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The crosslinking of the polymer matrix with compatible macromolecules results in a three-dimensional network structure that offers an enhancement in the controlled release properties of the material. In this sense, this work aimed to improve the release profile of mefenamic acid (MAC) through crosslinking strategies. κ-Carrageenan/sericin crosslinked blend was obtained by covalent and thermal crosslinking and the different formulations were characterized. The gastroresistant potential and release profile were evaluated in the dissolution assay. The effect and characterization of the particles were investigated. Multiple units presented high entrapment efficiency (94.11-104.25), high drug loading (36.50-47.50 %) and adequate particle size (1.34-1.57 mm) with rough surface and visually spherical shape. The Weibull model showed that drug release occurred by relaxation, erosion and Fickian diffusion. Material stability and absence of MAC -polymer interactions were demonstrated by FTIR and thermogravimetric analysis. DSC showed a stable character of MAC in the drug-loaded beads. Moreover, the application studies of κ-Car/Ser/carboxymethylcellulose in the in vitro intestine mode showed that the crosslinked blend increased cell viability (>85 %), while free MAC exhibited a cytotoxic effect. Finally, the crosslinked k-Car/Ser blend MAC -loaded showed promising properties of a sustained release form of anti-inflammatory drug.
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Sericinas , Sericinas/química , Ácido Mefenâmico/farmacologia , Polímeros , Carragenina/química , Liberação Controlada de Fármacos , Preparações de Ação Retardada/químicaRESUMO
Methylphenidate hydrochloride is used to treat children, adolescents, and adults with attention deficit/hyperactivity disorder (ADHD). Multiphasic release formulation has been used to control drug levels, mainly during children's school period. This study aimed to evaluate the bioequivalence between two methylphenidate hydrochloride extended-release tablets to meet regulatory requirements for registration in Brazil. Two independent studies (under fasting and fed conditions) designed as open-label, randomized, single-dose, two-period, two-way crossover trials were conducted in healthy subjects of both genders. Subjects were enrolled and randomly received a single dose of the test formulation methylphenidate hydrochloride 54 mg extended-release tablet (Consiv®, Adium S.A., São Paulo, Brazil) or the reference formulation (Concerta®, Janssen-Cilag Farmacêutica Ltd., São Paulo, Brazil), in each period, with a 7-day washout interval. Serial blood samples were collected up to 24 h post dose and methylphenidate plasma concentrations were obtained using a validated LC-MS/MS method. A total of 96 healthy subjects were enrolled in the fasting study, of which 80 completed the study. For the fed study, 52 healthy subjects were enrolled, and 46 subjects completed it. In both studies, 90% confidence intervals for Cmax, AUC0-t, AUC0-inf, and partial AUCs were within the acceptable limits of 80.00 to 125.00%. Thus, according to regulatory requirements, the test formulation (Consiv®) was considered to be bioequivalent to the reference formulation (Concerta®) in both conditions (fasting and fed) and, therefore, it can be considered interchangeable in clinical practice. Both formulations were safe and well tolerated in single-dose administration.
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The efficiency in the capabilities to store and release antioxidants depends on the film morphology and its manufacturing process, as well as on the type and methodology used to obtain the polyphenol extracts. Here, hydroalcoholic extracts of black tea polyphenols (BT) were obtained and dropped onto different polyvinyl alcohol (PVA) aqueous solutions (water or BT aqueous extract with and without citric acid, CA) to obtain three unusual PVA electrospun mats containing polyphenol nanoparticles within their nanofibers. It was shown that the mat obtained through the nanoparticles precipitated in BT aqueous extract PVA solution presented the highest total polyphenol content and antioxidant activity, and that the addition of CA as an esterifier or PVA crosslinker interfered with the polyphenols. The release kinetics in different food simulants (hydrophilic, lipophilic and acidic) were fitted using Fick's diffusion law and Peppas' and Weibull's models, showing that polymer chain relaxation is the main mechanism in all food simulants except for the acidic, which presented an abrupt release by Fick's diffusion mechanism of about 60% before being controlled. This research provides a strategy for the development of promising controlled-release materials for active food packaging, mainly for hydrophilic and acidic food products.
