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Palya M, Chevere JM, Drum M, Fowler S, Nusstein J, Reader A, Ni A. Pain Reduction of Ibuprofen Sodium Dihydrate Alone and in Combination with Acetaminophen in an Untreated Endodontic Pain Model: A Randomized, Double-blind Investigation. J Endod 2024; 50:881-888. [PMID: 38657900 DOI: 10.1016/j.joen.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Most pain studies have been based on a postsurgical, third molar model using ibuprofen (IBU)/acetaminophen (APAP). Studies have found quicker onset of pain relief with a newer formulation of IBU - ibuprofen sodium dihydrate (ISD). The purpose of this study was to compare pain reduction of ISD/APAP to ISD in an acute endodontic pain model of untreated patients experiencing moderate to severe pain with symptomatic apical periodontitis. METHODS AND MATERIALS In this double-blind randomized study, 64 adult emergency patients in acute moderate to severe pain, a pulpal diagnosis of symptomatic irreversible pulpitis or necrosis, and symptomatic apical periodontitis participated. Each patient randomly received either one dose of 768 mg ISD/1000 mg APAP or one dose of 768 mg ISD. Pain intensity scores were recorded every 15 minutes over 240 minutes using the Heft-Parker VAS along with time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief also recorded. The data were analyzed statistically. RESULTS Both ISD and ISD/APAP groups showed a progressive decrease in pain from baseline to 120 minutes after medication administration. Afterward, a relative plateau was seen in the patients' pain. There was no difference in the VAS scores between the ISD and ISD/APAP at any given time point, time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief. CONCLUSIONS The addition of APAP to ISD for pain control in an untreated endodontic pain model did not differ significantly from ISD alone.
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Affiliation(s)
- Morgan Palya
- Former Graduate Student in Endodontics, Division of Endodontics, The Ohio State University, Pittsburg, Pennsylvania
| | - Janine Matos Chevere
- Former Graduate Student in Endodontics, Division of Endodontics, The Ohio State University, Holland and Muskegon, Michigan
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Sara Fowler
- Associate Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - Andy Ni
- Assistant Professor, Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
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Pessano S, Gloeck NR, Tancredi L, Ringsten M, Hohlfeld A, Ebrahim S, Albertella M, Kredo T, Bruschettini M. Ibuprofen for acute postoperative pain in children. Cochrane Database Syst Rev 2024; 1:CD015432. [PMID: 38180091 PMCID: PMC10767793 DOI: 10.1002/14651858.cd015432.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Children often require pain management following surgery to avoid suffering. Effective pain management has consequences for healing time and quality of life. Ibuprofen, a frequently used non-steroidal anti-inflammatory drug (NSAID) administered to children, is used to treat pain and inflammation in the postoperative period. OBJECTIVES 1) To assess the efficacy and safety of ibuprofen (any dose) for acute postoperative pain management in children compared with placebo or other active comparators. 2) To compare ibuprofen administered at different doses, routes (e.g. oral, intravenous, etc.), or strategies (e.g. as needed versus as scheduled). SEARCH METHODS We used standard Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, CINAHL and trials registries in August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 17 years and younger, treated for acute postoperative or postprocedural pain, that compared ibuprofen to placebo or any active comparator. We included RCTs that compared different administration routes, doses of ibuprofen and schedules. DATA COLLECTION AND ANALYSIS We adhered to standard Cochrane methods for data collection and analysis. Our primary outcomes were pain relief reported by the child, pain intensity reported by the child, adverse events, and serious adverse events. We present results using risk ratios (RR) and standardised mean differences (SMD), with the associated confidence intervals (CI). We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 43 RCTs that enroled 4265 children (3935 children included in this review). We rated the overall risk of bias at the study level as high or unclear for 37 studies that had one or several unclear or high risk of bias judgements across the domains. We judged six studies as having a low risk of bias across all domains. Ibuprofen versus placebo (35 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen probably reduces child-reported pain intensity less than two hours postintervention compared to placebo (SMD -1.12, 95% CI -1.39 to -0.86; 3 studies, 259 children; moderate-certainty evidence). Ibuprofen may reduce child-reported pain intensity, two hours to less than 24 hours postintervention (SMD -1.01, 95% CI -1.24 to -0.78; 5 studies, 345 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events compared to placebo (RR 0.79, 95% CI 0.51 to 1.23; 5 studies, 384 children; low-certainty evidence). Ibuprofen versus paracetamol (21 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen likely reduces child-reported pain intensity less than two hours postintervention compared to paracetamol (SMD -0.42, 95% CI -0.82 to -0.02; 2 studies, 100 children; moderate-certainty evidence). Ibuprofen may slightly reduce child-reported pain intensity two hours to 24 hours postintervention (SMD -0.21, 95% CI -0.40 to -0.02; 6 studies, 422 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events (0 events in each group; 1 study, 44 children; low-certainty evidence). Ibuprofen versus morphine (1 RCT) No studies reported pain relief or pain intensity reported by the child or a third party, or serious adverse events. Ibuprofen likely results in a reduction in adverse events compared to morphine (RR 0.58, 95% CI 0.40 to 0.83; risk difference (RD) -0.25, 95% CI -0.40 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 4; 1 study, 154 children; moderate-certainty evidence). Ibuprofen versus ketorolac (1 RCT) No studies reported pain relief or pain intensity reported by the child, or serious adverse events. Ibuprofen may result in a reduction in adverse events compared to ketorolac (RR 0.51, 95% CI 0.27 to 0.96; RD -0.29, 95% CI -0.53 to -0.04; NNTB 4; 1 study, 59 children; low-certainty evidence). AUTHORS' CONCLUSIONS Despite identifying 43 RCTs, we remain uncertain about the effect of ibuprofen compared to placebo or active comparators for some critical outcomes and in the comparisons between different doses, schedules and routes for ibuprofen administration. This is largely due to poor reporting on important outcomes such as serious adverse events, and poor study conduct or reporting that reduced our confidence in the results, along with small underpowered studies. Compared to placebo, ibuprofen likely results in pain reduction less than two hours postintervention, however, the efficacy might be lower at two hours to 24 hours. Compared to paracetamol, ibuprofen likely results in pain reduction up to 24 hours postintervention. We could not explore if there was a different effect in different kinds of surgeries or procedures. Ibuprofen likely results in a reduction in adverse events compared to morphine, and in little to no difference in bleeding when compared to paracetamol. We remain mostly uncertain about the safety of ibuprofen compared to other drugs.
