Benzydamine is a locally-acting NSAID indicated for the symptomatic relief of pain in acute sore throat and for the symptomatic relief of oropharyngeal mucositis caused by radiation therapy.
- Brand Names
- Pharixia, Tantum
- Generic Name
- DrugBank Accession Number
Benzydamine (also known as Tantum Verde or Difflam), available as the hydrochloride salt, is a locally-acting nonsteroidal anti-inflammatory drug (NSAID) with local anaesthetic and analgesic properties. It is used topically for pain relief and anti-inflammatory treatment of the mouth, throat, or muscoskeletal system.
Although the indazole analogue benzydamine is a non-steroidal anti-inflammatory drug (NSAID), it has various physicochemical properties and pharmacologic activities that are different from those of traditional aspirin-like NSAIDs but facilitate benzydamine's mechanism of action as an effective locally-acting NSAID with local anaesthetic and analgesic properties. Moreover, unlike aspirin-like NSAIDs which are acids or metabolised to acids, benzydamine is in fact a weak base.
- Small Molecule
- Average: 309.413
- Chemical Formula
Available predominantly as a liquid mouthwash, oromucosal spray, or topical cream, benzydamine is most frequently employed as a locally acting analgesic and anti-inflammatory treatment for the relief of painful inflammatory conditions.
When formulated as a mouthwash or spray, benzydamine may be used to treat traumatic conditions like pharyngitis following tonsillectomy or the use of a naso-gastric tube, inflammatory conditions like pharyngitis, aphthous ulcers and oral ulceration due to radiation therapy, dentistry operations and procedures, or more general conditions like sore throat, sore tongue, sore gums, mouth ulcers, or discomfort caused by dentures. 6
When used as a topical cream, benzydamine may be employed to relieve symptoms associated with painful inflammatory conditions of the muscolo-skeletal system including acute inflammatory disorders such as myalgia and bursitis or traumatic conditions like sprains, strains, bruises, sore muscles, stiff joints, or even the after-effects of fractures. 7Reduce drug development failure ratesBuild, train, & validate machine-learning modelswith evidence-based and structured datasets.Build, train, & validate predictive machine-learning models with structured datasets.
- Associated Conditions
- Associated Therapies
- Contraindications & Blackbox Warnings
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Benzydamine is a non-steroidal anti-inflammatory drug (NSAID) designed to elicit local anesthetic and analgesic effects mainly for the mouth and throat. It specifically acts on the local mechanisms of inflammation such as pain, oedema, or granuloma. Typically applied topically, the drug demonstrates anti-inflammatory activity reducing oedema as well as exudate and granuloma formation. Moreover, benzydamine exhibits analgesic properties and local anaesthetic activity if pain is caused by an inflammatory condition. Benzydamine can be absorbed into the oral mucosa and intact skin. Once absorbed in the local area of pain or inflammation, benzydamine binds selectively to local inflamed tissues, usually allowing it to act with few adverse systemic effects. On average a period of 2 to 4 hours is necessary for the substance to reach peak plasma concentration. 5
Benzydamine can be synthesized with the reaction of the N-benzyl derivative from methyl anthranilate with nitrous acid to give N-nitoso derivative. This is next reduced by sodium thiosulfate to give transient hydrazine. This hydrazine can then undergo spontaneous internal hydrazide formation. Treating this resultant enolate with 3-chloro-1-dimethylamkino propane ultimately yields benzydamine.
