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Sarwinska D, Grimm M, Krause J, Schick P, Gollasch M, Mannaa M, Ritter CA, Weitschies W. Investigation of real-life drug intake behaviour in older adults and geriatric patients in Northern Germany - A biopharmaceutical perspective. Eur J Pharm Sci 2024; 200:106814. [PMID: 38815699 DOI: 10.1016/j.ejps.2024.106814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
Dosing conditions (type and amount of accompanying fluid, the type of food, the time of administration, and dosage form modifications such as crushing tablets) are critical and affect the performance of oral dosage forms in the gastrointestinal tract and thus bioavailability. Because older adults are the primary users of medications and are more susceptible to adverse effects, it is important to understand how they take their medications in order to reduce risks and increase benefits of the pharmacotherapy. The aim of the study was to investigate the real-life drug intake behaviour in geriatric patients and older adults and discuss their influence on drug absorption after oral administration. The data from two settings home vs. hospital and genders women vs. men were presented. A questionnaire study was performed among people aged at least 65 years from two settings (hospital vs. home), recruited mostly from community pharmacies and a regional hospital in Mecklenburg - Western Pomerania. The obtained data demonstrates that older adults and geriatric patients take their medications in the same way regardless of the setting and gender. There were no significant differences. Interviewed participants were mostly adherent to the doctor's recommendations and mostly took their medications in the same way every day. Medications are most commonly taken with a small (100 mL) or large (200 mL) glass of noncarbonated water, after food (during or after breakfast 64 % of intakes in the morning and during or after dinner 81 % of intakes in the evening). Meal usually consisted of bread, either with jam or honey (breakfast), or ham and cheese (dinner). All reported dosage form modifications were made to tablets. In almost all cases it was splitting the tablet, which was performed due to doctor's indication.
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Affiliation(s)
- Dorota Sarwinska
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489 Greifswald, Germany
| | - Michael Grimm
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489 Greifswald, Germany
| | - Julius Krause
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489 Greifswald, Germany
| | - Philipp Schick
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489 Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Marwan Mannaa
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Christoph A Ritter
- Clinical Pharmacy, Institute of Pharmacy, University of Greifswald, Friedrich-Ludwig-Jahn-Str. 17, 17489 Greifswald, Germany
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489 Greifswald, Germany.
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Nguyen Ngoc Pouplin J, Kaendiao T, Rahimi BA, Soni M, Basopia H, Shah D, Patil J, Dholakia V, Suthar Y, Tarning J, Mukaka M, Taylor WR. Bioequivalence of a new coated 15 mg primaquine formulation for malaria elimination. Malar J 2024; 23:176. [PMID: 38840151 PMCID: PMC11155120 DOI: 10.1186/s12936-024-04947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND With only one 15 mg primaquine tablet registered by a stringent regulatory authority and marketed, more quality-assured primaquine is needed to meet the demands of malaria elimination. METHODS A classic, two sequence, crossover study, with a 10-day wash out period, of 15 mg of IPCA-produced test primaquine tablets and 15 mg of Sanofi reference primaquine tablets was conducted. Healthy volunteers, aged 18-45 years, without glucose-6-phosphate dehydrogenase deficiency, a baseline haemoglobin ≥ 11 g/dL, creatinine clearance ≥ 70 mL/min/1.73 ms, and body mass index of 18.5-30 kg/m2 were randomized to either test or reference primaquine, administered on an empty stomach with 240 mL of water. Plasma primaquine and carboxyprimaquine concentrations were measured at baseline, then 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.333, 2.667, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 8.0, 10.0, 12.0, 16.0, 24.0, 36.0, 48.0 and 72.0 h by liquid chromatography coupled to tandem mass spectrometry. Primaquine pharmacokinetic profiles were evaluated by non-compartmental analysis and bioequivalence concluded if the 90% confidence intervals (CI) of geometric mean (GM) ratios of test vs. reference formulation for the peak concentrations (Cmax) and area under the drug concentration-time (AUC0-t) were within 80.00 to 125.00%. RESULTS 47 of 50 volunteers, median age 33 years, completed both dosing rounds and were included in the bioequivalence analysis. For primaquine, GM Cmax values for test and reference formulations were 62.12 vs. 59.63 ng/mL, resulting in a GM ratio (90% CI) of 104.17% (96.92-111.96%); the corresponding GM AUC0-t values were 596.56 vs. 564.09 ngxh/mL, for a GM ratio of 105.76% (99.76-112.08%). Intra-subject coefficient of variation was 20.99% for Cmax and 16.83% for AUC0-t. Median clearances and volumes of distribution were similar between the test and reference products: 24.6 vs. 25.2 L/h, 189.4 vs. 191.0 L, whilst the median half-lives were the same, 5.2 h. CONCLUSION IPCA primaquine was bioequivalent to the Sanofi primaquine. This opens the door to prequalification, registration in malaria endemic countries, and programmatic use for malaria elimination. Trial registration The trial registration reference is ISRCTN 54640699.
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Affiliation(s)
- Julie Nguyen Ngoc Pouplin
- Réseau Médicaments et Développement, 21Bis Avenue du Commandant l'Herminier, 44600, Saint-Nazaire, France.
