995 resultados para Active Pharmaceutical Ingredients


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The importance of this study is based on the need to obtain simple and efficient in vitro models to predict the in vivo toxicity of cosmetics, aiming not to use animals as experimental model. Here, we proposed the use of HepG2 cells, which are widely applied to simulate the hepatic function of the human organism in vitro. This cell line was chose since recent studies have shown that the liver is potentially the most frequently targeted organ by cosmetic ingredients, and beyond that, considering the widely application of in vitro assays to test the cutaneous permeation of cosmetic products, including the assays applying modified Franz cells, this technique becomes indispensable. Three different cosmetic active substances were used, and the toxicity to HepG2 cells was assessed by the MTT method. The treatment with hyaluronic acid showed no toxicity to HepG2 cells. Treating the cells with P. guajava L. extract were verified that increasing the amount of the extract in the media, the cellular viability decreased, and finally, the treatment of alpha-lipoic acid showed a cytoprotective effect in relation to the treatment with propylene glycol. The study demonstrated the suitability in using HepG2 cells to assess the safety of cosmetic active substances, helping in the prediction of if the substance could be hepatotoxic if could reach the bloodstream

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To evaluate the impact of a medication therapy management (MTM) program on the clinical outcomes and the quality of life (QoL) of a group of elderly patients with type 2 diabetes mellitus (DM). The study was conducted in a community pharmacy in Aracaju, Brazil, from February to November 2009. A quasi-experimental, longitudinal, prospective study was conducted by intervention. The group patients received medication therapy management from a clinical pharmacist. A sample of convenience was obtained for patients of both genders aged from 60 to 75 years. Monthly visits were scheduled over 10 months. At these consultations, sociodemographic, clinical data were obtained. QoL assessment was conducted using a generic instrument-the Medical Outcomes Studies 36-item Short Form Survey (SF-36 (R)). In total, 34 completed the study. The mean age of the patients was 65.9 (4.7) years. In total, 117 DRPs were identified. Patients' baseline and final evaluation measures for glycosylated hemoglobin, capillary blood glucose, blood pressure, and waist circumference were significantly different (p < 0.05). The domains of QoL assessed by the SF-36 (R) also shows significant differences between patients' baseline and final evaluation scores. The co-responsibility and active participation on the part of the elderly may have helped pharmacotherapy achieve its clinical and humanistic aims.

