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Meneses-Lorente G, Bentley D, Guerini E, Kowalski K, Chow-Maneval E, Yu L, Brink A, Djebli N, Mercier F, Buchheit V, Phipps A. Characterization of the pharmacokinetics of entrectinib and its active M5 metabolite in healthy volunteers and patients with solid tumors. Invest New Drugs 2021; 39:803-811. [PMID: 33462752 PMCID: PMC8068699 DOI: 10.1007/s10637-020-01047-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Entrectinib is an oral, CNS-active, potent inhibitor of tyrosine receptor kinases A/B/C, tyrosine kinase ROS proto-oncogene 1, and anaplastic lymphoma kinase approved for use in patients with solid tumors. We describe 3 clinical studies, including one investigating the single/multiple dose pharmacokinetics of entrectinib in patients and two studies in healthy volunteers investigating the absorption/distribution/metabolism/excretion (ADME) of entrectinib, its relative bioavailability, and effect of food on pharmacokinetics. METHODS The patient study is open-label with dose-escalation and expansion phases. Volunteers received entrectinib (100-400 mg/m2, and 600-800 mg) once daily with food in continuous 28-day cycles. In the ADME study, volunteers received a single oral dose of [14C]entrectinib 600 mg. In the third study, volunteers received single doses of entrectinib 600 mg as the research and marketed formulations in the fasted state (Part 1), and the marketed formulation in the fed and fasted states (Part 2). Entrectinib and its major active metabolite M5 were assessed in all studies. RESULTS Entrectinib was absorbed in a dose-dependent manner with maximum concentrations at ~4 h postdose and an elimination half-life of ~20 h. Entrectinib was cleared mainly through metabolism and both entrectinib and metabolites were eliminated mainly in feces (minimal renal excretion). At steady-state, the M5-to-entrectinib AUC ratio was 0.5 (with 600 mg entrectinib research formulation in patients). The research and marketed formulations were bioequivalent and food had no relevant effect on pharmacokinetics. CONCLUSIONS Entrectinib is well absorbed, with linear PK that is suitable for once-daily dosing, and can be taken with or without food.
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Affiliation(s)
| | | | - Elena Guerini
- Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | | | | | - Li Yu
- Roche Innovation Center, Little Falls, NJ, USA
| | - Andreas Brink
- Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Nassim Djebli
- Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Francois Mercier
- Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Vincent Buchheit
- Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Alex Phipps
- Roche Innovation Centre Welwyn, Roche Products Ltd, Welwyn Garden City, UK
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Tapp L, Ramsey JG, Wen A, Gerona R. Synthetic Cannabinoid and Mitragynine Exposure of Law Enforcement Agents During the Raid of an Illegal Laboratory - Nevada, 2014. MMWR Morb Mortal Wkly Rep 2017; 66:1291-1294. [PMID: 29190268 PMCID: PMC5708688 DOI: 10.15585/mmwr.mm6647a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND New psychoactive substances constitute a growing and dynamic class of abused drugs in the United States. On July 12, 2016, a synthetic cannabinoid caused mass intoxication of 33 persons in one New York City neighborhood, in an event described in the popular press as a "zombie" outbreak because of the appearance of the intoxicated persons. METHODS We obtained and tested serum, whole blood, and urine samples from 8 patients among the 18 who were transported to local hospitals; we also tested a sample of the herbal "incense" product "AK-47 24 Karat Gold," which was implicated in the outbreak. Samples were analyzed by means of liquid chromatography-quadrupole time-of-flight mass spectrometry. RESULTS The synthetic cannabinoid methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate (AMB-FUBINACA, also known as MMB-FUBINACA or FUB-AMB) was identified in AK-47 24 Karat Gold at a mean (±SD) concentration of 16.0±3.9 mg per gram. The de-esterified acid metabolite was found in the serum or whole blood of all eight patients, with concentrations ranging from 77 to 636 ng per milliliter. CONCLUSIONS The potency of the synthetic cannabinoid identified in these analyses is consistent with strong depressant effects that account for the "zombielike" behavior reported in this mass intoxication. AMB-FUBINACA is an example of the emerging class of "ultrapotent" synthetic cannabinoids and poses a public health concern. Collaboration among clinical laboratory staff, health professionals, and law enforcement agencies facilitated the timely identification of the compound and allowed health authorities to take appropriate action.