| | - Thoopmanee Kaendiao
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
| | - Bilal Ahmad Rahimi
- Department of Paediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mayur Soni
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Hensi Basopia
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Darshana Shah
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Jitendra Patil
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Vyom Dholakia
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Yash Suthar
- Cliantha Research Limited, Cliantha Corporate, Ahmedabad, Gujarat, India
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Walter R Taylor
- Mahidol Oxford Tropical Medicine Clinical Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Großmann L, Springub K, Krüger L, Winter F, Rump A, Kromrey ML, Bülow R, Hosten N, Dressman J, Weitschies W, Grimm M. Is there a fast track ("Darmstrasse") for fluids in the small intestine? Evidence from magnetic resonance imaging. Eur J Pharm Biopharm 2024; 198:114277. [PMID: 38582180 DOI: 10.1016/j.ejpb.2024.114277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/08/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The transit and distribution pattern of fluids in the small intestine is a key parameter for the dissolution and absorption of drugs. Although some information is known about the small intestinal water content after administration of fluid volumes and meals, the intestinal transit of orally ingested fluids and solutions has been barely investigated. The aim of this three-arm, cross-over, 9-subject human study was to investigate the transit of orally ingested water in the small intestine under fasting and postprandial conditions using MRI. To identify the ingested water, manganese gluconate, which can be identified with T1-weighted MRI sequences, was added as a marker. Using Horos (DICOM software), quantification of the distribution of Mn2+ ions in the gastrointestinal tract in fasted versus fed state (standard meal by FDA guidance and a light meal) was possible. The distribution and approximate wetted intestinal length was very similar in the fasting and postprandial states, suggesting rapid transport of water ingested after a meal through the chyme-filled small intestine in continuation of the "Magenstrasse" (stomach road). In some subjects, manganese gluconate reached deeper parts of the small intestine even more quickly in the postprandial state than in the fasting arm of the study. A deeper understanding of the behaviour of solutes in the gastrointestinal tract is fundamental to a mechanistic explanation for the kinetic interaction between food and drug intake (food effects).
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Affiliation(s)
- Linus Großmann
- University of Greifswald, Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, Felix-Hausdorff-Straße 3, 17491 Greifswald, Germany
| | - Katharina Springub
- University of Greifswald, Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, Felix-Hausdorff-Straße 3, 17491 Greifswald, Germany
| | - Linda Krüger
- University of Greifswald, Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, Felix-Hausdorff-Straße 3, 17491 Greifswald, Germany
| | - Fabian Winter
- University of Greifswald, Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, Felix-Hausdorff-Straße 3, 17491 Greifswald, Germany
| | - Adrian Rump
- University of Greifswald, Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, Felix-Hausdorff-Straße 3, 17491 Greifswald, Germany
| | - Marie-Luise Kromrey
- University Medicine Greifswald, Institute for Diagnostic Radiology and Neuroradiology, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Robin Bülow
- University Medicine Greifswald, Institute for Diagnostic Radiology and Neuroradiology, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Norbert Hosten
- University Medicine Greifswald, Institute for Diagnostic Radiology and Neuroradiology, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Jennifer Dressman
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Werner Weitschies
- University of Greifswald, Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, Felix-Hausdorff-Straße 3, 17491 Greifswald, Germany
| | - Michael Grimm
- University of Greifswald, Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, Felix-Hausdorff-Straße 3, 17491 Greifswald, Germany.
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Lee JH, Kuhar S, Seo JH, Pasricha PJ, Mittal R. Computational modeling of drug dissolution in the human stomach: Effects of posture and gastroparesis on drug bioavailability. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2022; 34:081904. [PMID: 35971381 PMCID: PMC9372820 DOI: 10.1063/5.0096877] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/23/2022] [Indexed: 05/25/2023]
Abstract
The oral route is the most common choice for drug administration because of several advantages, such as convenience, low cost, and high patient compliance, and the demand and investment in research and development for oral drugs continue to grow. The rate of dissolution and gastric emptying of the dissolved active pharmaceutical ingredient (API) into the duodenum is modulated by gastric motility, physical properties of the pill, and the contents of the stomach, but current in vitro procedures for assessing dissolution of oral drugs are limited in their ability to recapitulate this process. This is particularly relevant for disease conditions, such as gastroparesis, that alter the anatomy and/or physiology of the stomach. In silico models of gastric biomechanics offer the potential for overcoming these limitations of existing methods. In the current study, we employ a biomimetic in silico simulator based on the realistic anatomy and morphology of the stomach (referred to as "StomachSim") to investigate and quantify the effect of body posture and stomach motility on drug bioavailability. The simulations show that changes in posture can potentially have a significant (up to 83%) effect on the emptying rate of the API into the duodenum. Similarly, a reduction in antral contractility associated with gastroparesis can also be found to significantly reduce the dissolution of the pill as well as emptying of the API into the duodenum. The simulations show that for an equivalent motility index, the reduction in gastric emptying due to neuropathic gastroparesis is larger by a factor of about five compared to myopathic gastroparesis.
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Affiliation(s)
| | - S. Kuhar
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | | | - P. J. Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - R. Mittal
- Author to whom correspondence should be addressed:
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Tompson DJ, Davies C, Scott NE, Cannons EP, Kostapanos M, Gross AS, Powell M, Ino H, Shimamura R, Ogura H, Nagakubo T, Igarashi H, Nakano A. Comparison of the Pharmacokinetics of RIPK1 Inhibitor GSK2982772 in Healthy Western and Japanese Subjects. Eur J Drug Metab Pharmacokinet 2020; 46:71-83. [PMID: 33165774 PMCID: PMC7811991 DOI: 10.1007/s13318-020-00652-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background and Objectives GSK2982772 is an oral small-molecule RIPK1 inhibitor with potential therapeutic efficacy in immune-mediated inflammatory diseases (IMIDs). An inter-ethnic comparison of GSK2982772 pharmacokinetics was conducted based on data from Western (Study 1) and Japanese subjects (Study 2). Methods Both studies were single-centre, randomised, double-blind, placebo-controlled studies with objectives to assess the safety and characterise the pharmacokinetics of GSK2982772. Western subjects in Study 1 (NCT03305419), Part A (N = 15), were randomly assigned to receive 120 mg three times daily (TID), 240 mg TID, or 360 mg twice daily (BID) doses of GSK2982772, or placebo (TID or BID) for 1 day. Part B subjects (N = 47) received GSK2982772 120 mg TID, 240 mg TID, or placebo TID for 14 days. Japanese subjects in Study 2 (N = 13) (NCT03590613) were randomly assigned to receive TID doses of GSK2982772 60, 120, 240 mg TID or placebo TID for 1 day. Results GSK2982772 was well tolerated and adverse events were generally mild. Maximum observed plasma drug concentration (Cmax), time to reach Cmax (Tmax), area under the plasma drug concentration versus time curve after the first GSK2982772 dose (AUC(0–7)) of 120 and 240 mg, and (AUC(0–24)) values for the 120 and 240 mg TID doses over a single day were similar in Japanese and Western subjects. Conclusions The pharmacokinetics and tolerability of GSK2982772 were similar between Western and Japanese subjects, justifying inclusion of Japanese subjects in future global clinical studies to assess the therapeutic potential of RIPK1 inhibition for the treatment of IMIDs. Clinical Trials: NCT03305419 and NCT03590613 available from http://www.clinicaltrials.gov. Electronic supplementary material The online version of this article (10.1007/s13318-020-00652-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Debra J Tompson
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, UK.