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Affiliation(s)
- Sara Pessano
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Natasha R Gloeck
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Luca Tancredi
- Geriatrie, Hessing Stiftung, Augsburg, Germany
- Medical School, Regiomed, Coburg, Germany
| | - Martin Ringsten
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ameer Hohlfeld
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sumayyah Ebrahim
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Katona MT, Nagy-Katona L, Szabó R, Borbás E, Tonka-Nagy P, Takács-Novák K. Multi-Compartmental Dissolution Method, an Efficient Tool for the Development of Enhanced Bioavailability Formulations Containing Poorly Soluble Acidic Drugs. Pharmaceutics 2023; 15:pharmaceutics15030753. [PMID: 36986614 PMCID: PMC10051608 DOI: 10.3390/pharmaceutics15030753] [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: 01/17/2023] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
The purpose of this study was to investigate the applicability of the Gastrointestinal Simulator (GIS), a multi-compartmental dissolution model, to predict the in vivo performance of Biopharmaceutics Classification System (BCS) Class IIa compounds. As the bioavailability enhancement of poorly soluble drugs requires a thorough understanding of the desired formulation, the appropriate in vitro modelling of the absorption mechanism is essential. Four immediate release ibuprofen 200 mg formulations were tested in the GIS using fasted biorelevant media. In addition to the free acid form, ibuprofen was present as sodium and lysine salts in tablets and as a solution in soft-gelatin capsules. In the case of rapid-dissolving formulations, the dissolution results indicated supersaturation in the gastric compartment, which affected the resulting concentrations in the duodenum and the jejunum as well. In addition, a Level A in vitro-in vivo correlation (IVIVC) model was established using published in vivo data, and then the plasma concentration profiles of each formulation were simulated. The predicted pharmacokinetic parameters were consistent with the statistical output of the published clinical study. In conclusion, the GIS method was found to be superior compared to the traditional USP method. In the future, the method can be useful for formulation technologists to find the optimal technique to enhance the bioavailability of poorly soluble acidic drugs.
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Affiliation(s)
- Miklós Tamás Katona
- Department of Pharmaceutical Chemistry, Semmelweis University, 7 Hőgyes Endre Street, H-1092 Budapest, Hungary
- Egis Pharmaceuticals PLC, 116-120 Bökényföldi Street, H-1165 Budapest, Hungary
| | - Lili Nagy-Katona
- Department of Organic Chemistry and Technology, Budapest University of Technology and Economics, 3 Műegyetem rakpart, H-1111 Budapest, Hungary
| | - Réka Szabó
- Egis Pharmaceuticals PLC, 116-120 Bökényföldi Street, H-1165 Budapest, Hungary
| | - Enikő Borbás
- Department of Organic Chemistry and Technology, Budapest University of Technology and Economics, 3 Műegyetem rakpart, H-1111 Budapest, Hungary
| | - Péter Tonka-Nagy
- Egis Pharmaceuticals PLC, 116-120 Bökényföldi Street, H-1165 Budapest, Hungary
| | - Krisztina Takács-Novák
- Department of Pharmaceutical Chemistry, Semmelweis University, 7 Hőgyes Endre Street, H-1092 Budapest, Hungary
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Ossowicz-Rupniewska P, Szczepkowska K, Bednarczyk P, Nowak M, Nowak A, Duchnik W, Kucharski Ł, Struk Ł, Klimowicz A, Czech Z. New amino acid propyl ester ibuprofenates from synthesis to use in drug delivery systems. RSC Adv 2022; 12:35779-35792. [PMID: 36545107 PMCID: PMC9748978 DOI: 10.1039/d2ra05804a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to evaluate the effect of introducing structural modification of ibuprofen in the form of an ion pair on the permeability of ibuprofen through the skin and the properties of the adhesive layer of the medical patch produced. The active substances tested were the salts of ibuprofen obtained by pairing the anion of ibuprofen with organic cations such as propyl esters of amino acids such as tyrosine, tryptophan, histidine, or phenylalanine. For comparison, the penetration of unmodified ibuprofen and commercially available patches was also tested. Acrylate copolymers based on isobornyl methacrylate as a biocomponent and a monomer increasing the T g ("hard") were used to produce the adhesive layer of transdermal patches. The obtained patches were characterized in terms of adhesive properties and tested for the permeability of the active ingredient and the permeability of the active ingredient through the skin. This study demonstrates the possibility of developing acrylic-based photoreactive transdermal patches that contain biocomponents that can deliver a therapeutically appropriate dose of ibuprofen.
