Comparative analgesic efficacy of nimesulide and diclofenac gels after topical application on the skin

Nimesulide is a newer non-steroidal anti-inflammatory drug (NSAID) with selective cyclo-oxygenase (COX)-2 blocking property and has demonstrated a potent analgesic and anti-inflammatory activity on oral and rectal administration. However, the Cmax through both these routes is reached only after 3 h of administration. Dose-dependent gastrointestinal side effects also limit the concentration of drug that can be achieved at the site of inflammation when administered through these routes. The present study was conducted to evaluate the antinociception induced by a new gel formulation of nimesulide when applied on the skin. Efficacy of topical nimesulide gel 1% (w/w) was studied on mice in the acetic-acid-induced writhing, tail flick latency (TFL) test and formalin-induced pain models. The antinociceptive effect of nimesulide was compared to diclofenac gel (1% w/w). Both the drugs induced dose-dependent analgesia with peak effect seen between 90 and 120 min after treatment. Greater antinociceptive effect (expressed as percent maximum possible effect) was seen in the writhing test than in the TFL test, indicating the peripheral action of both drugs. Nimesulide evidenced significant protection in the first phase of formalin-induced pain indicating modulation of peripheral nociceptors unlike other conventional NSAIDs. This suggests that COX-2 may be a primary contributor to afferent evoked increase in prostanoid-mediated changes in pain processing. Antinociception seen following drug application on the skin was lower than that seen on intraperitoneal administration, indicating localised action following topical application. The findings of the present study suggest that the transgel formulation of nimesulide provides significant analgesic activity when applied topically.     

Penetration, permeation, and resorption of 8-methoxypsoralen. Comperative in vitro and in vivo studies after topical application of four standard preparations

The penetration, permeation, and resorption of radioactively labelled 8-Methoxypsoralen was investigated in human skin. Siultaneously, the effects to time and ointment carrier on the penetration kinetics were ascertained. The carriers tested were: vaseline, aqueous wool-wax alcohol ointment, aqueous hydrophilic ointment and polyethylene glycol ointment. The absolute concentrations of 8-Methoxypsoralen were estimated in the horny layer, epidermis and dermis. With the most advantageous carrier, aqueous wool-wax alcohol ointment, 4-6X10(-5) M and 10(-5) M were attained in the epidermis and dermis, respectively. Moreover, it was shown that the substance penetrates rapidly (10 min) into the epidermis and dermis and the high concentrations reached constant over a period of 16 h. Only with a formulation of aqueous wool-wax alcohols is any accumulation at all achieved in the deeper areas of the horny layer. A uniform decrease in drug concentration with increasing depth of the horny layer is found with the other 3 vehicles, whereby slight variations in concentrations pertain from carrier to carrier. 4 h after local application, 8-Methoxypsoralen can be detected in the urine. Regardless of the ointment base employed, 8-Methoxypsoralen is no longer detectable in the urine 40 h after application. In comparison to the oral therapy, the same magnitude of percutaneous resorption into the central compartment is to be derived from the data, if half the body surface is treated locally.     

Noninvasive evaluation of myocardial ischemia in Kawasaki disease: comparison between dipyridamole stress thallium imaging and exercise stress testing

PURPOSE: Reduction of the frequency of injections and localization of the absorption of drug molecules to the injection site would be of great advantage in epidural pain treatment. The epidural use of a controlled release gel of lidocaine and ibuprofen was studied. METHODS: The effect of a poloxamer gel (25%) containing 2% lidocaine.HCl and 2% ibuprofen.Na on the duration of analgesia after epidural administration to pigs was compared with drug in solution. Analgesia was assessed by observing the motor function and the nociceptive reflex-withdrawal response to painful pressure stimulation on the feet. Pharmacokinetic and histological examinations were performed. RESULTS: Analgesia lasted significantly longer after epidural lidocaine gel injection in comparison with the solution. The gel prolonged the systemic absorption, thereby increasing the epidural availability of lidocaine for spinal analgesia. Although the absorption of ibuprofen was prolonged after epidural gel injection, the duration of analgesia as compared with the solution was not prolonged. After epidural injection, only slight inflammatory changes were observed in the tissue structures of the epidural space, but none in the spinal cord. CONCLUSIONS: These results demonstrate poloxamer gel to be a promising controlled-release, injectable epidural formulation for the management of pain.     

