Pharmaceutical evaluation of compounded furosemide capsules and excipient performance

Abstract Compounding pharmacies play an important role not only in compounding personalized formulations, but also preparing drugs at the same concentration and dosage as those from commercial manufacturers. The excipients used in compounding are generally standardized for many drugs, however they do not consider the intrinsic properties, such as the poor water solubility, of each substance. The excipient performance of commercially available compounded furosemide capsules in 7 compounding pharmacies from Manaus was evaluated and compared them to the performance of the reference medicinal product (Lasix® tablets) and 2 batches of capsules made in-house (T2 and T4) with a standardized excipient. All batches were subjected to tests for weight variation, assay, uniformity of dosage units, disintegration and dissolution profile. Of the 7 different compound formulas acquired in the compounding pharmacies, only 2 passed all tests. Most formulas passed the tests for weight determination, disintegration time and assay, however batches from 2 establishments failed in regards to the uniformity of the content and 5 batches failed the dissolution test. The reference medicinal product was approved in all tests, as were the T2 capsules made in-house with drug-excipient ratio 1:2. These results confirm the importance of the excipient composition, especially for poorly soluble drugs.

Effect of intrabronchial platelet rich plasma on the exercise-induced pulmonary hemorrhage endoscopic score in thoroughbred racehorses using furosemide: a preliminary study / [Efeito da instilação intrabronquial de plasma rico em plaquetas no escore endoscópico da hemorragia pulmonar induzida por exercício em cavalos Puro-Sangue Inglês de corrida e usuários de furosemida: um estudo preliminar]

The high prevalence of exercise-induced pulmonary hemorrhage (EIPH) in athletic horses constitutes to be a challenge to the racing industry and a source of major concern to animal welfare. Both experimental and clinical evidence indicate that the use of autologous platelet-rich plasma (PRP) is a promising effector of repair in a variety of pulmonary conditions. The present study evaluated the effect of intrabronchial instillation of PRP on EIPH endoscopic scores from 37 Thoroughbred racehorses. Inclusion criteria were for animals to be EIPH-positive in, at least, two consecutive post-exercise endoscopic exams and to receive 250mg of furosemide IV four hours before racing. Animals were randomly assigned into 3 groups: placebo, control, and PRP instillation. All 37 Thoroughbred racehorses included had EIPH endoscopic scores pre- and post- treatment compared by statistical analysis. The bleeding score from the group receiving PRP was significantly lower than in the control and placebo groups. No adverse effects were observed in any animal during or after the experiment. It was possible to conclude that the intrabronchial instillation of autologous PRP was effective in reducing EIPH scores in racehorses receiving furosemide and that this bioproduct can be considered as a promising coadjuvant in controlling EIPH in athletic horses.(AU)

A alta prevalência de hemorragia pulmonar induzida por exercício (HPIE) em cavalos atletas é um desafio de longa data para a indústria de corridas, além de figurar como grande preocupação sobre o bem-estar animal. As evidências experimentais e clínicas indicam que o uso do plasma rico em plaquetas (PRP) de fonte autógena é promissor na terapêutica de diversas lesões pulmonares. O presente estudo objetivou avaliar as mudanças após corrida no escore endoscópico de HPIE de 37 cavalos Puro-Sangue Inglês que receberam instilação intrabronquial de PRP autólogo. Os animais selecionados eram HPIE-positivos em, ao menos, dois exames endoscópicos consecutivos e recebiam 250mg de furosemida IV administrado quatro horas antes de cada corrida. Na comparação dos escores endoscópicos pré e pós-tratamento, verificou-se que o escore de HPIE do grupo tratado com PRP foi significantemente menor que o dos grupos controle e placebo. Nenhum efeito adverso foi observado nos animais durante ou após o experimento. Concluiu-se que a instilação intrabronquial de PRP autólogo foi efetiva na redução do escore de HPIE de cavalos de corrida usuários de furosemida e que este bioproduto pode ser considerado uma alternativa promissora no controle de HPIE em cavalos atletas.(AU)

Stability of furosemide and chlorothiazide stored in syringes.

PURPOSE: The results of a study to determine the stability of solutions of furosemide and chlorothiazide over 96 hours are reported. METHODS: Chlorothiazide and furosemide were diluted in 5% dextrose USP to final concentrations of 10 and 1 mg/mL, respectively, and combined. In addition, sample solutions of chlorothiazide in dextrose, furosemide in dextrose, and dextrose alone were prepared for control purposes. The resulting solutions were analyzed immediately after preparation and 24, 48, 72, and 96 hours later using a liquid chromatography-tandem mass spectroscopy (LC-MS/MS) system with an electrospray ionization source. Mixtures and samples were diluted 10,000-fold prior to LC-MS/MS analysis so that concentrations of both drugs would be within the assay's linear range of detection. RESULTS: LC-MS/MS analysis showed that chlorothiazide typically eluted at 2.6 minutes and furosemide at 4.8 minutes. Each compound was degraded by exposure to strong ultraviolet light in a time-dependent manner. Both unmixed and mixed solutions retained over 90% of the original concentrations of chlorothiazide and furosemide for up to 96 hours. Furosemide and chlorothiazide are commonly used concomitantly to maximize diuresis in pediatric patients; the study findings suggest that solutions of furosemide and chlorothiazide can be combined in the same syringe without loss of stability for up to 96 hours. CONCLUSION: Solutions of chlorothiazide (10 mg/mL) and furosemide (1 mg/mL) stored either separately or together in polypropylene syringes remained stable for up to 96 hours at room temperature and protected from light.

