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Bor S, Kalkan İH, Savarino E, Rao S, Tack J, Pasricha J, Cangemi D, Schol J, Karunaratne T, Ghisa M, Ahuja NK, Lacy B. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36:e14774. [PMID: 38462678 DOI: 10.1111/nmo.14774] [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] [Received: 09/30/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects. PURPOSE Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.
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Affiliation(s)
- Serhat Bor
- Division of Gastroenterology, School of Medicine & Ege Reflux Study Group, Ege University, Izmir, Turkey
| | - İsmail H Kalkan
- Department of Gastroenterology, School of Medicine, TOBB University of Economics and Technology, Ankara, Turkey
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy
| | - Satish Rao
- Division of Gastroenterology and Hepatology, Digestive Health Center, Augusta University, Augusta, Georgia, USA
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jay Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Cangemi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jolien Schol
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Tennekon Karunaratne
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matteo Ghisa
- Digestive Endoscopy Unit, Division of Gastroenterology, Padua University Hospital, Padua, Italy
| | - Nitin K Ahuja
- Division of Gastroenterology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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2
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Umer MR, Mejia Crespo WE, Dugan S, Javed H, Suleman M, Afzal MW, Mumtaz H, Saqib M, Malik HM, Iftikhar M. Lansoprazole plus levosulpiride versus esomeprazole in participants with gastroesophageal reflux disease and erosive esophagitis: a double blinded randomized control trial. Ann Med Surg (Lond) 2023; 85:4866-4876. [PMID: 37811050 PMCID: PMC10553095 DOI: 10.1097/ms9.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023] Open
Abstract
Aim The aim was to compare the efficacy and safety of lansoprazole plus levosulpiride over esomeprazole. Methodology This randomized control trial recruited 1000 participants having symptomatic gastroesophageal reflux disease (GERD) and erosive esophagitis and they were blindly randomized into two groups in a 1:1 ratio with appropriate concealment. Group 1 was given lansoprazole plus levosulpiride combination twice daily whereas group 2 was prescribed only esomeprazole twice daily. The primary efficacy endpoint was the healing of erosive esophagitis and GERD at week 49. Secondary assessments included improvement in quality of life. Participants' quality of life was assessed before starting the treatment and post-treatment using a short-form health survey questionnaire (SF-36). Results The lansoprazole plus levosulpiride group had significantly lower rates of positive postintervention GERD and erosive esophagitis status, and higher rates of sustained resolution of heartburn compared to the esomeprazole alone group. However, the lansoprazole plus levosulpiride group also had a higher risk of nausea. Conclusion Lansoprazole plus levosulpiride is a more effective and safe treatment for GERD than esomeprazole alone. Participants in the lansoprazole plus levosulpiride group showed a significantly higher rate of sustained resolution of GERD, lower rates of postintervention GERD and erosive esophagitis status, and a higher incidence of nausea compared to the esomeprazole alone group. Although quality of life worsened in both groups, adverse effects did not significantly differ. These findings strongly support the use of lansoprazole plus levosulpiride as a preferred treatment option for GERD and erosive esophagitis, which could have significant clinical implications for managing this common condition.
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Affiliation(s)
| | | | | | | | - Muhammad Suleman
- Riphah International University Islamic International Medical College, Rawalpindi
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3
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Ullah A, Atia-tul-Wahab, Gong P, Khan AM, Choudhary MI. Identification of new inhibitors of NS5 from dengue virus using saturation transfer difference (STD-NMR) and molecular docking studies. RSC Adv 2022; 13:355-369. [PMID: 36605638 PMCID: PMC9768849 DOI: 10.1039/d2ra04836a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
The rapid spread of dengue virus has now emerged as a major health problem worldwide, particularly in tropical and sub-tropical regions. Nearly half of the human population is at risk of getting infection. Among the proteomes of dengue virus, nonstructural protein NS5 is conserved across the genus Flavivirus. NS5 comprises methyltransferase enzyme (MTase) domain, which helps in viral RNA capping, and RNA-dependent RNA polymerase (RdRp) domain, which is important for the virus replication. Negative modulation of NS5 decreases its activity and associated functions. Despite recent advances, there is still an immense need for effective approaches toward drug discovery against dengue virus. Drug repurposing is an approach to identify the new therapeutic indications of already approved drugs, for the treatment of both common and rare diseases, and can potentially lower the cost, and time required for drug discovery and development. In this study, we evaluated 75 compounds (grouped into 15 mixtures), including 13 natural compounds and 62 drugs, by using biophysical methods, for their ability to interact with NS5 protein, which were further validated by molecular docking and simulation studies. Our current study led to the identification of 12 ligands, including both 9 US-FDA approved drugs and 3 natural products that need to be further studied as potential antiviral agents against dengue virus.
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Affiliation(s)
- Asmat Ullah
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of KarachiKarachi75270Pakistan
| | - Atia-tul-Wahab
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of KarachiKarachi75270Pakistan
| | - Peng Gong
- Wuhan Institute of Virology, Chinese Academy of SciencesWuhanHubei 430071China
| | - Abdul Mateen Khan
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of KarachiKarachi75270Pakistan
| | - M. Iqbal Choudhary
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center of Chemical and Biological Sciences, University of KarachiKarachi75270Pakistan,H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of KarachiKarachi75270Pakistan,Department of Biochemistry, Faculty of Science, King Abdulaziz UniversityJeddah-21589Saudi Arabia
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Arshad A, Irfan M, Inam M, Hussain NHN, Ismail SB. Levosulpiride for Premature Ejaculation: A Systematic Review and Meta-Analysis. Am J Mens Health 2022; 16:15579883221124832. [PMID: 36154321 PMCID: PMC9515538 DOI: 10.1177/15579883221124832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Premature ejaculation (PE) is one of the major causes of sexual dysfunction. Levosulpiride is an off-label medicine used to treat PE, but no review on its efficacy exists. A systematic review and meta-analysis was performed to determine the efficacy of levosulpiride in treating PE. Databases PubMed, Science Direct, and Google Scholar were searched. Randomized control trials (RCTs) comparing levosulpiride with placebo or other medicine were selected. Odds ratio (OR) of improved intravaginal ejaculation latency time (IELT) was calculated. A total of 97 articles were retrieved from database search, of which only four RCTs containing 203 men met the selection criteria. All four RCTs were included in systematic review while only two were included in meta-analysis. A high selection and detection bias was found in both of these studies. Meta-analysis also showed the odds of improving IELT in PE patients using levosulpiride to be significantly higher (p < .05) compared with those who used placebo, OR: 100.81, 95% confidence interval (CI) [13.12-774.90], I2 = 0%. Odds of improving IELT for > 5 min (500% improvement) were also significantly higher (p < .05) compared with the placebo groups (OR: 38.88, 95% CI [5.12-295.29], I2 = 0%). The odds of improving IELT for > 1 min, but < 5 min were also significantly higher (p < .05) than placebo groups (OR: 32.84, 95% CI [4.15-259.75], I2 = 0%). Levosulpiride improved IELT, but even so, limited studies are available on this topic. Additional research is thus required to support the present review's findings.
