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McAtee R, Schmid SM, Tolbert MK, Hetzel S, Suchodolski JS, Pritchard JC. Effect of esomeprazole with and without a probiotic on fecal dysbiosis, intestinal inflammation, and fecal short-chain fatty acid concentrations in healthy dogs. J Vet Intern Med 2023; 37:2109-2118. [PMID: 37776099 PMCID: PMC10658524 DOI: 10.1111/jvim.16886] [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: 03/06/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Proton pump inhibitors can cause diarrhea and a transient increase in fecal dysbiosis index in dogs. It is unknown if concurrent probiotic administration mitigates these effects. OBJECTIVE/HYPOTHESIS To assess the fecal Canine Microbial Dysbiosis Index (CMDI), fecal short chain fatty acid (SCFA), and fecal calprotectin concentrations in dogs administered esomeprazole with and without a probiotic. ANIMALS Eleven healthy dogs. METHODS Prospective, within-subjects before and after study. All dogs received 7-day courses of esomeprazole (1 mg/kg PO q 24h) alone followed by esomeprazole with a probiotic (15 billion CFU/kg), separated by a 4-week washout period. Data were compared between phases using mixed effects ANOVA or generalized estimating equations with post-hoc Holm adjustment for 2-way comparisons. RESULTS Compared to baseline (mean CMDI -2.66, SD 3.04), fecal CMDI was not different with esomeprazole administration alone (mean CMDI -1.48, SD 3.32, P = .08), but there was a significant increase (Diff 3.05, 95% CI [1.37, 4.74], P < .001, Effect size 2.02) when esomeprazole and a probiotic were administered concurrently (mean CMDI 0.39, SD 2.83). CMDI was significantly higher when esomeprazole was administered with a probiotic than alone (Diff 1.87, 95% CI [0.19, 1.87], P = .02, Effect size 1.24). Fecal calprotectin and SCFA concentrations did not differ between phases. The occurrence of vomiting and diarrhea was not different from baseline when esomeprazole was administered alone (36%/27%) or with a probiotic (46%/9%). CONCLUSIONS AND CLINICAL IMPORTANCE In healthy dogs, concurrent administration of a probiotic is unlikely to lessen adverse effects associated with esomeprazole administration.
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Affiliation(s)
- Rae McAtee
- Department of Medical SciencesUniversity of Wisconsin‐Madison School of Veterinary MedicineMadisonWisconsinUSA
| | - Sarah M. Schmid
- Department of Small Animal Clinical SciencesUniversity of Tennessee Knoxville College of Veterinary MedicineKnoxvilleTennesseeUSA
| | - M. Katherine Tolbert
- Gastrointestinal Laboratory, Department of Small Animal Clinical SciencesSchool of Veterinary Medicine & Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Scott Hetzel
- Department of Biostatistics and Medical InformaticsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jan S. Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical SciencesSchool of Veterinary Medicine & Biomedical Sciences, Texas A&M UniversityCollege StationTexasUSA
| | - Jessica C. Pritchard
- Department of Medical SciencesUniversity of Wisconsin‐Madison School of Veterinary MedicineMadisonWisconsinUSA
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Smith JS, Gebert J, Bennett K, Ebner LS, Flynn R, Mulon PY, Harvill L, Escher OG, Kreuder AJ, Bergman J, Cox S. The pharmacokinetics and pharmacodynamics of esomeprazole in sheep after intravenous dosing. Front Vet Sci 2023; 10:1172023. [PMID: 37215479 PMCID: PMC10196163 DOI: 10.3389/fvets.2023.1172023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023] Open
Abstract
Abomasal (gastric) ulceration is a morbidity in sheep, and currently, there is a paucity of pharmacokinetic and pharmacodynamic data for gastroprotectant drugs reported for this species. The proton pump inhibitor esomeprazole has been used in small animal and human patients for gastroprotection via increasing the gastric pH. The objective of this study was to report the pharmacokinetic parameters and pharmacodynamic effect of esomeprazole in sheep after single intravenous dosing. Four healthy adult Southdown cross ewes had blood collected over a 24 h time period after single intravenous dosing of esomeprazole at 1.0 mg/kg. Abomasal fluid was sampled over 24 h before and after esomeprazole administration. Plasma samples were analyzed for concentrations of esomeprazole and the esomeprazole metabolite, esomeprazole sulfone by high performance liquid chromatography. Pharmacokinetic and pharmacodynamic data were evaluated