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Version5.0
StatusExpected but not Quantified
Creation Date2012-09-06 15:16:51 UTC
Update Date2023-02-21 17:18:28 UTC
HMDB IDHMDB0015333
Secondary Accession Numbers
  • HMDB15333
Metabolite Identification
Common NameLevetiracetam
DescriptionLevetiracetam is an anticonvulsant medication used to treat epilepsy. Levetiracetam may selectively prevent hypersynchronization of epileptiform burst firing and propagation of seizure activity. Levetiracetam binds to the synaptic vesicle protein SV2A, which is thought to be involved in the regulation of vesicle exocytosis. Although the molecular significance of levetiracetam binding to synaptic vesicle protein SV2A is not understood, levetiracetam and related analogs showed a rank order of affinity for SV2A which correlated with the potency of their antiseizure activity in audiogenic seizure-prone mice.
Structure
Data?1676999908
Synonyms
ValueSource
KeppraKegg
e KeppraKegg
LevitiracetamHMDB
Etiracetam, R-isomerHMDB
alpha-Ethyl-2-oxo-1-pyrrolidineacetamideHMDB
Etiracetam, S-isomerHMDB
Ucb L060HMDB
Ucb-L060HMDB
UCB brand OF levetiracetamHMDB
EtiracetamHMDB
Ucb L059HMDB
Ucb-L059HMDB
Etiracetam, R isomerHMDB
UcbL060HMDB
alpha Ethyl 2 oxo 1 pyrrolidineacetamideHMDB
Etiracetam, S isomerHMDB
R-Isomer etiracetamHMDB
S-Isomer etiracetamHMDB
Chemical FormulaC8H14N2O2
Average Molecular Weight170.209
Monoisotopic Molecular Weight170.105527702
IUPAC Name(2R)-2-(2-oxopyrrolidin-1-yl)butanamide
Traditional Namelevitiracetam
CAS Registry Number102767-28-2
SMILES
CC[C@@H](N1CCCC1=O)C(N)=O
InChI Identifier
InChI=1S/C8H14N2O2/c1-2-6(8(9)12)10-5-3-4-7(10)11/h6H,2-5H2,1H3,(H2,9,12)/t6-/m1/s1
InChI KeyHPHUVLMMVZITSG-ZCFIWIBFSA-N
Chemical Taxonomy
Description Belongs to the class of organic compounds known as alpha amino acids and derivatives. These are amino acids in which the amino group is attached to the carbon atom immediately adjacent to the carboxylate group (alpha carbon), or a derivative thereof.
KingdomOrganic compounds
Super ClassOrganic acids and derivatives
ClassCarboxylic acids and derivatives
Sub ClassAmino acids, peptides, and analogues
Direct ParentAlpha amino acids and derivatives
Alternative Parents
Substituents
  • Alpha-amino acid or derivatives
  • Fatty amide
  • Pyrrolidone
  • 2-pyrrolidone
  • Fatty acyl
  • N-alkylpyrrolidine
  • Pyrrolidine
  • Tertiary carboxylic acid amide
  • Carboxamide group
  • Lactam
  • Primary carboxylic acid amide
  • Azacycle
  • Organoheterocyclic compound
  • Organic oxide
  • Organopnictogen compound
  • Carbonyl group
  • Organooxygen compound
  • Organonitrogen compound
  • Organic nitrogen compound
  • Organic oxygen compound
  • Hydrocarbon derivative
  • Aliphatic heteromonocyclic compound
Molecular FrameworkAliphatic heteromonocyclic compounds
External DescriptorsNot Available
Ontology
Physiological effectNot Available
Disposition
ProcessNot Available
Role
Physical Properties
StateSolid
Experimental Molecular Properties
PropertyValueReference
Melting PointNot AvailableNot Available
Boiling PointNot AvailableNot Available
Water Solubility298 g/LNot Available
LogP-0.6Not Available
Experimental Chromatographic PropertiesNot Available
Predicted Molecular Properties
PropertyValueSource
Water Solubility298 g/LALOGPS
logP-0.64ALOGPS
logP-0.59ChemAxon
logS0.24ALOGPS
pKa (Strongest Acidic)16.09ChemAxon
pKa (Strongest Basic)-1.6ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count2ChemAxon
Hydrogen Donor Count1ChemAxon
Polar Surface Area63.4 ŲChemAxon
Rotatable Bond Count3ChemAxon
Refractivity44.08 m³·mol⁻¹ChemAxon
Polarizability17.78 ųChemAxon
Number of Rings1ChemAxon
BioavailabilityYesChemAxon
Rule of FiveYesChemAxon
Ghose FilterNoChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted Chromatographic Properties