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Mosquito-borne diseases such as dengue, malaria, yellow fever, chikungunya and Zika virus affect millions of people worldwide each year. Vector control and personal protection are very important to minimize the spread of diseases, and the use of repellent is an economic practice to prevent them. The application of repellent, which acts on the skin to form a vapor layer with a repellent odor to mosquitos, is recommended as an economic prevention and practice. The natural botanical product Citronella is an effective mosquito repellent due to the high concentrations of active chemical constituents present, notably terpenic alcohols. However, citronella tends to evaporate quickly from the skin surface, resulting in a rapid loss of activity. Strategies to increase repellency time, while at the same time minimizing toxicity, are major focuses of research and development in natural repellent products. Here we highlight the role of extended-release systems (ERS) of citronella oil in this approach.
Assuntos
Produtos Biológicos , Repelentes de Insetos , Malária , Infecção por Zika virus , Zika virus , Animais , Humanos , Repelentes de Insetos/farmacologia , Composição de Medicamentos , TerpenosRESUMO
Abstract Flaxseed (Linum usitatissimum L.) is the seed of a multipurpose plant of pharmaceutical interest, as its mucilage can be used as a natural matrix to develop extended-release dosage forms and potentially replace synthetic polymers. In this study, a 3² factorial design with two replicates of the central point was applied to optimize the development of extended-release granules of metformin HCl. The total fiber content of the mucilage as well as the friability and dissolution of the formulations were evaluated. The lyophilized mucilage presented a high total fiber content (42.63%), which suggests a high efficiency extraction process. Higher concentrations of the mucilage and metformin HCl yielded less friable granules. In addition, lower concentrations of metformin HCl and higher concentrations of the mucilage resulted in slower drug release during the dissolution assays. The release kinetics for most formulations were better represented by the Hixson-Crowell model, while formulations containing a higher concentration of the mucilage were represented by the Korsmeyer-Peppas model. Nonetheless, five formulations showed a longer release than the reference HPMC formulation. More desirable results were obtained with a higher concentration of the mucilage (13-18%) and a lower concentration of metformin (40%).
Assuntos
Linho/classificação , Mucilagem Vegetal/agonistas , Metformina/análise , Plantas/efeitos adversos , Polímeros/efeitos adversos , Preparações Farmacêuticas/análiseRESUMO
Different polymer matrix compositions based on sericin and alginate blend (using or not the covalent crosslinking agents dibasic sodium phosphate, polyvinyl alcohol and polyethylene glycol) were evaluated to entrap naproxen. Sericin has been shown to be essential for improving incorporation efficiency. Comparing the formulations with and without crosslinking agent, the best results were obtained for that composed only of sericin and alginate, with satisfactory values of entrapment efficiency (>80%) and drug loading capacity (>20%). In this case, delayed release (<10% in acid medium) and prolonged release (~360 min) were achieved, with a complex release mechanism involving swelling and polymer chain relaxation. The incorporation of the drug could be confirmed by the techniques of characterization of X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR), as well as drug compatibility with the polymer matrix. In addition, particles of suitable size for multiparticulate systems were obtained and with higher thermal stability when compared to the pure drug.
Assuntos
Alginatos , Sericinas , Preparações de Ação Retardada , Liberação Controlada de Fármacos , Ácido Glucurônico , Ácidos Hexurônicos , Microscopia Eletrônica de Varredura , Microesferas , Naproxeno , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
The objective of this study was to develop a dissolution test in order to establish an in vitro-in vivo correlation (IVIVC) model for desvenlafaxine succinate monohydrate (DVSM) extended release (ER) tablets. The in vitro release characteristics of the drug were determined using USP apparatus 1 at 75 rpm, with volume of HCl pH 1.2, acetate buffer solution (ABS) pH 4.5, or phosphate buffer solution (PBS) pH 6.8. In vivo plasma concentrations and pharmacokinetic parameters in healthy volunteers were obtained from a bioequivalence study. The similarity factors f1 and f2 were used to compare the dissolution data. The IVIVC model was developed using fraction dissolved and fraction absorbed of the reference product. For predictability, the results showed that the percentage prediction error (%PE) value of Cmax was 7.63%. The observed low prediction error for Cmax demonstrated that the IVIVC model was valid for this parameter.
