organic anion transporter \| Solute carrier family 21 member 3 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| 7.6.2.- \| 7.6.2.2 \| 7.6.2.3 \| Canalicular multidrug resistance protein \| Canalicular multispecific organic anion transporter 1 \| CMOAT \| CMOAT1 \| CMRP \| MRP2 \| Multidrug resistance-associated protein 2 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP	[ "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan", "Crixivan" ]	[ "Crixivan" ]	[]	[ "P03366" ]	[ "P10635", "P22309", "P08684", "P20815", "P24462" ]	[]	[ "P08183", "O15245", "P33527", "P46721", "Q9Y6L6", "Q92887", "O94956", "O95342" ]
DB00225	Gadodiamide	Gadodiamide is a linear, non-ionic gadolinium-based contrast agent (GBCA) that is used in magnetic resonance imaging (MRI) procedures to assist in the visualization of blood vessels.[A263086,A263091] GBCAs constitute the largest group of MR agents, and they are thought to be safer than nonionic iodinated contrast agents.[A263096] Approved by the FDA in 1993, gadodiamide is the first non-ionic GBCA to be used.[A263101] However, since linear, non-ionic GBCA is less stable than macrocyclic or ionic GBCA, gadodiamide can potentially lead to more gadolinium retention in the brain and thus more likely to cause side effects.[A263106]	liquid	Gadodiamide is indicated for the visualization of lesions with abnormal vascularity in the brain (intracranial lesions), spine, and associated tissues and the body (including the thoracic (noncardiac), abdominal, pelvic cavities, and retroperitoneal space) by the FDA and Health Canada.[L36873,L49881] Additionally, gadoliamide is approved by Health Canada to detect and localize tenosis in renal arteries and aorto-iliac arteries in magnetic resonance angiography (MRA).[L36873]	In magnetic resonance imaging, visualization of normal and pathologic tissue depends in part on variations in the radiofrequency signal intensity. These variations occur due to: changes in proton density; alteration of the spin-lattice or longitudinal relaxation time (T1); and variation of the spin-spin or transverse relaxation time (T2). Gadodiamide is a paramagnetic agent with unpaired electron spins which generate a local magnetic field. As water protons move through this local magnetic field, the changes in the magnetic field experienced by the protons reorient them with the main magnetic field more quickly than in the absence of a paramagnetic agent.[L49881] By increasing the relaxation rate, gadodiamide decreases both the T1 and T2 relaxation times in tissues where it is distributed. At clinical doses, the effect is primarily on the T1 relaxation time and produces an increase in signal intensity. Disruption of the blood-brain barrier or abnormal vascularity allows the accumulation of gadodiamide in lesions such as neoplasms, abscesses, and subacute infarcts. The pharmacokinetic parameters of gadodiamide in various lesions are not known.[L49881]	Gadodiamide paramagnetic molecule that develops a magnetic moment when placed in a magnetic field. The magnetic moment alters the relaxation rates of water protons in its vicinity in the body. Its use in magnetic resonance imaging (MRI) allows to selectively increase contrast in tissues where gadodiamide accumulates.[L49881]	The pharmacokinetics of intravenously administered gadodiamide in normal subjects conforms to an open, two-compartment model.[L49881]	There is no detectable biotransformation or decomposition of gadodiamide.	GBCAs cross the human placenta and result in fetal exposure and gadolinium retention. The human data on the association between GBCAs and adverse fetal outcomes are limited and inconclusive. In animal reproduction studies, no adverse fetal effects were observed with the administration of gadodiamide to pregnant rats during organogenesis at doses 1.3 times the maximum human dose based on body surface area. Because of the potential risks of gadolinium to the fetus, use gadodiamide only if imaging is essential during pregnancy and cannot be delayed.[L49881] Clinical consequences of overdose with gadodiamide have not been reported. The minimum lethal dose of intravenously administered gadodiamide in rats and mice is greater than 20 mmol/kg (200 times the recommended human dose of 0.1 mmol/kg; 67 times the cumulative 0.3 mmol/kg dose). Gadodiamide is dialyzable.[L49881] Long-term animal studies have not been performed to evaluate the carcinogenic potential of gadodiamide. The results of the following genotoxicity assays were negative: in vitro bacterial reverse mutation assay, in vitro Chinese Hamster Ovary (CHO)/Hypoxanthine Guanine Phosphoribosyl Transferase (HGPT) forward mutation assay, in vitro CHO chromosome aberration assay, and the in vivo mouse micronucleus assay at intravenous doses of 27 mmol/kg (approximately 7 times the maximum human dose based on a body surface area comparison). Impairment of male or female fertility was not observed in rats after intravenous administration three times per week at the maximum dose tested of 1.0 mmol/kg (approximately 0.5 times the maximum human dose based on a body surface area comparison).[L49881]	The mean distribution and elimination half-lives (reported as mean ± SD) were calculated to be of 3.7 ± 2.7 minutes and 77.8 ± 16 minutes, respectively.[L49881]	Gadodiamide does not bind to human serum proteins in vitro.[L49881]	Gadodiamide is eliminated primarily in the urine with 95.4 ± 5.5% (mean ± SD) of the administered dose eliminated by 24 hours.[L49881]	The volume of distribution of gadodiamide (200 ± 61 mL/kg) is equivalent to that of extracellular water. Following GBCA administration, gadolinium is present for months or years in the brain, bone, skin, and other organs.[L49881]	The renal and plasma clearance rates of gadodiamide are nearly identical (1.7 and 1.8 mL/min/kg, respectively), and are similar to that of substances excreted primarily by glomerular filtration.[L49881]	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved", "investigational" ]	[ "V08CA", "V08C", "V08", "V" ]	[ "Humans and other mammals" ]	[ { "cost": "6.49", "description": "Omniscan 287 mg/ml bottle", "unit": "ml" }, { "cost": "6.98", "description": "Omniscan 287 mg/ml vial", "unit": "ml" }, { "cost": "7.02", "description": "Omniscan prefill plus syringe", "unit": "ml" } ]	[ { "approved": "1996-10-01", "country": "United States", "expires": "2013-10-01", "number": "5560903" }, { "approved": "1994-11-08", "country": "United States", "expires": "2011-11-08", "number": "5362475" }, { "approved": "1995-06-06", "country": "Canada", "expires": "2012-06-06", "number": "1335819" } ]	Gadodiamida \| Gadodiamide \| Gadodiamide anhydrous	[ "Omniscan", "Omniscan", "Omniscan", "Omniscan Liq IV 287mg/ml" ]	[]	[]	[]	[]	[]	[]
DB00226	Guanadrel	Guanadrel is an antihypertensive agent and postganglionic adrenergic blocking agent.	solid	Used to treat and control hypertension.	High blood pressure adds to the work load of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled. Guanadrel works by controlling nerve impulses along certain nerve pathways. As a result, it relaxes the blood vessels so that blood passes through them more easily. This helps to lower blood pressure.	Guanadrel is an adrenergic neuron inhibitor that slowly displaces norepinephrine from its storage in nerve endings. It blocks the release of norepinephrine in response to the sympathetic nerve stimulation, leading to reduced arteriolar vasoconstriction, especially the reflex increase in sympathetic tone that occurs with a change in position.	Rapidly and readily absorbed from the gastrointestinal tract.	Primarily hepatic	Side effects include dizziness, drowsiness, headache, constipation, diarrhea, gas pains, loss of appetite, fatigue, and nasal congestion.	10 hours	Low, approximately 20%	null	null	null	Organic compounds	Organic oxygen compounds	Organooxygen compounds	Ethers	[ "approved" ]	[]	[ "Humans and other mammals" ]	[]	[]	Guanadrel \| Guanadrelum \| NAT1 \| NET \| NET1 \| Norepinephrine transporter \| SLC6A5 \| Solute carrier family 6 member 2	[]	[ "Anarel", "Hylorel" ]	[]	[ "P23975" ]	[]	[]	[]
DB00228	Enflurane	Enflurane is a halogenated inhalational anesthetic initially approved by the FDA in 1972. Since this date, it has been withdrawn from the US market.[L13646,L13649] Unlike its other inhalational anesthetic counterparts including [isoflurane] and [halothane], enflurane is known to induce seizure activity. In addition, it is known to cause increased cardio depressant effects when compared to other inhaled anesthetics.[A202022]	liquid	Enflurane may be used for both the induction and maintenance of general anesthesia. It can also be used to induce analgesia for vaginal delivery. Low concentrations of enflurane can also be used as an adjunct to general anesthetic drugs during delivery by Cesarean section.[L13646]	Enflurane rapidly induces anesthesia via the stimulation of inhibitory neural channels and the inhibition of excitatory neural channels. Muscle relaxation, obtundation of pharyngeal and laryngeal reflexes, and lowering of blood pressure are some of the main pharmacodynamic effects of this drug.[L13643] Enflurane also decreases cardiac muscle contractility.[A202022] High concentrations of enflurane may lead to uterine relaxation and increase the risk of uterine bleeding during delivery.[L13643] Rare but clinically significant elevations in ALT may indicate hepatoxicity from the use of enflurane.[A202016] In some susceptible patients, enflurane may cause malignant hyperthermia.[L13643]	The mechanism of action of enflurane is not completely established.[L13643] Studies on rats indicate that enflurane binds to GABAA and glycine receptors, causing depressant effects at the ventral neural horn. It has been reported that 30% of the central nervous system depressant effects on the spinal cord after enflurane is administered are caused by the (GABA-A) receptor while binding to glycine receptors is responsible for about 20 % of the depressant effects.[A10308] The relevance of these findings to humans is unknown. Other studies have found that enflurane binds to the calcium channels in the cardiac sarcoplasmic reticulum causing cardio depressant effects.[A202082,A202091,A202094] Other studies support that this drug potentiates glycine receptors, which results in central nervous system depressant effects.[A202097,A11019]	Enflurane is rapidly absorbed into the circulation through the lungs.[A203216,L13646] The minimum alveolar concentration is oxygen is 1.68%.[A202022]	Enflurane is metabolized by the CYP2E1 enzyme in the liver to produce inorganic fluoride ions, the major metabolite of enflurane metabolism.[A202118] One reference indicates that enflurane is only 2-5% eliminated after oxidative metabolism in the liver, however more recent evidence suggests that about 9% is eliminated via hepatic oxidation.[A202022]	The LD50 of enflurane in rats is 14000 ppm/3 hour(s) when inhaled.[L13871] There is limited information in the literature about enflurane overdose. Hepatotoxicity, cardiotoxicity, nephrotoxicity, and neurotoxicity are expected.[L13646] One report in the literature of an enflurane overdose describes an accidental fatal overdose in a 21-year-old male.[A203174] About 72 hours after death, high amounts of enflurane were found in the brain, blood, and subcutaneous fat. Gas chromatographic studies revealed enflurane concentrations of 350 mg/l-1 in the brain, 130 mg/l-1 in the blood, and 100 mg/l-1 in the subcutaneous fat.[A203174] In the event of an enflurane overdose, immediately stop the administration of enflurane, establish a patent airway, and administer pure oxygen by assisted or controlled ventilation.[L13646]	null	The plasma protein binding for enflurane is 97%.[T785]	Metabolism accounts for 5-9% of enflurane elimination, sometimes causing nephrotoxicity. Excretion through the skin is believed to be minimal.[A202022]	Enflurane distributes to the brain, blood, and subcutaneous fat.[A203174]	null	Organic compounds	Organohalogen compounds	Organofluorides	null	[ "approved", "investigational", "vet_approved" ]	[ "N01AB", "N01A", "N01", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "0.55", "description": "Ethrane inhalation", "unit": "ml" } ]	[]	2-chloro-1,1,2-trifluoroethyl difluoromethyl ether \| Alyrane \| Efrane \| Enflurane \| Enflurano \| Enfluranum \| Methylflurether \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-4 \| GABAAR subunit alpha-4 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit alpha-6 \| GABAAR subunit alpha-6 \| GABA(A) receptor subunit beta-1 \| GABAAR subunit beta-1 \| GABA(A) receptor subunit beta-2 \| GABAAR subunit beta-2 \| GABA(A) receptor subunit beta-3 \| GABAAR subunit beta-3 \| GABA(A) receptor subunit delta \| GABAAR subunit delta \| GABA(A) receptor subunit epsilon \| GABAAR subunit epsilon \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| GABA(A) receptor subunit pi \| GABAAR subunit pi \| GABA(A) receptor subunit theta \| GABAAR subunit theta \| CACNLG \| Dihydropyridine-sensitive L-type, skeletal muscle calcium channel subunit gamma \| Neuronal voltage-gated calcium channel gamma-2 subunit \| TARP gamma-2 \| Transmembrane AMPAR regulatory protein gamma-2 \| Neuronal voltage-gated calcium channel gamma-3 subunit \| TARP gamma-3 \| Transmembrane AMPAR regulatory protein gamma-3 \| Neuronal voltage-gated calcium channel gamma-4 subunit \| TARP gamma-4 \| Transmembrane AMPAR regulatory protein gamma-4 \| Neuronal voltage-gated calcium channel gamma-5 subunit \| TARP gamma-5 \| Transmembrane AMPAR regulatory protein gamma-5 \| Neuronal voltage-gated calcium channel gamma-6 subunit \| Neuronal voltage-gated calcium channel gamma-7 subunit \| TARP gamma-7 \| Transmembrane AMPAR regulatory protein gamma-7 \| CACNG6 \| Neuronal voltage-gated calcium channel gamma-8 subunit \| TARP gamma-8 \| Transmembrane AMPAR regulatory protein gamma-8 \| CACNL2A \| CCHL2A \| MHS3 \| Voltage-gated calcium channel subunit alpha-2/delta-1 \| KIAA0558 \| Voltage-gated calcium channel subunit alpha-2/delta-2 \| Voltage-gated calcium channel subunit alpha-2/delta-3 \| Voltage-gated calcium channel subunit alpha-2/delta-4 \| CACH2 \| CACN2 \| CACNL1A1 \| Calcium channel, L type, alpha-1 polypeptide, isoform 1, cardiac muscle \| CCHL1A1 \| Voltage-gated calcium channel subunit alpha Cav1.2 \| CACH3 \| CACN4 \| CACNL1A2 \| Calcium channel, L type, alpha-1 polypeptide, isoform 2 \| CCHL1A2 \| Voltage-gated calcium channel subunit alpha Cav1.3 \| CACNAF1 \| Voltage-gated calcium channel subunit alpha Cav1.4 \| CACH1 \| CACN1 \| CACNL1A3 \| Calcium channel, L type, alpha-1 polypeptide, isoform 3, skeletal muscle \| Voltage-gated calcium channel subunit alpha Cav1.1 \| CAB1 \| CACNLB1 \| Calcium channel voltage-dependent subunit beta 1 \| CAB2 \| CACNLB2 \| Calcium channel voltage-dependent subunit beta 2 \| Lambert-Eaton myasthenic syndrome antigen B \| MYSB \| CAB3 \| CACNLB3 \| Calcium channel voltage-dependent subunit beta 3 \| CAB4 \| CACNLB4 \| Calcium channel voltage-dependent subunit beta 4 \| BIII \| Brain calcium channel III \| CACH5 \| CACNL1A5 \| Calcium channel, L type, alpha-1 polypeptide isoform 5 \| Voltage-gated calcium channel subunit alpha Cav2.2 \| BI \| Brain calcium channel I \| CACH4 \| CACN3 \| CACNL1A4 \| Calcium channel, L type, alpha-1 polypeptide isoform 4 \| Voltage-gated calcium channel subunit alpha Cav2.1 \| BII \| Brain calcium channel II \| CACH6 \| CACNL1A6 \| Calcium channel, L type, alpha-1 polypeptide, isoform 6 \| Voltage-gated calcium channel subunit alpha Cav2.3 \| Cav3.1c \| KIAA1123 \| NBR13 \| Voltage-gated calcium channel subunit alpha Cav3.1 \| Low-voltage-activated calcium channel alpha1 3.2 subunit \| Voltage-gated calcium channel subunit alpha Cav3.2 \| Ca(v)3.3 \| KIAA1120 \| Voltage-gated calcium channel subunit alpha Cav3.3 \| Glycine receptor 48 kDa subunit \| Glycine receptor strychnine-binding subunit \| Potassium voltage-gated channel subfamily D member 1 \| Shal-type potassium channel KCND1 \| Voltage-gated potassium channel subunit Kv4.1 \| KIAA1044 \| Potassium voltage-gated channel subfamily D member 2 \| Voltage-gated potassium channel subunit Kv4.2 \| Potassium voltage-gated channel subfamily D member 3 \| Voltage-gated potassium channel subunit Kv4.3 \| Delayed-rectifier K(+) channel alpha subunit 1 \| Delayed-rectifier potassium channel subunit Kv9.1 \| hKv9.1 \| Potassium voltage-gated channel modifier subfamily S member 1 \| Delayed-rectifier K(+) channel alpha subunit 3 \| Delayed-rectifier potassium channel subunit Kv9.3 \| Kv9.3 \| Potassium voltage-gated channel subfamily S member 3 \| Voltage-gated K(+) channel HuKI \| Voltage-gated potassium channel HBK1 \| Voltage-gated potassium channel subunit Kv1.1 \| Voltage-gated potassium channel subunit Kv1.8 \| NGK1 \| Voltage-gated K(+) channel HuKIV \| Voltage-gated potassium channel HBK5 \| Voltage-gated potassium channel subunit Kv1.2 \| HGK5 \| HLK3 \| HPCN3 \| Voltage-gated K(+) channel HuKIII \| Voltage-gated potassium channel subunit Kv1.3 \| HPCN2 \| KCNA4L \| Voltage-gated K(+) channel HuKII \| Voltage-gated potassium channel HBK4 \| Voltage-gated potassium channel HK1 \| Voltage-gated potassium channel subunit Kv1.4 \| HPCN1 \| Voltage-gated potassium channel HK2 \| Voltage-gated potassium channel subunit Kv1.5 \| Voltage-gated potassium channel HBK2 \| Voltage-gated potassium channel subunit Kv1.6 \| Delayed rectifier potassium channel 1 \| DRK1 \| h-DRK1 \| Voltage-gated potassium channel subunit Kv2.1 \| Voltage-gated potassium channel subunit Kv2.2 \| Delayed rectifier potassium channel subunit IsK \| IKs producing slow voltage-gated potassium channel subunit beta Mink \| Minimal potassium channel \| MinK \| Minimum potassium ion channel-related peptide 1 \| MinK-related peptide 1 \| MiRP1 \| Potassium channel subunit beta MiRP1 \| Minimum potassium ion channel-related peptide 2 \| MinK-related peptide 2 \| MiRP2 \| Potassium channel subunit beta MiRP2 \| Minimum potassium ion channel-related peptide 3 \| MinK-related peptide 3 \| MiRP3 \| Potassium channel subunit beta MiRP3 \| AMME syndrome candidate gene 2 protein \| AMMECR2 \| KCNE1L \| Potassium channel subunit beta MiRP4 \| Potassium voltage-gated channel subfamily E member 1-like protein \| IKs producing slow voltage-gated potassium channel subunit alpha KvLQT1 \| KCNA8 \| KCNA9 \| KQT-like 1 \| KVLQT1 \| Voltage-gated potassium channel subunit Kv7.1 \| KQT-like 2 \| Neuroblastoma-specific potassium channel subunit alpha KvLQT2 \| Voltage-gated potassium channel subunit Kv7.2 \| KQT-like 3 \| Potassium channel subunit alpha KvLQT3 \| Voltage-gated potassium channel subunit Kv7.3 \| KQT-like 4 \| Potassium channel subunit alpha KvLQT4 \| Voltage-gated potassium channel subunit Kv7.4 \| KQT-like 5 \| Potassium channel subunit alpha KvLQT5 \| Voltage-gated potassium channel subunit Kv7.5 \| Neuronal potassium channel alpha subunit HNKA \| Voltage-gated potassium channel subunit Kv8.1 \| Voltage-gated potassium channel subunit Kv8.2 \| EAG \| EAG channel 1 \| EAG1 \| Ether-a-go-go potassium channel 1 \| h-eag \| hEAG1 \| Potassium voltage-gated channel subfamily H member 1 \| Voltage-gated potassium channel subunit Kv10.1 \| BEC2 \| Brain-specific eag-like channel 2 \| ELK channel 1 \| ELK1 \| Ether-a-go-go-like potassium channel 1 \| Potassium voltage-gated channel subfamily H member 4 \| Voltage-gated potassium channel subunit Kv12.3 \| EAG2 \| Ether-a-go-go potassium channel 2 \| hEAG2 \| Potassium voltage-gated channel subfamily H member 5 \| Voltage-gated potassium channel subunit Kv10.2 \| ELK channel 3 \| ELK1 \| ELK3 \| Ether-a-go-go-like potassium channel 3 \| hElk-1 \| Potassium voltage-gated channel subfamily H member 8 \| Voltage-gated potassium channel subunit Kv12.1 \| Eag homolog \| Eag-related protein 1 \| ERG \| ERG-1 \| ERG1 \| Ether-a-go-go-related gene potassium channel 1 \| Ether-a-go-go-related protein 1 \| H-ERG \| HERG \| hERG-1 \| hERG1 \| Potassium voltage-gated channel subfamily H member 2 \| Voltage-gated potassium channel subunit Kv11.1 \| BEC1 \| Brain-specific eag-like channel 1 \| ELK channel 2 \| ELK2 \| Ether-a-go-go-like potassium channel 2 \| KIAA1282 \| Potassium voltage-gated channel subfamily H member 3 \| Voltage-gated potassium channel subunit Kv12.2 \| Eag-related protein 2 \| ERG-2 \| ERG2 \| Ether-a-go-go-related gene potassium channel 2 \| Ether-a-go-go-related protein 2 \| hERG-2 \| hERG2 \| Potassium voltage-gated channel subfamily H member 6 \| Voltage-gated potassium channel subunit Kv11.2 \| Eag-related protein 3 \| ERG-3 \| ERG3 \| Ether-a-go-go-related gene potassium channel 3 \| Ether-a-go-go-related protein 3 \| hERG-3 \| Potassium voltage-gated channel subfamily H member 7 \| Voltage-gated potassium channel subunit Kv11.3 \| NGK2 \| Potassium voltage-gated channel subfamily C member 1 \| Voltage-gated potassium channel subunit Kv3.1 \| Voltage-gated potassium channel subunit Kv4 \| Potassium voltage-gated channel subfamily C member 2 \| Shaw-like potassium channel \| Voltage-gated potassium channel Kv3.2 \| KSHIIID \| Potassium voltage-gated channel subfamily C member 3 \| Voltage-gated potassium channel subunit Kv3.3 \| C1orf30 \| KSHIIIC \| Potassium voltage-gated channel subfamily C member 4 \| Voltage-gated potassium channel subunit Kv3.4 \| kH1 \| Potassium voltage-gated channel subfamily F member 1 \| Voltage-gated potassium channel subunit Kv5.1 \| kH2 \| Potassium voltage-gated channel subfamily G member 1 \| Voltage-gated potassium channel subunit Kv6.1 \| Cardiac potassium channel subunit \| KCNF2 \| Potassium voltage-gated channel subfamily G member 2 \| Voltage-gated potassium channel subunit Kv6.2 \| Potassium voltage-gated channel subfamily G member 3 \| Voltage-gated potassium channel subunit Kv10.1 \| Voltage-gated potassium channel subunit Kv6.3 \| KCNG3 \| Potassium voltage-gated channel subfamily G member 4 \| Voltage-gated potassium channel subunit Kv6.3 \| Voltage-gated potassium channel subunit Kv6.4 \| 1.1.1.- \| K(+) channel subunit beta-1 \| KCNA1B \| Kv-beta-1 \| 1.1.1.- \| hKvbeta2 \| K(+) channel subunit beta-2 \| KCNA2B \| KCNK2 \| Kv-beta-2 \| 7.2.2.10 \| ATP-dependent Ca(2+) pump PMR1 \| ATPase 2C1 \| Ca(2+)/Mn(2+)-ATPase 2C1 \| KIAA1347 \| PMR1L \| Secretory pathway Ca(2+)-transporting ATPase type 1 \| SPCA1 \| GluN1 \| Glutamate [NMDA] receptor subunit zeta-1 \| hNR1 \| N-methyl-D-aspartate receptor subunit NR1 \| NMD-R1 \| NMDAR1 \| GluN2A \| Glutamate [NMDA] receptor subunit epsilon-1 \| hNR2A \| N-methyl D-aspartate receptor subtype 2A \| NMDAR2A \| NR2A \| GluN2B \| Glutamate [NMDA] receptor subunit epsilon-2 \| hNR3 \| N-methyl D-aspartate receptor subtype 2B \| N-methyl-D-aspartate receptor subunit 3 \| NMDAR2B \| NR2B \| NR3 \| GluN2C \| Glutamate [NMDA] receptor subunit epsilon-3 \| N-methyl D-aspartate receptor subtype 2C \| NMDAR2C \| NR2C \| EB11 \| GluN2D \| Glutamate [NMDA] receptor subunit epsilon-4 \| N-methyl D-aspartate receptor subtype 2D \| NMDAR2D \| NR2D \| GluN3A \| KIAA1973 \| N-methyl-D-aspartate receptor subtype 3A \| NMDAR-L \| NMDAR3A \| NR3A \| GluN3B \| N-methyl-D-aspartate receptor subtype 3B \| NMDAR3B \| NR3B \| 7.2.2.10 \| Calcium pump 1 \| Calcium-transporting ATPase sarcoplasmic reticulum type, fast twitch skeletal muscle isoform \| Endoplasmic reticulum class 1/2 Ca(2+) ATPase \| SERCA1 \| SR Ca(2+)-ATPase 1 \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J	[ "Enflurane", "Enflurane", "Ethrane", "Ethrane Liq Inh", "Ethrane Liquid Inh" ]	[ "Alyrane", "Compound 347", "Endurane", "Enfluran" ]	[]	[ "P14867", "P47869", "P34903", "P48169", "P31644", "Q16445", "P18505", "P47870", "P28472", "O14764", "P78334", "Q8N1C3", "P18507", "Q99928", "O00591", "Q9UN88", "Q06432", "Q9Y698", "O60359", "Q9UBN1", "Q9UF02", "Q9BXT2", "P62955", "Q8WXS5", "P54289", "Q9NY47", "Q8IZS8", "Q7Z3S7", "Q13936", "Q01668", "O60840", "Q13698", "Q02641", "Q08289", "P54284", "O00305", "Q00975", "O00555", "Q15878", "O43497", "O95180", "Q9P0X4", "P23415", "Q9NSA2", "Q9NZV8", "Q9UK17", "Q96KK3", "Q9BQ31", "Q09470", "Q16322", "P16389", "P22001", "P22459", "P22460", "P17658", "Q14721", "Q92953", "P15382", "Q9Y6J6", "Q9Y6H6", "Q8WWG9", "Q9UJ90", "P51787", "O43526", "O43525", "P56696", "Q9NR82", "Q6PIU1", "Q8TDN2", "O95259", "Q9UQ05", "Q8NCM2", "Q96L42", "Q12809", "Q9ULD8", "Q9H252", "Q9NS40", "P48547", "Q96PR1", "Q14003", "Q03721", "Q9H3M0", "Q9UIX4", "Q9UJ96", "Q8TAE7", "Q8TDN1", "Q14722", "Q13303", "P98194", "Q05586", "Q12879", "Q13224", "Q14957", "O15399", "Q8TCU5", "O60391", "O14983" ]	[ "P05181" ]	[ "P02768" ]	[]
DB00229	Cefotiam	One of the cephalosporins that has a broad spectrum of activity against both gram-positive and gram-negative microorganisms.	solid	For treatment of severe infections caused by susceptible bacteria.	Cefotiam is a third generation beta-lactam cephalosporin antibiotic that works by inhibiting bacterial cell wall biosynthesis. It is a broad spectrum antibiotic that is effective against Gram positive and Gram negative bacteria.	The bactericidal activity of cefotiam results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs).	Rapidly absorbed following intramuscular injection. Bioavailability is 60% following intramuscular injection.	null	Adverse effects following overdosage include nausea, vomiting, epigastric distress, diarrhea, and convulsions.	Approximately 1 hour.	40%	null	null	null	Organic compounds	Organoheterocyclic compounds	Lactams	Beta lactams	[ "approved", "investigational" ]	[ "J01DC", "J01D", "J01", "J" ]	[ "Enteric bacteria and other eubacteria" ]	[]	[]	(6R,7R)-7-[2-(2-Amino-thiazol-4-yl)-acetylamino]-3-[1-(2-dimethylamino-ethyl)-1H-tetrazol-5-ylsulfanylmethyl]-8-oxo-5-thia-1-aza-bicyclo[4.2.0]oct-2-ene-2-carboxylic acid \| Cefotiam \| Cefotiamum \| CTM \| 2.4.1.129 \| PBP-3 \| pbpB \| Penicillin-binding protein 3 \| Peptidoglycan glycosyltransferase 3 \| PBP1 \| hOAT1 \| hPAHT \| hROAT1 \| OAT1 \| Organic anion transporter 1 \| PAH transporter \| PAHT \| Renal organic anion transporter 1 \| hOAT3 \| OAT3 \| Organic anion/dicarboxylate exchanger \| Solute carrier family 22 member 8	[]	[ "Ceradon", "Pansporin" ]	[]	[]	[]	[]	[ "Q4U2R8", "Q8TCC7" ]
DB00230	Pregabalin	Pregabalin is structurally similar to gamma-aminobutyric acid (GABA) - an inhibitory neurotransmitter.[A173995] It may be used to manage neuropathic pain, postherpetic neuralgia, and fibromyalgia among other conditions.[A187190] Although as per the FDA Label the mechanism of action has not been definitively characterized, there is evidence that pregabalin exerts its effects by binding to the α2δ subunit of voltage-dependent calcium channels.[A187190,L7066] Pregabalin is marketed by Pfizer under the trade name Lyrica and Lyrica Cr (extended release).[L1006,L7066] It may have dependence liability if misused but the risk appears to be highest in patients with current or past substance use disorders.[A31161]	solid	Pregabalin is indicated for the management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, neuropathic pain associated with spinal cord injury, and as adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older.[L7066]	Although the structure of pregabalin is similar to gamma-aminobutyric acid (GABA), it does not bind to GABA receptors.[A31163,A187190] Instead, it binds the alpha2-delta subunit of presynaptic voltage-gated calcium channels in the central nervous system.[A31163,A187190] Pregabalin does not modulate dopamine receptors, serotonin receptors, opiate receptors, sodium channels or cyclooxygenase activity.[A187190]	Although the mechanism of action has not been fully elucidated, studies involving structurally related drugs suggest that presynaptic binding of pregabalin to voltage-gated calcium channels is key to the antiseizure and antinociceptive effects observed in animal models.[L7066] By binding presynaptically to the alpha2-delta subunit of voltage-gated calcium channels in the central nervous system, pregabalin modulates the release of several excitatory neurotransmitters including glutamate, substance-P, norepinephrine, and calcitonin gene related peptide.[A31163] In addition, pregabalin prevents the alpha2-delta subunit from being trafficked from the dorsal root ganglia to the spinal dorsal horn, which may also contribute to the mechanism of action.[A36628] Although pregabalin is a structural derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), it does not bind directly to GABA or benzodiazepine receptors.[A31165]	After oral dosing administered in the fasted state, pregabalin absorption is rapid, and extensive.[A31165] Pregabalin oral bioavailability is reported to be ≥90% regardless of the dose.[A31165] Cmax is attained within 1.5 hours after single or multiple doses, and steady state is attained within 24-48 hours with repeated administration.[A31165,L7066] Both Cmax and AUC appear to be dose proportional.[A31165] Food decreases the rate of pregabalin absorption and as a result, lowers the Cmax by an estimated 25-30% and increases the Tmax to approximately 3 hours.[L7066] However, the effect of food does not appear to impact the total absorption of pregabalin in a way that is clinically relevant. As a result, pregabalin can be administered with or without food.[L7066]	Less than 2% of pregabalin is metabolized and it is excreted virtually unchanged in the urine.[A31165,L7066]	In a systematic review that included 38 randomized controlled trials, there were 20 identified adverse effects that were significantly associated with pregabalin, most of which involve the central nervous system and cognition. The identified adverse effects include vertigo, dizziness, balance disorder, incoordination, ataxia, blurred vision, diplopia, amblyopia, somnolence, confusional state, tremor, disturbance in attention, abnormal thinking, asthenia, fatigue, euphoria, edema, peripheral edema, dry mouth, and constipation [A175876]. The most common symptoms of pregabalin toxicity (dose range includes 800 mg/day and single doses up to 11,500 mg) include somnolence, confusion, restlessness, agitation, depression, affective disorder and seizures.[L9052] Since there is no antidote for pregabalin overdose, patients should receive general supportive care. If appropriate, gastric lavage or emesis may help eliminate unabsorbed pregabalin (healthcare providers should take standard precautions to maintain the airway).[L9052] Pregabalin pharmacokinetic properties suggest that extra-corporeal elimination methods including haemodialysis, may be useful in situations of severe toxicity.[A187105] However, there are cases where patients have presented with very high serum levels of pregabalin and have been successfully managed with supportive care alone.[A187105]	The elimination half life of pregabalin is 6.3 hours.[L7066]	Pregabalin is not plasma protein bound.[A31165,L7066]	Pregabalin is almost exclusively eliminated in the urine.[A187093,A187096] Further, based on preclinical studies, pregabalin does not appear to undergo racemization to the R enantiomer in the body.[A31168]	After oral administration of pregabalin, the reported apparent volume of distribution is roughly 0.5 L/kg.[L7066] Although pregabalin is not very lipophilic, it is able to cross the blood brain barrier(BBB).[A175894] System L transporters facilitate the transport of large amino acids across the BBB and it has been confirmed that pregabalin is a substrate.[L7066,A175894] This information suggests that system L transporters are responsible for pregabalin uptake into the BBB.[A175894] In rat models, pregabalin has been shown to cross the placenta.[L7066]	In young healthy subjects the mean renal clearance is estimated to be 67.0 to 80.9 mL mL/min.[L7066] Given pregabalin's lack of plasma protein binding, this clearance rate suggests that renal tubular reabsorption is involved.