Protection of human gastric mucosa against aspirin-enteric coating or dose reduction?
BACKGROUND: Aspirin is widely used for cardiovascular prophylaxis. AIM: To compare the effectiveness of two widely-used strategies-dose reduction and enteric coating-for the minimization of gastric mucosal injury or toxicity. METHODS: Twelve healthy volunteers were studied. On four separate occasions each received, under blinded conditions, five daily doses of plain aspirin 300 mg, plain aspirin 75 mg, enteric-coated aspirin 300 mg or placebo. Ex vivo prostaglandin E2 synthesis was stimulated by the vortex mixing of gastric mucosal biopsies in Tris saline and measured by radioimmunoassay. Mucosal injury was quantified both by counting erosions and with a visual analogue scale. RESULTS: All three preparations reduced prostaglandin E2 synthesis by day five, by (median) 84% for plain aspirin 300 mg, by 80% for enteric coated aspirin 300 mg and by 63% for plain aspirin 75 mg. There was little mucosal injury prior to the start of each dose and period and no significant change with placebo. Plain aspirin caused a dose-dependent mucosal injury, with two (median, IQR 0-7) gastric erosions after five days of plain aspirin 75 mg, and 18 (2-26) after five days of plain aspirin 300 mg. With enteric-coated aspirin 300 mg there were 0 (0-1) gastric erosions (P = 0.003 compared to plain aspirin 300 mg P = 0.11, compared to plain aspirin 75 mg). CONCLUSION: Enteric coated aspirin reduces acute gastric mucosal injury to placebo levels, despite its inhibition of prostaglandin synthesis. Enteric coating is an appropriate strategy for the prevention of gastric mucosal damage induced by low-dose aspirin, which warrants systematic clinical evaluation. (+info)
Enteric coating of aspirin significantly decreases gastroduodenal mucosal lesions.
BACKGROUND: Low-dose aspirin (acetylsalicylic acid, ASA) increases the risk of developing peptic ulceration. AIM: To investigate the gastroduodenal mucosal tolerability of enteric-coated ASA (EC-ASA) 100 mg/day compared to either placebo (study 1) or plain ASA 100 mg/day (study 2) in healthy volunteers. METHODS: Study 1: In this double-blind study 18 volunteers received randomized dosing with either EC-ASA 100 mg or placebo for 15 days. Study 2: 41 volunteers underwent randomized 7-day dosing of either EC-ASA 100 mg or plain ASA 100 mg in this double-blind, parallel-group, comparison study. In both studies acute gastroduodenal mucosal lesions were assessed endoscopically before treatment, on the morning of day 1 after the first dose (only in study 2), and on the morning after the last dose of the test medication. RESULTS: Study 1 did not reveal any significant differences between the lesion scores of EC-ASA and placebo. In contrast, in study 2 significantly higher total gastroduodenal mucosal lesion scores were observed on day 1 after the first dose and after 7 days of dosing with plain ASA (mean sum of the lesion scores in the gastric fundus, body, antrum and in the duodenal bulb: day 1: plain ASA 3.95+/-3.38 vs. EC-ASA 1.43+/-1.91, P = 0.03; day 7: plain ASA 6.35+/-4.10 vs. EC-ASA 2.00+/-2.02, P = 0.0004). Tolerance of the test drugs was good, and no other adverse events were observed. CONCLUSIONS: Enteric-coated aspirin 100 mg/day causes significantly less gastroduodenal damage over 7 days than the same dose of plain aspirin, when given to healthy subjects. There was little gastric injury and no significant differences between EC-ASA and placebo in this respect. (+info)
Pharmacodynamics and kinetics of omeprazole MUPS 20 mg and pantoprazole 40 mg during repeated oral administration in Helicobacter pylori-negative subjects.
BACKGROUND: Omeprazole has become available in a tablet formulation, a Multiple Unit Pellet System (MUPS) containing a large number of small individually enteric-coated micropellets. AIM: To compare the acid-inhibitory effect of omeprazole MUPS 20 mg with pantoprazole 40 mg and to describe the pharmacokinetics of both drugs following administration on day 1 and day 6. METHODS: Randomized, two-way crossover study. Sixteen Helicobacter pylori-negative healthy subjects, whose gastric acidity fell below pH 4 for 70% of a 24-h baseline period were included. Intragastric pH was measured continuously. RESULTS: On day 1 both drugs significantly raised median 24-h gastric pH compared to baseline. Median pH and percentages of time above pH 3 and 4 on day 1 and day 6 of administration were not significantly different, with the exception of median daytime pH on day 6, which was significantly higher with omeprazole (4.65 vs. 4.05). AUC and Cmax of omeprazole were significantly increased on day 6. AUC and Cmax of pantoprazole were not significantly increased. CONCLUSIONS: No significant difference in acid-inhibitory effect on day 1. On day 6 median daytime pH was significantly higher with omeprazole MUPS, but the percentages of time spent above pH 3 and 4 were not significantly different. The significant increase in bioavailability of omeprazole may contribute to the increased effect on day 6. (+info)
Gravimetric and spectrophotometric determination of some drugs--tertiary amine hydrochlorides in coated tablets.