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Affiliation(s)
- Axel J Adams
- From the Clinical Toxicology and Environmental Biomonitoring Laboratory (A.J.A., R.G.) and School of Medicine (A.J.A.), University of California, San Francisco, San Francisco, and the Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto (S.D.B.) - both in California; the Department of Emergency Medicine, Wyckoff Heights Medical Center, New York (L.I.); the Office of Diversion Control, Drug and Chemical Evaluation Section, Drug Enforcement Administration, Springfield, VA (J.T.); and the Chemical Defense Program, Office of Health Affairs, Department of Homeland Security, Washington, DC (M.S.)
| | - Samuel D Banister
- From the Clinical Toxicology and Environmental Biomonitoring Laboratory (A.J.A., R.G.) and School of Medicine (A.J.A.), University of California, San Francisco, San Francisco, and the Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto (S.D.B.) - both in California; the Department of Emergency Medicine, Wyckoff Heights Medical Center, New York (L.I.); the Office of Diversion Control, Drug and Chemical Evaluation Section, Drug Enforcement Administration, Springfield, VA (J.T.); and the Chemical Defense Program, Office of Health Affairs, Department of Homeland Security, Washington, DC (M.S.)
| | - Lisandro Irizarry
- From the Clinical Toxicology and Environmental Biomonitoring Laboratory (A.J.A., R.G.) and School of Medicine (A.J.A.), University of California, San Francisco, San Francisco, and the Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto (S.D.B.) - both in California; the Department of Emergency Medicine, Wyckoff Heights Medical Center, New York (L.I.); the Office of Diversion Control, Drug and Chemical Evaluation Section, Drug Enforcement Administration, Springfield, VA (J.T.); and the Chemical Defense Program, Office of Health Affairs, Department of Homeland Security, Washington, DC (M.S.)
| | - Jordan Trecki
- From the Clinical Toxicology and Environmental Biomonitoring Laboratory (A.J.A., R.G.) and School of Medicine (A.J.A.), University of California, San Francisco, San Francisco, and the Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto (S.D.B.) - both in California; the Department of Emergency Medicine, Wyckoff Heights Medical Center, New York (L.I.); the Office of Diversion Control, Drug and Chemical Evaluation Section, Drug Enforcement Administration, Springfield, VA (J.T.); and the Chemical Defense Program, Office of Health Affairs, Department of Homeland Security, Washington, DC (M.S.)
| | - Michael Schwartz
- From the Clinical Toxicology and Environmental Biomonitoring Laboratory (A.J.A., R.G.) and School of Medicine (A.J.A.), University of California, San Francisco, San Francisco, and the Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto (S.D.B.) - both in California; the Department of Emergency Medicine, Wyckoff Heights Medical Center, New York (L.I.); the Office of Diversion Control, Drug and Chemical Evaluation Section, Drug Enforcement Administration, Springfield, VA (J.T.); and the Chemical Defense Program, Office of Health Affairs, Department of Homeland Security, Washington, DC (M.S.)
| | - Roy Gerona
- From the Clinical Toxicology and Environmental Biomonitoring Laboratory (A.J.A., R.G.) and School of Medicine (A.J.A.), University of California, San Francisco, San Francisco, and the Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto (S.D.B.) - both in California; the Department of Emergency Medicine, Wyckoff Heights Medical Center, New York (L.I.); the Office of Diversion Control, Drug and Chemical Evaluation Section, Drug Enforcement Administration, Springfield, VA (J.T.); and the Chemical Defense Program, Office of Health Affairs, Department of Homeland Security, Washington, DC (M.S.)
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Abouchedid R, Ho JH, Hudson S, Dines A, Archer JRH, Wood DM, Dargan PI. Acute Toxicity Associated with Use of 5F-Derivations of Synthetic Cannabinoid Receptor Agonists with Analytical Confirmation. J Med Toxicol 2016; 12:396-401. [PMID: 27456262 DOI: 10.1007/s13181-016-0571-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/25/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Synthetic Cannabinoid Receptor Agonists (SCRAs) are the largest group of new psychoactive substances reported to the European Warning System and the United Nations Office on Drugs and Crime to date. The heterogeneous nature and speed of diversification of these compounds make it challenging to accurately characterise and predict harms of these compounds in pre-clinical studies, ahead of their appearance. CASE REPORT We report the case of a 19-year-old female who purchased three products from a headshop: two new psychoactive substances (sachets of "cannabis tea" and "mushroom tea") as well as two LSD blotters. After the "cannabis tea" was smoked and the two LSD blotters and "mushroom tea" were ingested, the patient became tachycardic (HR 128), developed seizures, agitation, visual hallucinations as well as suspected serotonergic toxicity (sustained ankle clonus 20-30 beats) 1-2 hours after use. She was treated with 1 mg of intravenous midazolam. Symptoms/signs resolved within 13 hours. No further supportive care was required. Plasma, blood, and urine samples confirmed the presence of two SCRAs: 5FAKB-48 and 5F-PB-22. The patient also reported therapeutic use of both fluoxetine and citalopram for depression. DISCUSSION To the best of our knowledge, this is the first case report of non-fatal intoxication with 5F-AKB-48 with analytical confirmation and exposure times. It also highlights the difficulties in understanding the pattern of toxicity of certain SCRAs in the context of psychotropic medications/co-morbid mental illness.
