Determination of benzonatate and its metabolite in human plasma by HPLC-MS/MS: A preliminary pharmacokinetic study in healthy Chinese volunteers after oral administration of benzonatate soft capsule.

Benzonatate has been used as a non-narcotic oral antitussive drug for many years. Its pharmacokinetics has never been reported due to the technical difficulties in detecting benzonatate by mass spectrometry. However, its concentration can be extrapolated based on the concentration of its metabolite, 4-(butylamino)benzoic acid (BBA). In this study, two sensitive high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) methods were developed and fully validated for the determination of the original 4-(butylamino)benzoic acid (method B) and total 4-(butylamino)benzoic acid (containing the original 4-(butylamino)benzoic acid and 4-(butylamino)benzoic acid converted from benzonatate after collection, method A). For both methods, one-step protein precipitation by methanol was performed to extract analytes from the plasma samples. Chromatographic separation was done on an InfinityLab Poroshell 120 Phenyl Hexyl column (2.1 mm × 50 mm, 2.7 µm, Agilent) with initial mobile phase consisting of 5 mM ammonium acetate containing 0.3% formic acid and acetonitrile (60:40, v/v) at a flow rate of 0.3 mL/min. Quantification was achieved by multiple reaction monitoring (MRM) in electron spray ionization (ESI) positive mode with the transitions of m/z 194.2 → 138.1 and 515.3 → 497.3 for 4-(butylamino)benzoic acid and telmisartan (the internal standard), respectively. The two methods exhibited good linearity over the concentration range of 10-10000 ng/mL. Both of the methods were successfully applied to the preliminary pharmacokinetic study in healthy Chinese volunteers after oral administration of benzonatate soft capsule at a single dose of 100 mg. The results showed that 4-(butylamino)benzoic acid and benzonatate were rapidly absorbed and reached a maximum concentration (Cmax) of 1708 ±â€¯457 ng/mL and 1063 ±â€¯460 ng/mL, respectively. The half-life (t1/2) were 1.32 ±â€¯0.29 h for 4-(butylamino)benzoic acid and 1.01 ±â€¯0.41 h for benzonatate. The area under the curve from 0 h to 10 h (AUC0-10) for 4-(butylamino)benzoic acid and benzonatate were 2103 ±â€¯918 ng/mL·h and 1097 ±â€¯559 ng/mL·h, respectively. And the data was valuable for further clinical study.

Analytical quantification, intoxication case series, and pharmacological mechanism of action for N-ethylnorpentylone (N-ethylpentylone or ephylone).

Synthetic cathinones continue to proliferate in clandestine drug markets worldwide. N-ethylnorpentylone (also known as N-ethylpentylone or ephylone) is a popular emergent cathinone, yet little information is available about its toxicology and pharmacology. Here we characterize the analytical quantification, clinical presentation, and pharmacological mechanism of action for N-ethylnorpentylone. Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) was used to quantify N-ethylnorpentylone in blood obtained from human cases. Clinical features exhibited by the intoxicated individuals are described. The activity of N-ethylnorpentylone at plasma membrane transporters for dopamine (DAT), norepinephrine (NET) and 5-HT (SERT) was assessed using in vitro assays measuring uptake inhibition and evoked release of [3 H] neurotransmitters in rat brain synaptosomes. Our LC-MS/MS method assayed N-ethylnorpentylone concentrations with limits of detection and quantification of 1 and 5 ng/mL, respectively. Quantitation was linear from 5 to 500 ng/mL, and the method displayed specificity and reproducibility. Circulating concentrations of N-ethylnorpentylone ranged from 7 to 170 ng/mL in clinical cases, and the associated symptoms included palpitations, tachycardia, agitation, hallucinations, coma and death. N-Ethylnorpentylone was a potent inhibitor at DAT (IC50  = 37 nM), NET (IC50  = 105 nM) and SERT (IC50  = 383 nM) but displayed no transporter releasing activity. We present a validated method for quantifying N-ethylnorpentylone in human case work. The drug is a psychomotor stimulant capable of inducing serious cardiovascular and neurological side-effects which can be fatal. In vitro findings indicate that N-ethylnorpentylone exerts its effects by potent blockade of DAT and NET, thereby elevating extracellular levels of dopamine and norepinephrine in the brain and periphery.

