The influence of aging and duration of nerve injury on the antiallodynic efficacy of analgesics in laboratory mice

INTRODUCTION

Increasing attention is being paid to the effects of organismic factors like age on pain sensitivity. However, very little data exist on this topic using modern algesiometric assays and measures in laboratory rodents.

OBJECTIVES

We investigated the effect of age and duration of nerve injury on baseline mechanical thresholds, neuropathic allodynia, and the antiallodynic and analgesic efficacy of 4 systemically administered analgesics: amitriptyline, diclofenac, morphine, and pregabalin.

METHODS

Mice of both sexes and 3 conditions were compared: Young-Young, in which baseline testing (von Frey thresholds), the injury producing neuropathic pain (spared nerve injury [SNI]) and subsequent drug testing occurred while mice were young (8-10 weeks); Young-Old, in which mice received the nerve injury while young but were tested for drug efficacy over 10 months later; and Old-Old, in which both the nerve injury and drug testing occurred at approximately 1 year of age.

RESULTS

Old-Old mice were found to display higher baseline mechanical sensitivity than other groups. No group differences were seen in SNI-induced allodynia in males; female Young-Old mice were found to display greatly reduced allodynia. With respect to drug efficacy, no differences among conditions were observed for amitriptyline, diclofenac, or morphine. For pregabalin, however, Young-Old mice displayed significantly reduced antiallodynia, and the drug was completely ineffective in Old-Old mice.

CONCLUSION

Novel findings include the apparent remission of SNI-induced allodynia in female mice 10 months after injury and reduced pregabalin antiallodynic effects produced by both the passage of time after nerve injury and aging.

Diclofenac exhibits synergism with azoles against planktonic cells and biofilms of Candida tropicalis

This study aimed to evaluate the effect of diclofenac on minimum inhibitory concentrations of antifungals against planktonic cells and biofilms of Candida tropicalis. Susceptibility testing of planktonic cells was evaluated using the broth microdilution assay and checkerboard method. Biofilm formation by C. tropicalis in the presence of diclofenac, alone or in combination with antifungals, was also evaluated, and scanning electron microscope (SEM) and confocal microscope (CLSM) analyses were performed. Diclofenac showed an MIC of 1024 μg ml^-1 against planktonic cells. The MICs of fluconazole and voriconazole against azole-resistant isolates were reduced 8- to 32-fold and 16- to 256-fold, respectively, when in combination with diclofenac. When in combination with fluconazole or voriconazole, diclofenac reduced the antifungal concentration necessary to inhibit C. tropicalis biofilm formation. In conclusion, diclofenac presents synergism with fluconazole and voriconazole against resistant C. tropicalis strains and improves the activity of these azole drugs against biofilm formation.

Coenzyme Q10 coadministration with diclofenac augmented impaired renal function in broiler chickens (Gallus gallus domesticus)

Aim:

This study aimed to investigate the effects of coenzyme Q10 (COQ10) and diclofenac coadministration on the hepatorenal function in broiler chickens (Gallus gallus domesticus).

Materials and Methods:

Birds (21 days old) were divided into six groups of eight birds each. The 1^st group was the control, the 2^nd group was treated orally with COQ10(30mg/kg b.wt), the 3^rdand 4^thgroups were treated intraperitoneally with diclofenac sodium at doses 1 and 2mg/kg b.wt, respectively, and the 5^thand 6^thgroups were treated with COQ10 (dose 30mg/kg b.wt, P.O.) and diclofenac sodium (dose 1mg/kg b.wt, I.P.) and COQ10 (dose 30mg/kg b.wt, P.O.) and diclofenac sodium (dose 2mg/kg b.wt, I.P.), respectively. The experiment lasted 5days. Twenty-four hours after the last administration, all the birds were sacrificed through cervical dislocation; blood samples were collected for serum biochemical analysis.

Results:

COQ10 induced a significant increase in aspartate aminotransferase (AST), urea, creatinine, sodium, potassium, and chloride, while diclofenac induced a significant increase in alanine aminotransferase (ALT), AST, total cholesterol, triglyceride, high-density lipoprotein, urea, creatinine, sodium, potassium, and chloride. However, when COQ10 and diclofenac were coadministered, we observed that COQ10 decreased the liver injury caused by diclofenac. However, COQ10 could not relieve the kidney injury caused by diclofenac, but worsened the impaired renal function.

Conclusion:

COQ10 protects the liver against diclofenac-induced liver injury while augmenting diclofenac-induced kidney injury.