with specialized software. Esomeprazole was rapidly eliminated after IV administration. Elimination half-life, area under the curve, initial concentration (C0), and clearance were 0.2 h, 1,197 h*ng/mL, 4,321 ng/mL, and 0.83 mL/h/kg, respectively. For the sulfone metabolite elimination half-life, area under the curve and maximum concentration were 0.16 h, 22.5 h*ng/mL, and 65.0 ng/mL, respectively. Abomasal pH was significantly elevated from 1 to 6 h after administration and remained above 4.0 for at least 8 h after administration. No adverse effects were noted in these sheep. Esomeprazole was rapidly eliminated in sheep, similar to goats. Abomasal pH was increased, but future studies will be necessary to develop a clinical management approach to the use of esomeprazole in sheep.
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Affiliation(s)
- Joe S. Smith
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
- Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Jessica Gebert
- Lincoln Memorial University, College of Veterinary Medicine, Harrogate, TN, United States
| | - Kailee Bennett
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Lisa Sams Ebner
- Lincoln Memorial University, College of Veterinary Medicine, Harrogate, TN, United States
| | - Ryan Flynn
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Lainey Harvill
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Olivia Grace Escher
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Amanda Jo Kreuder
- Veterinary Microbiology and Preventative Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Joan Bergman
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Sherry Cox
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
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3
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Gould EN, Szule JA, Wilson-Robles H, Steiner JM, Lennon EM, Tolbert MK. Esomeprazole induces structural changes and apoptosis and alters function of in vitro canine neoplastic mast cells. Vet Immunol Immunopathol 2023; 256:110539. [PMID: 36592548 DOI: 10.1016/j.vetimm.2022.110539] [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: 08/02/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Histamine-2 receptor antagonists such as famotidine and proton pump inhibitors such as esomeprazole are commonly used in canine MCT disease, but direct effects on dog MCs have not been evaluated. Omeprazole is a proton pump inhibitor which has been demonstrated to cause structural and functional changes to in vitro murine mast cells (MCs). It has not yet been determined if esomeprazole, the commercially available and commonly prescribed S-isomer of omeprazole, has similar effects. Our primary study objective was to evaluate and compare the effects of acid suppressants (esomeprazole and famotidine) on MC ultrastructure, viability, and function in vitro using both healthy and neoplastic MCs. Murine bone marrow derived mast cells (BMMC), human LAD2, and canine C2 and BR cells, were used for these studies, representing a single healthy (i.e., BMMCs) MC model and multiple neoplastic MC models (i.e., LAD2, C2, BR), respectively. The rat basophilic leukemic (RBL-2H3) and canine B cell lymphoma 17-71 cell lines served as granulocytic and agranulocytic control lines for experiments, respectively. The treatment effect of acid suppressants on MC ultrastructure was assessed via both light and transmission electron microscopy. Differences in MC viability was assessed between groups via MTS-based, colorimetric assays and flow cytometry. Degranulation was assessed by quantification of β-hexosaminidase (i.e., LAD2 and RBL-2H3). Esomeprazole-treated MCs of all lines exhibited dramatic time and concentration-dependent alterations in ultrastructure (i.e., increased vacuolization, compromise of cell membrane), increased apoptosis, and altered degranulation responses in comparison to famotidine and vehicle-treated cells. The canine B cell lymphoma cells consistently exhibited either no significant (i.e., cytotoxicity assays) or greatly diminished treatment responses (i.e., apoptosis) compared to MCs. Esomeprazole, but not famotidine, induces significant cytotoxicity, as well as alterations to cell structure and function to multiple lines of in vitro neoplastic MCs. Continued in vitro work investigating the specific mechanisms by which proton pump inhibitors induce these effects, as well as prospective, in vivo work comparing the treatment effects of acid suppressants on canine MCTs, are warranted.