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Affiliation(s)
- Adina Arshad
- Department of Zoology, Wildlife
and Fisheries, Pir Mehr Ali Shah, Arid Agriculture University, Rawalpindi,
Pakistan
| | - Muhammad Irfan
- Department of Zoology, Wildlife
and Fisheries, Pir Mehr Ali Shah, Arid Agriculture University, Rawalpindi,
Pakistan
| | - Muhammad Inam
- Department of Zoology, University
of the Punjab, Lahore, Pakistan,BISP, C & T Wing, Pakistan
Secretariat, Islamabad, Pakistan
| | - Nik Hazlina Nik Hussain
- Women’s Health Development Unit,
School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang
Kerian, Malaysia
| | - Shaiful Bahari Ismail
- Department of Family Medicine,
School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang
Kerian, Malaysia,Shaiful Bahari Ismail, Department
of Family Medicine, School of Medical Sciences, Health Campus,
Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Habib R, Azad AK, Akhlaq M, Al-Joufi FA, Shahnaz G, Mohamed HRH, Naeem M, Almalki ASA, Asghar J, Jalil A, Abdel-Daim MM. Thiolated Chitosan Microneedle Patch of Levosulpiride from Fabrication, Characterization to Bioavailability Enhancement Approach. Polymers (Basel) 2022; 14:polym14030415. [PMID: 35160403 PMCID: PMC8839939 DOI: 10.3390/polym14030415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
In this study, a first attempt has been made to deliver levosulpiride transdermally through a thiolated chitosan microneedle patch (TC-MNP). Levosulpiride is slowly and weakly absorbed from the gastrointestinal tract with an oral bioavailability of less than 25% and short half-life of about 6 h. In order to enhance its bioavailability, levosulpiride-loaded thiolated chitosan microneedle patches (LS-TC-MNPs) were fabricated. Firstly, thiolated chitosan was synthesized and characterized by nuclear magnetic resonance (1HNMR) spectroscopy, attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy, differential scanning calorimetry (DSC), and X-ray diffraction (XRD). Thiolated chitosan has been used in different drug delivery systems; herein, thiolated chitosan has been used for the transdermal delivery of LS. LS-TC-MNPs were fabricated from different concentrations of thiolated chitosan solution. Furthermore, the levosulpiride-loaded thiolated chitosan microneedle patch (LS-TC-MNP) was characterized by FTIR spectroscopic analysis, scanning electron microscopy (SEM) study, penetration ability, tensile strength, moisture content, patch thickness, and elongation test. LS-TC-MNP fabricated with 3% thiolated chitosan solution was found to have the best tensile strength, moisture content, patch thickness, elongation, drug-loading efficiency, and drug content. Thiolated chitosan is biodegradable, nontoxic and has good absorption and swelling in the skin. LS-TC-MNP-3 consists of 100 needles in 10 rows each with 10 needles. The length of each microneedle was 575 μm; they were pyramidal in shape, with sharp pointed ends and a base diameter of 200 µm. The microneedle patch (LS-TC-MNP-3) resulted in-vitro drug release of 65% up to 48 h, ex vivo permeation of 63.6%, with good skin biocompatibility and enhanced in-vivo pharmacokinetics (AUC = 986 µg/mL·h, Cmax = 24.5 µg/mL) as compared to oral LS dispersion (AUC = 3.2 µg/mL·h, Cmax = 0.5 µg/mL). Based on the above results, LS-TC-MNP-3 seems to be a promising strategy for enhancing the bioavailability of levosulpiride.
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Affiliation(s)
- Rukhshanda Habib
- Faculty of Pharmacy, Gomal University, Dera Ismail Khan 29050, Pakistan; (R.H.); (M.A.); (J.A.)
- Department of Pharmacology, University of Oxford, Mansfield Rd., Oxford OX1 3QT, UK
- Department of Pharmacy, Quaid-I-Azam University, Islamabad 45320, Pakistan;
- Department of Biotechnology, Quaid-I-Azam University, Islamabad 45320, Pakistan;
| | - Abul Kalam Azad
- Pharmaceutical Technology Unit, Faculty of Pharmacy, AIMST University, Bedong 08100, Kedah, Malaysia
- Correspondence: (A.K.A.); (M.M.A.-D.)
| | - Muhammad Akhlaq
- Faculty of Pharmacy, Gomal University, Dera Ismail Khan 29050, Pakistan; (R.H.); (M.A.); (J.A.)
| | - Fakhria A. Al-Joufi
- Department of Pharmacology, College of Pharmacy, Jouf University, Skaka 72341, Saudi Arabia;
| | - Gul Shahnaz
- Department of Pharmacy, Quaid-I-Azam University, Islamabad 45320, Pakistan;
| | - Hanan R. H. Mohamed
- Zoology Department, Faculty of Science, Cairo University, Giza 12613, Egypt;
| | - Muhammad Naeem
- Department of Biotechnology, Quaid-I-Azam University, Islamabad 45320, Pakistan;
| | - Abdulraheem S. A. Almalki
- Department of Chemistry, Faculty of Science, Taif University, P.O. Box 11099, Taif 21974, Saudi Arabia;
| | - Junaid Asghar
- Faculty of Pharmacy, Gomal University, Dera Ismail Khan 29050, Pakistan; (R.H.); (M.A.); (J.A.)
| | - Aamir Jalil
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Mohamed M. Abdel-Daim
- Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, P.O. Box 6231, Jeddah 21442, Saudi Arabia
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: (A.K.A.); (M.M.A.-D.)
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Wang L, She X, Chen Z, Quan S, Liu Y, Mai X, Yuan T, Fan H. Preparation and characterization of a chiral molecularly imprinted polymer with a novel functional monomer for controlled release of S-sulpiride. Int J Pharm 2021; 601:120526. [PMID: 33781882 DOI: 10.1016/j.ijpharm.2021.120526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 12/23/2022]
Abstract
A novel molecularly imprinted polymer (MIP) with chiral recognition affinity to S-sulpiride (S-SUL) enantiomer was prepared by using newly synthesized N-acryloyl-tryptophan (ATrp) as function monomer, S-SUL as the template molecule, and ethyleneglycol dimethacrylate (EGDMA) as the cross linker. Under the optimized synthesis conditions, the MIP was synthesized by bulk polymerization according to the molar ratio of 1:4 of S-SUL to ATrp, and structurally characterized by Fourier transform infrared spectroscopy (FT-IR), scanning electron microscope (SEM) and laser particle analysis. The results illustrated that the MIP offered uniform, loose and porous structure. The adsorption performance of the MIP was evaluated by the isotherm and kinetic models, and the adsorption isotherm conformed to the Freundlich model. The maximum adsorption capacity, selectivity factor and enantioselectivity coefficient to S-SUL were respectively 226.2389 µmol/g, 2.34 and 11.66. Based on the chiral recognition specificity, the drug release experiments demonstrated that the MIP as controlled and sustained release carrier could inhibit the release rate of S-enantiomer compared to the tablet without the MIP, exhibiting the potential of the MIP synthesized in chiral drug delivery.
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Affiliation(s)
- Liping Wang
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China; Guangdong Institute of Analysis (China National Analytical Center), Guangdong Academy of Science, Guangzhou 510070, China
| | - Xuhui She
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China; Guangzhou KingMed Center for Clinical Laboratory Co., Ltd., Guangzhou 510005, China
| | - Zhi Chen
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Sisi Quan
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yingtao Liu
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Xiaoman Mai
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Tiefeng Yuan
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Huajun Fan
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou 510006, China.
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7
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Joe J. Levosulpiride-Induced Neurological Adverse Effects: A Prospective Study from a Tertiary Care Center. Ann Indian Acad Neurol 2020; 23:174-176. [PMID: 32189857 PMCID: PMC7061517 DOI: 10.4103/aian.aian_449_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 11/04/2022] Open
Abstract
Background Levosulpiride (LS) is a prokinetic drug increasingly used for the gastric motility disorders. Despite its common use for the gastric motility disorder, the tendency to cause parkinsonism and acute dystonias are under-recognized as the major adverse effects. This study was aimed to evaluate the adverse effects of this drug in patients attending neurology clinics. Methods Patients presenting with new-onset extrapyramidal symptoms with respect to LS therapy were selected for the study. A detailed history had been taken using a questionnaire. All the patients were tested for neurological manifestations. The number of cases was then statistically analyzed. Results A total of 30 patients were diagnosed with LS-induced movement disorders. The average age of patients was 65 ± 12 years with 17 males and remaining females. Major presentations were tremor, stiffness, dystonia, neck or back pain, dysarthria, and abnormal feelings. Stiffness, tremor, or both were among the most common signs. A statistically significant (P = 0.0154) positive correlation (r = 0.8295) was found between the duration of LS treatment and incidence of tremor/stiffness. Among them, 19 patients were started with dopaminergic drugs and five were given symptomatic measures. Six patients had no follow-up. Conclusion The LS treatment was found to produce adverse effects such as tremor and stiffness. Early recognition of this condition is essential for its complete cure and better prognosis. Therefore, one should be cautious about the LS as one of the etiologies for acute recent-onset extrapyramidal syndromes while working up patients.