Intramuscular diclofenac is a cause of Nicolau syndrome in obese women: An observational study of consecutive ten patients

Nicolau syndrome is a skin and underlying tissue necrosis resulting from vascular occlusion after various injections of certain drugs. Intramuscular injections are the most common cause but it may occur after other types of parenteral interventions. There are many medications reported as causative factors inducing Nicolau syndrome including penicillin, nonsteroidal anti-inflammatory drugs, corticosteroids, local anesthetics, and several others. We present an observational study of diclofenac induced Nicolau syndrome.

Systematic review of topical diclofenac for the treatment of acute and chronic musculoskeletal pain

Aim: The objective was to systematically review the efficacy and safety of topical diclofenac in both acute and chronic musculoskeletal pain in adults.Methods: We used standard Cochrane methods. Searches were conducted in MEDLINE, EMBASE and The Cochrane Register of Studies; date of the final search was November 2018. Included studies were randomized, double blinded, with ten or more participants per treatment arm. The primary outcome of "clinical success" was defined as participant-reported reduction in pain of at least 50%. Details of adverse events (AEs) were recorded.Results: For acute pain, 23 studies (5170 participants) were included. Compared to placebo, number needed to treat (NNT) for different formulations were as follows: diclofenac plaster, 4.7 (95% CI 3.7-6.5); diclofenac plaster with heparin, 7.4 (95% CI 4.6-19); and diclofenac Emulgel, 1.8 (95% CI 1.5-2.1). 4.1% (78/1919) reported a local AE. For chronic pain, 21 studies (26 publications) with 5995 participants were included. Formulations included gel, solution with or without DMSO, emulsion and plaster. A clinical success rate of ∼60% (NNT 9.5 [95% CI 7-14.7]) was achieved with a variety of formulations. Local AEs (∼14%) were similar for both diclofenac and placebo.Conclusion: This systematic review of 11,000+ participants demonstrates that topical diclofenac is effective for acute pain, such as sprains, with minimal AEs. The effectiveness of topical diclofenac was also demonstrated in chronic musculoskeletal pain but with a higher NNT (worse) compared with acute pain. Formulation does play a part in effectiveness but needs further studies.

One-Pot Synthesis of Sulfur-Doped TiO2/Reduced Graphene Oxide Composite (S-TiO2/rGO) With Improved Photocatalytic Activity for the Removal of Diclofenac From Water

Sulfur-doped TiO2 (S-TiO2) composites with reduced graphene oxide (rGO), wt. % of rGO equal to 0.5%, 2.75%, and 5.0%, were prepared by a one-pot solvothermal procedure. The aim was to improve photocatalytic performance in comparison to TiO2 under simulated solar irradiation for the treatment of diclofenac (DCF) in aqueous medium. The obtained composites were characterized for physical-chemical properties using thermogravimetric analysis (TGA), X-ray diffractograms (XRD), Raman, scanning electron microscopy (SEM)/energy dispersive X-ray (EDX), Brauner Emmett Teller (BET), and photoluminescence (PL) analyses, indicating successful sulfur doping and inclusion of rGO. Sulfur doping and rGO have successfully led to a decrease in photogenerated charge recombination. However, both antagonistic and synergistic effects toward DCF treatment were observed, with the latter being brought forward by higher wt.% rGO. The composite with 5.0 wt.% rGO has shown the highest DCF conversion at pH 4 compared to that obtained by pristine TiO2, despite lower DCF adsorption during the initial dark period. The expected positive effects of both sulfur doping and rGO on charge recombination were found to be limited because of the subpar interphase contact with the composite and incomplete reduction of the GO precursor. Consequent unfavorable interactions between rGO and DCF negatively influenced the activity of the studied S-TiO2/rGO photocatalyst under simulated solar irradiation.

Efficacy and safety of combination of curcuminoid complex and diclofenac versus diclofenac in knee osteoarthritis: A randomized trial

BACKGROUND

To compare the efficacy and safety of combination of curcuminoid complex and diclofenac vs diclofenac alone in the treatment of knee osteoarthritis (OA).

METHODS

In this randomized trial, 140 patients of knee OA received either curcuminoid complex 500 mg (BCM-95) with diclofenac 50 mg 2 times daily or diclofenac 50 mg alone 2 times daily for 28 days. Patients were assessed at baseline, day 14 and day 28. Primary efficacy measures were Knee injury and OA outcome score (KOOS) subscale at day 14 and day 28. Anti-ulcer effect and patient-physician's global assessment of therapy at day 28 were included as secondary endpoints. Safety after treatment was evaluated by recording adverse events and laboratory investigations.