- Mechanism of action
Despite being categorized as a non-steroidal anti-inflammatory drug (NSAID), benzydamine demonstrates various mechanisms of action that differ from those of traditional aspirin-like NSAIDs. In particular, benzydamine predominantly acts by inhibiting the synthesis of pro inflammatory cytokines like tumour necrosis factor-alpha (TNF-α) and interleukin-1β (IL-1β) without largely affecting other pro inflammatory cytokines (ie. such as IL-6 and IL-8) or anti-inflammatory cytokines (ie. like IL-10 or IL-1 receptor antagonist). 3,5
Moreover, benzydamine is largely a weak inhibitor of prostaglandin synthesis as it has been shown to effectively inhibit cyclooxygenase (COX) and lipoxygenase enzyme activity only at concentrations of 1mM or greater. Considering most contemporary usages of benzydamine are topical applications that are generally not well absorbed through the skin and/or non-specialized mucosae, benzydamine does not often achieve the kind of absorption or blood concentrations necessary to cause any extraneous distant systemic effects or COX inhibition, allowing it to localize its action. 3,5
Additionally, it is also hypothesized that benzydamine is capable of inhibiting the oxidative burst of neutrophils and membrane stabilization. These actions are exhibited by the substance’s ability to inhibit the release of granules from neutrophils and to stabilize lysosomes. 3,5
Furthermore, benzydamine is capable of a local anaesthetic effect that may be related to its capability for inhibiting the release of inflammatory mediators like substance P and calcitonin gene related peptide from sensory nerve endings. Since substance P is capable of causing the release of histamine from mast cells, benzydamine’s prevention of substance P release further contributes to an anti-inflammatory effect. 3,5
Benzydamine also demonstrates a non-specific antibacterial activity against various bacterial strains that are resistant to broad-spectrum antibiotics such as ampicillin, chloramphenicol, and tetracycline at concentrations of about 3 mmol/L. Combinatorial use of benzydamine and other antibiotics like tetracycline and chloramphenicol are also synergistic against antibiotic resistant strains of Staphylococcus aureus and Pseudomonas aeruginosa. 3
Oral doses of benzydamine are well absorbed and plasma drug concentrations reach a peak fairly rapidly and then decline with a half-life of approximately 13 hours. When applied topically, although the local drug concentrations are relatively large, the systemic absorption of topically applied benzydamine is relatively low compared to oral doses. This low topical absorption contributes to a decreased potential for any systemic drug side-effects when benzydamine is administered in this way. 6
- Volume of distribution
- Protein binding
In general, however, when used at the recommended doses the levels at which benzydamine is absorbed or exposed into the body are usually not sufficient to produce systemic pharmacological effects [L
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- Route of elimination
The relatively high lipid solubility of the weak base benzydamine is thought to be associated with considerable passive resorption within the renal tubule, which suggests that only approximately 5% of benzydamine is excreted unchanged in the urine 1. At the same time however, other studies have suggested that considerably larger amounts (50-65%) of the drug is excreted unchanged in urine 4.
While several inactive oxidized metabolites of benzydamine are excreted in urine, the benzydamine N-oxide metabolite can remain in plasma and demonstrate a half-life that is longer than the parent benzydamine compound 1.
Nevertheless, it is generally believed that excretion occurs mainly through urine and is mostly in the form of inactive metabolites or conjugation products 8.
Benzydamine demonstrateas a systemic clearance of 170 ml/min 3.
- Adverse Effects
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Some possible adverse reactions that tend to be associated more with topical cream formulations of benzymadine include increased sensitivity to sunlight, and localized itching, skin rash, redness, or swelling 7.
The prescribing information for all formulations of benzymadine however, warn against the possibility of severe allergic reaction (anaphylaxis) associated with swelling of the throat and mouth, difficulty in swallowing, speaking, and breathing, or wheezing 5,6,7.
Intoxication is expected as a consequence of accidental ingestion of large quantities of benzydamine (over 300 mg ingestion). Other symptoms associated with overdose of ingested benzydamine include gastrointestinal and central nervous system symptoms like nausea, vomiting, abdominal pain, oesophageal irritation, dizziness, hallucinations, agitation, anxiety, and irritability 6.
The official prescribing information for benzydamine generally suggest that benzydamine mouthwashes and sprays should not be used in pregnancy 6,7 . Similarly, the official prescribing information for benzydamine also generally suggest that benzydamine mouthwashes and sprays should not be used during lactation unless considered essential by a physician 6,7.
The prescribing information for topical cream formulations of benzydamine note that benzydamine cream should not be used in pregnancy or lactation unless considered necessary by the physician 5.