[L7066]	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Amino acids, peptides, and analogues	[ "approved", "investigational" ]	[ "N02BF", "N02B", "N02", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "2.75", "description": "Lyrica 200 mg capsule", "unit": "capsule" }, { "cost": "2.75", "description": "Lyrica 225 mg capsule", "unit": "capsule" }, { "cost": "2.75", "description": "Lyrica 25 mg capsule", "unit": "capsule" }, { "cost": "2.75", "description": "Lyrica 300 mg capsule", "unit": "capsule" }, { "cost": "2.88", "description": "Lyrica 100 mg capsule", "unit": "capsule" }, { "cost": "2.88", "description": "Lyrica 150 mg capsule", "unit": "capsule" }, { "cost": "2.88", "description": "Lyrica 50 mg capsule", "unit": "capsule" }, { "cost": "2.88", "description": "Lyrica 75 mg capsule", "unit": "capsule" } ]	[ { "approved": "1996-10-08", "country": "United States", "expires": "2013-10-08", "number": "5563175" }, { "approved": "2005-06-14", "country": "Canada", "expires": "2019-05-10", "number": "2327285" }, { "approved": "2001-11-20", "country": "Canada", "expires": "2018-08-18", "number": "2297163" }, { "approved": "1999-12-14", "country": "United States", "expires": "2019-06-30", "number": "6001876" }, { "approved": "2010-11-09", "country": "United States", "expires": "2019-06-30", "number": "RE41920" }, { "approved": "2001-03-06", "country": "United States", "expires": "2019-06-30", "number": "6197819" }, { "approved": "2015-09-29", "country": "United States", "expires": "2027-05-02", "number": "9144559" }, { "approved": "2015-02-03", "country": "United States", "expires": "2027-05-02", "number": "8945620" }, { "approved": "2018-07-17", "country": "United States", "expires": "2027-05-02", "number": "10022447" } ]	(S)-3-Isobutyl GABA \| 3-Isobutyl GABA \| Pregabalin \| Pregabalina \| CACNL2A \| CCHL2A \| MHS3 \| Voltage-gated calcium channel subunit alpha-2/delta-1 \| EAAC1 \| EAAT3 \| Excitatory amino-acid carrier 1 \| HEAAC1 \| Neuronal and epithelial glutamate transporter \| Sodium-dependent glutamate/aspartate transporter 3 \| Solute carrier family 1 member 1 \| 4F2 LC \| 4F2 light chain \| 4F2LC \| CD98 light chain \| CD98LC \| E16 \| hLAT1 \| Integral membrane protein E16 \| L-type amino acid transporter 1 \| LAT1 \| MPE16 \| Solute carrier family 7 member 5 \| y+ system cationic amino acid transporter	[ "Ach-pregabalin", "Ach-pregabalin", "Ach-pregabalin", "Ach-pregabalin", "Ach-pregabalin", "Ach-pregabalin", "Ach-pregabalin", "Ach-pregabalin", "Act Pregabalin", "Act Pregabalin", "Act Pregabalin", "Act Pregabalin", "Act Pregabalin", "Act Pregabalin", "Act Pregabalin", "Act Pregabalin", "Ag-pregabalin", "Ag-pregabalin", "Ag-pregabalin", "Ag-pregabalin", "Ag-pregabalin", "Apo-pregabalin", "Apo-pregabalin", "Apo-pregabalin", "Apo-pregabalin", "Apo-pregabalin", "Apo-pregabalin", "Apo-pregabalin Capsules", "Apo-pregabalin Capsules", "Apo-pregabalin Capsules", "Apo-pregabalin Capsules", "Apo-pregabalin Capsules", "Apo-pregabalin Capsules", "Auro-pregabalin", "Auro-pregabalin", "Auro-pregabalin", "Auro-pregabalin", "Auro-pregabalin", "Auro-pregabalin", "Auro-pregabalin", "Auro-pregabalin", "Bio-pregabalin", "Bio-pregabalin", "Bio-pregabalin", "Bio-pregabalin", "Bio-pregabalin", "Bio-pregabalin", "Bio-pregabalin", "Bio-pregabalin", "Dom-pregabalin", "Dom-pregabalin", "Dom-pregabalin", "Dom-pregabalin", "Dom-pregabalin", "Dom-pregabalin", "Gd-pregabalin", "Gd-pregabalin", "Gd-pregabalin", "Gd-pregabalin", "Gd-pregabalin", "Gd-pregabalin", "Ipg-pregabalin", "Ipg-pregabalin", "Ipg-pregabalin", "Ipg-pregabalin", "Ipg-pregabalin", "Ipg-pregabalin", "Ipg-pregabalin", "Ipg-pregabalin", "Jamp Pregabalin Capsules", "Jamp Pregabalin Capsules", "Jamp Pregabalin Capsules", "Jamp Pregabalin Capsules", "Jamp Pregabalin Capsules", "Jamp Pregabalin Capsules", "Jamp-pregabalin", "Jamp-pregabalin", "Jamp-pregabalin", "Jamp-pregabalin", "Jamp-pregabalin", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica", "Lyrica CR", "Lyrica CR", "Lyrica CR", "Lyrica CR", "Lyrica CR", "Lyrica CR", "Lyrica CR", "M-pregabalin", "M-pregabalin", "M-pregabalin", "M-pregabalin", "M-pregabalin", "M-pregabalin", "M-pregabalin", "M-pregabalin", "Mar-pregabalin", "Mar-pregabalin", "Mar-pregabalin", "Mar-pregabalin", "Mar-pregabalin", "Mar-pregabalin", "Mar-pregabalin", "Mar-pregabalin", "Mint-pregabalin", "Mint-pregabalin", "Mint-pregabalin", "Mint-pregabalin", "Mint-pregabalin", "Mint-pregabalin", "Mint-pregabalin", "Mint-pregabalin", "Myl-pregabalin", "Myl-pregabalin", "Myl-pregabalin", "Myl-pregabalin", "Myl-pregabalin", "Myl-pregabalin", "Mylan-pregabalin", "Mylan-pregabalin", "Mylan-pregabalin", "Mylan-pregabalin", "Mylan-pregabalin", "Mylan-pregabalin", "Nat-pregabalin", "Nat-pregabalin", "Nat-pregabalin", "Nat-pregabalin", "Nat-pregabalin", "Nat-pregabalin", "Nra-pregabalin", "Nra-pregabalin", "Nra-pregabalin", "Nra-pregabalin", "Nra-pregabalin", "Nra-pregabalin", "Nra-pregabalin", "Nra-pregabalin", "Pendo-pregabalin", "Pendo-pregabalin", "PMS-pregabalin", "PMS-pregabalin", "PMS-pregabalin", "PMS-pregabalin", "PMS-pregabalin", "PMS-pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", 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"Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Accord", "Pregabalin Capsules", "Pregabalin Capsules", "Pregabalin Capsules", "Pregabalin Capsules", "Pregabalin Capsules", "Pregabalin Capsules", "Pregabalin Capsules", "Pregabalin Capsules", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "PREGABALIN capsules, CV", "Pregabalin Extended Release", "Pregabalin Extended Release", "Pregabalin Extended Release", "Pregabalin Extended Release", "Pregabalin Extended Release", "Pregabalin Extended Release", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Mylan Pharma", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Pfizer", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", 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Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Sandoz Gmbh", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin Zentiva", "Pregabalin-150", "Pregabalin-225", "Pregabalin-25", "Pregabalin-300", "Pregabalin-50", "Pregabalin-75", "Ratio-pregabalin", "Ratio-pregabalin", "Ratio-pregabalin", "Ratio-pregabalin", "Ratio-pregabalin", "Ratio-pregabalin", "Ratio-pregabalin", "Ratio-pregabalin", "Reddy-pregabalin", "Reddy-pregabalin", "Reddy-pregabalin", "Reddy-pregabalin", "Reddy-pregabalin", "Reddy-pregabalin", "Riva-pregabalin", "Riva-pregabalin", "Riva-pregabalin", "Riva-pregabalin", "Riva-pregabalin", "Riva-pregabalin", "S-pregabalin", "Sandoz Pregabalin", "Sandoz Pregabalin", "Sandoz Pregabalin", "Sandoz Pregabalin", "Sandoz Pregabalin", "Taro-pregabalin", "Taro-pregabalin", "Taro-pregabalin", "Taro-pregabalin", "Taro-pregabalin", "Taro-pregabalin", "Teva-pregabalin", "Teva-pregabalin", "Teva-pregabalin", "Teva-pregabalin", "Teva-pregabalin", "Teva-pregabalin", "Teva-pregabalin", "Teva-pregabalin", "Torrent-pregabalin", "Torrent-pregabalin", "Torrent-pregabalin", "Torrent-pregabalin", "Torrent-pregabalin", "Torrent-pregabalin", "Torrent-pregabalin", "Torrent-pregabalin" ]	[]	[]	[ "P54289" ]	[]	[]	[ "P43005", "Q01650" ]
DB00231	Temazepam	Temazepam, like many other similar and related benzodiazepines, acts as a gamma-aminobutyric acid (GABA) modulator and is capable of eliciting a variety of actions including sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and anxiolytic action [A175207, A175210, F3718, F3721]. Although the chemical synthesis of temazepam was established by 1965 [A175333], mainstream contemporary use of the medication did not occur until it's legitimate use as treatment for insomnia was accepted and approved later on. In particular, before temazepam saw regular prescription use in civilians it was - and still is - employed by the US military as a sedative-hypnotic medication to be taken by soldiers, pilots, etc. to obtain the necessary rest required for medical recovery or scheduled maneuvers and operations [A175339]. Regardless, temazepam has become one of the most frequently prescribed medications internationally and sees millions of prescriptions every year. Unfortunately, however, given its frequent use and the inherent nature of its pharmacological effects, temazepam - like many other benzodiazepines - possesses a high potential for misuse and is genuinely capable of developing drug tolerance, physical dependence, and addiction in users.	solid	Temazepam is specifically indicated only for the short-term management of insomnia [FDA Label], [L5539]. Furthermore, such management is generally predominantly associated with the symptomatic relief of transient and short-term insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings and/or early morning awakenings [F3718]. In particular, the official prescribing information for temazepam typically specifies that the instructions issued for dispensed prescriptions of the medication should indicate specifically that patients are only expected to use the therapy for short periods of time - usually 7-10 days in general [FDA Label, F3718]. Subsequently, treatment with temazepam should usually not exceed 7 to 10 consecutive days and nor should it be prescribed in quantities exceeding a one-month supply [F3718]. Some regional prescribing information also notes that temazepam may be used for premedication prior to minor surgery or other related procedures [L5539].	Temazepam is a benzodiazepine used as a hypnotic agent in the management of insomnia [FDA Label] [A175207, A175210, L5539, F3718, F3721]. Temazepam produces CNS depression at limbic, thalamic, and hypothalamic levels of the CNS [A175207, A175210, F3718, F3721]. Temazepam increases the affinity of the neurotransmitter gamma-aminobutyric acid (GABA) for GABA receptors by binding to benzodiazepine receptors [A175207, A175210, F3718, F3721]. Results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and anxiolytic action [A175207, A175210, F3718, F3721]. In sleep laboratory studies, the effect of temazepam was compared to placebo during a two week period [F3718]. The studies demonstrated a linear dose-response improvement in total sleep time and sleep latency with substantial drug-placebo differences apparent for total sleep time and for sleep latency at higher doses of temazepam [F3718]. Regardless, REM sleep was ultimately unchanged but slow wave sleep was decreased [F3718]. Moreover, a transient syndrome, known as "rebound insomnia", wherein the symptoms that led to treatment with temazepam in the first place recur in an enhanced form, may happen on withdrawal of temazepam treatment [F3718]. The possibility of this occurrence is in part why long term use of temazepam is not recommended due to worries over tolerance and dependence wherein patients' bodies become physiologically accustomed to the regular presence and pharmacological effect of higher and higher doses of the benzodiazepine used [F3718]. The duration of hypnotic effect and the profile of unwanted adverse effects may be influenced by the distribution and elimination half-lives of the administered temazepam and any active metabolites that may be formed [F3718]. When such half-lives are long, the drug or its metabolite(s) may accumulate during periods of nightly administration and be associated with impairments of cognitive and motor performance during waking hours [F3718]. Conversely, if half-lives are short, the drug and metabolites would be cleared before the next dose is ingested, and carry-over effects related to sedation or CNS depression should be minimal or not present at all [F3718]. However, during nightly use and for an extended period, pharmacodynamic tolerance or adaptation to some effects of benzodiazepine hypnotics may develop - which may also contribute to the possibility of 'rebound insomnia' [F3718]. Consequently, if the drug has a very short elimination half-life, it is possible that a relative deficiency (for example, in relation to benzodiazepine GABA(a) receptor sites) may occur at some point in the interval between each night's use [F3718]. This sequence of events may account for certain clinical findings reported happening after several weeks of nightly use of rapidly eliminated benzodiazepine hypnotics, including increased wakefulness during the last third of the night and the appearance of increased daytime anxiety [F3718].	Gamma-Aminobutyric acid (GABA) is considered the principal inhibitory neurotransmitter in the human body [A175207, A175210, F3718, F3721]. When GABA binds to GABA(a) receptors found in neuron synapses, chloride ions are conducted across neuron cell membranes via an ion channel in the receptors [A175207, A175210, F3718, F3721]. With enough chloride ions conducted, the local, associated neuron membrane potentials are hyperpolarized - making it more difficult or less likely for action potentials to fire, ultimately resulting in less excitation of the neurons [A175207, A175210, F3718, F3721]. Subsequently, benzodiazepines like temazepam can bind to benzodiazepine receptors that are components of various varieties of GABA(a) receptors [A175207, A175210, F3718, F3721]. This binding acts to enhance the effects of GABA by increasing GABA affinity for the GABA(a) receptor, which ultimately enhances GABA ligand binding at the receptors [A175207, A175210, F3718, F3721]. This enhanced ligand binding of the inhibitory neurotransmitter GABA to the receptors increases the aforementioned chloride ion conduction (perhaps reportedly via an increase in the frequency of the chloride channel opening), resulting in a hyperpolarized cell membrane that prevents further excitation of the associated neuron cells [A175207, A175210, F3718, F3721]. Combined with the notion that such benzodiazepine receptor associated GABA(a) receptors exist both peripherally and in the CNS, this activity consequently facilitates various effects like sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and anxiolytic action [A175207, A175210, F3718, F3721].	Studies demonstrate that between 90 to 100% of an orally administered temazepam dose is absorbed, making the medication very well absorbed [F3718, L5539]. The oral administration of 15 to 45 mg temazepam resulted in rapid absorption with significant blood levels achieved in 30 minutes and peak levels at 2-3 hours [F3718, L5539]. In particular, direct studies following the oral ingestion of 30 mg of temazepam revealed measurable plasma concentrations were obtained 10-20 minutes after dosing with peak plasma levels ranging between 666-982 ng/mL (with a mean of 865 ng/mL) presenting approximately 1.2-1.6 hours (with a mean of 1.5 hours) after the dosing [FDA Label]. Finally, a dose-proportional relationship was established for the area under the plasma concentration/time curve over the 15 to 30 mg dose range [FDA Label].	First-pass metabolism of temazepam is minimal at approximately 5-8% of an administered dose [F3718, L5539]. Nevertheless, temazepam is principally metabolized in the liver where most of the unchanged drug is directly conjugated to glucuronide and excreted in the urine [F3718, L5539]. In particular, the primary metabolite present in the blood is the O-conjugate of temazepam [FDA Label, F3718, L5539]. Less than 5% of the drug is demethylated to oxazepam and subsequently eliminated as the glucuronide [F3718, L5539]. Regardless, the glucuronides of temazepam have no demonstrable CNS activity and it is believed that no active metabolites are formed in general [FDA Label, F3718, L5539]. Since temazepam mainly undergoes Phase II conjugation reactions, it is proposed that it is devoid of CYP450 interactions.[A38982]	Manifestations of acute overdosage of temazepam, as with other benzodiazepines, can be expected to reflect the increasing CNS effects of the drug and include somnolence, confusion, and coma, with reduced or absent reflexes [FDA Label] [L5539, F3718, F3721]. With large overdoses, respiratory depression, hypotension, and finally coma can occur [FDA Label] [L5539, F3718, F3721]. Benzodiazepines like temazepam might cause fetal harm when administered to a pregnant woman. Transplacental distribution has in the past resulted in neonatal CNS depression following the ingestion of therapeutic doses of related benzodiazepine hypnotics like diazepam during the last weeks of pregnancy [FDA Label] [L5539, F3718, F3721]. It is not known whether this drug is excreted in human milk [FDA Label] [L5539, F3718, F3721]. Caution should, therefore, be exercised when temazepam is administered to a nursing woman [FDA Label] [L5539, F3718, F3721]. Safety and effectiveness in pediatric patients have not been established [FDA Label] [L5539, F3718, F3721]. Lower doses of temazepam, like 7.5 mg is recommended as the initial dosage for patients aged 65 and over since the risk of the development of oversedation, dizziness, confusion, ataxia and/or falls increases substantially with larger doses of benzodiazepines in elderly and debilitated patients [FDA Label] [L5539, F3718, F3721]. No evidence of carcinogenicity was observed in animal studies although hyperplastic liver nodules were observed in female mice exposed to the highest doses of temazepam [FDA Label] [L5539, F3718, F3721]. The clinical significance of this finding is not known [FDA Label] [L5539, F3718, F3721]. Fertility in male and female rats was not adversely affected by temazepam toxicity studies [FDA Label] [L5539, F3718, F3721]. No mutagenicity tests have been done with temazepam [FDA Label] [L5539, F3718, F3721].	The terminal half-life determined for temazepam is recorded as being between 3.5-18 hours, with a mean of 9 hours [F3718, L5539].	It has been recorded that about 96% of unchanged temazepam is bound to plasma proteins [F3718, L5539].	Following a single dose, 80-90% of the dose appears in the urine, predominantly as the O-conjugate metabolite, and 3-13% of the dose appears in the faeces [FDA Label] [F3718, L5539]. Less than 2% of the dose is excreted unchanged or as N-desmethyltemazepam in the urine [FDA Label] [F3718, L5539].	The volume of distribution documented for temazepam is 1.3-1.5 L/kg body weight - and in particular, 43-68 L/kg for the unbound fraction [L5539].	Studies regarding the clearance of temazepam have recorded the values of 1.03 ml/min/kg and 31 ml/min/kg for the clearance of total temazepam and the clearance of unbound temazepam, respectively [A175306].	Organic compounds	Organoheterocyclic compounds	Benzodiazepines	1,4-benzodiazepines	[ "approved", "investigational" ]	[ "N05CD", "N05C", "N05", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "7.67", "description": "Restoril 30 mg capsule", "unit": "capsule" }, { "cost": "7.87", "description": "Restoril 15 mg capsule", "unit": "capsule" }, { "cost": "9.94", "description": "Temazepam 22.5 mg capsule", "unit": "capsule" }, { "cost": "9.94", "description": "Temazepam 7.5 mg capsule", "unit": "capsule" }, { "cost": "11.37", "description": "Restoril 22.5 mg capsule", "unit": "capsule" }, { "cost": "11.37", "description": "Restoril 7.5 mg capsule", "unit": "capsule" }, { "cost": "0.12", "description": "Apo-Temazepam 15 mg Capsule", "unit": "capsule" }, { "cost": "0.12", "description": "Co Temazepam 15 mg Capsule", "unit": "capsule" }, { "cost": "0.12", "description": "Novo-Temazepam 15 mg Capsule", "unit": "capsule" }, { "cost": "0.12", "description": "Pms-Temazepam 15 mg Capsule", "unit": "capsule" }, { "cost": "0.12", "description": "Ratio-Temazepam 15 mg Capsule", "unit": "capsule" }, { "cost": "0.14", "description": "Apo-Temazepam 30 mg Capsule", "unit": "capsule" }, { "cost": "0.14", "description": "Co Temazepam 30 mg Capsule", "unit": "capsule" }, { "cost": "0.14", "description": "Novo-Temazepam 30 mg Capsule", "unit": "capsule" }, { "cost": "0.14", "description": "Pms-Temazepam 30 mg Capsule", "unit": "capsule" }, { "cost": "0.14", "description": "Ratio-Temazepam 30 mg Capsule", "unit": "capsule" }, { "cost": "0.58", "description": "Temazepam 15 mg capsule", "unit": "capsule" }, { "cost": "0.69", "description": "Temazepam 30 mg capsule", "unit": "capsule" } ]	[ { "approved": "1993-05-18", "country": "United States", "expires": "2010-05-18", "number": "5211954" } ]	Temazepam \| BZRP \| MBR \| Mitochondrial benzodiazepine receptor \| PBR \| Peripheral-type benzodiazepine receptor \| PKBS \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-4 \| GABAAR subunit alpha-4 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit alpha-6 \| GABAAR subunit alpha-6 \| GABA(A) receptor subunit beta-1 \| GABAAR subunit beta-1 \| GABA(A) receptor subunit beta-2 \| GABAAR subunit beta-2 \| GABA(A) receptor subunit beta-3 \| GABAAR subunit beta-3 \| GABA(A) receptor subunit delta \| GABAAR subunit delta \| GABA(A) receptor subunit epsilon \| GABAAR subunit epsilon \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| GABA(A) receptor subunit pi \| GABAAR subunit pi \| GABA(A) receptor subunit theta \| GABAAR subunit theta \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase	[ "Apo-temazepam", "Apo-temazepam", "Co Temazepam Capsules 15mg", "Co Temazepam Capsules 30mg", "Dom-temazepam", "Dom-temazepam", "Gen-temazepam 15mg", "Gen-temazepam 30mg", "Ntp-temazepam", "Ntp-temazepam", "Penta-temazepam Capsules", "Penta-temazepam Capsules", "PHL-temazepam", "PHL-temazepam", "PMS-temazepam", "PMS-temazepam", "PMS-temazepam - 15mg", "PMS-temazepam - 30mg", "Ratio-temazepam", "Ratio-temazepam", "Restoril", "Restoril", "Restoril", "Restoril", "Restoril", "Restoril", "Restoril", "Restoril", "Restoril", "Restoril", "Strazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam", "Temazepam-15", "Temazepam-30", "Teva-temazepam", "Teva-temazepam" ]	[ "Euhypnos", "Norkotral", "Normison", "Nortem", "Remestan", "Temaze", "Temtabs" ]	[ "Strazepam" ]	[ "P30536", "P14867", "P47869", "P34903", "P48169", "P31644", "Q16445", "P18505", "P47870", "P28472", "O14764", "P78334", "Q8N1C3", "P18507", "Q99928", "O00591", "Q9UN88", "P14867", "P47869", "P34903", "P31644", "Q8N1C3", "P18507", "Q99928" ]	[ "P08684", "P20813", "P11712" ]	[]	[]
DB00232	Methyclothiazide	A thiazide diuretic with properties similar to those of hydrochlorothiazide. (From Martindale, The Extra Pharmacopoeia, 30th ed, p825)	solid	For use in the management of hypertension either as the sole therapeutic agent or to enhance the effect of other antihypertensive drugs in the more severe forms of hypertension. Also used as adjunctive therapy in edema associated with congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy.	Methyclothiazide, a diuretic-antihypertensive agent, is a member of the benzothiadiazine (thiazide) class of drugs. Methyclothiazide has a per mg natriuretic activity approximately 100 times that of the prototype thiazide, chlorothiazide. At maximal therapeutic dosages, all thiazides are approximately equal in their diuretic/natriuretic effects. Like other benzothiadiazines, methyclothiazide also has antihypertensive properties, and may be used for this purpose either alone or to enhance the antihypertensive action of other drugs.	Methyclothiazide appears to block the active reabsorption of chloride and possibly sodium in the ascending loop of Henle, altering electrolyte transfer in the proximal tubule. This results in excretion of sodium, chloride, and water and, hence, diuresis. As a diuretic, methyclothiazide inhibits active chloride reabsorption at the early distal tubule via the Na-Cl cotransporter, resulting in an increase in the excretion of sodium, chloride, and water. Thiazides like methyclothiazide also inhibit sodium ion transport across the renal tubular epithelium through binding to the thiazide sensitive sodium-chloride transporter. This results in an increase in potassium excretion via the sodium-potassium exchange mechanism. The antihypertensive mechanism of methyclothiazide is less well understood although it may be mediated through its action on carbonic anhydrases in the smooth muscle or through its action on the large-conductance calcium-activated potassium (KCa) channel, also found in the smooth muscle.	Rapidly absorbed following oral administration.	null	Acute oral toxicity (LD<sub>50</sub>): >4000 mg/kg [Rat]. Symptoms of overdosage include electrolyte imbalance and signs of potassium deficiency such as confusion, dizziness, muscular weakness, and gastrointestinal disturbances.	null	null	null	null	null	Organic compounds	Organoheterocyclic compounds	Thiadiazines	Benzothiadiazines	[ "withdrawn" ]	[ "C03AA", "C03A", "C03", "C", "C03AB", "C03A", "C03", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "11.32", "description": "Methyclothiazide powder", "unit": "g" }, { "cost": "0.77", "description": "Enduron 5 mg tablet", "unit": "tablet" }, { "cost": "0.77", "description": "Methyclothiazide 5 mg tablet", "unit": "tablet" } ]	[]	Methyclothiazide \| BSC1 \| Bumetanide-sensitive sodium-(potassium)-chloride cotransporter 1 \| Kidney-specific Na-K-Cl symporter \| Na-K-2Cl cotransporter 2 \| NKCC2 \| 4.2.1.1 \| CA-I \| CAB \| Carbonate dehydratase I \| Carbonic anhydrase B \| Carbonic anhydrase I \| Cyanamide hydratase CA1 \| 4.2.1.1 \| CA-II \| CAC \| Carbonate dehydratase II \| Carbonic anhydrase C \| Carbonic anhydrase II \| Cyanamide hydratase CA2 \| 4.2.1.1 \| CA-IV \| Carbonate dehydratase IV \| Carbonic anhydrase IV	[ "Duretic 5mg", "Enduronyl", "Enduronyl", "Enduronyl Forte", "Methyclothiazide" ]	[ "Aquatensen", "Duretic", "Enduron" ]	[ "Enduronyl", "Enduronyl Forte", "Enduronyl" ]	[ "Q13621", "P00915", "P00918", "P22748" ]	[]	[]	[]
DB00233	Aminosalicylic acid	An antitubercular agent often administered in association with isoniazid. The sodium salt of the drug is better tolerated than the free acid.	solid	For the treatment of tuberculosis	Aminosalicylic acid is an anti-mycobacterial agent used with other anti-tuberculosis drugs (most often isoniazid) for the treatment of all forms of active tuberculosis due to susceptible strains of tubercle bacilli. The two major considerations in the clinical pharmacology of aminosalicylic acid are the prompt production of a toxic inactive metabolite under acid conditions and the short serum half life of one hour for the free drug. Aminosalicylic acid is bacteriostatic against <i>Mycobacterium tuberculosis</i> (prevents the multiplying of bacteria without destroying them). It also inhibits the onset of bacterial resistance to streptomycin and isoniazid.	There are two mechanisms responsible for aminosalicylic acid's bacteriostatic action against <i>Mycobacterium tuberculosis</i>. Firstly, aminosalicylic acid inhibits folic acid synthesis (without potentiation with antifolic compounds). The binding of para-aminobenzoic acid to pteridine synthetase acts as the first step in folic acid synthesis. Aminosalicylic acid binds pteridine synthetase with greater affinity than para-aminobenzoic acid, effectively inhibiting the synthesis of folic acid. As bacteria are unable to use external sources of folic acid, cell growth and multiplication slows. Secondly, aminosalicylic acid may inhibit the synthesis of the cell wall component, mycobactin, thus reducing iron uptake by <i>M. tuberculosis</i>.	null	Hepatic.	LD<sub>50</sub>=4 gm/kg (orally in mice); LD<sub>50</sub>=3650 mg/kg (orally in rabbits)	null	50-60%	null	null	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	Benzoic acids and derivatives	[ "approved" ]	[ "J04AA", "J04A", "J04", "J", "J04AA", "J04A", "J04", "J", "J04AA", "J04A", "J04", "J" ]	[ "Mycobacteria" ]	[ { "cost": "2.4", "description": "Aminosalicylic acid powder", "unit": "g" }, { "cost": "3.59", "description": "Paser granules 4 gm packet", "unit": "packet" } ]	[]	4-amino-2-hydroxybenzoic acid \| 4-aminosalicylate \| 4-aminosalicylic acid \| Aminosalicylic acid \| p-aminosalicylic acid \| para-amino salicylic acid \| para-aminosalicylic acid \| PAS \| 1.14.99.1 \| COX-1 \| COX1 \| Cyclooxygenase-1 \| PGH synthase 1 \| PGHS-1 \| PHS 1 \| Prostaglandin H2 synthase 1 \| Prostaglandin-endoperoxide synthase 1 \| 1.5.1.3 \| 1.14.99.1 \| COX-2 \| COX2 \| Cyclooxygenase-2 \| PGH synthase 2 \| PGHS-2 \| PHS II \| Prostaglandin H2 synthase 2 \| Prostaglandin-endoperoxide synthase 2 \| 2.7.11.10 \| Conserved helix-loop-helix ubiquitous kinase \| I-kappa-B kinase 1 \| I-kappa-B kinase alpha \| IkappaB kinase \| IkBKA \| IKK-1 \| IKK-A \| IKK-alpha \| IKK1 \| IKKA \| NFKBIKA \| Nuclear factor NF-kappa-B inhibitor kinase alpha \| TCF-16 \| TCF16 \| Transcription factor 16 \| 1.13.11.- \| 5-lipoxygenase \| 5-LO \| Arachidonate 5-lipoxygenase \| LOG5 \| 3.1.1.4 \| GIIE sPLA2 \| Phosphatidylcholine 2-acylhydrolase 2E \| sPLA2-IIE \| 1.11.2.2 \| MPO	[ "Granupas", "Nemasol Sodium Tab 500mg", "Paser" ]	[ "Pamisyl", "Rexipas", "Rezipas" ]	[]	[ "P23219", "P00374", "P35354", "O15111", "P09917", "Q9NZK7" ]	[ "P05164" ]	[]	[]
DB00234	Reboxetine	Reboxetine is an antidepressant drug used in the treatment of clinical depression, panic disorder and ADD/ADHD. Its mesylate (i.e. methanesulfonate) salt is sold under tradenames including Edronax, Norebox, Prolift, Solvex, Davedax or Vestra. Reboxetine has two chiral centers, but it only exists as two enantiomers, (R,R)-(-)- and (S,S)-(+)-reboxetine.	solid	For the treatment of clinical depression.	Reboxetine is a selective noradrenaline reuptake inhibitor (NaRI), the first drug of new antidepressant class. Reboxetine is an a-ariloxybenzyl derivative of morpholine. Reboxetine is primarily used to treat depression but has also been found useful in the treatment of narcolepsy and panic disorders.	Reboxetine is a selective inhibitor of noradrenaline reuptake. It inhibits noradrenaline reuptake <i>in vitro</i> to a similar extent to the tricyclic antidepressant desmethylimipramine. Reboxetine does not affect dopamine or serotonin reuptake and it has low <i>in vivo</i> and <i>in vitro</i> affinity for adrenergic, cholinergic, histaminergic, dopaminergic and serotonergic receptors.	Reboxetine is rapidly and extensively absorbed following oral administration.	Reboxetine is metabolized by dealkylation, hydroxylation and oxidation followed by glucuronide or sulphate conjugation. It is metabolized by the cytochrome P450 CYP isoenzyme 3A4.	Reports of seizures (rare) have been reported	12.5 hours	98%	null	null	null	Organic compounds	Benzenoids	Phenol ethers	null	[ "approved", "experimental" ]	[ "N06AX", "N06A", "N06", "N" ]	[ "Humans and other mammals" ]	[]	[]	Reboxetina \| Reboxetine \| NAT1 \| NET \| NET1 \| Norepinephrine transporter \| SLC6A5 \| Solute carrier family 6 member 2 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1	[]	[ "Davedax", "Edronax", "Norebox", "Prolift", "Solvex", "Vestra" ]	[]	[ "P23975" ]	[ "P08684", "P10635" ]	[]	[ "P08183" ]