RESULTS

Both treatment groups showed improvement in primary endpoints at each evaluation visit. Patients receiving curcuminoid complex plus diclofenac showed significantly superior improvement in KOOS subscales, viz. pain and quality of life at each study visit (P < .001) when compared to diclofenac. Less number of patients required rescue analgesics in curcuminoid complex plus diclofenac group (3%) compared to diclofenac group (17%). The number of patients who required histamine 2 (H2) blockers was significantly less in curcuminoid complex plus diclofenac group compared to diclofenac group (6% vs 28%, respectively; P < .001). Adverse effects were significantly less in curcuminoid complex plus diclofenac group (13% vs 38% in diclofenac group; P < .001). Patient's and physician's global assessment of therapy favored curcuminoid complex plus diclofenac than diclofenac.

CONCLUSION

Combination of curcuminoid complex and diclofenac showed a greater improvement in pain and functional capacity with better tolerability and could be a better alternative treatment option in symptomatic management of knee OA.

TRIAL REGISTRATION

ISRCTN, ISRCTN10074826.

A Behavioral Study of Promethazine Interaction with Analgesic Effect of Diclofenac: Pain Combination Therapy

OBJECTIVES

Pain is considered as a cause of sickness and the most prevalent symptom which makes people visit a physician. Nowadays, combination therapy is becoming useful to relieve chronic and postsurgical pain. The aim of this study was to study the promethazine (as an antihistamine) interactions with antinociceptive effect of diclofenac (as a non-steroidal anti-inflammatory drugs).

METHODS

In initial part of the study, we investigate the analgesic effect of diclofenac. Using writhing test, we demonstrate that diclofenac significantly reduces writhe response induced by acetic acid in a dose-dependent manner. In this study, we evaluate the combination effect of promethazine on diclofenac analgesic effect.

RESULTS

We observed that diclofenac inhibited pain in the dose dependent manner which means that by increasing dose of diclofenac a significant decrease in pain was observed. This experimental setup allowed calculation of the dose that caused 50% antinociception (ED50) for diclofenac. The ED50 for diclofenac in this study was determined to be 9.1 mg/kg according our previous study. Additionally, promethazine was showed a dose-dependent inhibition of writhes. The combination of different doses of promethazine (2, 4, 6 mg / kg) with diclofenac ED50 (9.1 mg / kg) was injected to mice. Promethazine 4 and 6 mg / kg in combination with diclofenac had significantly led to increase analgesic effect of diclofenac.

CONCLUSION

In conclusion, these results add important information to the existing knowledge on combination of diclofenac and antihistamine in pain therapies to be used in clinical practice and maybe helpful in designing the future guidelines.

Nanocellulose-Based Patches Loaded with Hyaluronic Acid and Diclofenac towards Aphthous Stomatitis Treatment

Nanostructured patches composed of bacterial nanocellulose (BNC), hyaluronic acid (HA) and diclofenac (DCF) were developed, envisioning the treatment of aphthous stomatitis. Freestanding patches were prepared via diffusion of aqueous solutions of HA and DCF, with different concentrations of DCF, into the wet BNC three-dimensional porous network. The resultant dual polysaccharides-based patches with a nanostructured morphology present thermal stability up to 200 °C, as well as good dynamic mechanical properties, with a storage modulus higher than 1.0 GPa. In addition, the patches are non-cytotoxic to human keratinocytes (HaCaT cells), with a cell viability of almost 100% after 24 h. The in vitro release profile of DCF from the patches was evaluated in simulated saliva, and the data refer to a diffusion- and swelling-controlled drug-release mechanism. The attained results hint at the possibility of using these dual polysaccharides-based oral mucosal patches to target aphthous stomatitis.