Overall, non-clinical data reveal no special hazards for humans based on conventional studies of safety pharmacology, repeated toxicity, genotoxicity, cardiogenic potential, and toxicity to reproduction 5. Additionally, there is no evidence of teratogenic effects in animal studies 6.
- Not Available
- Pharmacogenomic Effects/ADRs
- Not Available
- Drug Interactions
- This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction Abacavir Benzydamine may decrease the excretion rate of Abacavir which could result in a higher serum level. Abciximab The risk or severity of bleeding and hemorrhage can be increased when Benzydamine is combined with Abciximab. Acebutolol Benzydamine may decrease the antihypertensive activities of Acebutolol. Aceclofenac The risk or severity of adverse effects can be increased when Aceclofenac is combined with Benzydamine. Acemetacin The risk or severity of adverse effects can be increased when Benzydamine is combined with Acemetacin. Acenocoumarol The risk or severity of bleeding and hemorrhage can be increased when Benzydamine is combined with Acenocoumarol. Acetaminophen The risk or severity of adverse effects can be increased when Acetaminophen is combined with Benzydamine. Acetazolamide Acetazolamide may increase the excretion rate of Benzydamine which could result in a lower serum level and potentially a reduction in efficacy. Acetohexamide The protein binding of Acetohexamide can be decreased when combined with Benzydamine. Acetylsalicylic acid The risk or severity of adverse effects can be increased when Acetylsalicylic acid is combined with Benzydamine.Identify potential medication risksEasily compare up to 40 drugs with our drug interaction checker.Get severity rating, description, and management advice.Learn more
- Food Interactions
- No interactions found.
- Drug product information from 10+ global regionsOur datasets provide approved product information including:dosage, form, labeller, route of administration, and marketing period.Access drug product information from over 10 global regions.
- Product Ingredients
Ingredient UNII CAS InChI Key Benzydamine hydrochloride K2GI407R4Q 132-69-4 HNNIWKQLJSNAEQ-UHFFFAOYSA-N
- Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Pharixia Mouthwash 0.15 % w/v Buccal Pendopharm Division Of Pharmascience Inc 1996-12-02 Not applicable Pharixia Alcohol Free Mouthwash 0.15 % w/v Buccal Pendopharm Division Of Pharmascience Inc 2020-07-13 Not applicable Sun-benz - Liq 0.15% Liquid .15 % Dental; Oral Sun Pharmaceutical Industries Inc. 1997-04-03 2011-07-29 Tantum Mouthwash 0.15 % w/v Buccal Bausch Health, Canada Inc. 1993-12-31 Not applicable
- Generic Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Apo-benzydamine Oral Rinse Mouthwash 0.15 % Buccal Apotex Corporation 1998-11-09 Not applicable Novo-benzydamine Mouthwash; Solution 1.5 mg / mL Buccal; Oral Novopharm Limited 2008-06-03 2018-05-17 Novo-benzydamine - Oral Rinse Liquid; Mouthwash 1.5 mg / mL Buccal; Oral Novopharm Limited 1997-02-06 2015-10-26 Nu-benzydamine Oral Rinse Liquid 0.15 % Buccal Nu Pharm Inc Not applicable Not applicable Odan-benzydamine Mouthwash 0.15 % w/v Buccal Odan Laboratories Ltd 2017-08-11 Not applicable PMS-benzydamine Mouthwash 0.15 % w/v Buccal Pharmascience Inc 1999-04-30 Not applicable Ratio-benzydamine Solution 0.15 % Oral Ratiopharm Inc Division Of Teva Canada Limited 1997-03-24 2010-05-21
- Over the Counter Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image ดีโทรท สเปรย์ 0.3% (กลิ่นมิ้นท์) Spray 3 mg/1ml Oral บริษัท อินเตอร์ไทย ฟาร์มาซูติเคิ้ล แมนูแฟคเจอริ่ง จำกัด จำกัด 2017-12-02 Not applicable
- Mixture Products