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Succinato de Desvenlafaxina/administração & dosagem , Inibidores da Recaptação de Serotonina e Norepinefrina/administração & dosagem , Comprimidos , Adulto , Área Sob a Curva , Preparações de Ação Retardada/farmacocinética , Succinato de Desvenlafaxina/farmacocinética , Meia-Vida , Humanos , Técnicas In Vitro , Masculino , Inibidores da Recaptação de Serotonina e Norepinefrina/farmacocinética , Solubilidade , Adulto JovemRESUMO
Adherence is a major factor in the effectiveness of the injectable extended-release naltrexone as a relapse prevention treatment in opioid use disorder. We examined the value of a variant of the Go/No-go paradigm in predicting extended-release naltrexone adherence in 27 detoxified opioid use disorder patients who were offered up to 3 monthly extended-release naltrexone injections. Before extended-release naltrexone, participants performed a Go/No-go task that comprised positively valenced Go trials and negatively valenced No-go trials during a functional magnetic resonance imaging scan. Errors of commission and neural responses to the No-go vs Go trials were independent variables. Adherence, operationalized as the completion of all 3 extended-release naltrexone injections, was the outcome variable. Fewer errors of commission and greater left accumbal response during the No-go vs Go trials predicted better adherence. These findings support the clinical potential of the behavioral and neurophysiological correlates of response inhibition in the prediction of extended-release naltrexone treatment outcomes in opioid use disorder.
Assuntos
Adesão à Medicação , Naltrexona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Núcleo Accumbens/efeitos dos fármacos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Desempenho Psicomotor/efeitos dos fármacos , Adolescente , Adulto , Preparações de Ação Retardada/administração & dosagem , Feminino , Humanos , Injeções Intramusculares , Imageamento por Ressonância Magnética/métodos , Masculino , Adesão à Medicação/psicologia , Núcleo Accumbens/diagnóstico por imagem , Núcleo Accumbens/fisiologia , Transtornos Relacionados ao Uso de Opioides/diagnóstico por imagem , Transtornos Relacionados ao Uso de Opioides/psicologia , Estimulação Luminosa/métodos , Valor Preditivo dos Testes , Desempenho Psicomotor/fisiologia , Resultado do Tratamento , Adulto JovemRESUMO
Background: Previous research demonstrated that utilization management (UM) such as prior authorization (PA) or non-formulary (NF) restrictions may reduce pharmacy costs when designed and applied appropriately to certain drug classes. However, such access barriers may also have unintended consequences. Few studies systemically analyzed the impact of major UM strategies to extended-release (ER) opioids on different types of health plans. Objective: This study evaluated, from payer perspective, the impact of formulary restrictions (PA, NF, or step therapy [ST]) for branded oxycodone HCl extended release (OER) on market share, and healthcare resource utilization/costs in ER opioids patients for multiple types of health plans in the United States. Methods: This retrospective, longitudinal case-control study analyzed prescription and outpatient medical claims data (2012 to 2015) for adult ER opioid patients from US plans (commercial,/Medicare, national/regional) that instituted OER PA, NF, or ST. Patients from each restricted plan (cases) were matched to patients in an unrestricted plan (controls) on key patient characteristics. ER opioid market share and healthcare resource utilization/costs for both cases and controls were evaluated for the 6-month period before and after the formulary restriction dates. A difference-in-differences (DiD) approach was utilized to evaluate change in the total per patient per month (PPPM) healthcare utilization and costs. Results: The study comprised 1622 (national commercial PA), 2020 (regional commercial PA), 34 703 (national commercial ST), and 4372 (national Medicare NF) cases and equivalent number of controls. OER market share decreased after the formulary restrictions, with the national Medicare NF plan showing the greatest decrease (9.2%). DiD analyses indicated that PPPM office visit change in the PA and NF plans were non-significant (decreased by 0.1 and 0.2, P>0.05), but significant in the ST plan (increased by 0.1, P=0.0001). For most plans, no significant total monthly cost change was observed; PPPM costs decreased by $48.74 and $59.87 in ST and regional PA plans and increased by $37.90 in national NF plans (all P>0.05). Conclusions: This study observed that despite reducing the market share of OER, OER formulary restrictions had negligible impact on overall ER opioid utilization, and did not result in substantial pharmacy/medical cost savings.