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Affiliation(s)
- Jacob Joe
- Department of Neurology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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Łebkowska-Wieruszewskal B, Sartini I, Barsotti G, Camillo F, Rota A, Panzani D, Poapolathep A, Giorgi M. Pharmacokinetics of levosulpiride after single-dose administration by different routes in sheep (Ovis aries Linnaeus). Small Rumin Res 2019. [DOI: 10.1016/j.smallrumres.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Łebkowska-Wieruszewska B, Barsotti G, Camillo F, Rota A, Panzani D, Poapolathep A, Lisowski A, Giorgi M. Pharmacokinetics of levosulpiride after single-dose administration in goats (Capra hircus) by different routes of administration. J Vet Pharmacol Ther 2019; 42:440-446. [PMID: 31206720 DOI: 10.1111/jvp.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/23/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
Abstract
Levosulpiride (LSP) is the l-enantiomer of sulpiride, and LSP recently replacing sulpiride in several EU countries. Several studies about LSP in humans are present in the literature, but neither pharmacodynamic nor pharmacokinetic data of LSP is present for veterinary species. The aim of this study was to assess the pharmacokinetic profile of LSP after intravenous (IV), intramuscular (IM), and oral (PO) administration in goats. Animals (n = 6) were treated with 50 mg LSP by IV, IM, and PO routes according to a randomized cross-over design (3 × 3 Latin-square). Blood samples were collected prior and up to 24 hr after LSP administration and quantified using a validated HPLC method with fluorescence detection. IV and IM administration gave similar concentration versus time curve profiles. The IM mean bioavailability was 66.97%. After PO administration, the drug plasma concentrations were detectable only in the time range 1.5-4 hr, and the bioavailability (4.73%) was low. When the AUC was related to the administered dose in mg/kg, there was a good correlation in the IV and IM groups, but very low correlation for the PO route. In conclusion, the IM and IV administrations result in very similar plasma concentrations. Oral dosing of LSP in goats is probably not viable as its oral bioavailability was very low.
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Affiliation(s)
| | | | | | - Alessandra Rota
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Duccio Panzani
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Amnart Poapolathep
- Department of Pharmacology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Andrzej Lisowski
- Department of Biology and Animal Breeding, University of Life Sciences, Lublin, Poland
| | - Mario Giorgi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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Mishra D, Niranjan V, Kumar P. Levosulpiride-Induced Restless Leg Syndrome: A Case Report. PSYCHOSOMATICS 2019; 60:80-82. [PMID: 29776681 DOI: 10.1016/j.psym.2018.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/24/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Vijay Niranjan
- Department of Psychiatry, M.G.M. Medical College, Indore, MP, India
| | - Pradeep Kumar
- Department of Psychiatry, S. S. Medical College, Rewa, MP, India
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SAMIE M, BASHIR S, ABBAS J, KHAN S, AMAN N, JAN H, MUHAMMAD N. Design, Formulation and In Vitro Evaluation of Sustained-release Tablet Formulations of Levosulpiride. Turk J Pharm Sci 2018; 15:309-318. [PMID: 32454675 PMCID: PMC7227831 DOI: 10.4274/tjps.29200] [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: 08/28/2017] [Accepted: 11/02/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Levosulpiride is a widely used gastroprokinetic agent in the treatment of various gastric disorders; however, its short half-life and increased dosage frequency leads to non-compliance and possible adverse effects. The prime objective of the current study was to develop a sustained-release formulation of Levosulpiride incorporating bioresorbable cellulose derivatives. MATERIALS AND METHODS Sustained-release formulations of Levosulpiride were prepared through direct compression using various cellulose derivatives such as CMC sodium, HPC, and HPMC in different polymer-to-drug weight ratios as release-modifying polymers. The powder blends and compressed tablets were then subjected to pre-compressional and post-compressional evaluation, as well as FTIR analysis. In vitro release studies were performed for all formulations of the model drug in buffer solution of pH 6.8 at a wave length of 214 nm by a UV-visible light spectrophotometer. RESULTS The FTIR results confirmed that the interaction between components was physical, and from the different kinetic models data, the release profile was best expressed by the Higuchi model because the results showed high linearity. The results also showed formulation F9 to be the ideal one among the developed formulations, exhibiting sustained- release behavior. CONCLUSION Levosulpiride sustained-release matrices were prepared successfully using CMC sodium, HPC, and HPMC as the release-retarding polymer/carrier.
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Affiliation(s)
- Muhammad SAMIE
- COMSATS Institute of Information Technology, Department of Pharmacy, Abbottabad, Pakistan
| | - Sajid BASHIR
- Sargodha University, Faculty of Pharmacy, Sargodha, Pakistan
| | - Jabbar ABBAS
- People’s University of Medical and Health Sciences for Women, Institute of Pharmaceutical Sciences, Shaheed Benazir Abad, Pakistan
| | - Samiullah KHAN
- COMSATS Institute of Information Technology, Department of Pharmacy, Abbottabad, Pakistan
| | - Nargis AMAN
- COMSATS Institute of Information Technology, Department of Pharmacy, Abbottabad, Pakistan
| | - Habibullah JAN
- Abdul Wali Khan University Mardan, Department of Pharmacy, Mardan, Pakistan
| | - Naveed MUHAMMAD
- Abdul Wali Khan University Mardan, Department of Pharmacy, Mardan, Pakistan
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Srinandan V, Nagappan K, Patel S, Yamjala K, Byran G, Babu B. Simultaneous Quantification of Pantoprazole and Levosulpiride in Spiked Human Plasma Using High Performance Liquid Chromatography Tandem Mass Spectrometry. CURR PHARM ANAL 2018. [DOI: 10.2174/1573412914666180101142646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Pantoprazole (PTZ) and Levosulpiride (LS) were proven as effective agents for
the treatment of Gastro-Esophageal Reflux Disease (GERD). It is a complex motor disorder that results
in regurgitation of the gastric contents into the lower esophagus with consequent symptoms such as
heart burn, retrosternal pain, dysphagia and belching.
Methods:
A rapid, sensitive, selective and specific liquid chromatography- electro spray ionization
tandem mass spectrometry (LC-MS/MS) method was developed for the simultaneous quantification of
Pantoprazole (PTZ) and Levosulpiride (LS) in spiked Human Plasma. The method utilized SPE as sample
preparation technique and the analysis was carried out on a HPLC system utilizing electro spray
ionization as interface and triple quadrupole mass analyzer for quantification in MRM possitive mode.
Iloperidone was used as internal standard (IS). Chromatographic separation was performed on a Phenomenex
C-18 Column (4.6 mm x 50 mm, 5µ) with an isocratic elution mode utilizing a mobile phase
composition of Solution containing a mixture of 70 volumes of acetonitrile: 30 volumes of methanol
and 10mM ammonium formate (pH 4.0) at the ratio of 80:20 % v/v. The flow rate was maintained at
0.3 mL/min.
