Naproxen (CED0002039)

Record Information
Version1.0
Creation Date2016-05-22 04:28:29 UTC
Update Date2026-08-19 05:31:11 UTC
Accession NumberCHEM017580
Identification
Common NameNaproxen
ClassSmall Molecule
Description
Naproxen belongs to the naphthalenes, a class of benzenoids within the organic compounds. This compound has the formula C14H14O3 and an average molecular weight of 230.26 g/mol. It is used industrially as a softener and conditioner, and biologically as an analgesic (PMC11061303) and an anti-inflammatory drug (PMC7178346, PMC9053168). Its biological activity involves four recorded protein targets: pancreatic triacylglycerol lipase (PNLIP), peptostreptococcal albumin-binding protein (pab), prostaglandin G/H synthase 1 (PTGS1), and prostaglandin G/H synthase 2 (PTGS2), for which it acts as a binder or inhibitor. Naproxen is recorded in 14 sources, including drinking water and water supply; building and construction (tents or canopies); electrical and electronic equipment (radio transmission systems, television systems, magnets, and electric hearing aids); household cleaning and consumer products (tobacco product cases, pipe accessories, other smoking requisites, and non electric simulated smoking devices); and healthcare, pharmaceuticals and veterinary products (analgesics, gynecologicals, antiinflammatory and antirheumatic products, and topical products for joint and muscular pain). Exposure routes include topical, rectal, and oral. Regarding health effects, naproxen is associated with an increase in edema (PMC11859530). It has a therapeutic effect on inflammation (PMC9899055) and is used as a treatment for pain (PMC6415270), headache (PMC11459094), Crohn's disease (PMC11061303), osteoarthritis (PMC13074443), rheumatoid arthritis (PMC13074443), fever (PMC13074443, PMC8332605), and inflammation (PMC13074443, PMC8332605).
Contaminant TypeNot Available
Chemical Structure
Synonyms
ValueSource
(+)-(S)-6-Methoxy-alpha-methyl-2-naphthaleneacetic acidChEBI
(+)-(S)-NaproxenChEBI
(+)-2-(6-Methoxy-2-naphthyl)propionic acidChEBI
(+)-2-(Methoxy-2-naphthyl)-propionic acidChEBI
(+)-2-(Methoxy-2-naphthyl)-propionsaeureChEBI
(+)-NaproxenChEBI
(S)-(+)-2-(6-Methoxy-2-naphthyl)propionic acidChEBI
(S)-(+)-NaproxenChEBI
(S)-2-(6-Methoxy-2-naphthyl)propanoic acidChEBI
(S)-2-(6-Methoxy-2-naphthyl)propionic acidChEBI
(S)-6-Methoxy-alpha-methyl-2-naphthaleneacetic acidChEBI
(S)-NaproxenChEBI
NaproxeneChEBI
NaproxenoChEBI
NaproxenumChEBI
NaprosynKegg
(+)-(S)-6-Methoxy-a-methyl-2-naphthaleneacetateGenerator
(+)-(S)-6-Methoxy-a-methyl-2-naphthaleneacetic acidGenerator
(+)-(S)-6-Methoxy-alpha-methyl-2-naphthaleneacetateGenerator
(+)-(S)-6-Methoxy-α-methyl-2-naphthaleneacetateGenerator
(+)-(S)-6-Methoxy-α-methyl-2-naphthaleneacetic acidGenerator
(+)-2-(6-Methoxy-2-naphthyl)propionateGenerator
(+)-2-(Methoxy-2-naphthyl)-propionateGenerator
(S)-(+)-2-(6-Methoxy-2-naphthyl)propionateGenerator
(S)-2-(6-Methoxy-2-naphthyl)propanoateGenerator
(S)-2-(6-Methoxy-2-naphthyl)propionateGenerator
(S)-6-Methoxy-a-methyl-2-naphthaleneacetateGenerator
(S)-6-Methoxy-a-methyl-2-naphthaleneacetic acidGenerator
(S)-6-Methoxy-alpha-methyl-2-naphthaleneacetateGenerator
(S)-6-Methoxy-α-methyl-2-naphthaleneacetateGenerator
(S)-6-Methoxy-α-methyl-2-naphthaleneacetic acidGenerator
2-(6-Methoxy-2-naphthyl)propionic acidHMDB
AcusprainHMDB
AnexopenHMDB
ApronaxHMDB
ArtagenHMDB
ArthrisilHMDB
ArtrixenHMDB
ArtroxenHMDB
AtiflanHMDB
AxerHMDB
BipronylHMDB
CalosenHMDB
ClinosynHMDB
CongexHMDB
D-NaproxenHMDB
DanaproxHMDB
DaproxHMDB
DiocodalHMDB
DL NaproxenHMDB
DL-NaproxenHMDB
DukHMDB
DysmenalgitHMDB
Dysmenalgit NHMDB
Ec-naprosynHMDB
EquiproxenHMDB
FlexipenHMDB
FloginaxHMDB
FuxenHMDB
GenoxenHMDB
LefaineHMDB
LeniartilHMDB
NafasolHMDB
NaixanHMDB
NalyxanHMDB
NapflamHMDB
NapmelHMDB
NaposinHMDB
NaprosyneHMDB
Naproxen sodiumHMDB
NovonaproxHMDB
NycoprenHMDB
OpipramolHMDB
AnaproxHMDB
MethoxypropiocinHMDB
NaprosinHMDB
ProxenHMDB
AleveHMDB