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Pharmaceuticals are useful tools to prevent and treat human and animal diseases. Following administration, a significant fraction of pharmaceuticals is excreted unaltered into faeces and urine and may enter the aquatic ecosystem and agricultural soil through irrigation with recycled water, constituting a significant source of emerging contaminants into the environment. Understanding major factors influencing their environmental fate is consequently needed to value the risk, reduce contamination, and set up bioremediation technologies. The antiviral drug Tamiflu (oseltamivir carboxylate, OC) has received recent attention due to the potential use as a first line defence against H5N1 and H1N1 influenza viruses. Research has shown that OC is not removed during conventional wastewater treatments, thus having the potential to enter surface water bodies. A series of laboratory experiments investigated the fate and the removal of OC in surface water systems in Italy and Japan and in a municipal wastewater treatment plant. A preliminary laboratory study investigated the persistence of the active antiviral drug in water samples from an irrigation canal in northern Italy (Canale Emiliano Romagnolo). After an initial rapid decrease, OC concentration slowly decreased during the remaining incubation period. Approximately 65% of the initial OC amount remained in water at the end of the 36-day incubation period. A negligible amount of OC was lost both from sterilized water and from sterilized water/sediment samples, suggesting a significant role of microbial degradation. Stimulating microbial processes by the addition of sediments resulted in reduced OC persistence. Presence of OC (1.5 μg mL-1) did not significantly affect the metabolic potential of the water microbial population, that was estimated by glyphosate and metolachlor mineralization. In contrast, OC caused an initial transient decrease in the size of the indigenous microbial population of water samples. A second laboratory study focused on basic processes governing the environmental fate of OC in surface water from two contrasting aquatic ecosystems of northern Italy, the River Po and the Venice Lagoon. Results of this study confirmed the potential of OC to persist in surface water. However, the addition of 5% of sediments resulted in rapid OC degradation. The estimated half-life of OC in water/sediment of the River Po was 15 days. After three weeks of incubation at 20 °C, more than 8% of 14C-OC evolved as 14CO2 from water/sediment samples of the River Po and Venice Lagoon. OC was moderately retained onto coarse sediments from the two sites. In water/sediment samples of the River Po and Venice Lagoon treated with 14C-OC, more than 30% of the 14C-residues remained water-extractable after three weeks of incubation. The low affinity of OC to sediments suggests that the presence of sediments would not reduce its bioavailability to microbial degradation. Another series of laboratory experiments investigated the fate and the removal of OC in two surface water ecosystems of Japan and in the municipal wastewater treatment plant of the city of Bologna, in Northern Italy. The persistence of OC in surface water ranged from non-detectable degradation to a half-life of 53 days. After 40 days, less than 3% of radiolabeled OC evolved as 14CO2. The presence of sediments (5%) led to a significant increase of OC degradation and of mineralization rates. A more intense mineralization was observed in samples of the wastewater treatment plant when applying a long incubation period (40 days). More precisely, 76% and 37% of the initial radioactivity applied as 14C-OC was recovered as 14CO2 from samples of the biological tank and effluent water, respectively. Two bacterial strains growing on OC as sole carbon source were isolated and used for its removal from synthetic medium and environmental samples, including surface water and wastewater. Inoculation of water and wastewater samples with the two OC-degrading strains showed that mineralization of OC was significantly higher in both inoculated water and wastewater, than in uninoculated controls. Denaturing gradient gel electrophoresis and quantitative PCR analysis showed that OC would not affect the microbial population of surface water and wastewater. The capacity of the ligninolytic fungus Phanerochaete chrysosporium to degrade a wide variety of environmentally persistent xenobiotics has been largely reported in literature. In a series of laboratory experiments, the efficiency of a formulation using P. chrysosporium was evaluated for the removal of selected pharmaceuticals from wastewater samples. Addition of the fungus to samples of the wastewater treatment plant of Bologna significantly increased (P < 0.05) the removal of OC and three antibiotics, erythromycin, sulfamethoxazole, and ciprofloxacin. Similar effects were also observed in effluent water. OC was the most persistent of the four pharmaceuticals. After 30 days of incubation, approximately two times more OC was removed in bioremediated samples than in controls. The highest removal efficiency of the formulation was observed with the antibiotic ciprofloxacin. The studies included environmental aspects of soil contamination with two emerging veterinary contaminants, such as doramectin and oxibendazole, wich are common parasitic treatments in cattle farms.