Results:
PTZ, LS and IS were detected and quantified with proton adducts at m/z 383.37→200.00, m/z
341.42→112.15 and 426.48→261.00 respectively. The linearity and range was established by fortifying
blank plasma samples in the concentration range of 3.5-2000 ng/mL for PTZ and 3.0-2400 ng/mL for
LS. The correlation coefficient (r2) was found to be ≥ 0.993 for PTZ and (r2) ≥ 0.990 for LS. The lower
limit of quantification for PTZ was 3.5 ng/mL and LS was 3.0 ng/mL. The intra and inter day precision
and accuracy for PTZ and LS were within the limits fulfilling the international acceptance criteria. PTZ
and LS were found to be stable throughout three freeze-thaw cycles, bench top and short term stability
studies.
Conclusion:
The proposed validated LC-MS/MS method offers a sensitive quantification of PTZ and
LS in spiked human plasma and can be utilized for the quantification of PTZ and LS in real-time
samples.
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Affiliation(s)
- Vulli Srinandan
- Department of Pharmaceutical Analysis, JSS College of Pharmacy, A Constituent College of Jagadguru Sri Shivarathreeshwara University, Mysuru, Udhagamandalam, India
| | - Krishnaveni Nagappan
- Department of Pharmaceutical Analysis, JSS College of Pharmacy, A Constituent College of Jagadguru Sri Shivarathreeshwara University, Mysuru, Udhagamandalam, India
| | - Sonam Patel
- Department of Pharmaceutical Analysis, JSS College of Pharmacy, A Constituent College of Jagadguru Sri Shivarathreeshwara University, Mysuru, Udhagamandalam, India
| | - Karthik Yamjala
- Department of Pharmaceutical Analysis, JSS College of Pharmacy, A Constituent College of Jagadguru Sri Shivarathreeshwara University, Mysuru, Udhagamandalam, India
| | - Gowramma Byran
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, A Constituent College of Jagadguru Sri Shivarathreeshwara University, Mysuru, Udhagamandalam, India
| | - Basavan Babu
- Department of Pharmaceutical Analysis, JSS College of Pharmacy, A Constituent College of Jagadguru Sri Shivarathreeshwara University, Mysuru, Udhagamandalam, India
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Therapeutic switching of sulpiride, an anti-psychotic and prokinetic drug, to an anti-colitic drug using colon-specific drug delivery. Drug Deliv Transl Res 2018; 9:334-343. [DOI: 10.1007/s13346-018-00599-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Shin YJ, Choi JS, Ahn HK, Ryu HM, Kim MY, Han JY. Pregnancy outcomes in women reporting ingestion of levosulpiride in early pregnancy. J OBSTET GYNAECOL 2017. [PMID: 28631490 DOI: 10.1080/01443615.2017.1312307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate pregnancy outcomes of women who were inadvertently exposed to levosulpiride in early pregnancy. All 162 consecutive singleton pregnant women counselled through the Korean Motherisk Program, Cheil General Hospital, between April 2001 and April 2014, on teratogenic risk after inadvertent exposure to levosulpiride in early pregnancy were enrolled in this study. The women were exposed to levosulpiride at median 4.8 gestational weeks. The rate of miscarriage was not significantly different between groups (9.2% in those exposed and 5.5% in the non-exposed; p = .084). The rate of major malformations was not significantly different between exposed (2.7%) and non-exposed pregnancies (4.4%) (p = .481). All other pregnancy outcomes between the two groups were comparable (p > .05). Our data suggest that levosulpiride causes no significant adverse effects on pregnancy outcomes and therefore may be not a major teratogen.
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Affiliation(s)
- You Jung Shin
- a Department of Obstetrics and Gynaecology , Hankook General Hospital , Jeju , Republic of Korea
| | - June Seek Choi
- b Department of Obstetrics and Gynaecology , Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea.,c The Korean Motherisk Program, Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea
| | - Hyun Kyong Ahn
- b Department of Obstetrics and Gynaecology , Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea.,c The Korean Motherisk Program, Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea
| | - Hyun Mee Ryu
- b Department of Obstetrics and Gynaecology , Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea
| | - Moon Young Kim
- b Department of Obstetrics and Gynaecology , Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea
| | - Jung Yeol Han
- b Department of Obstetrics and Gynaecology , Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea.,c The Korean Motherisk Program, Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine , Seoul , Republic of Korea
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15
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Bioequivalence of a New Oral Levosulpiride Formulation Compared With a Standard One in Healthy Volunteers. Ther Drug Monit 2017; 39:118-123. [PMID: 28196046 DOI: 10.1097/ftd.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A monocentric, single-dose, open-label, 2-way, crossover randomized study was conducted by the San Matteo Phase I Clinical Trial Unit and Experimental Therapy (Pavia, Italy) to assess the bioequivalence and the systemic tolerability of a new oral formulation of levosulpiride (tablet 25 mg: test) versus a commercially available formulation on the Italian market (tablet 25 mg: reference). METHODS Thirty-five healthy adult volunteers, men (n = 19) and women (n = 16), aged between 18 and 55 years were screened and 32 of them were enrolled in the study. After having signed the written informed consent, each subject received a single oral dose of Test or Reference product with 250 mL of natural mineral water, in fasting conditions, interspersed with a 6-day washout period Blood samples were collected up to 36 hours after drug administration: the drug plasma levels were determined by high-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry. The pharmacokinetic parameters included peak plasma concentration (Cmax), time corresponding to Cmax (tmax), area under the plasma concentration-time curve from zero to infinity (AUC0-∞) or to the last sampling time assessment (AUC0-36), the elimination rate constant (ke), and the terminal half-life (t1/2). Safety was measured by pre- and post-treatment specific biochemical investigations, physical examination, electrocardiogram, occurrence of adverse events, and any information on patients' withdrawal. RESULTS The geometric mean ratio Test/Reference (90% confidence interval) for levosulpiride was 103.0% (95.8-110.8) for AUC0-36, 103.6% (95.9-111.9) for AUC0-∞, and 104.3% (94.9-114.6) for Cmax. ke and t1/2 were 0.07 (SD: 0.02) and 9 hours (8-12) for both the formulations. Clearance (L/h) was 29.6 (±13.5) and 30.7 (±14.2) for the test and the reference product, respectively. CONCLUSIONS Because the acceptance criteria required by the drug regulatory agency (European Medicines Agency, EMA) for bioequivalence prescribe limits of 80%-120% for untransformed data and 80%-125% for "ln" transformed data, we can confirm that the 2 formulations are bioequivalent, in terms of the rate and extent of absorption.
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16
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Poorani G, Uppuluri S, Uppuluri KB. Formulation, characterization, in vitro and in vivo evaluation of castor oil based self-nano emulsifying levosulpiride delivery systems. J Microencapsul 2016; 33:535-543. [DOI: 10.1080/02652048.2016.1223199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- G. Poorani
- Bioprospecting Laboratory, School of Chemical and Biotechnology, SASTRA University, Thanjavur, India
| | - Spandana Uppuluri
- Department of Pharmaceutical Chemistry, Nirmala College of Pharmacy, Mangalagiri, India
| | - Kiran Babu Uppuluri
- Bioprospecting Laboratory, School of Chemical and Biotechnology, SASTRA University, Thanjavur, India
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17
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Lu Y, Chen M, Huang Z, Tang C. Antidepressants in the Treatment of Functional Dyspepsia: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0157798. [PMID: 27310135 PMCID: PMC4911162 DOI: 10.1371/journal.pone.0157798] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/03/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Antidepressants have been empirically used in the treatment of functional dyspepsia (FD). However, results from recent clinical trials investigating their efficacy are conflicting. The aim of this study is to evaluate the efficacy of antidepressants in the management of FD in adults. METHODS Databases of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and BIOSIS Previews were searched for all randomized controlled trials (RCT) investigating efficacy of antidepressants in the management of FD in adult patients. Data of overall symptom unimproved and adverse events were compared between the antidepressants and placebo group. RESULTS The search strategy identified 432 citations. Of those, eight RCTs met the inclusion criteria and were included in the meta-analysis. The pooled relative risk (RR) of symptom unimproved with tricyclic antidepressants (TCAs) versus placebo was 0.76 (95% CI: 0.62 to 0.94, P = 0.01; I2 = 0%, P = 0.39). By contrast, selective serotonin reuptake inhibitors (SSRIs) did not show a benefit over placebo (RR = 1.00, 95% CI: 0.86 to 1.17, P = 0.95; I2 = 0%, P = 0.82). Adverse events were significantly more frequent among patients receiving antidepressants than those receiving placebos (RR = 1.64, 95% CI: 1.14 to 2.35, P = 0.007). CONCLUSION TCAs but not SSRIs, are effective in the treatment of FD, but antidepressants were also associated with more adverse events compared with placebo.