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Affiliation(s)
- Emily N Gould
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843, USA.
| | - Joseph A Szule
- Department of Veterinary Pathobiology, Image Analysis Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4461 TAMU, College Station, TX 77843, USA.
| | - Heather Wilson-Robles
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 408 Raymond Stotzer Parkway, College Station, TX 77845, USA.
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843, USA.
| | - Elizabeth M Lennon
- Department of Small Animal Clinical Sciences, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA 19104, USA.
| | - M Katherine Tolbert
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX 77843, USA.
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Fladung R, Smith JS, Hines MT, Soto-Gonzalez WM, Fayne B, Rahn RR, Escher OG, Harvill L, Bergman J, Garcia JD, Kreuder AJ, Cox S. Pharmacokinetics of esomeprazole in goats ( Capra aegagrus hircus) after intravenous and subcutaneous administration. Front Vet Sci 2022; 9:968973. [PMID: 36590808 PMCID: PMC9797722 DOI: 10.3389/fvets.2022.968973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background Stressed and hospitalized goats are at risk of developing abomasal (gastric) ulceration, but there is a paucity of pharmacokinetic studies for proton pump inhibiting drugs, such as, esomeprazole in goats. Objectives The objectives for this study were to estimate plasma pharmacokinetic parameters for esomeprazole in adult goats after intravenous (IV) and subcutaneous (SQ) administration. A secondary objective was to describe the plasma kinetics of the metabolite esomeprazole sulfone after IV and SC administration in goats. Materials and methods Esomeprazole was administered to 5 adult goats in a crossover study at doses of 1 mg/kg IV or 2 mg/kg SC. Plasma samples were collected over 36 h and analyzed via reverse phase HPLC to determine concentrations of esomeprazole and esomeprazole sulfone. Pharmacokinetic parameters were derived via non-compartmental analysis. Results Following IV administration, mean values for plasma clearance (Cl), elimination half-life [T1/2 (λz)], C0, and volume of distribution (V z ) of esomeprazole were estimated at 24.9 mL/min/kg, 6 min, 2.324 μg/mL, and 0.23 L/kg, respectively. After SC administration elimination half-life, maximum concentration (Cmax) and time to maximum concentration (Tmax) of esomeprazole were estimated at 29 min, 1.038 μg/mL, and 22 minutes respectively. Maximum concentrations of the sulfone metabolite were 32 and 18 ng/mL after IV and SC administration. Conclusion Esomeprazole was rapidly eliminated from plasma after both IV and SC injection in goats. The elimination half-life in goats appears to be shorter than reported in dogs, as well as less than that reported for pantoprazole in goats. The sulfone metabolite was detected and also rapidly eliminated from the plasma after both IV and SC administration. Additional pharmacodynamic investigations are needed to determine the efficacy of esomeprazole on abomasal (gastric) acid suppression in goats and could include larger doses or additional routes of administration.
