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Labbani-Motlagh Z, Amini S, Aliannejad R, Sadeghi A, Shafiee G, Heshmat R, Jafary M, Talaschian M, Akhtari M, Jamshidi A, Mahmoudi M, Sadeghi K. High-dose Intravenous Vitamin C in Early Stages of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Double-blind, Randomized, Controlled Clinical Trial. J Res Pharm Pract 2022; 11:64-72. [PMID: 36798102 PMCID: PMC9926917 DOI: 10.4103/jrpp.jrpp_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/01/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Based on previous studies in the sepsis population, Vitamin C could prevent injuries when administered in high doses and before the damage is established. This study aimed to evaluate the protective potentials of high-dose Vitamin C in the progression of coronavirus disease 2019 (COVID-19). Methods A double-blind, placebo-controlled clinical trial was conducted. Patients with moderate-to-severe disease severity based on the World Health Organization definition were enrolled and received 12 g/d Vitamin C (high-dose intravenous Vitamin C [HDIVC]) or placebo for 4 days. Sequential Organ Failure Assessment (SOFA) score as a primary outcome, National Early Warning Score, Ordinal Scale of Clinical Improvement, and cytokine storm biomarkers were recorded on days 0, 3, and 5. Survival was also assessed on day 28 after enrollment. Findings Seventy-four patients (37 patients in each group) were enrolled from April 5, 2020, to November 19, 2020, and all patients completed follow-up. A lower increase in SOFA score during the first 3 days of treatment (+0.026 vs. +0.204) and a higher decrease in this parameter in the last 2 days (-0.462 vs. -0.036) were observed in the treatment group. However, these differences did not reach a significance level (P = 0.57 and 0.12, respectively). Other indices of clinical and biological improvement, length of hospitalization, and intensive care unit admission days were the same between the two groups. Treatment did not affect the 28-day mortality. Conclusion Among patients with moderate-to-severe disease of COVID-19, the use of HDIVC plus standard care resulted in no significant difference in SOFA score or 28-day mortality compared to the standard care alone.
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Affiliation(s)
- Zohre Labbani-Motlagh
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahideh Amini
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran,Department of Pulmonary and Critical Care, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Rasoul Aliannejad
- Department of Pulmonary and Critical Care, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran,Advanced Thoracic Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Anahita Sadeghi
- Liver and Pancreatobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran,Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamadreza Jafary
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Talaschian
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Akhtari
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran,Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran,Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Sadeghi
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Kourosh Sadeghi, E-mail:
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Boukoufi C, Boudier A, Maincent P, Vigneron J, Clarot I. Food-inspired innovations to improve the stability of active pharmaceutical ingredients. Int J Pharm 2022; 623:121881. [PMID: 35680111 DOI: 10.1016/j.ijpharm.2022.121881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022]
Abstract
Food-processing and pharmaceutical industries share a lot of stability issues against the same physical, chemical, and microbiological phenomena. They also share some solutions to improve the stability as the use of preservatives and packaging. Ecological concerns lead to the development of tremendous innovations in food. Some of these innovations could also be beneficial in the pharmaceutical domain. The objective of this review is to evaluate the potential application of these findings in the pharmaceutical field and the main limits in terms of toxicity, environmental, economic and regulatory issues. The principal factors influencing the shelf-life were highlighted through the description of the stability studies usually performed in the pharmaceutical industry (according to European guidelines). To counter those factors, different solutions are currently available as preservatives and specific packaging. They were described and debated with an overview of recent food innovations in each field. The limits of the current solutions in the pharmaceutical field and the innovation in the food field have inspired a critical pharmaceutical outlook. The active and intelligent packaging for active pharmaceutical ingredients of the future is imagined.
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Affiliation(s)
- Célia Boukoufi
- Université de Lorraine, CITHEFOR, F-54000 Nancy, France; Pharmacy Department, University Hospital, 54511 Vandoeuvre-lès-Nancy, France
| | | | | | - Jean Vigneron
- Pharmacy Department, University Hospital, 54511 Vandoeuvre-lès-Nancy, France
| | - Igor Clarot
- Université de Lorraine, CITHEFOR, F-54000 Nancy, France.
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Palanisamy V, Sanphui P, Palanisamy K, Prakash M, Bansal AK. Design of Ascorbic Acid Eutectic Mixtures With Sugars to Inhibit Oxidative Degradation. Front Chem 2022; 10:754269. [PMID: 35615307 PMCID: PMC9125031 DOI: 10.3389/fchem.2022.754269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
L-Ascorbic acid (ASC), commonly known as vitamin C, acts as an anti-oxidant in the biological system. It is extensively used as an excipient in pharmaceutical industry, food supplements in fruit juices, and food materials due to its free radicals scavenging activity. Main drawback of ASC is its poor aqueous stability owing to the presence of lactone moiety that is easily oxidized to dehydroascorbic acid and further degraded. To improve aqueous stability and inhibit oxidative degradation, ASC was co-crystallized to constitute binary eutectic compositions with mono and di-saccharides such as glucose, sucrose, lactose, and mannitol. The eutectics were confirmed by their (single) lower melting endotherm compared to ASC and sugars, although Powder X-ray diffraction (PXRD) and Fourier transform Infrared spectroscopy (FT-IR) data confirmed the characteristics of their physical mixture. Scanning electron microscope (SEM) images of the binary eutectics confirmed their irregular morphology. The ASC eutectics exhibited improved shelf-life by 2–5-fold in weakly acidic (pH 5) and neutral (pH 7) aqueous buffer medium, whereas the eutectic with glucose enhanced shelf-life only by 1.1–1.2-fold in acidic medium (pH 3.3 and 4). Notably, stabilizing effect of the sugar eutectics decreased with increasing acidity of the medium. In addition, higher binding energy of the disaccharide eutectics partially supports the aqueous stability order of ASC in the neutral pH medium due to more number of non-bonded interactions than that of monosaccharides.
