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Li L, Li L, Jin Y, Shuang Y, Wang H. Preparation of a teicoplanin-bonded chiral stationary phase for simultaneous determination of clenbuterol and salbutamol enantiomers in meat by LC-MS/MS. Microchem J 2020. [DOI: 10.1016/j.microc.2020.104925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Jensen O, Rafehi M, Tzvetkov MV, Brockmöller J. Stereoselective cell uptake of adrenergic agonists and antagonists by organic cation transporters. Biochem Pharmacol 2020; 171:113731. [DOI: 10.1016/j.bcp.2019.113731] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
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Velasco‐Bejarano B, Bautista J, Noguez MO, Camacho E, Rodríguez ME, Rodríguez L. Resolution of
R‐(−)
and
S‐(+)‐
enantiomers of clenbuterol in pharmaceutical preparations and black‐market products using liquid chromatography–tandem mass spectrometry. Drug Test Anal 2017; 9:1738-1743. [DOI: 10.1002/dta.2294] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/10/2017] [Accepted: 08/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamín Velasco‐Bejarano
- Facultad de Estudios Superiores Cuautitlán‐UNAMDepartamento de Ciencias Químicas, Sección de Química Orgánica Av. 1 de mayo S/N, Col. Sta. María las Torres Cuautitlán Izcalli Estado de México México C.P. 54740
- Laboratorio Nacional de Prevención y Control del Dopaje‐CONADEDirección de Medicina y Ciencias Aplicadas Camino a Santa Teresa No. 482, Col. Peña Pobre, Delegación Tlalpan Ciudad de México México C. P. 14060
| | - Jahir Bautista
- Laboratorio Nacional de Prevención y Control del Dopaje‐CONADEDirección de Medicina y Ciencias Aplicadas Camino a Santa Teresa No. 482, Col. Peña Pobre, Delegación Tlalpan Ciudad de México México C. P. 14060
| | - Ma. Olivia Noguez
- Facultad de Estudios Superiores Cuautitlán‐UNAMDepartamento de Ciencias Químicas, Sección de Química Orgánica Av. 1 de mayo S/N, Col. Sta. María las Torres Cuautitlán Izcalli Estado de México México C.P. 54740
| | - Evangelina Camacho
- Laboratorio Nacional de Prevención y Control del Dopaje‐CONADEDirección de Medicina y Ciencias Aplicadas Camino a Santa Teresa No. 482, Col. Peña Pobre, Delegación Tlalpan Ciudad de México México C. P. 14060
| | - Martha E. Rodríguez
- Laboratorio Nacional de Prevención y Control del Dopaje‐CONADEDirección de Medicina y Ciencias Aplicadas Camino a Santa Teresa No. 482, Col. Peña Pobre, Delegación Tlalpan Ciudad de México México C. P. 14060
| | - Leonardo Rodríguez
- Laboratorio Nacional de Prevención y Control del Dopaje‐CONADEDirección de Medicina y Ciencias Aplicadas Camino a Santa Teresa No. 482, Col. Peña Pobre, Delegación Tlalpan Ciudad de México México C. P. 14060
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Lehmann DF, Wojnowicz S. The Evergreening of Biopharmaceuticals: Time to Defoliate. J Clin Pharmacol 2015; 56:383-9. [PMID: 26388527 DOI: 10.1002/jcph.642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Indexed: 11/07/2022]
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5
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Pan H, Li Q, Pan L, Liu X, Pan L, Zhang X, Bai H, Cheng M, Zhang Y. Stereoselective activity of 2-(4-amino-3-chloro-5- trifluomethyl-phenyl)-2-tert-butylamino-ethanol hydrochloride to improve the pulmonary function in asthma. Biomed Rep 2014; 2:539-544. [PMID: 24944804 DOI: 10.3892/br.2014.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/24/2014] [Indexed: 01/24/2023] Open
Abstract
Asthma is a chronic airway disease that is characterized by significantly exacerbated bronchospasms and marked inflammation of the airways. Although the etiology of asthma remains to be determined, genetic predisposition is one of the factors involved. β2-agonists compounds may serve as options for the treatment of bronchial asthma. The aim of the present study was to investigate the effects of 2-(4-amino-3-chloro-5-trifluomethyl-phenyl)-2-tert-butylamino-ethanol hydrochloride (SPFF) and its enantiomers with regard to improving asthmatic pulmonary function and selective binding to β2-adrenergic receptor. The bronchoconstrictor action of histamine in guinea pigs was conducted and the results demonstrated that (-)SPFF and (±)SPFF could significantly inhibit the increase of bronchoconstriction induced by histamine, while (+)SPFF did not show an effect. Inflammatory mediator release from allergic lung tissues was determined and it was found that (±)SPFF showed the highest activity among all the tested compounds, while the efficacy of (-)SPFF was similar to that of (+)SPFF. SPFF and its enantiomers stimulated cyclic adenosine monophosphate (cAMP) production in the asthmatic lung tissues examined, showing that asthmatic lung tissues had a significant cAMP enhancement in response to (-)SPFF and (±)SPFF compared with (+)SPFF. Cardiac contractility of the right atria was assessed in the guinea pigs to establish the receptor selectivity of the compounds. The results indicated that all the compounds had high affinities to the β2 receptor. In conclusion, with regards to asthmatic pulmonary function improvement, (-)SPFF was more efficient as compared to (+)SPFF, while no significant difference was observed for the receptor selectivity of (-)SPFF and (+)SPFF.