DB00235	Milrinone	Heart failure is a multifactorial condition that affects roughly 1-2% of the adult population. Often the result of long-term myocardial ischemia, cardiomyopathy, or other cardiac insults, heart failure results from an inability of the heart to perfuse peripheral tissues with sufficient oxygen and metabolites, resulting in complex systemic pathologies. Heart failure is underpinned by numerous physiological changes, including alteration in β-adrenergic signalling and cyclic adenosine monophosphate (cAMP) production, which affects the heart's contractile function and cardiac output.[A228323] Milrinone is a second-generation bipyridine phosphodiesterase (PDE) inhibitor created through chemical modification of [amrinone].[A228333] As a PDE-III inhibitor, milrinone results in increased cAMP levels and improves cardiac function and peripheral vasodilation in acute decongested heart failure.[A228338, A11759, A228323, A228333, A228348, L31483] Milrinone was originally synthesized at the Sterling Winthrop Research Institute in the 1980s.[A228333] It was approved by the FDA on December 31, 1987, and was marketed under the trademark PRIMACOR® by Sanofi-Aventis US before being discontinued.[L31483]	solid	Milrinone is indicated for the short-term (48 hours or less) treatment of patients with acute decompensated heart failure. Milrinone administration should occur together with close monitoring using appropriate electrocardiographic equipment and should occur in a facility equipped for the immediate treatment of potential cardiac events, including ventricular arrhythmias.[L31483]	Milrinone is a bipyridine derivative with positive inotropic and lusitropic effects that also results in peripheral vasodilation with minimal chronotropic effects over a therapeutic range of 100 to 300 ng/mL.[L31483, A228358] As such, milrinone is used in decompensated congestive heart failure.[L31483] Studies have demonstrated that milrinone exhibits sigmoidal effects, such that increasing milrinone plasma concentrations beyond a certain level results in no further hemodynamic changes.[A228358] Despite milrinone's benefits, both intravenous and oral use has been associated with increased frequency of ventricular arrhythmias, and long-term oral use has been associated with an increased risk of sudden death; in general, there are no data to support the safety or efficacy of milrinone use beyond 48 hours and patients should be monitored closely for cardiac dysfunction.[L31483] Also, as milrinone is primarily excreted renally, dose adjustments may be required in patients with impaired renal function.[L31483]	Heart failure is a condition characterized by the heart's inability to provide adequate perfusion to the peripheral tissues, resulting in systemic symptoms including pulmonary, gastrointestinal, renal, and cerebral dysfunction.[A228323] Although the biochemical and physiological processes underlying heart failure complex and variable, one such physiological response regulated by the sympathetic nervous system involves the eventual downregulation of cardiac β-receptors, decreased catecholamine sensitivity, and a corresponding decrease in adenylyl-cyclase-mediated signalling pathways.[A228323] Increased intracellular cAMP, mainly acting through protein kinase A, increases sarcolemmal calcium release through L-type calcium channels as well as calcium re-uptake mediated by phospholamban and troponin I; these actions correspond to positive inotropic and lusitropic effects, respectively.[A228323, A228333] Milrinone is a partial competitive inhibitor of phosphodiesterase III (PDE-III), with a measured IC<sub>50</sub> value of between 0.66 and 1.3 μM.[A228338, A11759] As a PDE-III inhibitor, milrinone results in an increase in intracellular cAMP, responsible for its pharmacological effects, including positive inotropy, positive lusitropy, and vasodilation.[A228323, A228333, A228348] As milrinone affects cAMP levels through PDE-III and not through β-adrenergic receptors, it is effective in patients who have downregulated or otherwise desensitized β-adrenergic receptors and can be administered together with β-agonists/antagonists.[A228353, A228358]	When administered as an IV bolus dose of 10-100 μg/kg, milrinone induces hemodynamic effects within 60 seconds reaching a peak effect by 2-5 minutes.[A228333] The plasma AUC is significantly dose-dependent.[L31483]	Animal studies suggest that two oxidative pathways are involved in milrinone metabolism, albeit only involving a small proportion of the administered dose. The major metabolite is the O-glucuronide metabolite.[A228333, L31483]	Toxicity information regarding milrinone is not readily available. Patients experiencing an overdose are at an increased risk of severe adverse effects such as hypotension and adverse cardiac events such as ventricular arrhythmias. Symptomatic and supportive measures are recommended.[L31483]	Milrinone administered intravenously to congestive heart failure patients had a mean terminal elimination half-life of 2.3 hours (injections between 12.5-125 μg/kg) and 2.4 hours (infusions between 0.2-0.7 μg/kg/min.[L31483]	Milrinone is approximately 70% bound to human plasma proteins.[L31483]	Milrinone is primarily excreted in the urine, with 60% of a dose recovered after two hours and 90% within eight hours. Approximately 83% of milrinone recovered in urine is unchanged while 12% is present as the main O-glucuronide metabolite.[A228333, A228358, L31483]	Milrinone administered intravenously to congestive heart failure patients had a volume of distribution of 0.38 L/kg (injections between 12.5-125 μg/kg) and 0.45 L/kg (infusions between 0.2-0.7 μg/kg/min.[L31483]	Milrinone administered intravenously to congestive heart failure patients had a clearance of 0.13 L/kg/hr (injections between 12.5-125 μg/kg) and 0.14 L/kg/hr (infusions between 0.2-0.7 μg/kg/min.[L31483]	Organic compounds	Organoheterocyclic compounds	Pyridines and derivatives	Bipyridines and oligopyridines	[ "approved" ]	[ "C01CE", "C01C", "C01", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.31", "description": "Milrinone lact 10 mg/10 ml vial", "unit": "ml" }, { "cost": "1.44", "description": "Milrinone lact 20 mg/20 ml vial", "unit": "ml" }, { "cost": "1.45", "description": "Milrinone-d5w 20 mg/100 ml", "unit": "ml" }, { "cost": "1.6", "description": "Primacor 0.2 mg/ml-d5w 100 ml", "unit": "ml" } ]	[]	1,6-Dihydro-2-methyl-6-oxo(3,4'-bipyridine)-5-carbonitrile \| Milrinona \| Milrinone \| Milrinonum \| 3.1.4.17 \| cGI-PDE \| CGI-PDE A \| cGMP-inhibited cAMP phosphodiesterase \| Cyclic GMP-inhibited phosphodiesterase A	[ "Apo-milrinone Injectable", "Milrinone Injection", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone lactate", "Milrinone lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate in Dextrose", "Milrinone Lactate Injection", "Milrinone Lactate Injection", "Milrinone Lactate Injection", "Milrinone Lactate Injection", "Milrinone Lactate Injection", "Milrinone Lactate Injection USP", "Milrinone Lactate Injection, USP", "Milrinone Lactate Injection, USP", "Primacor", "Primacor", "Primacor Injection 1mg/ml" ]	[ "Corotrop", "Corotrope", "Milrila" ]	[ "Milrinone Lactate in Dextrose" ]	[ "Q14432" ]	[]	[]	[]
DB00236	Pipobroman	An antineoplastic agent that acts by alkylation.	solid	For the treatment of polycythaemia vera and refractory chronic myeloid leukaemia.	Pipobroman is an antineoplastic agent. Specifically, it is a piperazine derivative with a chemical structure close to that of many DNA alkylating agents. Pipobroman has well-documented clinical activity against polycythemia vera and essential thrombocythemia.	The mechanism of action is uncertain, but due to the structural similarity with other DNA alkylating agents, pipobroman is thought to alkylate DNA leading to disruption of DNA synthesis and eventual cell death.[A6598]	Well absorbed from the GI tract.	null	Symptoms of overdose include hematologic toxicity, especially with chronic overdosage.	null	null	null	null	null	Organic compounds	Organoheterocyclic compounds	Diazinanes	Piperazines	[ "approved" ]	[ "L01AX", "L01A", "L01", "L" ]	[ "Humans and other mammals" ]	[]	[]	1,4-bis(3-bromopropionyl)piperazine \| N,N-bis-(3-bromopropionyl)-piperazine \| Pipobroman \| Pipobromanum	[]	[ "Vercite", "Vercyte" ]	[]	[]	[]	[]	[]
DB00237	Butabarbital	Butabarbital, or Butisol, is a fast onset barbiturate with short duration of action compared to other barbiturates.[A201977,L13613] This makes butabarbital a useful drug for treating severe insomnia and pre-operative anxiety.[A201977,L13613] Butabarbital is less commonly used in recent years, as more patients are typically prescribed benzodiazepines.[A19735] Its short duration of action gives butabarbital a high abuse potential, comparable to [secobarbital].[A201977,A201980] Butabarbital was granted FDA approval on 5 June 1939.[L13613]	solid	Butabarbital is indicated for use as a sedative or hypnotic.[L13613] Butabarbital should not be used to treat insomnia for longer than 2 weeks.[L13613]	Butabarbital potentiates GABAergic neurons while inhibiting neuronal acetylcholine and glutamate receptors to produce sedation.[A4384,A202085] Butabarbital is an intermediate acting barbiturate with a duration of action of approximately 6-8 hours.[L13613] The therapeutic index is quite wide as doses vary considerably from patient to patient.[L13613] Patients should be counselled regarding the risk of worsening insomnia, drowsiness, falls, and complex behaviour while not fully awake.[L13613]	Barbiturates like butabarbital potentiate GABA-A receptors and inhibit receptors for neuronal acetylcholine, and kainate.[A4384,A202085] GABA-A receptors are predominantly on the post-synaptic membrane, and upon activation, open chloride channels to hyperpolarize the neuron and decreased firing rate.[A202064] Potentiation of GABAergic neurons produces sedation.[A202064] Inhibition of neuronal acetylcholine receptors[A202085] and glutamate receptors of the kainate subtype[A202088] desensitize their respective neurons, producing sedation.	null	Data regarding the metabolism of butabarbital in humans are not readily available. In dogs, butabarbital undergoes metabolism to a final glucuronide metabolite.[A202043]	Patients experiencing an overdose may present with unsteady gait, slurred speech, nystagmus, confusion, poor judgement, irritability, and insomnia.[L13613] Acute overdoses may present as CNS depression, respiratory depression, oligouria, tachycardia, hypotension, low body temperature, coma, and shock.[L13613] An extreme overdose can lead to a flat EEG, resembling death, that is reversible provided there is no hypoxic brain damage.[L13613] Overdose can be treated with symptomatic and supportive treatment.[L13613]	Butabarbital has a half life of 100 hours but its duration of action is only 6-8 hours.[L13613]	Data regarding the protein binding of butbarbital is not readily available.[L13613] However, barbiturates generally bind to serum albumin.[A202028]	Barbiturates such as butabarbital are predominantly eliminated in the urine.[A202031,A202040,L13613] In dogs, 3-5% of the dose is eliminated in the urine as the unchanged parent compound.[A202043]	null	null	Organic compounds	Organoheterocyclic compounds	Diazines	Pyrimidines and pyrimidine derivatives	[ "approved", "illicit" ]	[ "N05CB", "N05C", "N05", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.89", "description": "Butisol sodium 30 mg tablet", "unit": "tablet" }, { "cost": "2.46", "description": "Butisol sodium 50 mg tablet", "unit": "tablet" } ]	[]	5-ethyl-5-(1-methylpropyl)-2,4,6(1H,3H,5H)-pyrimidinetrione \| 5-ethyl-5-(1-methylpropyl)barbituric acid \| 5-sec-butyl-5-ethyl-2,4,6(1H,3H,5H)-pyrimidinetrione \| 5-sec-butyl-5-ethylbarbituric acid \| 5-sec-butyl-5-ethylpyrimidine-2,4,6(1H,3H,5H)-trione \| Butabarbital \| Secbutabarbital \| Secbutabarbitale \| Secbutabarbitalum \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-4 \| GABAAR subunit alpha-4 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit alpha-6 \| GABAAR subunit alpha-6 \| GABA(A) receptor subunit beta-1 \| GABAAR subunit beta-1 \| GABA(A) receptor subunit beta-2 \| GABAAR subunit beta-2 \| GABA(A) receptor subunit beta-3 \| GABAAR subunit beta-3 \| GABA(A) receptor subunit delta \| GABAAR subunit delta \| GABA(A) receptor subunit epsilon \| GABAAR subunit epsilon \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| GABA(A) receptor subunit pi \| GABAAR subunit pi \| GABA(A) receptor subunit theta \| GABAAR subunit theta \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| NACHR alpha-10 \| NACHRA10 \| Nicotinic acetylcholine receptor subunit alpha-10 \| NACHRA3 \| NACRA4 \| NACHRA5 \| NACHRA7 \| NACHR alpha-9 \| NACHRA9 \| Nicotinic acetylcholine receptor subunit alpha-9 \| AMPA-selective glutamate receptor 1 \| GLUA1 \| GLUH1 \| GluR-1 \| GluR-A \| GluR-K1 \| GLUR1 \| Glutamate receptor ionotropic, AMPA 1 \| AMPA-selective glutamate receptor 2 \| GluA2 \| GluR-2 \| GluR-B \| GluR-K2 \| GLUR2 \| Glutamate receptor ionotropic, AMPA 2 \| AMPA-selective glutamate receptor 3 \| GluA3 \| GluR-3 \| GluR-C \| GluR-K3 \| GLUR3 \| GLURC \| Glutamate receptor ionotropic, AMPA 3 \| AMPA-selective glutamate receptor 4 \| GluA4 \| GluR-4 \| GluR-D \| GLUR4 \| Glutamate receptor ionotropic, AMPA 4 \| EAA3 \| Excitatory amino acid receptor 3 \| GluK1 \| GluR-5 \| GLUR5 \| Glutamate receptor 5 \| EAA4 \| Excitatory amino acid receptor 4 \| GluK2 \| GluR-6 \| GLUR6 \| Glutamate receptor 6 \| EAA5 \| Excitatory amino acid receptor 5 \| GluK3 \| GluR-7 \| GLUR7 \| Glutamate receptor 7 \| EAA1 \| Excitatory amino acid receptor 1 \| GluK4 \| Glutamate receptor KA-1 \| GRIK \| KA1 \| EAA2 \| Excitatory amino acid receptor 2 \| GluK5 \| Glutamate receptor KA-2 \| GRIK2 \| KA2 \| Glucose transporter type 1, erythrocyte/brain \| GLUT-1 \| GLUT1 \| HepG2 glucose transporter	[ "Butisol Sodium", "Butisol Sodium", "Butisol Sodium", "Butisol Sodium Tab 100mg", "Butisol Sodium Tab 15mg", "Butisol Sodium Tab 30mg", "Phenazopyridine Hydrochloride, Hyoscyamine Hydrobromide, and Butabarbital", "Phenazopyridine Plus", "Pyrelle H.B." ]	[ "Butalan", "Butisol", "Sarisol No. 2" ]	[ "Pyrelle H.B.", "Phenazopyridine Plus", "Phenazopyridine Hydrochloride, Hyoscyamine Hydrobromide, and Butabarbital" ]	[ "P14867", "P47869", "P34903", "P48169", "P31644", "Q16445", "P18505", "P47870", "P28472", "O14764", "P78334", "Q8N1C3", "P18507", "Q99928", "O00591", "Q9UN88", "P14867", "Q9GZZ6", "Q15822", "P32297", "P43681", "P30532", "Q15825", "P36544", "Q9UGM1", "P17787", "Q05901", "P30926", "P42261", "P42262", "P42263", "P48058", "P39086", "Q13002", "Q13003", "Q16099", "Q16478" ]	[]	[ "P02768" ]	[ "P11166" ]
DB00238	Nevirapine	A potent, non-nucleoside reverse transcriptase inhibitor (NNRTI) used in combination with nucleoside analogues for treatment of Human Immunodeficiency Virus Type 1 (HIV-1) infection and AIDS. Structurally, nevirapine belongs to the dipyridodiazepinone chemical class.	solid	For use in combination with other antiretroviral drugs in the ongoing treatment of HIV-1 infection.	Nevirapine is a non-nucleoside reverse transcriptase inhibitor (nNRTI) with activity against Human Immunodeficiency Virus Type 1 (HIV-1). HIV-2 RT and eukaryotic DNA polymerases (such as human DNA polymerases alpha, beta, or sigma) are not inhibited by nevirapine. Nevirapine is, in general, only prescribed after the immune system has declined and infections have become evident. It is always taken with at least one other HIV medication such as Retrovir or Videx. The virus can develop resistance to nevirapine if the drug is taken alone, although even if used properly, nevirapine is effective for only a limited time.	Nevirapine binds directly to reverse transcriptase (RT) and blocks the RNA-dependent and DNA-dependent DNA polymerase activities by causing a disruption of the enzyme's catalytic site. The activity of nevirapine does not compete with template or nucleoside triphosphates.	Nevirapine is readily absorbed (greater than 90%) after oral administration in healthy subjects and adults with HIV-1 infection. The absolute bioavailability in healthy adults following a single dose administration is 93 ± 9% (mean ± SD) for a 50 mg tablet and 91 ± 8% for an oral solution. Peak plasma nevirapine concentrations of 2 ± 0.4 mcg/mL (7.5 micromolar) were attained by 4 hours following a single 200 mg dose. Nevirapine tablets and suspension have been shown to be comparably bioavailable and interchangeable at doses up to 200 mg. When the oral tablet is given with a high-fat meal, the extent of absorption is compared to that of the fasted-state.	Hepatic. In vivo studies in humans and in vitro studies with human liver microsomes have shown that nevirapine is extensively biotransformed via cytochrome P450 3A4 metabolism to several hydroxylated metabolites.	Symptoms of overdose include edema, erythema nodosum, fatigue, fever, headache, insomnia, nausea, pulmonaryinfiltrates, rash, vertigo, vomiting, and weight decrease. The most common adverse reaction is rash.	45 hours	60% bound to plasma protein.	Thus cytochrome P450 metabolism, glucuronide conjugation, and urinary excretion of glucuronidated metabolites represent the primary route of nevirapine biotransformation and elimination in humans. Only a small fraction (<5%) of the radioactivity in urine (representing <3% of the total dose) was made up of parent compound; therefore, renal excretion plays a minor role in elimination of the parent compound.	* 1.21 ± 0.09 L/kg [apparent volume of distribution, healthy adults, IV] Nevirapine is capable of crossing the placenta and is found in breast milk.	null	Organic compounds	Organic nitrogen compounds	Organonitrogen compounds	Amines	[ "approved" ]	[ "J05AG", "J05A", "J05", "J", "J05AR", "J05A", "J05", "J", "J05AR", "J05A", "J05", "J" ]	[ "Human Immunodeficiency Virus" ]	[ { "cost": "9.3", "description": "Viramune 200 mg tablet", "unit": "tablet" } ]	[ { "approved": "1994-11-22", "country": "United States", "expires": "2012-05-22", "number": "5366972" }, { "approved": "1995-10-17", "country": "Canada", "expires": "2010-11-15", "number": "2030056" }, { "approved": "2013-06-11", "country": "United States", "expires": "2029-03-12", "number": "8460704" } ]	11-cyclopropyl-5,11-dihydro-4-methyl-6H-dipyrido(3,2-b:2',3'-e)(1,4)diazepin-6-one \| NEV \| Nevirapina \| Nevirapine \| Nevirapine anhydrous \| Nevirapine, anhydrous \| NVP \| Pr160Gag-Pol \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.14.- \| Coumarin 7-hydroxylase \| CYP2A3 \| CYPIIA6 \| Cytochrome P450 IIA3 \| Cytochrome P450(I) \| hOCT1 \| OCT1 \| Organic cation transporter 1	[ "Apo-nevirapine", "Apo-nevirapine XR", "Apo-zidovudine-lamivudine-nevirapine", "Auro-nevirapine", "Jamp Nevirapine", "Lamivudine, Nevirapine, and Zidovudine", "Mylan-nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine", "Nevirapine Extended Release", "Nevirapine Extended Release", "Nevirapine Teva", "Nevirapine Teva", "Nevirapine Teva", "Nevirapine Teva", "Nevirapine Teva", "Nevirapine Teva", "Teva-nevirapine", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune", "Viramune XR" ]	[]	[ "Lamivudine, Nevirapine, and Zidovudine", "Apo-zidovudine-lamivudine-nevirapine" ]	[ "P03366" ]	[ "P10635", "P05177", "P24462", "P08684", "P20813", "P20815", "P11712", "P11509" ]	[ "P02768" ]	[ "O15245" ]
DB00239	Oxiconazole	Oxiconazole is an antifungal agent that is commonly found in topical formulations. It is marketed under the brand names Oxistat and Oxistat, and is used in the treatment of various skin infections such as athlete's foot, jock itch and ringworm.	solid	For treatment of dermal fungal infection.	Oxiconazole is a broad-spectrum imidazole derivative whose antifungal activity is derived primarily from the inhibition of ergosterol biosynthesis, which is critical for cellular membrane integrity. It has fungicidal or fungistatic activity in vitro against a number of pathogenic fungi including the following dermatophytes, and yeasts: <i>T. rubrum</i>, <i>T. mentagrophytes</i>, <i>T. tonsurans</i>, <i>T. violaceum</i>, <i>E. floccosum</i>, <i>M. canis</i>, <i>M. audouini</i>, <i>M. gypseum</i>, <i>C. albicans</i>, and <i>M. furfur</i>.	Oxiconazole inhibits ergosterol biosynthesis, which is required for cytoplasmic membrane integrity of fungi. It acts to destabilize the fungal cyctochrome P450 51 enzyme (also known as Lanosterol 14-alpha demethylase). This is vital in the cell membrance structure of the fungus. Its inhibition leads to cell lysis. Oxiconazole has also been shown in inhibit DNA synthesis and suppress intracellular concentrations of ATP. Like other imidazole antifungals, Oxiconazole can increase membrane permeability to zinc, augmenting its cytotoxicity.	Systemic absorption of oxiconazole is low.	null	Side effects incliude pruritus, burning, irritation, erythema, stinging and allergic contact dermatitis and folliculitis, fissuring, maceration rash and nodules.	null	null	null	null	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	Halobenzenes	[ "approved" ]	[ "D01AC", "D01A", "D01", "D", "G01AF", "G01A", "G01", "G", "G01AF", "G01A", "G01", "G" ]	[ "Fungi" ]	[ { "cost": "2.23", "description": "Oxistat 1% cream", "unit": "g" }, { "cost": "48.99", "description": "Oxistat 1% Cream 15 gm Tube", "unit": "tube" }, { "cost": "90.31", "description": "Oxistat 1% Cream 30 gm Tube", "unit": "tube" }, { "cost": "93.13", "description": "Oxistat 1% Lotion 30ml Bottle", "unit": "bottle" }, { "cost": "157.99", "description": "Oxistat 1% Cream 60 gm Tube", "unit": "tube" } ]	[]	2',4'-Dichloro-2-imidazol-1-ylacetophenone (Z)-[O-(2,4-dichlorobenzyl)oxime] \| Oxiconazol \| Oxiconazole \| Oxiconazolum \| 1.14.13.70 \| CYP51 \| CYPLI \| Cytochrome P450 51 \| Cytochrome P450-14DM \| Cytochrome P450-LIA1 \| ERG16 \| Sterol 14-alpha demethylase \| 2,3-epoxysqualene--lanosterol cyclase \| 5.4.99.7 \| OSC \| Oxidosqualene--lanosterol cyclase \| Orphan nuclear receptor PAR1 \| Orphan nuclear receptor PXR \| Pregnane X receptor \| PXR \| Steroid and xenobiotic receptor \| SXR \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase	[ "Oxiconazole Nitrate", "Oxiconazole Nitrate", "Oxiconazole Nitrate Cream 1%", "Oxistat", "Oxistat", "Oxistat", "Oxistat", "Oxistat", "Oxistat", "Oxistat", "Oxistat", "Oxizole", "Oxizole" ]	[]	[]	[ "O75469" ]	[ "P08684", "P33261" ]	[]	[]
DB00240	Alclometasone	Alclometasone is synthetic glucocorticoid steroid for topical use in dermatology as anti-inflammatory, antipruritic, antiallergic, antiproliferative and vasoconstrictive agent.	solid	For the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.	Alclometasone is a synthetic corticosteroid for topical dermatologic use. The corticosteroids constitute a class of primarily synthetic steroids used topically as anti-inflammatory and antipruritic agents. Alclometasone is a selective glucocorticoid receptor agonist.	The mechanism of the anti-inflammatory activity of the topical steroids, in general, is unclear. However, corticosteroids are thought to act by the induction of phospholipase A<sub>2</sub> inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A<sub>2</sub>. Alclometasone initially binds the corticosteroid receptor. This complex migrates to the nucleus where it binds to different glucocorticoid response elements on the DNA. This in turn enhances and represses various genes, especially those involved in inflammatory pathways.	Topical corticosteroids can be absorbed from normal intact skin. Studies have shown that approximately 3% of steroid is absorbed during 8 hours of contact with intact skin of normal volunteers.	Hepatic.	Symptoms of overdose include suppression of adrenal glands, temporary decrease in white blood cell counts, symptoms of hypersensitivity (such as skin rash, hives, itching, and difficulty breathing), and increased susceptibility to infection.	null	null	null	null	null	Organic compounds	Lipids and lipid-like molecules	Steroids and steroid derivatives	Hydroxysteroids	[ "approved" ]	[ "D07AB", "D07A", "D07", "D", "S01BA", "S01B", "S01", "S" ]	[ "Humans and other mammals" ]	[ { "cost": "1.21", "description": "Alclometasone dipro 0.05% crm", "unit": "g" }, { "cost": "2.91", "description": "Aclovate 0.05% cream", "unit": "g" }, { "cost": "16.99", "description": "Alclometasone Dipropionate 0.05% Ointment 15 gm Tube", "unit": "tube" }, { "cost": "19.81", "description": "Alclometasone Dipropionate 0.05% Cream 15 gm Tube", "unit": "tube" }, { "cost": "39.27", "description": "Alclometasone Dipropionate 0.05% Ointment 60 gm Tube", "unit": "tube" }, { "cost": "41.31", "description": "Alclometasone Dipropionate 0.05% Cream 45 gm Tube", "unit": "tube" }, { "cost": "52.99", "description": "Aclovate 0.05% Ointment 15 gm Tube", "unit": "tube" }, { "cost": "52.99", "description": "Alclometasone Dipropionate 0.05% Cream 60 gm Tube", "unit": "tube" }, { "cost": "54.54", "description": "Aclovate 0.05% Cream 15 gm Tube", "unit": "tube" }, { "cost": "81.19", "description": "Aclovate 0.05% Cream 45 gm Tube", "unit": "tube" }, { "cost": "103.1", "description": "Aclovate 0.05% Cream 60 gm Tube", "unit": "tube" }, { "cost": "141.1", "description": "Aclovate 0.05% Ointment 60 gm Tube", "unit": "tube" } ]	[]	(7alpha,11beta,16alpha)-7-chloro-11,17,21-trihydroxy-16-methylpregna-1,4-diene-3,20-dione \| 7α-Chloro-16α-methylprednisolone \| Alclometasone \| CBG \| Serpin A6 \| Transcortin \| GR \| GRL \| Nuclear receptor subfamily 3 group C member 1 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| CBG \| Serpin A6 \| Transcortin	[ "Aclovate", "Aclovate", "Aclovate", "Aclovate", "Aclovate", "Aclovate", "Alclometasone Dipropionate", "Alclometasone Dipropionate", "Alclometasone Dipropionate", "Alclometasone Dipropionate", "Alclometasone Dipropionate", "Alclometasone Dipropionate", "Alclometasone dipropionate" ]	[]	[]	[ "P08185", "P04150" ]	[ "P08684" ]	[ "P08185" ]	[]
DB00241	Butalbital	Butalbital, or 5-allyl-5-isobutylbarbituric acid, is a derivative of barbituric acid which the hydrogens at position 5 are substituted by an allyl group and an isobutyl group. It is a short-to-intermediate acting member of barbiturates that exhibit muscle-relaxing and anti-anxiety properties that produce central nervous system (CNS) depression that ranges from mild sedation to general anesthesia.[A177754] Butalbital has a low degree of selectivity and a narrow therapeutic index.[A177754] Typically indicated to manage tension (or muscle contraction) headaches, butalbital is often combined with one or more therapeutic agents, such as acetylsalicylic acid, acetaminophen, aspirin, and caffeine. There have not been clinical trials that evaluate the clinical efficacy of butalbital in migraines [A177754] thus it is not indicated for such condition. As with other barbiturates, butalbital carries a risk of abuse or misuse potential, intoxication, hangover, tolerance, dependence, and overdosage possibly leading to death.[L10370] Butalbital‐containing analgesics can also produce a drug‐induced headache in addition to tolerance and dependence. Due to these risks, the use of butalbital-containing combination products is typically limited for use only in cases where other medications are deemed ineffective and such usage is advised to be carefully monitored.[A177754]	solid	Indicated for the management of the symptom complex of tension (or muscle contraction) headache, when other non-opioid analgesics and alternative treatments are inadequate, in various combinations with acetaminophen, aspirin, caffeine, and codeine .[L10370]	Butalbital is a short to intermediate-acting barbiturate that reversibly depresses the activity of excitable tissues, including the central nervous system in a nonselective manner.[A177754] Barbiturates exhibit muscle-relaxing and anti-anxiety properties [A177763] and they are capable of producing all levels of CNS mood alteration from excitation to mild sedation, hypnosis, and deep coma.[F4561] The sedative dose of butalbital in nontolerant individuals is 5-100 mg and the hypnotic dose is 100-200 mg.[T598] Pain perception and reaction are relatively unimpaired until the moment of unconsciousness.[A177754] In some cases, an unwanted paradoxical response of excitement may be observed instead of sedation with barbiturate treatment, which may be due to their depressant effects on inhibitory centers of the CNS.[A177754] At sufficiently high therapeutic doses, barbiturates induce anesthesia; however, barbiturates are reported to lose their effectiveness for sleep induction and sleep maintenance after 2 weeks.[F4561] Barbiturates are habit-forming; they can produce tolerance and both dependence and addiction, which is partly explained by decreased drug concentration at the site of action due to enhanced drug metabolism by induced enzymes, or to cellular adaptive changes. In addition, butalbital may lead to analgesic overuse headache.[A177754] While butalbital is expected to mediate similar actions as other members of the barbiturate drug class, the effects of butalbital in isolation are not well understood.[A177763] It is suggested that butalbital is added in combination products to antagonize the unwanted central stimulating effect of stimulatory ingredients such as caffeine.[A177763] Butalbital may decrease blood pressure and heart rate when administered at sedative and hypnotic doses.[L10370]	Butalbital is a CNS depressant that suppresses neuronal excitability, impulse conduction, and the release of neurotransmitters, similar to actions of other barbiturates.[T598] Barbiturates primarily mediate suppressive actions on polysynaptic neuronal responses by diminishing facilitation while enhancing inhibition.[A177754] Inhibition occurs at GABAergic synapses that express GABA-A receptors, which are transmembrane chloride ion channels that bind an inhibitory neurotransmitter GABA, barbiturates, benzodiazepines, neurosteroids, and ethanol.[A177754] Upon activation, GABA-A receptors allow Cl- influx and K+ efflux into the postjunctional terminal, resulting in inhibition of the postsynaptic neuron. It is suggested that barbiturates, including butalbital, enhances GABA binding to the GABA-A receptors [F4561] by binding to the α+/β− interface in the intracellular domain (ICD) as an allosteric modulator.[A177829] Additionally, barbiturates promote benzodiazepine binding to the receptor.[A177754] Barbiturates potentiate GABA-induced increases in chloride conductance and depress voltage-activated calcium currents while prolonging the duration of GABA-induced chloride channel opening.[A177754] Butalbital may also inhibit the excitatory effects mediated by AMPA receptors by reducing glutamate-induced depolarizations of the receptor. It is also proposed that barbiturates and opioids may potentiate the analgesic effects of each other when co-administered, although there are inconsistencies across preclinical data.[A177754]	Butalbital gets readily and rapidly absorbed from the gastrointestinal tract.[F4561] The time to reach the peak plasma concentrations is reported to be approximately 2 hours.[A177754] Typical blood concentrations of butalbital peaked at 2.1 mg/L and declined to 1.5 mg/L at 24 hr.[A177838] Plasma concentrations of 10 to 20 μg/mL have been associated with toxicity; coma and fatalities have occurred with concentrations of 25 to 30 μg/mL.[A177754]	Butalbital is expected to undergo nearly complete hepatic metabolism.[A177754] It primarily undergoes C5 oxidation to form 5-isobutyl-5-(2,3-dihydroxypropyl) barbituric acid, which is the major metabolite. Butalbital may also undergo omega-hydroxylation to form 5-allyl-5(3-hydroxy-2-methyl-1-propyl) barbituric acid.[A177835, L10370, T598]	Reported oral TDLO (woman) is 400 mg/kg and subcutaneous LD50 in rat is 160 mg/kg.[MSDS] The lowest acute dose of butalbital alone associated with death in adults is 2.0 g.[A177754] Symptoms of acute barbiturate poisoning include drowsiness, confusion, coma, respiratory depression, hypotension, and shock. Due to the CNS depressant effects, an overdose of barbiturates may lead to death.[L10370] Barbiturates are also associated with withdrawal reactions, which may lead to death if severe.[A177754]	The plasma half-life is about 35 hours. In a study of 5 healthy volunteers receiving 100 mg butalbital in combination with aspirin and caffeine, the mean plasma elimination half-life of butalbital was 61 hours, with the range of 35 to 88 hours.[A177838, T598]	The _in vitro_ plasma protein binding of butalbital is 45% over the concentration range of 0.5-20 mcg/mL. This falls within the range of plasma protein binding (20%-45%) reported with other barbiturates such as phenobarbital, pentobarbital, and secobarbital sodium.[L10370]	Butalbital predominantly undergoes renal elimination with 59 to 88% of the total dose administered being excreted from the kidneys as unchanged parent drug or metabolites.[L6121,L10370] Urinary excretion products included parent drug (about 3.6% of the dose), 5-isobutyl-5-(2,3-dihydroxypropyl) barbituric acid (about 24% of the dose), 5-allyl-5(3-hydroxy-2-methyl-1-propyl) barbituric acid (about 4.8%), products with the barbituric acid ring hydrolyzed with excretion of urea (about 14% of the dose), as well as unidentified materials.[L10370] Of the material excreted in the urine, 32% is conjugated.[L10370] Elimination is not complete within 24 hours, and the drug accumulates with frequent administration.[A177754]	The volume of distribution of butalbital is reported to be approximately 0.8 L/kg.[T598] Butalbital is expected to distribute to most of the tissues in the body [F4561], including the mamillary glands and placenta.[F4561] The plasma-to-blood concentration ratio was almost unity indicating that there is no preferential distribution of butalbital into either plasma or blood cells.[L10370]	There is limited data on the clearance of butalbital.	