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Affiliation(s)
- Rachel Fladung
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Joe S. Smith
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States,Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States,*Correspondence: Joe S. Smith ;
| | - Melissa T. Hines
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Windy Michelle Soto-Gonzalez
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Bryanna Fayne
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Rebecca R. Rahn
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Olivia Grace Escher
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Lainey Harvill
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Joan Bergman
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Jessica D. Garcia
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Amanda Jo Kreuder
- Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Sherry Cox
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
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Novel Esomeprazole Magnesium-Loaded Dual-Release Mini-Tablet Polycap: Formulation, Optimization, Characterization, and In Vivo Evaluation in Beagle Dogs. Pharmaceutics 2022; 14:pharmaceutics14071411. [PMID: 35890307 PMCID: PMC9323828 DOI: 10.3390/pharmaceutics14071411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Esomeprazole magnesium (EMP) is a proton pump inhibitor (PPI) that reduces acid secretion. EMP has a short plasma half-life (approximately 1.3 h); hence, nocturnal acid breakthrough (NAB) frequently occurs, disturbing the patient’s nighttime comfort and sleep. We aimed to develop a novel esomeprazole magnesium-loaded dual-release mini-tablet polycap (DR polycap) with a prolonged onset time and improved bioavailability to prevent NAB. The formulation of the EPM mini-tablet core resulted in rapid drug release. The core was coated with an inner coating and an Eudragit® L30D-55 aqueous dispersion coating to prepare the first-release mini-tablet. In addition, the core was coated with an inner coating and an aqueous dispersion of Eudragit® S100 and Eudragit® L100 coating to prepare the second-release mini-tablet. Each mini-tablet type was characterized using an in vitro dissolution test and microscopic examination. After testing, 10 of each mini-tablets were placed together in hard capsules to form DR polycaps. The combination of mini-tablets was optimized via in vitro release testing and in vivo pharmacokinetic studies. The AUC0–24h of the DR polycap was similar to that of a comparable commercial product (Nexium®); Cmax was lower by approximately 50%, and Tmax was extended by approximately 1.7-fold. In conclusion, DR polycap is an alternative to commercial products with improved NAB and dosing compliance because of its dual-release characteristics.
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Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal. Vet Sci 2021; 8:vetsci8050070. [PMID: 33922570 PMCID: PMC8146071 DOI: 10.3390/vetsci8050070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
In both human and veterinary healthcare, gastrointestinal protectants (GIPs) are considered a staple of clinical practice in that they are prescribed by general practitioners (GPs) and specialists alike. Concerning GIP use, overprescription of proton pump inhibitors (PPIs) has become a growing concern among human healthcare providers. This trend has also been documented within veterinary practice, prompting the American College of Veterinary Internal Medicine (ACVIM) to publish a consensus statement in 2018 concerning evidence-based indications for GIP use. This observational cross-sectional study evaluated self-reported prescribing protocols among Portuguese GPs to determine whether there is adherence to the consensus guidelines. Respondents were Portuguese GPs recruited by social media posts in veterinarian online forums. Data were collected from 124 respondents concerning their GIPs of choice and their rationales for prescribing them. Data were mined for prescription patterns and protocols. Among GIPs, PPIs were prescribed more often. Rationales for use included gastrointestinal ulceration and erosion (GUE), prophylactic management of nonerosive gastritis, pancreatitis, reflux esophagitis, and steroid-induced ulceration. Once-daily administration of PPIs was the most frequent dosing regime among respondents. Ninety-six percent of PPI prescribers advocated that the drug be administered either shortly before or at mealtime. Forty-nine percent of respondents supported long-term use of PPIs. Fifty-nine percent of respondents acknowledged discontinuing PPIs abruptly. This study supports that Portuguese GPs commonly prescribe GIPs in accordance with ACVIM recommendations to medically manage GUE. However, misuse of GIPs does occur, and they have been prescribed where their therapeutic value is debatable. Educational strategies should target GPs in an effort to reduce GIP misuse.
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Abstract
Esophagitis in cats and dogs is a consequence of increased exposure of the esophageal mucosa to gastroduodenal reflux. Causes can include anesthesia-related reflux, frequent vomiting, or lodged foreign bodies. An exception is eosinophilic esophagitis, an emerging primary inflammatory disease of the esophagus with a presumed allergic etiology. Reflux esophagitis owing to lower esophageal sphincter incompetence is often suspected; a tentative diagnosis can be made by endoscopic assessment, wireless esophageal pH-monitoring, or histologic examination. Because it can be difficult to distinguish diet-responsive upper gastrointestinal disease from esophagitis, response to treatment with gastric acid suppressants is needed to confirm the tentative diagnosis.
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Affiliation(s)
- Peter Hendrik Kook
- Department of Small Animals, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, Zurich 8057, Switzerland.