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Affiliation(s)
- He Pan
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Qian Li
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Li Pan
- Department of Medicinal Chemistry, School of Pharmaceutical Engineering, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China ; Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Xiaoguang Liu
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Lihong Pan
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Xia Zhang
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Hansheng Bai
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Maosheng Cheng
- Department of Medicinal Chemistry, School of Pharmaceutical Engineering, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China ; Key Laboratory of Structure-Based Drug Design and Discovery, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
| | - Yuyang Zhang
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, P.R. China
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Blake K, Raissy H. Chiral Switch Drugs for Asthma and Allergies: True Benefit or Marketing Hype. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2013; 26:157-160. [PMID: 24066264 DOI: 10.1089/ped.2013.0285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 11/12/2022]
Abstract
Enantiomers are one of several possible molecular configurations present in a drug that has at least 1 chiral center. A drug containing 2 or more enatiomers is called a racemic mixture. Enatiomers are being developed from racemic mixtures as drugs in their own right often to extend patent protection of highly popular drugs. However, the therapeutic advantages of single enantiomer drugs developed for respiratory use such as levalbuterol, arformoterol, and levocetirizine over their racemate has been disappointing. In addition, single enantiomer drugs may be several fold more expensive than the racemic drug. New single enantiomer drugs, which are stable (no interconversion back to the racemate) and have fewer adverse effects and a more predictable pharmacodynamic or pharmacokinetic profile would confer a therapeutic advantage and thus would be beneficial for clinical use.
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Affiliation(s)
- Kathryn Blake
- Biomedical Research Department, Center for Clinical Pharmacogenomics and Translational Research , Nemours Children's Clinic, Jacksonville, Florida
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Al-Moamary MS, Alhaider SA, Al-Hajjaj MS, Al-Ghobain MO, Idrees MM, Zeitouni MO, Al-Harbi AS, Al Dabbagh MM, Al-Matar H, Alorainy HS. The Saudi initiative for asthma - 2012 update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2012; 7:175-204. [PMID: 23189095 PMCID: PMC3506098 DOI: 10.4103/1817-1737.102166] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 11/15/2022] Open
Abstract
This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on "difficult-to-treat asthma." Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient-doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment.