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Zusammenfassung Die vorliegende Arbeit hat zum Ziel, pharmazeutisch-technologische Möglichkeiten der Retardierung bei ausgewählten Antiasthmatika zur pulmonalen Applikation anzuwenden. Dafür sollten Mikropartikel hergestellt und pharmazeutisch sowie biopharmazeutisch charakterisiert werden. Als Modellsubstanzen werden das Glukokortikoid Budesonid und das β2-Sympathomimetikum Salbutamol in Form seiner Base und seines Salzes verwendet. Die Auswahl erfolgt nach physikochemischen (Lipophilie, Molekulargewicht) und therapeutischen (Halbwertszeit der Wirkung, Applikationsfrequenz) Gesichtspunkten. Mikropartikel auf Polymerbasis ermöglichen eine kontrollierte Freigabe der Arzneistoffe über einen vorausbestimmten Zeitraum. Es erfolgt die Auswahl physiologisch unbedenklicher Hilfsstoffe (Polylaktide R 202H/ Poly(laktid-co-glykolide) RG 502H, RG 752-S) mit unterschiedlichen Anteilen an Coglykolid sowie unterschiedlichen Molekulargewichten, die sich prinzipiell zur Verzögerung der Freisetzung eignen und sich bei der parenteralen Applikation bereits bewährt haben. Die Sprühtrocknung wird als geeignetes pharmazeutisch-technologisches Verfahren zur Präparation von Mikropartikeln im Teilchengrößenbereich von 1- 10 Mikrometern beschrieben, welche den Wirkstoff mit möglichst hoher Beladung verkapselt. Die sprühgetrockneten Pulver sollen pharmazeutisch physikochemisch mittels Rasterelektronenmikroskopie (Morphologie), Laserdiffraktometrie (Teilchengrößenverteilung), DSC und Röntgenpulverdiffraktometrie (thermisches Verhalten) und mittels Stickstoff-Tief-Temperatur Adsorptionsverfahren (spezifische Oberfläche) charakterisiert werden. Zusätzlich wird die Wirkstoffbeladung der sprühgetrockneten Polymer-Mikropartikel mittels HPLC ermittelt. Die biopharmazeutische Charakterisierung der sprühgetrockneten Pulver erfolgt über die in-vitro Freigabekinetik und die Stabilität der Mikropartikel. Zusätzlich werden Versuche an Zellkulturen und in-vivo Versuche an Mäusen durchgeführt, um die Effekte der sprühgetrockneten Mikropartikel und des Hilfsstoffs hinsichtlich der Freisetzungsretardierung zu testen. Bei den in-vivo Versuchen werden der Atemwegswiderstand und die Verlängerung der exspiratorischen Phase (penh) als Parameter für einen antiasthmatischen Effekt gewählt. Die Lungenlavage Flüssigkeit wird zusätzlich überprüft. Die Ergebnisse zeigen, dass es mit Hilfe der Sprühtrocknung möglich ist, Polymer-Mikropartikel herzustellen, die aufgrund ihrer Partikelgröße von d50 ≤ 5,8 µm fähig sind, die unteren Abschnitte der Lunge zu erreichen. Die Morphologie der Mikropartikel ist abhängig vom zu versprühenden Produkt. Thermodynamisch und röntgenpulverdiffraktometrisch betrachtet handelt es sich um amorphe Produkte, die aber über lange Zeit in diesem Zustand stabil sind. Die Wiederfindung der eingesetzten Arzneistoffmenge in den sprühgetrockneten Polymer-Mikropartikeln und die Freigabeversuche zur Charakterisierung der Retardierungseigenschaften der verwendeten Polymere ergeben, dass es mit Hilfe der Sprühtrocknung von Budesonid und Salbutamol mit den Polymeren möglich ist, retardierende Mikropartikel herzustellen. Die Wiederfindung von Budesonid und Salbutamol in den sprühgetrockneten Polymer-Mikropartikeln entspricht nahezu der eingesetzten Menge. Bei Salbutamolsulfat ist dies nicht der Fall. In Zellkulturversuchen der murinen Zellinie RAW 264.7 ergaben sich Hinweise darauf, dass bei Konzentrationen von 10-6 M und 10-8 M, die Downregulation der IL-6 Konzentration durch die Sprüheinbettung von 9,1 % Budesonid mit PLGA in stärkerem Ausmaß erfolgte, als bei unverkapseltem Budesonid. Zusätzlich wurden in-vivo Versuche mit intranasaler und intraperitonealer Gabe durchgeführt. Die Budesonid-Polymer Sprüheinbettung wurde mit unverkapseltem Budesonid vergleichen. Nach intraperitonealer Gabe hatte die Sprüheinbettung mit Budesonid die besten Effekte hinsichtlich der Unterdrückung des penh und des Atemwegswiderstands auch bei steigenden Metacholinkonzentrationen. Die Auswertung der Lungenlavage Flüssigkeit zeigt sehr deutlich die Downregulation der IL-6 Konzentration in der Lunge durch die Sprüheinbettung mit Budesonid. Zur Zeit werden Vorbereitungen getroffen, ein Gerät zu testen, das in der Lage ist, ein Mikrospray zu generieren, so dass eine intratracheale Verabreichung möglich wäre.

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Water is susceptible to be used for numerous purposes, including edible, both for humans and animals. In the food animal production, drinking water is frequently used as a way to carry out the most common pharmacological treatments. In these cases, there are many variables which could degrade drugs dissolved in this mean, even when properly arranged pharmaceutical formulations are used. In fact, although a product obtains a Marketing Authorization through appropriate laboratory studies both drug stability and solubility, on the other hand the solubility of the same drug in natural water used as a drinking water is not documented. In the present study has been evaluated the dissolution kinetics (at 0 hours and 24 hours) of products, having oxytetracycline and tylosin as active ingredient, used in drinking water samples in order to see how the different physical and chemical factors that characterize the drinking water may affect therapeutic efficacy. In fact, multiple factors, also of little relevance if individually considered, are able to adversely affect the pharmacological treatment carried out in drinking water.

