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Patton GN, Lee HJ. Chemical Insights into Topical Agents in Intraocular Pressure Management: From Glaucoma Etiopathology to Therapeutic Approaches. Pharmaceutics 2024; 16:274. [PMID: 38399328 PMCID: PMC10891530 DOI: 10.3390/pharmaceutics16020274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Glaucoma encompasses a group of optic neuropathies characterized by complex and often elusive etiopathology, involvihttng neurodegeneration of the optic nerve in conjunction with abnormal intraocular pressure (IOP). Currently, there is no cure for glaucoma, and treatment strategies primarily aim to halt disease progression by managing IOP. This review delves into the etiopathology, diagnostic methods, and treatment approaches for glaucoma, with a special focus on IOP management. We discuss a range of active pharmaceutical ingredients used in glaucoma therapy, emphasizing their chemical structure, pharmacological action, therapeutic effectiveness, and safety/tolerability profiles. Notably, most of these therapeutic agents are administered as topical formulations, a critical aspect considering patient compliance and drug delivery efficiency. The classes of glaucoma therapeutics covered in this review include prostaglandin analogs, beta blockers, alpha agonists, carbonic anhydrase inhibitors, Rho kinase inhibitors, and miotic (cholinergic) agents. This comprehensive overview highlights the importance of topical administration in glaucoma treatment, offering insights into the current state and future directions of pharmacological management in glaucoma.
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Affiliation(s)
| | - Hyuck Jin Lee
- Department of Chemistry Education, Kongju National University, Gongju 32588, Chungcheongnam-do, Republic of Korea;
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2
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Fatimah SF, Lukitaningsih E, Martien R, Nugroho AK. Bibliometric analysis of articles on nanoemulsion and/or in-situ gel for ocular drug delivery system published during the 2011–2021 period. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e82847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The bibliometric data were extracted from the Scopus database to investigate the conceptual framework of ocular nanoemulsion and/or in-situ gel drug delivery system using “ocular” AND “nanoemulsion” OR “in-situ gel” keywords. The data were evaluated with RStudio and VOSviewer program.
The results reveal that the publication trends tend to increase continually. India is the most impactful country, and the most constructive institution is Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University. International Journal of Pharmaceutics is the top influential source. Ali A is the most prolific author. The title of the most impactful article was In-situ gelling systems based on Pluronic F127/Pluronic F68 formulations for ocular drug delivery”. “Controlled release” is the most popular keyword.
These results provide insights for stimulating research collaborations and revealing open issues of controlled-release ocular preparation to overcome an ocular barrier and enhance patient compliance.
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Qiu Y, Feng Y, Lindsay AC, Zeng X, Sperry J. Synthesis of bio-based 2-thiothiophenes. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2021; 379:20200350. [PMID: 34510923 DOI: 10.1098/rsta.2020.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 06/13/2023]
Abstract
While the synthesis of bio-based compounds containing carbon, oxygen and (to a lesser extent) nitrogen is well studied, the production of organosulfur compounds from biomass has received virtually no attention, despite their widespread application throughout the chemical industry. Herein, we demonstrate that a range of bio-based 2-thiothiophenes are available from the biopolymer cellulose, proving that functionally diverse small-molecule organosulfurs can be prepared independent of fossil carbon. This article is part of the theme issue 'Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 2)'.
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Affiliation(s)
- Yichen Qiu
- Centre for Green Chemical Science, University of Auckland, Auckland 1142, New Zealand
- College of Energy, Xiamen University, Xiamen 361102, People's Republic of China
- Xiamen Key Laboratory of Clean and High-valued Utilization for Biomass, Xiamen 361102, People's Republic of China
| | - Yunchao Feng
- College of Energy, Xiamen University, Xiamen 361102, People's Republic of China
- Xiamen Key Laboratory of Clean and High-valued Utilization for Biomass, Xiamen 361102, People's Republic of China
| | - Ashley C Lindsay
- Centre for Green Chemical Science, University of Auckland, Auckland 1142, New Zealand
| | - Xianhai Zeng
- College of Energy, Xiamen University, Xiamen 361102, People's Republic of China
- Xiamen Key Laboratory of Clean and High-valued Utilization for Biomass, Xiamen 361102, People's Republic of China
| | - Jonathan Sperry
- Centre for Green Chemical Science, University of Auckland, Auckland 1142, New Zealand
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Mehta A, Lewis A. Multimodal etiology of drug induced angle closure with topical glaucoma therapy. Am J Ophthalmol Case Rep 2021; 23:101152. [PMID: 34307961 PMCID: PMC8258634 DOI: 10.1016/j.ajoc.2021.101152] [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: 05/14/2020] [Revised: 04/09/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We present a case of acute onset of bilateral choroidal effusions leading to angle closure glaucoma attributed to multiple mechanism of actions causing ciliary body and aqueous flow disruption in the setting of topical glaucoma therapy with latanoprost, brimonidine 0.2%, and Brinzolamide 0.1%. OBSERVATION The patient presented with ocular hypertension in the setting of bilateral choroidal effusions, leading to angle closure without pupillary block. After cessation of the glaucoma drops and starting steroids and cycloplegics, the patient's symptoms resolved. CONCLUSIONS AND IMPORTANCE This case report highlights the various physiological mechanisms of action that can induce angle closure glaucoma from commonly used topical medications for glaucoma treatment. Thus, a keen awareness is warranted of this idiosyncratic reaction in order to avoid morbidity and long term vision loss.
