Details
Stereochemistry | ABSOLUTE |
Molecular Formula | C24H21F2NO3 |
Molecular Weight | 409.4252 |
Optical Activity | UNSPECIFIED |
Defined Stereocenters | 3 / 3 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
O[C@@H](CC[C@@H]1[C@H](N(C1=O)C2=CC=C(F)C=C2)C3=CC=C(O)C=C3)C4=CC=C(F)C=C4
InChI
InChIKey=OLNTVTPDXPETLC-XPWALMASSA-N
InChI=1S/C24H21F2NO3/c25-17-5-1-15(2-6-17)22(29)14-13-21-23(16-3-11-20(28)12-4-16)27(24(21)30)19-9-7-18(26)8-10-19/h1-12,21-23,28-29H,13-14H2/t21-,22+,23-/m1/s1
DescriptionSources: http://www.drugbank.ca/drugs/DB00973Curator's Comment: Description was created based on several sources, including
https://www.drugs.com/ezetimibe.html
Sources: http://www.drugbank.ca/drugs/DB00973
Curator's Comment: Description was created based on several sources, including
https://www.drugs.com/ezetimibe.html
Ezetimibe is an anti-hyperlipidemic medication which is used to lower cholesterol levels. Specifically, it appears to bind to a critical mediator of cholesterol absorption, the Niemann-Pick C1-Like 1 (NPC1L1) protein on the gastrointestinal tract epithelial cells as well as in hepatocytes. Ezetimibe is in a class of lipid-lowering compounds that selectively inhibits the intestinal absorption of cholesterol and related phytosterols. Ezetimibe, administered alone is indicated as adjunctive therapy to diet for the reduction of elevated total-C, LDL-C, and Apo B in patients with primary (heterozygous familial and non-familial) hypercholesterolemia. It is also used in combination therapy with HMG-CoA reductase inhibitors. Ezetimibe has a mechanism of action that differs from those of other classes of cholesterol-reducing compounds (HMG-CoA reductase inhibitors, bile acid sequestrants, fibric acid derivatives, and plant stanols). Ezetimibe does not inhibit cholesterol synthesis in the liver, or increase bile acid excretion but instead localizes and appears to act at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This causes a reduction of hepatic cholesterol stores and an increase in clearance of cholesterol from the blood; this distinct mechanism is complementary to that of HMG-CoA reductase inhibitors.
Originator
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
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Target ID: CHEMBL2027 Sources: http://www.drugbank.ca/drugs/DB00973 |
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Target ID: CHEMBL2782 Sources: http://www.drugbank.ca/drugs/DB00973 |
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Target ID: CHEMBL5161 Sources: https://www.ncbi.nlm.nih.gov/pubmed/18063367 |
200.0 nM [Ki] | ||
Target ID: CHEMBL612877 Sources: https://www.ncbi.nlm.nih.gov/pubmed/27600041 |
30.0 µM [IC50] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Primary | ZETIA Approved UseEzetimibe, administered alone, is indicated as adjunctive therapy to diet for the reduction of elevated total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and non-high-density lipoprotein cholesterol (non-HDL-C) in patients with primary (heterozygous familial and non-familial) hyperlipidemia. Launch Date2002 |
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Primary | ZETIA Approved UseHomozygous Familial Hypercholesterolemia (HoFH)
The combination of Ezetimibe and atorvastatin or simvastatin is indicated for the reduction of elevated total-C and LDL-C levels in patients with HoFH, as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) or if such treatments are unavailable. Launch Date2002 |
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Primary | ZETIA Approved UseEzetimibe is indicated as adjunctive therapy to diet for the reduction of elevated sitosterol and campesterol levels in patients with homozygous familial sitosterolemia. Launch Date2002 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
64.2 ng/mL |
20 mg single, oral dose: 20 mg route of administration: Oral experiment type: SINGLE co-administered: |
EZETIMIBE unknown | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
70.1 ng/mL |
10 mg 1 times / day multiple, oral dose: 10 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
EZETIMIBE unknown | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
|
3.4 ng/mL |
10 mg single, oral dose: 10 mg route of administration: Oral experiment type: SINGLE co-administered: |
EZETIMIBE unknown | Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
726 ng × h/mL |
20 mg single, oral dose: 20 mg route of administration: Oral experiment type: SINGLE co-administered: |
EZETIMIBE unknown | Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
|
743 ng × h/mL |
10 mg 1 times / day multiple, oral dose: 10 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
EZETIMIBE unknown | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
10% |
10 mg single, oral dose: 10 mg route of administration: Oral experiment type: SINGLE co-administered: |
EZETIMIBE unknown | Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: FASTED |
Doses
Dose | Population | Adverse events |
---|---|---|
10 mg 1 times / day steady, oral Recommended Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy, 57 years n = 1 Health Status: unhealthy Age Group: 57 years Sex: M Population Size: 1 Sources: |
Disc. AE: Liver injury... AEs leading to discontinuation/dose reduction: Liver injury Sources: |
10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy, children n = 92 Health Status: unhealthy Condition: Primary hypercholesterolemia Age Group: children Population Size: 92 Sources: |
Other AEs: Epilepsy congenital, Appendicitis... Other AEs: Epilepsy congenital (serious, 1 patient) Sources: Appendicitis (serious, 1 patient) Upper respiratory tract infection (below serious, 7 patients) |