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Affiliation(s)
- Paula Ossowicz-Rupniewska
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology Piastów Ave. 42 Szczecin 71-065 Poland
| | - Kaja Szczepkowska
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology Piastów Ave. 42 Szczecin 71-065 Poland
| | - Paulina Bednarczyk
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology Piastów Ave. 42 Szczecin 71-065 Poland
| | - Małgorzata Nowak
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology Piastów Ave. 42 Szczecin 71-065 Poland
| | - Anna Nowak
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin Powstańców Wielkopolskich Ave. 72 Szczecin 70-111 Poland
| | - Wiktoria Duchnik
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin Powstańców Wielkopolskich Ave. 72 Szczecin 70-111 Poland
| | - Łukasz Kucharski
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin Powstańców Wielkopolskich Ave. 72 Szczecin 70-111 Poland
| | - Łukasz Struk
- Department of Organic and Physical Chemistry, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology Piastów Ave. 42 Szczecin 71-065 Poland
| | - Adam Klimowicz
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin Powstańców Wielkopolskich Ave. 72 Szczecin 70-111 Poland
| | - Zbigniew Czech
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology Piastów Ave. 42 Szczecin 71-065 Poland
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Klebeko J, Krüger O, Dubicki M, Ossowicz-Rupniewska P, Janus E. Isopropyl Amino Acid Esters Ionic Liquids as Vehicles for Non-Steroidal Anti-Inflammatory Drugs in Potential Topical Drug Delivery Systems with Antimicrobial Activity. Int J Mol Sci 2022; 23:ijms232213863. [PMID: 36430346 PMCID: PMC9693575 DOI: 10.3390/ijms232213863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
New derivatives of non-steroidal anti-inflammatory drugs were synthesized via conjugation with L-amino acid isopropyl esters. The characteristics of the physicochemical properties of the obtained pharmaceutically active ionic liquids were determined. It has been shown how the incorporation of various L-amino acid esters as an ion pair affects the properties of the parent drug. Moreover, the antimicrobial activity of the obtained compounds was evaluated. The proposed structural modifications of commonly used drugs indicate great potential for use in topical and transdermal preparations.
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Affiliation(s)
- Joanna Klebeko
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, 71065 Szczecin, Poland
- Correspondence: ; Tel.: +48-449-48-01
| | - Oliver Krüger
- Department II Mathematics, Physics and Chemistry, Berliner Hochschule für Technik, Luxemburger Straße, 13353 Berlin, Germany
| | - Mateusz Dubicki
- Department of Inorganic Chemical Technology and Environment Engineering, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, 71065 Szczecin, Poland
| | - Paula Ossowicz-Rupniewska
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, 71065 Szczecin, Poland
| | - Ewa Janus
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, 71065 Szczecin, Poland
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Ossowicz-Rupniewska P, Klebeko J, Świątek E, Bilska K, Nowak A, Duchnik W, Kucharski Ł, Struk Ł, Wenelska K, Klimowicz A, Janus E. Influence of the Type of Amino Acid on the Permeability and Properties of Ibuprofenates of Isopropyl Amino Acid Esters. Int J Mol Sci 2022; 23:ijms23084158. [PMID: 35456976 PMCID: PMC9025941 DOI: 10.3390/ijms23084158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 02/05/2023] Open
Abstract
Modifications of (RS)-2-[4-(2-methylpropyl)phenyl] propanoic acid with amino acid isopropyl esters were synthesised using different methods via a common intermediate. The main reaction was the esterification of the carboxyl group of amino acids with isopropanol and chlorination of the amino group of the amino acid, followed by an exchange or neutralisation reaction and protonation. All of the proposed methods were very efficient, and the compounds obtained have great potential to be more effective drugs with increased skin permeability compared with ibuprofen. In addition, it was shown how the introduction of a modification in the form of an ion pair affects the properties of the obtained compound.
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Affiliation(s)
- Paula Ossowicz-Rupniewska
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, PL-71065 Szczecin, Poland; (J.K.); (E.Ś.); (K.B.); (E.J.)
- Correspondence: ; Tel.: +48-449-4801
| | - Joanna Klebeko
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, PL-71065 Szczecin, Poland; (J.K.); (E.Ś.); (K.B.); (E.J.)
| | - Ewelina Świątek
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, PL-71065 Szczecin, Poland; (J.K.); (E.Ś.); (K.B.); (E.J.)
| | - Karolina Bilska
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, PL-71065 Szczecin, Poland; (J.K.); (E.Ś.); (K.B.); (E.J.)
| | - Anna Nowak
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich Ave. 72, PL-70111 Szczecin, Poland; (A.N.); (Ł.K.); (A.K.)
| | - Wiktoria Duchnik
- Department of Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich Ave. 72, PL-70111 Szczecin, Poland;
| | - Łukasz Kucharski
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich Ave. 72, PL-70111 Szczecin, Poland; (A.N.); (Ł.K.); (A.K.)
| | - Łukasz Struk
- Department of Organic and Physical Chemistry, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology, Al. Piastów 42, PL-71065 Szczecin, Poland;
| | - Karolina Wenelska
- Department of Nanomaterials Physicochemistry, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 45, PL-70311 Szczecin, Poland;
| | - Adam Klimowicz
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich Ave. 72, PL-70111 Szczecin, Poland; (A.N.); (Ł.K.); (A.K.)
| | - Ewa Janus
- Department of Chemical Organic Technology and Polymeric Materials, Faculty of Chemical Technology and Engineering, West Pomeranian University of Technology in Szczecin, Piastów Ave. 42, PL-71065 Szczecin, Poland; (J.K.); (E.Ś.); (K.B.); (E.J.)