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Affiliation(s)
- Aditya Mehta
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - Andrew Lewis
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
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Pokrywka A, Skrzypiec-Spring M, Krzywański J, Rynkowski M, Saugy M, Faiss R. Cases reports: Unintended anti-doping rule violation after dorzolamide use several months prior to a doping control. Drug Test Anal 2021; 13:1803-1806. [PMID: 34463045 DOI: 10.1002/dta.3156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 01/19/2023]
Abstract
The use of specific medicine up to several months before a doping control is not be reported on the doping control form, while the drug could then still be detectable in urine in case of a very slow elimination. It may lead to a positive test result. For example, dorzolamide, a carbonic anhydrase inhibitor for topical ophthalmic application, has a very slow elimination rate via the renal route (half-life > 4 months). This substance can be a source of unintended anti-doping rule violations.
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Affiliation(s)
- Andrzej Pokrywka
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Martial Saugy
- REDs, Research & Expertise in antiDoping sciences, Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- REDs, Research & Expertise in antiDoping sciences, Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
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6
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Siafaka PI, Çağlar EŞ, Sipahi H, Charehsaz M, Aydın A, Üstündağ Okur N. Ocular microemulsion of brinzolamide: Formulation, physicochemical characterization, and in vitro irritation studies based on EpiOcular™ eye irritation assay. Pharm Dev Technol 2021; 26:765-778. [PMID: 34154503 DOI: 10.1080/10837450.2021.1944206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In recent years, the hydrophobic active substances have led researchers to develop new formulations to enhance bioavailability and dissolution rate; brinzolamide, a lipophilic drug belongs to carbonic anhydrase inhibitors, which cause reduction of intraocular pressure in patients suffering from glaucoma. Currently, the marketed product of brinzolamide is in the form of ocular drops; nonetheless, the conventional drops provide decreased therapeutic efficacy owing to their low bioavailability and pulsed drug release. Thus, the development of novel ocular formulations such as topical microemulsions is of high importance. In this work, the preparation of new microemulsions containing brinzolamide (0.2, 0.5 and 1% w/w) and comprised from isopropyl myristate, tween 80 and span 20 and Cremophor EL was performed. The obtained microemulsions were further characterized for their physicochemical properties. In addition, Fourier Transformed-Infrared spectroscopy was used touate the compatibility of active ingredients and components. In vitro release studies along with kinetic modeling were performed using the dialysis membrane method in simulated tear fluid. Bioadhesion studies were performed using Texture analysis. Finally, in vitro ocular irritation based on EpiOcular™ Eye Irritation Test and cytocompatibility studies was performed to examine any possible harm on ocular cells and predict in vivo safety profile.
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Affiliation(s)
- Panoraia I Siafaka
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey.,KES College, Nicosia, Cyprus
| | - Emre Şefik Çağlar
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Hande Sipahi
- Department of Toxicology, Faculty of Pharmacy, Yeditepe University, Istanbul, Turkey
| | - Mohammad Charehsaz
- Department of Toxicology, Faculty of Pharmacy, Yeditepe University, Istanbul, Turkey
| | - Ahmet Aydın
- Department of Toxicology, Faculty of Pharmacy, Yeditepe University, Istanbul, Turkey
| | - Neslihan Üstündağ Okur
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
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7
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Smith SM, Salmon JH, Abbaraju S, Amin R, Gilger BC. Tolerability, pharmacokinetics, and pharmacodynamics of a brinzolamide episcleral sustained release implant in normotensive New Zealand white rabbits. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Abstract
Clear vision is dependent on features that protect the anatomical integrity of the eye (cornea and sclera) and those that contribute to internal ocular homeostasis by conferring hemangiogenic (avascular tissues and antiangiogenic factors), lymphangiogenic (lack of draining lymphatics), and immunologic (tight junctions that form blood-ocular barriers, immunosuppressive cells, and modulators) privileges. The later examples are necessary components that enable the eye to maintain an immunosuppressive environment that responds to foreign invaders in a deviated manner, minimizing destructive inflammation that would impair vision. These conditions allowed for the observations made by Medawar, in 1948, of delayed rejection of allogenic tissue grafts in the anterior chamber of mouse eye and permit the sequestration of foreign invaders (eg, Toxoplasma gondii) within the retina of healthy individuals. Yet successful development of intraocular drugs (biologics and delivery devices) has been stymied by adverse ocular pathology, much of which is driven by immune pathways. The eye can be intolerant of foreign protein irrespective of delivery route, and endogenous ocular cells have remarkable plasticity when recruited to preserve visual function. This article provides a review of current understanding of ocular immunology and the potential role of immune mechanisms in pathology observed with intraocular drug delivery.