Sodium, naproxenHMDB
MNPAHMDB
SynflexHMDB
Naproxenate, sodiumHMDB
Sodium naproxenateHMDB
Chemical FormulaC14H14O3
Average Molecular Mass230.259 g/mol
Monoisotopic Mass230.094 g/mol
CAS Registry Number22204-53-1
IUPAC Name(2S)-2-(6-methoxynaphthalen-2-yl)propanoic acid
Traditional Namenaproxen
SMILESCOC1=CC2=C(C=C1)C=C(C=C2)[C@H](C)C(O)=O
InChI IdentifierInChI=1S/C14H14O3/c1-9(14(15)16)10-3-4-12-8-13(17-2)6-5-11(12)7-10/h3-9H,1-2H3,(H,15,16)/t9-/m0/s1
InChI KeyCMWTZPSULFXXJA-VIFPVBQESA-N
Chemical Taxonomy
Description Belongs to the class of organic compounds known as naphthalenes. Naphthalenes are compounds containing a naphthalene moiety, which consists of two fused benzene rings.
KingdomOrganic compounds
Super ClassBenzenoids
ClassNaphthalenes
Sub ClassNot Available
Direct ParentNaphthalenes
Alternative Parents
Substituents
  • Naphthalene
  • Anisole
  • Alkyl aryl ether
  • Monocarboxylic acid or derivatives
  • Ether
  • Carboxylic acid
  • Carboxylic acid derivative
  • Organic oxygen compound
  • Organic oxide
  • Hydrocarbon derivative
  • Organooxygen compound
  • Carbonyl group
  • Aromatic homopolycyclic compound
Molecular FrameworkAromatic homopolycyclic compounds
External Descriptors
Biological Properties
StatusDetected and Not Quantified
OriginNot Available
Cellular LocationsNot Available
Biofluid LocationsNot Available
Tissue LocationsNot Available
ApplicationsNot Available
Biological Roles
Chemical RolesNot Available
Organoleptic EffectsNot Available
Physical Properties
StateNot Available
AppearanceNot Available
Experimental Properties
PropertyValue
Melting PointNot Available
Boiling PointNot Available
SolubilityNot Available
Predicted Properties
PropertyValueSource
Water Solubility0.051 g/LALOGPS
logP3.29ALOGPS
logP2.99ChemAxon
logS-3.6ALOGPS
pKa (Strongest Acidic)4.19ChemAxon
pKa (Strongest Basic)-4.8ChemAxon
Physiological Charge-1ChemAxon
Hydrogen Acceptor Count3ChemAxon
Hydrogen Donor Count1ChemAxon
Polar Surface Area46.53 ŲChemAxon
Rotatable Bond Count3ChemAxon
Refractivity64.85 m³·mol⁻¹ChemAxon
Polarizability24.81 ųChemAxon
Number of Rings2ChemAxon
BioavailabilityYesChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Spectra
Spectra
Spectrum TypeDescriptionSplash KeyDeposition DateView
Predicted GC-MSPredicted GC-MS Spectrumsplash10-0540-1920000000-dfcdd431a9b1898cd2d2Not AvailableView Spectrum
Predicted GC-MSPredicted GC-MS Spectrumsplash10-0079-9840000000-4be264b19923ce29c773Not AvailableView Spectrum
Predicted GC-MSPredicted GC-MS SpectrumNot AvailableNot AvailableView Spectrum
Predicted GC-MSPredicted GC-MS SpectrumNot AvailableNot AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-001i-0190000000-64cc22cce1238357760eNot AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-0f79-0900000000-17f4e93fda31d93027a1Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-0fr6-0900000000-4dd08568cff27d62d867Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-000i-0910000000-149b16cac2d80de64d8aNot AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-00di-0900000000-e7dfead967f29853140dNot AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-01b9-0900000000-f5f45cee188a08ef62b1Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-014i-0900000000-6c076658da1c69f1b909Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-014i-0900000000-2e1269f26d5b927bca33Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-000i-0900000000-68cd0c5a3fcc15470c14Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-00di-0900000000-64e5ecb5632e32f89b2dNot AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-000i-0910000000-149b16cac2d80de64d8aNot AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-00di-0900000000-e7dfead967f29853140dNot AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-01b9-0900000000-f5f45cee188a08ef62b1Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-014i-0900000000-6c076658da1c69f1b909Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-014i-0900000000-2e1269f26d5b927bca33Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-000i-0900000000-b913db958cba90673250Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-01b9-0900000000-f35f797484d025dc2013Not AvailableView Spectrum