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Singla N, Bertoch T, Shenoy S, Munjal S. Efficacy and safety of single-dose DFN-15 for treatment of acute postsurgical dental pain: a randomized, double-blind, placebo-controlled study. Pain 2022; 163:91-99. [PMID: 34252915 PMCID: PMC8675044 DOI: 10.1097/j.pain.0000000000002312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT The analgesic efficacy and safety of DFN-15, a new oral liquid formulation of celecoxib with more rapid absorption than the capsule, were evaluated in the treatment of acute pain in adult patients after dental surgery. In this randomized, double-blind, placebo-controlled, dose-ranging study, 120 otherwise healthy adults who underwent the extraction of bilateral impacted mandibular third molar teeth and experienced moderate to severe pain postsurgery were randomly assigned, in a 1:1:1:1 ratio, to receive one dose of either placebo or DFN-15 at 3 doses: 62.5, 125, and 250 mg. Participants were evaluated at prespecified time points over 8 hours after study drug administration, using several instruments, including the 11-point Numerical Pain Rating Scale, 5-point Pain Relief Scale, and 5-point Treatment Satisfaction Scale. Rescue analgesic (oxycodone / acetaminophen) was permitted. The primary endpoint was the summed pain intensity difference (SPID) over the 6-hour postdose period (SPID6), which was compared between each DFN-15 dose and placebo using analysis of covariance. Other assessments of pain relief, use of rescue medication, and safety were also analyzed. All 3 doses of DFN-15 were significantly superior to placebo in SPID6 (least square mean difference over placebo: -756.6, -1120.7, and -1355.1, P < 0.0001 for all comparisons). In addition, DFN-15 was generally superior to placebo in other endpoints, including reduction of pain intensity, speed and magnitude of pain relief, treatment satisfaction, and rescue medication use. DFN-15 was similar to placebo in the incidence of adverse events with no apparent dose-related effects.
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Affiliation(s)
- Neil Singla
- Lotus Clinical Research, Pasadena, CA, United States
| | - Todd Bertoch
- JBR Clinical Research, Salt Lake City, UT, United States
| | | | - Sagar Munjal
- Dr Reddy's Laboratories, Princeton, NJ, United States
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Watson H, Hildebolt C, Rowland K. Pain relief with combination acetaminophen/codeine or ibuprofen following third-molar extraction: A systematic review and meta-analysis. PAIN MEDICINE 2021; 23:1176-1185. [PMID: 34850186 DOI: 10.1093/pm/pnab334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/13/2021] [Accepted: 11/06/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of our study was to perform a systematic review and meta-analysis of randomized, blinded, placebo-controlled studies that, following third-molar extraction, utilized either a combination of acetaminophen (600 mg) with codeine (60 mg) or ibuprofen (400 mg) for pain management. DESIGN We searched PubMed, and the trial registry ClinicalTrials.gov databases with the keywords "molar or molars", "tooth or teeth", "extraction" and "pain". Selected studies were: (1) randomized, blinded, placebo controlled, (2) utilized either a single-dose combination acetaminophen (600 mg) with codeine (60 mg) (A/C) or ibuprofen, and (3) recorded standardized pain relief (PR) at 6 hours, or summed total pain relief over 6 hours (TOTPAR6). Of the 2,949 articles that were identified, 79 were retrieved for full-text analysis, and 20 of these studies met our inclusion criteria. RESULTS For A/C, the weighted, standardized mean difference (SMD) for TOTPAR6 was 0.796 (0.597-0.995, 95% confidence interval), P < 0.001, and for PR at 6 h, the SMD was 0.0186 (0.007 to 0.378; P = 0.059), whereas for ibuprofen the SMD for TOTPAR6 was 3.009 (1.283 to 4.735; P = 0.001), and for PR at 6 h, the SMD was 0.854 (95% CI, 0.712 to 0.996; P < 0.001). A SMD of 0.8 or larger is indicative of a large effect. CONCLUSIONS Our data indicate that single dose of ibuprofen (400 mg) is an effective pain reducer for post third molar extraction pain.