In vitro transcorneal permeation of ketorolac from oil based ocular drops and ophthalmic ointment

Transcorneal permeation of ketorolac from oil based ocular drops and ophthalmic ointments was studied in vitro, using goat cornea. Cumulative (%) permeation of ketorolac through cornea, was found to be maximum with 0.2% (w/v) ketorolac drops in sesame oil followed by formulations in corn oil and soyabean oil. Ketorolac 1% (w/v) drops in castor oil increased the quantity permeated but cumulative (%) permeation was less. Permeation profiles of ketorolac were in consistence with the partition characteristic of drug between oil and aqueous phase. Formulations favouring corneal permeation of ketorolac increased corneal hydration. Addition of benzyl alcohol, a preservative, to oil drops reduced permeation of ketorolac and corneal hydration indicating possible protective effect of benzyl alcohol against corneal damage. Permeation studies on ointment formulations containing either ketorolac acid or ketorolac tromethamine salt indicated better permeation for formulation containing ketorolac tromethamine aqueous solution. Thus for better transcorneal permeation, ketorolac 0.2% (w/v) drops, formulated in sesame oil, containing 0.5% v/v benzyl alcohol and ophthalmic ointment containing 0.5% (w/w) ketorolac tromethamine in dissolved state appear suitable.     

A method to measure the solubility of drugs in ointment bases

The solubility of a drug in an ointment base is an important factor determining the efficacy of the formulation. However, it is difficult to measure the solubility of drugs in ointment bases. Thus, a rapid and simple method to determine the solubility of drugs in ointment bases was investigated. Using oxybenzone as a model drug, the bleeding liquid which leaked out from various ointments was collected, and the drug concentration in the bleeding liquid was measured. The drug concentrations in the bleeding liquid collected from soluble type ointments in which the drug is dissolved in bases were in accord with that in the ointments. On the other hand, the drug concentrations in the bleeding liquid collected from crystal dispersion type ointments in which drug crystal are dispersed in bases were the same in spite of the variance in total drug concentrations in the ointments. It was confirmed by microscopic examination that crystals do not flow out into bleeding liquid in the crystal dispersion type ointment. It was also confirmed that the solubility of the drug obtained in the present study was in a solubility range consistent with microscopic examination. Furthermore, an increase in the drug solubility was detected by this method when the drug solubility in the base was raised by adding a detergent into the base. And the results from this method were in accord with the results from microscopic examination. These results suggest that the drug concentration in bleeding liquid represents the solubility of the drug in an ointment.     

Contributing mechanisms for cysteine excitotoxicity in cultured cerebellar granule cells

The purpose of this research was to develop new in vitro methodology for measuring release from petrolatum-based semisolids and to determine whether two ointments, both of which contained betamethasone dipropionate, 0.05%, but with different formulations, could be distinguished by release measurements. Several receptor media were explored to optimize the procedure utilizing Franz-type cells. Analysis was by HPLC. The release slope was 1.5 to 6 times greater from the ointment than the "augmented" ointment (which had greater clinical potency). Release was highest with a receptor consisting of a 5% solution of hexane in acetonitrile. Even so, it was necessary to subject samples of receptor from the augmented ointment to evaporation followed by reconstitution with a smaller volume of mobile phase to bring corticosteroid concentrations up to quantifiable levels. In another series of experiments, the HPLC mobile phase was used as the receptor and a relatively large volume (100 microliters) was injected onto the column. With the second approach, measured concentrations were lower but more reproducible. Quantifiable levels of betamethasone dipropionate were obtained for both formulations beginning from the first data point (at 1 hr), with satisfactory linearity of plots of amount released per unit area of membrane versus the square root of time. Using this methodology, it was possible to distinguish the effect of formulation differences in two ointments containing the same drug in the same concentration.     

Basic principles in local dermatologic therapy

The vehicle or ointment base plays an important role in dermatological local treatment. This is true from a therapeutic point of view and with respect to quality of life as well. Vehicles exert pronounced effects on the epidermis; these effects include hydration, lubrication, drying, skin smoothness, occlusion and protection. The vehicle controls the release and penetration, and ultimately the bioavailability, of the dermatological active ingredients. An overly simplified rule of thumb is that a deep-layer effect is enhanced by increasing occlusion. Unfortunately, no uniform classification system exists. Frequently, users of topical applied products are confused by the non-uniform, and in some cases erroneous, vehicle designations. In particular, different names are used to describe the lipophilic emulsion systems. It would be important to consistently use the official designations here: hydrophilic cream or lipophilic (hydrophobic) cream or ointment. Dermatological pastes are also often misleading designated, without any further distinctions, as a uniform occlusive system. For practical applications, attention must be paid in particular to the different indications for hydrophilic and lipophilic vehicles. Hydrophilic, aqueous bases are to be used for acute lesions and seborrhoeic skin, fatty or oily lipophilic systems for dry hyperkeratotic lesions and sebostatic skin. The cosmetic acceptance of a vehicle has a direct impact on both compliance and therapeutic effect. More attention should be paid to these factors. Adverse reactions caused by single components of the vehicle are not unusual. If a lesion does not respond to local treatment, the diagnosis should be reconsidered; moreover, the vehicle and its components should be investigated for possible incompatibility reactions.     