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PURPOSE: In patients with type 2 diabetes mellitus, fixed-dose combinations (FDCs) of antihyperglycemic medications may provide complementary efficacy while reducing tablet burden and improving compliance. The aim of this study was to assess the bioequivalence and tolerability of 2 FDCs of dapagliflozin and metformin extended-release (XR) versus their individual component (IC) tablets. METHODS: An open-label, balanced, randomized, 2-way crossover, 4-arm study was conducted in 129 healthy Brazilian subjects (aged 18-55 years). Two oral doses of the FDCs (5 mg dapagliflozin and 500 mg metformin XR, and 10 mg dapagliflozin and 1000 mg metformin XR) were evaluated in fed and fasted states. FINDINGS: Under fed and fasted conditions the 5 mg dapagliflozin and 500 mg metformin XR FDC showed bioequivalence to its ICs. The 10 mg dapagliflozin and 1000 mg metformin XR FDC was bioequivalent to its ICs in fed subjects. Although AUC for the 10 mg dapagliflozin and 1000 mg metformin XR FDC was bioequivalent in fasted subjects, the Cmax for metformin was not bioequivalent to its ICs in fasted subjects (upper 90% CI was 127.5%, and thus outside the 80%-125% bioequivalence interval). The small increase in the fasted state is not considered clinically meaningful due to the small magnitude of the difference (9.2%), the lack of metformin Cmax being associated with efficacy or tolerability concerns, and the fasted state not being the recommended state for dosing of metformin XR. The safety profile and tolerability of the FDCs were similar to those of their ICs and no deaths or serious adverse events were reported. IMPLICATIONS: Both FDCs of dapagliflozin and metformin XR were bioequivalent to their ICs in fed and fasted subjects, except for the metformin Cmax from the 10 mg dapagliflozin and 1000 mg metformin XR FDC in fasted subjects. These data support the use of a dapagliflozin and metformin XR FDC in patients with type 2 diabetes mellitus.
Assuntos
Compostos Benzidrílicos/farmacocinética , Glucosídeos/farmacocinética , Hipoglicemiantes/farmacocinética , Metformina/farmacocinética , Adolescente , Adulto , Área Sob a Curva , Compostos Benzidrílicos/administração & dosagem , Compostos Benzidrílicos/efeitos adversos , Brasil , Estudos Cross-Over , Preparações de Ação Retardada , Combinação de Medicamentos , Jejum , Feminino , Glucosídeos/administração & dosagem , Glucosídeos/efeitos adversos , Voluntários Saudáveis , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Metformina/administração & dosagem , Metformina/efeitos adversos , Pessoa de Meia-Idade , Comprimidos , Equivalência Terapêutica , Adulto JovemRESUMO
A dissolution test for fesoterodine low dose extended-release tablets using liquid chromatographic (LC) method equipped with a C18 monolithic column was developed and validated. LC system was operated isocratically at controlled temperature (40 °C) using a mobile phase of acetonitrile:methanol:0.03 M ammonium acetate (pH 3.8) (30:15:55, v/v/v), run at a flow rate of 1.5 mL/min and detected at 208 nm. The best dissolution conditions for this formulation were achieved using a USP apparatus 2 (paddle) at 100 rpm and 900 mL of phosphate buffer at pH 6.8 as the dissolution medium. Validation parameters such as the specificity, linearity, accuracy, precision, and robustness were evaluated according to international guidelines, giving results within the acceptable range. The kinetic parameters of drug release were also investigated using model-dependent methods and the dissolution profiles were best described by the Higuchi model. The validated dissolution test can be applied for quality control of this formulation.