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8
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Lotti F, Twedt D, Warrit K, Bryan S, Vaca C, Krause L, Fukushima K, Boscan P. Effect of two different pre-anaesthetic omeprazole protocols on gastroesophageal reflux incidence and pH in dogs. J Small Anim Pract 2021; 62:677-682. [PMID: 33769569 DOI: 10.1111/jsap.13328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Gastroesophageal reflux can occur during anaesthesia and may lead to esophagitis and occasionally oesophageal stricture formation. The aim of the study is to assess two omeprazole protocols on gastroesophageal reflux incidence and pH in anaesthetised dogs. MATERIALS AND METHODS Fifty-five dogs undergoing elective ovariectomy were randomly assigned to: omeprazole single dose 1 mg/kg orally the evening before anaesthesia (20 dogs), omeprazole two doses 1 mg/kg orally the evening and 3 hours before anaesthesia (15 dogs), and control group that did not receive omeprazole (20 dogs). An oesophageal impedance/pH probe was used to measure gastroesophageal reflux incidence and pH during anaesthesia. RESULTS Gastroesophageal reflux was observed in 55% (11/20) of control dogs, 55% (11/20) of dogs receiving omeprazole once and 47% (7/15) of dogs receiving omeprazole twice. The incidence was not statistically significant different between groups. Gastroesophageal reflux pH (mean ± sd) was higher in dogs receiving omeprazole twice (6.3 ± 1.5), when compared to either control dogs (3.8 ± 1.1) or dogs receiving omeprazole once (4.1 ± 1.5). Strongly acidic reflux (pH < 4) was observed in 7% (1/15) of dogs receiving omeprazole twice versus 55% (11/20) and 35% (7/20) of control dogs and dogs receiving omeprazole once, respectively. CLINICAL SIGNIFICANCE Omeprazole administered the evening and 3 hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.
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Affiliation(s)
- F Lotti
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - D Twedt
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - K Warrit
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - S Bryan
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - C Vaca
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - L Krause
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - K Fukushima
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - P Boscan
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
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Abstract
A range of gastroprotective drugs are available for the treatment of esophagitis and gastroduodenal mucosal injury including acid suppressants (ie, histamine-2 receptor antagonists, proton pump inhibitors), coating agents, prostaglandin analogs, and antacids. Of these, the proton pump inhibitors are the most effective drugs for the medical treatment of upper gastrointestinal injury. However, proton pump inhibitors are not effective for all causes of upper gastrointestinal injury. The choice of gastroprotective drug should be guided by the cause and location of gastrointestinal injury and the potential for adverse effects.
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Affiliation(s)
- M Katherine Tolbert
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M College of Veterinary, 4474 TAMU
- College Station, TX 77843-4474, USA.
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Yang Y, Li X, Zhou Q, Sun L, Zhang T. Simultaneous determination of naproxen and esomeprazole in beagle dog plasma by supercritical fluid chromatography-tandem mass spectrometry coupled with evaporation-free liquid-liquid extraction. J Pharm Biomed Anal 2020; 193:113668. [PMID: 33176242 DOI: 10.1016/j.jpba.2020.113668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022]
Abstract
In order to avoid a risk of gastrointestinal toxic caused by naproxen (NAP), esomeprazole (ESOM) is generally used clinically in combination. The present work was undertaken to simultaneously determine NAP and ESOM in beagle dog plasma, and evaluated their pharmacokinetic behaviors in beagle dogs. Herein, ethyl acetate was used to extract the samples by using a time-saving evaporation-free liquid-liquid extraction (EF-LLE) method, then the samples were analyzed by supercritical fluid chromatography tandem mass spectrometry (SFC-MS/MS). The optimal analysis conditions were achieved with an ACQUITY UPC2™ BEH column maintained at 50℃ and eluted completely within 2 min using supercritical carbon dioxide and methanol with a gradient elution mode. Due to the large differences in plasma concentrations between NAP and ESOM, celecoxib and diazepam were selected as dual-internal standards (IS). The mass transition ion pairs were m/z 231.2 → 185.0, 346.9 → 198.2, 285.1 → 193.1 and 382.2 → 281.2 for NAP, ESOM, diazepam (IS for NAP) and celecoxib (IS for ESOM), respectively. The concentration of NAP and ESOM were linear within the range of 0.1-100 μg/mL (r > 0.993) and 0.005-5 μg/mL (r > 0.996) in beagle dog plasma, and the accuracy and precision of intra-day and inter-day of all quality control samples were within ±15 %. It was a method with the feature of rapid, sensitive and high-throughput, and would be practical for determining NAP and ESOM in biological samples simultaneously and for assessing their pharmacokinetic behaviors in clinical studies.
