Fixed-Dose Combination Enalapril/Nitrendipine

Simultaneous determination of enalapril maleate and nitrendipine in tablets using spectrophotometric methods manipulating ratio spectra

A fixed dose combination of enalapril maleate (EN) and nitrendipine (NT) achieved satisfactory blood pressure control rather than monotherapy. Four accurate spectrophotometric methods utilizing ratio spectra were developed and validated for the simultaneous determination of EN and NT in combined pharmaceutical dosage form (Eneas® tablets). The first method was first derivative ratio spectrophotometric method (¹DD) where the amplitudes maxima were measured at 219.2 nm and 233.4 nm for the determination of EN and NT, respectively. The second method was ratio difference spectrophotometric method where EN and NT were estimated by measuring the amplitudes difference between 213 nm and 225 nm on the ratio spectrum of EN and between 241 nm and 227 nm on the ratio spectrum of NT. The third method was ratio subtraction followed by extended ratio subtraction, EN was determined at 210 nm by subtraction of the constant values from the ratio spectrum then multiplication with the divisor (NT spectrum). An extended ratio subtraction method was then applied in order to determine NT at 235 nm by using the zero-order spectrum of EN (10 μg/ml) as a divisor. The fourth method was ratio subtraction coupled with constant multiplication methods. The zero- order absorption spectrum of the laboratory prepared mixture was divided by NT (12 μg/ml) spectrum, subsequently, the value of the constant was multiplied by the divisor to obtain the original spectrum of NT, followed by its subtraction from the laboratory prepared mixture to get the spectrum of EN. EN and NT were determined at 210 nm and 235 nm, respectively. Linearity was ascertained over the concentration ranges of (1-11 μg/ml) for EN and (2-14 μg/ml) for NT, for the first and second methods and (2-13 μg/ml) for EN and (3-20 μg/ml) of NT, for the third and fourth methods. Application of the methods to the determination of the cited drugs in Eneas® tablets gave satisfactory results. Methods validation confirmed their accuracy and selectivity. Statistical comparison of the results with the reported one showed no significant difference, regarding precision and accuracy. Routine analysis of the cited drugs in quality control laboratories could be performed using the developed methods.

Nucleophilic dearomatization of 4-aza-6-nitrobenzofuroxan by CH acids in the synthesis of pharmacology-oriented compounds

4-Aza-6-nitrobenzofuroxan (ANBF) reacts with 1,3-dicarbonyl compounds and other CH acids to give carbon-bonded 1,4-adducts – 1,4-dihydropyridines fused with furoxan ring. In the case of most acidic β-diketones, which exist mainly in the enol form in polar solvents, the reactions proceed in the absence of any added base emphasizing the highly electrophilic character of ANBF. The resulting compounds combine in one molecule NO-donor furoxan ring along with a pharmacologically important 1,4-dihydropyridine fragment and therefore can be considered as prospective platforms for the design of pharmacology-oriented heterocyclic systems.

Development and validation of an rp-hplc method for simultaneous determination of Ramipril and Amlodipine in tablets

An rp-hplc method for the simultaneous determination of Ramipril (RP) and Amlodipine (AL) in tablets was developed and validated by Chinese Pharmacopoeia 2010. The linearity of the proposed method was investigated in the range of 0.01–0.25 mg/mL (r²=0.9998) for RP and 0.014–0.36 mg/mL (r²=0.9997) for AL. The limits of detection (LOD) were 0.06 μg/mL and 0.02 μg/mL for RP and AL, and the limits of quantitation (LOQ) were 0.2 μg/mL and 0.07 μg/mL, respectively. Some major impurities and degradation products did not disturb the detection of RP and AL and the assay can thus be considered stability-indicating.

Compliance with the treatment of hypertension: the potential of combination therapy

Patient adherence to antihypertensive medication is vital to ensure the successful treatment of hypertension. Low levels of adherence to and persistence with prescribed therapy are major factors leading to the current poor rates of blood pressure control among patients with hypertension. There are many reasons for nonadherence to therapy including patient-, physician-, and therapy-related factors. Poor tolerability has a detrimental effect on adherence, therefore reducing the apparent effectiveness of agents with dose-dependent side effects. Various effective combination therapies are recommended by current guidelines, eg, beta-blocker plus calcium channel blocker (CCB), angiotensin receptor blocker (ARB) plus thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor plus thiazide diuretic, CCB plus thiazide diuretic, ACE inhibitor plus CCB, and ARB plus CCB, and these have the potential to increase adherence to therapy by combining a favorable tolerability profile with once-daily dosing.

Effectiveness and tolerability of fixed-dose combination enalapril plus nitrendipine in hypertensive patients: results of the 3-month observational, post-marketing, multicentre, prospective CENIT study

BACKGROUND AND OBJECTIVE

Monotherapy with any class of antihypertensive drug effectively controls blood pressure (BP) in only about 50% of patients. Consequently, the majority of patients with hypertension require combined therapy with two or more medications. This study aimed to evaluate the effectiveness (systolic BP [SBP]/diastolic BP [DBP] control) and tolerability of the fixed-dose combination enalapril/nitrendipine 10 mg/20 mg administered as a single daily dose in hypertensive patients.