Name Ingredients Dosage Route Labeller Marketing Start Marketing End Region Image ANDOREX GARGARA, 200 ML Benzydamine hydrochloride (22.5 mg/15mL) + Chlorhexidine gluconate (18 mg/15mL) Rinse Oral PHARMACTİVE İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable ANDOREX SPREY, 30 ML Benzydamine hydrochloride (0.3 mg/0.2mL) + Chlorhexidine gluconate (0.24 mg/0.2mL) Spray Oral PHARMACTİVE İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable BUCALIV® ULTRA Benzydamine hydrochloride (0.15 g) + Cetylpyridinium chloride (0.05 g) Solution Buccal; Oral LABORATORIO FRANCO COLOMBIANO - LAFRANCOL S.A.S. 2018-03-16 Not applicable CLİORO % 0,15 + % 0,12 GARGARA Benzydamine hydrochloride (300 mg/200ml) + Chlorhexidine gluconate (240 mg/200ml) Rinse Oral HELBA İLAÇ İÇ VE DIŞ SAN. TİC. LTD. ŞTİ. 2020-08-14 Not applicable CLIORO ORAL SPREY, 1 ADET Benzydamine hydrochloride (45 mg/30ml) + Chlorhexidine gluconate (36 mg/30ml) Oral HELBA İLAÇ İÇ VE DIŞ SAN. TİC. LTD. ŞTİ. 2020-08-14 Not applicable CLODER PLUS 30 ML ORAL SPREY Benzydamine hydrochloride (45 mg/30ml) + Chlorhexidine gluconate (36 mg/30ml) Oral NOBEL İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable CLODER PLUS GARGARA, 200 ML Benzydamine hydrochloride (150 mg/100ml) + Chlorhexidine gluconate (120 mg/100ml) Rinse Oral NOBEL İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable ENMIKS GARGARA , 200 ML Benzydamine hydrochloride (0.15 %) + Chlorhexidine gluconate (0.12 %) Rinse Oral BİLİM İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable ENMIKS ORAL SPREY ,30 ML Benzydamine hydrochloride (45 mg/30ml) + Chlorhexidine gluconate (36 mg/30ml) Spray Oral BİLİM İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable FARDOBEN %0,15+%0,12 GARGARA, 200 ML Benzydamine hydrochloride (0.15 %) + Chlorhexidine gluconate (0.12 %) Rinse Oral Deva Holding A.S. 2020-08-14 Not applicable
- Unapproved/Other Products
Name Ingredients Dosage Route Labeller Marketing Start Marketing End Region Image TANTUM %5 JEL, 100 G Benzydamine (5 %) Gel Topical ANGELİNİ İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable TANTUM %5 JEL, 50 G Benzydamine (5 %) Gel Topical ANGELİNİ İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable TANTUM VERDE % 0,15 120 ML GARGARA Benzydamine hydrochloride (180 mg/120ml) Rinse Oral ANGELİNİ İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable TANTUM VERDE 0,045 GR 30 ML SPREY Benzydamine hydrochloride (0.045 g/30ml) Rinse Oral ANGELİNİ İLAÇ SAN. VE TİC. A.Ş. 2020-08-14 Not applicable
- ATC Codes
- A01AD02 — Benzydamine
- A01AD — Other agents for local oral treatment
- A01A — STOMATOLOGICAL PREPARATIONS
- A01 — STOMATOLOGICAL PREPARATIONS
- A — ALIMENTARY TRACT AND METABOLISM
- M01AX — Other antiinflammatory and antirheumatic agents, non-steroids
- M01A — ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS
- M01 — ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS
- M — MUSCULO-SKELETAL SYSTEM
- M02AA — Antiinflammatory preparations, non-steroids for topical use
- M02A — TOPICAL PRODUCTS FOR JOINT AND MUSCULAR PAIN
- M02 — TOPICAL PRODUCTS FOR JOINT AND MUSCULAR PAIN
- M — MUSCULO-SKELETAL SYSTEM
- G02CC — Antiinflammatory products for vaginal administration
- G02C — OTHER GYNECOLOGICALS
- G02 — OTHER GYNECOLOGICALS
- G — GENITO URINARY SYSTEM AND SEX HORMONES
- Drug Categories
- Agents causing hyperkalemia
- Agents that produce hypertension
- Alimentary Tract and Metabolism
- Anti-Inflammatory Agents
- Anti-Inflammatory Agents, Non-Steroidal
- Antiinflammatory and Antirheumatic Products
- Antiinflammatory and Antirheumatic Products, Non-Steroids
- Antiinflammatory Preparations, Non-Steroids for Topical Use
- Antiinflammatory Products for Vaginal Administration
- Drugs that are Mainly Renally Excreted
- Genito Urinary System and Sex Hormones
- Heterocyclic Compounds, Fused-Ring
- Mouthwashes and Gargles
- Musculo-Skeletal System
- Nephrotoxic agents
- Non COX-2 selective NSAIDS
- Stomatological Preparations
- Throat Preparations
- Topical Products for Joint and Muscular Pain
- Chemical TaxonomyProvided by Classyfire
- This compound belongs to the class of organic compounds known as indazoles. These are compounds containing an indazole, which is structurally characterized by a pyrazole fused to a benzene.