| | - Carwyn Davies
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Sydney, NSW, Australia
| | - Nicola E Scott
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Edward P Cannons
- Global Clinical Sciences and Delivery, GlaxoSmithKline, Medicines Research Centre, Stevenage, Hertfordshire, UK
| | - Michalis Kostapanos
- Clinical Care Unit Cambridge, GlaxoSmithKline, and Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Annette S Gross
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Sydney, NSW, Australia
| | - Marcy Powell
- Safety and Medical Governance, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Hiroko Ino
- Clinical Pharmacology, Medicines Development, GlaxoSmithKline, Tokyo, Japan
| | - Ryutaro Shimamura
- Clinical Pharmacology, Medicines Development, GlaxoSmithKline, Tokyo, Japan
| | - Hirofumi Ogura
- Clinical Pharmacology, Medicines Development, GlaxoSmithKline, Tokyo, Japan
| | - Takashi Nagakubo
- Biomedical Data Sciences Department, GlaxoSmithKline, Tokyo, Japan
| | - Harue Igarashi
- Pre-Clinical Development Department, GlaxoSmithKline, Tokyo, Japan
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Karna SR, Singh P, Chambers P, Kongara K. Pharmacokinetics of morphine in combination with dexmedetomidine and maropitant following intramuscular injection in dogs anaesthetized with halothane. J Vet Pharmacol Ther 2019; 43:153-161. [PMID: 31856324 DOI: 10.1111/jvp.12831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate the pharmacokinetics of morphine in combination with dexmedetomidine and maropitant injected intramuscularly in dogs under general anaesthesia. Eight healthy dogs weighing 25.76 ± 3.16 kg and 3.87 ± 1.64 years of age were used in a crossover study. Dogs were randomly allocated to four groups: (1) morphine 0.6 mg/kg; (2) morphine 0.3 mg/kg + dexmedetomidine 5 μg/kg; (3) morphine 0.3 mg/kg + maropitant 1 mg/kg; (4) morphine 0.2 mg/kg + dexmedetomidine 3 μg/kg + maropitant 0.7 mg/kg. Blood samples were collected before, 15 and 30 min, and 1, 2, 3 4, 6 and 8 hr after injection of the test drugs. Plasma concentration of the drugs was determined by liquid chromatography-mass spectrometry. The elimination half-life (T1/2 ) of morphine was higher and the clearance rate (CL) was lower when combined with dexmedetomidine (T1/2 = 77.72 ± 20.27 min, CL = 119.41 ± 23.34 ml kg-1 min-1 ) compared to maropitant (T1/2 = 52.73 min ± 13.823 ml kg-1 min-1 , CL = 178.57 ± 70.55) or morphine alone at higher doses (T1/2 = 50.53 ± 12.55 min, CL = 187.24 ± 34.45 ml kg-1 min-1 ). Combining morphine with dexmedetomidine may increase the dosing interval of morphine and may have a clinical advantage.
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Affiliation(s)
- Sandeep Raj Karna
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Preet Singh
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Paul Chambers
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Kavitha Kongara
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Jotić A, Savić Vujović K, Milovanović J, Vujović A, Radin Z, Milić N, Vučković S, Medić B, Prostran M. Pain Management After Surgical Tonsillectomy: Is There a Favorable Analgesic? EAR, NOSE & THROAT JOURNAL 2019; 98:356-361. [PMID: 31072190 DOI: 10.1177/0145561319846065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to examine how ibuprofen and paracetamol prevent pain after cold-steel extracapsular tonsillectomy in children. Also, we examined the relation between age, gender, nausea, postoperative bleeding, antibiotic use, type of diet, and postoperative pain intensity and the type of administered analgesic. A prospective study was conducted on 147 children (95 males and 52 females, aged 7-17 years) who underwent tonsillectomy in the Clinical-Hospital Center "Dragiša Mišović" from January 1 to June 30, 2016. The degree of pain was measured using a visual analog scale (VAS). We did not observe any significant differences in postoperative nausea, hospitalization rate postoperative bleeding, and antibiotic use between the paracetamol and ibuprofen groups. A test of within-patient effects showed that VAS scores changed significantly during the postoperative follow-up period (P = .00), but there were no significant differences between the groups (P = .778). After 12 hours, 29.3% of the patients on paracetamol and 21.8% on ibuprofen were transferred to a soft diet; after 24 hours, 84.8% of the paracetamol group and 85.5% of the ibuprofen group were on a soft diet (χ2 test, P < .05). There was a statistically significant correlation between VAS scores measured 4 hours after the surgery and the time of transference to the soft diet (Spearman ρ test, P < .001). The transfer to soft and normal diets was not significantly different between the 2 groups as assessed by the VAS scores (Pearson χ2 test, P = .565).There is still no consensus on the most effective postoperative pain-control regiment after tonsillectomy. This study showed that satisfactory pain management was achieved equally with both paracetamol and ibuprofen.