LC-MS/MSLC-MS/MS Spectrumsplash10-004l-4900000000-e4dd2dd07b393d508ee4Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-001i-0390000000-8bab8d5b4ea21227ea6cNot AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-01q0-0960000000-f66eabdbaeb345d69ff8Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-0zi0-0900000000-74f939f129b9072f0315Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-004i-0390000000-b9c68cf2920eb7b41eacNot AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-00n0-0950000000-7e56ebeb218436f98f52Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-066r-2910000000-2191f1b5cabc1a005c8cNot AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-00n0-0920000000-eca41f81604c83496084Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-014i-0900000000-ac6f78d7d9335439757aNot AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-014i-0900000000-3dc25fd2b01a9c446908Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-0019-0890000000-d73ba296c6713bc54c45Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-000i-0900000000-d764364431d8b5c8e326Not AvailableView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrumsplash10-0a4i-0900000000-e4d413fb4e6aaa5516b0Not AvailableView Spectrum
Toxicity Profile
Mechanism of ToxicityNot Available
Carcinogenicity (IARC Classification)Not Available
Minimum Risk LevelNot Available
SymptomsNot Available
TreatmentNot Available
Toxicity Values
Toxicity ValueUnitValue RangeOrganismDose DescriptorRoute of ExposurePredicted or ExperimentalReference
554.0Log mg/kg[310:990]RatLD50oralpredictedNot Available
Health Effects
Health EffectRelationshipDirectionReference
inflammationis_treatment_forNot AvailablePMC13074443 , PMC8332605
inflammationhas_therapeutic_effect_onNot AvailablePMC9899055
rheumatoid arthritisis_treatment_forNot AvailablePMC13074443
feveris_treatment_forNot AvailablePMC13074443 , PMC8332605
painis_treatment_forNot AvailablePMC6415270
headacheis_treatment_forNot AvailablePMC11459094
edemaassociated_withincreasePMC11859530
osteoarthritisis_treatment_forNot AvailablePMC13074443
Crohn's diseaseis_treatment_forNot AvailablePMC11061303
Exposure Sources
Source IDSourceSectorReference
115Drinking waterDrinking water & water supplyNot Available
316GynecologicalsHealthcare, pharmaceuticals & veterinary productsNot Available
363Antiinflammatory and antirheumatic productsHealthcare, pharmaceuticals & veterinary productsNot Available
364Topical products for joint and muscular painHealthcare, pharmaceuticals & veterinary productsNot Available
370AnalgesicsHealthcare, pharmaceuticals & veterinary productsNot Available
503Tents Or CanopiesBuilding & ConstructionNot Available
516Electric Hearing AidsElectrical & Electronic EquipmentNot Available
527MagnetsElectrical & Electronic EquipmentNot Available
530Radio Transmission SystemsElectrical & Electronic EquipmentNot Available
537Television SystemsElectrical & Electronic EquipmentNot Available
559Non Electric Simulated Smoking DevicesHousehold cleaning & consumer productsNot Available
560Other Smoking RequisitesHousehold cleaning & consumer productsNot Available
562Pipe AccessoriesHousehold cleaning & consumer productsNot Available
567Tobacco Product CasesHousehold cleaning & consumer productsNot Available
584BuoysMarine, shipping & aquacultureNot Available
612Body Washing Or Cleaning ImplementsPersonal care & cosmeticsNot Available
616Face Mask CosmeticsPersonal care & cosmeticsNot Available
620Card GamesRecreation & sports surfacesNot Available
622Game AccessoriesRecreation & sports surfacesNot Available
630ToysRecreation & sports surfacesNot Available
633Azo DyesTextiles, leather & furnishingsNot Available
