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Bian Y, Scofield-Kaplan SM, Zemsky C, Campagnoli T, Ghadiali L, Glass LRD, Sallee B, Belsito DV, Winn BJ. Punctal Congestion Syndrome: A Reversible, Functional Punctal Stenosis Causing Epiphora in the Setting of Chronic Pretarsal Conjunctivitis. Ophthalmic Plast Reconstr Surg 2021; 37:S92-S97. [PMID: 32890120 PMCID: PMC7904972 DOI: 10.1097/iop.0000000000001840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a reversible syndrome of epiphora, functional punctal stenosis, and chronic pretarsal conjunctivitis associated with corticosteroid or corticosteroid-antibiotic eyedrop use. METHODS This is an Institutional Review Board-approved retrospective review of patients diagnosed with epiphora, punctal stenosis, and chronic conjunctivitis by a single surgeon (B.J.W.). These patients were subsequently invited to participate in a prospective study involving allergy skin patch testing for ophthalmic drops, common excipients, and active ingredients. RESULTS Thirteen patients received a diagnosis of punctal congestion syndrome. The average age was 63 years (range, 41-93) and 69.2% were female. Findings were bilateral in 61.5%. All had used preserved drops in the affected eye(s). Various antecedent diagnoses resulted in treatment with preserved drops. Patients experienced epiphora for an average of 3.8 months (median, 3 months; mode, 3 months; range, 1-8 months) prior to presentation. Two patients had undergone punctoplasty which failed to resolve symptoms. 92.3% of patients had been taking tobramycin-dexamethasone drops, loteprednol drops, or a combination of both prior to presentation. All were taken off preserved drops. 69.2% were also treated with a preservative-free loteprednol etabonate 0.5% ophthalmic ointment taper. All improved. Partial relief of symptoms was achieved by an average of 1.6 months (median, 2 months; mode, 2 months; standard deviation, ±0.7 months) and resolution of symptoms by 2.5 months (median, 2 months; mode, 2 months; standard deviation, ±1.7 months). One patient underwent patch testing with strong positive reactions to formaldehyde and neomycin and a weak positive reaction to gentamicin. CONCLUSIONS Functional punctal stenosis is associated with topical ophthalmic preparations, especially preserved corticosteroids and antibiotic-corticosteroid combinations. Treatment consists of removal of all preserved eyedrops. Symptoms often improve over several months.
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Affiliation(s)
- Yandong Bian
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | | | - Christine Zemsky
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | - Thalmon Campagnoli
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | - Larissa Ghadiali
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
- Hinsdale Eye Center, Hinsdale, IL
| | - Lora R. Dagi Glass
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
| | - Brigitte Sallee
- Department of Dermatology, Columbia University Irving
Medical Center, New York, NY
| | - Donald V. Belsito
- Department of Dermatology, Columbia University Irving
Medical Center, New York, NY
| | - Bryan J. Winn
- Department of Ophthalmology, Columbia University Irving
Medical Center, New York, NY
- Department of Ophthalmology, University of California, San
Francisco, San Francisco, CA
- Surgical Section, San Francisco Veterans Affairs Medical
Center, San Francisco, CA
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Mallandrich M, Calpena AC, Clares B, Parra A, García ML, Soriano JL, Fernández-Campos F. Nano-engineering of ketorolac tromethamine platforms for ocular treatment of inflammatory disorders. Nanomedicine (Lond) 2021; 16:401-414. [PMID: 33586454 DOI: 10.2217/nnm-2020-0403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: The development and optimization of Ketorolac tromethamine-loaded polylactic-co-glycolic acid nanoparticles (KT-NPs) for the treatment of inflammatory processes of the eye. Materials & methods: KT-NPs were developed by factorial design and characterized by assessing their physicochemical properties. Biopharmaceutical behavior studies, ocular tolerance, anti-inflammatory efficacy and bioavailability tests were performed on pigs. Results: Optimized KT-NPs of 112 nm, narrow distribution with encapsulation efficiency near 100% were obtained. KT release followed the Weibull model and there was significantly greater retention in the cornea and sclera than in the commercial reference. KT-NPs showed no signs of ocular irritancy and similar anti-inflammatory efficacy to the commercial reference. Conclusion: KT-NPs were a suitable alternative for the treatment of inflammatory disorders of the anterior and posterior segments of the eye as an alternative to conventional topical formulations.
