A novel, sensitive and selective method of UPLC/MS-MS for rapid simultaneous determination of midodrine and its active metabolite desglymidodrine in human plasma: Application to support bioequivalence study in healthy human volunteers

Facile Integration of Hanztsch's Switch-Off/On Modeled Fluorogenic Probe for Feasible Tagging and Tracking of the Midodrine Drug in Different Matrices; First Evaluation of the Method's Greenness, Whiteness, Blueness, Quantum Yield, and Tablets' Content Homogeneity

The proposed investigation follows a certain methodology to guarantee that the procedure employed is sustainable and green. It is noteworthy to mention that various tools have been implemented as potential indicators of environmental sustainability (greenness and whiteness). From a novelty viewpoint, a new tool, BAGI, for the method's blueness evaluation was applied to the planned method and showed a high applicability score. Fortunately, the WAC concept, which combines ecological and functional variables using the Green/Red/Blue design (RBG 12 tool), identifies the established analytical approach as white. In the planned study, a new, green, simple, nano-trace-sensitive, original fluorimetric methodology was established to analyze and assess midodrine hydrochloride content in different matrices. Midodrine's primary amine moiety reacts with Diacetylmethane/Oxymethylene reagent in an acetate buffer, which leads to generating a fluorescent dihydrolutidine derivative (Hantzsch-named reaction). Consequently, the signal strength of this compound was quantified at 487 nm, with an excitation wavelength of 426 nm. This analysis indicated that the technique exhibited linearity within the range of 0.05 to 1.1 µg mL-1 concentrations, accompanied by remarkably good sensitivity values (LOD and LOQ). The methodology employed in this examination was subjected to validation following the rules recognized by ICH. From the perspective of pharmacy and chemistry, the method presented in this study was successfully employed to analyze commercially available tablets, oral drops, and human fluids. The outcomes obtained demonstrated satisfactory recovery rates without any interference from excipients. Following the USP recommendations, the intended technique was finally implemented to explore the content homogeneity evaluation.

A review of analytical parameters in 'rapid' liquid chromatographic methods for bioanalysis: Can we do better?

Rapid bioanalysis is beneficial to many applications. However, how 'rapid' a method is, or could be, is often an unanswered question. In this statistical review, the authors have assessed multiple pre-analytical (i.e. sample preparation), and analytical method parameters specifically for liquid chromatography to assist researchers in developing and validating 'rapid' bioanalytical methods. We restricted the search to urine and plasma matrices only. Data were extracted from over 2,000 recent studies and evaluated to assess how these parameters affected the 'on-instrument' analysis time. In addition to methods using ultra-violet (UV) detection, there were a large number of mass spectrometric (MS) methods, allowing additional review of the differences between high- and low-resolution MS on analysis time. We observed that most (N = 922, 70 %) methods used 5 or 10 cm columns, and that whilst uptake of ultra-high performance (U)HPLC columns was good, the use of sub-5 cm columns and/or flow rates in excess of 1 mL/min was incredibly rare (N = 25, 3 %). The detector of choice for quantitative (U)HPLC-MS remains the triple quadrupole, although a number of groups report the use of high-resolution MS for such methods.

Utility of dansyl chloride for the establishment of a sensitive spectrofluorimetric approach for estimating midodrine hydrochloride: application to content uniformity testing

A new, straightforward spectrofluorimetric approach with high sensitivity was established for determining midodrine hydrochloride based on derivatizing this drug through its reaction with 5-(dimethylamino)naphthalene-1-sulfonyl chloride (dansyl chloride). The highly fluorescent product was extracted with methylene chloride, and then its emission was measured at 532 nm after excitation at 339 nm. The reaction was conducted in aqueous medium containing 0.1 M borate buffer (pH 8.2). The results showed that the proposed method is sensitive with high linearity in the range from 0.1 to 3 μg mL-1. The lower limits of detection and quantitation were 29 and 88 ng mL-1, respectively. Furthermore, the proposed approach was analytically assessed by applying the ICH guidelines. The suggested approach was effectively utilized for the estimation of the medicine in its marketable tablet formulations with excellent recovery and without any interfering effect from excipients. Moreover, the presented approach was utilized to test the content uniformity of commercial tablets following the USP guidelines.

Studying the kinetic of midodrine degradations using TLC Stability approach: Application to dosage form and human plasma

A simple, rapid and selective thin layer chromatographic method has been developed for estimation of the antihypotension drug, midodrine hydrochloride, in pure form, tablet, spiked plasma and artificially degraded samples. Separation was carried out using silica gel 60-F₂₅₄ as a stationary and mobile phase consisting of methanol: methylene chloride: ammonia in ratio of 8:2:0.2. The detection was carried out at wavelength of 290 nm. The retardation factor was found to be 0.7 and 0.49 for midodrine and its main degradation product desglymidodrine. The method showed linearity for midodrine over a concentration range of 50-1500 ng/spot with good correlation and determination coefficient. The method was applied successfully for analysis of commercial tablets and oral drops with good recovery and without interference of excipients. The method also was applied for studying the stability of the cited drug under different stress conditions including acidic, alkaline, hydrolytic, oxidative and photo- degradations. Furthermore, the kinetic of acidic and alkaline degradations was investigated and the rate constants were found to be 0.620 and 0.074 K h^-1 while half life time (t_1/2) values were 1.12 and 9.32 h, respectively.