Organic compounds	Organoheterocyclic compounds	Diazines	Pyrimidines and pyrimidine derivatives	[ "approved", "illicit" ]	[ "N05CB", "N05C", "N05", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.04", "description": "Butalbital compound tablet", "unit": "tablet" }, { "cost": "3.83", "description": "Butalbital powder", "unit": "g" } ]	[]	5-(2-methylpropyl)-5-prop-2-enyl-1,3-diazinane-2,4,6-trione \| 5-allyl-5-(2-methylpropyl)barbituric acid \| 5-allyl-5-(2'-methyl-n-propyl) barbituric acid \| 5-allyl-5-isobutyl-2,4,6(1H,3H,5H)-pyrimidinetrione \| 5-Allyl-5-isobutyl-pyrimidine-2,4,6-trione \| 5-allyl-5-isobutylbarbituric acid \| 5-isobutyl-5-allylbarbituric acid \| Allylbarbital \| Allylbarbitone \| Allylbarbituric acid \| Butalbarbital \| Butalbital \| Butalbitalum \| iso-butylallylbarbituric acid \| Itobarbital \| Tetrallobarbital \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-4 \| GABAAR subunit alpha-4 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit alpha-6 \| GABAAR subunit alpha-6 \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| GABA(A) receptor subunit alpha-2 \| GABAAR subunit alpha-2 \| GABA(A) receptor subunit alpha-3 \| GABAAR subunit alpha-3 \| GABA(A) receptor subunit alpha-4 \| GABAAR subunit alpha-4 \| GABA(A) receptor subunit alpha-5 \| GABAAR subunit alpha-5 \| GABA(A) receptor subunit alpha-6 \| GABAAR subunit alpha-6 \| GABA(A) receptor subunit beta-1 \| GABAAR subunit beta-1 \| GABA(A) receptor subunit beta-2 \| GABAAR subunit beta-2 \| GABA(A) receptor subunit beta-3 \| GABAAR subunit beta-3 \| GABA(A) receptor subunit delta \| GABAAR subunit delta \| GABA(A) receptor subunit epsilon \| GABAAR subunit epsilon \| GABA(A) receptor subunit gamma-1 \| GABAAR subunit gamma-1 \| GABA(A) receptor subunit gamma-2 \| GABAAR subunit gamma-2 \| GABA(A) receptor subunit gamma-3 \| GABAAR subunit gamma-3 \| GABA(A) receptor subunit pi \| GABAAR subunit pi \| GABA(A) receptor subunit theta \| GABAAR subunit theta \| GABA(A) receptor subunit alpha-1 \| GABAAR subunit alpha-1 \| NACRA4 \| NACHRA7 \| AMPA-selective glutamate receptor 2 \| GluA2 \| GluR-2 \| GluR-B \| GluR-K2 \| GLUR2 \| Glutamate receptor ionotropic, AMPA 2 \| EAA4 \| Excitatory amino acid receptor 4 \| GluK2 \| GluR-6 \| GLUR6 \| Glutamate receptor 6	[ "Acetaminophen, Butalbital and Caffeine", "Alagesic LQ", "Allzital", "Allzital", "Allzital", "Allzital", "Ascomp with Codeine", "Ascomp with Codeine", "Ascomp with Codeine", "Bupap", "Bupap", "Butal/APAP/Caff", "Butalbita,Acetaminophen and Caffeine", "Butalbital Acetaminophen and Caffeine", "Butalbital Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital And Acetaminophen", "Butalbital And Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital And Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "BUTALBITAL and ACETAMINOPHEN", "BUTALBITAL and ACETAMINOPHEN", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen 50 mg/325 mg", "Butalbital Compound", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, 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"Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine Plus", "Butalbital, Acetaminophen and Caffeine with Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetominophen and Caffeine", "Butalbital, Acetominophen and Caffeine", "Butalbital, Acetominophen and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, aspirin, and caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, aspirin, and caffeine", "Butalbital, aspirin, and caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, aspirin, and caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, aspirin, and caffeine", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "BUTALBITAL, ASPIRIN, CAFFEINE and CODEINE PHOSPHATE", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, Caffeine, and Codeine Phosphate", "Butalbital, Aspirin, Caffeine, and Codeine Phosphate", "Butalbital, Aspirin, Caffeine, and Codeine Phosphate", "Butalbital/Acetaminophen/Caffeine", "Butapap", "Capacet", "Dolgic Plus", "Esgic", "Esgic", "Esgic", "Esgic", "Esgic-Plus", "Esgic-Plus", "Esgic-Plus", "Esgic-Plus", "Fioricet", "Fioricet", "Fioricet", "Fioricet", "Fioricet", "Fioricet with Codeine", "Fioricet with Codeine", "Fioricet with Codeine", "Fiorinal", "Fiorinal", "Fiorinal", "Fiorinal", "Fiorinal Tab", "Fiorinal with Codeine", "Fiorinal with Codeine", "Fiorinal with Codeine", "Fiorinal-C 1/2", "Fiorinal-C 1/4", "Margesic", "Marten-Tab", "Orbivan", "Orbivan", "Orbivan CF", "Phrenilin", "Phrenilin", "Phrenilin Forte", "Phrenilin Forte", "Phrenilin Forte", "PMS-pharnal Capsules", "PMS-pharnal Tablets", "PMS-pharnal-C 1/4 Capsules", "PMS-pharnal-C1/2 Capsules", "Pronal - C1/2 Capsules", "Pronal C1/4 Capsules", "Pronal Capsules", "Pronal Tablets", "Tencon", "Tencon", "Teva-tecnal", "Teva-tecnal", "Teva-tecnal C 1/2", "Teva-tecnal C 1/4", "Trianal C½", "Trianal C¼", "Trianal Capsules", "Trianal Tablet", "Vanatol LQ", "Vanatol S", "Vtol LQ", "Zebutal", "Zebutal" ]	[ "Sandoptal" ]	[ "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, and Caffeine", "Orbivan", "Butalbital, Aspirin and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Acetaminophen and Caffeine Plus", "Butalbital, Aspirin and Caffeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Acetaminophen, Butalbital and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Fioricet with Codeine", "Fioricet", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital and Acetaminophen", "Fiorinal with Codeine", "Fiorinal", "Orbivan", "Butalbital and Acetaminophen", "Butalbital, Aspirin and Caffeine", "Esgic-Plus", "Butalbital, Acetaminophen and Caffeine", "Esgic-Plus", "Bupap", "Esgic-Plus", "Butalbital, Acetaminophen and Caffeine", "Esgic-Plus", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Aspirin and Caffeine", "Phrenilin Forte", "Orbivan CF", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin, and Caffeine", "Phrenilin", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Aspirin, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital Acetaminophen and Caffeine", "Dolgic Plus", "Alagesic LQ", "Butalbital, Aspirin and Caffeine", "Phrenilin", "Phrenilin Forte", "Butalbital, Acetominophen and Caffeine", "Butalbital, Acetominophen and Caffeine", "Esgic", "Fioricet", "Fioricet with Codeine", "Tencon", "Butalbital, Acetaminophen and Caffeine", "Zebutal", "Esgic", "Butalbital, Acetaminophen, Caffeine", "Butalbital and Acetaminophen 50 mg/325 mg", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital Compound", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Allzital", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, aspirin, and caffeine", "Capacet", "Butalbital and Acetaminophen", "Marten-Tab", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Fiorinal", "Butalbital, Aspirin, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Aspirin, Caffeine, and Codeine Phosphate", "Butalbital, Aspirin and Caffeine", "Butalbital And Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Fiorinal", "Fiorinal with Codeine", "Butalbital, Aspirin, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen and Caffeine", "Butalbital And Acetaminophen", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Allzital", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "BUTALBITAL, ASPIRIN, CAFFEINE and CODEINE PHOSPHATE", "Butalbital, Acetaminophen and Caffeine", "Esgic", "Zebutal", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Aspirin, and Caffeine", "Ascomp with Codeine", "Butalbital and Acetaminophen", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Vanatol LQ", "Butalbital and Acetaminophen", "Esgic", "Vanatol S", "Vtol LQ", "Butalbital, aspirin, and caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Allzital", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butapap", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Aspirin, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Ascomp with Codeine", "Fioricet with Codeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Tencon", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbita,Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Bupap", "Fioricet", "Margesic", "Butalbital, Aspirin and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, aspirin, and caffeine", "Butalbital and Acetaminophen", "Butalbital Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine with Codeine Phosphate", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetominophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin, and Caffeine", "Phrenilin Forte", "Fioricet", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, aspirin, and caffeine", "Butalbital And Acetaminophen", "Butalbital and Acetaminophen", "Fioricet", "Butalbital, Aspirin and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Fiorinal with Codeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen, and Caffeine", "Ascomp with Codeine", "Butalbital, Acetaminophen, and Caffeine", "Allzital", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Pronal - C1/2 Capsules", "Fiorinal-C 1/4", "Fiorinal-C 1/2", "Trianal Tablet", "Trianal Capsules", "PMS-pharnal-C 1/4 Capsules", "PMS-pharnal-C1/2 Capsules", "PMS-pharnal Capsules", "PMS-pharnal Tablets", "Teva-tecnal", "Teva-tecnal C 1/2", "Trianal C½", "Trianal C¼", "Pronal Tablets", "Teva-tecnal C 1/4", "Teva-tecnal", "Fiorinal Tab", "Pronal Capsules", "Pronal C1/4 Capsules", "Fiorinal", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Aspirin, and Caffeine", "Butalbital/Acetaminophen/Caffeine", "Butalbital, Acetaminophen, and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butal/APAP/Caff", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen and Caffeine", "Butalbital, Acetaminophen, Caffeine and Codeine Phosphate", "Butalbital, Acetaminophen, Caffeine", "Butalbital, Acetaminophen and Caffeine", "BUTALBITAL and ACETAMINOPHEN", "BUTALBITAL and ACETAMINOPHEN", "Butalbital, Acetaminophen and Caffeine", "Butalbital and Acetaminophen", "Butalbital, Acetaminophen and Caffeine", "Butalbital, aspirin, and caffeine" ]	[ "P47869", "P34903", "P48169", "P31644", "Q16445", "P14867", "P47869", "P34903", "P48169", "P31644", "Q16445", "P18505", "P47870", "P28472", "O14764", "P78334", "Q8N1C3", "P18507", "Q99928", "O00591", "Q9UN88", "P14867", "P43681", "P36544", "P42262", "Q13002" ]	[]	[]	[]
DB00242	Cladribine	Cladribine is a purine analogue or a chlorinated derivative of adenine [A263733] that causes apoptosis of B and T lymphocytes.[A350] Cladribine was first approved in the United States in 1993 [A263713] initially as a treatment for a number of hematological malignancies; currently, it is approved for the treatment of hairy cell leukemia.[A263733] In 2017 in Europe and in 2019 in the United States, cladribine was also approved for the treatment multiple sclerosis.[A263718]	solid	Intravenous cladribine is indicated for the treatment of active Hairy Cell Leukemia as defined by clinically significant anemia, neutropenia, thrombocytopenia or disease-related symptoms.[L50693] Oral cladribine is indicated for the treatment of relapsing forms of multiple sclerosis (MS), including relapsing-remitting disease and active secondary progressive disease, in adults. Because of its safety profile, the use of cladribine is generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate drug indicated for the treatment of MS.[L50688, L50708]	Cladribine is an antineoplastic agent with cytotoxic effects on actively dividing and quiescent B and T lymphocytes and monocytes.[L50688, L50693] It produces a dose-dependent reduction in lymphocyte count.[L50688] Because cladribine is resistant to deamination by adenosine deaminase (ADA), a purine-degrading enzyme, it is reported to have a prolonged intracellular residence time.[A350, A263723] Following oral administration, the lowest absolute lymphocyte counts occurred approximately 2 to 3 months after the start of each treatment cycle and were lower with each additional treatment cycle. At the end of Year 2, 2% of patients continued to have absolute lymphocyte counts less than 500 cells per microliter. The median time to recovery from lymphocyte counts less than 500 cells per microliter to at least 800 cells per microliter was approximately 28 weeks.[L50688]	Heightened activity of B and T lymphocytes have been implicated in the pathophysiology of hematological malignancies and MS.[A350, A263723, A263728] Cladribine is a purine nucleoside analog that closely resembles the molecular structure of deoxyadenosine.[A350] Upon uptake by dividing and nondividing lymphocytes via nucleoside transporter proteins,[A263728] cladribine is converted intracellularly to cladribine triphosphate (Cd-ATP, 2-chlorodeoxyadenosine triphosphate) by deoxycytidine kinase and mitochondrial deoxyguanosine kinase.[A263723, L50688] Because are high levels of deoxycytidine kinase and low levels of 5′-nucleotidase, an enzyme that inactivates Cd-ATP, in lymphocytes, Cd-ATP readily accumulates.[A350, A263723] Cd-ATP competes with adenine triphosphate in DNA synthesis, leading to DNA strand breaks.[A263713] Ultimately, cladribine causes apoptosis or autophagy in dividing and resting lymphocytes.[A263723, A263728] Cladribine can also induce cytotoxicity via other mechanisms. It induces poly(ADP-ribose) polymerase (PARP), a DNA repair enzyme, that exhausts the intracellular levels of nicotinamide adenine dinucleotide (NAD) and adenosine triphosphate (ATP), thereby causing apoptotic cell death.[A350] Recent evidence shows that cladribine can trigger apoptosis by changing the mitochondrial transmembrane potential, allowing cytochrome c and apoptosis-inducing factor to move into the cytosol. This initiates apoptosis through both caspase-dependent and caspase-independent pathways.[A350]	Oral bioavailability is approximately 40%.[L50688] Following the oral administration of 10 mg cladribine, the mean maximum concentration (C<sub>max</sub>) was in the range of 22 to 29 ng/ mL, and the corresponding mean AUC was in the range of 80 to 101 ng x h/mL.[L50688] The C<sub>max</sub> and AUC of cladribine increased proportionally across a dose range from 3 to 20 mg.[L50688] Under fasted conditions, the median time to maximum concentration (T<sub>max</sub>) was 0.5 h (range 0.5 to 1.5 hours).[L50688] A high-fat meal decreased C<sub>max</sub> by 29% and delayed T<sub>max</sub> to 1.5 hours (range one to three hours), but this difference is not expected to be clinically significant.[L50688] Following a cladribine injection given by continuous infusion over seven days, the mean steady-state serum concentration was estimated to be 5.7 ng/mL.[L50693]	Cladribine is a prodrug that is phosphorylated to cladribine monophosphate (Cd-AMP, 2-chlorodeoxyadenosine monophosphate) by deoxycytidine kinase and mitochondrial deoxyguanosine kinase in lymphocytes. Cd-AMP is further phosphorylated to cladribine diphosphate (Cd-ADP, 2-chlorodeoxyadenosine diphosphate) and the active moiety Cd-ATP. The dephosphorylation and deactivation of Cd-AMP is catalyzed by cytoplasmic 5’-nucleotidase (5’-NTase). The metabolism of cladribine in whole blood has not been fully characterized; however, extensive whole blood and negligible hepatic enzyme metabolism was observed, in vitro.[L50688]	Intraperitoneal LD<sub>50</sub> is 150 mg/kg in mice.[L50698] High doses of cladribine have been associated with irreversible neurologic toxicity (paraparesis/quadriparesis), acute nephrotoxicity, and severe bone marrow suppression resulting in neutropenia, anemia, and thrombocytopenia.[L50693] Lymphopenia may also occur, which is known to be dose-dependent.[L50688] There is no known antidote to cladribine overdosage; thus, treatment of overdosage consists of drug discontinuation, careful observation, and appropriate supportive measures.[L50693] Although it is not known whether cladribine can be removed from the circulation by dialysis or hemofiltration, because of its rapid and extensive intracellular and tissue distribution, hemodialysis is unlikely to eliminate cladribine to a significant extent.[L50688]	Cladribine plasma concentration after intravenous administration declines multi-exponentially with an average half-life of 6.7 +/- 2.5 hours.[L50693] Following oral administration, the terminal half-life is approximately one day.[L50688] The intracellular half-life is 15 hours for Cd-AMP and 10 hours for Cd-ATP.[L50688]	Cladribine is bound approximately 20% to plasma proteins.[L50693] Protein binding is independent of concentration in vitro.[L50688]	An average of 18% of the administered dose has been reported to be excreted in the urine of patients with solid tumours during a five-day continuous intravenous infusion of 3.5 to 8.1 mg/m<sup>2</sup>/day of cladribine injection.[L50693] Following oral administration of 10 mg cladribine in patients with MS, about 28.5% of the dose was excreted unchanged via the renal route. Renal clearance exceeded the glomerular filtration rate, indicating active renal secretion of cladribine.[L50688]	In general, the apparent volume of distribution of cladribine is approximately 9 L/kg, indicating an extensive distribution in body tissues.[L50693] In patients with hematologic malignancies who received a two-hour infusion of cladribine injection at a dose of 0.12 mg/kg, the mean steady-state volume of distribution was 4.5 ± 2.8 L/kg.[L50693] Following oral administration, the mean apparent volume of distribution ranges from 480 to 490 L.[L50688] Cladribine penetrates into cerebrospinal fluid. One report indicates that concentrations are approximately 25% of those in plasma.[L50693] A cerebrospinal fluid:plasma concentration ratio of approximately 0.25 was observed in cancer patients.[L50688]	In patients with hematologic malignancies who received a two-hour infusion of cladribine injection at a dose of 0.12 mg/kg, the mean clearance was 978 ± 422 mL/h/kg.[L50693]	Organic compounds	Nucleosides, nucleotides, and analogues	Purine nucleosides	Purine 2'-deoxyribonucleosides	[ "approved", "investigational" ]	[ "L04AA", "L04A", "L04", "L", "L01BB", "L01B", "L01", "L" ]	[ "Humans and other mammals" ]	[ { "cost": "34.2", "description": "Cladribine 10 mg/10 ml vial", "unit": "ml" }, { "cost": "102.78", "description": "Leustatin 10 mg/10 ml vial", "unit": "ml" } ]	[ { "approved": "2011-02-15", "country": "United States", "expires": "2024-04-11", "number": "7888328" }, { "approved": "2014-07-22", "country": "United States", "expires": "2024-04-11", "number": "8785415" }, { "approved": "2010-05-11", "country": "United States", "expires": "2026-10-16", "number": "7713947" }, { "approved": "2013-02-19", "country": "United States", "expires": "2026-05-31", "number": "8377903" }, { "approved": "2020-12-01", "country": "United States", "expires": "2038-11-23", "number": "10849919" } ]	(2R,3S,5R)-5-(6-amino-2-chloropurin-9-yl)-2-(hydroxymethyl)oxolan-3-ol \| 2-CdA \| 2-Chloro-2'-deoxy-beta-adenosine \| 2-Chloro-2'-deoxyadenosine \| 2-chloro-2′-deoxy-adenosine \| 2-chloro-6-amino-9-(2-deoxy-β-D-erythro-pentofuranosyl)purine \| 2-chloro-deoxyadenosine \| 2-Chlorodeoxyadenosine \| 2ClAdo \| Cladribina \| Cladribine \| Cladribinum \| CldAdo \| 1.17.4.1 \| Ribonucleoside-diphosphate reductase subunit M1 \| Ribonucleotide reductase large subunit \| RR1 \| 3.5.4.4 \| ADA1 \| Adenosine aminohydrolase \| 1.17.4.1 \| Ribonucleotide reductase small chain \| Ribonucleotide reductase small subunit \| RR2 \| 1.17.4.1 \| p53-inducible ribonucleotide reductase small subunit 2-like protein \| P53R2 \| TP53-inducible ribonucleotide reductase M2 B \| 2.7.7.7 \| DNA polymerase alpha catalytic subunit p180 \| POLA \| 2.7.7.7 \| 3'-5' exodeoxyribonuclease \| DNA polymerase II subunit A \| POLE1 \| DNA polymerase epsilon subunit B \| DNA polymerase II subunit 2 \| DPE2 \| Arsenic-transactivated protein \| AsTP \| CHRAC-17 \| CHRAC17 \| Chromatin accessibility complex 17 kDa protein \| DNA polymerase epsilon subunit p17 \| DNA polymerase II subunit 3 \| HuCHRAC17 \| DNA polymerase epsilon subunit p12 \| DNA polymerase II subunit 4 \| 2.4.2.1 \| Inosine phosphorylase \| Inosine-guanosine phosphorylase \| NP \| PNP \| 2.4.2.30 \| ADP-ribosyltransferase diphtheria toxin-like 1 \| ADPRT \| ADPRT 1 \| ARTD1 \| DNA ADP-ribosyltransferase PARP1 \| NAD(+) ADP-ribosyltransferase 1 \| PARP-1 \| Poly[ADP-ribose] synthase 1 \| PPOL \| Protein poly-ADP-ribosyltransferase PARP1 \| 2.7.1.74 \| dCK \| Deoxyadenosine kinase \| Deoxyguanosine kinase \| 2.7.1.113 \| Deoxyadenosine kinase, mitochondrial \| DGK \| 7.6.2.2 \| ABCP \| ATP-binding cassette sub-family G member 2 \| BCRP \| BCRP1 \| Breast cancer resistance protein \| CDw338 \| Mitoxantrone resistance-associated protein \| MXR \| Placenta-specific ATP-binding cassette transporter \| Urate exporter \| CNT 3 \| CNT3 \| Concentrative Na(+)-nucleoside cotransporter 3 \| hCNT3 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| ENT1 \| Equilibrative NBMPR-sensitive nucleoside transporter \| Equilibrative nitrobenzylmercaptopurine riboside-sensitive nucleoside transporter \| es nucleoside transporter \| hENT1 \| Nucleoside transporter, es-type \| Solute carrier family 29 member 1	[ "Cladribine", "Cladribine", "Cladribine", "Cladribine", "Cladribine", "Cladribine", "Cladribine", "Cladribine", "Cladribine", "Cladribine", "Cladribine Injection", "Cladribine Injection", "Leustatin", "Leustatin 1mg/ml", "Litak", "Litak", "Mavenclad", "Mavenclad", "Mavenclad", "Mavenclad", "Mavenclad", "Mavenclad", "Mavenclad", "Mavenclad", "Mavenclad" ]	[ "Litak", "Movectro", "Mylinax" ]	[]	[ "P23921", "P00813", "P31350", "Q7LG56", "P09884", "Q07864", "P56282", "Q9NRF9", "Q9NR33", "P00491", "P09874" ]	[ "P27707", "Q16854" ]	[]	[ "Q9UNQ0", "Q9HAS3", "P08183", "Q99808" ]
DB00243	Ranolazine	Chronic angina is a common cardiovascular condition affecting millions worldwide and causes significant disability while interfering with daily activities.[A189234] Ranolazine is a well-tolerated piperazine derivative used for the management of this condition, offering relief from uncomfortable and debilitating symptoms.[L3580] With a mechanism of action different from drugs used to treat the same condition, ranolazine is a promising anti-anginal therapy. It was originally approved by the FDA in 2006.[L5440]	solid	Ranolazine is indicated for the treatment of chronic angina. It can be used alone or in conjunction with nitrates, beta-blockers, angiotensin receptor blockers, anti-platelet drugs, calcium channel blockers, lipid-lowering drugs, and ACE inhibitors.[L3580] Ranolazine has also been used off-label for the treatment of certain arrhythmias, including ventricular tachycardia, however, this use is not strongly supported by scientific evidence.[A174940] Ranolazine has also been studied for the treatment of acute coronary syndrome, microvascular coronary dysfunction, arrhythmia, and glycemic control, which are not yet approved indications.[A174898,L3580]	Ranolazine exerts both antianginal and ischemic effects independent from lowering heart rate or blood pressure.[A189228,L3580] It blocks IKr, the rapid portion of the delayed rectifier potassium current, and prolongs the QTc interval in a dose-dependent fashion. The Ikr is important for cardiac repolarization.[L3580] Ranolazine exerts its therapeutic effects without negative chronotropic, dromotropic, or inotropic actions neither at rest, nor during exercise.[A174898]	Myocardial ischemia exerts effects on adenosine triphosphate flux, leading to a decrease in the energy available for contraction and relaxation of the heart muscle. Electrolyte balance of sodium and potassium is necessary for maintaining normal cardiac contraction and relaxation. Disruption of adequate sodium and potassium electrolyte balance leads to excessively high concentrations of sodium and calcium, which likely interferes with oxygen supply to the heart muscle. This imbalance eventually leads to angina symptoms of chest pain or pressure, nausea, and dizziness, among others.[A189234,L10965] The mechanism of action for ranolazine is not fully understood. At therapeutic concentrations, it can inhibit the cardiac late sodium 205 current (INa), which may affect the electrolyte balance in the myocardium, relieving angina symptoms. The clinical significance this inhibition in the treatment of angina symptoms is not yet confirmed.[L3580] Ranolazine inhibits sodium and potassium ion channel currents.[A174898] It has been shown to exert weak activity on L-type calcium channels making it a weak direct vasodilator and exerts minimal direct effects on atrioventricular nodal conduction.[A174913] Some additional mechanisms have been elucidated. Ranolazine exerts antagonistic activity towards the alpha 1 and beta 1 adrenergic receptors and inhibition of fatty acid oxidation.[A174898,A189252]	The time to reach peak serum concentration is quite variable but has been observed to be in the range of 2-6 hours, with steady-state within 3 days.[A174898] The FDA indicates a Tmax of 3-5 hours.[L3580] The average steady-state Cmax is about 2600 ng/mL. Absorption of ranolazine is not significantly affected by food consumption.[A174940] The bioavailability of ranolazine taken in the tablet form compared to that from a solution of ranolazine is about 76%.[L3580]	Ranolazine is rapidly heavily metabolized in the liver an gastrointestinal tract through the activity of the CYP3A4 enzyme with minor contributions from CYP2D6.[A174898,A174913,L3580] More than 40 ranolazine metabolites have been found in plasma and more than 100 metabolites have been identified in the urine.[A174946] Ranolazine and some of its metabolites are known to weakly inhibit CYP3A4. However, the activity of the metabolites of ranolazine has not been fully elucidated.[L5473]	The reported LD50 of oral ranolazine in the rat is 980 mg/kg.[MSDS] High oral doses of ranolazine have led to dizziness, nausea, and vomiting. These effects have been shown to be dose related. High intravenous doses can cause diplopia, confusion, paresthesia, in addition to syncope. In the case of an overdose, provide supportive therapy accompanied by continuous ECG monitoring for QT interval prolongation.[L3580]	The apparent terminal half-life of ranolazine is 7 hours.[A175030,L3580]	Approximately 62% of the administered dose of ranolazine is bound to plasma proteins.[A174946,L3580] Ranolazine appears to have a higher binding affinity for alpha-1 acid glycoprotein.[A175030,L5473]	From the administered dose, about 3/4 of the dose is excreted renally, while 1/4 of the dose is excreted in the feces. An estimated 5% of an ingested dose is excreted as unchanged drug.[A174898,L3580]	The mean apparent volume of distribution of ranolazine is reported to be 53.2 L[L5473] and the average steady-state volume of distribution is estimated to range from 85 to 180 L.[A38645]	The reported clearance rate of orally administered ranolazine is of 45 L/h when administered at a dose of 500 mg twice daily.[A38645] The clearance rate of ranolazine is dose-dependent and renal impairment can increase ranolazine serum concentration by 40-50%.[A174946]	Organic compounds	Benzenoids	Phenol ethers	Anisoles	[ "approved", "investigational" ]	[ "C01EB", "C01E", "C01", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "4.04", "description": "Ranexa 500 mg tablet", "unit": "tablet" }, { "cost": "4.06", "description": "Ranexa 500 mg 12 Hour tablet", "unit": "tablet" }, { "cost": "6.63", "description": "Ranexa 1000 mg tablet", "unit": "tablet" }, { "cost": "6.89", "description": "Ranexa 1000 mg 12 Hour tablet", "unit": "tablet" } ]	[ { "approved": "2001-10-16", "country": "United States", "expires": "2019-05-27", "number": "6303607" }, { "approved": "2002-11-12", "country": "United States", "expires": "2019-05-27", "number": "6479496" }, { "approved": "2003-02-25", "country": "United States", "expires": "2019-05-27", "number": "6525057" }, { "approved": "2003-05-13", "country": "United States", "expires": "2019-05-27", "number": "6562826" }, { "approved": "2003-09-16", "country": "United States", "expires": "2019-05-27", "number": "6620814" }, { "approved": "2005-02-08", "country": "United States", "expires": "2019-05-27", "number": "6852724" }, { "approved": "2005-03-08", "country": "United States", "expires": "2019-05-27", "number": "6864258" }, { "approved": "2003-09-09", "country": "United States", "expires": "2019-05-27", "number": "6617328" }, { "approved": "2002-04-09", "country": "United States", "expires": "2019-05-27", "number": "6369062" }, { "approved": "2003-01-07", "country": "United States", "expires": "2019-05-27", "number": "6503911" }, { "approved": "2021-01-26", "country": "United States", "expires": "2038-01-24", "number": "10898444" }, { "approved": "2018-01-24", "country": "United States", "expires": "2038-01-24", "number": "11510878" } ]	Ranolazina \| Ranolazine \| 3.4.21.7 \| NAC1 \| SCN1 \| Sodium channel protein brain I subunit alpha \| Sodium channel protein type I subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.1 \| hPN3 \| Peripheral nerve sodium channel 3 \| PN3 \| Sodium channel protein type X subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.8 \| hNaN \| Peripheral nerve sodium channel 5 \| PN5 \| SCN12A \| Sensory neuron sodium channel 2 \| SNS2 \| Sodium channel protein type XI subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.9 \| HBA \| HBSC II \| NAC2 \| SCN2A1 \| SCN2A2 \| Sodium channel protein brain II subunit alpha \| Sodium channel protein type II subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.2 \| KIAA1356 \| NAC3 \| Sodium channel protein brain III subunit alpha \| Sodium channel protein type III subunit alpha \| Voltage-gated sodium channel subtype III \| Voltage-gated sodium channel subunit alpha Nav1.3 \| SkM1 \| Sodium channel protein skeletal muscle subunit alpha \| Sodium channel protein type IV subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.4 \| hH1 \| Sodium channel protein cardiac muscle subunit alpha \| Sodium channel protein type V subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.5 \| Atypical sodium channel Nav2.1 \| Nax channel \| SCN6A \| Sodium channel protein type VII subunit alpha \| MED \| Sodium channel protein type VIII subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.6 \| hNE-Na \| NENA \| Neuroendocrine sodium channel \| Peripheral sodium channel 1 \| PN1 \| Sodium channel protein type IX subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.7 \| KIAA1158 \| Inward rectifier K(+) channel Kir2.2 \| Inward rectifier K(+) channel Kir2.2v \| IRK-2 \| IRK2 \| KCNJN1 \| Potassium channel, inwardly rectifying subfamily J member 12 \| Inward rectifier K(+) channel Kir2.4 \| IRK-4 \| IRK4 \| Potassium channel, inwardly rectifying subfamily J member 14 \| Cardiac inward rectifier potassium channel \| hIRK1 \| Inward rectifier K(+) channel Kir2.1 \| IRK-1 \| IRK1 \| Potassium channel, inwardly rectifying subfamily J member 2 \| Hippocampal inward rectifier \| HIR \| HIRK2 \| HRK1 \| Inward rectifier K(+) channel Kir2.3 \| IRK-3 \| IRK3 \| Potassium channel, inwardly rectifying subfamily J member 4 \| CACH2 \| CACN2 \| CACNL1A1 \| Calcium channel, L type, alpha-1 polypeptide, isoform 1, cardiac muscle \| CCHL1A1 \| Voltage-gated calcium channel subunit alpha Cav1.2 \| CACH3 \| CACN4 \| CACNL1A2 \| Calcium channel, L type, alpha-1 polypeptide, isoform 2 \| CCHL1A2 \| Voltage-gated calcium channel subunit alpha Cav1.3 \| CACNAF1 \| Voltage-gated calcium channel subunit alpha Cav1.4 \| CACH1 \| CACN1 \| CACNL1A3 \| Calcium channel, L type, alpha-1 polypeptide, isoform 3, skeletal muscle \| Voltage-gated calcium channel subunit alpha Cav1.1 \| CAB1 \| CACNLB1 \| Calcium channel voltage-dependent subunit beta 1 \| CAB2 \| CACNLB2 \| Calcium channel voltage-dependent subunit beta 2 \| Lambert-Eaton myasthenic syndrome antigen B \| MYSB \| CAB3 \| CACNLB3 \| Calcium channel voltage-dependent subunit beta 3 \| CAB4 \| CACNLB4 \| Calcium channel voltage-dependent subunit beta 4 \| ADRA1C \| Alpha-1A adrenoceptor \| Alpha-1A adrenoreceptor \| Alpha-1C adrenergic receptor \| Alpha-adrenergic receptor 1c \| Alpha-1B adrenoceptor \| Alpha-1B adrenoreceptor \| ADRA1A \| Alpha-1A adrenergic receptor \| Alpha-1D adrenoceptor \| Alpha-1D adrenoreceptor \| Alpha-adrenergic receptor 1a \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| AGP 1 \| AGP1 \| OMD 1 \| Orosomucoid-1 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| hMATE-1 \| MATE-1 \| MATE1 \| Solute carrier family 47 member 1 \| hMATE-2 \| Kidney-specific H(+)/organic cation antiporter \| MATE-2 \| MATE2 \| Solute carrier family 47 member 2	[ "Aspruzyo Sprinkle", "Aspruzyo Sprinkle", "Corzyna", "Corzyna", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranexa", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine", "Ranolazine" ]	[]	[]	[ "P00747", "P35498", "Q9Y5Y9", "Q9UI33", "Q99250", "Q9NY46", "P35499", "Q14524", "Q01118", "Q9UQD0", "Q15858", "Q07699", "O60939", "Q9NY72", "Q8IWT1", "Q14500", "Q9UNX9", "P63252", "P48050", "Q13936", "Q01668", "O60840", "Q13698", "Q02641", "Q08289", "P54284", "O00305", "P35348", "P35368", "P25100", "P08588" ]	[ "P08684", "P10635" ]	[ "P02763" ]	[ "O95342", "P08183", "Q96FL8", "Q86VL8" ]