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The protein silk fibroin (SF) from the silkworm Bombyx mori is a FDA-approved biomaterial used over centuries as sutures wire. Importantly, several evidences highlighted the potential of silk biomaterials obtained by using so-called regenerated silk fibroin (RSF) in biomedicine, tissue engineering and drug delivery. Indeed, by a water-based protocol, it is possible to obtain protein water-solution, by extraction and purification of fibroin from silk fibres. Notably, RSF can be processed in a variety of biomaterials forms used in biomedical and technological fields, displaying remarkable properties such as biocompatibility, controllable biodegradability, optical transparency, mechanical robustness. Moreover, RSF biomaterials can be doped and/or chemical functionalized with drugs, optically active molecules, growth factors and/or chemicals In this view, activities of my PhD research program were focused to standardize the process of extraction and purification of protein to get the best physical and chemical characteristics. The analysis of the chemo-physical properties of the fibroin involved both the RSF water-solution and the protein processed in film. Chemo-physical properties have been studied through: vibrational (FT-IR and Raman-FT) and optical (absorption and emission UV-VIS) spectroscopy, nuclear magnetic resonance (1H and 13C NMR), thermal analysis and thermo-gravimetric scan (DSC and TGA). In the last year of my PhD, activities were focused to study and define innovative methods of functionalization of the silk fibroin solution and films. Indeed, research program was the application of different methods of manufacturing approaches of the films of fibroin without the use of harsh treatments and organic solvents. New approaches to doping and chemical functionalization of the silk fibroin were studied. Two different methods have been identified: 1) biodoping that consists in the doping of fibroin with optically active molecules through the addition of fluorescent molecules in the standard diet used for the breeding of silkworms; 2) chemical functionalization via silylation.

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The importance of pyrazole and lactam-based molecules in medical and pharmaceutical fields is underlined by the multitude of active ingredients on trade, such as Sildenafil or Apixaban, by Pfizer. In this work, a synthesis of an organic molecule with promising anticancer activity has been developed. This molecular scaffold is characterized by a δ-lactam-fused pyrazolic core, with a well-known biological activity and amenable of further functionalization. The synthetic strategy adopted for the obtainment of the core was based on a 1,3-dipolar cycloaddition of a nitrilimine with an α,β-unsaturated δ-lactam. Secondly, in order to give the final compound an elevated pharmacological activity, a functionalization with a double “side chain”, namely molecular fragment able to improve the interaction with particular biological receptors, was achieved. The target compound was thus obtained, with a highly convergent synthesis, and will be tested for antiproliferative activities towards different cellular lines.

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En este artículo se estudia la calidad del proceso de fabricación pastillas de distinto origen, entre los que se incluyen productos genéricos. El resultado fundamental es que, las marcas oficiales y sus respectivos genéricos, no son iguales desde el punto de vista de su acabado, lo cual repercute directamente en su eficacia.Eine vollsUindige Charakterisierung von pharmazeutischen Tabletten besteht nicht nur in der Analyse der chemischen Zusammensetzung, sondern auch in der Untersuchung der Fertigung der inneren Struktur und der OberfUichenstruktur. Ziel dieser Arbeit ist es, die OberfUichenrauheit von Tabletten an Originalpra• paraten und Generika mittels Angularer Speckle Korre• lation (ASK) zu bestimmen. Die Ergebnisse zeigen un terschiedliche Rauheitswerte bei Tabletten mit gleichem Wirkstoff bei verschiedenen Tragerstoffen. Berührungslose Speckle-Rauheitsmessung konnte eingesetzt werden, um die Regelung des Produktionsprozesses zu verbessern, z. B. wahrend die Tabletten aus Pulver gepresst werden. A complete characterization of pharmaceutical tablets requires not only the analysis of its chemical com• pounds, but also of its inner and surface structure manufacturing. The aim of this work is to determine the sur face roughness of original and generic tablets by means of angular speckle correlation (ASC). The results show different roughness properties between tablets with the same active ingredients, but with different excipients. Contactless speckle roughness measurements could be used to im• prove the control of the production process, e. g., when tablets are pressed from powder.