METHODS

This was a post-authorization, multicentre, prospective, observational study conducted in primary care with a 3-month follow-up. Patients throughout Spain with uncontrolled hypertension (> or =140/90 mmHg for patients without diabetes mellitus, or > or =130/85 mmHg for patients with diabetes) on monotherapy or with any combination other than enalapril + nitrendipine, or who were unable to tolerate their previous antihypertensive therapy, were recruited. Change from previous to study treatment was according to usual clinical practice. BP was measured once after 5 minutes of rest in the sitting position. Therapeutic response was defined as follows: 'controlled' meant controlled BP (<140/90 mmHg for nondiabetic patients, or <130/85 mmHg for diabetic patients); 'response' meant controlled BP, or a decrease in SBP of > or =20 mmHg and in DBP of > or =10 mmHg. The main laboratory test parameters were documented at baseline and after 3 months. Patients aged >65 years, with diabetes, with isolated systolic hypertension (ISH; SBP > or =140 mmHg for patients without diabetes, SBP > or =130 mmHg for patients with diabetes) and who were obese (body mass index [BMI] > or =30 kg/m2) were analysed separately.

RESULTS

Of 6537 patients included, 5010 and 6354 patients were assessed in effectiveness and tolerability analyses, respectively. In the tolerability analysis population, there were 3023 men (47.6%) and 3321 women (52.4%). The mean (+/- SD) age of the tolerability analysis group was 62.8 (+/- 10.7) years. A total of 71.1% of the patients presented at least one clinical cardiovascular risk factor other than hypertension, with the most frequent being dyslipidaemia (42.3%), obesity (29.2%) and diabetes (23.9%). After 3 months of treatment, SBP and DBP showed mean (+/- SD) decreases of 26.5 (+/- 14.4) mmHg and 14.9 (+/- 9.0) mmHg, respectively, and 73.0% of patients responded to treatment while 40.9% achieved BP control (70.8%/36.1% in 2658 patients aged >65 years; 61.7%/46.8% in 1521 patients with diabetes; 55.3%/44.2% in 731 patients with ISH; 72.0%/36.4% in 1762 obese patients). Adverse events were reported in 10.8% of patients (n = 689). During the follow-up period, ten patients died and seven patients had serious adverse events; in no case was a causal relationship attributed to the study product.

CONCLUSIONS

The rate of SBP/DBP control achieved demonstrates the effectiveness of the fixed-dose enalapril/nitrendipine 10 mg/20 mg combination administered as a single daily dose in patients with essential hypertension not adequately controlled with monotherapy or with any combination other than enalapril + nitrendipine. The proportion and type of adverse events reported were as expected and have already been described for both components of the enalapril/nitrendipine 10 mg/20 mg combination. These results confirm the effectiveness of a strategy based on a fixed-dose enalapril/nitrendipine 10 mg/20 mg combination in reducing BP and achieving BP control goals.

Fixed-Drug Combinations as First-Line Treatment for Hypertension

As combinations of drugs from different classes that have synergistic or additive effect and properties to cancel out each others' untoward hemodynamic and metabolic effects become more and more widely used, their use as first-line therapy for the treatment of newly diagnosed hypertensive patients is growing in popularity as well. The possibility to begin therapy with a fixed 2-drug combination may be preferable to starting with monotherapy followed by upward titration and addition of other agents. More and more combinations are coming out on the market and proving their effectiveness in randomized controlled trials and in large multicenter studies. One suggestion is the "polypill," a fixed combination of multiple agents that address various components of the metabolic syndrome and coexisting common risk factors in both high-risk patients with conditions requiring polypharmacy, and in healthy asymptomatic individuals.

Combination drug treatment of hypertension: Have we come full circle?

Only 30% of hypertensive patients achieved and maintained adequate blood pressure control on a single drug in recent clinical trials. For the majority of patients who require two or more drugs to lower blood pressure to the currently recommended goals of 140/90 mm Hg or to 130/80 if they are diabetic or have chronic kidney disease, combinations of two or more drugs in a single pill offers an attractive alternative to taking multiple single drugs each day. Research has shown that the simpler the drug regimen the more likely patients are to be compliant in taking medications. Because a reduction in cardiovascular risk is linked to the extent to which elevated blood pressure is reduced, this benefit is not realized by patients who either discontinue their medications or are noncompliant. Carefully selected low doses of two antihypertensive drugs combined in a single pill offers other advantages including greater efficacy compared with high-dose monotherapy, a lower incidence of adverse effects, improved persistence in taking medications, fewer patient visits, and reduced cost to the health care system.