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Affiliation(s)
- Rachelle Abouchedid
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
| | - James H Ho
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | | | - Alison Dines
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - John R H Archer
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul I Dargan
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Hsin‐Hung Chen M, Dip A, Ahmed M, Tan ML, Walterscheid JP, Sun H, Teng B, Mozayani A. Detection and Characterization of the Effect of AB-FUBINACA and Its Metabolites in a Rat Model. J Cell Biochem 2015; 117:1033-43. [PMID: 26517302 PMCID: PMC5063098 DOI: 10.1002/jcb.25421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/28/2015] [Indexed: 01/05/2023]
Abstract
Synthetic cannabinoids were originally developed by academic and pharmaceutical laboratories with the hope of providing therapeutic relief from the pain of inflammatory and degenerative diseases. However, recreational drug enthusiasts have flushed the market with new strains of these potent drugs that evade detection yet endanger public health and safety. Although many of these drug derivatives were published in the medical literature, others were merely patented without further characterization. AB‐FUBINACA is an example of one of the new indazole‐carboxamide synthetic cannabinoids introduced in the past year. Even though AB‐FUBINACA has become increasingly prominent in forensic drug and toxicology specimens analyses, little is known about the pharmacology of this substance. To study its metabolic fate, we utilized Wistar rats to study the oxidative products of AB‐FUBINACA in urine and its effect on gene expressions in liver and heart. Rats were injected with 5 mg/kg of AB‐FUBINACA each day for 5 days. Urine samples were collected every day at the same time. On day 5 after treatment, we collected the organs such as liver and heart. The urine samples were analyzed by mass spectrometry, which revealed several putative metabolites and positioning of the hydroxyl addition on the molecule. We used quantitative PCR gene expression array to analyze the hepatotoxicity and cardiotoxicity on these rats and confirmed by real‐time quantitative RT‐PCR. We identified three genes significantly associated with dysfunction of oxidation and inflammation. Our study reports in vivo metabolites of AB‐FUBINACA in urine and its effect on the gene expressions in liver and heart. J. Cell. Biochem. 117: 1033–1043, 2016. © 2015 The Authors. Journal of Cellular Biochemistry Published by Wiley Periodicals. Inc.
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Affiliation(s)
| | - Aybike Dip
- Department of Administration of JusticeTexas Southern UniversityHoustonTexas77030
| | - Mostafa Ahmed
- Department of Administration of JusticeTexas Southern UniversityHoustonTexas77030
- Research Center for Human GeneticsThe Brown Foundation Institute of Molecular MedicineUniversity of Texas Health Science Center at HoustonHoustonTexas77030
| | - Michael L. Tan
- Research Center for Human GeneticsThe Brown Foundation Institute of Molecular MedicineUniversity of Texas Health Science Center at HoustonHoustonTexas77030
| | | | - Hua Sun
- Research Center for Human GeneticsThe Brown Foundation Institute of Molecular MedicineUniversity of Texas Health Science Center at HoustonHoustonTexas77030
| | - Ba‐Bie Teng
- Research Center for Human GeneticsThe Brown Foundation Institute of Molecular MedicineUniversity of Texas Health Science Center at HoustonHoustonTexas77030
- University of Texas Graduate School of Biomedical Sciences at HoustonHoustonTexas77030
| | - Ashraf Mozayani
- Department of Administration of JusticeTexas Southern UniversityHoustonTexas77030
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Wang PG, Zhang J, Gage EM, Schmidt JM, Rodila RC, Ji QC, El-Shourbagy TA. A high-throughput liquid chromatography/tandem mass spectrometry method for simultaneous quantification of a hydrophobic drug candidate and its hydrophilic metabolite in human urine with a fully automated liquid/liquid extraction. Rapid Commun Mass Spectrom 2006; 20:3456-64. [PMID: 17066370 DOI: 10.1002/rcm.2733] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
ABT-869 (A-741439) is an investigational new drug candidate under development by Abbott Laboratories. ABT-869 is hydrophobic, but is oxidized in the body to A-849529, a hydrophilic metabolite that includes both carboxyl and amino groups. Poor solubility of ABT-869 in aqueous matrix causes simultaneous analysis of both ABT-869 and its metabolite within the same extraction and injection to be extremely difficult in human urine. In this paper, a high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS/MS) method has been developed and validated for high-speed simultaneous quantitation of the hydrophobic ABT-869 and its hydrophilic metabolite, A-849529, in human urine. The deuterated internal standards, A-741439D(4) and A-849529D(4), were used in this method. The disparate properties of the two analytes were mediated by treating samples with acetonitrile, adjusting pH with an extraction buffer, and optimizing the extraction solvent and mobile phase composition. For a 100 microL urine sample volume, the lower limit of quantitation was approximately 1 ng/mL for both ABT-869 and A-849529. The calibration curve was linear from 1.09 to 595.13 ng/mL for ABT-869, and 1.10 to 600.48 ng/mL for A-849529 (r2 > 0.9975 for both ABT-869 and A-849529). Because the method employs simultaneous quantification, high throughput is achieved despite the presence of both a hydrophobic analyte and its hydrophilic metabolite in human urine.