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BACKGROUND: Reported cases of potassium overdoses have shown that this condition could generate several morbidities, mainly related to cardiac dysrhythmias even with fatal outcomes in some cases. Potassium salts in extended release tablets could form pharmacobezoars if a large amount is ingested. In relation to the above, when the patient has a pharmacobezoar, clinical findings may be delayed and may persist. The techniques available for removal of a pharmacobezoar are whole bowel irrigation (WBI), endoscopy or in some surgery [1]. Endoscopy as a decontamination method has shown promising results. CASE REPORT: A 42 year old woman, who intentionally ingested 100 tablets of extended release potassium chloride, 50 mg of clonazepam and an undisclosed amount of ethanol, presented with metabolic acidosis, hyperlactatemia and sinus tachycardia 2 h after ingestion. Gastric lavage and activated charcoal were applied initially, specific measures were not necessary. However, a transcutaneous pacemaker was placed. Because of her background, we considered a pharmacobezoar and an endoscopy were performed to remove 99 tablets of potassium that were isolated or forming concretions. DISCUSSION: The readily available techniques to remove a pharmacobezoar are whole bowel irrigation (WBI) and endoscopy; nevertheless there is not a consensus about their relative merits. Our patient was treated by endoscopy because we found on the X-ray a conglomerate of radiopaque images suggesting a pharmacobezoar. In this case we did not have any adverse effect. CONCLUSIONS: We consider that endoscopy could be an effective and safe method to remove a drug bezoar from the stomach in uncomplicated patients.
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Reproducibility of the tablet manufacturing process and control of its pharmaceutics properties depends on the optimization of formulation aspects and process parameters. Computer simulation such as Design of Experiments (DOE) can be used to scale up the production of this formulation, in particular for obtaining sustained-release tablets. Bromopride formulations are marketed in the form of extended-release pellets, which makes the product more expensive and difficult to manufacture. The aim of this study was to formulate new bromopride sustained release formulations as tablets, and to develop mathematical models to standardize the scale up of this formulation, controlling weight and hardness of the tablets during manufacture according to the USP 34th edition. DOE studies were conducted using Minitab(tm) software. Different excipient combinations were evaluated in order to produce bromopride sustained-release matrix tablets. In the scale-up study, data were collected and variations in tableting machine parameters were measured. Data were processed by Minitab(tm) software, generating mathematical equations used for prediction of powder compaction behavior, according to the settings of the tableting machine suitable for scale-up purposes. Bromopride matrix tablets with appropriate characteristics for sustained release were developed. The scale-up of the formulation with the most suitable sustained release profile was established by using mathematical models, indicating that the formulation can be a substitute for the pellets currently marketed.
A reprodutibilidade do processo de fabricação de comprimidos e o controle das suas propriedades farmacotécnicas depende da otimização dos aspectos de formulação e dos parâmetros de processo. O planejamento de experimentos como o Desenho de Experimentos (DOE) pode ser utilizado para acelerar a produção desta formulação, em particular, para a obtenção de comprimidos de liberação prolongada. Formulações de bromoprida são comercializadas sob a forma de péletes de liberação prolongada, o que torna o produto caro e de difícil fabricação. O objetivo deste estudo foi preparar novas formulações de bromoprida de liberação prolongada na forma de comprimidos e desenvolver modelos matemáticos visando ao escalonamento destas formulações, controlando o peso e a dureza dos comprimidos durante a fabricação, de acordo com a 34ª Edição da USP. Estudos de DOE foram realizados utilizando o software Minitab(tm). Diferentes combinações de excipientes foram avaliadas visando à obtenção dos comprimidos de liberação prolongada de bromoprida. No estudo de scale-up, coletaram-se e mediu-se a influência das variações nos parâmetros da máquina de compressão. Processaram-se os dados obtidos pelo software Minitab (tm), gerando equações matemáticas aptas para a previsão do comportamento de compactação do pó em escala industrial. Os comprimidos obtidos apresentavam características adequadas em termos de liberação sustentada, sendo a cinética de liberação estabelecida utilizando modelos matemáticos, indicando que esta formulação pode ser uma substituta aos péletes de bromoprida atualmente comercializados.