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Affiliation(s)
- Ana Jotić
- 1 Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.,2 Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Savić Vujović
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovica Milovanović
- 1 Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.,2 Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,4 Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,5 Clinic of Maxillofacial Surgery, Sechenov University, Moscow, Russia
| | | | - Zorana Radin
- 7 General hospital "Djorđe Jovanović", Zrenjanin, Serbia
| | - Nataša Milić
- 8 Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.,9 Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Sonja Vučković
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislava Medić
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prostran
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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9
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van Iersel MT, Velinova MI. A Change in Posture Significantly Affects Plasma Concentrations of Large Molecules Such as IgG Antibodies. J Clin Pharmacol 2018; 58:1340-1346. [PMID: 29746712 DOI: 10.1002/jcph.1150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/03/2018] [Indexed: 11/10/2022]
Abstract
In several studies with monoclonal antibodies, we observed spikes in plasma concentration profiles coinciding with a change of posture of study subjects. We hypothesized that these unexpected changes were due to fluid shifts from plasma to the interstitium. The objective of this study was to investigate size and time course of the change in total immunoglobulin G (IgG) concentration after a change in posture. Thirty-two healthy subjects were enrolled. After entry in the clinic, subjects remained upright for at least 1 hour, followed by IgG sampling. Thereafter, subjects remained supine or seated (16 subjects each) for 60 minutes while IgG was sampled frequently. The within-subject day-to-day variability of IgG measured in the same position was only 2.6%. After a change in posture from standing to supine, IgG dropped rapidly in all subjects during the first 10 minutes in the supine position (9.0% decrease) and more slowly thereafter, up to a 12.3% decrease after 60 minutes. After a change in posture from standing to sitting, the decrease in IgG was more variable and modest. After 10 minutes of sitting, IgG was 3.6% lower, and after 60 minutes IgG was 7.8% lower. Changing posture causes a bias of more than 10% in plasma concentrations of total IgG. Most of the change is reached after being 15 minutes in the same position. In clinical trials in which plasma concentrations of high-molecular drugs, highly protein-bound drugs, endogenous proteins, or blood cells are assessed, standardizing posture per time point is a useful approach for reducing variability.
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Affiliation(s)
| | - Maria I Velinova
- Early Development Services, PRA Health Sciences, Groningen, The Netherlands
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Hess C, Unger M, Madea B, Stratmann B, Tschoepe D. Range of therapeutic metformin concentrations in clinical blood samples and comparison to a forensic case with death due to lactic acidosis. Forensic Sci Int 2018; 286:106-112. [DOI: 10.1016/j.forsciint.2018.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/23/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
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Piirainen A, Kokki M, Lidsle HM, Lehtonen M, Ranta VP, Kokki H. Absorption of ibuprofen orodispersible tablets in early postoperative phase - a pharmacokinetic study. Curr Med Res Opin 2018; 34:683-688. [PMID: 29043849 DOI: 10.1080/03007995.2017.1394832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Patient-controlled oral analgesia has gained popularity in postoperative pain management. Anesthesia and surgery delay gastrointestinal tract function and this may therefore decrease bioavailability of drugs taken by mouth. To hasten absorption, an orodispersible ibuprofen tablet has been developed. In this study, we evaluated the pharmacokinetics and feasibility of orodispersible ibuprofen tablets in spine surgery patients. METHODS The study design was a prospective clinical trial where each patient served as her/his own control. Fifteen patients aged 19-75 years were given two orodispersible ibuprofen 200 mg tablets the day before surgery and two more tablets immediately after surgery. Blood samples for ibuprofen concentrations were taken at intervals for 6 hours following pre- and postsurgical administration of ibuprofen. RESULTS The mean preoperative area under time-concentration curve for ibuprofen (AUC0-360) was 4806 (SD 1104) min·mg/L, and after surgery it was 2141 (583) min·mg/L (mean difference 2664, 95% CI for difference 2003 to 3325, p < .001). The mean of the maximum preoperative plasma concentration of ibuprofen was three times higher, 26.7 (7.7) mg/L, than the postoperative value of 8.6 (2.1) mg/L (mean diff. 18.1, 95% CI 13.9 to 22.4, p < .001). Times to maximum concentration were similar pre- and postoperatively at 155 (58) minutes and 169 (113) minutes (p = .67). No serious or unexpected adverse events were recorded. CONCLUSIONS While orodispersible ibuprofen tablets were feasible, ibuprofen absorption decreased immediately after surgery compared to the day before surgery. Thus, further studies are needed to establish the adequate initial postoperative dose.
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Affiliation(s)
- A Piirainen
- a Department of Anaesthesia and Operative Services , Kuopio University Hospital , Kuopio , Finland
- b Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences , University of Eastern Finland
| | - M Kokki
- a Department of Anaesthesia and Operative Services , Kuopio University Hospital , Kuopio , Finland
- b Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences , University of Eastern Finland
| | - H M Lidsle
- c School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - M Lehtonen
- c School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - V P Ranta
- c School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - H Kokki
- a Department of Anaesthesia and Operative Services , Kuopio University Hospital , Kuopio , Finland
- b Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences , University of Eastern Finland
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12
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Krämer M, Heese P, Banger M, Madea B, Hess C. Range of therapeutic prothipendyl and prothipendyl sulfoxide concentrations in clinical blood samples. Drug Test Anal 2017; 10:1009-1016. [PMID: 29027369 DOI: 10.1002/dta.2319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 11/09/2022]
Abstract
Due to a lack of reference blood concentrations in the literature, the forensic evaluation of prothipendyl findings in blood samples is difficult. Interpretations with regard to the assessment of blood concentrations as well as an estimation of the ingested prothipendyl amounts were often vague. To describe a concentration range in clinical samples, prothipendyl and prothipendyl sulfoxide concentrations were determined in serum samples of 50 psychiatric patients receiving 40 mg, 80 mg, or 160 mg doses of prothipendyl. The analyses of prothipendyl and prothipendyl sulfoxide were carried out using validated methods of high performance liquid chromatography coupled to triple quadrupole mass spectrometry (LC-QQQ-MS), respectively. 40 mg doses caused average prothipendyl serum concentrations of 18.0 ng/mL (1 hour after intake) and 7.9 ng/mL (10.5 hours after intake), while 80 mg doses caused averages of 42.6 ng/mL and 15.2 ng/mL at the mentioned times of sampling. Irrespective of the given dose, prothipendyl concentrations below 30 ng/mL were observed in 80% of the patient samples taken 1 hour after ingestion as well as in 90% of the samples collected 10.5 hours after administration. Serum concentrations of the Phase I metabolite prothipendyl sulfoxide averaged 4.3 ng/mL (1 hour after intake) and 3.6 ng/mL (10.5 hours after intake). Possible drug-drug interactions regarding absorption and metabolism of prothipendyl are discussed. Results of the herein presented study are useful for the interpretation of analytical prothipendyl findings in forensic toxicology. The utility of the described concentration range is demonstrated by discussing two death cases involving prothipendyl findings.