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Affiliation(s)
- Hunter Watson
- Southern Illinois University School of Dental Medicine, Alton, IL
| | | | - Kevin Rowland
- University of Houston College of Medicine, Houston, TX
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Kellstein D, Leyva R. Evaluation of Fixed-Dose Combinations of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain: A Pilot, Dose-Ranging, Randomized Study. Drugs R D 2021; 20:237-247. [PMID: 32506309 PMCID: PMC7419400 DOI: 10.1007/s40268-020-00310-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction Ibuprofen and acetaminophen provide analgesia via different mechanisms of action and do not exhibit drug–drug interactions; therefore, combining low doses of each may provide greater efficacy without compromising safety. Objectives The present study assessed the analgesic efficacy of fixed-dose combinations (FDCs) of ibuprofen/acetaminophen (IBU/APAP) compared with ibuprofen 400 mg and placebo. Methods This 12-h, double-blind, proof-of-concept study compared three FDCs of IBU/APAP (200 mg/500 mg, 250 mg/500 mg, and 300 mg/500 mg) with ibuprofen 400 mg and placebo in patients with moderate-to-severe pain following third molar extraction. The primary endpoint was the time-weighted sum of pain relief and pain intensity difference scores from 0 to 8 h after dosing (SPRID[4]0–8). Time to meaningful pain relief (TMPR), duration of pain relief, and adverse events (AEs) were also assessed. Results In total, 394 patients were randomized. All active treatments were superior to placebo for SPRID[4]0–8 (all p < 0.001) but not significantly different from ibuprofen 400 mg. Median TMPR with FDCs and ibuprofen (44.5–54.1 and 56.2 min, respectively) was faster than with placebo (> 720 min; all p < 0.001 vs. placebo). Duration of pain relief was similar with the FDCs and ibuprofen 400 mg (9.7 –11.1 h) and longer than with placebo (1.6 h; all p < 0.001). AE incidence was comparable with all treatments. Conclusion Each IBU/APAP FDC provided analgesic efficacy comparable to that with ibuprofen 400 mg and superior to that with placebo. Each FDC provided MPR in < 1 h, duration of pain relief > 9 h, and tolerability similar to that with ibuprofen and placebo. ClinicalTrials.gov Registration NCT01559259 Electronic supplementary material The online version of this article (10.1007/s40268-020-00310-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Rina Leyva
- Pfizer Consumer Healthcare, Madison, NJ, USA
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10
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La Monaca G, Pranno N, Annibali S, Polimeni A, Pompa G, Cristalli MP. Effects of ibuprofen administration timing on oral surgery pain: A randomized clinical trial. Oral Dis 2021; 28:796-804. [PMID: 33486855 DOI: 10.1111/odi.13781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the analgesic effect of ibuprofen 400 mg given 30 min before or immediately after third molars surgery under local anaesthesia. MATERIALS AND METHODS The single-centre, randomized, split-mouth, triple-blind, clinical trial involved 38 outpatients, for a total of 76 bilateral symmetrical fully bone impacted mandibular third molars. Each patient was undergone to separate surgical sessions for the right and left side, and ibuprofen was randomly administered 30 min before or immediately after the intervention. Study participants recorded pain intensity using Numerical Rating Scale-11, the timing of rescue therapy intake and overall tablets consumption over 3 days. RESULTS The overall pain intensity score was lower in the group receiving ibuprofen immediately after (3.13 ± 2.46) than before (3.58 ± 2.40) surgery, with statistically significant differences only on the second and third days. The mean time to the first using rescue therapy was longer in the postoperative (598.33 ± 422.62 min) than in the preoperative (406.25 ± 149.79 min) analgesic treatment group (p = .123). The number of supplemented ibuprofen tablets did not differ (p = .530) between both groups. CONCLUSIONS Within the limits of the present study, ibuprofen administration immediately after surgery seemed to be more effective than preoperative administration.
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Affiliation(s)
- Gerardo La Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Susanna Annibali
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Pompa
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medical Surgical Sciences, Sapienza University of Rome, Rome, Italy
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11
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Hersh EV, Moore PA, Grosser T, Polomano RC, Farrar JT, Saraghi M, Juska SA, Mitchell CH, Theken KN. Nonsteroidal Anti-Inflammatory Drugs and Opioids in Postsurgical Dental Pain. J Dent Res 2020; 99:777-786. [PMID: 32286125 DOI: 10.1177/0022034520914254] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Postsurgical dental pain is mainly driven by inflammation, particularly through the generation of prostaglandins via the cyclooxygenase system. Thus, it is no surprise that numerous randomized placebo-controlled trials studying acute pain following the surgical extraction of impacted third molars have demonstrated the remarkable efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, etodolac, diclofenac, and ketorolac in this prototypic condition of acute inflammatory pain. Combining an optimal dose of an NSAID with an appropriate dose of acetaminophen appears to further enhance analgesic efficacy and potentially reduce the need for opioids. In addition to being on average inferior to NSAIDs as analgesics in postsurgical dental pain, opioids produce a higher incidence of side effects in dental outpatients, including dizziness, drowsiness, psychomotor impairment, nausea/vomiting, and constipation. Unused opioids are also subject to misuse and diversion, and they may cause addiction. Despite these risks, some dental surgical outpatients may benefit from a 1- or 2-d course of opioids added to their NSAID regimen. NSAID use may carry significant risks in certain patient populations, in which a short course of an acetaminophen/opioid combination may provide a more favorable benefit versus risk ratio than an NSAID regimen.