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Affiliation(s)
| | | | - Sharmila Masli
- 12259Boston University School of Medicine, Boston, MA, USA
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9
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Pepose JS, Hartman PJ, DuBiner HB, Abrams MA, Smyth-Medina RJ, Moroi SE, Meyer AR, Sooch MP, Jaber RM, Charizanis K, Klapman SA, Amin AT, Yousif JE, Lazar ES, Karpecki PM, Slonim CB, McDonald MB. Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial. Clin Ophthalmol 2021; 15:79-91. [PMID: 33447013 PMCID: PMC7802916 DOI: 10.2147/opth.s278169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Phentolamine mesylate ophthalmic solution (PMOS), applied to the eye topically, was shown previously to have beneficial effects in patients with dim light vision disturbances (DLD), including decreased pupil diameter (PD), improved best-corrected distance visual acuity (BCDVA), as well as lower intraocular pressure (IOP). The ORION-1 trial evaluated the long-term safety and efficacy of PMOS in a glaucomatous, presbyopic population. PATIENTS AND METHODS In this randomized, double-masked, multi-center, placebo-controlled, multiple-dose Phase 2b trial, 39 patients with elevated IOP were randomized to receive one evening dose of study medication or placebo for 14 days. The primary outcome measure was mean change in diurnal IOP, and the key secondary outcome measures included changes in PD, distance-corrected near visual acuity (DCNVA), and conjunctival hyperemia. RESULTS Use of 1% PMOS did not lead to a statistically significant decrease in diurnal IOP compared to placebo (P = 0.89) but trended toward a greater decrease in patients with lower IOP baselines. PMOS produced a statistically significant mean 20% PD reduction under both photopic and mesopic conditions that was sustained for 36 hours post-dosing. A statistically significant number of patients with PMOS compared to placebo demonstrated ≥1 line of improvement in photopic DCNVA at day 8 (P = 0.0018), day 15 (P = 0.0072), and day 16 (P = 0.0163), with a trend for 2- and 3-line improvements at all time points. There was no statistical difference in conjunctival hyperemia compared to placebo. CONCLUSION Although mean IOP was not lowered significantly, daily evening dosing of 1% PMOS was found to be well tolerated with no daytime conjunctival redness and demonstrated improvement in DCNVA with sustained PD reduction in a glaucomatous and presbyopic population. Smaller pupil size can have beneficial effects in improving symptoms of presbyopia and DLD, which will be the focus of further studies.
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Affiliation(s)
- Jay S Pepose
- Pepose Vision Institute, St. Louis, MO, USA
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Paul J Hartman
- Department of Ophthalmology, University of Rochester, Rochester, NY, USA
| | | | | | | | - Sayoko E Moroi
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | | | | | | | - Arin T Amin
- Ocuphire Pharma Inc, Farmington Hills, MI, USA
| | | | | | - Paul M Karpecki
- Kentucky College of Optometry, University of Pikeville, Pikeville, KY, USA
| | | | - Marguerite B McDonald
- Department of Ophthalmology, New York University Langone Medical Center, New York, NY, USA
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10
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Li T, Wang Y, Chen J, Gao X, Pan S, Su Y, Zhou X. Co-delivery of brinzolamide and miRNA-124 by biodegradable nanoparticles as a strategy for glaucoma therapy. Drug Deliv 2020; 27:410-421. [PMID: 32133894 PMCID: PMC7067192 DOI: 10.1080/10717544.2020.1731861] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Co-delivery nanoparticles with characteristics of intracellular precision release drug have been generally accepted as an effective therapeutic strategy for eye diseases. In this study, we designed a new co-delivery system (miRNA/NP-BRZ) as a lasting therapeutic approach to prevent the neuro-destructive after the long-term treatment of glaucoma. Neuroprotective and intraocular pressure (IOP) response were assessed in in vivo and in vitro models of glaucoma. At the meaning time, we describe the preparation of miRNA/NP-BRZ, drug release characteristics, intraocular tracing, pharmacokinetic and pharmacodynamics study and toxicity test. We found that miRNA/NP-BRZ could remarkably decrease IOP and significantly prevent retinal ganglion cell (RGC) damages. The new formula of miRNA-124 encapsulated in PEG-PSA-BRZ nanoparticles exhibits high encapsulation efficiency (EE), drug-loading capacity (DC), and stable controlled-release efficacy (EC). Moreover, we also verified that the miRNA/NP-BRZ system is significantly neuroprotective and nontoxic as well as lowering IOP. This study shows our co-delivery drug system would have a wide potential on social and economic benefits for glaucoma.