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Affiliation(s)
- Michael Krämer
- Institute of Forensic Medicine, Department of Forensic Toxicology, University Bonn, Germany
| | - Peter Heese
- Department of Addiction Disorders and Psychotherapy, LVR Hospital Bonn, Germany
| | - Markus Banger
- Department of Addiction Disorders and Psychotherapy, LVR Hospital Bonn, Germany
| | - Burkhard Madea
- Institute of Forensic Medicine, Department of Forensic Toxicology, University Bonn, Germany
| | - Cornelius Hess
- Institute of Forensic Medicine, Department of Forensic Toxicology, University Bonn, Germany
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13
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Delnomdedieu M, Forsberg A, Ogden A, Fazio P, Yu CR, Stenkrona P, Duvvuri S, David W, Al-Tawil N, Vitolo OV, Amini N, Nag S, Halldin C, Varrone A. In vivo measurement of PDE10A enzyme occupancy by positron emission tomography (PET) following single oral dose administration of PF-02545920 in healthy male subjects. Neuropharmacology 2017; 117:171-181. [PMID: 28122201 DOI: 10.1016/j.neuropharm.2017.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/09/2016] [Accepted: 01/20/2017] [Indexed: 11/30/2022]
Abstract
Phosphodiesterase 10A (PDE10A) is an enzyme highly enriched in the striatal medium spiny neurons. It is involved in the regulation of cytoplasmic levels of cAMP and cGMP and signaling within the basal ganglia. This study with PDE10A radioligand [18F]MNI-659 was designed to measure the enzyme occupancy of PF-02545920 in 8 healthy male volunteers (48 ± 4 years) after a single oral dose (10 mg or 20 mg) and to evaluate safety and tolerability. Arterial blood sampling was performed to obtain a metabolite-corrected plasma input function for the quantification of [18F]MNI-659 binding to PDE10A. The occupancy of PF-02545920 was calculated with two different methods: In Method 1, [18F]MNI-659 enzyme occupancy was calculated from the estimates of binding potential, using the cerebellum as a reference region; in Method 2, occupancy was estimated from the slope of the revised Lassen's plot. Serum concentrations of PF-02545920 were measured to determine the relationship between concentration and occupancy. Based on Method 1, striatal PDE10A occupancy increased with increasing PF-02545920 dose: 14-27% at 10 mg dose (N = 4) and 45-63% at 20 mg dose (N = 3). Comparable occupancies were observed using Lassen's plot Method 2: 10 mg: 14-37%; 20 mg: 46-55%. The relationship between exposure and occupancy was best described using an Emax model. The serum concentration associated with 50% occupancy was estimated to be 93.2 ng/mL. Single oral doses of 10 mg or 20 mg of PF-02545920 were safe and well tolerated in healthy male volunteers [NCT# 01918202].
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Affiliation(s)
| | - Anton Forsberg
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
| | - Adam Ogden
- Pfizer Neuroscience & Pain Research Unit, Cambridge, MA, USA.
| | - Patrik Fazio
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
| | - Ching-Ray Yu
- Pfizer Global Innovative Pharma, New York, NY, USA.
| | - Per Stenkrona
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
| | - Sridhar Duvvuri
- Pfizer Neuroscience & Pain Research Unit, Cambridge, MA, USA.
| | | | | | | | - Nahid Amini
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
| | - Sangram Nag
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
| | - Christer Halldin
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
| | - Andrea Varrone
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
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Licht D, Cohen R, Spiegelstein O, Rabinovich-Guilatt L, Zholkovsky M, Gilbert A, Dressman JB, Safadi M. Is it possible to achieve bio-equivalence between an oral solid immediate-release and an analogue enteric-coated formulation? J Pharm Pharmacol 2016; 68:1278-89. [DOI: 10.1111/jphp.12597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
While bioequivalence between enteric-coated and immediate-release formulations can be achieved in terms of AUC, gastric emptying of enteric-coated dosage forms is a stochastic event, usually leading to lower Cmax values than those observed with the corresponding immediate release. This article examines challenges of developing enteric-coated dosage forms which are bioequivalent to the corresponding immediate-release formulations in terms of both AUC and Cmax using rasagiline as a model compound.
Methods
In vitro drug release profiles of enteric-coated formulations were obtained and compared to those of the immediate-release formulation by dissolution testing. Pharmacokinetics was evaluated in bioequivalence studies in healthy human volunteers after single oral administration of enteric-coated and immediate-release formulations.
Key findings
The initial enteric-coated pellet formulation prototype was equivalent in terms of AUC, but differed in Cmax; a second formulation prototype, consisting of a single-unit core and enteric-coating film, proved to be bioequivalent to immediate-release rasagiline tablets in terms of AUC and Cmax. In vitro, it released rasagiline rapidly at a pH of 6.8.
Conclusions
Despite differences in gastric emptying between disintegrating immediate-release and enteric-coated solid dosage forms, bioequivalence in pharmacokinetic studies was achieved.