Diclofenac Versus Ketorolac for Pain Control After Primary Total Joint Arthroplasty: A Comparative Analysis

Introduction As total hip arthroplasty (THA) and total knee arthroplasty (TKA) transition to outpatient settings, appropriate pain management remains a challenge. Nonsteroidal anti-inflammatory drugs (NSAIDs) may subvert the need for postoperative opioids. This study evaluated: 1) total opioid consumption; 2) postoperative pain intensity; 3) discharge destination; 4) length of stay (LOS); and 5) THA and TKA patients' satisfaction in receiving adjunctive intravenous (IV) diclofenac or ketorolac. Methods In this retrospective cohort study, patients scheduled to undergo primary THA or TKA by a single surgeon between March 2017 and April 2018 were identified. Patients were stratified based on the receipt of IV diclofenac (THA: n = 25; TKA: n = 51) or IV ketorolac (THA: n = 28; TKA: n = 32) in addition to the standard pain management regimen. Student's t-testing and Chi-square were used to analyze continuous and categorical variables, respectively. Results TKA diclofenac patients had lower opioid consumption 12 hours postoperatively (p: 0.037). TKA patients in the diclofenac cohort were discharged to home less often (p: 0.025). Both diclofenac cohorts had greater patient satisfaction than the ketorolac cohorts (p: <0.05). There was no significant difference between groups in postoperative pain intensity at 24 or 48 hours or in the length of stay (p: >0.05 for all). Conclusion This study demonstrated that both TKA and THA patients treated with IV diclofenac had no difference in postoperative pain intensity while THA patients had no difference in opioid consumption relative to those treated with IV ketorolac. Further comparison of IV NSAIDs with other IV pain medications may provide broader insight into the ideal management for postoperative pain for this widening patient population.

In Situ Synthesis of Defect-Engineered MOFs as a Photoregenerable Catalytic Adsorbent: Understanding the Effect of LML, Adsorption Behavior, and Photoreaction Process

Defect-engineering is an exciting strategy for the modification of metal-organic frameworks (MOFs), which can go beyond the limit of conventional MOFs, tailor material properties, and incorporate multiple functionalities. Herein, based on the large mixed-linker approach, we successfully integrated tetrakis(4-carboxyphenyl)porphyrin (TCPP) into stable UiO-66 via an in situ one-pot synthetic method and used the obtained material for the removal of diclofenac (DF). TCPP@UiO-66 maintained the structure, excellent stability, and porosity of UiO-66. The defect density significantly affected the phase purity, crystallite morphology, and properties of TCPP@UiO-66s. Owing to the delicate balance between defects, stability, and porosity, TCPP@UiO-66(25%) was the optimal material in our system. The pseudo-second-order kinetic model and the Sips isothermal model described the adsorption of DF onto defect-engineered MOFs, and the adsorption capacity was 590 mg/g. Electrostatic interaction, Lewis acid-base interaction, π-π interaction, hydrogen bonding, and anion-π interaction were possible adsorption mechanisms. Moreover, under simulated sunlight irradiation, TCPP@UiO-66(25%) was catalytically active for the degradation of DF with a removal efficiency of 99%. It displayed good recyclability during three reaction cycles. The result of electron spin resonance revealed the generation of ¹O₂, implying the occurrence of type II photosensitization reaction. Meanwhile, the first-order rate constants of DF photodegradation after the addition of scavengers confirmed that h⁺ is also a key reactive species. Both the energy transfer from TCPP to triplet oxygen and the electron transfer from TCPP to Zr clusters contributed to the degradation of DF. The degradation byproducts of DF were monitored by three-dimensional excitation-emission matrix (3D EEM). Therefore, TCPP@UiO-66(25%) was an attractive photoregenerable catalytic adsorbent for the effective removal of DF. Combining the advantages of the parent framework and the functional linker, our strategy expands the functionality of the stable MOFs for potential applications in environmental remediation.

Photocatalytic Degradation of Diclofenac Using Al2O3-Nd2O3 Binary Oxides Prepared by the Sol-Gel Method

This paper reports the sol-gel synthesis of Al2O3-Nd2O3 (Al-Nd-x; x = 5%, 10%, 15% and 25% of Nd2O3) binary oxides and the photodegradation of diclofenac activated by UV light. Al-Nd-based catalysts were analyzed by N2 physisorption, XRD, TEM, SEM, UV-Vis and PL spectroscopies. The inclusion of Nd2O3 in the aluminum oxide matrix in the 10-25% range reduced the band gap energies from 3.35 eV for the γ-Al2O3 to values as low as 3.13-3.20 eV, which are typical of semiconductor materials absorbing in the UV region. γ-Al2O3 and Al-Nd-x binary oxides reached more than 92.0% of photoconverted diclofenac after 40 min of reaction. However, the photocatalytic activity in the diclofenac degradation using Al-Nd-x with Nd2O3 contents in the range 10-25% was improved with respect to that of γ-Al2O3 at short reaction times. The diclofenac photoconversion using γ-Al2O3 was 63.0% at 10 min of UV light exposure, whereas Al-Nd-15 binary oxide reached 82.0% at this reaction time. The rate constants determined from the kinetic experiments revealed that the highest activities in the aqueous medium were reached with the catalysts with 15% and 25% of Nd2O3, and these compounds presented the lowest band gap energies. The experimental results also demonstrated that Nd2O3 acts as a separator of charges favoring the decrease in the recombination rate of electron-hole pairs.