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A administração de princípios ativos pela mucosa oral é uma forma eficiente para a distribuição de fármacos e nutrientes, oferecendo diversas vantagens como uma fácil aplicação, evitando o metabolismo de primeira passagem hepática e potencialmente melhorando a biodisponibilidade dessas substâncias. A acerola e o camu-camu apresentam uma alta concentração de vitamina C e são consideradas fontes de diferentes compostos ativos, porém a vitamina C presente nas frutas é facilmente oxidada pelos fatores ambientais, e essas frutas são pouco acessíveis ao consumo populacional. Filmes de desintegração oral (FDO) podem apresentar rápido tempo de desintegração e fácil administração, o que os torna um material interessante para a veiculação de compostos com atividades farmacêuticas ou nutricionais. Assim, este trabalho teve como objetivo o desenvolvimento e caracterização de filmes de desintegração oral à base de amido e gelatina com adição de extrato seco de acerola e camu-camu produzidos por \"spray dryer\" como uma alternativa para a administração de vitamina C. Os FDOs foram produzidos pela técnica de casting, variando-se a proporção de amido e gelatina. Como plastificante foi utilizado o sorbitol (20 g / 100 g de polímero), mantendo-se constante a concentração de polímeros (2 g /100 g de solução filmogênica) e de extrato seco de acerola (4 g /100 g de solução filmogênica) e camu-camu (4 g / 100 g de solução filmogênica). Os extratos secos de acerola e camu-camu foram caracterizados com relação à concentração da vitamina C e da estabilidade desses extratos nessas condições (30 °C, UR 75 % e 40 °C, UR 75%). Os FDOs foram caracterizados em relação a espessura, propriedades mecânicas, ângulo de contato, FT-IR, microscopia electrônica de varredura, concentração de vitamina C, atividade antioxidante, atividade antimicrobiana, estabilidade da vitamina C, tempo de desintegração, estabilidade da atividade de eliminação de radicais de DPPH•, avaliação sensorial. Os extratos secos apresentaram uma boa estabilidade em relação à vitamina C e aos compostos antioxidantes (sequestro do radical DPPH•). Os FDOs sem adição de extrato, independente da formulação, mostraram-se homogêneos, com ausência de partículas insolúveis e alta capacidade de formação de filme. Para os FDOs com maior concentração de amido foi observado reduzido tempo de desintegração e pH próximo ao bucal. Após a adição dos extratos, os FDOs apresentaram redução do tempo de desintegração, boa aceitação sensorial, propriedades antioxidantes e estabilidade pelo sequestro do radical DPPH•. O pH de superfície dos filmes com adição de extrato seco de acerola foi mais próximo ao bucal quando comparado com os filmes com camu-camu. No entanto, os FDOs com acerola apresentaram reduzida estabilidade da vitamina C em relação ao tempo de armazenamento, enquanto que os filmes com camu-camu apresentaram melhor estabilidade. De modo geral, na formulação produzida apenas com amido (100 g de amido / 100 g de polímeros) observou-se uma maior concentração da vitamina C no final da estabilidade realizada à 30 °C e umidade relativa de 75 %, elevada estabilidade dos compostos ativos (DPPH) e alta taxa de uniformidade na distribuição da vitamina C no filme de desintegração oral. Dessa forma, os FDOs podem ser considerados uma boa alternativa para a suplementação de vitamina C.

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A simple method for the measurement of the active leflunomide metabolite A77 1726 in human plasma by HPLC is presented. The sample workup was simple, using acetonitrile for protein precipitation. Chromatographic separation of A77 1726 and the internal standard, alpha-phenylcinnamic acid, was achieved using a C-18 column with UV detection at 305 nm. The assay displayed reproducible linearity for A77 1726 with determination coefficients (r(2)) > 0.997 over the concentration range 0.5-60.0 mug/ml. The reproducibility (%CV) for intra- and inter-day assays of spiked controls was