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Affiliation(s)
- Yaoyao Lu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng Chen
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyin Huang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengwei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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18
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Development and validation of a high throughput UPLC-MS/MS method for simultaneous quantification of esomeprazole, rabeprazole and levosulpiride in human plasma. J Pharm Anal 2016; 6:190-198. [PMID: 29403981 PMCID: PMC5762496 DOI: 10.1016/j.jpha.2016.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/22/2015] [Accepted: 01/07/2016] [Indexed: 01/17/2023] Open
Abstract
A high throughput ultra pressure liquid chromatography–mass spectrometry (UPLC–MS/MS) method with good sensitivity and selectivity has been developed and validated for simultaneous quantification of esomeprazole, rabeprazole and levosulpiride in human plasma using lansoprazole as internal standard (IS). The extraction method based on liquid–liquid extraction technique was used to extract the analytes and IS from of 50 µL of human plasma using methyl tert-butyl ether:ethyl acetate (80:20, v/v), which offers a high recovery. Chromatographic separation of analytes and IS was achieved on a Hypersil gold C18 column using gradient mobile phase consisting of 2 mM ammonium formate/acetonitrile. The flow rate was set at 0.5 mL/min to elute all the analytes and IS within 1.00 min runtime. Detection of target compounds was performed on a triple quadruple mass spectrometer by multiple reaction monitoring (MRM) mode via positive electrospray ionization (ESI). Method validation results demonstrated that the developed method has good precision and accuracy over the concentration ranges of 0.1–2000 ng/mL for each analyte. Stability of compounds was established in a battery of stability studies, i.e., bench top, autosampler, dry extract and long-term storage stability as well as freeze-thaw cycles. The validated method has been successfully applied to analyze human plasma samples for application in pharmacokinetic studies.
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19
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Melani F, Pasquini B, Caprini C, Gotti R, Orlandini S, Furlanetto S. Combination of capillary electrophoresis, molecular modeling and NMR to study the enantioselective complexation of sulpiride with double cyclodextrin systems. J Pharm Biomed Anal 2015; 114:265-71. [DOI: 10.1016/j.jpba.2015.05.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/22/2015] [Accepted: 05/28/2015] [Indexed: 01/02/2023]
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20
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Singh H, Bala R, Kaur K. Efficacy and tolerability of levosulipride, domperidone and metoclopramide in patients with non-ulcer functional dyspepsia: a comparative analysis. J Clin Diagn Res 2015; 9:FC09-12. [PMID: 26023567 PMCID: PMC4437081 DOI: 10.7860/jcdr/2015/11613.5775] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/25/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This is a prospective, randomized study designed to demonstrate the efficacy of three study drugs (Levosulpiride, Domperidone and Metoclopramide) in Functional Dyspepsia. Subject recruitment was done from medicine outpatient department of the teaching hospital from June 2013 to November 2013. MATERIALS AND METHODS The data collection was performed by the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) question instrument for assessing the dyspeptic symptoms of functional dyspepsia in patients enrolled in the study were assessed at base line (Prior to initiation of therapy) and at the next 4 weeks on a 5-point scale. RESULT Among 120 patients 113 patients completed this study in three groups (G-1 Levosulpiride 40 patients, G-2 Domperidone 35 patients and G-3 Metoclopramide 38 patients) were followed up. Female gender was dominated (75), occupation wise most of patients belong to laborer (49) class. Highly significant improvement in symptoms scale was noticed in G-1 Levosulpiride 40 patients' group. CONCLUSION Functional Gastrointestinal disorders are not serious ailments but have a key impact on quality of life. overall dyspeptic symptom relief rates were significantly high in the Levosulpiride group (p<0.004) as compare to Domperidone and Metoclopramide groups. A proper understanding of disease process by health care personnel and by sufferer is obligatory to enhance the quality of life and daunting the self/over the counter medication in this condition.
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Affiliation(s)
- Harminder Singh
- Associate Professor, Department of Pharmacology, G.G.S. Medical College, Faridkot, Punjab, India
| | - Ritu Bala
- 3nd year Post-graduate Resident, Department of Pharmacology, G.G.S. Medical College, Faridkot, Punjab, India
| | - Kamalpreet Kaur
- Assistant Professor, Department of Pharmacology, G.G.S. Medical College, Faridkot, Punjab, India
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21
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Quality by design in the chiral separation strategy for the determination of enantiomeric impurities: development of a capillary electrophoresis method based on dual cyclodextrin systems for the analysis of levosulpiride. J Chromatogr A 2014; 1380:177-85. [PMID: 25582483 DOI: 10.1016/j.chroma.2014.12.065] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/18/2014] [Accepted: 12/21/2014] [Indexed: 11/21/2022]
Abstract
Quality by design (QbD) concepts, in accordance with International Conference on Harmonisation Pharmaceutical Development guideline Q8(R2), represent an innovative strategy for the development of analytical methods. In this paper QbD principles have been comprehensively applied in the set-up of a capillary electrophoresis method aimed to quantify enantiomeric impurities. The test compound was the chiral drug substance levosulpiride (S-SUL) and the developed method was intended to be used for routine analysis of the pharmaceutical product. The target of analytical QbD approach is to establish a design space (DS) of critical process parameters (CPPs) where the critical quality attributes (CQAs) of the method have been assured to fulfil the desired requirements with a selected probability. QbD can improve the understanding of the enantioseparation process, including both the electrophoretic behavior of enantiomers and their separation, therefore enabling its control. The CQAs were represented by enantioresolution and analysis time. The scouting phase made it possible to select a separation system made by sulfated-β-cyclodextrin and a neutral cyclodextrin, operating in reverse polarity mode. The type of neutral cyclodextrin was included among other CPPs, both instrumental and related to background electrolyte composition, which were evaluated in a screening phase by an asymmetric screening matrix. Response surface methodology was carried out by a Doehlert design and allowed the contour plots to be drawn, highlighting significant interactions between some of the CPPs. DS was defined by applying Monte-Carlo simulations, and corresponded to the following intervals: sulfated-β-cyclodextrin concentration, 9-12 mM; methyl-β-cyclodextrin concentration, 29-38 mM; Britton-Robinson buffer pH, 3.24-3.50; voltage, 12-14 kV. Robustness of the method was examined by a Plackett-Burman matrix and the obtained results, together with system repeatability data, led to define a method control strategy. The method was validated and was finally applied to determine the enantiomeric purity of S-SUL in pharmaceutical dosage forms.