Diclofenac Mouthwash as a potential therapy for reducing pain and discomfort in chemo-radiotherapy-induced oral mucositis

AIMS

Oral and/or oropharyngeal acute mucositis during and after chemo-radiotherapy (chemo-RT) for head and neck squamous cell carcinoma (HNSCC) can be extremely painful, sometimes requiring nasogastric feeding to enable adequate nutrition. The MASCC/ISOO evidence-based guidelines recommend benzydamine mouthwash for mucositis prevention in RT (recently updated to include chemo-RT), and a Cochrane systematic review found other agents to be effective in prophylaxis. Diclofenac mouthwash is licensed for painful oral mucosal inflammatory conditions but to our knowledge has not been assessed in chemo-RT-associated oral mucositis.

METHOD

A clinical observation and service evaluation study in 10 patients undergoing chemo-RT for HNSCC to assess the potential value of diclofenac mouthwash (0.74 mg/mL) in reducing symptoms. Patients used 20ml of mouthwash up to 4 times a day starting in week 3 (of a 6-week course of treatment), recording pain and discomfort scores using a visual analogue scale on days 0, 1,7 and 14 (until the end of week 4). As per our current clinical practice, oral mucositis was not clinically scored as an outcome. Statistical analysis was performed using a one-way ANOVA.

RESULTS

Using diclofenac mouthwash, 9/10 patients experienced pain score reduction from day 0 (mean score 6.75 ± SD 1.83) to day 2 (5.05 ± SD 1.62) and day 14 (4.09 ± SD 1.96).

CONCLUSIONS

Diclofenac mouthwash may be beneficial for managing chemo-RT-induced oral mucositis. While a prospective randomised clinical trial is needed, it can be prescribed for this condition within its current licence.

Primary Human Chondrocytes Affected by Cigarette Smoke-Therapeutic Challenges

Although several researchers have attested deleterious effects of smoking to the musculoskeletal system, the association between smoking and the onset of osteoarthritis (OA) remains unclear. Here, we investigate the effect of cigarette smoke extract (CSE) on primary human chondrocytes. The present study demonstrates that physiological concentrations of CSE (0.1%–10%) inhibit the viability, proliferation, and matrix formation of chondrocytes in a dose- and time-dependent manner. Significant amounts of free radicals were generated by 10% of CSE and led to cell death. A clinical dosage (4 mg/mL) of dexamethasone (Dex) showed toxic effects on chondrocytes, and the long-time treatment by lower doses (4–400 μg/mL) induced hypertrophic changes in the chondrocytes. To substitute Dex, diclofenac (Dic, 1 μg/mL) and acetaminophen (Ace, 10 μg/mL) were tested and did not worsen the metabolic activity of CSE-exposed chondrocytes. Hyaluronic acid (HA, 5 mg/mL) combined with Dic or Ace significantly inhibited the oxidative stress and enhanced the viability and matrix formation of CSE-exposed chondrocytes. This study shows for the first time that CSE mediates the disruption of cartilage through inducing cell death by increasing oxidative stress, and that this effect is fortified by Dex. The deleterious effects of CSE on chondrocytes could be reversed by treatment with HA combined with first-line analgesic/anti-inflammatory agents.

Diclofenac does not reduce the risk of acute pancreatitis in patients with primary sclerosing cholangitis after endoscopic retrograde cholangiography

BACKGROUND

The European Society of Gastrointestinal Endoscopy recommends rectal indomethacin or diclofenac before endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis. However, data on the prophylactic effect in patients with primary sclerosing cholangitis (PSC) are lacking.

METHODS

This was a retrospective case-control study. In 2009-2018, a total of 2000 ERCPs were performed in 931 patients with PSC. Case procedures (N = 1000 after November 2013) were performed after administration of rectal diclofenac. Control procedures (N = 1000 before November 2013) were performed with the same indication but without diclofenac. Acute post-ERCP pancreatitis and other ERCP-related adverse events (AEs) were evaluated.

