epalrestat epalrestat epalrestat is a carboxylic acid derivative and a noncompetitive and reversible aldose reductase inhibitor used for the treatment of diabetic neuropathy, which is one of the most common long-term complications in patients with diabetes mellitus. it reduces the accumulation of intracellular sorbitol which is believed to be the cause of diabetic neuropathy, retinopathy and nephropathy it is well tolerated, with the most commonly reported adverse effects being gastrointestinal issues such as nausea and vomiting, as well as increases in certain liver enzymes. chemically, epalrestat is unusual in that it is a drug that contains a rhodanine group. aldose reductase is the key enzyme in the polyol pathway whose enhanced activity is the basis of diabetic neuropathy. aldose reductase inhibitors (ari) target this enzyme. out of the many aris developed, ranirestat and fidarestat are in the trial stage. others have been discarded due to unacceptable adverse effects or weak efficacy. epalrestat is the only ari commercially available. it is easily absorbed into the neural tissue and inhibits the enzyme with minimum side effects. epalrestat names preferred iupac name acetic acid identifiers cas number 82159-09-9 y 3d model (jsmol) interactive image chebi chebi:31539 n chembl chembl56337 n chemspider 1266086 n echa infocard 100.200.343 kegg d01688 y pubchem cid 1549120 unii 424dv0807x n comptox dashboard (epa) dtxsid1046479 inchi inchi=1s/c15h13no3s2/c1-10(7-11-5-3-2-4-6-11)8-12-14(19)16(9-13(17)18)15(20)21-12/h2-8h,9h2,1h3,(h,17,18)/b10-7+,12-8- nkey: chnuojqwguiold-nfzzjpoksa-n ninchi=1/c15h13no3s2/c1-10(7-11-5-3-2-4-6-11)8-12-14(19)16(9-13(17)18)15(20)21-12/h2-8h,9h2,1h3,(h,17,18)/b10-7+,12-8-key: chnuojqwguiold-nfzzjpokbr smiles o=c(o)cn1c(=o)c(\sc1=s)=c/c(=c/c2ccccc2)c properties chemical formula c15h13no3s2 molar mass 319.401 g/mol density 1.43 g/cm3 melting point 210 °c (410 °f; 483 k) boiling point 516.8 °c (962.2 °f; 789.9 k) except where otherwise noted, data are given for materials in their standard state (at 25 °c , 100 kpa). n verify (what is yn ?) infobox references evidence it has been demonstrated in animal experiments that there is an improvement in sorbitol levels and na+/k+ atpase activity leading to improved nerve conduction velocity. diabetic rats treated with epalrestat showed improvement in morphological abnormalities of nerves. in a placebo controlled double blind trial of 196 patients, it was shown that epalrestat in a dose of 150 mg/day improved the effects of diabetic neuropathy like upper limb spontaneous pain, motor nerve conduction velocity, thresholds of vibratory sensation and autonomic nerve function as compared to a placebo. these effects were significantly better in those with poorer control of diabetes. a systematic review and metaanalysis showed that based on the results of 10 articles, it can be concluded that epalrestat has some benefit in the control of diabetic cardiovascular autonomic neuropathy but only in the early or mild cases. it also doesn't influence glycaemic control. brand names aldonil (zydus medica), india aldorin, bangladesh alrista (marketed and not manufactured by macleods), india epalrica-m (ordain global), india eparel 50 (microlabs ltd), india epimeth (zaiva lifesciences), india eplistat 150 sr (schem), india letostat-sr (amor pharmaceuticals), india listap-50 (vivid biotek), india tanglin (yangtze river pharmaceutical group), china