Quantitative cellular and nuclear volumetric alterations in epithelium from lichen planus lesions of human buccal mucosa

Rifaximin, the active ingredient of an antibiotic cream, is a synthetic antibiotic derived from rifamycin and characterized by minimal absorption. In animals, no absorption was detected after topical application on the skin. The question as to whether there is detectable absorption in man by the same administration route is answered by this study in healthy volunteers. One gram of the cream containing 5% rifaximin was massaged on a sizable surface of skin prepared prior to application by mechanical abrasion. Rifaximin concentrations in blood and urine were then determined by means of HPLC-electrochemical-coulometrical detection. Concentrations in all samples being less than 2.5 ng/ml, the method's limit of detection, it is concluded that there is no detectable absorption in man. No adverse reactions were reported during this one day study. The results confirm studies performed in animals which showed that rifaximin is not absorbed and is well tolerated.     

Preparation and utility of glibenclamide suppository for hospital use

Glibenclamide (GC) is widely used as an oral hypoglycemic drug in the treatment of non-insulin dependent diabetes mellitus (NIDDM). Since GC is usually taken for a long period, side effects and noncompliance are among the problems. In order to solve those problems, we prepared GC suppositories and examined their usefulness. Suppositories containing 4, 20, and 40 mg of GC were prepared and examined for drug release, drug absorption and blood glucose levels after the rectal administration of suppositories in rabbits. In the release test, GC suppositories released the drug continuously for 6 hours. The areas under the drug release time curve (ADT) of 20 and 40 mg GC suppositories were 3.5 and 6.2 times of 4 mg GC suppositories respectively. The plasma concentrations after administration of 4 and 20 mg GC suppositories showed about the same profiles for 6 hours. After administration of 40 mg GC suppositories, the maximum plasma concentration (Cmax) was observed at 2 hours. All the GC suppositories showed lower blood glucose levels compared with the control. The remainder of the area under the blood glucose concentration time curve between the control (RAUC) in the case of 40 mg GC suppository was 1.3 times larger than that of the 4 mg GC suppository. The GC suppositories sufficiently lowered the blood glucose levels. These results suggest that the GC suppositories should be useful in the hospital preparation for the treatment of NIDDM patients.     

Effect of temperature on bleeding and drug release from a liquid droplet dispersion ointment

A liquid droplet dispersion ointment, LDDS, a formulation containing a drug solution as droplets in an oily vehicle, is excellent for percutaneous drug absorption. Bleeding of LDDS and in vitro drug release from LDDS were found to be enhanced by temperature increase. The influence of temperature on the physical properties of LDDS was studied using differential scanning calorimetry and X-ray diffraction spectroscopy. The liquid component content, possibly a hydrocarbon in the vehicle, increased with temperature; this may have been due to melting of the vehicle. In this liquid component, the drug concentration measured by HPLC increased with temperature. This change in the drug concentration may cause an increase in drug release, leading to the conclusion that, compared with conventional ointments, temperature has much greater effect on drug release from LDDS.     

Pharmacokinetics and effect of food on the bioavailability of orally administered venlafaxine

Venlafaxine is a unique antidepressant currently under evaluation for treatment of various affective disorders. The pharmacokinetics and relative bioavailability of venlafaxine were evaluated in healthy volunteers after oral administration. The bioavailability of 50 mg of venlafaxine as a tablet relative to a solution was determined in a two-period randomized crossover study. The rate of absorption from the gastrointestinal tract was assessed by the time to peak plasma concentration (tmax), a model-dependent calculation of the first-order absorption rate constant, and a model-independent calculation of mean residence time. The extent of absorption was assessed by peak plasma concentration (Cmax) and area under the concentration-time curve (AUC). No statistically significant differences were observed between the two formulations for either the rate or extent of absorption. Similarly, systemic concentrations of the active O-demethylated metabolite did not significantly differ after administration of the two venlafaxine formulations. AUC ratios indicated that the relative bioavailabilities of the parent drug, and formulation of metabolite were approximately 98% and 92%, respectively, for the tablet versus the solution. A separate study was conducted to examine the influence of food on venlafaxine absorption from the 50-mg tablet. A standard, medium-fat breakfast eaten immediately before drug administration delayed the tmax of venlafaxine but did not affect Cmax or AUC. Therefore the tablet formulation of venlafaxine is bioequivalent to the oral solution, and the presence of food appears to decrease the rate but not the extent of absorption of venlafaxine from the tablet formulation.     