RESULTS

Post-ERCP pancreatitis developed in 49 (4.9%) procedures in the diclofenac group and 62 (6.2%) procedures in the control group (p = 0.241). No difference existed between the groups in terms of the severity of pancreatitis or any other acute AEs. The risk of pancreatitis was elevated in patients with native papilla: 11.4% in the diclofenac group and 8.7% in the control group (p = 0.294). In adjusted logistic regression, diclofenac did not reduce the risk of pancreatitis (odds ratio (OR) = 1.074, 95% confidence interval 0.708-1.629, p = 0.737). However, in generalised estimation equations with the advanced model, diclofenac seemed to diminish the risk of pancreatitis (OR = 0.503) but not significantly (p = 0.110).

CONCLUSION

In this large patient cohort in a low-risk unit, diclofenac does not seem to reduce the risk of post-ERCP pancreatitis in patients with PSC. The trend in the pancreatitis rate after ERCP is decreasing. The evaluation of the benefits of diclofenac among PSC patients warrants a randomised controlled study targeted to high-risk patients and procedures.

Kolaviron Diminishes Diclofenac-Induced Liver and Kidney Toxicity in Wistar Rats Via Suppressing Inflammatory Events, Upregulating Antioxidant Defenses, and Improving Hematological Indices

Diclofenac (DF) is widely used in the treatment of pain and fever. Despite it therapeutic benefits, it triggered hepatorenal injury. Thus, the present study investigated the protective roles of kolaviron (KV) against DF-induced hepatic and renal toxicity in rats. The rats were allotted into groups: control group received propylene glycol and treatment groups received DF, which induced hepatorenal toxicity in rats and different doses of KV that prevented systemic toxicity of DF in rats. Twenty-four hours after the last treatment, all the rats were killed. Pro-inflammatory levels, markers of liver and kidney functions, oxidative stress, hematological indices, and histopathological alterations were evaluated. Diclofenac caused significant increase in the plasma levels of creatinine and urea and activities of liver enzymes, including bilirubin level, pro-inflammatory markers, and plasma prostaglandin E₂ (PGE₂). It also caused significant alteration in renal and hepatic PGE₂, antioxidants, lipid peroxidation (malondialdehyde), and hematological indices. These toxic effects were confirmed by histological studies and levels of inflammatory infiltration (myeloperoxidase). However, KV significantly prevented or reduced the adverse effects of DF in the plasma, liver, and kidney of the rats pretreated with KV before DF administration. This study showed the efficacy of KV as hepatic and renal protector in DF-induced hepatorenal toxicity through reduction of oxidative stress and suppression of inflammation.

Topical Drug Delivery Systems Based on Bacterial Nanocellulose: Accelerated Stability Testing

Bacterial nanocellulose (BNC) membranes have enormous potential as systems for topical drug delivery due to their intrinsic biocompatibility and three-dimensional nanoporous structure, which can house all kinds of active pharmaceutical ingredients (APIs). Thus, the present study investigated the long-term storage stability of BNC membranes loaded with both hydrophilic and lipophilic APIs, namely, caffeine, lidocaine, ibuprofen and diclofenac. The storage stability was evaluated under accelerated testing conditions at different temperatures and relative humidity (RH), i.e., 75% RH/40 °C, 60% RH/25 °C and 0% RH/40 °C. All systems were quite stable under these storage conditions with no significant structural and morphological changes or variations in the drug release profile. The only difference observed was in the moisture-uptake, which increased with RH due to the hydrophilic nature of BNC. Furthermore, the caffeine-loaded BNC membrane was selected for in vivo cutaneous compatibility studies, where patches were applied in the volar forearm of twenty volunteers for 24 h. The cutaneous responses were assessed by non-invasive measurements and the tests revealed good compatibility for caffeine-loaded BNC membranes. These results highlight the good storage stability of the API-loaded BNC membranes and their cutaneous compatibility, which confirms the real potential of these dermal delivery systems.