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22
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Gong C, Agbokponto JE, Yang W, Simpemba E, Zheng X, Zhang Q, Ding L. Pharmacokinetics of levosulpiride after single and multiple intramuscular administrations in healthy Chinese volunteers. Acta Pharm Sin B 2014; 4:402-7. [PMID: 26579410 PMCID: PMC4629093 DOI: 10.1016/j.apsb.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/07/2014] [Accepted: 06/09/2014] [Indexed: 11/05/2022] Open
Abstract
The main purpose of this study was to evaluate the pharmacokinetics of levosulpiride in humans after single and multiple intramuscular injections. Six males and six females received single dose of either 25 mg or 50 mg levosulpiride, or multiple doses of 25 mg every 12 h for 5 consecutive days. In the single 25 mg study, the mean peak plasma concentration (Cmax) was 441 ng/mL, the mean area under the concentration–time curve from 0 to 36 h (AUC0–36) was 1724 ng h/mL, and the mean elimination half-life (t1/2) was 7.0 h. In the single 50 mg study, the mean Cmax was 823 ng/mL, the mean AUC0–36 was 3748 ng·h/mL, and the mean t1/2 was 6.8 h. After multiple doses of 25 mg levosulpiride, the average plasma concentration (Cav) was 136 ng/mL, the fluctuation index (DF) was 3.60, and the accumulation ratio (R) was 1.2. Levosulpiride injections appeared to be well tolerated by the subjects, and can be used for successive administration.
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23
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Saporito F, Andò G, Di Bella G, Oreto G. Acute heart failure due to pheochromocytoma crisis after levosulpiride administration. Int J Cardiol 2014; 175:383-4. [PMID: 24874901 DOI: 10.1016/j.ijcard.2014.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Francesco Saporito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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24
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Thummala VRR, Seshadri RK, Tharlapu SSJM, Ivaturi MR, Nittala SR. Development and Validation of a UPLC Method by the QbD-Approach for the Estimation of Rabeprazole and Levosulpiride from Capsules. Sci Pharm 2014; 82:307-26. [PMID: 24959404 PMCID: PMC4065125 DOI: 10.3797/scipharm.1310-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/16/2014] [Indexed: 11/22/2022] Open
Abstract
Statistical experimental design was used to optimize the chromatographic separations of two pharmaceutical compounds from their respective potential impurities. A fractional factorial design was utilized to study the effects of pH, organic solvent in mobile phases A&B, and flow rate on the resolution of Rabeprazole and Rabeprazole Sulfone, which had closely eluting peaks. A desirability function applied to the optimized conditions predicted the peak resolution between 2.2 and 2.7 for the Rabeprazole & Rabeprazole Sulfone impurity. The chromatographic method employed an Acquity UPLC, BEH C18 column (100 × 2.1 mm i.d., 1.7 μm particle size) with the mobile phase consisting of a phosphate buffer, pH 6.5, and acetonitrile in a gradient program. The flow rate and injection volumes were 0.45 mL/min & 5 μl, respectively, and detection was done at 254 nm. The chromatographic method was validated for linearity, accuracy, precision, specificity, and ruggedness according to ICH guidelines. The results clearly showed that the quality by design concept could be effectively applied to optimize a UPLC chromatographic method with fewer trials and error-free experimentation.
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Affiliation(s)
- Veera Raghava Raju Thummala
- Analytical Research and Development, Integrated Product Development, Dr. Reddy’s Laboratories Ltd., Bachupally, Hyderabad-500 072, India
| | - Raja Kumar Seshadri
- Analytical Research and Development, Integrated Product Development, Dr. Reddy’s Laboratories Ltd., Bachupally, Hyderabad-500 072, India
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25
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Abstract
This chapter reviews the spectrum and mechanisms of neurologic adverse effects of commonly used gastrointestinal drugs including antiemetics, promotility drugs, laxatives, antimotility drugs, and drugs for acid-related disorders. The commonly used gastrointestinal drugs as a group are considered safe and are widely used. A range of neurologic complications are reported following use of various gastrointestinal drugs. Acute neurotoxicities, including transient akathisias, oculogyric crisis, delirium, seizures, and strokes, can develop after use of certain gastrointestinal medications, while disabling and pervasive tardive syndromes are described following long-term and often unsupervised use of phenothiazines, metoclopramide, and other drugs. In rare instances, some of the antiemetics can precipitate life-threatening extrapyramidal reactions, neuroleptic malignant syndrome, or serotonin syndrome. In contrast, concerns about the cardiovascular toxicity of drugs such as cisapride and tegaserod have been grave enough to lead to their withdrawal from many world markets. Awareness and recognition of the neurotoxicity of gastrointestinal drugs is essential to help weigh the benefit of their use against possible adverse effects, even if uncommon. Furthermore, as far as possible, drugs such as metoclopramide and others that can lead to tardive dyskinesias should be used for as short time as possible, with close clinical monitoring and patient education.
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Affiliation(s)
- Annu Aggarwal
- Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Mohit Bhatt
- Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
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26
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Serra J. Levosulpirida en el manejo de la dispepsia funcional y la gastroparesia. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:586-90. [DOI: 10.1016/j.gastrohep.2010.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 07/15/2010] [Accepted: 07/16/2010] [Indexed: 11/28/2022]
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27
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Phapale PB, Lee HW, Lim MS, Seong SJ, Kim EH, Park J, Lee M, Hwang SK, Yoon YR. Liquid chromatography–tandem mass spectrometry quantification of levosulpiride in human plasma and its application to bioequivalence study. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:2280-5. [DOI: 10.1016/j.jchromb.2010.06.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/23/2010] [Accepted: 06/25/2010] [Indexed: 11/16/2022]
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28
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Cho HY, Yoo HD, Lee YB. Influence of ABCB1 genetic polymorphisms on the pharmacokinetics of levosulpiride in healthy subjects. Neuroscience 2010; 169:378-87. [PMID: 20438811 DOI: 10.1016/j.neuroscience.2010.04.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/20/2010] [Accepted: 04/26/2010] [Indexed: 01/11/2023]
Abstract
The purposes of this study were to clarify the involvement of P-glycoprotein in the absorption of levosulpiride in knockout mice that lack the Abcb1a/ 1b gene, and to evaluate the relationship between genetic polymorphisms in ABCB1 (exon 12, 21 and 26) and levosulpiride disposition in healthy subjects. The plasma and brain samples were obtained after oral administration (10 microg/g) of levosulpiride to abcb1a/1b(-/-) and wild-type mice (n=3 approximately 6 at each time point). The average brain-to-plasma concentration ratio and blood-brain barrier partitioning of levosulpiride were 2.3- and 2.0-fold higher in Abcb1a/1b(-/-) mice than in wild-type mice, respectively. A total of 58 healthy Korean volunteers receiving a single oral dose of 25 mg levosulpiride participated in this study. The subjects were evaluated for polymorphisms of the ABCB1 exon 12 C1236T, exon 21 G2677A/T (Ala893Ser/Thr) and exon 26 C3435T using polymerase chain reaction restriction fragment length polymorphism. The PK parameters (AUC(0-4h), AUC(0-infinity) and C(max.)) of ABCB1 2677TT and 3435TT subjects were significantly higher than those of subjects with at least one wild-type allele (P<0.05). The results indicate that levosulpiride is a P-glycoprotein substrate in vivo, which is supported by the effects of SNPs 2677G>A/T in exon 21 and 3435C>T in exon 26 of ABCB1 on levosulpiride disposition.
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Affiliation(s)
- H Y Cho
- Clinical Trials Management Division, Korea Food & Drug Administration, 194 Tongilro, Eunpyeong-gu, Seoul, 122-704, Republic of Korea
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29
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Shin HW, Kim MJ, Kim JS, Lee MC, Chung SJ. Levosulpiride-induced movement disorders. Mov Disord 2010; 24:2249-53. [PMID: 19795476 DOI: 10.1002/mds.22805] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Levosulpiride is a substituted benzamide that is widely used for the management of dyspepsia and emesis. However, little is known about levosulpiride-induced movement disorders (LIM). The aim of this study was to investigate the clinical characteristics of patients with LIM. Among 132 consecutive patients who were diagnosed with drug-induced movement disorders between January 2002 and March 2008, 91 patients with LIM were identified and their medical records reviewed. Seventy-eight (85.7%) patients were aged more than 60 years. The most common LIM was parkinsonism (LIP) (n = 85, 93.4%), followed by tardive dyskinesia (n = 9, 9.9%) and isolated tremor (n = 3, 3.3%). Twenty-one (24.7%) of the 85 patients with LIP were rated as Hoehn and Yahr stage III-V. The oro-lingual area was the only body part that was involved by tardive dyskinesia. LIM persisted after withdrawal of levosulpiride in 48.1% of patients with LIP, 66.7% with dyskinesia, and none with isolated tremor. None of clinical and MRI features predicted the reversibility of LIP. Levosulpiride frequently causes drug-induced movement disorders, presenting mainly with LIP followed by lower face dyskinesia. The symptoms are often severe, and irreversible even after the withdrawal of levosulpiride. Physicians should be cautious in using levosulpiride, especially in elderly patients.