- Organic compounds
- Super Class
- Organoheterocyclic compounds
- Sub Class
- Direct Parent
- Alternative Parents
- Alkyl aryl ethers / Benzene and substituted derivatives / Pyrazoles / Heteroaromatic compounds / Trialkylamines / Azacyclic compounds / Organopnictogen compounds / Hydrocarbon derivatives
- Alkyl aryl ether / Amine / Aromatic heteropolycyclic compound / Azacycle / Azole / Benzenoid / Benzopyrazole / Ether / Heteroaromatic compound / Hydrocarbon derivative
- Molecular Framework
- Aromatic heteropolycyclic compounds
- External Descriptors
- Not Available
- Affected organisms
- Humans and other mammals
- CAS number
- InChI Key
- IUPAC Name
- General References
- Baldock GA, Brodie RR, Chasseaud LF, Taylor T, Walmsley LM, Catanese B: Pharmacokinetics of benzydamine after intravenous, oral, and topical doses to human subjects. Biopharm Drug Dispos. 1991 Oct;12(7):481-92. [Article]
- Silvestrini B, Barcellona PS, Garau A, Catanese B: Toxicology of benzydamine. Toxicol Appl Pharmacol. 1967 Jan;10(1):148-59. [Article]
- Quane PA, Graham GG, Ziegler JB: Pharmacology of benzydamine. Inflammopharmacology. 1998;6(2):95-107. doi: 10.1007/s10787-998-0026-0. [Article]
- Catanese B, Grasso A, Silverstrini B: Studies on the absorption and elimination of benzydamine in the mouse, rat, dog, and man. Arzneimittelforschung. 1966 Oct;16(10):1354-7. [Article]
- Electronic Medicines Compedium Difflam (Benzydamine Hydrochloride) Spray Monograph [Link]
- Electronic Medicines Compedium Benzydamine Hydrochloride 0.15% w/v Mouthwash Monograph [Link]
- Electronic Medicines Compedium Difflam (Benzydamine Hydrochloride) 3% Cream Monograph [Link]
- Benzydamine - Tantum Verde [Link]
- Download (343 KB)
- Clinical Trials
Phase Status Purpose Conditions Count 4 Active Not Recruiting Prevention Impacted Third Molar Tooth 1 4 Completed Other Intubation; Complication 1 4 Completed Prevention Post Operative Nausea and Vomiting (PONV) / Sore Throat 1 4 Completed Prevention Sore Throat 1 4 Completed Supportive Care Pain / Quality of Life (QOL) 1 4 Completed Treatment Acute Sore Throat 1 3 Completed Supportive Care Head and Neck Carcinoma / Mucositis 1 3 Completed Treatment Radiation Effects / Stomatitis 1 3 Completed Treatment Sore Throat 1 3 Not Yet Recruiting Treatment Oral Mucositis 1
- Not Available
- Not Available
- Dosage Forms