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Affiliation(s)
- Mohamed S. Al-Moamary
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami A. Alhaider
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Respiratory Division, Department of Medicine, Medical College, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed O. Al-Ghobain
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Majdy M. Idrees
- Pulmonary Division, Department of Medicine, Military Hospital, Riyadh, Saudi Arabia
| | - Mohammed O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Adel S. Al-Harbi
- Department of Pediatrics, Military Hospital, Riyadh, Saudi Arabia
| | - Maha M. Al Dabbagh
- Department of Pediatrics, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hussain Al-Matar
- Department of Medicine, Imam Abdulrahman Al Faisal, Dammam, Saudi Arabia
| | - Hassan S. Alorainy
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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8
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Lundblad LKA, Rinaldi LM, Poynter ME, Riesenfeld EP, Wu M, Aimi S, Barone LM, Bates JHT, Irvin CG. Detrimental effects of albuterol on airway responsiveness requires airway inflammation and is independent of β-receptor affinity in murine models of asthma. Respir Res 2011; 12:27. [PMID: 21385381 PMCID: PMC3060863 DOI: 10.1186/1465-9921-12-27] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 03/07/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Inhaled short acting β2-agonists (SABA), e.g. albuterol, are used for quick reversal of bronchoconstriction in asthmatics. While SABA are not recommended for maintenance therapy, it is not uncommon to find patients who frequently use SABA over a long period of time and there is a suspicion that long term exposure to SABA could be detrimental to lung function. To test this hypothesis we studied the effect of long-term inhaled albuterol stereoisomers on immediate allergic response (IAR) and airway hyperresponsiveness (AHR) in mouse models of asthma. METHODS Balb/C mice were sensitized and challenged with ovalbumin (OVA) and then we studied the IAR to inhaled allergen and the AHR to inhaled methacholine. The mice were pretreated with nebulizations of either racemic (RS)-albuterol or the single isomers (S)- and (R)-albuterol twice daily over 7 days prior to harvest. RESULTS We found that all forms of albuterol produced a significant increase of IAR measured as respiratory elastance. Similarly, we found that AHR was elevated by albuterol. At the same time a mouse strain that is intrinsically hyperresponsive (A/J mouse) was not affected by the albuterol isomers nor was AHR induced by epithelial disruption with Poly-L-lysine affected by albuterol. CONCLUSIONS We conclude that long term inhalation treatment with either isomer of albuterol is capable of precipitating IAR and AHR in allergically inflamed airways but not in intrinsically hyperresponsive mice or immunologically naïve mice. Because (S)-albuterol, which lacks affinity for the β2-receptor, did not differ from (R)-albuterol, we speculate that isomer-independent properties of the albuterol molecule, other than β2-agonism, are responsible for the effect on AHR.
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Affiliation(s)
- Lennart K A Lundblad
- Vermont Lung Center, Department of Medicine, University of Vermont, 149 Beaumont Ave, Burlington, VT 05401, USA.
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9
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Beattie D, Bradley M, Brearley A, Charlton SJ, Cuenoud BM, Fairhurst RA, Gedeck P, Gosling M, Janus D, Jones D, Lewis C, McCarthy C, Oakman H, Stringer R, Taylor RJ, Tuffnell A. A physical properties based approach for the exploration of a 4-hydroxybenzothiazolone series of β2-adrenoceptor agonists as inhaled long-acting bronchodilators. Bioorg Med Chem Lett 2010; 20:5302-7. [DOI: 10.1016/j.bmcl.2010.06.136] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 06/21/2010] [Accepted: 06/24/2010] [Indexed: 11/28/2022]
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Al-Moamary MS, Al-Hajjaj MS, Idrees MM, Zeitouni MO, Alanezi MO, Al-Jahdali HH, Al Dabbagh M. The Saudi Initiative for Asthma. Ann Thorac Med 2009; 4:216-33. [PMID: 19881170 PMCID: PMC2801049 DOI: 10.4103/1817-1737.56001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 09/02/2009] [Indexed: 12/04/2022] Open
Abstract
The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.