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Affiliation(s)
- Yuanhang Yang
- Department of Pharmaceutical Analysis, Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China
| | - Xiaoting Li
- Department of Pharmaceutical Analysis, Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China
| | - Qi Zhou
- Department of Pharmaceutical Analysis, Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China
| | - Lingling Sun
- Liaoning Inspection, Examination and Certification Center, Guihe Street 46, Shenyang 110023, China
| | - Tianhong Zhang
- Department of Pharmaceutical Analysis, Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China.
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Ryan P, Odunayo A, Price J, Hecht S, Hillsman S, Galyon G, Steiner J, Tolbert MK. Comparative analysis of the effect of PO administered acid suppressants on gastric pH in healthy cats. J Vet Intern Med 2020; 34:1879-1885. [PMID: 32885499 PMCID: PMC7517516 DOI: 10.1111/jvim.15887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are among the most commonly prescribed medications for esophagitis and upper gastrointestinal erosion and ulceration in cats. Newer PPIs such as lansoprazole and esomeprazole are believed to be effective in cats, but the effect of many of these PPIs on gastric pH in cats has not been explored. HYPOTHESIS/OBJECTIVES To evaluate the efficacy of PO esomeprazole, dexlansoprazole, and lansoprazole on intragastric pH in healthy cats. We hypothesized that esomeprazole and lansoprazole would provide superior acid suppression compared to dexlansoprazole and reach pH goals extrapolated from people for the treatment of esophagitis and duodenal ulceration. ANIMALS Twelve healthy research cats. METHODS Randomized, 3-way crossover study. Cats were given esomeprazole and lansoprazole at a dosage of 1 mg/kg PO q12h or dexlansoprazole at 6 mg/kg PO q12h. Intragastric pH was recorded at baseline and for 4 days of treatment. Mean pH and the mean percentage time (MPT) intragastric pH was ≥3 or ≥4 were compared among and within treatment groups. RESULTS Cats treated with lansoprazole had a lower MPT ± SD of intragastric pH ≥3 (8.8 ± 6.8%) and mean ± SD pH (1.6 ± 0.5) than did cats treated with dexlansoprazole (41.2 ± 34.6% and 3.11 ± 1.6, respectively) or esomeprazole (54 ± 33.8% and 4.1 ± 3.9, respectively;P ≤ .04). Esomeprazole was the only treatment that achieved the goals defined for people for the treatment of duodenal ulceration by Day 4 of treatment (MPT ± SD of intragastric pH ≥4 of 77.1 ± 29.2%). CONCLUSIONS AND CLINICAL IMPORTANCE Orally administered esomeprazole might be a superior acid suppressant in cats compared to PO lansoprazole or dexlansoprazole.