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Affiliation(s)
- Vasanthi Palanisamy
- Department of Chemistry, Faculty of Engineering and Technology, SRM Institute of Science and Technology, Chennai, India
| | - Palash Sanphui
- Department of Chemistry, Faculty of Engineering and Technology, SRM Institute of Science and Technology, Chennai, India
- *Correspondence: Palash Sanphui, ; Arvind Kumar Bansal,
| | - Kandhan Palanisamy
- Department of Chemistry, Faculty of Engineering and Technology, SRM Institute of Science and Technology, Chennai, India
| | - Muthuramalingam Prakash
- Department of Chemistry, Faculty of Engineering and Technology, SRM Institute of Science and Technology, Chennai, India
| | - Arvind Kumar Bansal
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, India
- *Correspondence: Palash Sanphui, ; Arvind Kumar Bansal,
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Masse MH, Ménard J, Sprague S, Battista MC, Cook DJ, Guyatt GH, Heyland DK, Kanji S, Pinto R, Day AG, Cohen D, Annane D, McGuinness S, Parke R, Carr A, Arabi Y, Vijayaraghavan BKT, D'Aragon F, Carbonneau É, Maslove D, Hunt M, Rochwerg B, Millen T, Chassé M, Lebrasseur M, Archambault P, Deblois E, Drouin C, Lellouche F, Lizotte P, Watpool I, Porteous R, Clarke F, Marinoff N, Belley-Côté É, Bolduc B, Walker S, Iazzetta J, Adhikari NKJ, Lamontagne F. Lessening Organ dysfunction with VITamin C (LOVIT): protocol for a randomized controlled trial. Trials 2020; 21:42. [PMID: 31915072 PMCID: PMC6950903 DOI: 10.1186/s13063-019-3834-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background Sepsis is a health problem of global importance; treatments focus on controlling infection and supporting failing organs. Recent clinical research suggests that intravenous vitamin C may decrease mortality in sepsis. We have designed a randomized controlled trial (RCT) to ascertain the effect of vitamin C on the composite endpoint of death or persistent organ dysfunction at 28 days in patients with sepsis. Methods LOVIT (Lessening Organ dysfunction with VITamin C) is a multicenter, parallel-group, blinded (participants, clinicians, study personnel, Steering Committee members, data analysts), superiority RCT (minimum n = 800). Eligible patients have sepsis as the diagnosis for admission to the intensive care unit (ICU) and are receiving vasopressors. Those admitted to the ICU for more than 24 h are excluded. Eligible patients are randomized to high-dose intravenous vitamin C (50 mg/kg every 6 h for 96 h) or placebo. The primary outcome is a composite of death or persistent organ dysfunction (need for vasopressors, invasive mechanical ventilation, or new and persisting renal replacement therapy) at day 28. Secondary outcomes include persistent organ dysfunction-free days to day 28, mortality and health-related quality of life at 6 months, biomarkers of dysoxia, inflammation, infection, endothelial function, and adverse effects (hemolysis, acute kidney injury, and hypoglycemia). Six subgroup analyses are planned. Discussion This RCT will provide evidence of the effect of high-dose intravenous vitamin C on patient-important outcomes in patients with sepsis. Trial registration clinicaltrials.gov, NCT03680274, first posted 21 September 2018.
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Affiliation(s)
- Marie-Hélène Masse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Julie Ménard
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Marie-Claude Battista
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Salmaan Kanji
- Departments of Pharmacy and Critical Care, The Ottawa Hospital and Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston, ON, Canada
| | - Dian Cohen
- No institutional affiliation, No institutional affiliation, Sherbrooke, QC, Canada
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Lab Inflammation & Infection, U1173 University Paris Saclay-UVSQ/INSERM, Garches, France
| | - Shay McGuinness
- Cardiothoracic and Vascular ICU, Auckland City Hospital, Auckland, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rachael Parke
- Cardiothoracic and Vascular ICU, Auckland City Hospital, Auckland, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand.,School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Anitra Carr
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Yaseen Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Frédérick D'Aragon
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Élaine Carbonneau
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - David Maslove
- Department of Critical Care Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Miranda Hunt
- Department of Critical Care Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Bram Rochwerg
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Michaël Chassé
- Centre de Recherche du Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
| | - Martine Lebrasseur
- Centre de Recherche du Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
| | - Patrick Archambault
- Faculté de Médecine, Université Laval, Québec City, QC, Canada.,Département des soins intensifs du Centre intégré de santé et des services sociaux de Chaudière-Appalaches (Secteur Alphonse-Desjardins), Lévis, QC, Canada
| | - Estel Deblois
- Département des soins intensifs du Centre intégré de santé et des services sociaux de Chaudière-Appalaches (Secteur Alphonse-Desjardins), Lévis, QC, Canada
| | - Christine Drouin
- Department of Critical Care Research, St. Joseph's Healthcare, Hamilton, ON, Canada.,Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lellouche
- Department of Medecine, Université Laval and Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, QC, Canada
| | - Patricia Lizotte
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - Irene Watpool
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - France Clarke
- Department of Critical Care Research, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Nicole Marinoff
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Émilie Belley-Côté
- Division of Cardiology, Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| | - Brigitte Bolduc
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Scott Walker
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Canada and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - John Iazzetta
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - François Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada.
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