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Affiliation(s)
- Dannit Licht
- Discovery and Product Development, Global Research and Development, Teva Pharmaceutical Industries, Ltd, Netanya, Israel
| | - Rachel Cohen
- Discovery and Product Development, Global Research and Development, Teva Pharmaceutical Industries, Ltd, Netanya, Israel
| | - Ofer Spiegelstein
- Discovery and Product Development, Global Research and Development, Teva Pharmaceutical Industries, Ltd, Netanya, Israel
| | - Laura Rabinovich-Guilatt
- Discovery and Product Development, Global Research and Development, Teva Pharmaceutical Industries, Ltd, Netanya, Israel
| | - Marina Zholkovsky
- Discovery and Product Development, Global Research and Development, Teva Pharmaceutical Industries, Ltd, Netanya, Israel
| | - Adrian Gilbert
- Discovery and Product Development, Global Research and Development, Teva Pharmaceutical Industries, Ltd, Netanya, Israel
| | - Jennifer B Dressman
- Department of Pharmaceutical Technology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Muhammad Safadi
- Discovery and Product Development, Global Research and Development, Teva Pharmaceutical Industries, Ltd, Netanya, Israel
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Jelacic S, Bollag L, Bowdle A, Rivat C, Cain KC, Richebe P. Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2016; 30:997-1004. [PMID: 27521969 DOI: 10.1053/j.jvca.2016.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The authors hypothesized that intravenous acetaminophen as an adjunct analgesic would significantly decrease 24-hour postoperative opioid consumption. DESIGN Double-blind, randomized, placebo-controlled trial. SETTING A single academic medical center. PARTICIPANTS The study was comprised of 68 adult patients undergoing cardiac surgery. INTERVENTIONS Patients were assigned randomly to receive either 1,000 mg of intravenous acetaminophen or placebo immediately after anesthesia induction, at the end of surgery, and then every 6 hours for the first 24 hours in the intensive care unit, for a total of 6-1,000 mg doses. MEASUREMENTS AND MAIN RESULTS The primary outcome was 24-hour postoperative opioid consumption. The secondary outcomes included 48-hour postoperative opioid consumption, incisional pain scores, opioid-related adverse effects, length of mechanical ventilation, length of intensive care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48 hours postoperatively. The mean±standard deviation postoperative 24-hour opioid consumption expressed in morphine equivalents was significantly less in the acetaminophen group (45.6±29.5 mg) than in the placebo group (62.3±29.5 mg), representing a 27% reduction in opioid consumption (95% CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and opioid-related adverse effects between the 2 groups. A significantly greater number of patients in the acetaminophen group responded "very much" and "extremely well" when asked how their overall pain experience met their expectation (p = 0.038). CONCLUSIONS The administration of intravenous acetaminophen during cardiac surgery and for the first 24 hours postoperatively reduced opioid consumption and improved patient satisfaction with their overall pain experience but did not reduce opioid side effects.
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Affiliation(s)
| | | | | | - Cyril Rivat
- Department of Anesthesiology and Pain Medicine
| | - Kevin C Cain
- Biostatistics, University of Washington School of Public Health, Seattle, WA
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16
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Tobler A, Hösli R, Mühlebach S, Huber A. Free phenytoin assessment in patients: measured versus calculated blood serum levels. Int J Clin Pharm 2016; 38:303-9. [PMID: 26746902 DOI: 10.1007/s11096-015-0241-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Total serum drug levels are routinely determined for the therapeutic drug monitoring of selected, difficult-to-dose drugs. For some of these drugs, however, knowledge of the free fraction is necessary to adapt correct dosing. Phenytoin, with its non-linear pharmacokinetics, >90 % albumin binding and slow elimination rate, is such a drug requiring individualization in patients, especially if rapid intravenous loading and subsequent dose adaptation is needed. In a prior long-term investigation, we showed the excellent performance of pharmacy-assisted Bayesian forecasting support for optimal dosing in hospitalized patients treated with phenytoin. In a subgroup analysis, we evaluated the suitability of the Sheiner-Tozer algorithm to calculate the free phenytoin fraction in hypoalbuminemic patients. OBJECTIVE To test the usefulness of the Sheiner-Tozer algorithm for the correct estimation of the free phenytoin concentrations in hospitalized patients. SETTING A Swiss tertiary care hospital. METHOD Free phenytoin plasma concentration was calculated from total phenytoin concentration in hypoalbuminemic patients and compared with the measured free phenytoin. The patients were separated into a low (35 ≤ albumin ≥ 25 g/L) and a very low group (albumin <25 g/L) for comparing and statistically analyzing the calculated and the measured free phenytoin concentration. MAIN OUTCOME MEASURES Calculated and the measured free phenytoin concentration. RESULTS The calculated (1.2 mg/L (SD = 0.7) and the measured (1.1 mg/L (SD = 0.5) free phenytoin concentration correlated. The mean difference in the low and the very low albumin group was: 0.10 mg/L (SD = 1.4) (n = 11) and 0.13 mg/L (SD = 0.24) (n = 12), respectively. Although the variability of the data could be a bias, no statistically significant difference between the groups was found: t test (p = 0.78), the Passing-Bablok regression, the Spearman's rank correlation coefficient of r = 0.907 and p = 0.00. The Bland-Altman plot including the regression analysis revealed no systematic differences between the calculated and the measured value [M = 0.11 (SD = 0.28)]. CONCLUSION In absence of a free phenytoin plasma concentration measurement also in hypoalbuminemic patients, the Sheiner-Tozer algorithm represents a useful tool to assist therapeutic monitoring to calculate or control free phenytoin by using total phenytoin and the albumin concentration.
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Affiliation(s)
- Andrea Tobler
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland
| | - Raphael Hösli
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland.
| | - Andreas Huber
- Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
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Remmerie B, Ariyawansa J, De Meulder M, Coppola D, Berwaerts J. Drug-Drug Interaction Studies of Paliperidone and Divalproex Sodium Extended-Release Tablets in Healthy Participants and Patients with Psychiatric Disorders. J Clin Pharmacol 2015; 56:683-92. [DOI: 10.1002/jcph.648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Bart Remmerie
- Janssen Research & Development; Division of Janssen Pharmaceutica NV; Beerse Belgium
| | - Jay Ariyawansa
- Janssen Research & Development; Division of Janssen Pharmaceutica NV; Beerse Belgium
| | - Marc De Meulder
- Janssen Research & Development; Division of Janssen Pharmaceutica NV; Beerse Belgium
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Long-term and short-term effects of hemodialysis on liver function evaluated using the galactose single-point test. ScientificWorldJournal 2014; 2014:260939. [PMID: 25121113 PMCID: PMC4121263 DOI: 10.1155/2014/260939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/15/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022] Open
Abstract
Aim. The galactose single-point (GSP) test assesses functioning liver mass by measuring the galactose concentration in the blood 1 hour after its administration. The purpose of this study was to investigate the impact of hemodialysis (HD) on short-term and long-term liver function by use of GSP test. Methods. Seventy-four patients on maintenance HD (46 males and 28 females, 60.38 ± 11.86 years) with a mean time on HD of 60.77 ± 48.31 months were studied. The GSP values were compared in two groups: (1) before and after single session HD, and (2) after one year of maintenance HD. Results. Among the 74 HD patient, only the post-HD Cr levels and years on dialysis were significantly correlated with GSP values (r = 0.280, P < 0.05 and r = −0.240, P < 0.05, resp.). 14 of 74 patients were selected for GSP evaluation before and after a single HD session, and the hepatic clearance of galactose was similar (pre-HD 410 ± 254 g/mL, post-HD 439 ± 298 g/mL, P = 0.49). GSP values decreased from 420.20 ± 175.26 g/mL to 383.40 ± 153.97 g/mL after 1 year maintenance HD in other 15 patients (mean difference: 19.00 ± 37.66 g/mL, P < 0.05). Conclusions. Patients on maintenance HD for several years may experience improvement of their liver function. However, a single HD session does not affect liver function significantly as assessed by the GSP test. Since the metabolism of galactose is dependent on liver blood flow and hepatic functional mass, further studies are needed.