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Affiliation(s)
- Hae-Won Shin
- Parkinson/Alzheimer Center, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kim HJ, Cho JY, Cho YJ, Hong KS. Levosulpiride-induced resting orolingual tremor. Mov Disord 2009; 24:1700-1. [DOI: 10.1002/mds.22578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Liu CM, Chiu MJ, Fang CC, Chen WJ. Letter To The Editor: “Xylazine abuse: A rare cause of syncope”. Clin Toxicol (Phila) 2008; 45:309-11. [PMID: 17453890 DOI: 10.1080/15563650601073520] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Herbert MK, Holzer P. Standardized concept for the treatment of gastrointestinal dysmotility in critically ill patients--current status and future options. Clin Nutr 2007; 27:25-41. [PMID: 17933437 DOI: 10.1016/j.clnu.2007.08.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 07/20/2007] [Indexed: 12/22/2022]
Abstract
Inhibition of gastrointestinal motility is a major problem in critically ill patients. Motor stasis gives rise to subsequent complications including intolerance to enteral feeding, enhanced permeability of the atrophic intestinal mucosa and conditions as severe as systemic inflammatory response syndrome, sepsis and multiple organ failure. Although the diagnosis of motility disturbances in critically ill patients is difficult, the type and site of the disturbance are important to consider in the analysis of the condition and in the choice of therapeutic approach. The pharmacological treatment of impaired gastrointestinal motility is difficult to handle for the clinician, because the underlying mechanisms are complex and not fully understood and the availability of pharmacological treatment options is limited. In addition, there is a lack of controlled studies on which to build an evidence-based treatment concept for critically ill patients. Notwithstanding this situation, there has been remarkable progress in the understanding of the integrated regulation of gastrointestinal motility in health and disease. These advances, which largely relate to the organization of the enteric nervous system and its signaling mechanisms, enable the intensivist to develop a standardized concept for the use of prokinetic agents in the treatment of impaired gastrointestinal motility in critically ill patients.
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Affiliation(s)
- Michael K Herbert
- Department of Anaesthesiology, University of Wuerzburg, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany.
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Koo T, Kim M, Kim D, Shim C, Chung S. Quantification of Levosulpiride in Human Plasma by High‐Performance Liquid Chromatography. ANAL LETT 2006. [DOI: 10.1080/00032710600867499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Gastrointestinal promotility drugs stimulate smooth muscle contractions to enhance gastric emptying and small and large bowel transit. Currently available drug classes with prokinetic properties include antidopaminergic agents, serotonergic agents, and motilin-receptor agonists. Due to moderate prokinetic effects, poor symptomatic responses and the presence of adverse effects, there is a clear need for new classes of prokinetics. Several newer prokinetic drugs and drug classes are currently under evaluation. Selecting candidate agents and designing the appropriate therapeutic trials is hampered by the lack of insight in the pathophysiology of motility-related symptoms. As gastrointestinal motor disorders are chronic, relapsing, and remitting disorders, it seems desirable that studies with candidate prokinetic drugs establish a long-term efficacy and not only short-term effects on gastrointestinal functions.
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Affiliation(s)
- G Karamanolis
- Center for Gastroenterological Research, KU Leuven, Leuven, Belgium
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Hojo M, Miwa H, Yokoyama T, Ohkusa T, Nagahara A, Kawabe M, Asaoka D, Izumi Y, Sato N. Treatment of functional dyspepsia with antianxiety or antidepressive agents: systematic review. J Gastroenterol 2005; 40:1036-42. [PMID: 16322947 DOI: 10.1007/s00535-005-1687-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 06/20/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND The pathophysiology of functional dyspepsia (FD) has not been elucidated precisely; accordingly, effective management of FD has not yet been found. Until now, treatment with antianxiety or antidepressive agents has been empirically applied; however, the efficacy of these treatments has not been established. We carried out this study to estimate the efficacy of these treatment approaches by systematically reviewing the literature concerning trials with agents that are efficacious against anxiety, neurosis, or depression. METHODS Articles were searched from the MEDLINE database up to October 2003, using the terms, "antianxiety agents", "antidepressants", and "dyspepsia", and from reference lists of published articles. Finally, studies in which the effectiveness of drugs was clearly stated were selected from the retrieved articles. RESULTS Thirteen articles, on 1717 patients, were selected from among 90 articles retrieved through our literature search. In 11 of the 13 studies, dyspeptic symptoms were improved significantly by treatment. Statistical analysis of 4 trials showed a significant benefit of treatment with antianxiety or antidepressive agents (pooled relative risk, 0.55; 95% confidence interval [CI], 0.36-0.85), although funnel plots were asymmetric. CONCLUSIONS Antianxiety or antidepressive agents may be effective in the treatment of FD patients, though further clinical trials are necessary.
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Affiliation(s)
- Mariko Hojo
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Jin SE, Ban E, Kim YB, Kim CK. Development of HPLC method for the determination of levosulpiride in human plasma. J Pharm Biomed Anal 2004; 35:929-36. [PMID: 15193738 DOI: 10.1016/j.jpba.2004.02.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2003] [Revised: 02/14/2004] [Accepted: 02/20/2004] [Indexed: 11/27/2022]
Abstract
A rapid and simple high performance liquid chromatography (HPLC) method was developed and validated for determination of levosulpiride in human plasma. After extraction with ethylacetate/methylene chloride (5:1, v/v), analysis of levosulpiride in plasma samples was carried out using a reverse phase C18 column with fluorescence detector (maximum excitation at 300 nm and maximum emission at 365 nm) for separation and quantification. A mixture of methanol-20 mM phosphate buffer (pH 3.5, 16:84, v/v) was used as a mobile phase. The method was specific and sensitive with a limit of quantification of 5 ng/ml. This HPLC method was validated by examining the precision and accuracy for inter- and intra-day analysis in the concentration range of 5-150 ng/ml. The relative standard deviation (R.S.D.) in inter- and intra-day validation were 8.16-19.75 and 3.90-11.69%, respectively. In stability tests, levosulpiride in human plasma was stable during the storage and assay procedure. The method was applied to the bioequivalence study of two levosulpiride tablet formulations (25 mg) after a single oral administration.