Predicted Collision Cross Sections

PredictorAdduct TypeCCS Value (Å2)Reference
DarkChem[M+H]+139.82731661259
DarkChem[M-H]-135.82531661259
DeepCCS[M+H]+145.28430932474
DeepCCS[M-H]-142.81930932474
DeepCCS[M-2H]-178.31930932474
DeepCCS[M+Na]+153.82330932474
AllCCS[M+H]+137.832859911
AllCCS[M+H-H2O]+133.732859911
AllCCS[M+NH4]+141.732859911
AllCCS[M+Na]+142.832859911
AllCCS[M-H]-135.332859911
AllCCS[M+Na-2H]-136.632859911
AllCCS[M+HCOO]-138.032859911

Predicted Kovats Retention Indices

Underivatized

MetaboliteSMILESKovats RI ValueColumn TypeReference
LevetiracetamCC[C@@H](N1CCCC1=O)C(N)=O2188.7Standard polar33892256
LevetiracetamCC[C@@H](N1CCCC1=O)C(N)=O1700.7Standard non polar33892256
LevetiracetamCC[C@@H](N1CCCC1=O)C(N)=O1605.3Semi standard non polar33892256

Derivatized

Derivative Name / StructureSMILESKovats RI ValueColumn TypeReference
Levetiracetam,1TMS,isomer #1CC[C@H](C(=O)N[Si](C)(C)C)N1CCCC1=O1644.5Semi standard non polar33892256
Levetiracetam,1TMS,isomer #1CC[C@H](C(=O)N[Si](C)(C)C)N1CCCC1=O1678.1Standard non polar33892256
Levetiracetam,1TMS,isomer #1CC[C@H](C(=O)N[Si](C)(C)C)N1CCCC1=O2426.0Standard polar33892256
Levetiracetam,2TMS,isomer #1CC[C@H](C(=O)N([Si](C)(C)C)[Si](C)(C)C)N1CCCC1=O1731.6Semi standard non polar33892256
Levetiracetam,2TMS,isomer #1CC[C@H](C(=O)N([Si](C)(C)C)[Si](C)(C)C)N1CCCC1=O1812.3Standard non polar33892256
Levetiracetam,2TMS,isomer #1CC[C@H](C(=O)N([Si](C)(C)C)[Si](C)(C)C)N1CCCC1=O2239.4Standard polar33892256
Levetiracetam,1TBDMS,isomer #1CC[C@H](C(=O)N[Si](C)(C)C(C)(C)C)N1CCCC1=O1854.6Semi standard non polar33892256
Levetiracetam,1TBDMS,isomer #1CC[C@H](C(=O)N[Si](C)(C)C(C)(C)C)N1CCCC1=O1930.3Standard non polar33892256
Levetiracetam,1TBDMS,isomer #1CC[C@H](C(=O)N[Si](C)(C)C(C)(C)C)N1CCCC1=O2473.3Standard polar33892256
Levetiracetam,2TBDMS,isomer #1CC[C@H](C(=O)N([Si](C)(C)C(C)(C)C)[Si](C)(C)C(C)(C)C)N1CCCC1=O2156.5Semi standard non polar33892256
Levetiracetam,2TBDMS,isomer #1CC[C@H](C(=O)N([Si](C)(C)C(C)(C)C)[Si](C)(C)C(C)(C)C)N1CCCC1=O2267.4Standard non polar33892256
Levetiracetam,2TBDMS,isomer #1CC[C@H](C(=O)N([Si](C)(C)C(C)(C)C)[Si](C)(C)C(C)(C)C)N1CCCC1=O2334.7Standard polar33892256
Spectra

GC-MS Spectra

Spectrum TypeDescriptionSplash KeyDeposition DateSourceView
Predicted GC-MSPredicted GC-MS Spectrum - Levetiracetam GC-MS (Non-derivatized) - 70eV, Positivesplash10-002g-9300000000-c7be6e1922b5359940b62017-09-01Wishart LabView Spectrum
Predicted GC-MSPredicted GC-MS Spectrum - Levetiracetam GC-MS (Non-derivatized) - 70eV, PositiveNot Available2021-10-12Wishart LabView Spectrum