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Abstract
Delta⁹-tetrahydrocannabinol (THC) competes with the endogenous cannabinoids arachidonoyl ethanolamide (anandamide) and 2-arachidonoyl glycerol (2-AG) at cannabinoid receptors. This may cause adaptive changes in the endocannabinoid signaling cascade with possible consequences for the biological functions of the endocannabinoid system. We show that administration of a single oral dose of 20 mg THC to 30 healthy volunteers resulted in higher circulating concentrations of anandamide, 2-AG, palmitoyl ethanolamide, and oleoylethanolamide at 2 and 3 hours after administration as compared with placebo. At 2 hours after THC administration, changes in oleoylethanolamide plasma concentrations from baseline were linearly related to the THC plasma concentrations. In rats, treatment with the CB₁/CB₂ agonist WIN 55,212 also increased plasma endocannabinoid concentrations. However, this was associated with a decrease of ethanolamide endocannabinoids in specific brain regions including spinal cord, cortex, and hypothalamus; whereas 2-arachidonoyl glycerol increased in the cortex. Thus, administration of THC to human volunteers influenced the concentrations of circulating endocannabinoids, which was mimicked by WIN-55,212 in rats, suggesting that exogenous cannabinoids may lead to changes in the endocannabinoid system that can be detected in plasma.
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20
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Sanaka M, Urita Y, Yamamoto T, Shirai T, Kimura S, Aoyagi H, Kuyama Y. Right recumbent position on gastric emptying of water evidenced by 13C breath testing. World J Gastroenterol 2013; 19:362-5. [PMID: 23372358 PMCID: PMC3554820 DOI: 10.3748/wjg.v19.i3.362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 12/11/2012] [Accepted: 12/15/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the impact of the right recumbent position with the sitting position on gastric emptying of water.
METHODS: In eight healthy male volunteers, the 13C acetate breath test was performed twice to assess gastric emptying of 100 mL tap water. Subjects were seated in one test and lying on their right side in the other. In both positions, pulmonary 13CO2 exhalation curves were obtained by plotting breath data against time. Percent gastric retention curves were created by analyzing data using the Wagner-Nelson protocol.
RESULTS: No significant posture effect was found in pulmonary 13CO2 output curves (P = 0.2150), whereas a significant effect was seen in gastric retention curves (P = 0.0315). The percent retention values at 10 min and 15 min were significantly smaller when subjects were in the right recumbent position compared with the seated position (P < 0.05). Our results verified the accelerating effect of the right recumbent position on gastric emptying of non-nutritive solutions. Concerning clinical implications, this study suggests that placing patients with acute pain on their right side after oral administration of analgesic drugs in solution is justified as an effective practice for rapid pain relief. For patients with gastrointestinal reflux symptoms, sleeping in the right recumbent position may reduce nocturnal symptoms, as delayed gastric emptying can cause reflux symptoms.
CONCLUSION: Gastric emptying of water occurs more quickly when a subject lies on the right side compared with sitting.
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Hosli R, Tobler A, Konig S, Muhlebach S. A Quantitative Phenytoin GC-MS Method and its Validation for Samples from Human ex situ Brain Microdialysis, Blood and Saliva Using Solid-Phase Extraction. J Anal Toxicol 2013; 37:102-9. [DOI: 10.1093/jat/bks137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Singla NK, Parulan C, Samson R, Hutchinson J, Bushnell R, Beja EG, Ang R, Royal MA. Plasma and Cerebrospinal Fluid Pharmacokinetic Parameters After Single-Dose Administration of Intravenous, Oral, or Rectal Acetaminophen. Pain Pract 2012; 12:523-32. [DOI: 10.1111/j.1533-2500.2012.00556.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ohmure H, Takada H, Nagayama K, Sakiyama T, Tsubouchi H, Miyawaki S. Mastication Suppresses Initial Gastric Emptying by Modulating Gastric Activity. J Dent Res 2011; 91:293-8. [DOI: 10.1177/0022034511433847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Because various mastication-related factors influence gastric activity, the functional relationship between mastication and gastric function has not been fully elucidated. To investigate the influence of mastication on gastric emptying and motility, we conducted a randomized trial to compare the effects of mastication on gastric emptying and gastric myoelectrical activity under conditions that excluded the influences of food comminution, taste, and olfaction. A 13C-acetate breath test with electrogastrography and electrocardiography was performed in 14 healthy men who ingested a test meal with or without chewing gum. Autonomic nerve activity was evaluated by fluctuation analysis of heart rate. Gastric emptying was significantly delayed in the ‘ingestion with mastication’ group. Gastric myoelectrical activity was significantly suppressed during mastication and increased gradually in the post-mastication phase. A decrease in the high-frequency power of heart rate variability was observed coincidentally with gastric myoelectrical activity suppression. These findings suggest that initial gastric emptying is suppressed by mastication, and that the suppression is caused by mastication-induced inhibition of gastric activity (UMIN Clinical Trial Registration no. UMIN000005351).