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Affiliation(s)
- Mohamed S Al-Moamary
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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11
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Hao Z, Zhang Y, Pan L, Su X, Cheng M, Wang M, Zhao H, Wu Y. Comparison of enantiomers of SPFF, a novel beta2-Adrenoceptor agonist, in bronchodilating effect in guinea pigs. Biol Pharm Bull 2008; 31:866-72. [PMID: 18451509 DOI: 10.1248/bpb.31.866] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous study on racemic SPFF [2-(4-amino-3-chloro-5-trifluomethyl-phenyl)-2-tert-butylamino-ethanol hydrochloride], a novel beta2-adrenoceptor agonist, has validated that it is a potent, long-acting bronchodilator with relative higher beta2-adrenoceptor selectivity. On the basis of this study, we compared the pharmacological properties of SPFF and its enantiomers ((-)-SPFF and (+)-SPFF) in guinea pigs taking isoprenaline or salbutamol (SAB) as referenced drugs. For the relaxation of both normal and precontracted trachea strips in vitro, (-)-SPFF was found more potent than (+/-)-SPFF or (+)-SPFF. Moreover, we confirmed that the bronchodilator effect of (-)- and (+)-enantiomers were due to activation of the beta2-adrenoceptor because this effect was antagonized by a specific beta2-adrenoceptor antagonist, ICI-118551, with similar pA2 values to those of (+/-)-SPFF. Radioligand binding assay revealed that affinity of (-)-enantiomer to beta2-adrenoceptor was 6 and 164 fold greater than that of (+/-)- and (+)-SPFF, respectively. In addition, isomeric difference of overall selectivity between (-)-SPFF and (+)-SPFF was 10.7 fold for lung versus atria. (-)-SPFF displayed almost the same protective effect against bronchospasm induced by histamine-acetylcholine aerosol in conscious guinea pigs as (+/-)-SPFF did. However, the latent time of (+)-SPFF (1 mg.kg(-1)) was significantly shorter than that of (+/-)- and (-)-SPFF at the same doses. Finally, in the inhibition of histamine-induced increase of pulmonary resistance (RL) in anesthetized guinea pigs, (-)-SPFF was 1.3 and 3.5 times more potent than (+/-)- and (+)-SPFF. Correspondingly, in inhibiting the decrease of pulmonary compliance (CL) , the potencies of (-)- and (+)-enantiomers were approximately equivalent to that of (+/-)-SPFF. Furthermore, a study on the long-lasting action of the test drugs had shown that the effects of (-)-SPFF (30 microg.kg(-1)), (+/-)-SPFF (30 microg.kg(-1)) and (+)-SPFF (100 microg.kg(-1)) in inhibiting the increase of RL all lasted for 4 h. Nevertheless, the effects of (-)- and (+)-enantiomers were slightly lower 4 h after intraduodenal administration in inhibiting the decrease of CL. In conclusion, (-)-SPFF may be beneficial for the treatment of asthma because of its more potent efficacy and higher adrenoceptor affinity than (+/-)- or (+)-SPFF.
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Affiliation(s)
- Zhihui Hao
- Department of Pharmacology, School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, No.103 Wenhua Rd., Shenyang 110016, PR China
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Abstract
Asthma is one of the most common chronic illnesses affecting children. However, distinguishing true asthma from recurrent respiratory symptoms is often a challenge for primary care providers. Many risk factors can help predict persistent disease, including presence of allergies or eczema, family history, symptoms apart from obvious infection, and the severity of previous episodes. Because neither cure nor prevention is currently a viable option, the treatment is aimed at minimizing symptoms and maximizing asthma control.
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Affiliation(s)
- Lora J Stewart
- Premier Allergy and Asthma, 18525 E Smoky Hill Road, #C, P.C., Centennial, Colorado 80015, USA.
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Raissy HH, Harkins M, Esparham A, Kelly HW. Comparison of the dose response to levalbuterol with and without pretreatment with S-albuterol after methacholine-induced bronchoconstriction. Pharmacotherapy 2007; 27:1231-6. [PMID: 17723076 DOI: 10.1592/phco.27.9.1231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine the effect of S-albuterol on the dose response to levalbuterol in patients with moderate bronchoconstriction induced by a methacholine challenge. DESIGN Prospective, randomized, double-blind, placebo-controlled, crossover study. SETTING University-affiliated clinical trial center. PATIENTS Twenty-two adults with mild, stable asthma. INTERVENTION At the screening visit, patients were switched from their beta2-agonist to ipratropium bromide for use as an as-needed rescue therapy. At the baseline visit 2-6 days later, the provocative concentration of methacholine to induce a 30% decrease in forced expiratory volume in 1 second (FEV(1) PC(30)) was determined, followed by a nebulized racemic albuterol dose-response study with three doses of albuterol, to familiarize patients with the procedures. At visits 2 and 3, patients were randomly assigned to receive nebulized normal saline placebo or S-albuterol 5 mg before the methacholine challenge and were administered three escalating doses of levalbuterol after the challenge. MEASUREMENTS AND MAIN RESULTS Area under the curve for FEV(1) over 40 minutes (AUC(0-40)) after administration of levalbuterol was the primary outcome, with slope of FEV(1) as the secondary outcome. In addition, the fraction of exhaled nitric oxide (FeNO) was measured before and after the challenges. In the 17 patients who met criteria for completion, no deleterious effect for S-albuterol was found for FEV(1) PC(30), AUC(0-40) FEV(1), or the FEV(1) slope(0-40). However, S-albuterol reduced the provocative concentration of methacholine to induce a 20% decrease in FEV(1) (PC(20) 0.52 +/- 2.06 vs 0.39 +/- 1.58 mg/ml, placebo vs S-albuterol, p=0.044) but did not affect FeNO. CONCLUSION A single high dose of S-albuterol did not alter the bronchodilator response to levalbuterol. The effect on bronchial responsiveness requires further study.