Assuntos
Comprimidos/análise , Antieméticos/análise , Projetos de Pesquisa , Cinética , Escalas de PreparaçãoRESUMO
The aim of this work is to present the two one-sided test (TOST) as an alternative approach to compare dissolution profiles of extended-release dosage forms. The dissolution profiles of oxycodone extended-release tablets containing 10 mg, 20 mg and 40 mg (reference and generic) were evaluated according to the requirements described in United States Pharmacopeia. These dissolution profiles were compared using the conventional similarity factor (f2) and the proposed TOST as an equivalence test. TOST is a simple and alternative approach to compare dissolution profiles of extended-release dosage forms. It allows us to identify the time-point (or time-points) that did not show similarity. We concluded that the two one-sided test performed at a significance level of 5% and defined as D = 10 showed results comparable to those obtained by the conventional similarity factor (f2).
O objetivo deste trabalho é apresentar o teste uni-caudal duplo (TOST) como uma abordagem alternativa na comparação do perfil de dissolução de formas farmacêuticas de liberação prolongada. Os perfis de dissolução de comprimidos de liberação prolongada de oxicodona contendo 10 mg, 20 mg e 40 mg (genérico e referência) foram avaliados de acordo com os requisitos descritos na Farmacopeia Americana. Estes perfis de dissolução foram comparados empregando-se o fator de semelhança convencional (f2) e o método TOST como teste de equivalência. TOST é uma abordagem simples e alternativa para a comparação de perfis de dissolução de formas farmacêuticas de liberação prolongada. Este permite identificar o ponto (ou pontos) que não apresentou semelhança. Considerando-se D = 10, concluímos que o teste uni-caudal duplo num nível de significância de 5% apresenta resultados comparáveis àqueles obtidos com o fator de semelhança convencional (f2).
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Formas de Dosagem/normas , Dissolução , Habilidades para Realização de Testes/métodos , Comprimidos/classificação , Equivalência TerapêuticaRESUMO
The pharmacodynamic properties of fluvoxamine maleate include the modulation of different populations of serotonergic, dopaminergic, and sigma receptors and/or transporters, a complex pattern of activity that may account for its efficacy in the treatment of obsessive-compulsive disorder (OCD). Nevertheless, its pharmacokinetic profile and its pattern of side effects may hinder a rapid dose escalation, a therapeutic strategy that might be utterly desirable in patients with OCD. In preclinical studies, the maximum plasma concentration and bioavailability of an extended-release (CR) formulation of fluvoxamine were, respectively, 38% and 16% lower than those of the standard (ie, non-CR) formulation. Recently, the US Food and Drug Administration approved the fluvoxamine CR formulation for the treatment of OCD in adults. This approval was based on the results of a double-blind, placebo-controlled study with 253 OCD patients in which fluvoxamine CR showed a consistently earlier onset of therapeutic effects than other selective serotonin reuptake inhibitors, as reported in previous studies. The use of the CR formulation of fluvoxamine allowed a particularly aggressive dosing strategy at the beginning of the titration phase, ie, treatment could be started with a single dose of fluvoxamine CR 100 mg at bedtime, while keeping the occurrence of side effects and the rate of compliance at levels comparable to those reported for the use of immediate-release fluvoxamine.
