Marked increase in proton pump inhibitors use in Australia

Objectives: To examine the trends in the prescribing of subsidised proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs), in the Australian population from 1995 to 2006 to encourage discussion regarding appropriate clinical use. PPIs and H2RAs are the second highest drug cost to the publicly subsidised Pharmaceutical Benefits Scheme (PBS). Design: Government data on numbers of subsidised scripts, quantity and doses for PPIs and H2RAs were analysed by gender and age, dose and indication. Main outcome measure: Drug utilisation as DDD [defined daily dose]/1000 population/day. Results: The use of combined PPIs increased by 1318%. Utilisation increased substantially after the relaxation of the subsidised indications for PPIs in 2001. Omeprazole had the largest market share but was substituted by its S-enantiomer esomeprazole after its introduction in 2002. There was considerable use in the elderly with the peak use being in those aged 80 years and over. The utilisation of H2RAs declined 72% over 12 years. Conclusions: PPI use has increased substantially, not only due to substitution of H2RAs but to expansion in the overall market. Utilisation does not appear to be commensurate with prevalence of gastro-oesophageal reflux disease (GORD) nor with prescribing guidelines for PPIs, with significant financial costs to patients and PBS. This study encourages clinical discussion regarding quality use of these medicines. © 2010 John Wiley & Sons, Ltd.

Molecular dynamics simulations of PPI dendrimer-drug complexes

Dendrimeric nanoparticles are potential drug delivery devices which can enhance the solubility of hydrophobic drugs, thus increasing their bioavailability and sustained release action. A quantitative understanding of the dendrimer-drug interactions can give valuable insight into the solubility and release profile of hydrophobic drug molecules in various solvent conditions. Fully atomistic molecular dynamics (MD) simulations have been performed to study the interactions of G5 PPIEDA (G5 ethylenediamine cored poly(propylene imine)) dendrimer and two well known drugs (Famotidine and Indomethacin) at different pH conditions. The study suggested that at low pH the dendrimer-drug complexes are thermodynamically unstable as compared to neutral and high pH conditions. Calculated Potential of Mean Force (PMF) by umbrella sampling showed that the release of drugs from the dendrimer at low pH is spontaneous, median release at neutral pH and slow release at high pH. In addition, Molecular Mechanics Poisson-Boltzmann Surface Area (MM-PBSA) binding free energy calculations were also performed at each umbrella sampling window to identify the various energy contributions. To understand the effect of dendrimer chemistry and topology on the solubility and release profile of drugs, this study is extended to explore the solubility and release profile of phenylbutazone drug complexed with G3 poly(amidoamine) and G4 diaminobutane cored PPI dendrimers. The results indicate that the pH-induced conformational changes in dendrimer, ionization states, dendrimer type and pK(a) of the guest molecules influence the free energy barrier and stability of complexation, and thus regulate drug loading, solubility and release.

Determination of ranitidine in urine by capillary electrophoresis-electrochemiluminescent detection

The fast analysis of ranitidine is of clinical importance in understanding its efficiency and a patient's treatment history. In this paper, a novel determination method for ranitidine based on capillary electrophoresis-electrochemiluminescence detection is described. The conditions affecting separation and detection were investigated in detail. End-column detection of ranitidine in 5 mM Ru(bpy)(3)(2+) solution at applied voltage of 1.20 V was performed. Favorable ECL intensity with higher column efficiency was achieved by electrokinetic injection for 10 s at 10 kV. The R.S.D. values of ECL intensity and migration time were 6.38 and 1.84% for 10(-4) M and 6.01 and 0.60% for 10(-5) M, respectively. A detection limit of 7 x 10(-8) M (S/N = 3) was achieved. The proposed method was applied satisfactorily to the determination of ranitidine in urine in 6 min.

New grafted PLA-g-PEG polymeric nanoparticles used to improve bioavailability of oral drugs.