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Affiliation(s)
- Hengameh H Raissy
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA
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Abstract
The purpose of this review is to determine whether the proinflammatory actions identified in vitro for (S)-albuterol provide a clinically significant therapeutic advantage for levalbuterol over racemic albuterol. Clinical trials evaluating the bronchodilation in chronic and acute asthma provide conflicting evidence. Older trials suggested an advantage for levalbuterol; however, the newer trials have failed to confirm those advantages. Although (S)-albuterol produces increased bronchial hyperresponsiveness in vitro and in animal models, this has not been consistently confirmed in clinical trials; however, the heterogeneity of the trials precludes definitive conclusions. Current clinical trials do not provide evidence of a substantial advantage of levalbuterol over racemic albuterol although the data are insufficient to determine whether subsets of the patient population might benefit from single isomer therapy.
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Affiliation(s)
- H William Kelly
- Department of Pediatrics, Pediatrics/Pulmonary, MSC10-5590, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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15
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Page CP, Spina D. Beta2-agonists and bronchial hyperresponsiveness. Clin Rev Allergy Immunol 2007; 31:143-62. [PMID: 17085790 DOI: 10.1385/criai:31:2:143] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/11/2022]
Abstract
Bronchial hyperresponsiveness (BHR) is a characteristic feature of asthma, and individuals with this disease respond to a range of physiological and chemical insults that are otherwise innocuous to healthy subjects, suggesting that the mechanisms underlying this phenomenon are characteristic of the asthma phenotype. BHR can be increased following exposure to environmental allergens in suitably sensitized individuals, pollutants, and certain viruses and can also be exacerbated by exposure to certain drugs, including nonsteroidal anti-inflammatory agents and beta-blockers. Although beta2-agonists administered acutely remain the treatment for the symptoms of asthma, paradoxically, regular treatment with these drugs can result in an increase in BHR, and this has been suggested to contribute to the increase in asthma morbidity and mortality that has been reported by numerous investigators. This article highlights our current understanding of this phenomenon and examines the potential mechanisms responsible for this effect.
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Affiliation(s)
- Clive P Page
- Sackler Institute of Pulmonary Pharmacology, School of Biomedical and Health Sciences, King's College London, United Kingdom.
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Blake K. Review of guidelines and the literature in the treatment of acute bronchospasm in asthma. Pharmacotherapy 2007; 26:148S-55S. [PMID: 16945061 DOI: 10.1592/phco.26.9part2.148s] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Asthma is a common chronic condition that disproportionately affects persons younger than 45 years. Asthma exacerbations can be sudden and severe, requiring treatment in the emergency department or hospitalization. Children younger than 15 years are 2-4 times more likely to have asthma as the first-listed hospital discharge diagnosis compared with those in other age groups. An estimated 12.8 million missed school days and 24.5 million lost work days due to asthma occurred in 2003. Drugs used in the treatment of acute asthma include inhaled beta(2)-agonists, oral corticosteroids, and inhaled anticholinergics. Levalbuterol was evaluated in several recent trials for treatment of asthma in the emergency department, for its effect in improving pulmonary function and on hospitalization rate. Theophylline, intravenous beta(2)-agonists, intravenous magnesium sulfate, and inhaled anesthetics have not been proven useful in the emergency management of asthma. The effectiveness of inhalation devices is dependent on age, cooperation of the patient, and technique.