DB00244	Mesalazine	An anti-inflammatory agent, structurally related to the salicylates and non-steroidal anti-inflammatory drugs like acetylsalicylic acid, which is active in inflammatory bowel disease [A174022]. Although demonstrably effective in treating and maintaining remission for ulcerative colitis, mesalazine has historically faced a number of issues regarding its lack of stability as a pharmaceutical agent [A174019]. Throughout the late seventies and the eighties, important research initiatives developed stable mesalazine formulations like the eudragit-S coating of Asacol brand mesalazine and the Pentasa brand's encapsulation of mesalazine within microgranules [A174019]. In the present day, contemporary research regarding novel methods to stabilize mesalazine continues and interest in the agent's capacity to decrease inflammatory activity and subsequently potentially reduce the risk of colorectal cancer in conditions like ulcerative colitis is maintained.[A174019,A174022]	solid	Mesalazine is indicated for the treatment of mildly to moderately active ulcerative colitis in adults and patients 5 years or older.[L36280,L36275]. Mesalazine is also indicated for the maintenance of remission of ulcerative colitis in adults and maintenance of remission of Crohn's ileocolitis.[L44196,L5101]	Mesalazine is one of the two components of sulphasalazine, the other being sulphapyridine. It is the latter responsible for most of the side effects associated with sulphasalazine therapy, while mesalazine is known to be the active moiety in the treatment of ulcerative colitis [L5101]. Mesalazine is thought to dampen the inflammatory process through its ability to inhibit prostaglandin synthesis, interfere with leukotriene synthesis, and consequent leukocyte migration as well as act as a potent scavenger of free radicals.[L37023] Regardless of the mode of action, mesalazine appears to be active mainly topically rather than systemically.[L37023] Intraperitoneally administered mesalazine at 30 and 340 mg/kg daily had similar efficacy in attenuating colitis as prednisolone 4 to 550 mg/kg daily given intraperitoneally or sulphasalazine 0.34 to 5 mg/kg given orally in immune complex-induced colitis mice.[A254851] Mesalazine at 5 mmol/L and sulphasalazine 1.5 mmol/L also reversed the increase in water and chloride secretion and decrease the sodium in dinitrochlorbenzene-induced colitis guinea pig.[A254851]	Although the mechanism of action of mesalazine is not fully understood, it is believed to possess a topical anti-inflammatory effect on colonic epithelial cells.[L36230] Mucosal production of arachidonic acid metabolites, both through the cyclooxygenase pathways, i.e., prostanoids, and through the lipoxygenase pathways, i.e., leukotrienes and hydroxyeicosatetraenoic acids, is increased in patients with chronic inflammatory bowel disease, and it is possible that mesalazine diminishes inflammation by blocking cyclooxygenase and inhibiting prostaglandin production in the colon.[L36230] Furthermore, mesalazine also has the potential to inhibit the activation of Nuclear Factor kappa B (NFkB) and consequently the production of key pro-inflammatory cytokines.[A16800,A4391,A16799] It has been proposed that reduced expression of PPAR gamma nuclear receptors (gamma form of peroxisome proliferator-activated receptors) may be implicated in ulcerative colitis, and that mesalazine produces pharmacodynamic effects through direct activation of PPAR gamma receptors in the colonic/rectal epithelium.[A16797,A16798,A16516,A16515] Other research also showed the potential involvement of inducible NO synthase (iNOS) and that mesalazine can inhibit this enzyme to amiliorate the enteropathy in inflammatory bowel diseases.[L37023] Moreover, since increased leukocyte migration, abnormal cytokine production, increased production of arachidonic acid metabolites, particularly leukotriene B4, and increased free radical formation in the inflamed intestinal tissue are all present in patients with inflammatory bowel disease it is also believed that mesalazine has in-vitro and in-vivo pharmacological effects that inhibit leukocyte chemotaxis, decrease cytokine and leukotriene production and scavenge for free radicals.[L5107]	Depending on the formulation administered, prescribing information for orally administered delayed-released tablets of 2.4g or 4.8g of mesalazine given once daily for 14 days to healthy volunteers was to found to be about 21% to 22% of the administered dose [FDA Label] while prescribing information for an orally administered controlled-release capsule formulation suggests 20% to 30% of the mesalazine in the formulation is absorbed.[F3001] In contrast, when mesalamine is administered orally as an unformulated 1-g aqueous suspension, mesalazine is approximately 80% absorbed.[F3001]	Mesalazine is metabolized both pre-systemically by the intestinal mucosa and systemically in the liver to N-acetyl-5-aminosalicylic acid (N-Ac-5-ASA) principally by NAT-1. Some acetylation also occurs through the action of colonic bacteria.[L5107,L44196]	Mesalazine caused no increase in the incidence of neoplastic lesions over controls in a two-year study of Wistar rats fed up to 320 mg/kg/day of mesalazine admixed with diet (about 1.7 times the recommended human intra-rectal dose of CANASA, based on body surface area). Mesalazine was not mutagenic in the Ames test, the mouse lymphoma cell (TK+/-) forward mutation test, or the mouse micronucleus test. No effects on fertility or reproductive performance of the male and female rats were observed at oral mesalamine doses up to 320 mg/kg/day (about 1.7 times the recommended human intra-rectal dose of mesalazine, based on body surface area).[L36280] Mesalazine is an aminosalicylate, and symptoms of salicylate toxicity include nausea, vomiting and abdominal pain, tachypnea, hyperpnea, tinnitus, and neurologic symptoms (headache, dizziness, confusion, seizures). Severe salicylate intoxication may lead to electrolyte and blood pH imbalance and potentially to other organ involvement (e.g., renal and liver). There is no specific antidote for mesalamine overdose; however, conventional therapy for salicylate toxicity may be beneficial in the event of acute overdosage and may include gastrointestinal tract decontamination to prevent further absorption. Correct fluid and electrolyte imbalance by the administration of appropriate intravenous therapy and maintain adequate renal function.[L36230] Mesalazine is known to be substantially excreted by the kidney, and the risk of adverse reactions may be greater in patients with impaired renal function. Evaluate renal function in all patients prior to initiation and periodically while on Asacol HD therapy. Monitor patients with known renal impairment or a history of renal disease or taking nephrotoxic drugs for decreased renal function and mesalamine-related adverse reactions.[L36230]	For the delayed-release formulation, after intravenous administration, the elimination half-life of mesalamine is reported to be approximately 40 minutes. After oral dosing, the median terminal half life values for mesalamine are usually about 25 hours, but are variable, ranging from 1.5 to 296 hours. There is a large inter-subject and intra-subject variability in the plasma concentrations of mesalamine and N-acetyl-5-aminosalicylic acid and in their terminal half-lives following the administration of mesalazine.[L36275] For the extended-release formulation, following single and multiple doses of mesalazine, the mean half-lives were 9 to 10 hours for 5-ASA, and 12 to 14 hours for N-Ac-5-ASA.[L44196] The mean elimination half-life was 5 hours (CV=73%) for 5-ASA and 5 hours (CV=63%) for N-acetyl-5-ASA in patients taking 500 mg mesalazine as a rectal suppository every 8 hours for 6 days.[L36280] For the rectal enema suspension formulation, the elimination half-life was 0.5 to 1.5 hours for 5-ASA and 5 to 10 hours for N-acetyl-5-ASA.[L40978]	In an in vitro study, at 2.5 mcg/mL, mesalamine and N-Ac-5-ASA are 43±6% and 78±1% bound, respectively, to plasma proteins. Protein binding of N-Ac-5-ASA does not appear to be concentration dependent at concentrations ranging from 1 to 10 mcg/mL.[L44196]	Elimination of mesalazine is mainly via the renal route following metabolism to N-acetyl-5-aminosalicylic acid (acetylation) [L40848]. However, there is also limited excretion of the parent mesalazine drug in the urine.[L40848] After the oral administration of the extended-release formulation of mesalazine, of the approximately 21% to 22% of the drug absorbed, less than 8% of the dose was excreted unchanged in the urine after 24 hours, compared with greater than 13% for N-acetyl-5-aminosalicylic acid.[L40848] When given the controlled-release formulation, about 130 mg free mesalazine was recovered in the feces following a single 1-g dose, which was comparable to the 140 mg of mesalazine recovered from the molar equivalent sulfasalazine tablet dose of 2.5 g F3001]. Elimination of free mesalazine and salicylates in feces increased proportionately with the dose given. N-acetylmesalazine was the primary compound excreted in the urine (19% to 30%) following the controlled-release dosing.[F3001] In patients with ulcerative proctitis treated with mesalamine 500 mg as a rectal suppository every 8 hours for 6 days, 12% or less of the dose was eliminated in urine as unchanged 5-ASA and 8% to 77% was eliminated as N-acetyl-5-ASA following the initial dose. At steady state, 11% or less of the dose was eliminated in the urine as unchanged 5-ASA and 3% to 35% was eliminated as N-acetyl-5-ASA.[L36280]	For the extended-release formulation, mesalazine has a Vd of 18 L, confirming minimal extravascular penetration of systemically available drug.[L44201] For the delayed-release formulation, the apparent volume of distribution was estimated to be 4.8 L.[L44206]	The mean (SD) renal clearance in L/h for mesalazine following the single dose administration of mesalazine delayed-release tablets 4.8g under fasting conditions to young and elderly subjects were documented as 2.05 ± 1.33 in young subjects aged 18 to 35 years old, 2.04 ± 1.16 in elderly subjects aged 65 to 75 years old and 2.13 ± 1.20 in elderly subjects older than 75 years.[L40848]	Organic compounds	Benzenoids	Benzene and substituted derivatives	Benzoic acids and derivatives	[ "approved" ]	[ "A07EC", "A07E", "A07", "A" ]	[ "Humans and other mammals" ]	[ { "cost": "1.07", "description": "Pentasa 250 mg capsule", "unit": "capsule" }, { "cost": "1.14", "description": "Asacol 800 800 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "1.23", "description": "Salofalk 500 mg Suppository", "unit": "suppository" }, { "cost": "1.8", "description": "Pentasa 1 g Suppository", "unit": "suppository" }, { "cost": "1.81", "description": "Salofalk 1000 mg Suppository", "unit": "suppository" }, { "cost": "1.94", "description": "Asacol ec 400 mg tablet", "unit": "tablet" }, { "cost": "2.22", "description": "Asacol 400 mg Enteric Coated Tabs", "unit": "tab" }, { "cost": "2.66", "description": "Pentasa 500 mg capsule", "unit": "capsule" }, { "cost": "3.88", "description": "Asacol hd dr 800 mg tablet", "unit": "tablet" }, { "cost": "3.96", "description": "Salofalk (2 g/60 g) 2 g/enm Enema", "unit": "enema" }, { "cost": "4.17", "description": "Pentasa (1 g/100Ml) 1 g/enm Enema", "unit": "enema" }, { "cost": "5.02", "description": "Pentasa (4 g/100 Ml) 4 g/enm Enema", "unit": "enema" }, { "cost": "6.24", "description": "Canasa 500 mg suppository", "unit": "suppository" }, { "cost": "6.73", "description": "Salofalk (4 g/60 g) 4 g/enm Enema", "unit": "enema" }, { "cost": "13.88", "description": "Canasa 1000 mg suppository", "unit": "suppository" }, { "cost": "488.32", "description": "Canasa 30 1000 mg Suppository Box", "unit": "box" }, { "cost": "0.41", "description": "Rowasa 4 gm/60 ml enema", "unit": "ml" }, { "cost": "0.42", "description": "Novo-5 Asa 400 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "0.56", "description": "Salofalk 500 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "0.59", "description": "Asacol 400 mg Enteric-Coated Tablet", "unit": "tablet" }, { "cost": "0.63", "description": "Pentasa 500 mg Sustained-Release Tablet", "unit": "tablet" }, { "cost": "0.69", "description": "Mesasal 500 mg Enteric-Coated Tablet", "unit": "tablet" } ]	[ { "approved": "1996-07-30", "country": "United States", "expires": "2013-07-30", "number": "5541170" }, { "approved": "2009-06-09", "country": "Canada", "expires": "2021-10-24", "number": "2444814" }, { "approved": "2002-08-20", "country": "Canada", "expires": "2012-06-16", "number": "2111697" }, { "approved": "2010-01-12", "country": "United States", "expires": "2027-07-24", "number": "7645801" }, { "approved": "2004-08-10", "country": "United States", "expires": "2020-06-08", "number": "6773720" }, { "approved": "2013-05-07", "country": "United States", "expires": "2028-06-06", "number": "8436051" }, { "approved": "2012-07-10", "country": "United States", "expires": "2028-06-06", "number": "8217083" }, { "approved": "2005-05-17", "country": "United States", "expires": "2021-11-15", "number": "6893662" }, { "approved": "2013-11-12", "country": "United States", "expires": "2021-11-15", "number": "8580302" }, { "approved": "2015-07-28", "country": "United States", "expires": "2021-11-15", "number": "9089492" }, { "approved": "2014-12-16", "country": "United States", "expires": "2018-04-20", "number": "8911778" }, { "approved": "2003-04-22", "country": "United States", "expires": "2018-04-20", "number": "6551620" }, { "approved": "2012-12-25", "country": "United States", "expires": "2018-04-20", "number": "8337886" }, { "approved": "2014-10-21", "country": "United States", "expires": "2030-05-01", "number": "8865688" }, { "approved": "2013-07-30", "country": "United States", "expires": "2018-04-20", "number": "8496965" }, { "approved": "2015-01-27", "country": "United States", "expires": "2018-04-20", "number": "8940328" }, { "approved": "2015-02-17", "country": "United States", "expires": "2018-04-20", "number": "8956647" }, { "approved": "2003-11-18", "country": "United States", "expires": "2020-04-13", "number": "6649180" } ]	3-carboxy-4-hydroxyaniline \| 5-aminosalicylic acid \| 5-ASA \| m-Aminosalicylic acid \| Mesalamine \| Mesalazina \| Mésalazine \| Mesalazine \| Mesalazinum \| p-Aminosalicylsaeure \| 1.14.99.1 \| COX-2 \| COX2 \| Cyclooxygenase-2 \| PGH synthase 2 \| PGHS-2 \| PHS II \| Prostaglandin H2 synthase 2 \| Prostaglandin-endoperoxide synthase 2 \| 1.14.99.1 \| COX-1 \| COX1 \| Cyclooxygenase-1 \| PGH synthase 1 \| PGHS-1 \| PHS 1 \| Prostaglandin H2 synthase 1 \| Prostaglandin-endoperoxide synthase 1 \| 1.13.11.- \| 5-lipoxygenase \| 5-LO \| Arachidonate 5-lipoxygenase \| LOG5 \| NR1C3 \| Nuclear receptor subfamily 1 group C member 3 \| PPAR-gamma \| 2.7.11.10 \| Conserved helix-loop-helix ubiquitous kinase \| I-kappa-B kinase 1 \| I-kappa-B kinase alpha \| IkappaB kinase \| IkBKA \| IKK-1 \| IKK-A \| IKK-alpha \| IKK1 \| IKKA \| NFKBIKA \| Nuclear factor NF-kappa-B inhibitor kinase alpha \| TCF-16 \| TCF16 \| Transcription factor 16 \| 2.7.11.10 \| I-kappa-B kinase 2 \| I-kappa-B-kinase beta \| IkBKB \| IKK-2 \| IKK-B \| IKK-beta \| IKK2 \| IKKB \| NFKBIKB \| Nuclear factor NF-kappa-B inhibitor kinase beta \| Serine/threonine protein kinase IKBKB \| 1.14.13.39 \| HEP-NOS \| Hepatocyte NOS \| Inducible NO synthase \| Inducible NOS \| iNOS \| NOS type II \| NOS2A \| Peptidyl-cysteine S-nitrosylase NOS2 \| 2.3.1.5 \| AAC1 \| Arylamide acetylase 1 \| MNAT \| Monomorphic arylamine N-acetyltransferase \| N-acetyltransferase type 1 \| NAT-1 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9	[ "5-asa", "Apriso", "Apriso", "Apriso", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol", "Asacol 800", "Asacol HD", "Asacol Hd", "Asacol HD", "Canasa", "Canasa", "Canasa", "Delzicol", "Delzicol", "Delzicol", "Delzicol", "Delzicol", "Lialda", "Lialda", "Lialda", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine", "Mesalamine Rectal", "Mesasal", "Mezavant", "Mezera", "Mezera", "Mezera", "Mezera", "Ntp-5-aminosalicylic Acid", "Octasa", "Octasa", "Pendo-5 Asa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa", "Pentasa Enema 2g/100ml", "Pentasa Extended-release Tablets 250mg", "Rowasa", "Rowasa", "Salofalk", "Salofalk", "Salofalk", "Salofalk", "Salofalk", "Salofalk (r) 5-asa Enteric Coated Tab- 250mg", "Salofalk (r) 5-asa Suppositories - 250mg", "sF Rowasa", "sfRowasa Sulfite-Free Formulation", "Teva-5 Asa", "Zaldyon", "Zaldyon" ]	[ "Asacolitin", "Claversal", "Fisalamine", "Iialda", "Lixacol" ]	[]	[ "P35354", "P23219", "P09917", "P37231", "O15111", "O14920", "P35228" ]	[ "P18440" ]	[]	[ "Q9Y6L6", "Q9NPD5", "O94956" ]
DB00245	Benzatropine	Benztropine, with the chemical formula 3alpha-diphenylmethoxytropane, is a tropane-based dopamine inhibitor used for the symptomatic treatment of Parkinson's disease. It is a combination molecule between a tropane ring, similar to cocaine, and a diphenyl ether from the dialkylpiperazines determined to be a dopamine uptake inhibitor since 1970. The generation of structure-activity relationships proved that benztropine derivatives with the presence of a chlorine substituent in the para position in one of the phenyl rings produces an increased potency for dopamine uptake inhibition as well as a decreased inhibition of serotonin and norepinephrine.[A37914] Benztropine was developed by USL Pharma and officially approved by the FDA on 1996.[L5500]	solid	Benztropine is indicated to be used as an adjunct in the therapy of all forms of parkinsonism. It can also be used for the control of extrapyramidal disorders due to neuroleptic drugs.[T203] The extrapyramidal symptoms are defined as drug-induced disorders that include symptoms of dystonia, akathisia, parkinsonism, bradykinesia, tremors, and dyskinesia.[A175120] Parkinsonism is a general term that refers to the group of neurological disorders that produce symptoms similar to Parkinson's disease such as tremors, slow movement, and stiffness. The parkinsonism includes a large number of disorders and some of them have not been clearly defined.[L5509]	The inhibition of dopamine reuptake by benztropine produces a dose-dependent increase of dopamine in the nerve terminal of the dopaminergic system.[A1628] Clinically the activity of benztropine is observed after 1-2 hours of oral administration and after a few minutes of intramuscular administration with a last-longing effect of about 24 hours. Reports have indicated that benztropine has a very large sedative effect.[A1628] The antihistaminic effect of benztropine is very similar to the effect found in [pyrilamine] and the anticholinergic activity was found to be equal to [atropine] _ex vivo_ and of about 50% activity _in vivo_.[F3679]	Benztropine is an agent with anti-muscarinic and antihistaminic effects. Its main mechanism of action is presented by the selective inhibition of dopamine transporters but it also presents affinity for histamine and muscarine receptors.[A175084] It is widely known that benztropine is a potent inhibitor of presynaptic carrier-mediated dopamine transport. As well, it is known to be an analog of atropine and hence, it has a large affinity for muscarinic receptors M1 in the human brain. Once bound, benztropine blocks the activity of the muscarinic receptors mainly in the striatum.[A1628] The increased advantage of benztropine lays on the antagonism of acetylcholine activity which corrects the imbalance between dopamine and acetylcholine in Parkinson patients.[F3679]	Oral administration of 1.5 mg of benztropine is slowly absorbed in the gastrointestinal tract and it reaches a peak concentration of 2.5 ng/ml in about 7 hours.[A175087] It has an approximate oral bioavailability of 29%.[T445]	Benztropine has been shown to undergo metabolism mainly marked by N-oxidation, N-dealkylation and ring hydroxylation.[A175087] The extensive metabolism of benztropine produces eight phase-I metabolites plus four glucuronide conjugates.[A1628]	The oral LD50 of benztropine is reported to be of 940 mg/kg in rats.[MSDS] In the presence of overdose with benztropine, it has been observed symptoms of circulatory collapse, cardiac arrest, respiratory depression, respiratory arrest, psychosis, shock, coma, seizure, ataxia, combativeness, anhidrosis, hyperthermia, fever, dysphagia, decreased bowel sounds and sluggish pupils.[F3682]	The elimination half-life of benztropine is very variable and it is reported to be of around 36 hours.[F3682]	About 95% of the administered dose of benztropine is found bound to plasma proteins.[T445]	Benztropine is mainly excreted in the urine but it is also found in the feces unchanged.[A1628]	Benztropine is expected to present a large volume of distribution between 12-30 L/kg.[A175126]	Extensive pharmacodynamic or pharmacokinetic studies have not been performed.	Organic compounds	Benzenoids	Benzene and substituted derivatives	Diphenylmethanes	[ "approved" ]	[ "N04AC", "N04A", "N04", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "26.38", "description": "Benztropine mesylate powder", "unit": "g" }, { "cost": "33.0", "description": "Benztropine 2 mg/2 ml vial", "unit": "ml" }, { "cost": "37.5", "description": "Benztropine 2 mg/2 ml ampule", "unit": "ml" }, { "cost": "70.09", "description": "Cogentin 2 mg/2 ml ampule", "unit": "ml" }, { "cost": "0.02", "description": "Pms-Benztropine 1 mg Tablet", "unit": "tablet" }, { "cost": "0.05", "description": "Pms-Benztropine 2 mg Tablet", "unit": "tablet" }, { "cost": "0.06", "description": "Apo-Benztropine 2 mg Tablet", "unit": "tablet" }, { "cost": "0.26", "description": "Benztropine Mesylate 2 mg tablet", "unit": "tablet" }, { "cost": "0.27", "description": "Benztropine Mesylate 0.5 mg tablet", "unit": "tablet" }, { "cost": "0.27", "description": "Benztropine Mesylate 1 mg tablet", "unit": "tablet" }, { "cost": "0.34", "description": "Benztropine mes 0.5 mg tablet", "unit": "tablet" }, { "cost": "0.38", "description": "Benztropine mes 1 mg tablet", "unit": "tablet" }, { "cost": "0.41", "description": "Benztropine mes 2 mg tablet", "unit": "tablet" } ]	[]	3-alpha-(diphenylmethoxy)tropane \| 3endo-benzhydryloxytropane \| 3α-(diphenylmethoxy)-1αH,5αH-tropane \| 3α-(diphenylmethoxy)tropane \| 3α-benzhydryloxy-8-methyl-8-azabicyclo[3.2.1]octane \| Benzatropina \| Benzatropine \| Benzatropinum \| benzhydryl 8-methyl-8-azabicyclo[3.2.1]oct-3-yl ether \| Benztropine \| Tropine benzohydryl ether \| DA transporter \| DAT \| DAT1 \| Solute carrier family 6 member 3 \| H1-R \| H1R \| HH1R \| 5HT transporter \| 5HTT \| HTT \| SERT \| Solute carrier family 6 member 4 \| NAT1 \| NET \| NET1 \| Norepinephrine transporter \| SLC6A5 \| Solute carrier family 6 member 2	[ "Bensylate Tab 2mg", "Benztropine", "Benztropine", "Benztropine 2 Tab 2mg", "Benztropine mesylate", "Benztropine mesylate", "Benztropine mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate", "Benztropine Mesylate Injection, USP", "Benztropine Mesylate Injection, USP", "Benztropine Omega", "Cogentin", "Cogentin", "Cogentin Inj 1mg/ml", "Cogentin Tab 2mg", "Dom-benztropine", "Pdp-benztropine", "Pdp-benztropine", "Pdp-benztropine", "PMS-benztropine 2mg/tab", "PMS-benztropine Tab 0.5mg" ]	[ "Apo-Benztropine", "Cogentinol", "PMS Benztropine" ]	[]	[ "P11229", "Q01959", "P35367", "P31645", "P23975" ]	[]	[ "P02768" ]	[]
DB00246	Ziprasidone	Disorders such as schizophrenia and bipolar disorder can significantly impair mood, cognition, and behavior.[A190525] These mental illnesses can often be accompanied by comorbidities such as depression and substance abuse, and can significantly impact the quality of life of patients and caregivers.[A190525] Luckily, several treatment options for psychotic disorders have been introduced to market since the realization of chlorpromazine's antipsychotic properties in 1952.[A190525] Second generation antipsychotics (commonly referred to as atypical antipsychotics) include [clozapine], [quetiapine], [olanzapine], [aripiprazole] and [ziprasidone] among others, and are generally thought to be as efficacious as first generation antipsychotics but differ in their adverse effect profiles.[A190525,A190534] First generation antipsychotics are associated with extrapyramidal adverse effects while atypical antipsychotics are linked to weight gain, impaired glucose tolerance and metabolic syndrome.[A190534,A190537] Ziprasidone is used to treat schizophrenia and bipolar disorder.[A180748] It can effectively reduce the rate and time of relapses in schizophrenia, and can be used to treat manic episodes in bipolar disorder although the mechanism of action is unknown.[A180748] Although ziprasidone is classified as an atypical antipsychotic, it appears to have a lower incidence of metabolic adverse effects compared to other medications in the same class.[A190525]	solid	In its oral form, ziprasidone is approved for the treatment of schizophrenia, as monotherapy for acute treatment of manic or mixed episodes related to bipolar I disorder, and as adjunctive therapy to lithium or valproate for maintenance treatment of bipolar I disorder.[L7342] The injectable formulation is approved only for treatment of acute agitation in schizophrenia.[L7342]	Ziprasidone is classified as a "second generation" or "atypical" antipsychotic and is a dopamine and 5HT2A receptor antagonist with a unique receptor binding profile. As previously mentioned, ziprasidone has a very high 5-HT2A/D2 affinity ratio, binds to multiple serotonin receptors in addition to 5-HT2A, and blocks monoamine transporters which prevents 5HT and NE reuptake. On the other hand, ziprasidone has a low affinity for muscarinic cholinergic M1, histamine H1, and alpha1-adrenergic receptors.[A174562]	The effects of ziprasidone are differentiated from other antispychotics based on its preference and affinity for certain receptors. Ziprasidone binds to serotonin-2A (5-HT2A) and dopamine D2 receptors in a similar fashion to other atypical antipsychotics; however, one key difference is that ziprasidone has a higher 5-HT2A/D2 receptor affinity ratio when compared to other antipsychotics such as olanzapine, quetiapine, risperidone, and aripiprazole.[A363] Ziprasidone offers enhanced modulation of mood, notable negative symptom relief, overall cognitive improvement and reduced motor dysfunction which is linked to it's potent interaction with 5-HT2C, 5-HT1D, and 5-HT1A receptors in brain tissue.[A363] Ziprasidone can bind moderately to norepinephrine and serotonin reuptake sites which may contribute to its antidepressant and anxiolytic activity.[A363] Patient's taking ziprasidone will likely experience a lower incidence of orthostatic hypotension, cognitive disturbance, sedation, weight gain, and disruption in prolactin levels since ziprasidone has a lower affinity for histamine H1, muscarinic M1, and alpha1-adrenoceptors.[A363]	In the absence of food, ziprasidone's oral bioavailability is 60%, and absorption may reach 100% if ziprasidone is taken with a meal containing at least 500 kcal. The difference in bioavailability has little to do with the fat content of the food and appears to be related to the bulk of the meal since more absorption occurs the longer ziprasidone remains in the stomach.[A174562]	Ziprasidone is heavily metabolized in the liver with less than 5% of the drug excreted unchanged in the urine.[A174277] The primary reductive pathway is catalyzed by aldehyde oxidase, while 2 other less prominent oxidative pathways are catalyzed by CYP3A4.[A174277] Ziprasidone is unlikely to interact with other medications metabolized by CYP3A4 since only 1/3 of the antipsychotic is metabolized by the CYP3A4 system.[A174277] There are 12 identified ziprasidone metabolites (abbreviations italicized): Ziprasidone sulfoxide, ziprasidone sulfone, (6-chloro-2-oxo-2,3-dihydro-1H-indol-5-yl)acetic acid (_OX-COOH_), OX-COOH glucuronide, 3-(piperazine-1-yl)-1,2-benzisothiazole (_BITP_), BITP sulfoxide, BITP sulfone, BITP sulfone lactam, S-Methyl-dihydro-ziprasidone, S-Methyl-dihydro-ziprasidone-sulfoxide, 6-chloro-5-(2-piperazin-1-yl-ethyl)-1,3-dihydro-indol-2-one (_OX-P_), and dihydro-ziprasidone-sulfone.[A190558] As suggested by the quantity of metabolites, ziprasidone is metabolized through several different pathways. Ziprasidone is sequentially oxidized to ziprasidone sulfoxide and ziprasidone sulfone, and oxidative N-dealkylation of ziprasidone produces OX-COOH and BITP.[A190558] OX-COOH undergoes phase II metabolism to yield a glucuronidated metabolite while BITP is sequentially oxidized into BITP sulfoxide, BITP sulfone, then BITP sulfone lactam.[A190558] Ziprasidone can also undergo reductive cleavage and methylation to produce S-Methyl-dihydro-ziprasidone and then further oxidation to produce S-Methyl-dihydro-ziprasidone-sulfoxide.[A190558] Finally dearylation of ziprasidone produces OX-P, and the process of hydration and oxidation transforms the parent drug into dihydro-ziprasidone-sulfone.[A190558] Although CYP3A4 and aldehyde oxidase are the primary enzymes involved in ziprasidone metabolism[A174277], the pathways associated with each enzyme have not been specified.	The most common adverse reactions reported with ziprasidone include somnolence, respiratory tract infections, extrapyramidal symptoms, dizziness, akathisia, abnormal vision, asthenia, vomiting, headache and nausea. [L7342]	The half life of ziprasidone is 6-7 hours.[A174562]	Ziprasidone is extensively protein bound with over 99% of the drug bound to plasma proteins, primarily albumin and alpha1-acid glycoprotein.[A190594,L7342]	Ziprasidone is extensively metabolized after oral administration with only a small amount excreted in the urine (<1%) or feces (<4%) as unchanged drug.	The mean apparent volume of distribution of Ziprasidone is 1.5 L/kg.[L7342]	The mean apparent systemic clearance is 7.5 mL/min/kg.[L7342]	Organic compounds	Organoheterocyclic compounds	Diazinanes	Piperazines	[ "approved" ]	[ "N05AE", "N05A", "N05", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "1.86", "description": "Zeldox 20 mg Capsule", "unit": "capsule" }, { "cost": "2.13", "description": "Zeldox 40 mg Capsule", "unit": "capsule" }, { "cost": "2.13", "description": "Zeldox 60 mg Capsule", "unit": "capsule" }, { "cost": "2.13", "description": "Zeldox 80 mg Capsule", "unit": "capsule" }, { "cost": "8.14", "description": "Geodon 20 mg capsule", "unit": "capsule" }, { "cost": "8.14", "description": "Geodon 40 mg capsule", "unit": "capsule" }, { "cost": "9.88", "description": "Geodon 60 mg capsule", "unit": "capsule" }, { "cost": "9.88", "description": "Geodon 80 mg capsule", "unit": "capsule" }, { "cost": "16.22", "description": "Geodon 20 mg vial", "unit": "vial" }, { "cost": "1407.72", "description": "Zoladex 10.8 mg Implant Syringe", "unit": "syringe" } ]	[ { "approved": "1992-07-28", "country": "United States", "expires": "2010-01-23", "number": "5134127" }, { "approved": "2003-07-01", "country": "Canada", "expires": "2018-12-16", "number": "2256227" }, { "approved": "2000-02-15", "country": "Canada", "expires": "2013-08-30", "number": "2105114" }, { "approved": "2001-06-12", "country": "United States", "expires": "2018-12-18", "number": "6245766" }, { "approved": "2000-11-21", "country": "United States", "expires": "2019-05-27", "number": "6150366" }, { "approved": "2001-05-15", "country": "United States", "expires": "2017-04-01", "number": "6232304" }, { "approved": "2002-06-04", "country": "United States", "expires": "2017-04-01", "number": "6399777" }, { "approved": "2000-08-29", "country": "United States", "expires": "2017-03-26", "number": "6110918" }, { "approved": "2007-02-13", "country": "United States", "expires": "2020-05-18", "number": "7175855" } ]	Ziprasidona \| Ziprasidone \| Ziprasidonum \| Dopamine D2 receptor \| NACHRA7 \| 5-HT-2 \| 5-HT-2A \| HTR2 \| Serotonin receptor 2A \| 5-HT-1A \| 5-HT1A \| ADRB2RL1 \| ADRBRL1 \| G-21 \| Serotonin receptor 1A \| 5-HT-1D \| 5-HT-1D-alpha \| 5-HT1D \| HTR1DA \| HTRL \| Serotonin 1D alpha receptor \| Serotonin receptor 1D \| 5-HT-1C \| 5-HT-2C \| 5-HT1C \| 5-HT2C \| 5-HTR2C \| 5-hydroxytryptamine receptor 1C \| HTR1C \| Serotonin receptor 2C \| Dopamine D1 receptor \| D(5) dopamine receptor \| D1beta dopamine receptor \| Dopamine D5 receptor \| DRD1B \| DRD1L2 \| Dopamine D3 receptor \| D(2C) dopamine receptor \| Dopamine D4 receptor \| 5-HT-1B \| 5-HT-1D-beta \| 5-HT1B \| HTR1DB \| S12 \| Serotonin 1D beta receptor \| Serotonin receptor 1B \| 5-HT-1E \| 5-HT1E \| S31 \| Serotonin receptor 1E \| 5-HT-6 \| 5-HT6 \| Serotonin receptor 6 \| 5-HT-7 \| 5-HT-X \| 5-HT7 \| Serotonin receptor 7 \| H1-R \| H1R \| HH1R \| ADRA1C \| Alpha-1A adrenoceptor \| Alpha-1A adrenoreceptor \| Alpha-1C adrenergic receptor \| Alpha-adrenergic receptor 1c \| Alpha-1B adrenoceptor \| Alpha-1B adrenoreceptor \| ADRA2R \| ADRAR \| Alpha-2 adrenergic receptor subtype C10 \| Alpha-2A adrenoceptor \| Alpha-2A adrenoreceptor \| Alpha-2AAR \| ADRA2L1 \| ADRA2RL1 \| Alpha-2 adrenergic receptor subtype C2 \| Alpha-2B adrenoceptor \| Alpha-2B adrenoreceptor \| Alpha-2BAR \| ADRA2L2 \| ADRA2RL2 \| Alpha-2 adrenergic receptor subtype C4 \| Alpha-2C adrenoceptor \| Alpha-2C adrenoreceptor \| Alpha-2CAR \| 5-HT-3 \| 5-HT3-A \| 5-HT3A \| 5-HT3R \| 5-hydroxytryptamine receptor 3 \| 5HT3R \| HTR3 \| Serotonin receptor 3A \| Serotonin-gated ion channel receptor \| 5-HT3-B \| 5-HT3B \| Serotonin receptor 3B \| 5-HT3-C \| 5-HT3C \| Serotonin receptor 3C \| 5-HT3-D \| 5-HT3D \| Serotonin receptor 3D \| 5-HT3-E \| 5-HT3E \| Serotonin receptor 3E \| 5-HT-5 \| 5-HT-5A \| 5-HT5A \| Serotonin receptor 5A \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.2.3.1 \| Aldehyde oxidase 1 \| AO \| Azaheterocycle hydroxylase \| AGP 1 \| AGP1 \| OMD 1 \| Orosomucoid-1 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1	[ "Auro-ziprasidone", "Auro-ziprasidone", "Auro-ziprasidone", "Auro-ziprasidone", "Gd-ziprasidone", "Gd-ziprasidone", "Gd-ziprasidone", "Gd-ziprasidone", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Geodon", "Mylan-ziprasidone", "Mylan-ziprasidone", "Mylan-ziprasidone", "Mylan-ziprasidone", "PMS-ziprasidone", "PMS-ziprasidone", "PMS-ziprasidone", "PMS-ziprasidone", "Truemed Group LLC", "Zeldox", "Zeldox", "Zeldox", "Zeldox", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Hydrochloride", "Ziprasidone Mesylate", "Ziprasidone Mesylate", "Ziprasidone Mesylate", "Ziprasidone Mesylate", "Ziprasidone Mesylate", "Ziprasidone Mesylate" ]	[]	[]	[ "P14416", "P36544", "P28223", "P08908", "P28221", "P28335", "P21728", "P21918", "P35462", "P21917", "P28222", "P28566", "P50406", "P34969", "P35367", "P35348", "P35368", "P08913", "P18089", "P18825", "P11229", "P08172", "P20309", "P08173", "P08912", "P46098", "O95264", "Q8WXA8", "Q70Z44", "A5X5Y0", "P47898" ]	[ "P08684", "Q06278" ]	[ "P02768", "P02763" ]	[ "P08183" ]