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Affiliation(s)
- Tingting Li
- Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China.,Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ye Wang
- Department of Biological pharmacy, School of Pharmacy, Jilin University, Changchun, China
| | - Jiahao Chen
- Department of Biological pharmacy, School of Pharmacy, Jilin University, Changchun, China
| | - Xiaoshu Gao
- Department of Biological pharmacy, School of Pharmacy, Jilin University, Changchun, China
| | - Siqi Pan
- Department of Biological pharmacy, School of Pharmacy, Jilin University, Changchun, China
| | - Yu Su
- Department of Biological pharmacy, School of Pharmacy, Jilin University, Changchun, China
| | - Xinrong Zhou
- Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
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11
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Vo A, Feng X, Patel D, Mohammad A, Kozak D, Choi S, Ashraf M, Xu X. Factors affecting the particle size distribution and rheology of brinzolamide ophthalmic suspensions. Int J Pharm 2020; 586:119495. [PMID: 32553495 DOI: 10.1016/j.ijpharm.2020.119495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/24/2020] [Accepted: 05/30/2020] [Indexed: 01/22/2023]
Abstract
Drug particle size distribution (PSD) and dispersion viscosity are two critical quality attributes that govern the performance of topical ophthalmic suspensions, such as suspension physical stability, ocular retention, and drug release characteristics.. An in-depth knowledge of the effects of formulation and manufacturing process on these critical quality attributes may facilitate the product and process development, quality control, as well as support regulatory policy and approval. The current study has investigated the effect of formulation and process parameters on the quality attributes of brinzolamide ophthalmic suspensions. In the first step, three milling techniques (probe sonication, microfluidization, and media milling with a planetary centrifugal mixer) were evaluated for manufacturing of brinzolamide suspension. Out of the three techniques, the planetary centrifugal media milling yielded the narrowest PSD and thus was considered the most viable lab-scale technique for this purpose. In the next step, various process parameters of media milling were evaluated using a central-composite experimental design. The independent variables included bead size, agitating intensity, and process time while the PSD of drug particles (D50) was the response variable. The effect of shear rate and shear time of the homogenization process and the concentration of carbomer on the rheological properties of the suspension were studied using a Box-Behnken design. Additionally, effects of sodium chloride and mannitol concentration on the rheological properties of the suspension was also investigated. Sodium chloride was found to exert a pronounced effect on rheology of the suspension. Despite variations in the carbomer concentration, a suspension of comparable rheology could be prepared by controlling the process parameters namely the shear rate and process time.
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Affiliation(s)
- Anh Vo
- Division of Product Quality Research, Office of Testing and Research, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; Office of Research Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Xin Feng
- Division of Product Quality Research, Office of Testing and Research, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Deval Patel
- Division of Product Quality Research, Office of Testing and Research, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; Office of Research Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Adil Mohammad
- Division of Product Quality Research, Office of Testing and Research, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Darby Kozak
- Office of Research Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Stephanie Choi
- Office of Research Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Muhammad Ashraf
- Division of Product Quality Research, Office of Testing and Research, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Xiaoming Xu
- Division of Product Quality Research, Office of Testing and Research, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
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12
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Dixit A, Ashish A, Sharma R. A comparative study on efficacy of fixed combination timolol/brinzolamide versus travoprost monotherapy in drug-naïve open-angle glaucoma patients. Ther Adv Ophthalmol 2020; 12:2515841420909666. [PMID: 32440640 PMCID: PMC7227157 DOI: 10.1177/2515841420909666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/24/2020] [Indexed: 10/26/2022] Open
Abstract
Background Glaucoma is most common irreversible cause of blindness in India. First line management of open-angle glaucoma is either beta blockers or prostaglandin analogs monotherapy. Monotherapy rarely achieves target intraocular pressure within 2 years and patients are shifted to combination medications, usually fixed-dose combination. Objective To compare travoprost monotherapy and timolol/brinzolamide fixed-dose combination for their intraocular pressure lowering efficacy, their effects on hemodynamic parameters and cup disc ratio reversibility in newly diagnosed drug-naïve open-angle glaucoma patients. Material and methods In a 12-week, prospective, randomised, single-blind study, patients were randomised to receive twice daily 0.5% timolol and 0.2% brinzolamide fixed-dose combination (n = 52) or once daily travoprost 0.004% (n = 52). Intraocular pressure, blood pressure, pulse rate and cup disc ratio were compared across treatment groups over 3 months. Results Significant reduction (p < 0.001) in intraocular pressure by 27.99% and 30.49% at 12th-week visit as compared with baseline was observed in monotherapy and fixed-dose combination group, respectively. Significant changes in pulse rate (9 beats/min) and systolic blood pressure (2.35 mmHg) was observed in fixed-dose combination group. No cup disc ratio reversibility was observed at the end of study. Conjunctival hyperaemia (n = 14) and transient blurring of vision (n = 16) were most commonly reported adverse drug reaction in monotherapy and fixed-dose combination, respectively. Conclusion The 0.5% timolol and 0.2% brinzolamide fixed-dose combination produced greater reduction in intraocular pressure than those produced by 0.004% travoprost alone in drug-naïve open-angle glaucoma patients.