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El vértigo es un síntoma que se caracteriza por la ilusión de movimiento. Esto afecta tanto el bienestar individual como la capacidad para realizar las actividades propias de la vida cotidiana, ejerciendo un impacto negativo sobre la calidad de vida, por lo tanto es importante encontrar una terapia efectiva y cómoda que permita al paciente incorporarse a las labores de la vida diaria lo mas rápido posible y con la mejor calidad de vida. Métodos: Se evaluó la efectividad en el tratamiento del vértigo de origen periférico de dos formulaciones de nimodipina, la nimodipina convencional de administración tres veces al día (Nimotop® 30 mg) versus la nimodipina 90 mg. AP de administración una vez al día (Tropocer®). Se realizó un estudio clínico prospectivo, aleatorizado, doble ciego, doble simulado (doble dummy), multicéntrico nacional, de grupos paralelos, donde se incluyeron pacientes con vértigo de origen periférico, definido como una puntuación mayor o igual a 7 en el Vertigo-Dizziness Differential Diagnosis Score (VDDDS)¹. Los pacientes fueron evaluados mediante la escala Índice de Severidad del Vértigo2 y el Índice de Discapacidad Vestibular. Resultados: En el grupo de nimodipina AP el Índice de Severidad del Vértigo² disminuyó en un cincuenta por ciento en el 38% de los pacientes a los 14 días, en 53% y 92% a las 4 y 8 semanas respectivamente. El Índice de Discapacidad Vestibular disminuyó en un 50% a los 14 días en el 31% de los pacientes y en 77% y 92% a las 4 y 8 semanas respectivamente. En el grupo de nimodipina convencional el Índice de Severidad del Vértigo disminuyó en un 50% en: 25% de los pacientes a los 14 días, en 67% y 93% a las 4 y 8 semanas respectivamente. El índice de Discapacidad Vestibular disminuyó en 50% a los 14 días en el 30% de los pacientes y en 78% y 100% a las 4 y 8 semanas respectivamente, sin diferencias significativas entre los grupos
Vertigo is a symptom that is characterized by the illusion of movement. It affects both individual welfare and the ability to perform activities of daily living, having a negative impact on quality of life, so it is important to find a comfortable and effective therapy that allows the patient to join the work of the daily life as soon as possible and with the best quality of life. Methods: We evaluated the effectiveness in the treatment of vertigo of peripheral origin of two formulations of nimodipine: conventional nimodipine of administration three times daily (30 mg Nimotop®) versus nimodipine 90 mg. Extender Release (ER) administration once day (ER Tropocer® 90 mg). We performed a prospective, randomized, double-blind, double dummy, national multicenter parallel-group, clinical study which included patients with vertigo of peripheral origin, defined as a score greater than or equal to 7 at the Vertigo-dizziness Differential Diagnosis Score (VDDDS). Patients were evaluated with the scale Index of Severity of Vertigo and Vestibular Disability Index. Results: In the nimodipine ER group, the index of severity of vertigo decreased 50%: in 38% of patients to 14 days in 53% and 92% at 4 and 8 weeks respectively. The vestibular disability index decreased 50% to 14 days in 31% of patients and in 77% and 92% at 4 and 8 weeks respectively. In the nimodipine Conventional group, the index of severi-ty of vertigo decreased in 50% in 25% of patients to 14 days in 67% and 93% at 4 and 8 weeks respectivelyAU)
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Feminino , Bloqueadores dos Canais de Cálcio , Nimodipina/administração & dosagem , Vertigem/diagnóstico , Vertigem/terapia , FarmacologiaRESUMO
Divalproex sodium extended-release dosage form (divalproex-ER) has been promoted as innovative formulation for the treatment of epilepsy and manic disorders, and for migraine headache prevention, with the advantage of being dosing once a day. Due to a significant decreasing in the peak-trough fluctuation of plasma valproic acid levels, in comparison with the twice-daily dosing of conventional delayed-release formulations (divalproex-DR), concentration-dependent side effects would be prevented. However the main constraint for divalproex-ER usage is the need to be administered in a higher daily dose, because of its lower bioavailability, in order to prevent eventual breakthrough seizures when patients are switched from the twice-daily divalproex DR regimen. Taking into account free plasma drug levels, divalproex ER/DR relative bioavailability could be assessed as low as 75 percent in fasting condition. In order to overcome the need of increase divalproex-ER daily dose, maintenance of the twice-daily regimen is suggested. Divalproex-ER administered every 12 hours not only increases steady state trough concentration to a higher value in comparison with divalproex-DR, avoiding inefficacy of the treatment, but also achieves the safest manner to treat patients with valproic acid because of reaching practically a plateau profile of drug levels.