The Antitussive Benzonatate Is Not Tumorigenic in Rodent Carcinogenicity Studies.

Benzonatate is a peripheral oral antitussive that dampens the activity of cough stretch receptors. Rodent carcinogenicity studies were performed in Tg.rasH2 mice and Wistar Han rats. Mice were orally gavaged benzonatate at 10, 30, 75, and 100 mg/kg/day for males and 5, 15, and 50 mg/kg/day for females. Rats were gavaged at 10, 30, and 90 mg/kg/day for males and 5, 15, and 50 mg/kg/day for females. Higher doses in males were due to differences in maximum tolerated doses in dose-ranging studies. In both species, benzonatate was not detected in plasma because of rapid ester hydrolysis producing 4-(butylamino) benzoic acid (BBA) and methylated polyethylene glycol polymer. This metabolism was similar in human plasma; therefore, plasma BBA was used to show systemic exposure. Both species had no evidence of a benzonatate-related increase in any neoplasm. A slight increase in nasal cavity exudative inflammation was present in benzonatate-dosed male mice. Retinal atrophy was observed in male rats at ≥30 mg/kg/day, but the incidence was within historical control data range and not related to benzonatate. In conclusion, benzonatate and its 2 major metabolites were not carcinogenic in rodent carcinogenicity studies at BBA exposures of ≥32 and 70 times a 200 mg human benzonatate dose, respectively.

N-Ethyl Pentylone (Ephylone) Intoxications: Quantitative Confirmation and Metabolite Identification in Authentic Human Biological Specimens.

N-ethyl pentylone (ephylone) has been identified as the most recent novel stimulant to emerge into the arena of evolving novel psychoactive substances (NPS). Due to its novelty, information regarding case reports with associated quantitative confirmations, biotransformation pathways, and identified unique metabolites will assist the scientific community in understanding the implications of the emergence and risks associated with N-ethyl pentylone use. Authentic blood specimens (n = 26) submitted as part of toxicological death investigations or drugged driving casework tested positive for N-ethyl pentylone, and were quantitatively analyzed by liquid chromatography tandem mass spectrometry (LC-MS-MS). N-ethyl pentylone concentrations ranged from 12 to 1,200 ng/mL, with mean (±standard deviation) and median concentrations of 313 (±366) and 125 ng/mL, respectively, excluding one case measured at 50,000 ng/mL. N-ethyl pentylone was often found in combination with other drugs of abuse and NPS, include a variety of novel opioids including fentanyl analogs. Oral fluid specimens (n = 5), collected from recreational drug users at a dance music festival, were quantitatively analyzed using LC-MS-MS. Concentrations ranged from 12.6 to 1,377 ng/mL. Additional analysis was performed to characterize the metabolic profile of N-ethyl pentylone using human liver microsomes (HLM), followed by confirmation of the presence of the proposed metabolites in a subset of the blood specimens and oral fluid specimens. Metabolomic analysis was performed using a liquid chromatograph quadrupole time-of-flight mass spectrometer (LC-QTOF), followed by data processing using MetabolitePilot™ software. In vivo verification of in vitro HLM-generated metabolites resulted in the confirmation of four metabolites. Reduction of the beta-ketone to an alcohol resulted in the most prominent metabolite found in the authentic specimens, and its uniqueness to N-ethyl pentylone leads to this metabolite being an appropriate biomarker to determine N-ethyl pentylone ingestion. This is the first study to report N-ethyl pentylone concentrations and to characterize the metabolic profile of N-ethyl pentylone.

Clinical Presentation, Autopsy Results and Toxicology Findings in an Acute N-Ethylpentylone Fatality.