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Affiliation(s)
- Phillip Ryan
- Department of Small Animal Clinical Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Josh Price
- Department of Small Animal Clinical Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Shanna Hillsman
- Department of Small Animal Clinical Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Gina Galyon
- Department of Small Animal Clinical Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Joerg Steiner
- Department of Small Animal Clinical Sciences, Texas A&M University, College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - M Katherine Tolbert
- Department of Small Animal Clinical Sciences, Texas A&M University, College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
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El-Kimary EI, Ragab MAA. Recent Analytical Methodologies for the Determination of Omeprazole and/or Its Active Isomer Esomeprazole in Different Matrices: A Critical Review. Crit Rev Anal Chem 2020; 52:106-130. [DOI: 10.1080/10408347.2020.1791042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eman I. El-Kimary
- Faculty of Pharmacy, Department of Pharmaceutical Analytical Chemistry, University of Alexandria, El-Messalah, Alexandria, Egypt
| | - Marwa A. A. Ragab
- Faculty of Pharmacy, Department of Pharmaceutical Analytical Chemistry, University of Alexandria, El-Messalah, Alexandria, Egypt
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Kuhl A, Odunayo A, Price J, Hecht S, Marshall K, Steiner J, Tolbert MK. Comparative analysis of the effect of IV administered acid suppressants on gastric pH in dogs. J Vet Intern Med 2020; 34:678-683. [PMID: 32020689 PMCID: PMC7096616 DOI: 10.1111/jvim.15718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/20/2020] [Indexed: 01/12/2023] Open
Abstract
Background Upper gastrointestinal (GI) ulceration and bleeding in critically ill dogs can cause severe anemia and increase morbidity. Acid suppressants using proton pump inhibitors or histamine‐2 receptor blockers administered IV is commonly recommended. Hypothesis/Objectives To evaluate the efficacy of IV administered esomeprazole, pantoprazole, and famotidine constant rate infusion (CRI) on increasing the intragastric pH of dogs. We hypothesized that esomeprazole and famotidine CRI would provide superior acid suppression compared to pantoprazole and reach pH goals for the treatment of GI bleeding. Animals Nine healthy research Beagles. Methods Randomized, 3‐way crossover. Dogs received pantoprazole or esomeprazole at 1 mg/kg IV q12h and famotidine with a loading dose of 1 mg/kg followed by 8 mg/kg IV CRI daily for 3 consecutive days. The intragastric pH was recorded at baseline and for 72 hours of treatment. The mean pH and the mean percentage time (MPT) the intragastric pH was ≥3 or ≥4 were compared among and within treatment groups. Results Significant increases in mean pH (P < 0.0001), MPT ≥3 (P < 0.001), and MPT ≥4 (P = 0.0006) were noted over time with all 3 treatments. The time effect did not differ by treatment for mean pH, MPT ≥3, and MPT ≥4 (P = .29, .56, and .37, respectively); however, only esomeprazole and famotidine CRI achieved the goals established for the treatment of gastroduodenal ulceration in people. Conclusions and Clinical Importance Famotidine CRI and esomeprazole might be superior acid suppressants compared to standard doses of pantoprazole for the first 72 hours of treatment.
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Affiliation(s)
- Amanda Kuhl
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Josh Price
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Kristen Marshall
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - Joerg Steiner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A & M University, College Station, Texas
| | - M Katherine Tolbert
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas A & M University, College Station, Texas
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Seo DH, Lee JB, Hwang JH, Jeong JW, Song GH, Koo TS, Seo KW. Pharmacokinetics and pharmacodynamics of intravenous esomeprazole at 2 different dosages in dogs. J Vet Intern Med 2018; 33:531-535. [PMID: 30548689 PMCID: PMC6430889 DOI: 10.1111/jvim.15383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/14/2018] [Indexed: 11/28/2022] Open
Abstract
Background Although the demand for esomeprazole is increasing in veterinary medicine, the pharmacokinetics (PK) and pharmacodynamics of esomeprazole have been described in only a few studies. Objective To determine the PK of 0.5 and 1 mg/kg esomeprazole administered IV q12h and to investigate its effects on intragastric pH in healthy dogs. Animals Six adult Beagles. Methods Open‐label, randomized, and crossover design. The dogs received 0.5 or 1 mg/kg esomeprazole IV q12h for 48 hours. Plasma concentrations of esomeprazole were measured by high‐performance liquid chromatography‐tandem mass spectrometry. Intragastric pH was determined using the Bravo pH monitoring system and recorded as mean percentage time (MPT) for which pH was ≥3 and ≥4 for 24 hours in each group. Results The peak plasma concentration and area under the curve from the time of dosing to the last measurable concentration in the 1 mg/kg group were higher than those in the 0.5 mg/kg group. However, when the dosage normalized, intergroup differences were not significant. The MPTs for which intragastric pH was ≥3 and ≥4 for 48 hours were 88% ± 7% and 81% ± 9% for the 0.5 mg/kg group and 90% ± 9% and 85% ± 11% for the 1 mg/kg group, respectively, with no significant intergroup differences. Conclusions and Clinical Importance The pharmacokinetic parameters and acid suppressant effect for 0.5 and 1 mg/kg esomeprazole were not significantly different. Furthermore, the efficacy of esomeprazole 0.5 mg/kg IV q12h was sufficient to increase intragastric pH in Beagles.