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Affiliation(s)
- Alok Dixit
- Department of Pharmacology, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - Atul Ashish
- Department of Pharmacology, Uttar Pradesh University of Medical Sciences, Saifai 206130, Etawah, Uttar Pradesh, India
| | - Reena Sharma
- Department of Ophthalmology, Uttar Pradesh University of Medical Sciences, Saifai, India
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13
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Machen L, Razeghinejad R, Myers JS. Fixed-combination topical anti-hypertensive ophthalmic agents. Expert Opin Pharmacother 2020; 21:1269-1282. [PMID: 32228188 DOI: 10.1080/14656566.2020.1743264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Fixed-combination glaucoma medications have altered the paradigm of ocular hypertension and glaucoma treatment and are in widespread use today. A comprehensive review of fixed-combination medications will help educate and inform providers for optimal patient care. AREAS COVERED In this review, the authors describe the composition, mechanism of action, efficacy, side effects, and safety profile of fixed-combination agents for the treatment of ocular hypertension and glaucoma as well as comparisons between the most frequently prescribed medications. EXPERT OPINION Fixed-combination therapeutics provide an effective and efficient means of lowering intraocular pressure with comparable side effects and outcomes to constituent parts with lower patient exposure to preservatives and improvement in compliance.
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Affiliation(s)
- Lindsay Machen
- Glaucoma Service, Wills Eye Hospital , Philadelphia, PA, USA
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14
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Core-shell lipid-polymer nanoparticles as a promising ocular drug delivery system to treat glaucoma. CHINESE CHEM LETT 2020. [DOI: 10.1016/j.cclet.2019.04.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Glaucoma is the second leading cause of blindness worldwide. Even though significant advances have been made in its management, currently available antiglaucoma therapies suffer from considerable drawbacks. Typically, the success and efficacy of glaucoma medications are undermined by their limited bioavailability to target tissues and the inadequate adherence demonstrated by patients with glaucoma. The latter is due to a gradual decrease in tolerability of lifelong topical therapies and the significant burden to patients of prescribed stepwise antiglaucoma regimens with frequent dosing which impact quality of life. On the other hand, glaucoma surgery is restricted by the inability of antifibrotic agents to efficiently control the wound healing process without causing severe collateral damage and long-term complications. Evolution of the treatment paradigm for patients with glaucoma will ideally include prevention of retinal ganglion cell degeneration by the successful delivery of neurotrophic factors, anti-inflammatory drugs, and gene therapies. Nanotechnology-based treatments may surpass the limitations of currently available glaucoma therapies through optimized targeted drug delivery, increased bioavailability, and controlled release. This review addresses the recent advances in glaucoma treatment strategies employing nanotechnology, including medical and surgical management, neuroregeneration, and neuroprotection.
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16
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Scruggs BA, Chen CV, Pfeifer W, Wiley JS, Wang K, Drack AV. Efficacy of topical brinzolamide in children with retinal dystrophies. Ophthalmic Genet 2019; 40:350-358. [PMID: 31496370 DOI: 10.1080/13816810.2019.1660381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Inherited retinal dystrophies are a leading cause of irreversible blindness in children in the United States. Topical carbonic anhydrase inhibitors have improved central vision and cystoid macular edema in patients with retinal dystrophies, but few studies have assessed their efficacy in children. Materials and Methods: A retrospective chart review was performed with Institutional Review Board approval to identify pediatric patients with inherited retinal dystrophies who received topical brinzolamide at a single university center between 2008 and 2015. Serial visual acuity and central macular thicknesses were compared to assess the efficacy of brinzolamide. Results: Seven subjects were identified who met the inclusion criteria. Four had juvenile X-linked retinoschisis, two had retinitis pigmentosa, and one had Leber congenital amaurosis. All were prescribed brinzolamide thrice daily; however, one patient was completely non-compliant. Four of the six treated patients exhibited a mild decrease in central macular thickness in both eyes during the study with all six treated patients having significantly improved vision at the first endpoint, 33.2 ± 8.2 months after treatment initiation. For treated patients, average visual acuity (LogMAR) ± standard error of the mean improved from 0.5 ± 0.04 pre-treatment to 0.3 ± 0.1 at the second endpoint, 50.2 ± 7.3 months after treatment initiation. Conclusions: Mild anatomic improvement of macular cysts was seen in pediatric patients using brinzolamide. Visual acuity improvement occurred even without significant reduction in macular cysts. Further studies are needed to determine whether the beneficial effects of carbonic anhydrase inhibitors are sustained in children with inherited retinal degenerations.