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Affiliation(s)
- E V Hersh
- Department of Oral Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - P A Moore
- Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - T Grosser
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R C Polomano
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - J T Farrar
- Departments of Epidemiology/Biostatistics and Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M Saraghi
- Department of Dentistry/Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, New York City, NY, USA
| | - S A Juska
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - C H Mitchell
- Department of Basic and Translational Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - K N Theken
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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12
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Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain. Clin J Pain 2020; 36:495-504. [DOI: 10.1097/ajp.0000000000000828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Janus E, Ossowicz P, Klebeko J, Nowak A, Duchnik W, Kucharski Ł, Klimowicz A. Enhancement of ibuprofen solubility and skin permeation by conjugation with l-valine alkyl esters. RSC Adv 2020; 10:7570-7584. [PMID: 35492154 PMCID: PMC9049830 DOI: 10.1039/d0ra00100g] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/12/2020] [Indexed: 11/21/2022] Open
Abstract
New ibuprofen derivatives were made via conjugation with l-valine alkyl esters (ValOR), where R was changed from an ethyl to a hexyl group. The ionic structure was confirmed using NMR and FTIR. Specific rotation, solubility in commonly used solvents, thermal properties including phase transitions temperatures, and thermal stability were also determined. The ionic structure with a protonated amine group on an l-valine ester and melting points below 100 °C allowed inclusion of these ibuprofen derivatives into the pharmaceutically active protic ionic liquids. The ibuprofen salt solubility in deionised water and two buffer solutions at pH 5.4 and 7.4 were established and compared with the parent acid solubility. The octanol/water (buffer) partition coefficient, permeation through porcine skin, and accumulation in the skin were also measured. Ibuprofen pairing with l-valine alkyl esters [ValOR][IBU], caused higher solubility and a greater drug molecule absorption through biological membranes. log P was lower for ibuprofen salts than for the acid and it increased with a longer l-valine ester cation alkyl chain. In vitro porcine skin tests showed that ibuprofen salts with a propyl or isopropyl ester in l-valine are particularly relevant for topical application. They provide transport for ibuprofen through the skin at much higher rate than the unmodified acid and a higher permeated ibuprofen concentration, which can improve efficacy. Thus, synthesised ibuprofen derivatives could be used as drug carriers in transdermal systems to provide better drug bioavailability, and they can be also be the source of exogenous l-valine. New ibuprofen derivatives made via conjugation with l-valine alkyl esters have better solubility in aqueous solutions and a lower log P value compared to the parent acid. They provide faster and more completely permeation of drug through the skin.![]()
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Affiliation(s)
- Ewa Janus
- West Pomeranian University of Technology, Szczecin
- Faculty of Chemical Technology and Engineering
- Department of Chemical Organic Technology and Polymeric Materials
- 71-065 Szczecin
- Poland
| | - Paula Ossowicz
- West Pomeranian University of Technology, Szczecin
- Faculty of Chemical Technology and Engineering
- Department of Chemical Organic Technology and Polymeric Materials
- 71-065 Szczecin
- Poland
| | - Joanna Klebeko
- West Pomeranian University of Technology, Szczecin
- Faculty of Chemical Technology and Engineering
- Department of Chemical Organic Technology and Polymeric Materials
- 71-065 Szczecin
- Poland
| | - Anna Nowak
- Pomeranian Medical University in Szczecin
- Department of Cosmetic and Pharmaceutical Chemistry
- 70-111 Szczecin
- Poland
| | - Wiktoria Duchnik
- Pomeranian Medical University in Szczecin
- Department of Cosmetic and Pharmaceutical Chemistry
- 70-111 Szczecin
- Poland
| | - Łukasz Kucharski
- Pomeranian Medical University in Szczecin
- Department of Cosmetic and Pharmaceutical Chemistry
- 70-111 Szczecin
- Poland
| | - Adam Klimowicz
- Pomeranian Medical University in Szczecin
- Department of Cosmetic and Pharmaceutical Chemistry
- 70-111 Szczecin
- Poland
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14
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Chen CT, Chen CH, Sheu C, Chen JP. Ibuprofen-Loaded Hyaluronic Acid Nanofibrous Membranes for Prevention of Postoperative Tendon Adhesion through Reduction of Inflammation. Int J Mol Sci 2019; 20:E5038. [PMID: 31614502 PMCID: PMC6834315 DOI: 10.3390/ijms20205038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023] Open
Abstract
A desirable multi-functional nanofibrous membrane (NFM) for prevention of postoperative tendon adhesion should be endowed with abilities to prevent fibroblast attachment and penetration and exert anti-inflammation effects. To meet this need, hyaluronic acid (HA)/ibuprofen (IBU) (HAI) NFMs were prepared by electrospinning, followed by dual ionic crosslinking with FeCl3 (HAIF NFMs) and covalent crosslinking with 1,4-butanediol diglycidyl ether (BDDE) to produce HAIFB NFMs. It is expected that the multi-functional NFMs will act as a physical barrier to prevent fibroblast penetration, HA will reduce fibroblast attachment and impart a lubrication effect for tendon gliding, while IBU will function as an anti-inflammation drug. For this purpose, we successfully fabricated HAIFB NFMs containing 20% (HAI20FB), 30% (HAI30FB), and 40% (HAI40FB) IBU and characterized their physico-chemical properties by scanning electron microscopy, Fourier transformed infrared spectroscopy, thermal gravimetric analysis, and mechanical testing. In vitro cell culture studies revealed that all NFMs except HAI40FB possessed excellent effects in preventing fibroblast attachment and penetration while preserving high biocompatibility without influencing cell proliferation. Although showing significant improvement in mechanical properties over other NFMs, the HAI40FB NFM exhibited cytotoxicity towards fibroblasts due to the higher percentage and concentration of IBU released form the membrane. In vivo studies in a rabbit flexor tendon rupture model demonstrated the efficacy of IBU-loaded NFMs (HAI30FB) over Seprafilm® and NFMs without IBU (HAFB) in reducing local inflammation and preventing tendon adhesion based on gross observation, histological analyses, and biomechanical functional assays. We concluded that an HAI30FB NFM will act as a multi-functional barrier membrane to prevent peritendinous adhesion after tendon surgery.
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Affiliation(s)
- Chien-Tzung Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Collage of Medicine, Kwei-San, Taoyuan 33305, Taiwan.