DB00247	Methysergide	An ergot derivative that is a congener of lysergic acid diethylamide. It antagonizes the effects of serotonin in blood vessels and gastrointestinal smooth muscle, but has few of the properties of other ergot alkaloids. Methysergide is used prophylactically in migraine and other vascular headaches and to antagonize serotonin in the carcinoid syndrome.	solid	For the treatment of vascular headache	Methysergide has been shown, <i>in vitro</i> and <i>in vivo</i>, to inhibit or block the effects of serotonin, a substance which may be involved in the mechanism of vascular headaches. Serotonin has been variously described as a central neurohumoral agent or chemical mediator, as a "headache substance" acting directly or indirectly to lower pain threshold, as an intrinsic "motor hormone" of the gastrointestinal tract, and as a "hormone" involved in connective tissue reparative processes.	Methysergide is serotonin antagonists acts on central nervous system (CNS), which directly stimulates the smooth muscle leading to vasoconstriction. Some alpha-adrenergic blocking activity has been reported. Suggestions have been made by investigators as to the mechanism whereby Methysergide produces its clinical effects, but this has not been finally established, although it may be related to the antiserotonin effect.	Rapid	Hepatic	Few cases of acute methysergide intoxication have been reported. The possible symptom complex is therefore not fully known. The following symptoms are based on these few case reports. Euphoria, hyperactivity, tachycardia, dilated pupils, and dizziness have been reported in a child with a dose of 20-24 mg of methysergide. In adults, peripheral vasospasm, with diminished or absent pulses, coldness, mottling and cyanosis, has been observed at a dose of 200 mg. Ischemic tissue damage has not been reported in acute overdosage with methysergide.	null	null	null	null	null	Organic compounds	Alkaloids and derivatives	Ergoline and derivatives	Lysergic acids and derivatives	[ "approved" ]	[ "N02CA", "N02C", "N02", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "4.26", "description": "Desyrel 100 mg tablet", "unit": "tablet" }, { "cost": "2580.0", "description": "Methysergide maleate 100% powder", "unit": "g" } ]	[]	(+)-9,10-Didehydro-N-(1-(hydroxymethyl)propyl)-1,6-dimethylergoline-8β-carboxamide \| (+)-N-(1-(Hydroxymethyl)propyl)-1-methyl-D-lysergamide \| 1-Methyl-D-lysergic acid butanolamide \| 1-Methyl-dextro-lysergic acid (+)-1-hydroxy-2-butylamide \| 1-Methyllysergic acid butanolamide \| 1-Methylmethylergonovine \| 9,10-Didehydro-N-(1-(hydroxymethyl)propyl)-1,6-dimethylergoline-8-carboxamide \| Méthysergide \| Methysergide \| Methysergidum \| Metisergida \| Metisergido \| N-(1-(Hydroxymethyl)propyl)-1-methyl-dextro-(+)-lysergamide \| 5-HT-2B \| 5-HT2B \| Serotonin receptor 2B \| 5-HT-1C \| 5-HT-2C \| 5-HT1C \| 5-HT2C \| 5-HTR2C \| 5-hydroxytryptamine receptor 1C \| HTR1C \| Serotonin receptor 2C \| 5-HT-2 \| 5-HT-2A \| HTR2 \| Serotonin receptor 2A \| 5-HT-1A \| 5-HT1A \| ADRB2RL1 \| ADRBRL1 \| G-21 \| Serotonin receptor 1A \| 5-HT-7 \| 5-HT-X \| 5-HT7 \| Serotonin receptor 7 \| 5-HT-1B \| 5-HT-1D-beta \| 5-HT1B \| HTR1DB \| S12 \| Serotonin 1D beta receptor \| Serotonin receptor 1B \| 5-HT-1F \| 5-HT1F \| HTR1EL \| Serotonin receptor 1F \| 5-HT-1E \| 5-HT1E \| S31 \| Serotonin receptor 1E \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase	[ "Sansert", "Sansert" ]	[ "Deseril", "Desernil" ]	[]	[ "P41595", "P28335", "P28223", "P08908", "P34969", "P28222", "P30939", "P28566" ]	[ "P08684" ]	[]	[]
DB00248	Cabergoline	Cabergoline, an ergot derivative, is a long-acting dopamine agonist and prolactin inhibitor. It is used to treat hyperprolactinemic disorders and Parkinsonian Syndrome. Cabergoline possesses potent agonist activity on dopamine D2 receptors.	solid	For the treatment of hyperprolactinemic disorders, either idiopathic or due to prolactinoma (prolactin-secreting adenomas). May also be used to manage symptoms of Parkinsonian Syndrome as monotherapy during initial symptomatic management or as an adjunct to levodopa therapy during advanced stages of disease.	Cabergoline stimulates centrally-located dopaminergic receptors resulting in a number of pharmacologic effects. Five dopamine receptor types from two dopaminergic subfamilies have been identified. The dopaminergic D1 receptor subfamily consists of D<sub>1</sub> and D<sub>5</sub> subreceptors, which are associated with dyskinesias. The dopaminergic D2 receptor subfamily consists of D<sub>2</sub>, D<sub>3</sub> and D<sub>4</sub> subreceptors, which are associated with improvement of symptoms of movement disorders. Thus, agonist activity specific for D2 subfamily receptors, primarily D<sub>2</sub> and D<sub>3</sub> receptor subtypes, are the primary targets of dopaminergic antiparkinsonian agents. It is thought that postsynaptic D2 stimulation is primarily responsible for the antiparkinsonian effect of dopamine agonists, while presynaptic D2 stimulation confers neuroprotective effects. This semisynthetic ergot derivative exhibits potent agonist activity on dopamine D<sub>2</sub>- and D<sub>3</sub>-receptors. It also exhibits: agonist activity (in order of decreasing binding affinities) on 5-hydroxytryptamine (5-HT)<sub>2B</sub>, 5-HT<sub>2A</sub>, 5-HT<sub>1D</sub>, dopamine D<sub>4</sub>, 5-HT<sub>1A</sub>, dopamine D<sub>1</sub>, 5-HT<sub>1B</sub> and 5-HT<sub>2C</sub> receptors and antagonist activity on α<sub>2B</sub>, α<sub>2A</sub>, and α<sub>2C</sub> receptors. Parkinsonian Syndrome manifests when approximately 80% of dopaminergic activity in the nigrostriatal pathway of the brain is lost. As this striatum is involved in modulating the intensity of coordinated muscle activity (e.g. movement, balance, walking), loss of activity may result in dystonia (acute muscle contraction), Parkinsonism (including symptoms of bradykinesia, tremor, rigidity, and flattened affect), akathesia (inner restlessness), tardive dyskinesia (involuntary muscle movements usually associated with long-term loss of dopaminergic activity), and neuroleptic malignant syndrome, which manifests when complete blockage of nigrostriatal dopamine occurs. High dopaminergic activity in the mesolimbic pathway of the brain causes hallucinations and delusions; these side effects of dopamine agonists are manifestations seen in patients with schizophrenia who have overractivity in this area of the brain. The hallucinogenic side effects of dopamine agonists may also be due to 5-HT<sub>2A</sub> agonism. The tuberoinfundibular pathway of the brain originates in the hypothalamus and terminates in the pituitary gland. In this pathway, dopamine inhibits lactotrophs in anterior pituitary from secreting prolactin. Increased dopaminergic activity in the tuberoinfundibular pathway inhibits prolactin secretion.	The dopamine D<sub>2</sub> receptor is a 7-transmembrane G-protein coupled receptor associated with G<sub>i</sub> proteins. In lactotrophs, stimulation of dopamine D<sub>2</sub> causes inhibition of adenylyl cyclase, which decreases intracellular cAMP concentrations and blocks IP3-dependent release of Ca<sup>2+</sup> from intracellular stores. Decreases in intracellular calcium levels may also be brought about via inhibition of calcium influx through voltage-gated calcium channels, rather than via inhibition of adenylyl cyclase. Additionally, receptor activation blocks phosphorylation of p42/p44 MAPK and decreases MAPK/ERK kinase phosphorylation. Inhibition of MAPK appears to be mediated by c-Raf and B-Raf-dependent inhibition of MAPK/ERK kinase. Dopamine-stimulated growth hormone release from the pituitary gland is mediated by a decrease in intracellular calcium influx through voltage-gated calcium channels rather than via adenylyl cyclase inhibition. Stimulation of dopamine D<sub>2</sub> receptors in the nigrostriatal pathway leads to improvements in coordinated muscle activity in those with movement disorders. Cabergoline is a long-acting dopamine receptor agonist with a high affinity for D2 receptors. Receptor-binding studies indicate that cabergoline has low affinity for dopamine D1, α<sub>1</sub>,- and α<sub>2</sub>- adrenergic, and 5-HT<sub>1</sub>- and 5-HT<sub>2</sub>-serotonin receptors.	First-pass effect is seen, however the absolute bioavailability is unknown.	Hepatic. Cabergoline is extensively metabolized, predominately via hydrolysis of the acylurea bond of the urea moiety. Cytochrome P-450 mediated metabolism appears to be minimal. The main metabolite identified in urine is 6-allyl-8b-carboxy-ergoline (4-6% of dose). Three other metabolites were identified urine (less than 3% of dose).	Overdosage might be expected to produce nasal congestion, syncope, or hallucinations.	The elimination half-life is estimated from urinary data of 12 healthy subjects to range between 63 to 69 hours.	Moderately bound (40% to 42%) to human plasma proteins in a concentration-independent manner.	After oral dosing of radioactive cabergoline to five healthy volunteers, approximately 22% and 60% of the dose was excreted within 20 days in the urine and feces, respectively. Less than 4% of the dose was excreted unchanged in the urine.	null	* renal cl=0,008 L/min * nonrenal cl=3.2 L/min	Organic compounds	Alkaloids and derivatives	Ergoline and derivatives	Lysergic acids and derivatives	[ "approved" ]	[ "N04BC", "N04B", "N04", "N", "G02CB", "G02C", "G02", "G" ]	[ "Humans and other mammals" ]	[ { "cost": "37.39", "description": "Cabergoline 0.5 mg tablet", "unit": "tablet" } ]	[]	(8R)-6-allyl-N-[3-(dimethylamino)propyl]-N-(ethylcarbamoyl)ergoline-8-carboxamide \| (8β)-N-[3-(dimethylamino)propyl]-N-[(ethylamino)carbonyl]-6-(2-propenyl)-ergoline-8-carboxamide \| 1-((6-allylergolin-8β-yl)carbonyl)-1-(3-(dimethylamino)propyl)-3-ethylurea \| 1-[(6-allylergoline-8β-yl)carbonyl]-1-[3-(dimethylamino)propyl]-3-ethylurea \| 1-ethyl-3-(3'-dimethylamionpropyl)-2-(6'-allylergoline-8'β-carbonyl)urea \| Cabergolina \| Cabergoline \| Cabergolinum \| Dopamine D2 receptor \| 5-HT-2B \| 5-HT2B \| Serotonin receptor 2B \| Dopamine D3 receptor \| 5-HT-2 \| 5-HT-2A \| HTR2 \| Serotonin receptor 2A \| ADRA2L1 \| ADRA2RL1 \| Alpha-2 adrenergic receptor subtype C2 \| Alpha-2B adrenoceptor \| Alpha-2B adrenoreceptor \| Alpha-2BAR \| 5-HT-1D \| 5-HT-1D-alpha \| 5-HT1D \| HTR1DA \| HTRL \| Serotonin 1D alpha receptor \| Serotonin receptor 1D \| D(2C) dopamine receptor \| Dopamine D4 receptor \| ADRA2R \| ADRAR \| Alpha-2 adrenergic receptor subtype C10 \| Alpha-2A adrenoceptor \| Alpha-2A adrenoreceptor \| Alpha-2AAR \| 5-HT-1A \| 5-HT1A \| ADRB2RL1 \| ADRBRL1 \| G-21 \| Serotonin receptor 1A \| ADRA2L2 \| ADRA2RL2 \| Alpha-2 adrenergic receptor subtype C4 \| Alpha-2C adrenoceptor \| Alpha-2C adrenoreceptor \| Alpha-2CAR \| D(5) dopamine receptor \| D1beta dopamine receptor \| Dopamine D5 receptor \| DRD1B \| DRD1L2 \| Dopamine D1 receptor \| 5-HT-1B \| 5-HT-1D-beta \| 5-HT1B \| HTR1DB \| S12 \| Serotonin 1D beta receptor \| Serotonin receptor 1B \| 5-HT-1C \| 5-HT-2C \| 5-HT1C \| 5-HT2C \| 5-HTR2C \| 5-hydroxytryptamine receptor 1C \| HTR1C \| Serotonin receptor 2C \| 5-HT-7 \| 5-HT-X \| 5-HT7 \| Serotonin receptor 7 \| ADRA1C \| Alpha-1A adrenoceptor \| Alpha-1A adrenoreceptor \| Alpha-1C adrenergic receptor \| Alpha-adrenergic receptor 1c \| Alpha-1B adrenoceptor \| Alpha-1B adrenoreceptor \| ADRA1A \| Alpha-1A adrenergic receptor \| Alpha-1D adrenoceptor \| Alpha-1D adrenoreceptor \| Alpha-adrenergic receptor 1a \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ADRB2R \| B2AR \| Beta-2 adrenoceptor \| Beta-2 adrenoreceptor \| Dopamine D1 receptor \| D(5) dopamine receptor \| D1beta dopamine receptor \| Dopamine D5 receptor \| DRD1B \| DRD1L2 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1	[ "Act Cabergoline", "Apo-cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Cabergoline", "Dostinex", "Dostinex", "Jamp Cabergoline" ]	[ "Cabaser" ]	[]	[ "P14416", "P41595", "P35462", "P28223", "P18089", "P28221", "P21917", "P08913", "P08908", "P18825", "P21918", "P21728", "P28222", "P28335", "P34969", "P35348", "P35368", "P25100", "P08588", "P07550", "P21728", "P21918" ]	[ "P08684" ]	[]	[ "P08183" ]
DB00249	Idoxuridine	An analog of deoxyuridine that inhibits viral DNA synthesis. The drug is used as an antiviral agent.	solid	For use in keratoconjunctivitis and keratitis caused by herpes simplex virus.	In chemical structure idoxuridine closely approximates the configuration of thymidine, one of the four building blocks of DNA (the genetic material of the Herpes virus). As a result, idoxuridine is able to replace thymidine in the enzymatic step of viral replication or "growth". The consequent production of faulty DNA results in a pseudostructure which cannot infect or destroy tissue. In short, by pre-empting a vital building block in the genetic material of the Herpes simplex virus, Herplex-D topical solution destroys the infective and destructive capacity of the viral material. The virus infected cell may only be attacked during the period of active synthesis of DNA. This occurs early in the development of the Herpes simplex lesion, but at different times in different cells. Therefore, ideally, the affected area should remain saturated with the antiviral agent.	Idoxuridine acts as an antiviral agent by inhibiting viral replication by substituting itself for thymidine in viral DNA. This in turn inhibits thymidylate phosphorylase and viral DNA polymerases from properly functioning. The effect of Idoxuridine results in the inability of the virus to reproduce or to infect/destroy tissue.	Systemic absorption is unlikely following ocular administration even when nasolacrimal secretions are swallowed, since vidarabine is rapidly deaminated in the gastrointestinal tract.	Idoxuridine is rapidly inactivated by deaminases or nucleotidases.	Hypersensitivity or increased sensitivity of eyes to light. LD<sub>50</sub>=3080 mg/kg (orally in mice).	null	null	null	null	null	Organic compounds	Nucleosides, nucleotides, and analogues	Pyrimidine nucleosides	Pyrimidine 2'-deoxyribonucleosides	[ "approved", "investigational" ]	[ "D06BB", "D06B", "D06", "D", "J05AB", "J05A", "J05", "J", "S01AD", "S01A", "S01", "S" ]	[ "Herpes simplex virus" ]	[ { "cost": "273.88", "description": "Idoxuridine powder", "unit": "g" } ]	[]	(+)-5-Iodo-2'-deoxyuridine \| 1-(2-Deoxy-beta-D-ribofuranosyl)-5-iodouracil \| 1-beta-D-2'-Deoxyribofuranosyl-5-iodouracil \| 1beta-D-2'-Deoxyribofuranosyl-5-iodouracil \| 2'-Deoxy-5-iodouridine \| 5-iodo-2'-deoxyuridine \| 5-Iododeoxyuridine \| 5-Iodouracil deoxyriboside \| Idoxuridin \| Idoxuridina \| Idoxuridine \| Idoxuridinum \| IdU \| Iododeoxyridine \| Iodoxuridine \| Joddeoxiuridin \| 2.7.1.21 \| UL23	[ "Dendrid", "Herplex", "Herplex D", "Sandoz Idoxuridine" ]	[ "Herpid", "Herpidu", "Idulea", "Idustatin", "Keresid", "Oftan IDU", "Virexen" ]	[]	[]	[]	[]	[]
DB00250	Dapsone	A sulfone active against a wide range of bacteria but mainly employed for its actions against mycobacterium leprae. Its mechanism of action is probably similar to that of the sulfonamides which involves inhibition of folic acid synthesis in susceptible organisms. It is also used with pyrimethamine in the treatment of malaria. (From Martindale, The Extra Pharmacopoeia, 30th ed, p157-8)	solid	For the treatment and management of leprosy and dermatitis herpetiformis.	Dapsone is a sulfone with anti-inflammatory immunosuppressive properties as well as antibacterial and antibiotic properties. Dapsone is the principal drug in a multidrug regimen recommended by the World Health Organization for the treatment of leprosy. As an anti-infective agent, it is also used for treating malaria and, recently, for Pneumocystic carinii pneumonia in AIDS patients. Dapsone is absorbed rapidly and nearly completely from the gastrointestinal tract. Dapsone is distributed throughout total body water and is present in all tissues. However, it tends to be retained in skin and muscle and especially in the liver and kidney: traces of the drug are present in these organs up to 3 weeks after therapy cessation.	Dapsone acts against bacteria and protozoa in the same way as sulphonamides, that is by inhibiting the synthesis of dihydrofolic acid through competition with para-amino-benzoate for the active site of dihydropteroate synthetase. The anti-inflammatory action of the drug is unrelated to its antibacterial action and is still not fully understood.	Bioavailability is 70 to 80% following oral administration.	Hepatic, mostly CYP2E1-mediated.	Overdosage might be expected to produce nasal congestion, syncope, or hallucinations. Measures to support blood pressure should be taken if necessary.	28 hours (range 10-50 hours)	70 to 90%	Renal	null	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	Benzenesulfonyl compounds	[ "approved", "investigational" ]	[ "J04BA", "J04B", "J04", "J", "J04BA", "J04B", "J04", "J", "D10AX", "D10A", "D10", "D", "J04BA", "J04B", "J04", "J" ]	[ "Mycobacteria", "Mycobacterium leprae" ]	[ { "cost": "5.38", "description": "Dapsone powder", "unit": "g" }, { "cost": "5.52", "description": "Aczone 5% gel", "unit": "g" }, { "cost": "35.99", "description": "Dapsone 30 25 mg tablet Box", "unit": "box" }, { "cost": "42.99", "description": "Dapsone 30 100 mg tablet Box", "unit": "box" }, { "cost": "0.2", "description": "Dapsone 25 mg tablet", "unit": "tablet" }, { "cost": "0.86", "description": "Dapsone 100 mg tablet", "unit": "tablet" } ]	[ { "approved": "2004-11-30", "country": "Canada", "expires": "2017-09-10", "number": "2265461" }, { "approved": "2000-05-09", "country": "United States", "expires": "2016-09-11", "number": "6060085" }, { "approved": "1999-01-26", "country": "United States", "expires": "2016-09-11", "number": "5863560" }, { "approved": "2003-09-16", "country": "United States", "expires": "2016-09-11", "number": "6620435" }, { "approved": "2015-10-20", "country": "United States", "expires": "2033-11-18", "number": "9161926" }, { "approved": "2016-12-13", "country": "United States", "expires": "2033-11-18", "number": "9517219" }, { "approved": "2013-11-18", "country": "United States", "expires": "2033-11-18", "number": "11273132" } ]	1,1'-sulfonylbis(4-aminobenzene) \| 1,1'-Sulfonylbis[4-aminobenzene] \| 4-(4-amino-benzenesulfonyl)-phenylamine \| 4-(4-aminophenylsulfonyl)aniline \| 4-(4-aminophenylsulfonyl)benzenamine \| 4-aminophenyl sulfone \| 4,4'-dapsone \| 4,4'-diaminodiphenyl sulfone \| 4,4'-Diaminodiphenyl sulphone \| 4,4'-Diaminodiphenylsulfone \| 4,4'-sulfonylbisaniline \| 4,4'-Sulfonylbisbenzenamine \| 4,4'-Sulfonylbisbenzeneamine \| 4,4'-Sulfonyldianilin \| 4,4'-sulfonyldianiline \| bis(4-aminophenyl)sulfone \| Bis(p-aminophenyl) sulfone \| DADPS \| Dapsona \| Dapsone \| Dapsonum \| DDS \| Diaphenylsulfone \| p-aminophenyl sulfone \| p,p-sulphonylbisbenzamine \| p,p-sulphonylbisbenzenamine \| p,p'-diaminodiphenyl sulfone \| DHPS 2 \| Dihydropteroate pyrophosphorylase 2 \| 2.5.1.15 \| DHPS \| Dihydropteroate pyrophosphorylase \| folP \| 1.11.2.2 \| MPO \| 1.14.14.1 \| CYPIIC18 \| Cytochrome P450-6b/29c \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.13.148 \| 1.14.13.32 \| 1.14.13.8 \| Dimethylaniline monooxygenase [N-oxide-forming] 3 \| Dimethylaniline oxidase 3 \| FMO 3 \| FMO form 2 \| FMO II \| Hepatic flavin-containing monooxygenase 3 \| Trimethylamine monooxygenase \| 1.14.99.1 \| COX-1 \| COX1 \| Cyclooxygenase-1 \| PGH synthase 1 \| PGHS-1 \| PHS 1 \| Prostaglandin H2 synthase 1 \| Prostaglandin-endoperoxide synthase 1 \| 1.14.99.1 \| COX-2 \| COX2 \| Cyclooxygenase-2 \| PGH synthase 2 \| PGHS-2 \| PHS II \| Prostaglandin H2 synthase 2 \| Prostaglandin-endoperoxide synthase 2 \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 2.3.1.5 \| AAC2 \| Arylamide acetylase 2 \| N-acetyltransferase type 2 \| N-hydroxyarylamine O-acetyltransferase \| NAT-2 \| PNAT \| Polymorphic arylamine N-acetyltransferase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2	[ "011503 Dapsone 6% / Niacinamide 2% / Spironolactone 5%", "011504 Dapsone 8.5% / Niacinamide 4%", "Aczone", "Aczone", "Aczone", "Aczone", "Aczone", "Aczone 7.5", "Avlosulfon Tab 100mg", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone", "Dapsone 100 mg", "Dapsone 25 mg", "Dapsone 6% / Niacinamide 2% / Spironolactone 5%", "Dapsone 6% / Niacinamide 2% / Tretinoin 0.025%", "Dapsone 6% / Niacinamide 4%", "Dapsone 8.5% / Niacinamide 2% / Spironolactone 5%", "Dapsone 8.5% / Niacinamide 2% / Tretinoin 0.025%", "Dapsone 8.5% / Niacinamide 4%", "Mar-dapsone", "Riva-dapsone", "Taro-dapsone" ]	[]	[ "Dapsone 6% / Niacinamide 4%", "Dapsone 8.5% / Niacinamide 4%", "Dapsone 8.5% / Niacinamide 2% / Tretinoin 0.025%", "Dapsone 6% / Niacinamide 2% / Tretinoin 0.025%", "Dapsone 8.5% / Niacinamide 2% / Spironolactone 5%", "Dapsone 6% / Niacinamide 2% / Spironolactone 5%", "011503 Dapsone 6% / Niacinamide 2% / Spironolactone 5%", "011504 Dapsone 8.5% / Niacinamide 4%" ]	[]	[ "P05164", "P33260", "P11712", "P05181", "P08684", "P31513", "P23219", "P35354", "P10632", "P33261", "P11245", "P20815", "P24462" ]	[]	[]
DB00251	Terconazole	Terconazole is an anti-fungal drug that is mainly used to treat vaginal yeast infections (or vaginal candidiasis). It is classified as a _triazole ketal derivative_.[A178096] Terconazole was initially approved by the FDA in 1987.[FDA label] This drug is available in cream and suppository forms and both have demonstrated high levels of safety, efficacy, and tolerability in clinical trials. [A178093]Due to the existence of 2 stereocentres, there are 4 possible stereoisomers for terconazole.	solid	For the treatment of candidiasis (a yeast-like fungal infection) of the vulva and vagina.	Terconazole is a triazole antifungal agent available for intravaginal use. It is structurally related to imidazole-derivative antifungal agents, although terconazole and other triazoles have 3 nitrogens in the azole ring. By inhibiting the 14-alpha-demethylase (lanosterol 14-alpha-demethylase), Terconazole inhibits ergosterol synthesis. Depletion of ergosterol in fungal membrane disrupts the structure and many functions of fungal membrane leading to inhibition of fungal growth.	Terconazole may exert its antifungal activity by disrupting normal fungal cell membrane permeability. Terconazole and other triazole antifungal agents inhibit cytochrome P450 14-alpha-demethylase in susceptible fungi, which leads to the accumulation of lanosterol and other methylated sterols and a decrease in ergosterol concentration. Depletion of ergosterol in the membrane disrupts the structure and function of the fungal cell leading to a decrease or inhibition of fungal growth.	Following intravaginal administration of terconazole in humans, absorption ranged from 5-8% in three hysterectomized subjects and 12-16% in two non-hysterectomized subjects with tubal ligations	Systemically absorbed drug appears to be rapidly and extensively metabolized. Terconazole primarily undergoes oxidatative N- and O-dealkylation, dioxolane ring cleavage, and conjugation.	The oral LD<sub>50</sub> values were found to be 1741 and 849 mg/kg for the male and female in rat.	6.9 hours (range 4.0-11.3)	94.9%	Following oral (30 mg) administration of 14C-labelled terconazole, excretion of radioactivity was both by renal (32-56%) and fecal (47-52%) routes.	null	null	null	null	null	null	[ "approved" ]	[ "G01AG", "G01A", "G01", "G" ]	[ "Fungi" ]	[ { "cost": "1.17", "description": "Terazol 7 cream", "unit": "g" }, { "cost": "2.35", "description": "Terconazole 0.8% cream", "unit": "g" }, { "cost": "2.54", "description": "Zazole 0.8% vaginal cream", "unit": "g" }, { "cost": "2.64", "description": "Terazol 3 cream", "unit": "g" }, { "cost": "42.57", "description": "Terconazole 0.4% Cream 45 gm Tube", "unit": "tube" }, { "cost": "42.57", "description": "Terconazole 0.8% Cream 20 gm Tube", "unit": "tube" }, { "cost": "50.9", "description": "Terconazole 3 80 mg Suppository Box", "unit": "box" }, { "cost": "53.99", "description": "Terazol 3 3 80 mg Suppository Box", "unit": "box" }, { "cost": "54.0", "description": "Terazol 7 0.4% Cream 45 gm Tube", "unit": "tube" }, { "cost": "55.99", "description": "Terazol 3 0.8% Cream 20 gm Tube", "unit": "tube" }, { "cost": "0.96", "description": "Terconazole 0.4% cream", "unit": "g" } ]	[]	Terconazole \| 1.14.13.70 \| CYP51 \| CYPLI \| Cytochrome P450 51 \| Cytochrome P450-14DM \| Cytochrome P450-LIA1 \| ERG16 \| Sterol 14-alpha demethylase	[ "Taro-terconazole", "Terazol 3", "Terazol 3", "Terazol 3", "Terazol 3", "Terazol 3", "Terazol 3", "Terazol 3", "Terazol 3 Dual Pak", "Terazol 3 Dual Pak", "Terazol 3 Vaginal Cream 0.8%", "Terazol 3 Vaginal Ovules 80mg", "Terazol 7", "Terazol 7", "Terazol 7", "Terazol 7 Vaginal Cream 0.4%", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole", "Terconazole Vaginal Cream 0.8%", "Terconazole Vaginal Cream 0.8%", "Terconazole Vaginal Cream 0.8%", "Zazole", "Zazole", "Zazole" ]	[ "Terazol" ]	[ "Terazol 3 Dual Pak", "Terazol 3 Dual Pak" ]	[]	[]	[]	[]
DB01320	Fosphenytoin	Fosphenytoin is a water-soluble phenytoin prodrug used only in hospitals for the treatment of epileptic seizures. It works by slowing down impulses in the brain that cause seizures. Its main mechanism is to block frequency-dependent, use-dependent and voltage-dependent neuronal sodium channels, and therefore limit repetitive firing of action potentials.	solid	Fosphenytoin is indicated for the treatment of generalized tonic-clonic status epilepticus and for the prevention and treatment of seizures occurring during neurosurgery in adult patients. It can also be substituted, short-term, for oral phenytoin in patients aged two years and older when oral phenytoin administration is not possible.[L20619]	Fosphenytoin is a water-soluble phenytoin prodrug used for the treatment of epileptic seizures. Following parenteral administration of fosphenytoin, fosphenytoin is converted to the anticonvulsant phenytoin by endogenous phosphatases. Each 1.5 mg of fosphenytoin sodium is equivalent to 1.0mg of phenytoin sodium (PE equivalents); care should be taken to calculate the dose required in PE equivalents properly. Serious adverse effects such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), and hematopoietic complications may occur and indicate an alternate antiepileptic should be used. Withdrawal of fosphenytoin sodium may precipitate seizures and should be done gradually.[L20619]	Fosphenytoin is a prodrug of phenytoin and accordingly, its anticonvulsant effects are attributable to phenytoin. Phenytoin acts on sodium channels on the neuronal cell membrane, limiting the spread of seizure activity and reducing seizure propagation. By promoting sodium efflux from neurons, phenytoin tends to stabilize the threshold against hyperexcitability caused by excessive stimulation or environmental changes capable of reducing membrane sodium gradient. This includes the reduction of post-tetanic potentiation at synapses. Loss of post-tetanic potentiation prevents cortical seizure foci from detonating adjacent cortical areas.	Fosphenytoin at 15 to 20 mg PE/kg infused at 100 to 150 mg PE/min intravenously yields free plasma phenytoin concentrations similar to an equivalent dose of phenytoin sodium administered at 50 mg/min. Single intravenous administration of fosphenytoin shows a linear increase in mean maximum total phenytoin concentration while the mean maximum unbound phenytoin concentrations increase with both dose and infusion rate. Fosphenytoin is rapidly converted to phenytoin following intravenous administration with a half-life of 15 minutes; if administered intramuscularly, the peak plasma phenytoin concentration is not reached until three hours.[L20619]	Fosphenytoin is metabolized, likely by phosphatases, to phenytoin, phosphate, and formaldehyde; the formaldehyde is subsequently converted into formate. The phenytoin produced is metabolized hepatically by CYP2C9 and, to a lesser extent, by CYP2C19.[L20619]	Nausea, vomiting, lethargy, tachycardia, bradycardia, asystole, cardiac arrest, hypotension, syncope, hypocalcemia, metabolic acidosis, and death have been reported in cases of overdosage with fosphenytoin. The median lethal dose of fosphenytoin given intravenously in mice and rats was 156 mg PE/kg and approximately 250 mg PE/kg, or about 0.6 and 2 times, respectively, the maximum human loading dose on a mg/m2 basis. Signs of acute toxicity in animals included ataxia, labored breathing, ptosis, and hypoactivity.	Fosphenytoin has a conversion half-life of approximately 15 minutes. The resulting phenytoin has a wide range of mean total half-life values (12 to 28.9 hours), with longer half-life times at higher administered doses.[L20619]	Fosphenytoin is extensively bound (95-99%) to human plasma proteins, primarily albumin, and displays saturable binding kinetics over a physiologically relevant range of fosphenytoin concentrations. Like fosphenytoin, phenytoin is extensively bound, again mainly to albumin, but can be displaced by fosphenytoin itself. Phenytoin is typically about 88% bound in the absence of fosphenytoin, but this drops to around 60% 0.5-1 hour following fosphenytoin infusion while fosphenytoin is being converted to phenytoin.[L20619]	Phenytoin derived from fosphenytoin administration is excreted in the urine primarily as 5-(p-hydroxyphenyl)-5-phenylhydantoin and its glucuronide. There is little unchanged phenytoin (1%–5% of the administered dose), and essentially no fosphenytoin recovered in urine.[L20619]	The volume of distribution of fosphenytoin increases with dose and rate, ranging between 4.3 and 10.8 L.[L20619]	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	Diphenylmethanes	[ "approved", "investigational" ]	[ "N03AB", "N03A", "N03", "N" ]	[ "Humans and other mammals" ]	[ { "cost": "8.63", "description": "Cerebyx 500 mg pe/10 ml vial", "unit": "ml" }, { "cost": "0.61", "description": "Fosphenytoin 500 mg pe/10 ml", "unit": "ml" } ]	[ { "approved": "2017-09-05", "country": "United States", "expires": "2029-03-13", "number": "9750822" }, { "approved": "2016-11-15", "country": "United States", "expires": "2033-02-27", "number": "9493582" }, { "approved": "2013-04-02", "country": "United States", "expires": "2029-03-13", "number": "8410077" }, { "approved": "2015-12-01", "country": "United States", "expires": "2029-03-13", "number": "9200088" }, { "approved": "2009-12-22", "country": "United States", "expires": "2029-03-13", "number": "7635773" } ]	(3-Phosphoryloxymethyl)phenytoin \| Fosfenitoina \| Fosphenytoin \| Fosphenytoine \| Fosphenytoinum \| hH1 \| Sodium channel protein cardiac muscle subunit alpha \| Sodium channel protein type V subunit alpha \| Voltage-gated sodium channel subunit alpha Nav1.5 \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase \| 2.4.1.17 \| GNT1 \| Phenol-metabolizing UDP-glucuronosyltransferase \| UDP-glucuronosyltransferase 1-F \| UDP-glucuronosyltransferase 1A6 \| UDPGT 1-6 \| UGT-1F \| UGT1 \| UGT1-06 \| UGT1.6 \| UGT16 \| UGT1F \| 2.4.1.17 \| GNT1 \| lugP4 \| UDP-glucuronosyltransferase 1-9 \| UDP-glucuronosyltransferase 1-I \| UDPGT 1-9 \| UGT-1I \| UGT1 \| UGT1-09 \| UGT1.9 \| UGT19 \| UGT1A9 \| UGT1I \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| CYPIIC17 \| CYPIIC19 \| Cytochrome P450-11A \| Cytochrome P450-254C \| Fenbendazole monooxygenase (4'-hydroxylating) \| Mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| Serpin A7 \| T4-binding globulin \| TBG	[ "Cerebyx", "Cerebyx", "Cerebyx", "Cerebyx", "Cerebyx", "Cerebyx", "Fosphenytoin", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin Sodium", "Fosphenytoin sodium", "Fosphenytoin sodium", "Fosphenytoin sodium", "Fosphenytoin sodium", "Sesquient", "Sesquient" ]	[ "Prodilantin", "Sesquient" ]	[]	[ "Q14524" ]	[ "P05177", "P19224", "O60656", "P33261", "P20813", "P11712", "P08684" ]	[ "P02768", "P05543" ]	[]