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Affiliation(s)
- Brittni A Scruggs
- The Roy J. and Lucille A. Carver College of Medicine, University of Iowa , Iowa City , Iowa , USA.,Department of Ophthalmology and Visual Sciences, University of Iowa , Iowa City , Iowa , USA.,University of Iowa Institute for Vision Research , Iowa City , Iowa , USA
| | - Constance V Chen
- The Roy J. and Lucille A. Carver College of Medicine, University of Iowa , Iowa City , Iowa , USA.,Department of Ophthalmology and Visual Sciences, University of Iowa , Iowa City , Iowa , USA.,University of Iowa Institute for Vision Research , Iowa City , Iowa , USA
| | - Wanda Pfeifer
- Department of Ophthalmology and Visual Sciences, University of Iowa , Iowa City , Iowa , USA.,University of Iowa Institute for Vision Research , Iowa City , Iowa , USA
| | - Jill S Wiley
- Department of Ophthalmology and Visual Sciences, University of Iowa , Iowa City , Iowa , USA.,University of Iowa Institute for Vision Research , Iowa City , Iowa , USA
| | - Kai Wang
- The Roy J. and Lucille A. Carver College of Medicine, University of Iowa , Iowa City , Iowa , USA.,Department of Biostatistics, College of Public Health, University of Iowa , Iowa City , Iowa , USA
| | - Arlene V Drack
- The Roy J. and Lucille A. Carver College of Medicine, University of Iowa , Iowa City , Iowa , USA.,Department of Ophthalmology and Visual Sciences, University of Iowa , Iowa City , Iowa , USA.,University of Iowa Institute for Vision Research , Iowa City , Iowa , USA
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17
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Mahboobian MM, Seyfoddin A, Aboofazeli R, Foroutan SM, Rupenthal ID. Brinzolamide–loaded nanoemulsions: ex vivo transcorneal permeation, cell viability and ocular irritation tests. Pharm Dev Technol 2019; 24:600-606. [DOI: 10.1080/10837450.2018.1547748] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mohammad Mehdi Mahboobian
- Department of Pharmaceutics, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Seyfoddin
- Drug Delivery Research Group, School of Science, Auckland University of Technology, Auckland, New Zealand
| | - Reza Aboofazeli
- Department of Pharmaceutics, School of Pharmacy and Protein Technology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Foroutan
- Department of Pharmaceutics, School of Pharmacy and Protein Technology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilva Dana Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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18
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Evaluation of pentablock co-polymer (PTS sol ) for sustained topical ocular drug delivery. J Drug Deliv Sci Technol 2017. [DOI: 10.1016/j.jddst.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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19
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Mahboobian MM, Seyfoddin A, Rupenthal ID, Aboofazeli R, Foroutan SM. Formulation Development and Evaluation of the Therapeutic Efficacy of Brinzolamide Containing Nanoemulsions. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2017; 16:847-857. [PMID: 29201076 PMCID: PMC5610741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Brinzolamide (BZ) is an intraocular pressure reducing agent with low bioavailability. The purpose of the present study was to overcome this issue by development of BZ containing nanoemulsions (NEs) as an ocular drug delivery system with desirable therapeutic efficacy. Brinzolamide NEs were prepared by the spontaneous emulsification method. Based on initial release studies, twelve formulations with the slowest release characteristics were subjected to further physicochemical investigations such as particle size, polydispersity index, pH, refractive index, osmolality and viscosity. The therapeutic efficacy of these formulations was assessed by measuring the intraocular pressure after instillation of the prepared NEs in normotensive albino rabbit eyes. Nanoemulsions with suitable physicochemical properties exhibited high formulation stability under different conditions. more over biological evaluations indicated that using lower drug concentrations in NE formulations (0.4%) had a similar or even better pharmacodynamic effect compared to the commercial suspension with a higher drug concentration (1%). Our findings suggest that NEs could be effectively used as carriers for enhancing the bioavailability of topically applied ophthalmic drugs.
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Affiliation(s)
- Mohammad Mehdi Mahboobian
- Department of Pharmaceutics, School of Pharmacy & Protein Technology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Seyfoddin
- School of Applied Sciences, Auckland University of Technology, New Zealand.
| | - Ilva D. Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Reza Aboofazeli
- Department of Pharmaceutics, School of Pharmacy & Protein Technology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohsen Foroutan
- Department of Pharmaceutics, School of Pharmacy & Protein Technology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Corresponding author: E-mail:
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20
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Fu J, Sun F, Liu W, Liu Y, Gedam M, Hu Q, Fridley C, Quigley HA, Hanes J, Pitha I. Subconjunctival Delivery of Dorzolamide-Loaded Poly(ether-anhydride) Microparticles Produces Sustained Lowering of Intraocular Pressure in Rabbits. Mol Pharm 2016; 13:2987-95. [PMID: 27336794 DOI: 10.1021/acs.molpharmaceut.6b00343] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Topical medications that inhibit the enzyme carbonic anhydrase (CAI) are widely used to lower intraocular pressure in glaucoma; however, their clinical efficacy is limited by the requirement for multiple-daily dosing, as well as side effects such as blurred vision and discomfort on drop instillation. We developed a biodegradable polymer microparticle formulation of the CAI dorzolamide that produces sustained lowering of intraocular pressure after subconjunctival injection. Dorzolamide was ion paired with sodium dodecyl sulfate (SDS) and sodium oleate (SO) with 0.8% and 1.5% drug loading in poly(lactic-co-glycolic acid) (PLGA), respectively. Encapsulating dorzolamide into poly(ethylene glycol)-co-poly(sebacic acid) (PEG3-PSA) microparticles in the presence of triethylamine (TEA) resulted in 14.9% drug loading and drug release that occurred over 12 days in vitro. Subconjunctival injection of dorzolamide-PEG3-PSA microparticles (DPP) in Dutch belted rabbits reduced IOP as much as 4.0 ± 1.5 mmHg compared to untreated fellow eyes for 35 days. IOP reduction after injection of DPP microparticles was significant when compared to baseline untreated IOPs (P < 0.001); however, injection of blank microparticles (PEG3-PSA) did not affect IOP (P = 0.9). Microparticle injection was associated with transient clinical vascularity and inflammatory cell infiltration in conjunctiva on histological examination. Fluorescently labeled PEG3-PSA microparticles were detected for at least 42 days after injection, indicating that in vivo particle degradation is several-fold longer than in vitro degradation. Subconjunctival DPP microparticle delivery is a promising new platform for sustained intraocular pressure lowering in glaucoma.