New issues in the management of cytomegalovirus retinitis in AIDS patients

The pharmacokinetic profile of ibuprofen (CAS 15687-27-1) in a Fast Melting Tablet (FMT), a modified release formulation (encapsulation of the active ingredient in gastroresistant microcapsules), was compared with that of sugar coated tablets (SCT; Moment 200). In the following paper an open, single dose, cross-over study in eighteen healthy volunteers (9 males and 9 females--mean age 27 years) is reported. The results of the study demonstrated that the rate of absorption of the FMT was markedly slower than that of the SCT. In fact, the geometric mean peak plasma concentration (Cmax) and median peak time (tmax) were 12.04 micrograms/ml at 3.5 h with the new formulation, and 18.71 micrograms/ml at 1 h with the SCT, respectively. The longer absorption time and diminished peak plasma concentration did not affect the extent of absorption of the two formulations, expressed by AUCo-t and AUC (90% confidence interval: 0.89-1.00 for AUCo-t and 0.92-1.03 for AUC). The safety profile of both drugs proved to be very good and no clinically significant adverse events were observed.     

Effect of concentration, pH, and preservative on in vitro transcorneal permeation of ibuprofen and flurbiprofen from non-buffered aqueous drops

Influence of drug concentration, pH of aqueous drops and some commonly used preservatives on in vitro transcorneal permeation of ibuprofen and flurbiprofen were investigated using goat cornea. Increase in drug concentration in the drops made in normal saline resulted in increase in quantity permeated but decrease in cumulative percent permeation of both drugs. Permeation of each drug from 0.5% drops was maximum at acidic pH (6.4) and decreased with increase in pH of the drops. Normal saline, as a vehicle, favoured permeation of each drug, hence retained in the formulation. Benzalkonium chloride and chlorobutanol enhanced cumulative percent permeation of ibuprofen while benzalkonium chloride and phenyl mercuric nitrate increased permeation of flurbiprofen. Benzalkonium chloride being incompatible with 0.5% drops (pH 6.4) of either drug, chlorobutanol appears suitable for ibuprofen drops and phenyl mercuric nitrate for flurbiprofen drops.     

Pharmacodynamics of a liposomal preparation for local anaesthesia

A phospholipid containing formulation with tetracaine (CAS 94-24-6) for topical anaesthesia was developed. In vitro drug liberation as well as in vivo efficacy and duration of the anaesthetic effect were investigated. The in vitro liberation constant was 0-.626 +/- 0.005 mg/(cm2.square root of h for a liposomal gel formulation containing 2% (m/l) tetracaine. The gel showed high efficacy in anaesthetizing the skin after topical application. After 60 min of application complete anaesthesia of the skin was observed with all volunteers. The duration of anaesthesia after removing the application system was 150 min on average. The determination of the in vivo penetration rate resulted in values between 0.010 and 0.015 mumol/min.cm2 tetracaine.     

Mathematical modelling of drug transport in emulsion systems

Two mathematical models for the prediction of drug transport in triphasic (oil, water and micellar) emulsion systems as a function of micellar concentration have been developed and these models were evaluated by comparing experimental and simulated data. Fick's first law was used to derive a transport model for hydrophilic drugs, assuming that the oil/water (o/w) partitioning process was fast compared with membrane transport and therefore drug transport was limited by the membrane. Consecutive rate equations were used to model transport of hydrophobic drugs in emulsion systems assuming that the o/w interface acts as a barrier to drug transport. Benzoic acid and phenol were selected as hydrophilic model drugs. Phenylazoaniline and benzocaine were selected as hydrophobic model drugs. Transport studies at pH 3.0 and 7.0 were conducted using side-by-side diffusion cells. According to the hydrophilic model, an increase in micellar concentration is expected to decrease drug transport rates. The effective permeability coefficients (Peff) of drugs were calculated using an equation relating Peff and the total apparent volume of drug distribution (determined experimentally using drug/membrane permeability and partition coefficient values). The hydrophobic model was fitted to the experimental data for the cumulative amount of model drug in the receiver cells using a weighted least-squares estimation program (PCNONLIN). The oil/continuous phase partitioning rates (k1) and the membrane transport rates (k2) were estimated. The goodness of fit was assessed from the correlation coefficients of plots of predicted versus experimental data. The predicted data were consistent with the experimental data for both the hydrophilic and hydrophobic models.     