DB00253	Medrysone	Medrysone is a corticosteroid used in ophthalmology.	solid	For the treatment of allergic conjunctivitis, vernal conjunctivitis, episcleritis, and epinephrine sensitivity.	Medrysone is a topical anti-inflammatory corticoidsteroids for ophthalmic use. In patients with increased intraocular pressure and in those susceptible to a rise in intraocular pressure, there is less effect on pressure with medrysone than with dexamethasone or betamethasone. Corticoidsteroids inhibit the edema, fibrin deposition, capillary dilation, and phagocytic migration of the acute inflammatory response, as well as capillary proliferation, deposition of collagen, and scar formation.	There is no generally accepted explanation for the mechanism of action of ocular corticosteroids. However, corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2. Initially, the drug binds to the glucocorticoid receptor in the cytosol. This migrates to the nucleus and binds to genetic elements which cause activation and repression of the involved genes in the inflammatory pathway.	Rapidly absorbed following oral administration.	null	null	null	null	null	null	null	Organic compounds	Lipids and lipid-like molecules	Steroids and steroid derivatives	Pregnane steroids	[ "approved" ]	[ "S01BA", "S01B", "S01", "S" ]	[ "Humans and other mammals" ]	[]	[]	11beta-Hydroxy-6alpha-methylpregn-4-ene-3,20-dione \| Medrisona \| Medrysone \| Medrysonum \| ERR-alpha \| ERR1 \| ESRL1 \| Estrogen receptor-like 1 \| Estrogen-related receptor alpha \| NR3B1 \| Nuclear receptor subfamily 3 group B member 1 \| ERR beta-2 \| ERR-beta \| ERRB2 \| ESRL2 \| Estrogen receptor-like 2 \| Estrogen-related receptor beta \| NR3B2 \| Nuclear receptor subfamily 3 group B member 2 \| ERR gamma-2 \| ERR3 \| ERRG2 \| Estrogen receptor-related protein 3 \| KIAA0832 \| NR3B3 \| Nuclear receptor subfamily 3 group B member 3 \| GR \| GRL \| Nuclear receptor subfamily 3 group C member 1 \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIIA5 \| Cytochrome P450-PCN3 \| CBG \| Serpin A6 \| Transcortin \| OATP \| OATP-1 \| OATP-A \| OATP1 \| OATP1A2 \| Organic anion-transporting polypeptide 1 \| SLC21A3 \| Sodium-independent organic anion transporter \| Solute carrier family 21 member 3 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| hOAT3 \| OAT3 \| Organic anion/dicarboxylate exchanger \| Solute carrier family 22 member 8	[ "Hms", "Hms" ]	[]	[]	[ "P11474", "O95718", "P62508", "P04150" ]	[ "P08684", "P20815" ]	[ "P08185" ]	[ "P46721", "P08183", "Q8TCC7" ]
DB00255	Diethylstilbestrol	A synthetic nonsteroidal estrogen used in the treatment of menopausal and postmenopausal disorders. It was also used formerly as a growth promoter in animals. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), diethylstilbestrol has been listed as a known carcinogen. (Merck, 11th ed) The FDA withdrew its approval for the use of all oral and parenteral drug products containing 25 milligrams or more of diethylstilbestrol per unit dose.[L43942]	solid	Used in the treatment of prostate cancer. Previously used in the prevention of miscarriage or premature delivery in pregnant women prone to miscarriage or premature delivery.	Diethylstilbestrol is a synthetic estrogen that was developed to supplement a woman's natural estrogen production. In 1971, the Food and Drug Administration (FDA) issued a Drug Bulletin advising physicians to stop prescribing DES to pregnant women because it was linked to a rare vaginal cancer in female offspring.	Estrogens diffuse into their target cells and interact with a protein receptor, the estrogen receptor. Target cells include the female reproductive tract, the mammary gland, the hypothalamus, and the pituitary. The effect of Estrogen binding their receptors causes downstream increases the hepatic synthesis of sex hormone binding globulin (SHBG), thyroid-binding globulin (TBG), and other serum proteins and suppress follicle-stimulating hormone (FSH) from the anterior pituitary. The combination of an estrogen with a progestin suppresses the hypothalamic-pituitary system, decreasing the secretion of gonadotropin-releasing hormone (GnRH).	null	Hepatic.	Symptoms of overdose include nausea and vomiting, and withdrawal bleeding may occur in females.	null	null	null	null	null	null	null	null	null	[ "approved", "investigational", "withdrawn" ]	[ "L02AA", "L02A", "L02", "L", "L02AA", "L02A", "L02", "L", "G03CC", "G03C", "G03", "G", "G03CB", "G03C", "G03", "G" ]	[ "Humans and other mammals" ]	[ { "cost": "13.77", "description": "Diethylstilbestrol powder", "unit": "g" } ]	[]	(E)-3,4-bis(4-hydroxyphenyl)-3-hexene \| (E)-4,4'-(1,2-diethyl-1,2-ethenediyl)bisphenol \| 4,4'-dihydroxy-α,β-diethylstilbene \| DES \| Diethylstilbestrol \| Diéthylstilbestrol \| Diethylstilbestrolum \| Dietilestilbestrol \| Stilboestrol \| trans-4,4'-(1,2-diethyl-1,2-ethenediyl)bisphenol \| trans-Diethylstilbesterol \| trans-Diethylstilbestrol \| trans-Diethylstilboesterol \| α,α'-diethyl-(E)-4,4'-stilbenediol \| ER-beta \| ESTRB \| NR3A2 \| Nuclear receptor subfamily 3 group A member 2 \| ER \| ER-alpha \| ESR \| Estradiol receptor \| NR3A1 \| Nuclear receptor subfamily 3 group A member 1 \| ERR gamma-2 \| ERR3 \| ERRG2 \| Estrogen receptor-related protein 3 \| KIAA0832 \| NR3B3 \| Nuclear receptor subfamily 3 group B member 3 \| ERR-alpha \| ERR1 \| ESRL1 \| Estrogen receptor-like 1 \| Estrogen-related receptor alpha \| NR3B1 \| Nuclear receptor subfamily 3 group B member 1 \| ERR beta-2 \| ERR-beta \| ERRB2 \| ESRL2 \| Estrogen receptor-like 2 \| Estrogen-related receptor beta \| NR3B2 \| Nuclear receptor subfamily 3 group B member 2 \| BHLHE75 \| Class E basic helix-loop-helix protein 75 \| hTIF2 \| NCoA-2 \| SRC2 \| TIF2 \| Transcriptional intermediary factor 2 \| Orphan nuclear receptor PAR1 \| Orphan nuclear receptor PXR \| Pregnane X receptor \| PXR \| Steroid and xenobiotic receptor \| SXR \| DHTR \| Dihydrotestosterone receptor \| NR3C4 \| Nuclear receptor subfamily 3 group C member 4 \| ABP \| SBP \| Sex steroid-binding protein \| SHBG \| TeBG \| Testis-specific androgen-binding protein \| Testosterone-estradiol-binding globulin \| Testosterone-estrogen-binding globulin \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J \| 2.1.1.6 \| 1.14.14.14 \| ARO1 \| CYAR \| CYP19 \| CYPXIX \| Cytochrome P-450AROM \| Cytochrome P450 19A1 \| Estrogen synthase \| ATTR \| PALB \| Prealbumin \| TBPA \| 7.6.2.2 \| ABCP \| ATP-binding cassette sub-family G member 2 \| BCRP \| BCRP1 \| Breast cancer resistance protein \| CDw338 \| Mitoxantrone resistance-associated protein \| MXR \| Placenta-specific ATP-binding cassette transporter \| Urate exporter \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| KIAA0880 \| OATP-B \| OATP-RP2 \| OATP2B1 \| OATPB \| OATPRP2 \| Organic anion transporter B \| Organic anion transporter polypeptide-related protein 2 \| Organic anion transporting polypeptide 2B1 \| SLC21A9 \| Solute carrier family 21 member 9 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP	[ "Honvol Ampoules 250mg", "Honvol Tablets 100mg", "Stilbestrol 0.5mg Tablet", "Stilbestrol 1.0mg Tablet", "Stilbestrol Tab 1mg", "Stilbestrol Tablets 0.1 mg", "Stilbestrol Tablets 0.5 mg", "Stilbestrol Tablets 1.0 mg", "Stilboestrol Tab 0.1mg", "Stilboestrol Tab 0.5mg" ]	[ "Distilbene", "Stilbestrol", "Stilbetin" ]	[]	[ "Q92731", "P03372", "P62508", "P11474", "O95718", "Q15596", "O75469", "P10275", "P04278" ]	[ "P08684", "P10632", "P11712", "P05181", "P21964", "P11511" ]	[ "P02766" ]	[ "Q9UNQ0", "P08183", "Q9Y6L6", "O94956", "O95342" ]
DB00257	Clotrimazole	This drug is a broad spectrum antimycotic or antifungal agent. Clotrimazole's antimycotic properties were discovered in the late 1960s [A174094]. Clotrimazole falls under the _imidazole_ category of _azole_ antifungals, possessing broad-spectrum antimycotic activity [A174094]. It is available in various preparations, including creams, pessaries, and troche formulations (slowly dissolving tablets). As well as its antifungal activity, clotrimazole has become a drug of interest in treating several other diseases such as sickle cell disease, malaria and some cancers [A174094]. The minimal side effect profile of this drug and its uncomplicated metabolic profile have led it to gain widespread acceptance for the treatment of mycotic outbreaks such as vaginal yeast infections as well as athlete's foot [A174097].	solid	Topical preparations Clotrimazole topical cream is indicated for the topical treatment of the following dermal infections [F3088], [F3121]: Tinea pedis, tinea cruris, and tinea corporis due to _Trichophyton rubrum_, _Trichophyton mentagrophytes_, _Epidermophyton floccosum_ Candidiasis due to _Candida albicans_ Tinea versicolor due to _Malassezia furfur_ Diaper rash infected by _Candida albicans_ In some preparations, clotrimazole may be combined with betamethasone dipropionate, a corticosteroid [F3121]. Oral preparations The oral troche preparation is indicated for the local treatment of oropharyngeal candidiasis [FDA label]. It is also indicated as a prophylactic drug to reduce the incidence of oropharyngeal candidiasis in patients immunocompromised by conditions such as chemotherapy, radiotherapy, or steroid therapy utilized in the treatment of leukemia, solid tumors, or renal transplantation [FDA label]. Troche preparations are not indicated for the treatment of any systemic mycoses [FDA label].	Clotrimazole is a broad-spectrum antifungal agent that inhibits the growth of pathogenic yeasts by changing the permeability of cell membranes. The action of clotrimazole is fungistatic at concentrations of drug up to 20 mcg/mL and may be fungicidal _in vitro_ against Candida albicans and other species of the genus Candida at higher concentrations [FDA label]. Unfortunately, resistance to clotrimazole, which was rare in the past, is now common in various patient populations [A174094]. Clotrimazole is generally considered to be a fungistatic, and not a fungicidal drug, although this contrast is not absolute, as clotrimazole shows fungicidal properties at higher concentrations [A174094].	Clotrimazole acts primarily by damaging the permeability barrier in the cell membrane of fungi. Clotrimazole causes inhibition of ergosterol biosynthesis, an essential constituent of fungal cell membranes. If ergosterol synthesis is either completely or partially inhibited, the cell is no longer able to construct an intact and functional cell membrane [F3088],[F3100]. Because ergosterol directly promotes the growth of fungal cells in a hormone‐like fashion, rapid onset of the above events leads to dose-dependent inhibition of fungal growth [A174094]. Though decreased ergosterol, due to the inhibition of lanosterol 14-demethylase (also known as _CYP51_) [A174094] is accepted to be primarily responsible for the antimycotic properties of clotrimazole, this drug also shows other pharmacological effects. These include the inhibition of sarcoplasmic reticulum Ca2+‐ATPase, depletion of intracellular calcium, and blocking of calcium‐dependent potassium channels and voltage‐dependent calcium channels [A174094]. The action of clotrimazole on these targets accounts for other effects of this drug that are separate from its antimycotic activities [A174094].	Because clotrimazole is generally not significantly absorbed, drug interactions are not a major issue with its use [A174094].	Hepatic (metabolized to inactive metabolites) [L5173].	Symptoms of overdose include erythema, stinging, blistering, peeling, edema, pruritus, urticaria, burning, and general irritation of the skin, and cramps. As with all topical agents, skin sensitization may result [F3088]. Oral LD50 (rat): 708 mg/kg; Intraperitoneal LD50 (rat): 445 mg/kg; Subcutaneous LDLO (rat): 10 g/kg; Oral LD50 (mouse): 761 mg/kg; Subcutaneous LDLO (mouse): 10 g/kg; Intraperitoneal LD50 (mouse): 108 mg/kg;[F3124] Overdose This drug poses no risk of acute intoxication, as it is unlikely to occur following a single vaginal or dermal application of an overdose (application over a large area under conditions favorable to absorption) or accidental oral ingestion. There is no specific antidote [F3100]. Effects on Fertility No human studies of the effects of clotrimazole on fertility have been conducted; however, animal studies have not shown any effects on the drug on fertility [F3088]. Use in Pregnancy There are limited data regarding the use of clotrimazole in pregnant women. Animal studies do not show direct or indirect harmful effects on reproduction. Although the topical application of clotrimazole may result in very low serum and tissue levels, the use of clotrimazole topical cream by pregnant women is not recommended unless it is advised by the prescribing physician. Clotrimazole topical cream should not be used in the first trimester of pregnancy unless it is considered by the physician to be essential to patient well-being [F3088]. Use in Breastfeeding Available pharmacodynamic/toxicological studies in animals have shown excretion of clotrimazole/metabolites in breastmilk. Clotrimazole should not be administered during breastfeeding. Although the topical application of clotrimazole has resulted in very low serum and tissue levels, the use of clotrimazole topical cream by lactating women is not recommended unless it recommended by the prescribing physician [F3088].	null	98% [L5170]	Mainly hepatic [L5173].	The topical form is minimally absorbed in the serum and tissues [F3088]. Clotrimazole is a lipophilic drug [A174118], and has been shown to be secreted in breastmilk in animal studies [F3088]. There are limited data available regarding the volume of distribution following oral troche administration.	null	Organic compounds	Benzenoids	Triphenyl compounds	null	[ "approved", "vet_approved" ]	[ "D01AC", "D01A", "D01", "D", "A01AB", "A01A", "A01", "A", "G01AF", "G01A", "G01", "G", "G01AF", "G01A", "G01", "G" ]	[ "Yeast and other fungi" ]	[ { "cost": "1.03", "description": "Gyne-lotrimin insert", "unit": "insert" }, { "cost": "1.28", "description": "Lotrimin 1% cream", "unit": "g" }, { "cost": "1.33", "description": "Mycelex-7 100 mg vaginal tablet", "unit": "tablet" }, { "cost": "1.61", "description": "Clotrimazole 10 mg troche", "unit": "troche" }, { "cost": "1.85", "description": "Mycelex 10 mg troche", "unit": "troche" }, { "cost": "5.2", "description": "Clotrimazole powder", "unit": "g" }, { "cost": "17.99", "description": "Clotrimazole 1% Cream 15 gm Tube", "unit": "tube" }, { "cost": "17.99", "description": "Clotrimazole 1% Solution 10ml Bottle", "unit": "bottle" }, { "cost": "24.99", "description": "Clotrimazole 1% Solution 30ml Bottle", "unit": "bottle" }, { "cost": "35.99", "description": "Clotrimazole 1% Cream 30 gm Tube", "unit": "tube" }, { "cost": "49.99", "description": "Clotrimazole 1% Cream 45 gm Tube", "unit": "tube" }, { "cost": "117.04", "description": "Clotrimazole 70 10 mg Troche Bottle", "unit": "bottle" }, { "cost": "0.04", "description": "Lotrimin af 2% liquid spray", "unit": "g" }, { "cost": "0.05", "description": "Lotrimin af 2% spray powder", "unit": "g" }, { "cost": "0.18", "description": "Clotrim 1% vaginal cream", "unit": "g" }, { "cost": "0.24", "description": "Ra clotrimazole af cream", "unit": "g" }, { "cost": "0.25", "description": "Sm antifungal 1% cream", "unit": "g" }, { "cost": "0.27", "description": "Antifungal 1% cream", "unit": "g" }, { "cost": "0.32", "description": "CVS Pharmacy clotrimazole 1% cream", "unit": "g" }, { "cost": "0.33", "description": "Desenex 1% cream", "unit": "g" }, { "cost": "0.37", "description": "Ra athlete's 1% foot cream", "unit": "g" }, { "cost": "0.46", "description": "Ra clotrimazole 3 cream", "unit": "g" }, { "cost": "0.5", "description": "Clotrimazole 3 2% cream", "unit": "g" }, { "cost": "0.53", "description": "Clotrimazole 1% cream", "unit": "g" }, { "cost": "0.68", "description": "Lotrimin ultra 1% cream", "unit": "g" }, { "cost": "0.86", "description": "Clotrimazole insert", "unit": "insert" }, { "cost": "0.9", "description": "Mycelex 1% cream", "unit": "g" } ]	[]	1-((2-Chlorophenyl)diphenylmethyl)-1H-imidazole \| 1-(o-Chloro-α,α-diphenylbenzyl)imidazole \| 1-(o-Chlorotrityl)imidazole \| 1-(α-(2-Chlorophenyl)benzhydryl)imidazole \| Clotrimazol \| Clotrimazole \| Clotrimazolum \| CDw128b \| CXC-R2 \| CXCR-2 \| GRO/MGSA receptor \| High affinity interleukin-8 receptor B \| IL-8 receptor type 2 \| IL-8R B \| IL8RB \| 1.14.13.70 \| CYP51 \| CYPLI \| Cytochrome P450 51 \| Cytochrome P450-14DM \| Cytochrome P450-LIA1 \| ERG16 \| Sterol 14-alpha demethylase \| Gardos channel \| hIK1 \| hKCa4 \| hSK4 \| IK1 \| IKCA1 \| KCa3.1 \| KCA4 \| Putative Gardos channel \| SK4 \| SKCa 4 \| SKCa4 \| Orphan nuclear receptor PAR1 \| Orphan nuclear receptor PXR \| Pregnane X receptor \| PXR \| Steroid and xenobiotic receptor \| SXR \| G-protein coupled receptor 109A \| G-protein coupled receptor HM74A \| GPR109A \| HCA2 \| HM74A \| Niacin receptor 1 \| NIACR1 \| Nicotinic acid receptor \| 1.14.14.1 \| CYPIIC8 \| Cytochrome P450 form 1 \| Cytochrome P450 IIC2 \| Cytochrome P450 MP-12 \| Cytochrome P450 MP-20 \| S-mephenytoin 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.13.- \| CYPIIB6 \| Cytochrome P450 IIB1 \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| 1,4-cineole 2-exo-monooxygenase \| 1.14.14.- \| Coumarin 7-hydroxylase \| CYP2A3 \| CYPIIA6 \| Cytochrome P450 IIA3 \| Cytochrome P450(I) \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase \| 1.14.14.1 \| 4-nitrophenol 2-hydroxylase \| CYP2E \| CYPIIE1 \| Cytochrome P450-J \| 1.14.14.1 \| CYPIIIA7 \| Cytochrome P450-HFLA \| P450HLp2 \| ATP-binding cassette sub-family B member 1 \| MDR1 \| Multidrug resistance protein 1 \| P-glycoprotein 1 \| PGY1 \| Phospholipid transporter ABCB1 \| 7.6.2.- \| ATP-binding cassette sub-family B member 11 \| BSEP \| Liver-specific organic anion transporter 1 \| LST-1 \| LST1 \| OATP-2 \| OATP-C \| OATP1B1 \| OATP2 \| OATPC \| Organic anion transporter SLC21A6 \| SLC21A6 \| SLCO1B1 \| Sodium-independent organic anion-transporting polypeptide 2 \| Solute carrier family 21 member 6 \| Liver-specific organic anion transporter 2 \| LST-2 \| LST2 \| OATP-8 \| OATP1B3 \| OATP8 \| Organic anion transporter 8 \| Organic anion-transporting polypeptide 8 \| SLC21A8 \| Solute carrier family 21 member 8	[ "1MED Clotrimazole 1% Antifungal Cream", "1MED Clotrimazole 1% Antifungal Cream", "Akin Anti-fungal", "Alevazol", "Anti Fungal", "Anti-Fungal", "Anti-Fungal Cream", "Antifungal", "Antifungal", "Antifungal", "Antifungal", "Antifungal Cream", "Antifungal Foot", "Aptrimazole 1.0% Antifungal Cream", "Aspiera Anti-Fungal", "Astonea Clotrimazole 1% Athletes Foot", "Athlete Foot Cream with Clotrimazole", "Athlete s Foot Afac", "Athletes Foot", "Athletes Foot", "Athletes Foot", "Athletes Foot", "Athletes Foot Antifungal Antifungal", "Atopalm Clotrimazole Antifungal", "Atopalm Clotrimazole Antifungal", "Au Kah Chuen Antifungal", "Au Kah Chuen Antifungal", "Best Choice Clotrimazole", "Betamethasone Clotrimazole", "Blossom Pharmaceuticals Antifungal", "Botanimedix TineaRX Antifungal Drying Emulsion", "Budpak Antifungal Clotrimazole", "Canesoral Combi", "Canesoral Combi 1 Day", "Canesten 1 Day Internal Cream", "Canesten 1 Vaginal Tablet Combi-pak", "Canesten 1 Vaginal Tablet Combi-pak", "Canesten 1% Topical Cream", "Canesten 1% Topical Solution", "Canesten 100mg Vaginal Inserts", "Canesten 2% Vaginal Cream", "Canesten 200 Mg Vaginal Inserts", "Canesten 3 Day Internal Cream", "Canesten 3 Vaginal Tablet Combi-pak", "Canesten 3 Vaginal Tablet Combi-pak", "Canesten 6 Day Internal Cream", "Canesten Combi 1 Day", "Canesten Combi 1 Day", "Canesten Combi 1 Day Comfortab + Extra Strength External Cream", "Canesten Combi 1 Day Comfortab + Extra Strength External Cream", "Canesten Combi 1 Day Internal + External Creams", "Canesten Combi 1 Day Internal + External Creams", "Canesten Combi 1 Day Soft Capsule + Extra Strength External Cream", "Canesten Combi 1 Day Soft Capsule + Extra Strength External Cream", "Canesten Combi 3 Day", "Canesten Combi 3 Day", "Canesten Combi-pak 1 Day Therapy", "Canesten Combi-pak 1 Day Therapy", "Canesten Comfortab 1", "Canesten Comfortab 3", "Canesten Crm 1% Top", "Canesten Crm 1% Vag", "Canesten External Antifungal Cream", "Canesten External Cream", "Canesten Extra Strength External Antifungal Cream", "Canesten Liq 1%", "Canesten Soft Capsule 1", "Canesten V", "Canesten Vaginal Inserts 100mg", "CAREALL Clotrimazole", "CAREALL Clotrimazole", "CAREONE Clotrimazole", "Ciclomazole", "Clotrimaderm External Cream", "Clotrimaderm Topical", "Clotrimaderm Topical Solution 1% USP", "Clotrimaderm Vaginal 3", "Clotrimaderm Vaginal 6", "Clotrimaderm-fluconazole Combi-pack", "ClotrimazOil Antifungal", "Clotrimazol", "Clotrimazol Dual", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole", "Clotrimazole 1%", "Clotrimazole 1%", "Clotrimazole 1%", "Clotrimazole 1% Athletes Foot", "Clotrimazole 1% Athletes Foot", "Clotrimazole 1% Athletes Foot", "Clotrimazole 1% Athletes Foot", "Clotrimazole 1% Athletes Foot", "Clotrimazole 1% Topical Antifungal Cream", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole Antifungal", "Clotrimazole Antifungal", "Clotrimazole Antifungal", "Clotrimazole Antifungal", "Clotrimazole Antifungal", "Clotrimazole Athletes Foot", "Clotrimazole Athletes Foot", "Clotrimazole Cream 1%", "Clotrimazole Cream 1%", "Clotrimazole Cream 1%", "Clotrimazole External Antifungal Cream", "Clotrimazole External Cream", "Clotrimazole Extra Strength External Antifungal Cream", "Clotrimazole Jock Itch", "Clotrimazole Jock Itch", "Clotrimazole Topical", "Clotrimazole Topical Solution 1%", "Clotrimazole Topical Solution USP, 1%", "Clotrimazole Topical Solution USP, 1%", "Clotrimazole Topical Solution USP, 1%", "Clotrimazole Topical Solution USP, 1%", "Clotrimazole Topical Solution USP, 1%", "Clotrimazole Vaginal 3", "Clotrimazole Vaginal 6", "Clotrimazole-fluconazole Combi", "Clotrimazole/Betameth", "Cura Hongo Antifungal", "CVS Antifungal Ringworm", "CVS Clotrimazole Maximum Strength", "CVS Pharmacy Clotrimazole 3", "CVS Pharmacy Clotrimazole 3", "CVS Pharmacy ITCH RELIEF ANTIFUNGAL", "CVSHealth Antifungal", "DermacinRx Therazole Pak", "Dermatin Antifungal", "Dermatin Antifungal", "Desenex", "Dr Sheffield Athletes Foot", "Dynarex Antifungal", "Equaline Antifungal Cream", "Equaline Clotrimazole Antifungal", "Equate Jock Itch", "Exchange Select Atheletes foot", "Extra Strength Clotrimazole Extra Fort -fluconazole Combi", "Family Care Antifungal", "Family Care Clotrimazole Anti-Fungal Cream 1%", "Family Care Clotrimazole Antifungal", "Family Wellness Antifungal", "Family Wellness Antifungal", "Family Wellness Clotrimazole 1 Anti Fungal Cream", "Fastrin Anti - Fungal Skin Care", "Femmesil", "First Aid Research Antifungal .5oz", "First Aid Research Antifungal Cream 1oz", "Foot Care Clotrimazole", "Footlogix", "Footlogix Intensive Care Diabetic Formula", "Forticept Antifungal Cooling", "Forticept Antifungal Foot Cream", "Forticept Antifungal Foot Gel", "Fortinia", "Fortinia", "Fortinia OF", "FungaZoil Advanced", "Fungicure Intensive", "Fungicure Liquid Gel", "Fungicure Liquid Gel", "Fungicure Manicure Pedicure", "Fungicure Manicure Pedicure Anti Fungal", "Fungicure Manicure Pedicure Liquid Gel", "Fungicure Pumpspray", "Fungistat Max", "Fungistat Max", "Gehwol Fusskraft Nail and Skin Protection", "Gehwol med Foot", "Gehwol Nail Protection Pen", "Gerlasan Hand", "Good Neighbor Pharmacy Clotrimazole", "Good Neighbor Pharmacy Clotrimazole 3", "Good Sense Athletes Foot antifungal", "Goodsense Athletes Foot", "Gyne-Lotrimin 3", "Gyne-Lotrimin 7", "Healthy Accents Antifungal", "HEB Antifungal", "Hua Tuo Xian Gao", "Hua Tuo Xian Gao Antifungal", "JiDeSheng", "JiDeSheng", "Jock Itch", "Jock Itch", "Jock Itch", "Jock Itch", "Jock Itch Antifungal", "Jock Itch Clotrimazole Antifungal", "Jock Itch Cream with Clotrimazole", "Jock-eze", "Kerasal foot and toe", "Kleer-Plex Fungistat Athlete Foot Cure", "Kleer-Plex Fungistat Fungus Cure", "Kroger ATHLETES FOOT", "Kroger Jock Itch", "Lakesia", "Leader Athletes Foot Clotrimazole", "Leader Clotrimazole Anti-Fungal", "Live Better Antifungal", "Lotriderm", "Lotrimin", "Lotrimin", "Lotrimin", "Lotrimin", "Lotrimin", "Lotrimin", "Lotrimin Antifungal", "Lotrimin Antifungal", "Lotrisone", "Lotrisone", "Lotrisone", "Lucky SuperSoft Athletes Foot", "Lucky SuperSoft Athletes Foot", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "Major Clotrimazole", "MakeSense", "meijer Athletes Foot", "Meijer Athletes Foot Cream AF", "meijer Clotrimazole 3", "Meijer Clotrimazole Antifungal", "Micotrin AC", "Mycelex", "Mycelex", "Myclo Crm 10mg", "Myclo Crm 50mg", "Myclo Solution", "Myclo Tab 100mg", "Myclo-derm Cream 1%", "Myclo-derm Solution 1%", "Myclo-gyne Cream 1%", "Myclo-gyne Inserts", "Mycozyl AC", "Neo-zol Cream 1%", "Neo-zol Vaginal Cream 1%", "Neo-zol Vaginal Cream 2%", "Occulus Skin Hydrating Topical Foam CLO-1", "Occulus SKIN HYDRATING TOPICAL FOAM CLO-1 ANTIFUNGAL FOAM", "Oheal Manuka Honey Eczema Cream", "Oheal Manuka Honey Eczema Cream", "Oheal Ringworm Cream", "Olp Clotrimazole", "Our Family Athletes Foot", "Pedesil", "Pedesil Maximum Strength", "Pedesil Maximum Strength", "PerfectHeal Antifungal", "PMS-clotrimazole-betamethasone", "PRO-EX Anti Fungal", "Protective and Moisturizing Skin", "Protective Nail and skin", "Publix athletic foot", "Quality Choice Athletes Foot", "Quality Choice Clotrimazole", "Rexall Athletes Foot", "Rexall Athletes Foot", "Rexall Jock Itch", "Rexall Jock Itch", "Ringworm", "Ringworm", "Rite Aid antifungal ringworm", "Rugby Antifungal Clotrimazole", "Rugby Antifungal Clotrimazole", "Rugby Antifungal Clotrimazole", "Rugby Clotrimazole Antifungal Cream", "S-Cream CLOTRIMAZOLE Cream 1%", "Scheinpharm Clotrimazole 1%", "Shield and Protect Anti-Fungal", "Shopko Athletes Foot", "ShopRite antifungal", "Signature Care Antifungal", "Signature Care Athletes Foot", "Signature Care Athletes Foot", "Signature Care Jock Itch", "Silka Ringworm", "SIMPLY VITAL Antifungal Cream", "Skin Repair", "Smart Sense Athletes Foot Antifungal", "Smooth Gator Fungus Eliminator", "Soothing Antifungal Cream", "SoundBody Clotrimazole Antifungal", "Sunmark Clotrimazole", "sunmark Clotrimazole 3", "Taro-clotrimazole/betamethasone Dipropionate", "Terbinafine HCl Chlortimazole and Tolnaftate", "Terrasil Anti-fungal Treatment", "Terrasil Anti-Fungal Treatment", "Terrasil Anti-Fungal Treatment MAX", "Terrasil Antifungal Cream Maximum Strength", "Terrasil Athletes Foot AntiFungal Treatment Max", "Terrasil Foot and Nail Anti-Fungal", "Terrasil Foot and Nail Anti-Fungal Maximum Strength", "Terrasil Jock Itch Treatment Maximum Strength", "Terrasil Jock-Itch Treatment MAX", "Terrasil JockItch Treatment Maximum Strength", "Terrasil Rapid-Clear Anti-Fungal", "Terrasil Rapid-Clear Anti-Fungal", "Terrasil Ringworm Treatment MAX", "Terrasil Tinea Treatment MAX", "Terrasil Tinea Treatment Maximum Strength", "TerrasilMed ANTIFUNGAL", "Thera plus Antifungal Clotrimazole", "TheraPlus Plus", "TM-Clotrimazole", "TopCare Antifungal", "Topcare Athletes Foot", "TopCare Clotrimazole 3", "Up and Up Athletes Foot", "Up and Up Jock Itch Relief", "UpandUp Clotrimazole", "Votriza-AL", "Walgreens Clotrimazole", "Walgreens Clotrimazole 3", "Walgreens Clotrimazole Antifungal", "Walgreens Clotrimazole Antifungal", "Walgreens Jock Itch", "Western Family Athletes Foot", "WinCo Antifungal", "WinCo Foods Antifungal", "Zapotol Clotrimazole" ]	[ "Canesten", "Canifug", "Clotrimaderm", "Empecid", "FemCare", "Fungicip", "Gyne-Lotrimin", "Myclo-Derm", "Myclo-Gyne" ]	[ "Clotrimazole and Betamethasone Dipropionate", "Betamethasone Clotrimazole", "Lotrisone", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Terrasil Rapid-Clear Anti-Fungal", "Terrasil Rapid-Clear Anti-Fungal", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Lotrisone", "DermacinRx Therazole Pak", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Lotrisone", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Terbinafine HCl Chlortimazole and Tolnaftate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Ciclomazole", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Canesten Combi-pak 1 Day Therapy", "Canesten Combi-pak 1 Day Therapy", "Canesten 1 Vaginal Tablet Combi-pak", "Canesten 1 Vaginal Tablet Combi-pak", "Canesten 3 Vaginal Tablet Combi-pak", "Canesten 3 Vaginal Tablet Combi-pak", "Clotrimaderm-fluconazole Combi-pack", "Clotrimazole-fluconazole Combi", "Canesten Combi 1 Day Internal + External Creams", "Canesten Combi 1 Day Internal + External Creams", "Canesten Combi 3 Day", "Canesten Combi 3 Day", "Canesten Combi 1 Day", "Canesten Combi 1 Day", "Canesoral Combi", "Canesoral Combi 1 Day", "Extra Strength Clotrimazole Extra Fort -fluconazole Combi", "Lotriderm", "PMS-clotrimazole-betamethasone", "Taro-clotrimazole/betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole/Betameth", "Canesten Combi 1 Day Comfortab + Extra Strength External Cream", "Canesten Combi 1 Day Comfortab + Extra Strength External Cream", "Clotrimazole and Betamethasone Dipropionate", "Canesten Combi 1 Day Soft Capsule + Extra Strength External Cream", "Canesten Combi 1 Day Soft Capsule + Extra Strength External Cream", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate", "Clotrimazole and Betamethasone Dipropionate" ]	[ "P25025", "O15554", "O75469", "Q8TDS4" ]	[ "P10632", "P08684", "P20813", "P10635", "P11509", "P11712", "P05181", "P24462" ]	[]	[ "P08183", "O95342", "Q9Y6L6", "Q9NPD5" ]
DB00258	Calcium acetate	The chemical compound calcium acetate is the calcium salt of acetic acid. It has been commonly referred to as the acetate of lime. The anhydrous form is very hygroscopic, therefore the monohydrate is the common form.	solid	Calcium acetate is one of a number of calcium salts used to treat hyperphosphatemia (too much phosphate in the blood) in patients with kidney disease.	Patients with advanced renal insufficiency (creatinine clearance less than 30 ml/min) exhibit phosphate retention and some degree of hyperphosphatemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy, and soft-tissue calcification. The mechanism by which phosphate retention leads to hyperparathyroidism is not clearly delineated. Therapeutic efforts directed toward the control of hyperphosphatemia include reduction in the dietary intake of phosphate, inhibition of absorption of phosphate in the intestine with phosphate binders, and removal of phosphate from the body by more efficient methods of dialysis. The rate of removal of phosphate by dietary manipulation or by dialysis is insufficient. Dialysis patients absorb 40% to 80% of dietary phosphorus. Therefore, the fraction of dietary phosphate absorbed from the diet needs to be reduced by using phosphate binders in most renal failure patients on maintenance dialysis. Calcium acetate when taken with meals combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces. Maintenance of serum phosphorus below 6.0 mg/dl is generally considered as a clinically acceptable outcome of treatment with phosphate binders. Calcium acetate is highly soluble at neutral pH, making the calcium readily available for binding to phosphate in the proximal small intestine.	Calcium acetate and other calcium salts are phosphate binders. They work by binding with the phosphate in the food you eat, so that it is eliminated from the body without being absorbed.	40% is absorbed in the fasting state and approximately 30% is absorbed in the nonfasting state following oral administration.	null	Oral, rat: LD<sub>50</sub> = 4280 mg/kg. Symptoms of overdose include mild hypercalcemia (constipation; loss of appetite; nausea and vomiting), and severe hypercalcemia (confusion; full or partial loss of consciousness; incoherent speech).	null	null	Calcium acetate when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces.	null	null	Organic compounds	Organic acids and derivatives	Carboxylic acids and derivatives	Carboxylic acids	[ "approved", "investigational" ]	[ "V03AE", "V03A", "V03", "V", "A11GB", "A11G", "A11", "A", "V03AE", "V03A", "V03", "V" ]	[ "Humans and other mammals" ]	[ { "cost": "1.05", "description": "PhosLo 667 mg capsule", "unit": "capsule" }, { "cost": "0.41", "description": "Phoslo 667 mg tablet", "unit": "tablet" } ]	[ { "approved": "2003-06-10", "country": "United States", "expires": "2021-04-03", "number": "6576665" }, { "approved": "2005-04-05", "country": "United States", "expires": "2021-07-30", "number": "6875445" }, { "approved": "2013-11-26", "country": "United States", "expires": "2030-02-23", "number": "8591938" }, { "approved": "2013-11-26", "country": "United States", "expires": "2027-07-20", "number": "8592480" }, { "approved": "2015-07-28", "country": "United States", "expires": "2027-07-20", "number": "9089528" } ]	Acetate of lime \| Brown acetate of lime \| Calcio acetato \| Calcium acetate \| calcium ethanoate \| calcium(II) acetate \| Gray acetate of lime \| Lime acetate \| Lime pyrolignite	[ "Aluminum Acetate Astringent", "Aluminum Acetate Astringent", "Astringent", "Astringent", "Astringent Solution", "Astringent Solution", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate", "Calcium Acetate 667 mg", "Calcium Acetate Tab 667mg", "Calphron", "Domeboro", "Eliphos", "Eliphos", "Eliphos", "Hyperlyte (multi-electrolyte Concentrate)", "Kerasal Athletes Foot Rapid Symptom Relief Medicated Soak", "Lypholyte", "Lypholyte Multi-electrolyte Conc Inj", "Nutrilyte", "Phoslo", "Phoslo", "Phoslo", "Phoslo", "PhosLo", "Phoslo", "Phoslo Tablets", "Phoslyra", "ProcalAmine" ]	[ "Phoslo", "Teltozan" ]	[ "Aluminum Acetate Astringent", "Nutrilyte", "Aluminum Acetate Astringent", "Astringent", "Domeboro", "ProcalAmine", "Lypholyte Multi-electrolyte Conc Inj", "Lypholyte", "Hyperlyte (multi-electrolyte Concentrate)", "Kerasal Athletes Foot Rapid Symptom Relief Medicated Soak", "Astringent Solution", "Astringent Solution", "Astringent" ]	[]	[]	[]	[]