50 mg 1 times / day multiple, oral Highest studied dose Dose: 50 mg, 1 times / day Route: oral Route: multiple Dose: 50 mg, 1 times / day Sources: |
unhealthy n = 15 Health Status: unhealthy Population Size: 15 Sources: |
|
10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy n = 75 Health Status: unhealthy Condition: Type 2 Diabetes Population Size: 75 Sources: |
Other AEs: Cataract, Abdominal pain upper... Other AEs: Cataract (serious, 1 patient) Sources: Abdominal pain upper (serious, 1 patient) Type 2 diabetes mellitus (below serious, 7 patients) |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Liver injury | Disc. AE | 10 mg 1 times / day steady, oral Recommended Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy, 57 years n = 1 Health Status: unhealthy Age Group: 57 years Sex: M Population Size: 1 Sources: |
Upper respiratory tract infection | below serious, 7 patients | 10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy, children n = 92 Health Status: unhealthy Condition: Primary hypercholesterolemia Age Group: children Population Size: 92 Sources: |
Appendicitis | serious, 1 patient | 10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy, children n = 92 Health Status: unhealthy Condition: Primary hypercholesterolemia Age Group: children Population Size: 92 Sources: |
Epilepsy congenital | serious, 1 patient | 10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy, children n = 92 Health Status: unhealthy Condition: Primary hypercholesterolemia Age Group: children Population Size: 92 Sources: |
Type 2 diabetes mellitus | below serious, 7 patients | 10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy n = 75 Health Status: unhealthy Condition: Type 2 Diabetes Population Size: 75 Sources: |
Abdominal pain upper | serious, 1 patient | 10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy n = 75 Health Status: unhealthy Condition: Type 2 Diabetes Population Size: 75 Sources: |
Cataract | serious, 1 patient | 10 mg 1 times / day steady, oral Dose: 10 mg, 1 times / day Route: oral Route: steady Dose: 10 mg, 1 times / day Sources: |
unhealthy n = 75 Health Status: unhealthy Condition: Type 2 Diabetes Population Size: 75 Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
not significant | unlikely (co-administration study) Comment: administered using cocktail approach: caffeine, tolbutamide, dextromethorphan, IV midazolam, and dapsone Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=19 Page: 19.0 |
||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=18 Page: 18.0 |
yes [IC50 0.25 uM] | |||
Page: 11.0 |
yes [IC50 2.2 uM] | unlikely Comment: page 8: R-value extrapolation indicate potential for DDI as unlikely Page: 11.0 |
||
Page: 11.0 |
yes [IC50 2.9 uM] | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=18 Page: 18.0 |
yes [IC50 24 uM] |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=18 Page: 18.0 |
no | |||
yes | ||||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=18 Page: 18.0 |
yes | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=18 Page: 18.0 |
yes | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=18 Page: 18.0 |
yes | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21445_Zetia_biopharmr_P1.pdf#page=18 Page: 18.0 |
yes |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
PubMed
Title | Date | PubMed |
---|---|---|
Molecule of the month. Ezetimibe. | 2001 Apr |
|
Effectiveness and tolerability of ezetimibe in patients with primary hypercholesterolemia: pooled analysis of two phase II studies. | 2001 Aug |
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Cholesterol absorption inhibition: a strategy for cholesterol-lowering therapy. | 2001 Dec |
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Ezetimibe, a potent cholesterol absorption inhibitor, normalizes combined dyslipidemia in obese hyperinsulinemic hamsters. | 2001 Jun |
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Ezetimibe (Schering-Plough). | 2001 Mar |
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[Other antihyperlipidemic drugs with novel mechanism]. | 2001 Mar |
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Novel approaches to lipid lowering: what is on the horizon? | 2001 Mar 8 |
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The synergistic hypocholesterolemic activity of the potent cholesterol absorption inhibitor, ezetimibe, in combination with 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitors in dogs. | 2001 Oct |
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[Statins remain the standard. New methods for lipid lowering therapy]. | 2001 Oct 18 |
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Ezetimibe selectively inhibits intestinal cholesterol absorption in rodents in the presence and absence of exocrine pancreatic function. | 2001 Sep |
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New advances in lipid-modifying therapies for reducing cardiovascular risk. | 2002 |
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Gateways to Clinical Trials. | 2002 Apr |
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Ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia. | 2002 Dec 18 |
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[Ezetimib. A new cholesterol absorption inhibitor]. | 2002 Jul |
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[Lipid control in the double pack. Combined drugs to achieve the goal]. | 2002 Jun 6 |
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Gateways to clinical trials. | 2002 May |
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Combination therapy for combined dyslipidemia. | 2002 Nov 20 |
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[Ezetimib--the first selective cholesterol resorption inhibitors. Strengthening of statins]. | 2002 Nov 28 |