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Affiliation(s)
- Jie Fu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Fengying Sun
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Wenhua Liu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Yanfei Liu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Manasee Gedam
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Qi Hu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Colleen Fridley
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Harry A Quigley
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Justin Hanes
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Ian Pitha
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
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21
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Li H, Liu Y, Zhang Y, Fang D, Xu B, Zhang L, Chen T, Ren K, Nie Y, Yao S, Song X. Liposomes as a Novel Ocular Delivery System for Brinzolamide: In Vitro and In Vivo Studies. AAPS PharmSciTech 2016; 17:710-7. [PMID: 26335415 DOI: 10.1208/s12249-015-0382-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/28/2015] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to investigate the potential of liposomes as an ophthalmic delivery system for brinzolamide (Brz) to enhance the local glaucomatous therapeutic effect. The liposomes of Brz (Brz-LPs) were produced by the thin-film dispersion method with a particle size of 84.33 ± 2.02 nm and an entrapment efficiency of 98.32 ± 1.61%. Differential scanning calorimetry (DSC) and X-ray powder diffraction (XRD) analysis proved that Brz was successfully entrapped into Brz-LPs. Brz-LPs displayed a biphasic release pattern in vitro with burst release initially and sustained release afterwards. The corneal permeability was measured using modified Franz-type diffusion cells, and Brz-LPs showed 6.2-fold increase in the apparent permeability coefficient when compared with the commercial available formulation (B rz-Sus). Moreover, Brz-LPs (1 mg/mL Brz) showed a more sustained and effective intraocular pressure reduction (5-10 mmHg) than Brz-Sus (10 mg/mL Brz) in white New Zealand rabbits. Therefore, Brz-LPs were a hopeful formulation of Brz for glaucoma treatment and worthy of further investigation.
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22
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Sharma S, Trikha S, Perera SA, Aung T. Clinical effectiveness of brinzolamide 1%-brimonidine 0.2% fixed combination for primary open-angle glaucoma and ocular hypertension. Clin Ophthalmol 2015; 9:2201-7. [PMID: 26648686 PMCID: PMC4664487 DOI: 10.2147/opth.s72380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main first-line treatment strategy for glaucoma is to reduce intraocular pressure (IOP) by topical ocular hypotensive medications, but many patients require multiple medications for adequate IOP control. Fixed-combination therapies provide several benefits, including simplified treatment regimens, theoretical improved treatment adherence, elimination of the potential for washout of the first drug by the second, and the reduction in ocular exposure to preservatives. β-Adrenoceptor antagonists (particularly 0.5% timolol) are the most commonly used agents in combination with other classes of drugs as fixed-combination eyedrops, but they are contraindicated in many patients, owing to local allergy or systemic side effects. A fixed-combination preparation without a β-blocker is therefore warranted. This paper reviews the clinical effectiveness of brinzolamide 1% and brimonidine 0.2% fixed combination (BBFC) for use in patients with primary open-angle glaucoma and ocular hypertension. We searched PubMed and the ClinicalTrials.gov registry, and identified three randomized controlled trials comparing BBFC vs its constituents (brimonidine vs brinzolamide), and one comparing BBFC with unfixed brimonidine and brinzolamide. All of the studies demonstrated mean diurnal IOP to be statistically significantly lower in the BBFC group compared with constituent groups and noninferior to that with the concomitant group using two separate bottles. The safety profile of BBFC was consistent with that of its individual components, the most common ocular adverse events being ocular hyperemia, visual disturbances, and ocular allergic reactions. Common systemic adverse effects included altered taste sensation, oral dryness, fatigue, somnolence, and decreased alertness. BBFC seems to be a promising new fixed combination for use in glaucoma patients. However, long-term effects of BBFC on IOP, treatment adherence, and safety need to be determined.