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Affiliation(s)
- H. Ohmure
- Kagoshima University Graduate School of Medical and Dental Sciences, Department of Orthodontics, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - H. Takada
- Kagoshima University Graduate School of Medical and Dental Sciences, Department of Orthodontics, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - K. Nagayama
- Kagoshima University Graduate School of Medical and Dental Sciences, Department of Orthodontics, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - T. Sakiyama
- Kagoshima University Medical and Dental Hospital, Division of Endoscopy, Kagoshima, Japan
| | - H. Tsubouchi
- Kagoshima University Graduate School of Medical and Dental Sciences, Department of Digestive Disease and Lifestyle related Disease, Kagoshima, Japan
| | - S. Miyawaki
- Kagoshima University Graduate School of Medical and Dental Sciences, Department of Orthodontics, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
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Queckenberg C, Wachall B, Erlinghagen V, Di Gion P, Tomalik-Scharte D, Tawab M, Gerbeth K, Fuhr U. Pharmacokinetics, pharmacodynamics, and comparative bioavailability of single, oral 2-mg doses of dexamethasone liquid and tablet formulations: a randomized, controlled, crossover study in healthy adult volunteers. Clin Ther 2011; 33:1831-41. [PMID: 22047811 DOI: 10.1016/j.clinthera.2011.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/11/2011] [Accepted: 10/12/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dexamethasone is a glucocorticoid used widely worldwide for immunosuppressive treatment, allergies, bronchiolitis, and croup, among others. For children, liquid formulations are especially suitable because, compared with other dosage forms, both exact dosing and proper intake are facilitated. OBJECTIVE The objective was to evaluate the pharmacokinetics, pharmacodynamics, and comparative bioavailability of a commercial liquid oral dexamethasone formulation intended for pediatric use relative to those of a tablet. METHODS In a randomized, controlled, crossover study in 24 healthy adult volunteers, we administered single doses of the liquid and tablet formulation, containing 2 mg of dexamethasone each. Blood samples were taken up to 24 hours postdose. Quantification was carried out using a validated specific and sensitive high-pressure liquid chromatography with UV detector method. Noncompartmental pharmacokinetic parameters were compared between treatments according to European Medicines Agency (EMA) bioequivalence guidelines. For AUC(0-t) and C(max), the 90% CI for the ratio of the test and reference products should be contained within the predetermined acceptance interval of 80% to 125%. As a pharmacodynamic variable, we measured suppression of endogenous cortisol (predose and postdose). RESULTS Both preparations showed similar pharmacokinetic and pharmacodynamic profiles but high between-subject variability of pharmacokinetic key parameters and endogenous cortisol concentrations (>30%). Mean AUC(0-t), AUC(0-∞), and C(max) were 37.8 ng/mL/h, 46.0 ng/mL/h, and 9.35 ng/mL, respectively, for the liquid and 41.3 ng/mL/h, 48.1 ng/mL/h, and 9.17 ng/mL, respectively, for the tablet formulation. T(max) was 0.89 hour (liquid) and 0.97 hour (tablet). The point estimates and 90% CIs for AUC(0-t), AUC(0-∞), and C(max) ratios (liquid vs tablet) were 91.42% (82.05%-101.86%), 95.72% (84.46%-108.5%), and 102.04% (86.94%-119.76%), respectively. Thus, point estimates and 90% CIs were within the bioequivalence range of 80% to 125% for all relevant parameters, including the pharmacodynamic parameter AUEC (area under the effect curve). CONCLUSIONS This single-dose study suggests that the test and reference products met the EMA regulatory criteria to assume bioequivalence in these fasting healthy male and female volunteers. German Register of Clinical Trials registration number: DRKS00000785.
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Affiliation(s)
- Christian Queckenberg
- Department of Pharmacology, Clinical Pharmacology, Hospital of the University of Cologne, Cologne, Germany
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Biller S, Baumgarten D, Haueisen J. A novel marker design for magnetic marker monitoring in the human gastrointestinal tract. IEEE Trans Biomed Eng 2011; 58:3368-75. [PMID: 21968707 DOI: 10.1109/tbme.2011.2166074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic marker monitoring (MMM) is a technique to determine the motility of the gastrointestinal tract and to observe the dissolution of pharmaceutical compounds. Today's magnetic markers usually consist of magnetized magnetite. Because of their weak magnetic fields, highly sensitive sensor systems are required. For a wider class of applications, stronger markers and more flexible measurement setups are necessary. In this paper, a novel marker design is introduced. This marker comprises one permanent magnet and a compartment of iron powder in a magnetically unstable configuration. During dissolution of the pharmaceuticals, the powder is redistributed around the magnet, thereby altering the externally measured magnetic induction. Based on this design, magnetically marked tablets and capsules were prepared and their magnetic field during dissolution was observed. Magnetic induction values were between 16 and 0.2 μT at distances of 5-30 cm, which is considerably higher compared to the pico-Tesla range of conventional markers. During dissolution, the magnetic induction decreased by between 14% and 27%. These values could be confirmed in detailed finite element method simulations. In conclusion, the present results indicate that our novel marker design is well suited for MMM with more flexible sensor technologies, such as magnetoresistive sensors.
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Affiliation(s)
- Sebastian Biller
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau D-98684, Germany.
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Lim MD, Dickherber A, Compton CC. Before you analyze a human specimen, think quality, variability, and bias. Anal Chem 2010; 83:8-13. [PMID: 21114268 DOI: 10.1021/ac1018974] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Personalized medicine requires capabilities to detect and measure health-associated biomarkers with increasingly specific and sensitive methods, putting analytical chemists at the front lines of translational research. Analytical scientists must be upstream in the experimental design process because the analysis of a biospecimen (tissue, blood, etc.) presents technical and experimental design complexities. (To listen to a podcast about this feature, please go to the Analytical Chemistry multimedia page at pubs.acs.org/page/ancham/audio/index.html.).
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Affiliation(s)
- Mark David Lim
- AAAS Science and Technology Policy Fellowship Program and National Cancer Institute, National Institutes of Health, USA
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Circadian Rhythmicity in Levodopa Pharmacokinetics in Patients With Parkinson Disease. Clin Neuropharmacol 2010; 33:181-5. [DOI: 10.1097/wnf.0b013e3181e70f7a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ma JD, Nafziger AN, Mylott W, Haughey DB, Rocci ML, Bertino JS. Lack of effect of subject posture on intravenous midazolam clearance: implications for hepatic cytochrome P450 3A phenotyping. Br J Clin Pharmacol 2008; 67:374-5. [PMID: 19220276 DOI: 10.1111/j.1365-2125.2008.03361.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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