Form Route Strength Rinse Oral Mouthwash Buccal 0.15 % Solution Oral Solution Oral 0.15 g Tablet, coated 50 mg Cream Topical 3 % Gel Transmucosal 0.5 % Paste, dentifrice Dental 5 mg/g Solution Oral 0.15 % Cream Vaginal Spray Transmucosal 0.15 % Solution Topical 0.15 g Tablet Transmucosal 3 MG Tablet, film coated Oral Tablet Buccal 3 mg Tablet Oral 3 mg Solution Buccal; Oral Powder Topical; Vaginal 0.498 g Powder Topical; Vaginal 5.3 g Solution Buccal; Oral 0.3 g Cream Vaginal 0.5 g Solution Topical; Vaginal 100 mg Spray Oral Solution Buccal; Oral 150 mg Spray, metered Oral Gel Oral Solution Oral Cream Topical 5 % Gel Topical 5 % Gel Topical 5 G Injection, solution Intramuscular 5 mg/5ml Ointment Topical 3 % Ointment Topical 5 G Pill 50 MG Solution / drops Oral 3 % Suppository Rectal 100 MG Suppository Rectal 25 mg Suppository Rectal 50 MG Powder, for solution Vaginal Cream Vaginal 0.5 % Douche Vaginal 100 mg/100ml Granule, for solution Vaginal 500 MG Solution Vaginal 0.1 % Solution Vaginal 500 MG/10ML Tablet, soluble Oral Mouthwash; solution Buccal; Oral 1.5 mg / mL Liquid; mouthwash Buccal; Oral 1.5 mg / mL Liquid Buccal 0.15 % Mouthwash Buccal 0.15 % w/v Solution Buccal; Oral 0.15 g Spray, metered Oral Spray Oral Tablet Transmucosal Tablet Transmucosal Lozenge Oral Liquid Dental; Oral .15 % Lozenge Oral Cream Topical Gel Topical Granule, for solution Vaginal Solution Vaginal Mouthwash Oral Pastille Oral Mouthwash Oral Paste, dentifrice Dental 0.5 % Rinse Oral Powder Vaginal Spray Oral 1.5 mg/1ml Spray Oral 3 mg/1ml Lozenge Oral 3 mg
- Not Available
- Not Available
- Experimental Properties
Property Value Source melting point (°C) 320°F MSDS water solubility Miscible MSDS
- Predicted Properties
Property Value Source Water Solubility 0.0491 mg/mL ALOGPS logP 3.78 ALOGPS logP 3.66 ChemAxon logS -3.8 ALOGPS pKa (Strongest Basic) 9.26 ChemAxon Physiological Charge 1 ChemAxon Hydrogen Acceptor Count 3 ChemAxon Hydrogen Donor Count 0 ChemAxon Polar Surface Area 30.29 Å2 ChemAxon Rotatable Bond Count 7 ChemAxon Refractivity 105.56 m3·mol-1 ChemAxon Polarizability 35.62 Å3 ChemAxon Number of Rings 3 ChemAxon Bioavailability 1 ChemAxon Rule of Five Yes ChemAxon Ghose Filter Yes ChemAxon Veber's Rule Yes ChemAxon MDDR-like Rule Yes ChemAxon
- Predicted ADMET Features
- Not Available
- Mass Spec (NIST)
- Not Available
Spectrum Spectrum Type Splash Key Predicted GC-MS Spectrum - GC-MS Predicted GC-MS Not Available Predicted MS/MS Spectrum - 10V, Positive (Annotated) Predicted LC-MS/MS Not Available Predicted MS/MS Spectrum - 20V, Positive (Annotated) Predicted LC-MS/MS Not Available Predicted MS/MS Spectrum - 40V, Positive (Annotated) Predicted LC-MS/MS Not Available Predicted MS/MS Spectrum - 10V, Negative (Annotated) Predicted LC-MS/MS Not Available Predicted MS/MS Spectrum - 20V, Negative (Annotated) Predicted LC-MS/MS Not Available Predicted MS/MS Spectrum - 40V, Negative (Annotated) Predicted LC-MS/MS Not Available
Drug created on September 15, 2015 19:55 / Updated on September 19, 2021 19:53