The clinical presentation, autopsy findings and toxicology results in an acute fatality involving N-ethylpentylone, a new cathinone derivative, are described. Law enforcement transported a male who was agitated and exhibiting unusual behavior to a local hospital. Upon arrival at the hospital, his body temperature was 105.5 degrees Fahrenheit and his blood pH was 6.7. Clinical laboratory analysis revealed elevated troponins, rhabdomyolysis, hypoglycemia, hepatic and renal injury, respiratory failure and disseminated intravascular coagulation. He was intubated and admitted to the intensive care unit, treated with cooling blankets, bicarbonate and intravenous fluids. Despite medical treatment, he went into cardiac arrest and was pronounced dead ~36 h after admission. Autopsy findings identified some abrasions on his arms and legs, a bloody nose and a mildly enlarged heart. Antemortem blood was analyzed by gas chromatography coupled with a mass spectrometer which identified N-ethylpentylone. Based on clinical presentation, autopsy findings and toxicology results, the medical examiner concluded the cause of death was intoxication by N-ethylpentylone and the manner of death was accident.

Pharmacokinetics of butafosfan after intravenous and intramuscular administration in piglets.

The pharmacokinetics and bioavailability of butafosfan in piglets were investigated following intravenous and intramuscular administration at a single dose of 10 mg/kg body weight. Plasma concentration-time data and relevant parameters were best described by noncompartmental analysis after intravenous and intramuscular injection. The data were analyzed through WinNolin 6.3 software. After intravenous administration, the mean pharmacokinetic parameters were determined as T1/2λz of 3.30 h, Cl of 0.16 L kg/h, AUC of 64.49 ± 15.07 µg h/mL, Vss of 0.81 ± 0.44/kg, and MRT of 1.51 ± 0.27 h. Following intramuscular administration, the Cmax (28.11 µg/mL) was achieved at Tmax (0.31 h) with an absolute availability of 74.69%. Other major parameters including AUC and MRT were 48.29 ± 21.67 µg h/mL and 1.74 ± 0.29 h, respectively.

Pharmacokinetics and metabolism of 3,4-dichlorophenyl-propenoyl-sec.-butylamine in rats by high performance liquid chromatography-ion trap mass spectrometry.

The pharmacokinetics (PK) and metabolism of 3,4-dichlorophenyl-propenoyl-sec.-butylamine (3,4-DCPB), a novel antiepileptic drug, were investigated after its oral administration to rats (100 mg/kg) by HPLC. The absorption and elimination of 3,4-DCPB were rapid. 3,4-DCPB was found to undergo extensive metabolism as the major route of elimination. Structures of the metabolites present in rat plasma were identified with liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS/MS). It was concluded that 3,4-DCPB was involved in the multiple metabolic pathways (hydrolysis, dealkylation and oxidation) and the hydrolysis product, 3,4-dichloro-cinnamic acid (M1) appeared to be the major metabolite.

Benzonatate overdose associated with seizures and arrhythmias.

BACKGROUND: Benzonatate is an antitussive with a unique chemical structure. It can contain as many as 8 structural analogs. Therefore, laboratory analysis of benzonatate is difficult. We report 2 cases of benzonatate poisoning with seizures and cardiac arrest and an analytical method to identify and quantify benzonatate in human plasma. CASE REPORTS: Case 1: A 12-month-old male presented to the emergency department of a rural hospital following ingestion of an unknown amount of benzonatate. Upon arrival, the child was seizing and in full cardiac arrest. Resuscitative measures were unsuccessful and the child died shortly after arriving at the emergency department. Case 2: A 39-year-old male ingested 36 benzonatate capsules in a suicide attempt. Enroute to the health care facility, the patient experienced a seizure, had a cardiac arrest, and was cardioverted. Upon arrival at the emergency department, the patient was acidotic with a pH of 6.8. Gastric lavage was performed followed by the administration of activated charcoal. Six hours after arrival at the emergency department, the patient was alert, oriented, and hemodynamically stable. The patient was observed for 24 hours and subsequently discharged. Laboratory confirmation of benzonatate in the plasma of the patient was performed using high-pressure liquid chromatography with tandem mass spectrometry (MS/MS). The benzonatate concentration was estimated to be 2.5 micrograms/mL. CONCLUSION: Seizures and cardiac arrest are possible following an acute ingestion. Quantitative analysis of benzonatate is possible using high-pressure liquid chromatography with tandem mass spectrometry. Routine analysis for benzonatate is not common.