643HeadwearTextiles, leather & furnishingsNot Available
652RopesTextiles, leather & furnishingsNot Available
653SewingTextiles, leather & furnishingsNot Available
655Slide FastenersTextiles, leather & furnishingsNot Available
Pathways
3 pathways
Targets
StructureProteinUniProt IDOrganismRelationshipDetails
Aldo-keto reductase family 1 member C3 structureClick to view 3D structureAldo-keto reductase family 1 member C3P42330HumansPredicted (SEA)0.0778492
Aldo-keto reductase family 1 member C2 structureClick to view 3D structureAldo-keto reductase family 1 member C2P52895HumansPredicted (SEA)0.0778492
Prostaglandin G/H synthase 1 structureClick to view 3D structureProstaglandin G/H synthase 1P23219HumansPredicted (SEA)0.0778492
Prostaglandin G/H synthase 2 structureClick to view 3D structureProstaglandin G/H synthase 2P35354HumansPredicted (SEA)0.467095
Click to view 3D structureProstaglandin G/H synthase 1P05979Ovis ariesPredicted (SEA)0.467095
Click to view 3D structureSolute carrier family 22 member 6Q4U2R8HumansPredicted (SEA)0.0778492
Click to view 3D structureProstaglandin G/H synthase 2P79208Ovis ariesPredicted (SEA)0.0778492
Click to view 3D structureSolute carrier family 22 member 6O35956Rattus norvegicusPredicted (SEA)0.0778492
Click to view 3D structureProstaglandin G/H synthase 1Q63921Rattus norvegicusPredicted (SEA)0.311397
Click to view 3D structureProstaglandin G/H synthase 2Q05769Mus musculusPredicted (SEA)5.60514
Replicase polyprotein 1ab structureClick to view 3D structureReplicase polyprotein 1abP0DTD1SARS-CoV-2Predicted (SEA)35.9663
Epidermal growth factor receptor structureClick to view 3D structureEpidermal growth factor receptorP00533HumansPredicted (SEA)369.628
Carbonic anhydrase 1 structureClick to view 3D structureCarbonic anhydrase 1P00915HumansPredicted (SEA)94.4311
Aldo-keto reductase family 1 member C4 structureClick to view 3D structureAldo-keto reductase family 1 member C4P17516HumansPredicted (SEA)3.58106
Carbonic anhydrase 9 structureClick to view 3D structureCarbonic anhydrase 9Q16790HumansPredicted (SEA)92.5627
Carbonic anhydrase 12 structureClick to view 3D structureCarbonic anhydrase 12O43570HumansPredicted (SEA)87.3468
Carbonic anhydrase 14 structureClick to view 3D structureCarbonic anhydrase 14Q9ULX7HumansPredicted (SEA)42.0386
Cytochrome P450 1A2 structureClick to view 3D structureCytochrome P450 1A2P05177HumansPredicted (SEA)162.549
Aldo-keto reductase family 1 member B1 structureClick to view 3D structureAldo-keto reductase family 1 member B1P15121HumansPredicted (SEA)22.1092
Click to view 3D structureCarbonic anhydrase 15Q99N23Mus musculusPredicted (SEA)24.9118
Click to view 3D structureCarbonic anhydrase 13Q9D6N1Mus musculusPredicted (SEA)19.3066
Click to view 3D structureCarbonic anhydrase 5A, mitochondrialP35218HumansPredicted (SEA)50.9134
Cytochrome P450 2C9 structureClick to view 3D structureCytochrome P450 2C9P11712HumansPredicted (SEA)384.264
Click to view 3D structureHormone-sensitive lipaseP15304Rattus norvegicusPredicted (SEA)0.700643
Aldo-keto reductase family 1 member B10 structureClick to view 3D structureAldo-keto reductase family 1 member B10O60218HumansPredicted (SEA)17.9832
Concentrations
StatusValueUnitSample LocationReference
External Links
DrugBank IDDB00788
HMDB IDHMDB0001923
FooDB IDFDB022741
Phenol Explorer IDNot Available
KNApSAcK IDNot Available
BiGG IDNot Available
BioCyc IDNot Available
METLIN ID1461
PDB IDNot Available
Wikipedia LinkNaproxen
Chemspider ID137720
ChEBI ID7476
PubChem Compound ID156391
Kegg Compound IDC01517
YMDB IDNot Available
ECMDB IDNot Available
References
Synthesis ReferenceNot Available
MSDSNot Available
General References
1. Haupt D, Pettersson C, Westerlund D: Separation of (R)- and (S)-naproxen using micellar chromatography and an alpha 1-acid-glycoprotein column: application for chiral monitoring in human liver microsomes by coupled-column chromatography. J Biochem Biophys Methods. 1992 Dec;25(4):273-84.
