Background and Purpose: In 2016, one person died and four others had mild-tosevere neurological symptoms during a phase I trial of the fatty acid amide hydrolase (FAAH) inhibitor BIA 10-2474.Experimental Approach: Pharmacodynamic and pharmacokinetic studies were performed with BIA 10-2474, PF-04457845 and JNJ-42165279 using mice, rats and human FAAH expressed in COS cells. Selectivity was evaluated by activity-based protein profiling (APBB) in rats. BIA 10-2474 effect in stroke-prone spontaneously hypertensive rats (SHRSP) was investigated.Key Results: BIA 10-2474 was 10-fold less potent than PF-04457845 in inhibiting human FAAH in situ but inhibited mouse brain and liver FAAH with ED 50 values of 13.5 and 6.2 μgÁkg −1 , respectively. Plasma and brain BIA 10-2474 levels were consistent with in situ potency and neither BIA 10-2474 nor its metabolites accumulated following repeat administration. FAAH and α/β-hydrolase domain containing 6 were the primary targets of BIA 10-2474 and, at higher exposure levels, ABHD11, PNPLA6, PLA2G15, PLA2G6 and androgen-induced protein 1. At 100 mgÁkg −1 for 28 days, the level of several lipid species containing arachidonic acid increased. Daily treatment of SHRSP with BIA 10-2474 did not affect mortality rate or increased the incidence of haemorrhage or oedema in surviving animals.Conclusions and Implications: BIA 10-2474 potently inhibits FAAH in vivo, similarly to PF-04457845 and interacts with a number of lipid processing enzymes, some previously identified in human cells as off-targets particularly at high levels of exposure.These interactions occurred at doses used in toxicology studies, but the implication of these off-targets in the clinical trial accident remains unclear.Abbreviations: 2-AG, 2-arachidonoylglycerol; AA, arachidonic acid; ABHD6, α/β-hydrolase domain containing 6; ABPP, activity-based protein profiling; AEA, anandamide; AIG1, androgeninduced protein 1; BCRP, breast cancer resistance protein; CES, carboxyl esterase; CYP, cytochrome P450; DAG, diacylglycerol; FAAH, fatty acid amide hydrolase; LIPE, lipase E; MATE, multidrug and toxin extrusion; MDR, multidrug resistance; OAT, organic anion transporter; OCT, organic cation transporter; OEA, oleoylethanolamide; PC, phosphatidylcholine; PE, phosphatidylethanolamine; PEA, palmitoylethanolamide; P-gp, P-glycoprotein; PLA2G15, PLA 2 Group 15; PLA2G6, PLA 2 Group 6; PNPLA6, patatin-like phospholipase domain containing 6; SHRSP, Spontaneously hypertensive rats stroke prone; TAMRA-FP, tetramethylrhodamine-fluorophosphonate.