Development of a simple validated spectrofluorometric method for the assay of midodrine in tablets dosage form; Application to content uniformity testing

A new sensitive spectrofluorimetric technique has been established for the estimation of midodrine hydrochloride. This method depends on the condensation reaction of ortho-phthalaldehyde with the primary aliphatic amine of midodrine in the presence of 2-mercapto-ethanol. The pH of the medium was adjusted to 9.0 using 0.1 M borate buffer. The fluorescence of the product was measured at wavelength of 451 nm after excitation at 334 nm. The method was rectilinear over a concentrations range of 0.1 to 1.5 µg mL^-1. The lower detection and quantitation limits were 31 and 94 ng mL^-1, respectively. The method was investigated following the guidelines of the International Council of Harmonization. Analysis of commercial tablet dosage form was carried out successfully by the current method with excellent recovery percentages and with no influence from coexisted pharmaceutical additives .This method was used to evaluate the uniformity of the contents of commercial tablets according to the United States Pharmacopoeia.

Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies

Postural orthostatic tachycardia syndrome (POTS) is a clinically heterogeneous disorder with multiple contributing pathophysiologic mechanisms manifesting as symptoms of orthostatic intolerance in the setting of orthostatic tachycardia (increase in heart rate by at least 30 beats per minute upon assuming an upright position) without orthostatic hypotension. The three major pathophysiologic mechanisms include partial autonomic neuropathy, hypovolemia, and hyperadrenergic state. Patients often will exhibit overlapping characteristics from more than one of these mechanisms. The approach to the treatment of POTS centers on treating the underlying pathophysiologic mechanism. Stockings, abdominal binders, and vasoconstrictors are used to enhance venous return in partial neuropathic POTS. Exercise and volume expansion are the main treatment strategies for hypo-volemic POTS. For hyperadrenergic POTS, beta-blockers and avoidance of norepinephrine reuptake inhibitors is important. Attempts should be made to discern which pathophysiologic mechanism(s) may be afflicting patients so that treatment regimens can be individualized.

Simple ultrasensitive spectrofluorimetric method for determination of midodrine in its tablet form: Application to content uniformity testing

A novel, simple, sensitive method was developed for determining midodrine spectrofluorimetrically in both its raw pure form and its tablet form. This study is based on the native fluorescence of midodrine and discusses the optimum solvent used and the wavelength range. The presented method was then validated with respect to linearity, accuracy, precision, and limits of detection and quantitation. The constructed calibration curve showed a linear range of 0.1-2.0 μg/ml. The limit of detection and limit of quantitation values were 0.03 and 0.10 μg/ml respectively. Finally, content uniformity testing was applied according to the United States Pharmacopoeia by adapting the presented method.

The convenient use of fluorescamine for spectrofluorimetric determination of midodrine hydrochloride in pure form and its tablets formulation: Application to content uniformity testing

A novel sensitive and simple spectrofluorimetric method was developed then validated for determination of midodrine in both its authentic pure form and its tablets. This method is based on the reaction between midodrine's aliphatic primary amine moiety with fluorescamine reagent, using borate buffer at pH 7.8 and yielding a highly fluorescent product whose fluorescence intensity was measured at 462 nm after excitation at 388 nm. This method represents the first attempt for determination of midodrine spectrofluorimetrically. A calibration curve was constructed showing that the linear range was 0.2-3.0 μg/ml. The limit of detection and limit of quantitation values were 0.06 and 0.19 μg/ml respectively. The correlation coefficient (r) and the determination coefficient (r² ) values were 0.9992 and 0.9984 respectively. The proposed method was validated according to ICH guidelines and successfully applied for determination of midodrine in its tablets with an overall % recovery of 99.56 ± 0.95. Finally, the presented method was adapted to study the content uniformity test according to United States Pharmacopeia guidelines.

Orthostatic hypotension for the cardiologist

PURPOSE OF REVIEW

Orthostatic hypotension is a phenomenon commonly encountered in a cardiologist's clinical practice that has significant diagnostic and prognostic value for a cardiologist. Given the mounting evidence associating cardiovascular morbidity and mortality with orthostatic hypotension, cardiologists will play an increasing role in treating and managing patients with orthostatic hypotension.

RECENT FINDINGS

The American College of Cardiology, American Heart Association, and Heart Rhythm Society recently published consensus guidelines on the diagnosis, treatment, and management of syncope and their instigators, including orthostatic hypotension. Additionally, consensus guidelines have also been recently updated, reinforcing the universal definition orthostatic hypotension and its closely associated pathologies. Finally, the United States Food and Drug Administration (FDA) recently approved droxidopa, a synthetic oral norepinephrine prodrug, in 2014 for the treatment of neurogenic orthostatic hypotension (nOH), and it represents a well tolerated, effective, and easy to use intervention for nOH. This represents only the second drug approved by the FDA for orthostatic hypotension, the first being midodrine in 1986. A handful of smaller head-to-head studies have pitted not only pharmacologic agents to one another but also nonpharmacologic interventions to pharmacologic agents. Additionally, recent studies have also reported on more convenient screening tools for orthostatic hypotension.

SUMMARY

Though there have been many advances in the management of orthostatic hypotension, nOH remains a chronic, debilitating, and often progressively fatal condition. Cardiologists can play a very important role in optimizing hemodynamics in this patient population to improve quality of life and minimize cardiovascular risk.