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Affiliation(s)
- Do-Hyun Seo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jong-Bok Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Kangwon National University, Chuncheon-si, Republic of Korea
| | - Ji-Hye Hwang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jong-Woo Jeong
- Graduate School of New Drug Discovery and Development, Chungnam National University, Daejeon, Republic of Korea
| | - Gun-Ho Song
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Tae-Sung Koo
- Graduate School of New Drug Discovery and Development, Chungnam National University, Daejeon, Republic of Korea
| | - Kyoung-Won Seo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
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Marks SL, Kook PH, Papich MG, Tolbert MK, Willard MD. ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats. J Vet Intern Med 2018; 32:1823-1840. [PMID: 30378711 PMCID: PMC6271318 DOI: 10.1111/jvim.15337] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
The gastrointestinal (GI) mucosal barrier is continuously exposed to noxious toxins, reactive oxygen species, microbes, and drugs, leading to the development of inflammatory, erosive, and ultimately ulcerative lesions. This report offers a consensus opinion on the rational administration of GI protectants to dogs and cats, with an emphasis on proton pump inhibitors (PPIs), histamine type-2 receptor antagonists (H2 RAs), misoprostol, and sucralfate. These medications decrease gastric acidity or promote mucosal protective mechanisms, transforming the management of dyspepsia, peptic ulceration, and gastroesophageal reflux disease. In contrast to guidelines that have been established in people for the optimal treatment of gastroduodenal ulcers and gastroesophageal reflux disease, effective clinical dosages of antisecretory drugs have not been well established in the dog and cat to date. Similar to the situation in human medicine, practice of inappropriate prescription of acid suppressants is also commonplace in veterinary medicine. This report challenges the dogma and clinical practice of administering GI protectants for the routine management of gastritis, pancreatitis, hepatic disease, and renal disease in dogs and cats lacking additional risk factors for ulceration or concerns for GI bleeding. Judicious use of acid suppressants is warranted considering recent studies that have documented adverse effects of long-term supplementation of PPIs in people and animals.
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Affiliation(s)
- Stanley L. Marks
- Department of Medicine & EpidemiologySchool of Veterinary Medicine, University of California, DavisDavisCalifornia
| | - Peter H. Kook
- Vetsuisse Faculty, Clinic for Small Animal Internal Medicine, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Mark G. Papich
- Department of Molecular Biomedical SciencesNorth Carolina State University, College of Veterinary MedicineRaleighNorth Carolina
| | - M. K. Tolbert
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, Texas A & M UniversityCollege StationTexas
| | - Michael D. Willard
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, Texas A & M UniversityCollege StationTexas
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Liu R, Li P, Xiao J, Yin Y, Sun Z, Bi K, Li Q. A fast, sensitive, and high throughput method for the determination of esomeprazole in dog plasma by UHPLC–MS/MS: Application to formulation development of the compound preparation of esomeprazole. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1068-1069:352-357. [DOI: 10.1016/j.jchromb.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/07/2017] [Accepted: 11/02/2017] [Indexed: 12/12/2022]
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