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Affiliation(s)
- Su-Eon Jin
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, San 56-1, Shillim-Dong, Kwanak-Gu, Seoul 151-742, South Korea
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Mearin F, Rodrigo L, Pérez-Mota A, Balboa A, Jiménez I, Sebastián JJ, Patón C. Levosulpiride and cisapride in the treatment of dysmotility-like functional dyspepsia: a randomized, double-masked trial. Clin Gastroenterol Hepatol 2004; 2:301-8. [PMID: 15067624 DOI: 10.1016/s1542-3565(04)00059-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Levosulpiride is a benzamide derivate D(2) dopamine antagonist with prokinetic activity that can accelerate gastric emptying and reduce discomfort in response to gastric distention. The aim of the study is to compare the clinical efficacy of levosulpiride and cisapride in patients with dysmotility-like functional dyspepsia. METHODS In a exploratory pilot study performed as a multicenter, randomized, double-masked trial, the effects of 8 weeks of treatment with either levosulpiride, 25 mg, 3 times daily (n = 69) or cisapride, 10 mg, 3 times daily (n = 71) were compared. Individual symptoms (pain/discomfort, fullness, bloating, early satiety, and nausea/vomiting), global symptom score, effect on health-related quality of life (HRQoL), and anxiety-state and anxiety-trait were evaluated. Adverse events also were recorded. RESULTS Both levosulpiride and cisapride improved dyspeptic symptoms and decreased total symptom score (79.9% and 71.3%, respectively); no significant statistical difference between treatments was found (P = 0.07 for total symptom score). HRQoL improved similarly after both treatments, whereas no change was observed in anxiety. Medication-related adverse effects were present in 13 of 69 patients (18.8%) in the levosulpiride group and 8 of 71 patients (11.3%) in the cisapride group. Significantly more (P = 0.03) patients treated with cisapride had to abandon the trial because of side effects. CONCLUSIONS Levosulpiride is at least as effective as cisapride in the treatment of dysmotility-like functional dyspepsia.
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Affiliation(s)
- Fermín Mearin
- Institute of Functional and Motor Digestive Disorders, Centro Médico Teknon, Barcelona, Spain.
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Cho HY, Lee YB. Improvement and validation of a liquid chromatographic method for the determination of levosulpiride in human serum and urine. J Chromatogr B Analyt Technol Biomed Life Sci 2003; 796:243-51. [PMID: 14581065 DOI: 10.1016/j.jchromb.2003.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A rapid, selective and highly sensitive reversed-phase high-performance liquid chromatography (HPLC) method was developed for the determination of levosulpiride, 5-(aminosulfonyl)-N-[(1-ethyl-2-pyrrolidinyl)methyl]-2-methoxy benzamide, in human serum and urine. The method involved the extraction with a dichloromethane followed by back-extraction into 0.025 M sulfuric acid. HPLC analysis was carried out using reversed-phase isocratic elution with a Luna C(18)(2) 5 microm column, a mobile phase of acetonitrile-0.01 M potassium hydrogen phosphate (30:70, v/v, adjusted to pH 8.5 with triethylamine), and a fluorescence detector with excitation at 300 nm and emission at 365 nm. The chromatograms showed good resolution and sensitivity and no interference of human serum and urine. The calibration curves were linear over the concentration range 0.25-200 ng/ml for serum and 0.2-20 microg/ml for urine with correlation coefficients greater than 0.997. Intra- and inter-day assay precision and accuracy fulfilled the international requirements. The mean absolute recovery for human serum was 89.8+/-3.7%. The lower limits of quantitation in human serum and urine were 0.25 ng/ml and 0.2 microg/ml, respectively, which were sensitive enough for pharmacokinetic studies. Stability studies showed that levosulpiride in human serum and urine was stable during storage, or during the assay procedure. This method was successfully applied to the study of pharmacokinetics of levosulpiride in human volunteers following a single oral administration of levosulpiride (25 mg) tablet.
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Affiliation(s)
- Hea-Young Cho
- College of Pharmacy and Institute of Bioequivalence and Bridging Study, Chonnam National University, 300 Yongbong-Dong, Buk-Gu, Gwangju 500-757, Republic of Korea
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Distrutti E, Fiorucci S, Hauer SK, Pensi MO, Vanasia M, Morelli A. Effect of acute and chronic levosulpiride administration on gastric tone and perception in functional dyspepsia. Aliment Pharmacol Ther 2002; 16:613-22. [PMID: 11876717 DOI: 10.1046/j.1365-2036.2002.01180.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Altered visceral perception is common in functional dyspepsia (FD). Dopaminergic pathways control gastrointestinal motility, but whether they modulate visceral sensitivity is unknown. AIM To investigate whether levosulpiride, a D2 antagonist, modulates gastric sensitivity and compliance in dyspeptic patients. METHODS Eight healthy subjects and 16 dyspeptic patients underwent graded gastric distensions using a tensostat. In dyspeptic patients the same isotonic distensions were repeated during either levosulpiride or saline administration. Eight FD patients were evaluated after 4-week treatment with oral levosulpiride. Gastrointestinal symptoms were evaluated using a 100 mm visual analogue score. Perception was scored on a scale of 0 to 6. RESULTS Although healthy subjects and FD patients had similar gastric compliance, FD patients tolerated lower tension levels. At the same distending tension levels, levosulpiride decreased gastric compliance and perception score (14 +/- 6% and 38 +/- 10% change, respectively; P < 0.05 vs. saline) only in FD patients. Isotonic distensions exhibited very reproducible perception. Chronic levosulpiride administration significantly reduced dyspeptic symptoms and increased discomfort threshold. CONCLUSIONS Compared with healthy subjects, FD patients show marked gastric hypersensitivity. In FD patients levosulpiride decreased the perception of gastric distension with an action unrelated to change of gastric tone. Chronic levosulpiride administration significantly ameliorates gastrointestinal symptoms and increases the discomfort threshold.
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Affiliation(s)
- E Distrutti
- Gastroenterology Unit, University of Perugia, GiEnne Pharma, Milano, Italy.
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Mansi C, Borro P, Giacomini M, Biagini R, Mele MR, Pandolfo N, Savarino V. Comparative effects of levosulpiride and cisapride on gastric emptying and symptoms in patients with functional dyspepsia and gastroparesis. Aliment Pharmacol Ther 2000; 14:561-9. [PMID: 10792119 DOI: 10.1046/j.1365-2036.2000.00742.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The efficacy of several prokinetic drugs on dyspeptic symptoms and on gastric emptying rates are well-established in patients with functional dyspepsia, but formal studies comparing different prokinetic drugs are lacking. AIM To compare the effects of chronic oral administration of cisapride and levosulpiride in patients with functional dyspepsia and delayed gastric emptying. METHODS In a double-blind crossover comparison, the effects of a 4-week administration of levosulpiride (25 mg t.d.s.) and cisapride (10 mg t.d.s.) on the gastric emptying rate and on symptoms were evaluated in 30 dyspeptic patients with functional gastroparesis. At the beginning of the study and after levosulpiride or cisapride treatment, the gastric emptying time of a standard meal was measured by 13C-octanoic acid breath test. Gastrointestinal symptom scores were also evaluated. RESULTS The efficacy of levosulpiride was similar to that of cisapride in significantly shortening (P < 0.001) the t1/2 of gastric emptying. No significant differences were observed between the two treatments with regards to improvements in total symptom scores. However, levosulpiride was significantly more effective (P < 0.01) than cisapride in improving the impact of symptoms on the patients' every-day activities and in improving individual symptoms such as nausea, vomiting and early postprandial satiety. CONCLUSION The efficacy of levosulpiride and cisapride in reducing gastric emptying times with no relevant side-effects is similar. The impact of symptoms on patients' everyday activities and the improvement of some symptoms such as nausea, vomiting and early satiety was more evident with levosulpiride than cisapride.
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Affiliation(s)
- C Mansi
- Department of Internal Medicine, Genoa University, Italy.
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Buckingham JC. Fifteenth Gaddum Memorial Lecture December 1994. Stress and the neuroendocrine-immune axis: the pivotal role of glucocorticoids and lipocortin 1. Br J Pharmacol 1996; 118:1-19. [PMID: 8733570 PMCID: PMC1909484 DOI: 10.1111/j.1476-5381.1996.tb15360.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- J C Buckingham
- Department of Pharmacology, Charing Cross and Westminster Medical School, London
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Ronchi DD, Ruggeri M, Belelli G, Volterra V. Levosulpiride versus pimozide in negative symptoms of schizophrenia. Curr Ther Res Clin Exp 1996. [DOI: 10.1016/s0011-393x(96)80085-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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