MS/MS Spectra

Spectrum TypeDescriptionSplash KeyDeposition DateSourceView
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-QTOF , positive-QTOFsplash10-0fb9-0900000000-5d10dc46b3d8459f51362017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-QTOF , positive-QTOFsplash10-004i-0900000000-eed0f7c0281298a901e02017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-QTOF , positive-QTOFsplash10-004i-0900000000-904c39fde7b4a564f4f92017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-QTOF , positive-QTOFsplash10-004i-0900000000-043119aa2fce9bf106a62017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-QTOF , positive-QTOFsplash10-004i-0900000000-baaa7247861e2a0c32dc2017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-0udi-0900000000-e4d3bcf5f9604374d9742017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-0fb9-0900000000-c54dadca90f9667c5e5e2017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-0900000000-43e7dddd01af305596742017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-0900000000-bcf3b82b0418f01f7c882017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-0900000000-af204f882b93928b37862017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-2900000000-0d85e8e75dfd969db1532017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-6900000000-8038b6a6542f48ef1db62017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-0fb9-0900000000-b79c1cd502a80d2cc5a52017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-0900000000-b2783da92be1f59563002017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-0900000000-656f696fd6f22abd3b8c2017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-0900000000-05fe19e5eb84577847c02017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-1900000000-b7a6c4f29c539bcb255c2017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-004i-4900000000-159b3785ab54ec35d7ae2017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Levetiracetam LC-ESI-ITFT , positive-QTOFsplash10-0udi-0900000000-4576e782d08537cb54d32017-09-14HMDB team, MONAView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Levetiracetam 10V, Positive-QTOFsplash10-00di-0900000000-ec0076a60bef1bfe06dd2016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Levetiracetam 20V, Positive-QTOFsplash10-0fb9-2900000000-22b720450ebfea7045542016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Levetiracetam 40V, Positive-QTOFsplash10-0006-9100000000-17a515534beb406070e02016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Levetiracetam 10V, Negative-QTOFsplash10-014i-0900000000-7470975ba67c5de6162e2016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Levetiracetam 20V, Negative-QTOFsplash10-00pl-5900000000-50443438445390c4345a2016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Levetiracetam 40V, Negative-QTOFsplash10-0006-9000000000-517ee6018ae48754d1b72016-08-03Wishart LabView Spectrum

NMR Spectra

Spectrum TypeDescriptionDeposition DateSourceView
Predicted 1D NMR1H NMR Spectrum (1D, 100 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 100 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 1000 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 1000 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 200 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 200 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 300 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 300 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 400 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 400 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 500 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 500 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 600 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 600 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 700 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 700 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 800 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 800 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 900 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 900 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum

IR Spectra

Spectrum TypeDescriptionDeposition DateSourceView
Predicted IR SpectrumIR Ion Spectrum (Predicted IRIS Spectrum, Adduct: [M-H]-)2023-02-03FELIX labView Spectrum
Predicted IR SpectrumIR Ion Spectrum (Predicted IRIS Spectrum, Adduct: [M+H]+)2023-02-03FELIX labView Spectrum
Predicted IR SpectrumIR Ion Spectrum (Predicted IRIS Spectrum, Adduct: [M+Na]+)2023-02-03FELIX labView Spectrum
Biological Properties
Cellular Locations
  • Cytoplasm
  • Membrane
Biospecimen Locations
  • Blood
  • Urine
Tissue LocationsNot Available
Pathways
Normal Concentrations
BiospecimenStatusValueAgeSexConditionReferenceDetails
BloodExpected but not QuantifiedNot QuantifiedNot AvailableNot AvailableTaking drug identified by DrugBank entry DB01202 details
UrineExpected but not QuantifiedNot QuantifiedNot AvailableNot AvailableTaking drug identified by DrugBank entry DB01202 details
Abnormal Concentrations
Not Available
Predicted Concentrations
BiospecimenValueOriginal ageOriginal sexOriginal conditionComments
Blood0.000 uMAdult (>18 years old)BothNormalPredicted based on drug qualities
Blood0.000 umol/mmol creatinineAdult (>18 years old)BothNormalPredicted based on drug qualities
Associated Disorders and Diseases
Disease ReferencesNone
Associated OMIM IDsNone
DrugBank IDNot Available
Phenol Explorer Compound IDNot Available
FooDB IDNot Available
KNApSAcK IDNot Available
Chemspider ID390096
KEGG Compound IDC07841
BioCyc IDNot Available
BiGG IDNot Available
Wikipedia LinkLevetiracetam
METLIN IDNot Available
PubChem Compound441341
PDB IDNot Available
ChEBI ID352567
Food Biomarker OntologyNot Available
VMH IDNot Available
MarkerDB IDNot Available
Good Scents IDNot Available
References
Synthesis ReferenceNot Available
Material Safety Data Sheet (MSDS)Not Available
General ReferencesNot Available