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Affiliation(s)
- Mireia Mallandrich
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - Ana C Calpena
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - Beatriz Clares
- Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain.,Department of Pharmacy & Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Alexander Parra
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain
| | - María L García
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Nanoscience & Nanotechnology Institute (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | - José L Soriano
- Department of Pharmacy & Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Francisco Fernández-Campos
- Department of Pharmacy & Pharmaceutical Technology & Physical Chemistry, Faculty of Pharmacy & Food Sciences, University of Barcelona, 08028 Barcelona, Spain.,Reig-Jofre Laboratories, Av. de les Flors s/n, 08970 Sant Joan Despí, Spain
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3
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Lorenzo-Veiga B, Diaz-Rodriguez P, Alvarez-Lorenzo C, Loftsson T, Sigurdsson HH. In Vitro and Ex Vivo Evaluation of Nepafenac-Based Cyclodextrin Microparticles for Treatment of Eye Inflammation. NANOMATERIALS 2020; 10:nano10040709. [PMID: 32283583 PMCID: PMC7221994 DOI: 10.3390/nano10040709] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
The aim of this study was to design and evaluate novel cyclodextrin (CD)-based aggregate formulations to efficiently deliver nepafenac topically to the eye structure, to treat inflammation and increase nepafenac levels in the posterior segment, thus attenuating the response of inflammatory mediators. The physicochemical properties of nine aggregate formulations containing nepafenac/γ-CD/hydroxypropyl-β (HPβ)-CD complexes as well as their rheological properties, mucoadhesion, ocular irritancy, corneal and scleral permeability, and anti-inflammatory activity were investigated in detail. The results were compared with a commercially available nepafenac suspension, Nevanac® 3 mg/mL. All formulations showed microparticles, neutral pH, and negative zeta potential (–6 to –27 mV). They were non-irritating and nontoxic and showed high permeation through bovine sclera. Formulations containing carboxymethyl cellulose (CMC) showed greater anti-inflammatory activity, even higher than the commercial formulation, Nevanac® 0.3%. The optimized formulations represent an opportunity for topical instillation of drugs to the posterior segment of the eye.
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Affiliation(s)
- Blanca Lorenzo-Veiga
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, IS-107 Reykjavik, Iceland; (B.L.-V.); (T.L.)
| | - Patricia Diaz-Rodriguez
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Ciencias de la Salud, Universidad de la Laguna (ULL), Campus de Anchieta, 38200 La Laguna (Tenerife), Spain;
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Thorsteinn Loftsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, IS-107 Reykjavik, Iceland; (B.L.-V.); (T.L.)
| | - Hakon Hrafn Sigurdsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, IS-107 Reykjavik, Iceland; (B.L.-V.); (T.L.)
- Correspondence:
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Abstract
PURPOSE There has been a recent explosion in the variety of techniques used to accomplish corneal cross-linking (CXL) for the treatment of ectatic corneal diseases. To understand the success or failure of various techniques, we review the physicochemical basis of corneal CXL and re-evaluate the current principles and long-standing conventional wisdom in the light of recent, compelling, and sometimes contradictory research. METHODS Two clinicians and a medicinal chemist developed a list of current key topics, controversies, and questions in the field of corneal CXL based on information from current literature, medical conferences, and discussions with international practitioners of CXL. RESULTS Standard corneal CXL with removal of the corneal epithelium is a safe and efficacious procedure for the treatment of corneal ectasias. However, the necessity of epithelium removal is painful for patients, involves risk and requires significant recovery time. Attempts to move to transepithelial corneal CXL have been hindered by the lack of a coherent understanding of the physicochemistry of corneal CXL. Misconceptions about the applicability of the Bunsen-Roscoe law of reciprocity and the Lambert-Beer law in CXL hamper the ability to predict the effect of ultraviolet A energy during CXL. Improved understanding of CXL may also expand the treatment group for corneal ectasia to those with thinner corneas. Finally, it is essential to understand the role of oxygen in successful CXL. CONCLUSIONS Improved understanding of the complex interactions of riboflavin, ultraviolet A energy and oxygen in corneal CXL may provide a successful route to transepithelial corneal CXL.
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Luaces-Rodríguez A, Touriño-Peralba R, Alonso-Rodríguez I, García-Otero X, González-Barcia M, Rodríguez-Ares MT, Martínez-Pérez L, Aguiar P, Gómez-Lado N, Silva-Rodríguez J, Herranz M, Ruibal-Morell Á, Lamas MJ, Otero-Espinar FJ, Fernández-Ferreiro A. Preclinical characterization and clinical evaluation of tacrolimus eye drops. Eur J Pharm Sci 2018; 120:152-161. [PMID: 29705214 DOI: 10.1016/j.ejps.2018.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/02/2018] [Accepted: 04/24/2018] [Indexed: 12/28/2022]
Abstract
Severe allergic ocular diseases as atopic keratoconjunctivitis can induce corneal damage due to inflammatory substances released from giant papillae. Tacrolimus eye drops are one of the current therapeutic alternatives for its treatment. This work is aimed at developing and characterizing a 0.03% tacrolimus ophthalmic formulation, which was introduced in three types of vehicles (BBS, PVA and Hyaluronic Acid). For this, we have performed in vitro (stability studies) and in vivo assays (corneal permanence time measured directly by Positron Emission Tomography) of three potential formulations. Next, the best formulation was selected, and its toxicological profile and clinical effectiveness have been evaluated. The biopermanence studies (direct measurements and PET/CT) showed that the formulations with PVA and Hyaluronic Acid present more retention time on the ocular surface of rats than PBS. From the stability study, we have determined that tacrolimus with PVA in cold storage is the best option. Tacrolimus with PVA has shown lower cytotoxicity than cyclosporine at early times. On the other hand, the pilot study performed has shown significant improvements in patients, with no noticeable adverse reactions. Based on stability, biopermanence, safety and clinical effectiveness studies, we concluded that tacrolimus-PVA eye drops are a suitable candidate for its clinical application in inflammatory ophthalmology diseases.