Les nanoparticules (NPs) de polymère ont montré des résultats prometteurs pour leur utilisation comme système de transport de médicaments pour une libération contrôlée du médicament, ainsi que pour du ciblage. La biodisponibilité des médicaments administrés oralement pourrait être limitée par un processus de sécrétion intestinale, qui pourrait par la suite être concilié par la glycoprotéine P (P-gp). La dispersion de la Famotidine (modèle de médicament) à l’intérieur des nanoparticules (NPs) pegylées a été évaluée afin d’augmenter la biodisponibilité avec du polyéthylène glycol (PEG), qui est connu comme un inhibiteur de P-gp. L’hypothèse de cette étude est que l’encapsulation de la Famotidine (un substrat de P-gp) à l’intérieur des NPs préparées à partir de PEG-g-PLA pourrait inhiber la fonction P-gp. La première partie de cette étude avait pour but de synthétiser quatre copolymères de PEG greffés sur un acide polylactide (PLA) et sur un squelette de polymère (PLA-g-PEG), avec des ratios de 1% et 5% (ratio molaire de PEG vs acide lactique monomère) de soit 750, soit 2000 Da de masse moléculaire. Ces polymères ont été employés afin de préparer des NPs chargés de Famotidine qui possède une faible perméabilité et une solubilité aqueuse relativement basse. Les NPs préparées ont été analysées pour leur principaux paramètres physicochimiques tels que la taille et la distribution de la taille, la charge de surface (Potentiel Zeta), la morphologie, l’efficacité d’encapsulation, le pourcentage résiduel en alcool polyvinylique (PVA) adsorbé à la surface des NPs, les propriétés thermiques, la structure cristalline et la libération du médicament. De même, les formules de NPs ont été testées in vitro sur des cellules CaCo-2 afin dʼévaluer la perméabilité bidirectionnelle de la Famotidine. Généralement, les NPs préparées à partir de polymères greffés PLA-g-5%PEG ont montré une augmentation de la perméabilité du médicament, ce par l’inhibition de l’efflux de P-gp de la Famotidine dans le modèle CaCo-2 in vitro. Les résultats ont montré une baisse significative de la sécrétion de la Famotidine de la membrane basolatéral à apical lorsque la Famotidine était encapsulée dans des NPs préparées à partir de greffes de 5% PEG de 750 ou 2000 Da, de même que pour d’autres combinaisons de mélanges physiques contenant du PEG5%. La deuxième partie de cette étude est à propos de ces NPs chargées qui démontrent des résultats prometteurs en termes de perméabilité et d’inhibition d’efflux de P-gp, et qui ont été choises pour développer une forme orale solide. La granulation sèche a été employée pour densifier les NPs, afin de développer des comprimés des deux formules sélectionnées de NPs. Les comprimés à base de NPs ont démontré un temps de désintégration rapide (moins d’une minute) et une libération similaire à la Famotidine trouvée sur le marché. Les résultats de l’étude du transport de comprimés à base de NPs étaient cohérents avec les résultats des formules de NPs en termes d’inhibition de P-gp, ce qui explique pourquoi le processus de fabrication du comprimé n’a pas eu d’effet sur les NPs. Mis ensemble, ces résultats montrent que l’encapsulation dans une NP de polymère pegylé pourrait être une stratégie prometteuse pour l’amélioration de la biodisponibilité des substrats de P-gp.

A benchmark method for global optimization problems in structure determination from powder diffraction data

Quasi-Newton-Raphson minimization and conjugate gradient minimization have been used to solve the crystal structures of famotidine form B and capsaicin from X-ray powder diffraction data and characterize the chi(2) agreement surfaces. One million quasi-Newton-Raphson minimizations found the famotidine global minimum with a frequency of ca 1 in 5000 and the capsaicin global minimum with a frequency of ca 1 in 10 000. These results, which are corroborated by conjugate gradient minimization, demonstrate the existence of numerous pathways from some of the highest points on these chi(2) agreement surfaces to the respective global minima, which are passable using only downhill moves. This important observation has significant ramifications for the development of improved structure determination algorithms.

