Details of the Drug

General Information of Drug (ID: DM0YJSB)

• Drug Name: Enflurane
• Synonyms: Alyrane; Efrane; Enflurano; Enfluranum; Enfran; Enlirane; Ethrane; Etran; Methylflurether; Abbott Brand of Enflurane; AstraZeneca Brand of Enflurane; Baxter Anaesthesia Brand of Enflurane; Pisa Brand of Enflurane; Zeneca Brand of Enflurane; Anesthetic 347; C 347; OHIO 347; Anesthetic Compound No. 347; Enflurane [Anaesthetics,volatile]; Enflurano [INN-Spanish]; Enfluranum [INN-Latin]; Ethrane (TN); Enflurane (JP15/USP/INN); Enflurane [USAN:BAN:INN:JAN]; Ether, 2-chloro-1,1,2-trifluoroethyl difluoromethyl; (+-)-2-Chloro-1,1,2-trifluoroethyl difluoromethyl ether; 2-Chloro-1,1,2-trifluoroethyl difluoromethyl ether; 2-Chloro-1-(difluoromethoxy)-1,1,2-trifluoroethane

Indication

Disease Entry	ICD 11	Status	REF
Anaesthesia	9A78.6	Approved	[1]

• Therapeutic Class: Anesthetics
• Drug Type: Small molecular drug
• #Ro5 Violations (Lipinski): 0:
  Molecular Weight (mw); 184.49
  Logarithm of the Partition Coefficient (xlogp); 2.1
  Rotatable Bond Count (rotbonds); 3
  Hydrogen Bond Donor Count (hbonddonor); 0
  Hydrogen Bond Acceptor Count (hbondacc); 6
• ADMET Property:
  Elimination: Metabolism accounts for 5-9% of enflurane elimination [2]
  Metabolism: The drug is metabolized via the CYP2E1 enzyme in the liver [3]
• Chemical Identifiers:
  Formula: C3H2ClF5O
  IUPAC Name: 2-chloro-1-(difluoromethoxy)-1,1,2-trifluoroethane
  Canonical SMILES: C(C(OC(F)F)(F)F)(F)Cl
  InChI: InChI=1S/C3H2ClF5O/c4-1(5)3(8,9)10-2(6)7/h1-2H
  InChIKey: JPGQOUSTVILISH-UHFFFAOYSA-N
• Cross-matching ID:
  PubChem CID: 3226
  ChEBI ID: CHEBI:4792
  CAS Number: 13838-16-9
  DrugBank ID: DB00228
  TTD ID: D0AO9S
  INTEDE ID: DR0579

Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
Glutamate receptor AMPA (GRIA)	TTAN6JD	NOUNIPROTAC	Suppressor	[4]

Drug-Metabolizing Enzyme (DME)

DME Name	DME ID	UniProt ID	MOA	REF
Cytochrome P450 2E1 (CYP2E1) Main DME	DEVDYN7	CP2E1_HUMAN	Substrate	[5]
Cytochrome P450 2F1 (CYP2F1)	DED5AT3	CP2F1_HUMAN	Substrate	[6]

Molecular Expression Atlas of This Drug

• The Studied Disease: Anaesthesia
• ICD Disease Classification: 9A78.6

Molecule Name	Molecule Type	Gene Name	p-value	Fold-Change	Z-score
Glutamate receptor AMPA (GRIA)	DTT	NO-GeName	1.79E-04	-0.69	-0.58
Cytochrome P450 2E1 (CYP2E1)	DME	CYP2E1	1.87E-04	-1.20E-01	-3.22E-01
Cytochrome P450 2F1 (CYP2F1)	DME	CYP2F1	2.22E-02	-5.20E-02	-3.58E-01

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Same Disease as Enflurane

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Disease	REF
Propofol	DMB4OLE	Moderate	Additive CNS depression effects by the combination of Enflurane and Propofol.	Corneal disease [9A76-9A78]	[7]

Coadministration of a Drug Treating the Disease Different from Enflurane (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Framycetin	DMF8DNE	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Framycetin.	Alcoholic liver disease [DB94]	[8]
Paromomycin	DM1AGXN	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Paromomycin.	Amoebiasis [1A36]	[8]
Kanamycin	DM2DMPO	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Kanamycin.	Bacterial infection [1A00-1C4Z]	[8]
Amikacin	DM5PDRB	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Amikacin.	Bacterial infection [1A00-1C4Z]	[8]
Streptomycin	DME1LQN	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Streptomycin.	Bacterial infection [1A00-1C4Z]	[8]
Gentamicin	DMKINJO	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Gentamicin.	Bacterial infection [1A00-1C4Z]	[8]
Netilmicin	DMRD1QK	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Netilmicin.	Bacterial infection [1A00-1C4Z]	[8]
Tobramycin	DMUI0CH	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Tobramycin.	Bacterial infection [1A00-1C4Z]	[8]
Ceritinib	DMB920Z	Moderate	Decreased metabolism of Enflurane caused by Ceritinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[9]
Droperidol	DM0DXA8	Major	Increased risk of prolong QT interval by the combination of Enflurane and Droperidol.	Nausea/vomiting [MD90]	[10]
Plazomicin	DMKMBES	Moderate	Increased risk of nephrotoxicity by the combination of Enflurane and Plazomicin.	Urinary tract infection [GC08]	[8]

References

• [1] URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Ligand id: 7175).
• [2] Dale O, Brown BR Jr: Clinical pharmacokinetics of the inhalational anaesthetics. Clin Pharmacokinet. 1987 Mar;12(3):145-67. doi: 10.2165/00003088-198712030-00001.
• [3] Lee A, Kuo B: Metoclopramide in the treatment of diabetic gastroparesis. Expert Rev Endocrinol Metab. 2010;5(5):653-662.
• [4] Enflurane directly depresses glutamate AMPA and NMDA currents in mouse spinal cord motor neurons independent of actions on GABAA or glycine receptors. Anesthesiology. 2000 Oct;93(4):1075-84.
• [5] Stereoselective metabolism of enflurane by human liver cytochrome P450 2E1. Drug Metab Dispos. 1995 Dec;23(12):1426-30.
• [6] Clinical enflurane metabolism by cytochrome P450 2E1. Clin Pharmacol Ther. 1994 Apr;55(4):434-40.
• [7] Gill SS, Wright EM, Reilly CS "Pharmacokinetic interaction of propofol and fentanyl: single bolus injection study." Br J Anaesth 65 (1990): 760-5. [PMID: 2265045]
• [8] Motuz DJ, Watson WA, Barlow JC, et al "The increase in urinary alanine aminopeptidase excretion associated with enflurane anesthesia is increased further by aminoglycosides." Anesth Analg 67 (1988): 770-4. [PMID: 2899408]
• [9] Cerner Multum, Inc. "Australian Product Information.".
• [10] Canadian Pharmacists Association.