2. Rossat J, Maillard M, Nussberger J, Brunner HR, Burnier M: Renal effects of selective cyclooxygenase-2 inhibition in normotensive salt-depleted subjects. Clin Pharmacol Ther. 1999 Jul;66(1):76-84.
3. Cakrt M, Hercegova A, Lesko J, Polonsky J, Sadecka J, Skacani I: Isotachophoretic determination of naproxen in the presence of its metabolite in human serum. J Chromatogr A. 2001 May 4;916(1-2):207-14.
4. Bertin P, Lapicque F, Payan E, Rigaud M, Bailleul F, Jaeger S, Treves R, Netter P: Sodium naproxen: concentration and effect on inflammatory response mediators in human rheumatoid synovial fluid. Eur J Clin Pharmacol. 1994;46(1):3-7.
5. Ozkaya-Bayazit E: Topical provocation in fixed drug eruption due to metamizol and naproxen. Clin Exp Dermatol. 2004 Jul;29(4):419-22.
6. Bruno R, Iliadis A, Jullien I, Guego M, Pinhas H, Cunci S, Cano JP: Naproxen kinetics in synovial fluid of patients with osteoarthritis. Br J Clin Pharmacol. 1988 Jul;26(1):41-4.
7. Fagerholm U, Breuer O, Swedmark S, Hoogstraate J: Pre-clinical pharmacokinetics of the cyclooxygenase-inhibiting nitric oxide donor (CINOD) AZD3582. J Pharm Pharmacol. 2005 May;57(5):587-97.
8. Schwartz JI, Vandormael K, Malice MP, Kalyani RN, Lasseter KC, Holmes GB, Gertz BJ, Gottesdiener KM, Laurenzi M, Redfern KJ, Brune K: Comparison of rofecoxib, celecoxib, and naproxen on renal function in elderly subjects receiving a normal-salt diet. Clin Pharmacol Ther. 2002 Jul;72(1):50-61.
9. Hercegova A, Sadecka J, Polonsky J: Determination of some antirheumatics by capillary isotachophoresis. Electrophoresis. 2000 Aug;21(14):2842-7.
10. Jick H, Derby LE, Garcia Rodriguez LA, Jick SS, Dean AD: Nonsteroidal antiinflammatory drugs and certain rare, serious adverse events: a cohort study. Pharmacotherapy. 1993 May-Jun;13(3):212-7.
11. Toothaker RD, Barker SH, Gillen MV, Helsinger SA, Kindberg CG, Hunt TL, Powell JH: Absence of pharmacokinetic interaction between orally co-administered naproxen sodium and diphenhydramine hydrochloride. Biopharm Drug Dispos. 2000 Sep;21(6):229-33.
12. el Mouelhi M, Beck S, Bock KW: Stereoselective glucuronidation of (R)- and (S)-naproxen by recombinant rat phenol UDP-glucuronosyltransferase (UGT1A1) and its human orthologue. Biochem Pharmacol. 1993 Oct 5;46(7):1298-300.
13. van Hecken A, Depre M, Wynants K, Vanbilloen H, Verbruggen A, Arnout J, Vanhove P, Cariou R, De Schepper PJ: Effect of clopidogrel on naproxen-induced gastrointestinal blood loss in healthy volunteers. Drug Metabol Drug Interact. 1998;14(3):193-205.
14. Mikami E, Goto T, Ohno T, Matsumoto H, Nishida M: Simultaneous analysis of naproxen, nabumetone and its major metabolite 6-methoxy-2-naphthylacetic acid in pharmaceuticals and human urine by high-performance liquid chromatography. J Pharm Biomed Anal. 2000 Oct;23(5):917-25.
15. Rodrigues AD, Kukulka MJ, Roberts EM, Ouellet D, Rodgers TR: [O-methyl 14C]naproxen O-demethylase activity in human liver microsomes: evidence for the involvement of cytochrome P4501A2 and P4502C9/10. Drug Metab Dispos. 1996 Jan;24(1):126-36.
16. Albrecht C, Melgert BN, Reichen J, Poelstra K, Meijer DK: Effect of chronic bile duct obstruction and LPS upon targeting of naproxen to the liver using naproxen-albumin conjugate. J Drug Target. 1998;6(2):105-17.
17. https://www.ncbi.nlm.nih.gov/pubmed/?term=18044350
18. https://www.ncbi.nlm.nih.gov/pubmed/?term=24478225
19. https://www.ncbi.nlm.nih.gov/pubmed/?term=9784154