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Affiliation(s)
- Andrea Luaces-Rodríguez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Rosario Touriño-Peralba
- Ophthalmology Department, University Clinical Hospital Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Iria Alonso-Rodríguez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Xurxo García-Otero
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Pharmacy Department, University Clinical Hospital Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - María Teresa Rodríguez-Ares
- Ophthalmology Department, University Clinical Hospital Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Laura Martínez-Pérez
- Ophthalmology Department, University Clinical Hospital Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Pablo Aguiar
- Molecular Imaging Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Noemí Gómez-Lado
- Molecular Imaging Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Jesús Silva-Rodríguez
- Molecular Imaging Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Michel Herranz
- Molecular Imaging Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Álvaro Ruibal-Morell
- Molecular Imaging Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María Jesús Lamas
- Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Pharmacy Department, University Clinical Hospital Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Francisco J Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain.
| | - Anxo Fernández-Ferreiro
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Pharmacy Department, University Clinical Hospital Santiago de Compostela (SERGAS), Santiago de Compostela, Spain.
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Cyclodextrin Enhances Corneal Tolerability and Reduces Ocular Toxicity Caused by Diclofenac. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:5260976. [PMID: 29636847 PMCID: PMC5831967 DOI: 10.1155/2018/5260976] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/01/2017] [Accepted: 12/17/2017] [Indexed: 01/08/2023]
Abstract
With advances in refractive surgery and demand for cataract removal and lens replacement, the ocular use of nonsteroidal anti-inflammatory drugs (NSAIDs) has increased. One of the most commonly used NSAIDs is diclofenac (Diclo). In this study, cyclodextrins (CDs), α-, β-, γ-, and HP-β-CDs, were investigated with in vitro irritation and in vivo ulceration models in rabbits to reduce Diclo toxicity. Diclo-, α-, β-, γ-, and HP-β-CD inclusion complexes were prepared and characterized and Diclo-CD complexes were evaluated for corneal permeation, red blood cell (RBCs) haemolysis, corneal opacity/permeability, and toxicity. Guest- (Diclo-) host (CD) solid inclusion complexes were formed only with β-, γ-, and HP-β-CDs. Amphipathic properties for Diclo were recorded and this surfactant-like functionality might contribute to the unwanted effects of Diclo on the surface of the eye. Contact angle and spreading coefficients were used to assess Diclo-CDs in solution. Reduction of ocular toxicity 3-fold to16-fold and comparable corneal permeability to free Diclo were recorded only with Diclo-γ-CD and Diclo-HP-β-CD complexes. These two complexes showed faster healing rates without scar formation compared with exposure to the Diclo solution and to untreated groups. This study also highlighted that Diclo-γ-CD and Diclo-HP-β-CD demonstrated fast healing without scar formation.
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Luaces-Rodríguez A, Díaz-Tomé V, González-Barcia M, Silva-Rodríguez J, Herranz M, Gil-Martínez M, Rodríguez-Ares MT, García-Mazás C, Blanco-Mendez J, Lamas MJ, Otero-Espinar FJ, Fernández-Ferreiro A. Cysteamine polysaccharide hydrogels: Study of extended ocular delivery and biopermanence time by PET imaging. Int J Pharm 2017. [DOI: 10.1016/j.ijpharm.2017.06.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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8
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Fernández-Ferreiro A, Santiago-Varela M, Gil-Martínez M, González-Barcia M, Luaces-Rodríguez A, Díaz-Tome V, Pardo M, Méndez JB, Piñeiro-Ces A, Rodríguez-Ares MT, Lamas MJ, Otero-Espinar FJ. In VitroEvaluation of the Ophthalmic Toxicity Profile of Chlorhexidine and Propamidine Isethionate Eye Drops. J Ocul Pharmacol Ther 2017; 33:202-209. [DOI: 10.1089/jop.2016.0053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Anxo Fernández-Ferreiro
- Department Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Department of Pharmacy, Xerencia de Xestión Integrada de Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS-ISCIII), Santiago de Compostela, Spain
| | - María Santiago-Varela
- Department of Ophthalmology, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - María Gil-Martínez
- Department of Ophthalmology, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Department of Pharmacy, Xerencia de Xestión Integrada de Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS-ISCIII), Santiago de Compostela, Spain
| | - Andrea Luaces-Rodríguez
- Department Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Victoria Díaz-Tome
- Department Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - María Pardo
- Obesidomic Group, Health Research Institute of Santiago de Compostela (IDIS-ISCIII), Santiago de Compostela, Spain
| | - José Blanco Méndez
- Department Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Antonio Piñeiro-Ces
- Department of Ophthalmology, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - María Teresa Rodríguez-Ares
- Department of Ophthalmology, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Maria Jesus Lamas
- Department of Pharmacy, Xerencia de Xestión Integrada de Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS-ISCIII), Santiago de Compostela, Spain
| | - Francisco J. Otero-Espinar
- Department Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
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