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Affiliation(s)
- Kathryn Blake
- Center for Clinical Pediatric Pharmacology Research, Nemours Children's Clinic, Jacksonville, Florida 32247, USA
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17
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Kelly HW. What is new with the beta2-agonists: issues in the management of asthma. Ann Pharmacother 2005; 39:931-8. [PMID: 15811904 DOI: 10.1345/aph.1e611] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the more recent literature addressing the issue of whether beta2-agonists can worsen asthma and/or increase the risk of severe exacerbations and death from asthma. DATA SOURCES PubMed was searched (2001-December 2004), along with the Food and Drug Administration and Cochrane Library Web sites. In addition, the bibliographies of recent reviews of the subject were assessed. STUDY SELECTION AND DATA EXTRACTION Randomized clinical trials, retrospective and prospective cohort studies, and meta-analyses published in the past 3 years were reviewed. Studies assessing the potential for beta2-agonists to worsen outcomes in asthma as well as long-term studies assessing asthma outcomes that included an arm with regular administration of short- or long-acting inhaled beta2-agonists (LABAs) were selected. Worsening asthma was defined as a decline in lung function, an increase in bronchial hyperresponsiveness, exacerbations, or death. Studies older than 3 years selected from the bibliographies of the primary articles that addressed background perspective were also included where appropriate. DATA SYNTHESIS The studies fell into 3 primary categories with some overlap: those assessing toxicity of the S-enantiomer of albuterol, those evaluating the risk of specific genotypes regarding worsening asthma, and those assessing asthma outcomes with LABA therapy. CONCLUSIONS The current data on the use of beta2-agonists continue to support the national and international guidelines for the treatment of asthma. That is, short-acting inhaled beta2-agonists should only be used as needed for symptoms and prevention of exercise-induced bronchospasm, and LABAs should only be used regularly as adjunctive therapy with inhaled corticosteroids in patients whose asthma is not controlled with low to medium doses of the inhaled corticosteroid.
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Affiliation(s)
- H William Kelly
- Department of Pediatrics, Pediatrics/Pulmonary, MSC10-5590, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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18
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Lötvall J, Palmqvist M, Ankerst J, Persson G, Rosenborg J, Bengtsson T, Rott Z, Poczi M, Devai A, Waldeck B. The effect of formoterol over 24 h in patients with asthma: the role of enantiomers. Pulm Pharmacol Ther 2004; 18:109-13. [PMID: 15649853 DOI: 10.1016/j.pupt.2004.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Revised: 10/27/2004] [Accepted: 10/28/2004] [Indexed: 11/29/2022]
Abstract
The single-dose effect of formoterol racemate and enantiomers on bronchodilatation up to 24 h was determined. Forty-six reversible asthmatic patients were randomised to this double blind, crossover study. Formoterol was inhaled by nebulizer (HaloLite); 4.5 and 36 microg of the racemate (rac-formoterol), 2.25 and 18 microg of (R;R)-formoterol, 18 mirog of (S;S)-formoterol, or placebo. Airway and systemic effects were assessed by serial measurements of forced expiratory volume during the first second, FEV1 (24 h), and heart rate (4 h). Rac- and (R;R)-formoterol significantly and dose-dependently increased FEV1 with similar mean maximal effect. (S;S)-formoterol was without significant effects on FEV1 and heart rate. (R;R)- and rac-formoterol were still effective 22-24 h after single high doses, but this was associated with some systemic side effect (increased heart rate) initially. Average 22-24 h FEV1 was 8% (rac-formoterol 36 microg) and 11% ((R;R)-formoterol 18 microg) over placebo, respectively. No significant differences in effects were observed between rac- and (R;R)-formoterol. Thus, the single dose bronchodilatating effect of formoterol resides in (R;R)-formoterol. This study does not indicate a clinically important advantage of (R;R)-formoterol as acute bronchodilator compared to the racemate.
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Affiliation(s)
- Jan Lötvall
- The Lung Pharmacology Group, Department of Respiratory Medicine and Allergology, University of Göteborg, Sweden
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19
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Abstract
Most new drugs are marketed as single enantiomers but many older agents are still available in racemic form. As these drugs reach the end of their patent life manufacturers become interested in marketing single enantiomer equivalents. This is called 'chiral switching' and it has been claimed that it will bring clinical benefits in terms of improved efficacy, more predictable pharmacokinetics or reduced toxicity. We reviewed the clinical evidence and prices for three recently marketed single enantiomer versions of widely used racemic drugs: escitalopram, esomeprazole and levosalbutamol. Claims of increased efficacy were based on comparisons of non-equivalent doses and any advantages seemed small and clinically unimportant. Prices of esomeprazole and levosalbutamol were higher than their racemic alternatives and we predict that these prices will remain high despite the market presence of generic versions of the racemates. Patent protection and a perception of superiority based on promotion rather than evidence will maintain price premiums for single enantiomer drugs that are not justified on the basis of clinical performance.