Intravenous pharmacokinetics of moxifloxacin following simultaneous administration with flunixin meglumine or diclofenac in sheep

In this study, the pharmacokinetics of moxifloxacin (5 mg/kg) was determined following a single intravenous administration of moxifloxacin alone and co-administration with diclofenac (2.5 mg/kg) or flunixin meglumine (2.2 mg/kg) in sheep. Six healthy Akkaraman sheep (2 ± 0.3 years and 53.5 ± 5 kg of body weight) were used. A longitudinal design with a 15-day washout period was used in three periods. In the first period, moxifloxacin was administered by an intravenous (IV) injection. In the second and third periods, moxifloxacin was co-administered with IV administration of diclofenac and flunixin meglumine, respectively. The plasma concentration of moxifloxacin was assayed by high-performance liquid chromatography. The pharmacokinetic parameters were calculated using a two-compartment open pharmacokinetic model. Following IV administration of moxifloxacin alone, the mean elimination half-life (t_1/2β ), total body clearance (Cl_T ), volume of distribution at steady state (V_dss ) and area under the curve (AUC) of moxifloxacin were 2.27 hr, 0.56 L h^-1  kg^-1 , 1.66 L/kg and 8.91 hr*µg/ml, respectively. While diclofenac and flunixin meglumine significantly increased the t_1/2β and AUC of moxifloxacin, they significantly reduced the Cl_T and V_dss . These results suggest that anti-inflammatory drugs could increase the therapeutic efficacy of moxifloxacin by altering its pharmacokinetics.

First Electrochemical Sensor (Screen-Printed Carbon Electrode Modified with Carboxyl Functionalized Multiwalled Carbon Nanotubes) for Ultratrace Determination of Diclofenac

A simple, sensitive and time-saving differential-pulse adsorptive stripping voltammetric (DPAdSV) procedure using a screen-printed carbon electrode modified with carboxyl functionalized multiwalled carbon nanotubes (SPCE/MWCNTs-COOH) for the determination of diclofenac (DF) is presented. The sensor was characterized using optical profilometry, SEM, and cyclic voltammetry (CV). The use of carboxyl functionalized MWCNTs as a SPCE modifier improved the electron transfer process and the active surface area of sensor. Under optimum conditions, very sensitive results were obtained with a linear range of 0.1–10.0 nmol L⁻¹ and a limit of detection value of 0.028 nmol L⁻¹. The SPCE/MWCNTs-COOH also exhibited satisfactory repeatability, reproducibility, and selectivity towards potential interferences. Moreover, for the first time, the electrochemical sensor allows determining the real concentrations of DF in environmental water samples without sample pretreatment steps.

Effect of Controlled Heat Application on Topical Diclofenac Formulations Evaluated by In Vitro Permeation Tests (IVPT) Using Porcine and Human Skin

PURPOSE

Heat therapy is widely used for pain relief and may unintentionally be used in conjunction with pain relieving topical formulations. The purpose of this study was to evaluate the influence of heat on the permeation of diclofenac through porcine and human skin, comparing four marketed products.

METHODS

In vitro permeation tests (IVPT) were performed on porcine skin from a single miniature pig and human skin from three donors. Skin temperature was maintained at either 32 ± 1°C or 42 ± 1°C to mimic normal and elevated skin temperature conditions, respectively.

RESULTS

IVPT studies on porcine and human skin were able to demonstrate heat-induced enhancement in flux and cumulative amount of drug permeated from the four diclofenac products. The pivotal data showed the most significant heat-induced enhancement for the solution, followed by the patch and two gels in decreasing order of significance based on p values. Diclofenac solution showed the highest flux and cumulative amount permeated at both baseline and elevated skin temperature compared to the patch and gels.

CONCLUSIONS

The studies demonstrated that exposure to heat can alter drug permeation from topical formulations, but the increased levels are not expected to lead to systemic concentrations that are of concern. Formulation design and excipients can influence drug permeation at elevated skin temperature.

Removal of Diclofenac, Paracetamol, and Carbamazepine from Model Aqueous Solutions by Magnetic Sol-Gel Encapsulated Horseradish Peroxidase and Lignin Peroxidase Composites

Sustainable and green synthesis of nanocomposites for degradation of pharmaceuticals was developed via immobilization and stabilization of the biological strong oxidizing agents, peroxidase enzymes, on a solid support. Sol–gel encapsulated enzyme composites were characterized using electron microscopy (TEM, SEM), atomic force microscopy, FTIR spectroscopy, and thermogravimetric analysis. Horseradish peroxidase (HRP) and lignin peroxidase (LiP) were adsorbed onto magnetite nanoparticles and sol–gel encapsulated in a surface silica layer. Encapsulation enhanced the stability of the biocatalysts over time and thermal stability. The biocatalysts showed appreciable selectivity in oxidation of the organic drinking water pollutants diclofenac, carbamazepine, and paracetamol with improved activity being pharmaceutical specific for each enzyme. In particular, sol–gel encapsulated LiP- and HRP-based nanocomposites were active over 20 consecutive cycles for 20 days at 55 °C (24 h/cycle). The stability of the sol–gel encapsulated catalysts in acidic medium was also improved compared to native enzymes. Carbamazepine and diclofenac were degraded to 68% and 64% by sol–gel LiP composites respectively at pH 5 under elevated temperature. Total destruction of carbamazepine and diclofenac was achieved at pH 3 (55 °C) within 3 days, in the case of both immobilized HRP and LiP. Using NMR spectroscopy, characterization of the drug decomposition products, and decomposition pathways by the peroxidase enzymes suggested.