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Affiliation(s)
- Sourabh Sharma
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Sameer Trikha
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Shamira A Perera
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore ; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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23
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Huang Q, Rui EY, Cobbs M, Dinh DM, Gukasyan HJ, Lafontaine JA, Mehta S, Patterson BD, Rewolinski DA, Richardson PF, Edwards MP. Design, Synthesis, and Evaluation of NO-Donor Containing Carbonic Anhydrase Inhibitors To Lower Intraocular Pressure. J Med Chem 2015; 58:2821-33. [DOI: 10.1021/acs.jmedchem.5b00043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Qinhua Huang
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Eugene Y. Rui
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Morena Cobbs
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Dac M. Dinh
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Hovhannes J. Gukasyan
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Jennifer A. Lafontaine
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Saurabh Mehta
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Brian D. Patterson
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - David A. Rewolinski
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Paul F. Richardson
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
| | - Martin P. Edwards
- La Jolla Laboratories, Pfizer Worldwide
Research and Development, 10770 Science
Center Drive, San Diego, California 92121, United States
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24
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Greig SL, Deeks ED. Brinzolamide/Brimonidine: A Review of Its Use in Patients with Open-Angle Glaucoma or Ocular Hypertension. Drugs Aging 2015; 32:251-60. [DOI: 10.1007/s40266-015-0250-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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25
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Abstract
Topical ocular medications have been widely prescribed and successfully used in children for the management of different ophthalmic disorders. We present 2 infants admitted to our pediatric intensive care unit who developed altered state of consciousness, hypotonia, hypothermia, bradycardia, and apnea after instillation of ophthalmic drops. The second infant also had hypotension and broncho-obstruction. Few days before admission, both infants were diagnosed with congenital glaucoma, and topical antiglaucoma treatment was initiated. Ophthalmic drops with brimonidine and brinzolamide were prescribed to both patients, whereas the second infant also received topical timolol. After elimination of other possible causes, the diagnosis of intoxication with topical antiglaucoma medications was established. After discontinuation of eye drops and vigorous symptomatic treatment, both infants recovered without sequels. Topically applied ophthalmic drops may cause life-threatening systemic adverse effects in infants, such as central nervous system depression and cardiogenic shock. Moreover, these 2 patients illustrate the importance of careful evaluation of all topical medications and their consideration as possible causes of the derangements in critically ill infants.
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26
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Kadam RS, Jadhav G, Ogidigben M, Kompella UB. Ocular pharmacokinetics of dorzolamide and brinzolamide after single and multiple topical dosing: implications for effects on ocular blood flow. Drug Metab Dispos 2011; 39:1529-37. [PMID: 21673129 DOI: 10.1124/dmd.111.040055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ophthalmic carbonic anhydrase inhibitors have been shown to improve retinal and optic nerve blood flow. However, the relative tissue distributions of commercially available carbonic anhydrase inhibitors to the optic nerve are not known. The objective of this study was to compare the ocular pharmacokinetics and tissue distribution profiles of dorzolamide and brinzolamide after single and multiple topical applications. Pigmented rabbits were treated with single or multiple topical administrations of 30 μl of Trusopt (dorzolamide hydrochloride ophthalmic solution, 2%) to one eye and 30 μl of Azopt (brinzolamide ophthalmic suspension, 1%) to the other eye. Rabbits were euthanized at 10 predetermined time intervals over a period of 24 h, and ocular tissues and plasma samples were collected. For multiple dosing, rabbits were dosed twice per day with an 8-h interval between two doses, groups of rabbits were euthanized at 7, 14, and 21 days at 1 h after the last dose, and ocular tissues and plasma samples were collected. Drug levels in tissue samples were measured using liquid chromatography/tandem mass spectrometry. Pharmacokinetic parameters (C(max), T(max), and AUC(0-24)) were estimated by noncompartmental analysis. After a single dose, dorzolamide delivery (AUC(0-24)) to the aqueous humor, anterior sclera, posterior sclera, anterior retina, posterior retina, anterior vitreous, and optic nerve was 2-, 7-, 2.6-, 1.4-, 1.9-, 1.2-, and 9-fold higher than those of brinzolamide. C(max) was 2- to 5-fold higher for dorzolamide than that of brinzolamide in all of the ocular tissue. After multiple dosing, dorzolamide levels in the aqueous humor, sclera, retina, vitreous humor, and optic nerve were higher than those of brinzolamide, but statistical significance was achieved only with aqueous humor, vitreous humor, and optic nerve. Dorzolamide levels in the aqueous humor, anterior vitreous, posterior vitreous, and optic nerve were 1.4- to 3.2-, 2.4- to 2.7-, 2.2- to 4.5-, and 2.4- to 5.2-fold higher than those of brinzolamide. Upon multiple dosing, both drugs accumulated in all of the tissues except the conjunctiva, where the drug levels were lower than those observed with single dosing. No significant differences were found in the AUC values of these two drugs in the cornea and conjunctiva after single and multiple dosing. Drug levels were significantly higher in anterior regions than posterior regions in the sclera, retina, and vitreous for both drugs.
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Affiliation(s)
- Rajendra S Kadam
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 E. Montview Blvd., Aurora, CO 80045, USA
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