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Affiliation(s)
- Peter Mansfield
- Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia
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20
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Abstract
Stereoselectivity has been known to play a role in drug action for 100 years or more. Nevertheless, chiral drugs have been developed and used as racemates, neglecting the fact that they comprise mixtures of two or more compounds which may have quite different pharmacological properties. A very limited access to pure enantiomers in the past has been responsible for this unsatisfactory state of affairs. During the last 20 years, significant achievements have made it possible to perform stereoselective synthesis and analysis. Today, novel chiral drugs are as a rule developed as single enantiomers. Yet, studies of old racaemic drugs are still designed, performed and published without mention of the fact that two or more compounds are involved. In recent years, a number of old racaemic drugs have been re-evaluated and re-introduced into the clinical area as the pure, active enantiomer (the eutomer). While in principle correct, the clinical benefit of this shift from a well established racaemate to a pure enantiomer often seems to be limited and sometimes exaggerated. Racaemic drugs with a deleterious enantiomer that does not contribute to the therapeutic effect (the distomer), may have been sorted out in the safety evaluation process. However, in the future any pharmacological study of racaemic drugs must include the pure enantiomers. This will generate new, valuable information on stereoselectivity in drug action and interaction.
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Affiliation(s)
- Bertil Waldeck
- Institute for Physiological Sciences, Department of Pharmacology, University of Lund, BMC F13, S-221 84 Lund, Sweden.
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22
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Bojarski J. Stereoselective chromatography of cardiovascular drugs: an update. JOURNAL OF BIOCHEMICAL AND BIOPHYSICAL METHODS 2002; 54:197-220. [PMID: 12543499 DOI: 10.1016/s0165-022x(02)00143-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This review reports the latest achievements in chromatographic enantioseparations of various classes of cardiovascular drugs and selected applications of these methods in pharmaceutical and clinical analysis. The use of these drugs as test compounds for new chiral stationary phases and different parameters of chromatographic processes is also presented.
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Affiliation(s)
- Jacek Bojarski
- Department of Organic Chemistry, Medical College, Faculty of Pharmacy, Jagiellonian University, Medyczna 9, 30-688 Cracow, Poland.
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23
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Abstract
Inhaled beta(2)-adrenoceptor agonists are by far the most effective and safe bronchodilators currently available. They have not been surpassed by any other bronchodilating principle. The way to this position has been long and started with the first successful treatment of acute, severe asthma with s.c. injections of adrenaline 100 years ago. Over the years, synthetic congeners of adrenaline have been produced and tested for their pharmacological properties. During the first decades, little attention was given airway smooth muscle. The discovery of isoprenaline in 1940 was the first major step towards selective bronchodilation. This compound became a key tool for the classification of adrenoceptors into alpha and beta. Salbutamol and terbutaline were the first to show a significant attenuation of the cardiostimulant effect and confirmed the subdivision of beta-adrenoceptors into beta(1) and beta(2). Much effort was made to eliminate the next dose-limiting side effect, skeletal muscle tremor but in vain. Prolonged duration of action was achieved in three ways: with bambuterol, an orally active carbamate ester prodrug of terbutaline, salmeterol, an inhaled beta(2)-adrenoceptor agonist emerging from a purposeful research project, and formoterol which was found, accidentally, to have a long duration of action when inhaled. Throughout the 20th century, beta-adrenoceptor agonists have been developed and marketed as racemates. The pharmacological activity usually resides in the (R)-enantiomer. Despite claims for the opposite, there is so far no compelling evidence that the presence of the less active (S)-enantiomer is of any harm to the patient. One hundred years of experience of structural modifications of adrenaline has shown that the possibilities to modify the properties of this endogenous prototype appear to be unlimited.
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Affiliation(s)
- Bertil Waldeck
- Clinical Science, AstraZeneca R&D Lund, SE-221 87, Lund, Sweden.