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, College of Medicine, Keelung 20401, Taiwan.
| | - Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Collage of Medicine, Kwei-San, Taoyuan 33305, Taiwan.
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan.
| | - Chialin Sheu
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan.
| | - Jyh-Ping Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Collage of Medicine, Kwei-San, Taoyuan 33305, Taiwan.
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan.
- Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33302, Taiwan.
- Department of Materials Engineering, Ming Chi University of Technology, Tai-Shan, New Taipei City 24301, Taiwan.
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15
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Theken KN, Hersh EV, Lahens NF, Lee HM, Li X, Granquist EJ, Giannakopoulos HE, Levin LM, Secreto SA, Grant GR, Detre JA, FitzGerald GA, Grosser T, Farrar JT. Variability in the Analgesic Response to Ibuprofen Is Associated With Cyclooxygenase Activation in Inflammatory Pain. Clin Pharmacol Ther 2019; 106:632-641. [PMID: 30929268 PMCID: PMC6753944 DOI: 10.1002/cpt.1446] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 01/31/2023]
Abstract
The mechanisms underlying interindividual variability in analgesic efficacy of nonsteroidal anti‐inflammatory drugs (NSAIDs) are not well understood. Therefore, we performed pain phenotyping, functional neuroimaging, pharmacokinetic/pharmacodynamic assessments, inflammation biomarkers, and gene expression profiling in healthy subjects who underwent surgical extraction of bony impacted third molars and were treated with ibuprofen (400 mg; N = 19) or placebo (N = 10). Analgesic efficacy was not associated with demographic or clinical characteristics, ibuprofen pharmacokinetics, or the degree of cyclooxygenase inhibition by ibuprofen. Compared with partial responders to ibuprofen (N = 9, required rescue medication within the dosing interval), complete responders (N = 10, no rescue medication) exhibited greater induction of urinary prostaglandin metabolites and serum tumor necrosis factor‐α and interleukin 8. Differentially expressed genes in peripheral blood mononuclear cells were enriched for inflammation‐related pathways. These findings suggest that a less pronounced activation of the inflammatory prostanoid system is associated with insufficient pain relief on ibuprofen alone and the need for additional therapeutic intervention.
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Affiliation(s)
- Katherine N Theken
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elliot V Hersh
- Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicholas F Lahens
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hyo Min Lee
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Xuanwen Li
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Eric J Granquist
- Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Helen E Giannakopoulos
- Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence M Levin
- Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stacey A Secreto
- Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory R Grant
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Garret A FitzGerald
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tilo Grosser
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John T Farrar
- Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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16
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Schachtel B, Aspley S, Shephard A, Schachtel E, Lorton MB, Shea T. Onset of analgesia by a topically administered flurbiprofen lozenge: a randomised controlled trial using the double stopwatch method. Br J Pain 2018; 12:208-216. [PMID: 30349694 DOI: 10.1177/2049463718756152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The double stopwatch (DSW) method for determining the onset of analgesic activity has been implemented extensively by investigators studying orally administered drugs. Objective The aim of this randomised, placebo-controlled trial was to use the DSW method to determine the time to onset of analgesia of a single dose of a topically administered non-steroidal anti-inflammatory drug, flurbiprofen 8.75 mg lozenge. Methods Adults with acute sore throat (n = 122) were examined to confirm the presence of tonsillopharyngitis (Tonsillo-Pharyngitis Assessment) and sore throat pain of at least moderate intensity (≥6 on a 0-10 Sore Throat Scale). Lozenges containing flurbiprofen 8.75 mg or inert ingredients (identically flavoured) were administered under double-blind conditions in the clinic while patients assessed pain and pain relief over 3 hours. Onset of analgesia was determined using the DSW method and reported as the Kaplan-Meier median time to meaningful relief. The median time to first perceived relief was also documented. Results About 78% of flurbiprofen-treated patients reported meaningful pain relief compared with 48% of placebo-treated patients (p < 0.01); median time to meaningful relief for flurbiprofen-treated patients was 43 minutes (placebo-treated patients were right-censored due to non-responsivity; p = 0.01). Median time to first perceived pain relief was 11 minutes for flurbiprofen-treated patients and 19 minutes for placebo-treated patients (p = 0.03). Flurbiprofen lozenge was well tolerated, with no serious adverse events occurring and no patient discontinuing due to an adverse event. Conclusion These results indicate that the DSW method can be successfully applied to the evaluation of the onset of action of a locally administered analgesic in patients with acute sore throat, demonstrating that the onset of action (time to meaningful pain relief) of flurbiprofen lozenge was <45 minutes.