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Objective: The objective of the study was to characterise the population pharmacokinetic properties of itraconazole and its active metabolite hydroxyitraconazole in a representative paediatric population of cystic fibrosis and bone marrow transplant (BMT) patients and to identify patient characteristics influencing the pharmacokinetics of itraconazole. The ultimate goals were to determine the relative bioavailability between the two oral formulations (capsules vs oral solution) and to optimise dosing regimens in these patients. Methods: All paediatric patients with cystic fibrosis or patients undergoing BMT at The Royal Children's Hospital, Brisbane, QLD, Australia, who were prescribed oral itraconazole for the treatment of allergic bronchopulmonary aspergillosis (cystic fibrosis patients) or for prophylaxis of any fungal infection (BMT patients) were eligible for the study. Blood samples were taken from the recruited patients as per an empirical sampling design either during hospitalisation or during outpatient clinic visits. ltraconazole and hydroxy-itraconazole plasma concentrations were determined by a validated high-performance liquid chromatography assay with fluorometric detection. A nonlinear mixed-effect modelling approach using the NONMEM software to simultaneously describe the pharmacokinetics of itraconazole and its metabolite. Results: A one-compartment model with first-order absorption described the itraconazole data, and the metabolism of the parent drug to hydroxy-itraconazole was described by a first-order rate constant. The metabolite data also showed one-compartment characteristics with linear elimination. For itraconazole the apparent clearance (CLitraconazole) was 35.5 L/hour, the apparent volume of distribution (V-d(itraconazole)) was 672L, the absorption rate constant for the capsule formulation was 0.0901 h(-1) and for the oral solution formulation was 0.96 h-1. The lag time was estimated to be 19.1 minutes and the relative bioavailability between capsules and oral solution (F-rel) was 0.55. For the metabolite, volume of distribution, V-m/(F (.) f(m)), and clearance, CL/(F (.) fm), were 10.6L and 5.28 L/h, respectively. The influence of total bodyweight was significant, added as a covariate on CLitraconazoie/F and V-d(itraconazole)/F (standardised to a 70kg person) using allometric three-quarter power scaling on CLitraconazole/F, which therefore reflected adult values. The unexplained between-subject variability (coefficient of variation %) was 68.7%, 75.8%, 73.4% and 61.1% for CLitraconazoie/F, Vd(itraconazole)/F, CLm/(F (.) fm) and F-rel, respectively. The correlation between random effects of CLitraconazole and Vd((itraconazole)) was 0.69. Conclusion: The developed population pharmacokinetic model adequately described the pharmacokinetics of itraconazole and its active metabolite, hydroxy-itraconazole, in paediatric patients with either cystic fibrosis or undergoing BMT. More appropriate dosing schedules have been developed for the oral solution and the capsules to secure a minimum therapeutic trough plasma concentration of 0.5 mg/L for these patients.

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Objectives: The aim of the study was to characterise the population pharmacokinetics (popPK) properties of itraconazole (ITRA) and its active metabolite hydroxy-ITRA in a representative paediatric population of cystic fibrosis (CF) and bone marrow transplant (BMT) patients. The goals were to determine the relative bioavailability between the two oral formulations, and to explore improved dosage regimens in these patients. Methods: All paediatric patients with CF taking oral ITRA for the treatment of allergic bronchopulmonary aspergillosis and patients undergoing BMT who were taking ITRA for prophylaxis of any fungal infection were eligible for the study. A minimum of two blood samples were drawn after the capsules and also after switching to oral solution, or vice versa. ITRA and hydroxy-ITRA plasma concentrations were measured by HPLC[1]. A nonlinear mixed-effect modelling approach (NONMEM 5.1.1) was used to describe the PK of ITRA and hydroxy-ITRA simultaneously. Simulations were used to assess dosing strategies in these patients. Results: Forty-nine patients (29CF, 20 BMT) were recruited to the study who provided 227 blood samples for the population analysis. A 1-compartment model with 1st order absorption and elimination best described ITRA kinetics, with 1st order conversion to hydroxy-ITRA. For ITRA, the apparent clearance (ClItra/F) and volume of distribution (Vitra/F) was 35.5L/h and 672L, respectively; the absorption rate constant for the capsule formulation was 0.0901 h-1 and for the oral solution formulation it was 0.959 h-1. The capsule comparative bioavailability (vs. solution) was 0.55. For hydroxy-ITRA, the apparent volume of distribution and clearance were 10.6 L and 5.28 L/h, respectively. Of several screened covariates only allometrically scaled total body weight significantly improved the fit to the data. No difference between the two populations was found. Conclusion: The developed popPK model adequately described the pharmacokinetics of ITRA and hydroxy-ITRA in paediatric patients with CF and patients undergoing BMT. High inter-patient variability confirmed previous data in CF[2], leukaemia and BMT[3] patients. From the population model, simulations showed the standard dose (5 mg/kg/day) needs to be doubled for the solution formulation and even 4 times more given of the capsules to achieve an adequate target therapeutic trough plasma concentration of 0.5 mg/L[4] in these patients.