Enzymes

General function:
Involved in ion channel activity
Specific function:
Voltage-sensitive calcium channels (VSCC) mediate the entry of calcium ions into excitable cells and are also involved in a variety of calcium-dependent processes, including muscle contraction, hormone or neurotransmitter release, gene expression, cell motility, cell division and cell death. The isoform alpha-1B gives rise to N-type calcium currents. N-type calcium channels belong to the 'high-voltage activated' (HVA) group and are blocked by omega-conotoxin-GVIA (omega-CTx-GVIA) and by omega-agatoxin- IIIA (omega-Aga-IIIA). They are however insensitive to dihydropyridines (DHP), and omega-agatoxin-IVA (omega-Aga-IVA). Calcium channels containing alpha-1B subunit may play a role in directed migration of immature neurons
Gene Name:
CACNA1B
Uniprot ID:
Q00975
Molecular weight:
262493.8
References
  1. De Smedt T, Raedt R, Vonck K, Boon P: Levetiracetam: the profile of a novel anticonvulsant drug-part I: preclinical data. CNS Drug Rev. 2007 Spring;13(1):43-56. [PubMed:17461889 ]
  2. Lukyanetz EA, Shkryl VM, Kostyuk PG: Selective blockade of N-type calcium channels by levetiracetam. Epilepsia. 2002 Jan;43(1):9-18. [PubMed:11879381 ]
General function:
Involved in transmembrane transport
Specific function:
Plays a role in the control of regulated secretion in neural and endocrine cells, enhancing selectively low-frequency neurotransmission. Positively regulates vesicle fusion by maintaining the readily releasable pool of secretory vesicles
Gene Name:
SV2A
Uniprot ID:
Q7L0J3
Molecular weight:
82694.7
References
  1. Lynch BA, Lambeng N, Nocka K, Kensel-Hammes P, Bajjalieh SM, Matagne A, Fuks B: The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci U S A. 2004 Jun 29;101(26):9861-6. Epub 2004 Jun 21. [PubMed:15210974 ]
  2. Stahl SM: Psychopharmacology of anticonvulsants: levetiracetam as a synaptic vesicle protein modulator. J Clin Psychiatry. 2004 Sep;65(9):1162-3. [PubMed:15367040 ]
  3. Lambeng N, Grossmann M, Chatelain P, Fuks B: Solubilization and immunopurification of rat brain synaptic vesicle protein 2A with maintained binding properties. Neurosci Lett. 2006 May 1;398(1-2):107-12. Epub 2006 Jan 24. [PubMed:16434140 ]
  4. Gillard M, Chatelain P, Fuks B: Binding characteristics of levetiracetam to synaptic vesicle protein 2A (SV2A) in human brain and in CHO cells expressing the human recombinant protein. Eur J Pharmacol. 2006 Apr 24;536(1-2):102-8. Epub 2006 Mar 10. [PubMed:16556440 ]
  5. Newton HB, Dalton J, Goldlust S, Pearl D: Retrospective analysis of the efficacy and tolerability of levetiracetam in patients with metastatic brain tumors. J Neurooncol. 2007 Sep;84(3):293-6. Epub 2007 Apr 13. [PubMed:17431542 ]
  6. Johannessen Landmark C: Antiepileptic drugs in non-epilepsy disorders: relations between mechanisms of action and clinical efficacy. CNS Drugs. 2008;22(1):27-47. [PubMed:18072813 ]
  7. De Smedt T, Raedt R, Vonck K, Boon P: Levetiracetam: the profile of a novel anticonvulsant drug-part I: preclinical data. CNS Drug Rev. 2007 Spring;13(1):43-56. [PubMed:17461889 ]

Transporters

General function:
Involved in ATP binding
Specific function:
Mediates hepatobiliary excretion of numerous organic anions. May function as a cellular cisplatin transporter
Gene Name:
ABCC2
Uniprot ID:
Q92887
Molecular weight:
174205.6
References
  1. Baltes S, Gastens AM, Fedrowitz M, Potschka H, Kaever V, Loscher W: Differences in the transport of the antiepileptic drugs phenytoin, levetiracetam and carbamazepine by human and mouse P-glycoprotein. Neuropharmacology. 2007 Feb;52(2):333-46. Epub 2006 Oct 10. [PubMed:17045309 ]
General function:
Involved in ATP binding
Specific function:
Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells
Gene Name:
ABCB1
Uniprot ID:
P08183
Molecular weight:
141477.3
References
  1. Baltes S, Gastens AM, Fedrowitz M, Potschka H, Kaever V, Loscher W: Differences in the transport of the antiepileptic drugs phenytoin, levetiracetam and carbamazepine by human and mouse P-glycoprotein. Neuropharmacology. 2007 Feb;52(2):333-46. Epub 2006 Oct 10. [PubMed:17045309 ]
  2. Luna-Tortos C, Fedrowitz M, Loscher W: Several major antiepileptic drugs are substrates for human P-glycoprotein. Neuropharmacology. 2008 Dec;55(8):1364-75. doi: 10.1016/j.neuropharm.2008.08.032. Epub 2008 Sep 11. [PubMed:18824002 ]