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24
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Vakily M, Mehvar R, Brocks D. Stereoselective pharmacokinetics and pharmacodynamics of anti-asthma agents. Ann Pharmacother 2002; 36:693-701. [PMID: 11918522 DOI: 10.1345/aph.1a248] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the previously published studies on pharmacokinetics and pharmacodynamics of chiral drugs used in the treatment of asthma. DATA SOURCES Primary and review articles were identified with a MEDLINE search (1980-May 2001) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION All English-language studies and reviews obtained from the MEDLINE search pertaining to stereoselective pharmacokinetics and pharmacodynamics of chiral anti-asthma drugs were assessed. DATA SYNTHESIS Several anti-asthma drugs (e.g., beta(2)-adrenergic agonists, leukotriene modifiers) are chiral and marketed as racemates, which consist of equal proportions of 2 enantiomers. Significant stereoselectivity has also been reported in pharmacodynamics and pharmacokinetics of the beta(2)-agonists. The enantiomers of beta(2)-agonists in the R configuration are primarily responsible for the bronchodilating effects of the racemate. The plasma concentrations of the enantiomers of anti-asthma drugs may differ as a reflection of stereoselectivity in clearance, volume of distribution, and route of administration. CONCLUSIONS Stereoselectivity in the pharmacokinetics of anti-asthma drugs may complicate the relationship between dose and/or plasma concentration of racemic drug versus effect relationship. An appreciation of the stereoselective pharmacokinetics and pharmacodynamics of chiral anti-asthma drugs may optimize the use of these agents in asthmatic patients.
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Affiliation(s)
- Majid Vakily
- Department of Drug Metabolism and Pharmacology, TAP Pharmaceutical Product Inc., Lake Forest, IL 60045-4832, USA.
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25
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Lötvall J, Palmqvist M, Arvidsson P, Maloney A, Ventresca GP, Ward J. The therapeutic ratio of R-albuterol is comparable with that of RS-albuterol in asthmatic patients. J Allergy Clin Immunol 2001; 108:726-31. [PMID: 11692096 DOI: 10.1067/mai.2001.119152] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND It has been suggested that R-albuterol produces bronchodilation that is comparable with that of racemic albuterol (RS-albuterol) on a 4:1 dose-for-dose basis but systemic side effects on a 2:1 basis, implying better therapeutic ratio for R-albuterol. OBJECTIVE We sought to carefully compare the bronchodilating and systemic effects of R- and RS-albuterol by using a crossover study design. METHODS Twenty asthmatic patients (15.1%-28.7% FEV(1) reversibility) were given R-albuterol (6.25-1600 microg), S-albuterol (6.25-1600 microg), RS-albuterol (12.5-3200 microg), or placebo in a crossover, double-blind, placebo-controlled fashion. Cumulative doses were given with a Mefar dosimeter, and FEV(1), heart rate, and plasma K(+) levels were measured 20 minutes after each dose. RESULTS Both R- and RS-albuterol produced dose-related improvement in FEV(1) and, at higher doses, increased heart rate and decreased plasma K(+) levels. Neither placebo nor S-albuterol had any significant effect. Individual estimates of the potency ratio for R-albuterol/RS-albuterol were calculated and summarized across all subjects. The geometric mean potency ratio for effects on FEV(1) was 1.9 (95% CI, 1.3-2.8), on HR of 1.9 (95% CI, 1.3-2.9), and on K(+) level of 1.7 (95% CI, 1.3-2.1). CONCLUSION All pharmacologic effects of RS-albuterol reside with the R-enantiomer, and S-albuterol is clinically inactive. The R-albuterol/RS-albuterol potency ratios for local (FEV(1)) and systemic effects (heart rate and K(+)) are similar, suggesting a comparable therapeutic ratio for R-albuterol and RS-albuterol in asthmatic subjects.
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Affiliation(s)
- J Lötvall
- Department of Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
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26
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Ahrens R, Weinberger M. Levalbuterol and racemic albuterol: are there therapeutic differences? J Allergy Clin Immunol 2001; 108:681-4. [PMID: 11692088 DOI: 10.1067/mai.2001.119407] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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27
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Anderson GP. Interactions between corticosteroids and beta-adrenergic agonists in asthma disease induction, progression, and exacerbation. Am J Respir Crit Care Med 2000; 161:S188-96. [PMID: 10712373 DOI: 10.1164/ajrccm.161.supplement_2.a1q4-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- G P Anderson
- Lung Disease Research Laboratory, Department of Pharmacology, University of Melbourne, Parkville, Australia.
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