Stereoselective cardiotoxic effects of terodiline.

OBJECTIVE: To study the cardiovascular and electrocardiographic (ECG) effects of the R(+)- and S(-)- enantiomers of terodiline. The racemic drug was previously used to treat detrusor instability but was withdrawn after it caused serious ventricular arrhythmias associated with prolongation of the QT interval. METHODS: A double-blind, placebo-controlled, randomized crossover study was performed that involved nine healthy volunteers who were given single oral doses of racemic terodiline hydrochloride (200 mg), R(+)-terodiline hydrochloride (100 mg), S(-)-terodiline tartrate (100 mg), or placebo. Plasma concentrations of each enantiomer and cardiovascular and ECG effects, including QT intervals and QT dispersion, were measured over 14 days after each treatment. RESULTS: Both racemic and R(+)-terodiline significantly increased QT interval, corrected QT interval (QTc), and QRS duration (all p < 0.05), without affecting QT dispersion. S(-)-Terodiline tartrate (100 mg) did not affect QTc. Peak effects occurred 8 hours after dosing when increases in QTc from baseline (95% confidence intervals) were -3 (-20, 13) for placebo, 23 (8, 37) for racemic terodiline, 19 (6, 33) for R(+)-terodiline, and 0 (-10, 9) ms1/2 for S(-)-terodiline. Although differences were observed between the pharmacokinetics of the two enantiomers, these were not sufficient to account for the differences in ECG effects, and elimination half-lives were similar. Elimination of terodiline enantiomers was not significantly delayed in two genotypic poor metabolizers of debrisoquin (CYP2D6). CONCLUSIONS: QT prolongation associated with racemic terodiline is caused exclusively by the R(+)-enantiomer, which therefore appears to be responsible for the ventricular arrhythmias caused by the drug.

Concentration dependent cardiotoxicity of terodiline in patients treated for urinary incontinence.

OBJECTIVE: Terodiline, an antimuscarinic and calcium antagonist drug, was used to treat detrusor instability but was withdrawn in 1991 after provoking serious ventricular arrhythmias associated with increases in the corrected QT interval (QTc). This research was performed to relate drug induced electrocardiographic changes in asymptomatic recipients to plasma concentrations of the R(+) and S(-) terodiline enantiomers. SETTING: Urological and geriatric clinics and wards. SUBJECTS: Asymptomatic patients taking terodiline in stable dose. METHODS: Electrocardiograms (50 mm/s) were collected from patients while they were taking terodiline and compared with ECGs obtained before or after terodiline. QT interval, heart rate corrected QT interval (QTc), and QT dispersion (QTd) were measured. Drug induced electrocardiographic changes were related to plasma concentrations of R(+) and S(-) terodiline. RESULTS: During terodiline treatment mean QTc and QTd were prolonged (491(43) and 84 (35) ms 1/2) compared with measurements made off therapy (443 (33) and 42 (17) ms 1/2, paired t tests, P < 0.002 and P < 0.01 respectively) in the 12 patients in sinus rhythm. The mean (95% confidence interval) drug induced increases were 48 (23 to 74) ms 1/2 for QTc and 42 (13 to 70) ms 1/2 for QTd. These increases correlated with total plasma terodiline (QTc: r = 0.77, P < 0.006, QTd: r = 0.68, P < 0.025) and with plasma concentrations of both terodiline enantiomers. CONCLUSIONS: Terodiline increases QTc and QTd in a concentration dependent manner. It is not clear whether this is a stereoselective effect and, if so, which enantiomer is responsible. The results suggest that drug induced torsade de pointes is a type A (concentration dependent) adverse drug reaction.

In vivo and in vitro electrophysiologic effects of terodiline on dog myocardium.