Identification of drugs in pharmaceutical dosage forms by X-ray powder diffractometry

A simple X-ray powder diffractometric (XRD) method was developed for the identification of the active ingredient in a variety of dosage forms. The method was successfully used to unambiguously identify the active ingredient(s) in tablet, capsule, suppository and ointment formulations. The unique feature of the method is that it provides information about the solid-state of the drug. Thus, a capsule formulation containing anhydrous ampicillin was readily distinguished from that containing ampicillin trihydrate. The USP stipulates the use of the beta-polymorphic form of anhydrous carbamazepine in carbamazepine tablets. Contamination by the alpha-polymorph (down to a level of 1.4% w/w of the formulation) could be detected. In some of the multicomponent formulations, there was a pronounced overlap of the powder patterns of ingredients which made identification difficult. This problem was solved by using a pattern subtraction technique, which permitted selective subtraction of the XRD pattern of the constituents of the formulation from the overall XRD pattern. Such an approach enabled identification of the drug even when it constituted only 5% w/w of the formulation. The method also permitted simultaneous identification of the multiple active ingredients in trimethoprim-sulfamethoxazole and acetaminophen-aspirin-caffeine formulations.     

Myocardial infarction in france: Prognosis improvement?

BACKGROUND: Cyclosporine for the treatment of psoriasis constitutes a new approach. Alternative systemic cyclosporine derivatives have been studied to find an immunosuppressive drug with fewer adverse effects. Tacrolimus is one of these new immunosuppressive drugs. Systematically, it has been proven effective in treating psoriasis. A topical formulation of tacrolimus is attractive because it has fewer adverse effects and is useful for a large group of patients. We report for the first time on the efficacy of nonocclusive topical tacrolimus in the treatment of psoriasis. OBSERVATIONS: After a washout phase of 2 weeks, patients were randomized to receive 0.005% calcipotriol ointment twice daily, placebo ointment once daily, or 0.3% tacrolimus ointment once daily. One psoriatic plaque was treated with a surface area of 40 to 200 cm2. Efficacy was estimated using the local psoriasis severity index. The reduction in the local psoriasis severity index score after 6 weeks was 62.5% in the calcipotriol group, 33.3% in the tacrolimus group, and 42.9% in the placebo group. CONCLUSIONS: There was no statistically significant difference between the efficacy of tacrolimus and placebo ointment (P = .77). Calcipotriol ointment, applied twice daily, had a better effect than tacrolimus ointment and placebo ointment once daily.     

Preparation and stability testing of a hydrogel for topical analgesia

With the commercial availability of a cream (EMLA) containing a eutectic mixture of local anaesthetics, 2.5% (w/w) lidocaine and 2.5% (w/w) prilocaine, effective topical anaesthesia of the intact skin is possible without the need for subcutaneous injections or exposure to high concentrations of local anaesthetics. In our hospital a topical anaesthetic product was designed for the same purpose. The home-made product contains a eutectic mixture of a local anaesthetic (5% w/w) and l-menthol (1% w/w). Prilocaine was used as the local anaesthetic because it is known for its safety and its well investigated analgesic effects. The eutectic mixture of prilocaine and l-menthol was mixed with a carbopol hydrogel (1% w/w). Preliminary testing of this anaesthetic hydrogel in our hospital has yielded satisfactory results. The anaesthetic hydrogel was found to be stable after at least 3 months' storage at ambient temperature.     

Controlled systemic absorption and increased anesthetic effect of bupivacaine following epidural administration of bupivacaine-hydroxypropyl-beta-cyclodextrin complex

PURPOSE: To investigate the influence of complexation between bupivacaine and hydroxypropyl-beta-cyclodextrin (HP-beta-CD) on the systemic absorption and on the pharmacodynamic effect of bupivacaine following epidural administration in a rabbit model. METHODS: Bupivacaine and bupivacaine-HP-beta-CD complex were administered according to a randomized and cross-over design in six rabbits chronically instrumented with an epidural catheter. The plasma concentrations of bupivacaine and the duration and intensity of the motor blockade were evaluated. RESULTS: Complexation with HP-beta-CD led to a decrease in the maximum plasma concentration of bupivacaine. Individual absorption kinetics evaluated by Loo-Riegelman absorption analysis indicated that systemic absorption resulted from two parallel first-order processes. Only the faster absorption phase was slowed by complexation with HP-beta-CD. The duration of the motor blockade was increased almost twice but the intensity was not modified. CONCLUSIONS: Complexation with HP-beta-CD could be a promising drug delivery system to improve the therapeutic index of bupivacaine.