Four drugs in the form of coated tablets: Amitryptylinum (Amitryptyline) (1), Imipramin (Imipramine) (2), Chloropyribenzaminum (Chloropyramine) (3), and Phenazolinum (Antazoline) (4) were determined gravimetrically and spectrophotometrically in the same process by using complexes with ammonium molybdate. Stoichiometry of the complexes was established by elemental analysis and analysis of the incineration residue (MoO3). The complexes were characterized by IR and UV spectra and melting points. Contents of the drugs in the complexes were also determined spectrophotometrically. In this method Beer's law was found to obey over the concentration ranges 10-80 micrograms/ml (complex of 1), 10-100 micrograms/ml (complexes of 2 and 3), and 10-60 micrograms/ml (complex of 4). This method was validated in terms of precision, linearity, limit of detection and limit of quantitation. The two methods of the drug determination used in a single process of analysis, verify each other. (+info)
Sustained release and enteric coated NSAIDs: are they really GI safe?
Non-steroidal anti-inflammatory drugs (NSAIDs) have commonly been associated with upper gastrointestinal (GI) tract side effects including a high incidence of gastric and duodenal ulceration. Recent reports implicate NSAID use and mucosal injury in the small and large intestine. A trend in NSAID development has been an attempt to improve therapeutic efficacy and reduce the severity of upper GI side effects through modified release dosage forms of NSAIDs such as enteric-coating (EC) or sustained release (SR) formulations. It is possible that modified release formulations may increase the exposure of active drug to the mucosa distally to the duodenal bulb, and thereby increase toxicity to distal GI regions where the effects are difficult to monitor. A systematic literature review through Medline, Embase, and Index Medicus was made to identify toxicological effects induced by modified release formulations of NSAIDs in the small and large intestine. An analysis of the identified toxicological effects of these formulations was made. SR and EC NSAID use has been associated with both small and large intestinal bleeding, anaemia, strictures, ulcerations, perforations, and death. Modified release NSAIDs may cause significant morbidity in some patients. NSAID modified release delivery systems are not guarantors of GI safety. Since SR and EC NSAIDs are widely prescribed and some EC products are available without a prescription, heightened awareness of these toxicological manifestations in more distal sites of the GI tact may reduce morbidity. (+info)
Effect of an enteric-release formulation of naloxone on intestinal transit in volunteers taking codeine.
INTRODUCTION: Constipation is a common side-effect of opioid therapy; in addition to their analgesic effect, opioids reduce intestinal secretion and motility with an increase in whole-gut transit time. Naloxone, a specific opioid antagonist, reverses these effects but may also cause symptoms of opioid withdrawal in patients on long-term therapy. AIM: To use an enteric-release formulation, designed to produce a topical effect in the gut, with minimum systemic effects. METHODS: Naloxone 10 mg b.d. and codeine 30 mg b.d. were used with identical placebo capsules in four sets of studies; 12 male volunteers were given the drugs alone and in combination, with a control study involving double placebo, during each of four study periods. Whole-gut transit time was calculated and compared for each treatment period. RESULTS: Naloxone, both alone and with codeine, significantly shortened the mean whole-gut transit time compared with the control period, respectively, from 53.1 to 42.1 h (P=0.005) and to 40.7 h (P=0.024). Urgency to defecate was reported by two volunteers on naloxone alone and by three on combination therapy. CONCLUSIONS: The results show that the naloxone formulation counteracts the effect of codeine on intestinal transit, suggesting that it may have useful clinical applications. (+info)
Enteric-release glyceryl trinitrate in active Crohn's disease: a randomized, double-blind, placebo-controlled trial.
BACKGROUND: Mucosal ischaemia may contribute to the pathogenesis of Crohn's disease. Microvascular abnormalities have been found in colonic resection specimens, and mucosal levels of constitutive nitric oxide synthase are reduced. AIM: To assess the efficacy of a novel, enteric-release formulation of the nitric oxide donor, glyceryl trinitrate, aimed at increasing the mucosal circulation and relaxing smooth muscle in the affected bowel. METHODS: The trial was randomized, double-blind and placebo-controlled. Baseline disease activity was assessed by a structured symptom diary, with blood tests and a quality of life assessment. Patients with a Crohn's disease activity index of > or = 150 and < 450 were randomized to receive 12 weeks of either glyceryl trinitrate (initially 6 mg twice daily, increasing to 9 mg twice daily after 6 weeks) or an identical placebo. Assessments were repeated at 6 and 12 weeks. RESULTS: Seventy patients (22 male) entered the study; 34 were given glyceryl trinitrate and 36 placebo. At 12 weeks, there were no differences between the treatment groups in terms of Crohn's disease activity index, pain, stool frequency, inflammatory markers or quality of life scores. CONCLUSIONS: Enteric-release glyceryl trinitrate did not benefit patients with mild to moderately active Crohn's disease. Whilst ischaemia may contribute to the pathogenesis of Crohn's disease, our results fail to provide supportive evidence for this hypothesis. (+info)
Simultaneous quantification of promazine hydrochloride and its sulfoxide in pharmaceutical preparations.
The use of derivative UV-spectrophotometry is proposed for the simultaneous quantification of promazine hydrochloride in the presence of sulfoxide, and vice versa. For this purpose, mathematical parameters were established for generating derivative spectra of analytes. The determination of promazine was made using the first-order derivative (deltalambda = 10 nm, second polynomial degree) at 268 nm. The quantification of sulfoxide was achieved by applying third-derivative spectra (deltalambda = 14 nm, sixth polynomial degree) based on measurements of the amplitude at 342 - 344 nm. An elaborated method was successfully used to determine analytes in commercial promazine pharmaceuticals. The obtained results agreed well with those obtained by the HPLC method. (+info)