INTRODUCTION: Terodiline hydrochloride, widely prescribed for urinary incontinence, has been reported to cause bradycardia and torsades de pointes. METHODS AND RESULTS: In this study, we characterized the electrophysiologic effects of terodiline in dog cardiac tissues in vivo and in isolated canine cardiac Purkinje fibers. Terodiline (1 to 10 microM) resulted in dose-dependent reduction of action potential amplitude and maximal upstroke velocity (Vmax). The threshold for these effects was approximately 2 microM (0.6 mg/L), and the changes were cycle-length dependent. Terodiline (> or = 2 microM) also depressed the action potential plateau but did not significantly alter action potential duration at concentrations < or = 10 microM. In vivo studies demonstrated that high doses of terodiline (3 mg/kg) lengthened AH and HV intervals, slowed spontaneous sinus rate, prolonged ventricular refractoriness, and inhibited vagally induced slowing of the sinus node. Sympathetic effects on spontaneous sinus rate were unchanged. In both isolated canine Purkinje fibers and anesthetized dogs, terodiline did not evoke afterdepolarizations, repetitive firing, or ventricular tachyarrhythmias under normal or hypokalemic conditions. CONCLUSION: Our findings suggest that terodiline (> or = 1 to 2 microM) leads to blockade of sodium and calcium channels as well as muscarinic receptors in canine cardiac tissues.

Determination of an irreversible inhibitor of monoamine oxidase B (MDL 72974A) in human plasma and urine by gas chromatography-positive-ion chemical ionization mass spectrometry.

A sensitive and specific assay has been developed for the quantitative measurement in human plasma and urine of the irreversible inhibitor of monoamine oxidase B [(E)-4-fluoro-beta-fluoromethylenebenzene-butanamine HCl salt] (MDL 72974A) (I). This assay is based on gas chromatography-mass spectrometry with ammonia as the chemical ionization reagent gas. After addition of 1-fluoro-2-(4-chlorobenzene)-ethanamine HCl salt (MDL 71946A) as the internal standard, plasma (1 ml) and urine (100 microliter) samples were extracted using an automated solid-liquid extraction procedure on CN columns. The eluent was dried with a stream of nitrogen, and the residue was derivatized with pentafluoropropionic anhydride. Selected-ion monitoring of the [MNH4]+ ions m/z 361 (I) and 351 (internal standard) was used for quantification. The method yielded a linear response over the concentration range 0.25-100 pmol/ml in plasma with a limit of quantitation of 0.25 pmol/ml. The within-day reproducibility at a concentration of 5 pmol/ml was 4.6% and at a concentration of 50 pmol/ml was 1.3%. The day-to-day reproducibility was 5.2 and 7.0% at concentrations of 10 and 30 pmol/ml, respectively. The method was applied to the quantification of I in plasma and urine after the administration of 12-mg doses of I to a healthy male volunteer.

An apparent fatal overdose of terodiline.

The results of a forensic toxicological investigation on a young man with an unknown cause of death are reported here. Analysis revealed the presence of a possibly fatal level of terodiline in blood and urine. No other drugs were detected. Terodiline was detected by thin-layer and gas-liquid chromatography and identified by gas chromatography/mass spectrometry. Quantification was carried out by a mass fragmentographic procedure using the m/z 100 from terodiline for selective ion monitoring (SIM). The blood and urine concentrations were found to be greater than 10 mg/L, whereas therapeutic concentrations in serum are usually not more than 1 mg/L. Support and confirmation of the laboratory results was provided at the subsequent inquest. It was revealed that the deceased had died from the inhalation of vomit due to an oral overdose of terodiline. To the best of our knowledge this is the first reported death due to fatal poisoning with terodiline in the United Kingdom.