Are prescribers not aware of cardiovascular contraindications for diclofenac? A claims data analysis

OBJECTIVES

To compare diclofenac use before and after implementation of European risk minimization measures in 2013, focusing on diclofenac initiators and prevalence of congestive heart failure (NYHA class II-IV), ischaemic heart disease, peripheral arterial disease and cerebrovascular disease (new contraindications) in these patients in Germany.

METHODS

We included adults with health insurance coverage on 1 January 2011 (cohort 2011) or 1 January 2014 (cohort 2014) and during a 1-year pre-observation period. We defined diclofenac initiators as persons filling a prescription of systemic diclofenac in 2011 (cohort 2011) or 2014 (cohort 2014) and without such a prescription during the respective pre-observation period.

RESULTS

Each cohort comprised >10 million persons. Between 2011 and 2014, the age-standardized proportion of persons initiating diclofenac decreased by 29% (from 8.2% to 5.8%) amongst female patients and by 26% (from 8.5% to 6.3%) amongst male patients; in the subgroup of persons with new contraindications, this proportion decreased by 33% (from 9.8% to 6.6%) amongst female patients and by 31% (from 10.0% to 6.7%) amongst male patients. Amongst diclofenac initiators, the proportion of those with new contraindications did not change between 2011 (12.0%) and 2014 (11.8%).

CONCLUSION

The overall decline of about 30% in diclofenac initiation between 2011 and 2014 was largely independent of the presence or absence of new contraindications. The proportion of diclofenac initiators with a new contraindication remained at a high level (more than one in ten patients), demonstrating the need for research at the prescriber level (e.g. interventional studies) and further measures to improve patient safety.

A Facile One-Pot Synthesis of 3-Methylbenzisoxazoles <i>via</i> a Key Intermediate of <i>ortho</i>-Ethoxyvinyl Nitroaryls by Domino Rearrangement and Their Anti- Inflammatory Activity

BACKGROUND

Recently, there has been a lot of scientific interest in exploring the syntheses of oxygen and nitrogen-containing heterocyclic compounds due to their pharmacological activities. In addition, benzisoxazoles play a very important role in organic synthesis as key intermediates.

OBJECTIVE

In this paper, we focused on developing a novel synthetic route for biologically active arylisoxazoles under normal conditions, and simplified it to get high purities and yields, and also reported their anti-inflammatory activities.

METHODS

An efficient and simple method has been explored for the synthesis of novel 3-methyl arylisoxazoles from o-nitroaryl halides via o-ethoxyvinylnitroaryls, using dihydrated stannous chloride (SnCl2.2H2O) in MeOH / EtOAc (1:1) via Domino rearrangement in one pot synthesis.

RESULTS

We synthesized novel 3-methylarylisoxazoles from o-nitroarylhalides via o-ethoxyvinylnitroaryls, using dihydrated stannous chloride (SnCl2.2H2O) in MeOH / EtOAc (1:1) via domino rearrangement. In this reduction, nitro group and ethoxy vinyl group change to the functional acyl ketones, followed by hetero cyclization. Here, the reaction proceeds without the isolation of intermediates like 2-acylnitroarenes and 2- acylanilines. All the synthesized compounds were completely characterized by the NMR and mass spectra. The compounds were also explored for their anti-inflammatory activity by carrageenan-induced inflammation in the albino rats (150-200 g) of either sex used in this entire study with the use of Diclofenac sodium as the standard drug. The initial evaluations identified leading targets with good to moderate anti-inflammatory activity.

CONCLUSION

A simple, one-pot and convenient method has been explored for the synthesis of novel 3- methylarylisoxazoles with high purity and reaction yields. All the compounds 3a, 3c, 3d, 3f, 3g and 3h exhibited 51-64% anti-inflammatory activities.