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Gateways to clinical trials. | 2002 Oct |
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Promising therapies for cholesterol reduction. | 2002 Sep |
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[Statins plus cholesterol resorption inhibitor. LDL goal values attainable]. | 2002 Sep 19 |
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Efficacy and safety of ezetimibe coadministered with pravastatin in patients with primary hypercholesterolemia: a prospective, randomized, double-blind trial. | 2003 Apr |
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Combined lipid lowering drug therapy for the effective treatment of hypercholesterolaemia. | 2003 Apr |
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Efficacy and safety of ezetimibe coadministered with lovastatin in primary hypercholesterolemia. | 2003 Feb 15 |
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A novel therapeutic approach to dyslipidemia. | 2003 Jan |
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Combination therapy for dyslipidemia. | 2003 Jan |
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Perspectives in cholesterol-lowering therapy: the role of ezetimibe, a new selective inhibitor of intestinal cholesterol absorption. | 2003 Jul 1 |
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Ezetimibe added to ongoing statin therapy reduced LDL cholesterol in primary hypercholesterolemia. | 2003 Jul-Aug |
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Evaluation of the efficacy, safety, and tolerability of ezetimibe in primary hypercholesterolaemia: a pooled analysis from two controlled phase III clinical studies. | 2003 Jun |
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Sterol absorption by the small intestine. | 2003 Jun |
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Ezetimibe for management of hypercholesterolemia. | 2003 Jun |
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What future for combination therapies? | 2003 Mar |
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New cholesterol-lowering drug makes its mark. | 2003 Mar |
|
New lipid-modifying therapies. | 2003 Mar |
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Gateways to clinical trials. | 2003 May |
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Three new drugs for hyperlipidemia. | 2003 May |
|
52nd Annual Scientific Session of the American College of Cardiology, Chicago, March 30-April 2, 2003. | 2003 May |
|
[Controlling LDL cholesterol from 2 sides. "I have never seen such low LDL values"]. | 2003 May 15 |
Patents
Sample Use Guides
In Vivo Use Guide
Sources: https://www.drugs.com/ezetimibe.html
10 mg orally once a day
Route of Administration:
Oral
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/26167075
10uM/L ezetimibe treatment of Huh7 hepatocytes significantly decreased PA-induced fat accumulation and increased PA-reduced mRNA and protein expression involved in autophagy
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Classification Tree | Code System | Code | ||
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NDF-RT |
N0000008553
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WHO-ATC |
C10BA05
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WHO-VATC |
QC10AX09
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WHO-VATC |
QC10BA06
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WHO-ATC |
C10BA06
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WHO-ATC |
C10BA02
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WHO-ATC |
C10AX09
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WHO-VATC |
QC10BA05
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NCI_THESAURUS |
C29703
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WHO-VATC |
QC10BA02
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LIVERTOX |
NBK548095
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NDF-RT |
N0000175911
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EOR26LQQ24
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8010
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EOR26LQQ24
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C47529
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1269028
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ZETIA
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PRIMARY | APPROVE APRIL 2007 | ||
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150311
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m5228
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SUB16430MIG
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163222-33-1
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CHEMBL1138
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100000091598
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7737
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DB00973
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Ezetimibe
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1125
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DTXSID1044223
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N0000008553
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PRIMARY | Decreased Cholesterol Absorption [PE] | ||
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341248
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LL-18
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EZETIMIBE
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6816
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758923
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49040
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C108606
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ACTIVE MOIETY
METABOLITE (PARENT)
METABOLITE (PARENT)