DB00259	Sulfanilamide	Sulfanilamide is a molecule containing the sulfonamide functional group attached to an aniline.	solid	For the treatment of vulvovaginitis caused by <i>Candida albicans</i>.	Sulfanilamide is a sulfonamide antibiotic. The sulfonamides are synthetic bacteriostatic antibiotics with a wide spectrum against most gram-positive and many gram-negative organisms. However, many strains of an individual species may be resistant. Sulfonamides inhibit multiplication of bacteria by acting as competitive inhibitors of <i>p</i>-aminobenzoic acid in the folic acid metabolism cycle. Bacterial sensitivity is the same for the various sulfonamides, and resistance to one sulfonamide indicates resistance to all. Most sulfonamides are readily absorbed orally. However, parenteral administration is difficult, since the soluble sulfonamide salts are highly alkaline and irritating to the tissues. The sulfonamides are widely distributed throughout all tissues. High levels are achieved in pleural, peritoneal, synovial, and ocular fluids. Although these drugs are no longer used to treat meningitis, CSF levels are high in meningeal infections. Their antibacterial action is inhibited by pus.	Sulfanilamide is a competitive inhibitor of bacterial enzyme dihydropteroate synthetase. This enzyme normally uses para-aminobenzoic acid (PABA) for synthesizing the necessary folic acid. The inhibited reaction is normally necessary in these organisms for the synthesis of folic acid. Without it, bacteria cannot replicate.	Sulfonamides are absorbed through the vaginal mucosa. There are no pharmacokinetic data available describing how much of an intravaginal dose reaches the systemic circulation.	null	Oral, mouse LD<sub>50</sub> = 3700 mg/kg; Intravenous, mouse LD<sub>50</sub> = 621 mg/kg; Oral, rabbit LD<sub>50</sub> = 1300 mg/kg. Side effects include itching, burning, skin rash, redness, swelling, or other sign of irritation not present before use of this medicine and long-term use of sulfonamides may cause cancer of the thyroid gland.	null	null	null	null	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	Benzenesulfonamides	[ "approved" ]	[ "G01AE", "G01A", "G01", "G", "J01EB", "J01E", "J01", "J", "D06BA", "D06B", "D06", "D" ]	[ "Candida albicans and other yeasts" ]	[ { "cost": "110.97", "description": "AVC Vaginal 15% Cream 120 gm Tube", "unit": "tube" }, { "cost": "0.22", "description": "Sodium sulfanilamide powder", "unit": "g" }, { "cost": "0.33", "description": "Avc 15% cream", "unit": "g" } ]	[]	4-aminobenzene sulfonic acid amide \| 4-azanylbenzenesulfonamide \| p-aminobenzenesulfamide \| p-aminobenzenesulfonamide \| para-aminobenzenesulfonamide \| Prontosil album \| SA \| Streptocide \| Sulfamine \| Sulfanilamida \| Sulfanilamide \| Sulfanilamidum \| Sulphanilamide \| 2.5.1.15 \| dhpS \| Dihydropteroate pyrophosphorylase	[ "Avc", "Avc Cream - 15%", "AVC Vaginal", "AVC Vaginal" ]	[ "Streptocid" ]	[]	[]	[]	[]	[]
DB00260	Cycloserine	Antibiotic substance produced by Streptomyces garyphalus.	solid	Used in combination with up to 5 other drugs as a treatment for Mycobacterium avium complex (MAC) and is also used to treat tuberculosis (TB).	Cycloserine, a broad-spectrum antibiotic, may be bactericidal or bacteriostatic, depending on its concentration at the site of infection and the susceptibility of the organism. Cycloserine works by blocking the formation of these peptidoglycans. By doing this the walls of the bacteria become weak and it results in the death of the bacteria	Cycloserine is an analog of the amino acid D-alanine. It interferes with an early step in bacterial cell wall synthesis in the cytoplasm by competitive inhibition of two enzymes, L-alanine racemase, which forms D-alanine from L-alanine, and D-alanylalanine synthetase, which incorporates D-alanine into the pentapeptide necessary for peptidoglycan formation and bacterial cell wall synthesis.	Rapidly and almost completely absorbed (70 to 90%) from the gastrointestinal tract following oral administration.	null	Oral LD<sub>50</sub> in mouse is 5290 mg/kg, and in rat is over 5000 mg/kg. Symptoms of a cycloserine overdose include drowsiness, confusion, headache, dizziness, irritability, numbness and tingling, difficulty speaking, paralysis, abnormal behavior, seizures, and unconsciousness.	Half-life in patients with normal renal function is 10 hours, and is prolonged in patients with impaired renal function.	null	null	null	null	Organic compounds	Organoheterocyclic compounds	Azolines	Isoxazolines	[ "approved" ]	[ "J04AB", "J04A", "J04", "J" ]	[ "Enteric bacteria and other eubacteria", "Mycobacterium tuberculosis" ]	[ { "cost": "6.0", "description": "Seromycin 250 mg pulvule", "unit": "each" }, { "cost": "7.53", "description": "Seromycin 250 mg capsule", "unit": "each" } ]	[]	(+)-4-amino-3-isoxazolidinone \| (+)-cycloserine \| alpha-Cycloserine \| Cicloserina \| cyclo-D-Serine \| Cyclosérine \| Cycloserine \| Cycloserinum \| D-(+)-cycloserine \| D-4-amino-3-isoxazolidinone \| D-4-amino-3-isoxazolidone \| D-Cycloserine \| DCS \| Orientomycin \| α-Cycloserine \| GluN1 \| Glutamate [NMDA] receptor subunit zeta-1 \| hNR1 \| N-methyl-D-aspartate receptor subunit NR1 \| NMD-R1 \| NMDAR1 \| 6.3.2.4 \| D-Ala-D-Ala ligase A \| D-alanylalanine synthetase A \| 5.1.1.1 \| 4.1.1.28 \| AADC \| DDC \| DOPA decarboxylase \| PAT2 \| Proton/amino acid transporter 2 \| Solute carrier family 36 member 2 \| TRAMD1 \| Tramdorin-1 \| Transmembrane domain rich protein 1	[ "Cycloserine", "Cycloserine", "Cycloserine", "Cycloserine", "Seromycin", "Seromycin", "Seromycin", "Seromycin", "Seromycin Cap 250mg" ]	[ "Oxamycin", "Tisomycin" ]	[]	[ "Q05586" ]	[ "P20711" ]	[]	[ "Q495M3" ]
DB00261	Anagrelide	Anagrelide is a platelet-reducing agent used to lower dangerously elevated platelet levels (i.e. to treat thrombocythemia) in patients with myeloproliferative neoplasms.[L14153] It is an oral imidazoquinazoline that was first approved for use in the US in 1997.[A214274] It appears to carry a better response rate than other thrombocythemia treatments (e.g. [busulfan], [hydroxyurea]) and may be better tolerated.[A214274]	solid	Anagrelide is indicated for the treatment of thrombocythemia, secondary to malignant neoplasms, to reduce platelet count and the associated risk of thrombosis. It is also beneficial in the amelioration of thrombocythemia symptoms including thrombo-hemorrhagic events.[L14153]	Anagrelide decreases platelet counts by suppressing transcription factors necessary for the synthesis and maturation of platelet-producing cells.[L14153] The drug itself appears to have a relatively short residence time in the body necessitating twice or four times daily dosing. However, given that the pharmacological effect of anagrelide therapy is reliant on a gradual suppression of platelet-producing cells, it may take 7 to 14 days[L14300] for its administration to be reflected in reduced platelet counts - for this reason any changes to anagrelide doses should not exceed 0.5 mg/day in any one week.[L14153] Evidence from animal studies suggests anagrelide may impair female fertility.[L14153] Female patients of reproductive age should be advised of the potential for adverse effects on fertility prior to initiating therapy.	The exact mechanism by which anagrelide lowers platelet count is unclear. Evidence from human trials suggests a dose-related suppression of megakaryocyte maturation, the cells responsible for platelet production - blood drawn from patients receiving anagrelide showed a disruption to the post-mitotic phase of megakaryocyte development and a subsequent reduction in their size and ploidy.[L14300] This may be achieved via indirect suppression of certain transcription factors required for megakaryocytopoeisis, including GATA-1 and FOG-1.[L14153] Anagrelide is a known inhibitor of phosphodiesterase 3A (PDE3A), although its platelet-lowering effects appear unrelated to this inhibition.[A204317] While PDE3 inhibitors, as a class, can inhibit platelet aggregation, this effect is only seen at higher anagrelide doses (i.e. greater than those required to reduce platelet count).[L14153] Modulation of PDE3A has been implicated in causing cell cycle arrest and apoptosis in cancer cells expressing both PDE3A and SLFN12,[A204167] and may be of value in the treatment of gastrointestinal stromal tumours.[A204314]	Following oral administration, the bioavailability of anagrelide is approximately 70%.[L14153] Given on an empty stomach, the C<sub>max</sub> is reached within 1 hour (T<sub>max</sub>) of administration. Co-administration with food slightly lowers the C<sub>max</sub> and increases the AUC, but not to a clinically significant extent.[L14153]	Anagrelide is extensively metabolized, primarily in the liver by cytochrome P450 1A2 (CYP1A2), into two major metabolites: 6,7-dichloro-3-hydroxy-1,5 dihydro-imidazo[2,1-b]quinazolin-2-one (3-hydroxy anagrelide) and 2-amino-5,6-dichloro-3,4,-dihydroquinazoline (RL603). The 3-hydroxy metabolite is considered pharmacologically active and carries a similar potency and efficacy in regards to its platelet-lowering effects, but inhibits PDE3 with a potency 40x greater than that of the parent drug.[L14153]	The oral LD<sub>50</sub> of anagrelide as reported in rats and mice is >1500mg/kg and >2500mg/kg, respectively.[L14243] Symptoms of overdose may include hypotension, sinus tachycardia, and vomiting. As the therapeutic effect of anagrelide (i.e. platelet reduction) is dose-related, significant thrombocytopenia is expected in instances of overdose.[L14153] Treatment of overdose should involve careful monitoring of platelet counts and complications such as bleeding.[L14153] Employ symptomatic and supportive measures if clinically indicated.	The t<sub>1/2</sub> of anagrelide and its active metabolite, 3-hydroxy anagrelide, are approximately 1.5 hours and 2.5 hours, respectively.[L14153]	null	Following metabolism, urinary excretion of metabolites appears to be the primary means of anagrelide elimination. Less than 1% of an administered dose is recovered in the urine as unchanged parent drug, while approximately 3% and 16-20% of the administered dose is recovered as 3-hydroxy anagrelide and RL603, respectively.[L14153]	null	null	Organic compounds	Organoheterocyclic compounds	Diazanaphthalenes	Benzodiazines	[ "approved" ]	[ "L01XX", "L01X", "L01", "L" ]	[ "Humans and other mammals" ]	[ { "cost": "5.94", "description": "Anagrelide hcl 0.5 mg capsule", "unit": "each" }, { "cost": "7.37", "description": "Agrylin 0.5 mg capsule", "unit": "each" }, { "cost": "11.91", "description": "Anagrelide hcl 1 mg capsule", "unit": "each" }, { "cost": "13.03", "description": "Agrylin 1 mg capsule", "unit": "each" } ]	[]	Anagrelida \| Anagrelide \| Anagrelidum \| 3.1.4.17 \| cGI-PDE \| CGI-PDE A \| cGMP-inhibited cAMP phosphodiesterase \| Cyclic GMP-inhibited phosphodiesterase A \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYPIA2 \| Cytochrome P(3)450 \| Cytochrome P450 4 \| Cytochrome P450-P3 \| Hydroperoxy icosatetraenoate dehydratase	[ "Agrylin", "Agrylin", "Agrylin", "Anagrelide", "Anagrelide", "Anagrelide", "Anagrelide", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Hydrochloride", "Anagrelide Mylan", "Anagrelide Mylan", "Dom-anagrelide", "Mylan-anagrelide", "PHL-anagrelide", "PMS-anagrelide", "Sandoz Anagrelide", "Xagrid" ]	[]	[]	[ "Q14432" ]	[ "P05177" ]	[]	[]
DB00262	Carmustine	A cell-cycle phase nonspecific alkylating antineoplastic agent. It is used in the treatment of brain tumors and various other malignant neoplasms. (From Martindale, The Extra Pharmacopoeia, 30th ed, p462) This substance may reasonably be anticipated to be a carcinogen according to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985). (From Merck Index, 11th ed)	solid	For the treatment of brain tumors, multiple myeloma, Hodgkin's disease and Non-Hodgkin's lymphomas.	Carmustine is one of the nitrosoureas indicated as palliative therapy as a single agent or in established combination therapy with other approved chemotherapeutic agents in treatment of brain tumors, multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphomas. Although it is generally agreed that carmustine alkylates DNA and RNA, it is not cross resistant with other alkylators. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins.	Carmustine causes cross-links in DNA and RNA, leading to the inhibition of DNA synthesis, RNA production and RNA translation (protein synthesis). Carmustine also binds to and modifies (carbamoylates) glutathione reductase. This leads to cell death.	5 to 28% bioavailability	Hepatic and rapid with active metabolites. Metabolites may persist in the plasma for several days.	The oral LD<sub>50</sub>s in rat and mouse are 20 mg/kg and 45 mg/kg, respectively. Side effects include leukopenia, thrombocytopenia, nausea. Toxic effects include pulmonary fibrosis (20-0%) and bone marrow toxicity.	15-30 minutes	80%	Approximately 60% to 70% of a total dose is excreted in the urine in 96 hours and about 10% as respiratory CO2.	null	null	Organic compounds	Organic acids and derivatives	Organic carbonic acids and derivatives	Ureas	[ "approved", "investigational" ]	[ "L01AD", "L01A", "L01", "L" ]	[ "Humans and other mammals" ]	[ { "cost": "205.69", "description": "Bicnu 100 mg vial", "unit": "vial" }, { "cost": "3667.95", "description": "Gliadel wafer", "unit": "each" }, { "cost": "22611.26", "description": "Gliadel Wafer 8 7.7 mg Wafers Box", "unit": "box" } ]	[]	BCNU \| bis-chloroethylnitrosourea \| Bischloroethyl nitrosourea \| Carmustina \| Carmustine \| Carmustinum \| N,N'-Bis(2-chloroethyl)-N-nitrosourea \| 1.8.1.7 \| GLUR \| GR \| GRase \| GRD1	[ "Bicnu", "BiCNU", "BiCNU", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine", "Carmustine for Injection USP", "Carmustine Obvius", "Gliadel", "Gliadel", "Gliadel Wafer" ]	[ "Becenun", "Carmubris", "Carustine", "Nitrumon" ]	[]	[ "P00390" ]	[]	[]	[]
DB00263	Sulfisoxazole	A short-acting sulfonamide antibacterial with activity against a wide range of gram- negative and gram-positive organisms.	solid	For the treatment of severe, repeated, or long-lasting urinary tract infections, meningococcal meningitis, acute otitis media, trachoma, inclusion conjunctivitis, nocardiosis, chancroid, toxoplasmosis, malaria and other bacterial infections.	Sulfisoxazole is a sulfonamide antibiotic. The sulfonamides are synthetic bacteriostatic antibiotics with a wide spectrum against most gram-positive and many gram-negative organisms. However, many strains of an individual species may be resistant. Sulfonamides inhibit multiplication of bacteria by acting as competitive inhibitors of <i>p</i>-aminobenzoic acid in the folic acid metabolism cycle. Bacterial sensitivity is the same for the various sulfonamides, and resistance to one sulfonamide indicates resistance to all. Most sulfonamides are readily absorbed orally. However, parenteral administration is difficult, since the soluble sulfonamide salts are highly alkaline and irritating to the tissues. The sulfonamides are widely distributed throughout all tissues. High levels are achieved in pleural, peritoneal, synovial, and ocular fluids. Although these drugs are no longer used to treat meningitis, CSF levels are high in meningeal infections. Their antibacterial action is inhibited by pus.	Sulfisoxazole is a competitive inhibitor of the enzyme dihydropteroate synthetase. It inhibits bacterial synthesis of dihydrofolic acid by preventing the condensation of the pteridine with para-aminobenzoic acid (PABA), a substrate of the enzyme dihydropteroate synthetase. The inhibited reaction is necessary in these organisms for the synthesis of folic acid.	null	null	LD<sub>50</sub>=6800 mg/kg (Orally in mice)	null	null	The mean urinary excretion recovery following oral administration of sulfisoxazole is 97% within 48 hours, of which 52% is intact drug, with the remaining as the N4-acetylated metabolite. It is excreted in human milk.	null	null	Organic compounds	Benzenoids	Benzene and substituted derivatives	Benzenesulfonamides	[ "approved", "vet_approved" ]	[ "J01EB", "J01E", "J01", "J", "G01AE", "G01A", "G01", "G", "S01AB", "S01A", "S01", "S" ]	[ "Enteric bacteria and other eubacteria" ]	[ { "cost": "1.01", "description": "Sulfisoxazole crystals", "unit": "g" }, { "cost": "0.25", "description": "Sulfazine 500 mg tablet", "unit": "tablet" }, { "cost": "0.38", "description": "Sulfazine ec 500 mg tablet", "unit": "tablet" }, { "cost": "0.42", "description": "Sulfazine EC 500 mg Enteric Coated Tabs", "unit": "tab" } ]	[]	3,4-Dimethyl-5-sulfanilamidoisoxazole \| 3,4-Dimethyl-5-sulfonamidoisoxazole \| 3,4-Dimethyl-5-sulphanilamidoisoxazole \| 3,4-Dimethyl-5-sulphonamidoisoxazole \| 3,4-Dimethylisoxazole-5-sulfanilamide \| 3,4-Dimethylisoxazole-5-sulphanilamide \| 4-Amino-N-(3,4-dimethyl-5-isoxazolyl)benzenesulfonamide \| 4-Amino-N-(3,4-dimethyl-5-isoxazolyl)benzenesulphonamide \| 5-(4-Aminophenylsulfonamido)-3,4-dimethylisoxazole \| 5-(p-Aminobenzenesulfonamido)-3,4-dimethylisoxazole \| 5-(p-Aminobenzenesulphonamido)-3,4-dimethylisoxazole \| 5-Sulfanilamido-3,4-dimethylisoxazole \| 5-Sulphanilamido-3,4-dimethyl-isoxazole \| N'-(3,4)Dimethylisoxazol-5-yl-sulphanilamide \| N1-(3,4-dimethyl-5-isoxazolyl)sulfanilamide \| N1-(3,4-dimethyl-5-isoxazolyl)sulphanilamide \| Sulfadimethylisoxazole \| Sulfafurazol \| Sulfafurazole \| Sulfafurazolum \| Sulfaisoxazole \| Sulfasoxazole \| Sulfisonazole \| Sulfisoxasole \| Sulfisoxazol \| Sulfisoxazole \| Sulfofurazole \| Sulphadimethylisoxazole \| Sulphafurazol \| Sulphafurazole \| Sulphaisoxazole \| Sulphisoxazol \| Sulphofurazole \| 2.5.1.15 \| dhpS \| Dihydropteroate pyrophosphorylase \| (R)-limonene 6-monooxygenase \| (S)-limonene 6-monooxygenase \| (S)-limonene 7-monooxygenase \| 1.14.14.1 \| Cholesterol 25-hydroxylase \| CYP2C10 \| CYPIIC9 \| Cytochrome P-450MP \| Cytochrome P450 MP-4 \| Cytochrome P450 MP-8 \| Cytochrome P450 PB-1 \| S-mephenytoin 4-hydroxylase	[ "Apo Sulfisoxazole Tab 500mg", "Novo-soxazole 500mg", "Sulfisoxazole", "Sulfizole Tab 500mg" ]	[ "Gantrisin", "Neoxazol" ]	[]	[]	[ "P11712" ]	[]	[]
DB00264	Metoprolol	Metoprolol is a selective beta-1 blocker commonly employed as the succinate and tartrate derivatives depending if the formulation is designed to be of immediate release or extended release.[A175159, L5530] The possibility of the generation of these formulations comes from the lower systemic bioavailability of the succinate derivative.[T274] To this date, it is one of the preferred beta-blockers in general clinical guidelines and it is widely prescribed in the Netherlands, New Zealand, and the US.[A175162] Metoprolol was developed since 1969 by US Pharmaceutical Holdings I and FDA approved in 1978.[L5527]	solid	Metoprolol is indicated for the treatment of angina, heart failure, myocardial infarction, atrial fibrillation, atrial flutter and hypertension.[A175141,L36065,L45553] Some off-label uses of metoprolol include supraventricular tachycardia and thyroid storm.[A175141] All the indications of metoprolol are part of cardiovascular diseases. These conditions correspond to a number of diseases that involve the function of the heart and blood vessels. The underlying causes of these conditions are variable and can be due to genetic disposition, lifestyle decisions such as smoking, obesity, diet, and lack of exercise, and comorbidity with other conditions such as diabetes. The cardiovascular diseases are the leading cause of death on a global scale.[L5533]	Administration of metoprolol in normal subjects is widely reported to produce a dose-dependent reduction on heart rate and cardiac output.[A175141] This effect is generated due to a decreased cardiac excitability, cardiac output, and myocardial oxygen demand.[T76] In the case of arrhythmias, metoprolol produces its effect by reducing the slope of the pacemaker potential as well as suppressing the rate of atrioventricular conduction.[T451] The Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) trial showed a significant improvement in sudden cardiac death and myocardial infarction when patients were given with metoprolol as compared with diuretics. As well, in clinical trials performed in 1990, metoprolol reduces mortality and re-infarction in 17% of the individuals when administered chronically after an episode of myocardial infarction.[A175141]	Metoprolol is a beta-1-adrenergic receptor inhibitor specific to cardiac cells with negligible effect on beta-2 receptors. This inhibition decreases cardiac output by producing negative chronotropic and inotropic effects without presenting activity towards membrane stabilization nor intrinsic sympathomimetics.[A175141]	When metoprolol is administered orally, it is almost completely absorbed in the gastrointestinal tract.[A175141] The maximum serum concentration is achieved 20 min after intravenous administration and 1-2 hours after oral administration. The bioavailability of metoprolol is of 100% when administered intravenously and when administered orally it presents about 50% for the tartrate derivative and 40% for the succinate derivative.[T274] The absorption of metoprolol in the form of the tartrate derivative is increased by the concomitant administration of food.[T274]	Metoprolol goes through significant first-pass hepatic metabolism which covers around 50% of the administered dose.[A175141] The metabolism of metoprolol is mainly driven by the activity of CYP2D6[A175162] and to a lesser extent due to the activity of CYP3A4. The metabolism of metoprolol is mainly represented by reactions of hydroxylation and O-demethylation.[L5530]	Oral administration of metoprolol to rats presents an LD50 in the range of 3090 to 4670 mg/kg. Cases of overdose have reported bradycardia, hypotension, bronchospasm, and cardiac failure. In the case of an overdose, gastric lavage is recommended followed by specific treatment according to symptoms.[FDA label] Metoprolol is not reported to be carcinogenic nor mutagenic nor to impair fertility. The only event registered is the increase of macrophages in pulmonary alveoli and slight biliary hyperplasia. When metoprolol was given for long periods of time on the highest dose, there was evidence of small benign lung tumors.[FDA label]	The immediate release formulations of metoprolol present a half-life of about 3-7 hours.[A175141]	Metoprolol is not highly bound to plasma proteins and only about 11% of the administered dose is found bound. It is mainly bound to serum albumin.[A175141]	Metoprolol is mainly excreted via the kidneys. From the eliminated dose, less than 5% is recovered unchanged.[A175141]	The reported volume of distribution of metoprolol is 4.2 L/kg.[T274] Due to the characteristics of metoprolol, this molecule is able to cross the blood-brain barrier and even 78% of the administered drug can be found in cerebrospinal fluid.[L5536]	The reported clearance rate on patients with normal kidney function is 0.8 L/min. In cirrhotic patients, the clearance rate changes to 0.61 L/min.[A175171]	Organic compounds	Benzenoids	Phenols	Tyrosols and derivatives	[ "approved", "investigational" ]	[ "C07FB", "C07F", "C07", "C", "C07FX", "C07F", "C07", "C", "C07FX", "C07F", "C07", "C", "C07FB", "C07F", "C07", "C", "C07AB", "C07A", "C07", "C", "C07BB", "C07B", "C07", "C", "C07CB", "C07C", "C07", "C", "C07BB", "C07B", "C07", "C" ]	[ "Humans and other mammals" ]	[ { "cost": "1.13", "description": "Metoprolol Succinate 50 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "1.17", "description": "Metoprolol Succinate 25 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "1.24", "description": "Toprol xl 25 mg tablet", "unit": "tablet" }, { "cost": "1.24", "description": "Toprol xl 50 mg tablet", "unit": "tablet" }, { "cost": "1.29", "description": "Lopresor 1 mg/ml", "unit": "ml" }, { "cost": "1.43", "description": "Toprol XL 25 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "1.43", "description": "Toprol XL 50 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "1.44", "description": "Metoprolol succ er 100 mg tablet", "unit": "tablet" }, { "cost": "1.53", "description": "Metoprolol Succinate 100 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "1.81", "description": "Lopressor 50 mg tablet", "unit": "tablet" }, { "cost": "1.86", "description": "Toprol xl 100 mg tablet", "unit": "tablet" }, { "cost": "1.93", "description": "Toprol XL 100 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "2.06", "description": "Lopressor hct 50-25 tablet", "unit": "tablet" }, { "cost": "2.14", "description": "Lopressor HCT 50-25 mg tablet", "unit": "tablet" }, { "cost": "2.21", "description": "Lopressor HCT 100-25 mg tablet", "unit": "tablet" }, { "cost": "2.29", "description": "Metoprolol succ er 200 mg tablet", "unit": "tablet" }, { "cost": "2.62", "description": "Metoprolol Succinate 200 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "2.75", "description": "Lopressor 100 mg tablet", "unit": "tablet" }, { "cost": "2.82", "description": "Lopressor hct 100-50 tablet", "unit": "tablet" }, { "cost": "2.96", "description": "Toprol xl 200 mg tablet", "unit": "tablet" }, { "cost": "3.06", "description": "Lopressor HCT 100-50 mg tablet", "unit": "tablet" }, { "cost": "3.08", "description": "Toprol XL 200 mg 24 Hour tablet", "unit": "tablet" }, { "cost": "3.21", "description": "Lopressor hct 100-25 tablet", "unit": "tablet" }, { "cost": "3.85", "description": "Lopressor 5 mg/5 ml ampul", "unit": "ml" }, { "cost": "5.51", "description": "Metoprolol tartrate powder", "unit": "g" }, { "cost": "0.07", "description": "Apo-Metoprolol 25 mg Tablet", "unit": "tablet" }, { "cost": "0.07", "description": "Pms-Metoprolol-L 25 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Apo-Metoprolol (Type L) 50 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Apo-Metoprolol 50 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Mylan-Metoprolol (Type L) 50 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Novo-Metoprol (Fc) 50 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Novo-Metoprol 50 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Nu-Metop 50 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Pms-Metoprolol-L 50 mg Tablet", "unit": "tablet" }, { "cost": "0.13", "description": "Sandoz Metoprolol (Type L) 50 mg Tablet", "unit": "tablet" }, { "cost": "0.19", "description": "Apo-Metoprolol Sr 100 mg Sustained-Release Tablet", "unit": "tablet" }, { "cost": "0.19", "description": "Sandoz Metoprolol Sr 100 mg Sustained-Release Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Apo-Metoprolol (Type L) 100 mg Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Apo-Metoprolol 100 mg Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Mylan-Metoprolol (Type L) 100 mg Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Novo-Metoprol (Fc) 100 mg Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Novo-Metoprol 100 mg Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Nu-Metop 100 mg Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Pms-Metoprolol-L 100 mg Tablet", "unit": "tablet" }, { "cost": "0.23", "description": "Sandoz Metoprolol (Type L) 100 mg Tablet", "unit": "tablet" }, { "cost": "0.3", "description": "Lopresor 50 mg Tablet", "unit": "tablet" }, { "cost": "0.34", "description": "Metoprolol tartrate 25 mg tablet", "unit": "tablet" }, { "cost": "0.34", "description": "Apo-Metoprolol Sr 200 mg Sustained-Release Tablet", "unit": "tablet" }, { "cost": "0.34", "description": "Lopresor Sr 100 mg Sustained-Release Tablet", "unit": "tablet" }, { "cost": "0.34", "description": "Sandoz Metoprolol Sr 200 mg Sustained-Release Tablet", "unit": "tablet" }, { "cost": "0.56", "description": "Metoprolol tartrate 50 mg tablet", "unit": "tablet" }, { "cost": "0.61", "description": "Lopresor 100 mg Tablet", "unit": "tablet" }, { "cost": "0.61", "description": "Lopresor Sr 200 mg Sustained-Release Tablet", "unit": "tablet" }, { "cost": "0.8", "description": "Metoprolol tartrate 100 mg tablet", "unit": "tablet" }, { "cost": "0.8", "description": "Toprol xl 100 mg tablet sa", "unit": "tablet" }, { "cost": "0.87", "description": "Metoprolol succ er 25 mg tablet", "unit": "tablet" }, { "cost": "0.9", "description": "Metoprolol succ er 50 mg tablet", "unit": "tablet" } ]	[ { "approved": "2017-07-11", "country": "United States", "expires": "2035-07-09", "number": "9700530" }, { "approved": "2016-11-29", "country": "United States", "expires": "2035-07-09", "number": "9504655" } ]	(RS)-Metoprolol \| 1-(isopropylamino)-3-[4-(2-methoxyethyl)phenoxy]propan-2-ol \| DL-metoprolol \| Metoprolol \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ADRB2R \| B2AR \| Beta-2 adrenoceptor \| Beta-2 adrenoreceptor \| ADRB1R \| B1AR \| Beta-1 adrenoceptor \| Beta-1 adrenoreceptor \| ADRB2R \| B2AR \| Beta-2 adrenoceptor \| Beta-2 adrenoreceptor \| ADRB3R \| B3AR \| Beta-3 adrenoceptor \| Beta-3 adrenoreceptor \| 1,4-cineole 2-exo-monooxygenase \| 1,8-cineole 2-exo-monooxygenase \| 1.14.14.1 \| Albendazole monooxygenase (sulfoxide-forming) \| Albendazole sulfoxidase \| Cholesterol 25-hydroxylase \| CYP3A3 \| CYPIIIA3 \| CYPIIIA4 \| Cytochrome P450 3A3 \| Cytochrome P450 HLp \| Cytochrome P450 NF-25 \| Cytochrome P450-PCN1 \| Nifedipine oxidase \| Quinine 3-monooxygenase \| 1.14.14.- \| Cholesterol 25-hydroxylase \| CYP2DL1 \| CYPIID6 \| Cytochrome P450-DB1 \| Debrisoquine 4-hydroxylase \| hOCT2 \| OCT2 \| Organic cation transporter 2	[ "Aa-metoprolol SR", "Aa-metoprolol SR", "Ag-metoprolol-L", "Ag-metoprolol-L", "Ag-metoprolol-L", "Apo-metoprolol", "Apo-metoprolol", "Apo-metoprolol", "Apo-metoprolol (type L)", "Apo-metoprolol (type L)", "Ava-metoprolol", "Ava-metoprolol", "Ava-metoprolol (type L)", "Ava-metoprolol (type L)", "Betaloc Durules Tab 200 mg", "Betaloc IV Inj 1 mg/ml", "Betaloc Tab 100 mg", "Betaloc Tab 50 mg", "Co Metoprolol-L Tablets 100mg", "Co Metoprolol-L Tablets 50mg", "Dom-metoprolol-B - Tab 50mg", "Dom-metoprolol-B Tab 100mg", "Dom-metoprolol-L", "Dom-metoprolol-L", "Dom-metoprolol-L", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Gen-metoprolol Tablets 100mg", "Gen-metoprolol Tablets 50mg", "Hypertensolol", "Jamp-metoprolol-L", "Jamp-metoprolol-L", "Jamp-metoprolol-L", "Kapspargo", "Kapspargo", "Kapspargo", "Kapspargo", "Lopresor 100mg", "Lopresor 50mg", "Lopresor Inj 1.0mg/ml", "Lopresor SR 100mg", "Lopresor SR 200 mg", "Lopressor", "Lopressor", "Lopressor", "Lopressor", "Lopressor", "Lopressor", "Lopressor", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol", "Metoprolol SR", "Metoprolol SR", "Metoprolol SR", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol Succinate", "Metoprolol 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"Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide 100 mg-25 mg", "Metoprolol Tartrate and Hydrochlorothiazide 100 mg-50 mg", "Metoprolol Tartrate and Hydrochlorothiazide 50 mg-25 mg", "Metoprolol Tartrate film coated", "Metoprolol Tartrate film coated", "Metoprolol Tartrate Injection USP", "Metoprolol Tartrate Injection USP", "Metoprolol Tartrate Injection USP", "Metoprolol Tartrate Injection USP", "Metoprolol Tartrate Injection, USP", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Metoprolol-L", "Mylan-metoprolol (type L)", "Mylan-metoprolol (type L)", "Mylan-metoprolol (type L)", "Ntp-metoprolol", "Ntp-metoprolol", "Ntp-metoprolol", "Ntp-metoprolol", "Nu-metop Tab 100mg", "Nu-metop Tab 50mg", "Nu-metoprolol", "Nu-metoprolol", "Nu-metoprolol", "Nu-metoprolol (type L)", "Nu-metoprolol (type L)", "Nu-metoprolol SR", "Nu-metoprolol SR", "Pendo-metoprolol-L", "Pendo-metoprolol-L", "Penta-metoprolol Tablets", "Penta-metoprolol Tablets", "PMS-metoprolol-B Tablets - 100mg", "PMS-metoprolol-B Tablets - 50mg", "PMS-metoprolol-L", "PMS-metoprolol-L", "PMS-metoprolol-L", "PMS-metoprolol-L SR", "PMS-metoprolol-L SR", "Q-metoprolol (type L)", "Q-metoprolol (type L)", "Q-metoprolol (type L)", "Riva-metoprolol-L", "Riva-metoprolol-L", "Riva-metoprolol-L", "Sandoz Metoprolol (type L)", "Sandoz Metoprolol (type L)", "Sandoz Metoprolol (type L)", "Sandoz Metoprolol (type L)", "Sandoz Metoprolol SR", "Sandoz Metoprolol SR", "Teva-metoprolol", "Teva-metoprolol", "Teva-metoprolol", "Teva-metoprolol", "Teva-metoprolol", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprol XL", "Toprolxl XL", "Toprolxl XL", "Toprolxl XL", "Truemed Group LLC" ]	[ "Corvitol", "Minax", "Selokeen", "TOPROL-XL" ]	[ "Hypertensolol", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Dutoprol", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Succinate and Hydrochlorothiazide", "Metoprolol Succinate and Hydrochlorothiazide", "Metoprolol Succinate and Hydrochlorothiazide", "Dutoprol", "Dutoprol", "Dutoprol", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide", "Metoprolol Tartrate and Hydrochlorothiazide 50 mg-25 mg", "Metoprolol Tartrate and Hydrochlorothiazide 100 mg-25 mg", "Metoprolol Tartrate and Hydrochlorothiazide 100 mg-50 mg", "Dutoprol", "Dutoprol", "Dutoprol", "Lopressor HCT", "Lopressor HCT", "Lopressor HCT" ]	[ "P08588", "P07550", "P08588", "P07550", "P13945" ]	[ "P08684", "P10635" ]	[ "P02768" ]	[ "O15244" ]

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