Pharmacokinetic aspects of Tert-Butylaminoethyl disulfide, an experimental drug against schistosomiasis in mice

Um estudo preliminar da farmacocinética do t-butilamino-etil-dissulfeto foi conduzido utilizando droga fria ou radioativa em duas diferentes doses (35 e 300 mg/Kg). Amostras de plasma ou sangue foram tratadas com ditiotreiol, ácido perclórico, e, após filtraçäo, submetidas a uma subseqüente purificaçäo em um "batch" de resina aniônica. Na etapa final, a droga foi retida em coluna de resina catiônica, eluída com NaCl 1 M e detectada pelo método de Ellman (1958). Alternativamente, a droga radioativa foi detectada por cintilaçäo líquida. Os resultados correspondentes a droga total administrada na menor dose sugeriram um comportamento farmacocinético relacionado ao modelo de um compartimento aberto, com os seguintes parâmetros: área sob a curva intravenosa (ASCI.V.): 671 ñ 14; ASCoral: 150 ñ 40 microng.min.ml-1; constante de eliminaçäo: 0,07 min-1; meia-vida biológica: 9,8 min; volume de distribuiçäo: 0,74 ml/g. Para a dose mais alta, os resultados indicaram aparentemente a ocorrência de um modelo mais complexo e näo adequadamente classificado. Analisados em conjunto os resultados sugerem a ocorrência de um comportamento farmacocinético dose-dependente. A droga é absorvida e eliminada rapidamente, sendo este último processo relacionado principalmente a metabolizaçäo. A droga parece mais tóxica quando administrada via I.V. porque por esta via ela näo sobre metabolismo de primeira passagem e, é, por outro lado rapidamente distribuída para os tecidos. O nível sanguíneo máximo tolerado pelos animais parece ser de 16 microng/ml

Pharmacokinetic aspects of tert-butylaminoethyl disulfide, an experimental drug against schistosomiasis in mice.

A preliminary study of the pharmacokinetic parameters of t-Butylaminoethyl disulfide was performed after administration of two different single doses (35 and 300 mg/kg) of either the cold or labelled drug. Plasma or blood samples were treated with dithiothreitol, perchloric acid, and, after filtration, submitted to further purification with anionic resin. In the final step, the drug was retained on a cationic resin column, eluted with NaCl 1M and detected according to the method of Ellman (1958). Alternatively, radioactive drug was detected by liquid scintillation counting. The results corresponding to the smaller dose of total drug suggested a pharmacokinetic behavior related to a one open compartment model with the following parameters: area under the intravenous curve (AUCi.v.): 671 +/- 14; AUCoral: 150 +/- 40 micrograms.min.ml-1; elimination rate constant: 0.071 min-1; biological half life: 9.8 min; distribution volume: 0.74 ml/g. For the higher dose, the results seemed to obey a more complex undetermined model. Combining the results, the occurrence of a dose-dependent pharmacokinetic behavior is suggested, the drug being rapidly absorbed and rapidly eliminated; the elimination process being related mainly to metabolization. The drug seems to be more toxic when administered I.V. because by this route it escapes first pass metabolism, while being quickly distributed to tissues. The maximum tolerated blood level seems to be around 16 micrograms/ml.

Terodiline in the treatment of urinary frequency and motor urge incontinence. A controlled multicentre trial.