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Affiliation(s)
- Bernard Schachtel
- Schachtel Research Company, Inc., Jupiter, FL, USA.,Yale School of Public Health, New Haven, CT, USA
| | - Sue Aspley
- Reckitt Benckiser Healthcare Ltd, Slough, UK
| | | | | | | | - Tim Shea
- Reckitt Benckiser, Parsippany, NJ, USA
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17
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Hong S, Xu K, Guo S, Yuan L, Wang H. Development and Validation of a New Simple HPLC Method for the Determination of 3-[4-(2-Methylpropyl)phenyl] Propanoic Acid as an Impurity of Ibuprofen and Ibuprofen Sodium. Chromatographia 2017. [DOI: 10.1007/s10337-017-3320-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Cristofoletti R, Dressman JB. Bridging the Gap Between In Vitro Dissolution and the Time Course of Ibuprofen-Mediating Pain Relief. J Pharm Sci 2016; 105:3658-3667. [DOI: 10.1016/j.xphs.2016.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022]
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19
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Ibuprofen sodium is absorbed faster than standard Ibuprofen tablets: results of two open-label, randomized, crossover pharmacokinetic studies. Drugs R D 2016; 14:283-90. [PMID: 25395311 PMCID: PMC4269818 DOI: 10.1007/s40268-014-0070-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background A novel ibuprofen (IBU) formulation, Advil® Film-Coated Tablets (IBUNa), was developed. Objective Pharmacokinetic comparison of IBUNa versus other IBU formulations. Study Design Two randomized, single-dose, open-label, five-way crossover pharmacokinetic studies. Setting Inpatient research clinic. Subjects Seventy-one healthy adult volunteers. Intervention Study 1: In three periods, fasted subjects received 400-mg IBU dose equivalents as IBUNa 2 × 256 mg, Advil® Liqui-Gels® (IBULG) 2 × 200 mg, and Motrin® IB (IBUMot) 2 × 200 mg tablets. In two periods following a high-fat breakfast, subjects received 400-mg IBU dose equivalents as IBUNa 2 × 256 mg and IBULG 2 × 200 mg. Study 2: In five study periods, fasted subjects received 400-mg IBU dose equivalents as IBUNa 2 × 256 mg, Advil® FastGel® (IBUFG) 2 × 200 mg, Nurofen® (IBUNur) 2 × 200 mg, Advil® (IBUAdv) 2 × 200 mg, and Nurofen® Express containing IBU lysinate (IBULys) 2 × 342 mg. Main Outcome Measure Log-transformed area under the plasma concentration versus time curve to last observable concentration (AUCL) and maximum plasma concentration (Cmax) were the primary pharmacokinetic parameters; time to maximum measured plasma concentration (Tmax) was analyzed post hoc. Results IBUNa was bioequivalent to IBULG (fasted and fed) and IBUFG and IBULys (fasted) for rate (Cmax) and extent (AUCL) of IBU absorption. After fasting, AUCL was bioequivalent for IBUNa and IBUMot, IBUAdv, and IBUNur, but Cmax occurred significantly earlier with IBUNa. After fasting, median IBUNaTmax was comparable to that for IBULG, IBUFG, and IBULys, but was much shorter than that for IBUMot, IBUNur, and IBUAdv. Food slowed absorption of IBUNa and IBULG similarly. All treatments were tolerated similarly. Conclusion IBUNa is absorbed faster but to a similar extent as standard IBU formulations.
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20
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Packman E, Leyva R, Kellstein D. Onset of analgesia with ibuprofen sodium in tension-type headache: a randomized trial. J Pharm Health Care Sci 2015; 1:13. [PMID: 26819724 PMCID: PMC4728914 DOI: 10.1186/s40780-015-0012-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background Ibuprofen is known to be efficacious in the treatment of tension-type headache, the most common form of primary headache. A novel tablet formulation of ibuprofen sodium is more rapidly absorbed than standard ibuprofen. This study evaluated onset of analgesia and overall efficacy of ibuprofen sodium in episodic-type tension headache (ETTH) compared with standard ibuprofen and placebo. Methods This randomized, double-blind, single-center, parallel-group study included adults aged 18–65 years with ≥4 moderately severe ETTHs per month for 6 months. Within 45 minutes of onset of at least moderately severe ETTH, subjects were randomized 2:2:1 to receive a single oral dose of ibuprofen sodium tablets (Advil® Film Coated; 2 × 256 mg [equivalent to 400 mg standard ibuprofen]), standard ibuprofen tablets (Motrin®; 2 × 200 mg), or placebo. The coprimary end points were time-weighted sum of pain relief rating and pain intensity difference scores over 3 hours (SPRID 0–3) and time to meaningful pain relief (MPR) assessed by double-stopwatch method. Results A total of 226 subjects were randomized to ibuprofen sodium (n = 91), standard ibuprofen (n = 89), and placebo (n = 46). Demographics and baseline characteristics were comparable between treatment groups. Mean SPRID 0–3 scores were significantly superior (P < .001) for ibuprofen sodium (9.6) and standard ibuprofen (9.8) versus placebo (3.5), but were not significantly different from each other (P = .812). Time to MPR was significantly (P < .001) shorter for ibuprofen sodium and standard ibuprofen compared with placebo (median 40.6, 48.5, and >180 minutes, respectively). Time to MPR was numerically faster for ibuprofen sodium than standard ibuprofen. This difference was not statistically significant (P = .253) using the protocol-specified analysis but was (P = .022) in a post hoc analysis using the Gehan-Wilcoxon test, which assigns higher weights to earlier events. (The post hoc analysis was performed because Kaplan-Meier graphs and results for time to first perceptible relief favored ibuprofen sodium over standard ibuprofen at earlier time points.) There were no adverse events. Conclusions This novel ibuprofen sodium tablet provided rapid, efficacious relief of ETTH and was well tolerated. Trial registration ClinicalTrials.gov NCT01362491.
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Affiliation(s)
- Elias Packman
- Institute for Applied Pharmaceutical Research, 214 Sycamore Avenue, Merion Station, PA 19066 USA
| | - Rina Leyva
- Pfizer Consumer Healthcare, 1 Giralda Farms, Madison, NJ 07940 USA
| | - David Kellstein
- Pfizer Consumer Healthcare, 1 Giralda Farms, Madison, NJ 07940 USA
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