Thermal behavior of some antihistamines

Thermogravimetry (TG), differential scanning calorimetry (DSC), polarized light thermal microscopy (PLTM), as well as X-ray powder diffraction (XRD) and Fourier transformed infrared spectroscopy (FTIR) were used to study the thermal behavior and the chemical structure of cimetidine, famotidine, ranitidine-HCl, and nizatidine. The TG-DSC curves show that the famotidine and ranitidine-HCl suffer decomposition during melting and they are thermally less stable in comparison with cimetidine and nizatidine, the latter being the most stable of all the drugs studied in this study. The DSC curves of famotidine and ranitidine-HCl show exothermic peaks immediately after the melting, confirming the occurrence of thermal decomposition. The DSC curves also show that the cimetidine and nizatidine have some thermal stability after melting. The thermal events shown in the PLTM images are consistent with the results shown in the TG-DSC and DSC curves. The XRD patterns show that the cimetidine and famotidine are less crystalline compared with ranitidine-HCl and nizatidine. The theoretical FTIR bands are in agreement with those obtained experimentally, and in some cases, no difference is observed between the theoretical and experimental values, even being identical in one of the cases. © 2012 Akadémiai Kiadó, Budapest, Hungary.

Estudo termoanalítico e caracterização no estado sólido de alguns anti-histamínicos

Pós-graduação em Ciência e Tecnologia de Materiais - FC

Effect of continuous gastric enteral feeding on tonometric measurement of gastric intramucosal carbon dioxide levels in healthy volunteers

Purpose. The aim of this research was to evaluate the effect of enteral feeding on tonometric measurement of gastric regional carbon dioxide levels (PrCO2) in normal healthy volunteers. Design and methods. The sample included 12 healthy volunteers recruited by the University Clinical Research Center (UCRC). An air tonometry system monitored PrCO2 levels using a tonometer placed in the lumen of the stomach via orogastric intubation. PrCO2 was automatically measured and recorded every 10 minutes throughout the five hour study period. An oral dose of famotidine 40 mg was self-administered the evening prior to and the morning of the study. Instillation of Isocal® High Nitrogen (HN) was used for enteral feeding in hourly escalating doses of 0, 40, 60, and 80 ml/hr with no feeding during the fifth hour. Results . PrCO2 measurements at time 0 and 10 minutes (41.4 ± 6.5 and 41.8 ± 5.7, respectively) demonstrated biologic precision (Levene's Test statistic = 0.085, p-value 0.774). Biologic precision was lost between T130 and T140 40 when compared to baseline TO (Levene's Test statistic = 1.70, p-value 0.205; and 3.205, p-value 0.042, respectively) and returned to non-significant levels between T270 and T280 (Levene's Test statistic = 3.083, p-value 0.043; and 2.307, p-value 0.143, respectively). Isocal® HN significantly affected the biologic accuracy of PrCO2 measurements (repeated measures ANOVA F 4.91, p-value <0.001). After 20 minutes of enteral feeding at 40 ml/hr, PrCO2 significantly increased (41.4 ± 6.5 to 46.6 ± 4.25, F = 5.4, p-value 0.029). Maximum variance from baseline (41.4 ± 6.5 to 61.3 ± 15.2, F = 17.22, p-value <0.001) was noted after 30 minutes of Isocal® HN at 80 ml/hr or 210 minutes from baseline. The significant elevations in PrCO2 continued throughout the study. Sixty minutes after discontinuation of enteral feeding, PrCO2 remained significantly elevated from baseline (41.4 ± 6.5 to 51.8 ± 9.2, F = 10.15, p-value 0.004). Conclusion. Enteral feeding with Isocal® HN significantly affects the precision and accuracy of PrCO2 measurements in healthy volunteers. ^