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Affiliation(s)
- Perry G Wang
- Department of Drug Analysis, Abbott Laboratories, Abbott Park, IL 60064, USA
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Rovei V, Escourrou J, Campistron G, Ego D, Thiola A, Ribet A, Houin G. The pharmacokinetics of bendazac-lysine and 5-hydroxybendazac, its main metabolite, in patients with hepatic cirrhosis. Eur J Clin Pharmacol 1988; 35:391-6. [PMID: 3197747 DOI: 10.1007/bf00561370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We have studied the pharmacokinetics of bendazac and its major metabolite, 5-hydroxybendazac, in 11 patients with hepatic cirrhosis after the oral administration of a single 500 mg tablet of bendazac-lysine, and compared them with those obtained from 10 healthy adults. The rate of absorption of bendazac, as assessed by tmax and Cmax, is similar in patients and in healthy subjects. The drug is eliminated mostly by metabolism in healthy adults, more than 60% of the dose being excreted in the urine as 5-hydroxybendazac and its glucuronide. Hepatic insufficiency impairs this metabolism, a two-fold decrease in apparent plasma clearance (CL/f) being observed in the patients. Although the plasma unbound fraction of bendazac is increased in patients (the drug is highly bound to plasma albumin), the apparent volume of distribution (V/f) is unchanged. In consequence, the half-life of bendazac is increased two-fold in the patients. Impairment of metabolism decreases the formation of 5-hydroxybendazac, but metabolism remains the main route of its elimination. Renal excretion of bendazac accounts for about 10% of the dose in both patients with cirrhosis and healthy subjects. We conclude that in patients with severe hepatic insufficiency the daily dose of bendazac-lysine should be halved.
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Affiliation(s)
- V Rovei
- Centre de Recherche Delalande, Rueil Malmaison, France
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Catanese B, Barillari G, Picollo R, Corradino C. Plasma levels and metabolism of bendazac lysine salt in man. Boll Chim Farm 1986; 125:298-302. [PMID: 3814364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Catanese B, Valeri P, Durando L, Gismondi A. Tissue distribution, urinary, fecal and biliary excretion of 14C bendazac L-lysine salt in rats. Pharmacol Res Commun 1985; 17:425-32. [PMID: 4034626 DOI: 10.1016/0031-6989(85)90077-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The distribution of bendazac in the plasma and some rat tissues was studied after single oral administration of 14C bendazac L-lysine salt. The drug is distributed in varying amounts in the liver, kidneys, spleen, muscle, plasma and lens. In these tissues, the drug kinetics is similar, except for the lens where elimination of the drug is slower. More than 80% of the radioactivity administered is excreted through the urine and feces. Fecal excretion is due to the high biliary excretion.
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Leclaire R, Besner JG, Band P, Mailhot S, Gervais P, De Sanctis A, Deschamps M, Liverani L. High-performance liquid chromatography of lonidamine in human plasma and urine. J Chromatogr 1983; 277:427-32. [PMID: 6643634 DOI: 10.1016/s0378-4347(00)84871-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Andersson K, Larsson H. Percutaneous absorption of benzydamine in guinea pig and man. Arzneimittelforschung 1974; 24:1686-8. [PMID: 4479782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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12
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Kameníková L, Oelschläger H, Jindra A. [Pharmacokinetic study of morpholinoethoxyindazole in the rat organism]. Cesk Farm 1973; 22:116-9. [PMID: 4701737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Catanese B, Lisciani R, Silvestrini B. Urinary metabolites of benzydamine in rats. Arzneimittelforschung 1972; 22:882-4. [PMID: 5068205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Lisciani R, Barcellona PS, Silvestrini B. Topical activity of bendazac on experimental burns. Jpn J Pharmacol 1971; 21:69-73. [PMID: 5317253 DOI: 10.1254/jjp.21.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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