Divalproato de sodio de liberación prolongada (divalproex-ER) es un producto innovador que ha sido promovido tanto para el tratamiento de la epilepsia y de los desórdenes maníacos como también para la prevención de la migraña, con la ventaja de poder administrarse una sola vez al día. Dado que la fluctuación de niveles plasmáticos de ácido valproico resulta menor que la originada por la administración dos veces al día del producto convencional de liberación retardada (divalproex-DR), se estarían previniendo los efectos secundarios dependientes de la concentración del fármaco. Sin embargo, y considerando la menor biodisponibilidad del producto, el uso de divalproex-ER tiene el principal inconveniente de necesitar una mayor dosis diaria a los efectos de evitar una eventual reaparición de crisis cuando los pacientes cambian de tratamiento desde divalproex-DR. Teniendo en cuenta los niveles plasmáticos libres del fármaco, la biodisponibilidad relativa divalproex ER/DR podría afirmarse que sea aún más baja, tanto como 75 por ciento cuando los estudios son realizados en ayunas. A los efectos de no incrementar la dosis diaria de divalproex-ER se sugiere mantener un régimen de administración cada 12 horas. La administración de divalproex-ER dos veces al día no sólo incrementa las concentraciones de valle, respecto a divalproex-DR, sino que logra un perfil de niveles de ácido valproico prácticamente de meseta, lográndose así un tratamiento eficaz y con la mayor seguridad para los pacientes.
Assuntos
Humanos , Ácido Valproico/uso terapêutico , Epilepsia/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Disponibilidade Biológica , Preparações de Ação RetardadaRESUMO
Polymers like cellulose (MethocelTM K100MPRCR, K15MPRCR and E4MCR) at different proportions (15-35 percent) were used to slow the release of theophylline (100 mg) from capsules. Volumetric method for powder filling capsules was used to prepare the capsules. Drug release from capsules was performed using apparatus 1, at 100 rpm and 900 mL of intestinal medium without enzymes (pH 7.5), at 37 ºC, following the USP 28th ed. (Test 8). Dissolution profiles were compared to two batches of commercial extended-release capsules. Capsules compounded with 35 percent (wt/wt) of MethocelTM E4MCR showed dissolution profile according to the official especifications. Similar results were reproduced with other ten compounded batches. Commercial extended-release capsules containing theophylline pellets (100 mg) showed quick drug release when submitted to the same test, indicating that, in these conditions, the capsules did not show prolonged release. Mathematical models like zero-order, first-order and Higuchi were applied in kinetic studies of theophylline release from the compounded capsules. Polymers were efficient to control the release of theophylline in capsules involving diffusion and erosion as mechanisms, and that first-order model was the best fitted one for theophylline matrix capsules. These results support that compounded extended-release capsules can be prepared, since the drug release tests can be done.
Cápsulas de liberação modificada contendo 100 mg de teofilina foram preparadas com polímeros derivados da celulose (Methocel® K100MPRCR, K15MPRCR e E4MCR) em diferentes concentrações, 15-35 por cento, empregando-se o método volumétrico. Estudos de liberação do fármaco foram realizados de acordo com a Farmacopéia Americana 28 ed., (Teste 8), empregando aparato 1, rotação de 100 rpm e temperatura de 37 ºC em 900 mL de meio fluido intestinal sem enzimas (pH 7,5). Os perfis de dissolução foram comparados ao de duas especialidades farmacêuticas comerciais. A formulação, com 35 por cento de Methocel® E4MCR, evidenciou perfis de liberação de acordo com as especificações e os resultados foram reprodutíveis para 10 lotes manipulados com a mesma formulação. As cápsulas comerciais de liberação prolongada contendo 100 mg de teofilina (microgrânulos), submetidas ao mesmo ensaio, apresentaram rápida liberação do fármaco, indicando que a liberação não é fator limitante para a absorção. Avaliou-se a cinética de liberação do fármaco empregando os modelos matemáticos de ordem zero, primeira ordem e Higuchi. Conclui-se que as matrizes obtidas foram capazes de modular a liberação, envolvendo os mecanismos de difusão e erosão, prevalecendo o modelo de primeira ordem e que as cápsulas de liberação modificada podem ser manipuladas, desde que testes de liberação sejam realizados.