Terodiline is a secondary amine with antimuscarinic and calcium antagonistic properties. It has complete bioavailability from the gastro-intestinal tract and a mean elimination half-life of 60 hours. This paper describes a randomized, double-blind, two period cross-over (3 week periods) trial in women with motor urge incontinence without other neurological symptoms. The drug was given b.i.d., 12.5 mg in the morning and 25 mg at night. The trial was performed as a multicentre study and monitored by frequent site visits during the 9 months when patients entered the study. Eighty-nine patients from 19 clinics fulfilled the inclusion criteria of the protocol. Cystometrograms (CMG) (bladder capacity, volume at first desire to void, residual urine) and micturition characteristics over 3 to 7 days were measured during a one week run-in period and during the last week of each treatment period. The patients' preferences were assessed for the two treatment periods as well as vis-à-vis the run-in period. Side effects were evaluated at the end of each treatment period. There were 16 drop-outs and withdrawals during period 1 and 9 during period 2 (5 and 3 due to cystitis, 7 and 2 due to side effects, and 4 and 4 lost to follow up, respectively). During the evaluation of the data a treatment by period interaction was observed which motivated a parallel group analysis to be performed in addition to a cross-over trial analysis. Statistically significant differences in patient preferences were demonstrated (63% preferred terodiline in comparison with placebo and 69% terodiline in comparison with run-in). No statistically significant difference in incidence of side effects could be demonstrated between terodiline and placebo. Based on all data available 35% of the patients had side effects on placebo and 53% on terodiline. Twelve per cent reported dryness of the mouth on placebo and 25% on terodiline. Of the 9 patients (10%) withdrawn from the study because of side effects, 7 had terodiline as first treatment, one had placebo and one terodiline as second treatment. The frequency of voluntary micturitions decreased during period 1 from 9.6 to 8.9 (-0.7) per 24 hours on placebo and from 9.9 to 7.3 (-2.6) on terodiline. Involuntary micturitions decreased from 2.3 to 1.7 (-0.6) on placebo and from 2.5 to 1.5 (-1.0) on terodiline. The changes during terodiline were statistically significant.(ABSTRACT TRUNCATED AT 400 WORDS)

The effect of terodiline on patients with detrusor instability.

In a double-blind cross-over study the effects and safety of terodiline were evaluated in 24 patients with detrusor instability. The optimum dosage was assessed by comparing 37.5 mg and 50 mg with placebo in three 4-week periods. All patients were assessed subjectively and by cystometry. Two-thirds of patients who completed the trial obtained symptomatic relief with terodiline although objectively there was only a weak dose-related tendency to favour terodiline. Ten patients reported side effects. Two patients did not complete the study due to drug intolerance.

Evaluation of long-term safety and clinical benefit of terodiline in women with urgency/urge incontinence. A multicentre study.

Terodiline is a secondary amine with anticholinergic and calcium antagonistic properties. The drug has been shown in controlled studies to be effective in patients with motor urge incontinence. In order to evaluate safety and clinical benefits of terodiline during long-term therapy in women with urgency/urge incontinence, a 6-month study has been performed. The study was designed as an open multicentre study with a run-in period and assessments after 3 and 6 months treatment. One hundred patients with a mean age of 48 years (range 18-78) were included. The daily dose was 50 mg, given as 25 mg in the morning and 25 mg at night. The safety was evaluated by recording of adverse reactions and measurements of haematology (B-Hb, B-erythrocytes, B-leukocytes, B-thrombocytes), liver function (S-ALAT, S-ASAT, S-ALP), kidney function (S-creatinine), ESR, heart rate and blood pressure. Clinical benefits were assessed by changes in micturition patterns, cystometry and patient preferences. Ninety-one patients were evaluated after 3 months and seventy after both 3 and 6 months. Terodiline was in most patients well tolerated and adverse reactions, usually those to be expected from the pharmacological effects of the drug, caused withdrawals in 12 patients. Mean levels of all variables on clinical chemistry were well within the normal range. No significant changes were seen except for a small increase in B-thrombocytes, S-creatinine and ESR. No significant changes in heart rate or blood pressure occurred except for a small but statistically significant increase (about 2 mmHg) in resting diastolic blood pressure after 6 months. A statistically significant decrease of voluntary as well as involuntary micturitions was seen. The number of voluntary micturitions decreased from a mean of 10.8 during run-in by 2.4 per day (p less than 0.01) during the first period and by 2.5 per day (p less than 0.01) during the whole 6-month therapy. Involuntary micturitions decreased by 1.3 from 2.7 per day (p less than 0.01) after 3 months and by 1.1 per day (p less than 0.01) after 6 months. Both bladder volume at first sensation to void and the maximum cystometric bladder capacity increased significantly from 134 ml by 56 (p less than 0.01) and 63 ml (p less than 0.01) after 3 and 6 months and from 252 ml by 54 (p less than 0.01) and 66 ml (p less than 0.01) after 3 and 6 months, respectively. No significant changes in bladder pressure or residual urine were shown.(ABSTRACT TRUNCATED AT 400 WORDS)