Correlação in vitro - in vivo de comprimidos matriciais de furosemida complexada à hidroxipropil-ß-ciclodextrina: métodos in vitro, in vivo e in silico / In vitro - in vivo correlation of matrix tablets of furosemide complexed with hidroxypropyl-ß-cyclodextrin: in vitro, in vivo and in silico methods

A correlação in vitro - in vivo (CIVIV) refere-se ao estabelecimento de uma relação racional entre uma propriedade in vitro de uma forma farmacêutica (FF) e uma característica biológica, ou parâmetros derivados destas, produzidas a partir da absorção do fármaco, liberado por uma FF. Para o desenvolvimento de uma CIVIV, são necessárias três ou mais formulações, as quais são avaliadas em relação ao comportamento de dissolução e à biodisponibilidade (BD), e por meio do cálculo de deconvolução, estimam-se as frações absorvidas. A furosemida, fármaco modelo, é um diurético usado no tratamento de hipertensão. Este fármaco é classificado como classe IV do sistema de classificação biofarmacêutico (SCB) (Amidon et al., 1995). O objetivo do presente trabalho foi estabelecer uma CIVIV para formas farmacêuticas (FFs) de liberação modificada contendo complexo de furosemida e hidroxipropil-ß-ciclodextrina (HP-ß-CD), a partir de ensaios de dissolução e estudos de BD. O complexo de furosemida e HP-ß-CD foi obtido por liofilização e caracterizado por análise térmica, solubilidade e permeabilidade. A partir do complexo, foram produzidas cinco formulações de comprimidos de liberação modificada, com diferentes concentrações de hidroxipropilmetilcelulose (HPMC) (10-30%). Estas foram submetidas aos estudos de dissolução com o aparato II. Destas, foram selecionadas três formulações com perfis distintos e submetidas ao estudo com o aparato IV e posteriormente ao estudo de BD. A partir destes resultados foi estabelecida uma CIVIV e esta foi avaliada por meio da validação interna. Foi realizado o estudo in silico de previsão das curvas de decaimento plasmático com emprego dos programas, STELLA® e Simcyp®, a partir dos dados: solubilidade da furosemida; dissolução a partir das formulações e dados farmacocinéticos obtidos a partir da injeção intravenosa do medicamento referência. Quanto à caracterização do complexo, os ensaios termoanalíticos sugerem que a furosemida forme complexo de inclusão com a HP-ß-CD pela técnica da liofilização. Observou-se o aumento da solubilidade em relação ao fármaco puro. Entretanto, quanto à permeabilidade, avaliada por meio do PAMPA (permeabilidade em membrana artificial paralela), os resultados foram semelhantes entre o fármaco puro e o complexo. Quanto ao comportamento de dissolução, avaliado com emprego dos aparatos II e IV, observou-se que as formulações apresentaram perfis de dissolução distintos. Os resultados do estudo de BD indicaram que a concentração do HPMC tem impacto relevante na absorção da furosemida. Foram obtidas correlações lineares a partir dos dados de fração absorvida e de dissolução, com coeficiente de determinação de 0,7662 para o aparato II e de 0,96017 para o IV. A validação interna da CIVIV empregando o aparato IV indicou que a correlação foi satisfatória. O estudo in silico de previsão das curvas de decaimento plasmático demonstrou que, nas condições empregadas, o modelo desenvolvido com o STELLA® foi mais preditivo do que o obtido pelo Simcyp®

The in vitro - in vivo correlation (IVIVC) refers to the establishment of a rational relationship between a in vitro property of a pharmaceutical form (PF) and a biological characteristic or parameters derived from those, produced from the absorption of a drug released from a PF. For the development of an IVIVC, it is necessary three or more formulations, which are evaluated in relation to the dissolution behavior and for bioavailability (BA), calculating by deconvolution, an estimated absorbed fractions. Furosemide, a model drug, is a diuretic used in the treatment of hypertension. This drug is classified as class IV from biopharmaceutical classification system (BCS) (Amidon et al., 1995). The objective of this study was to establish an IVIVC for pharmaceutical forms (PFs) with modified release containing furosemide complexed with hydroxypropyl-ß-cyclodextrin (HP-ß-CD), from dissolution tests and BA studies. The complex of furosemide and HP-ß-CD was obtained by freeze-drying and characterized by thermal analysis, the solubility and the permeability. From the complex were produced five modified release tablet formulations, with different concentrations of hydroxypropylmethylcellulose (HPMC) (10-30%). These formulations were subjected to dissolution studies with the apparatus II. From these, three formulations with distinct profiles were selected and subjected to dissolution study with apparatus IV and subsequently to the BA study. From these results, an IVIVC was established and this was evaluated by internal validation. The in silico study was conducted to predict plasma decay curves with employment programs, STELLA® and Simcyp®, from the following data: furosemide solubility, dissolution from the formulations evaluated and pharmacokinetic data obtained from intravenous drug reference. From characterization of the complex, the thermoanalytical tests suggest that furosemide form inclusion complex with HP-ß-CD by freeze-drying technique. It was observed an increased solubility compared to the pure drug. However, permeability results, as assessed by the PAMPA (Parallel artificial membrane permeability), were similar for both furosemide and the complex. As for the dissolution behavior, evaluated with apparatus II and IV, so it was observed that the formulations showed an distintict profile. it was observed that the formulations produced showed different dissolution profiles. The results form BA assays indicated that the HPMC concentration has an important impact on the furosemide absorption. It was obtained a linear correlation from absorption fraction and dissolution data, with the determination coefficient of 0.7662 to apparatus II and 0.96017 from apparatus IV. Internal validation, with the IVIVC obtainted from apparatus IV, indicated that the correlation obtained was satisfactory. The in silico study predicted plasma decay curves, showed that under the conditions used, the model developed with STELLA® was more predictive than the model obtained by Simcyp®

A simple and sensitive spectrofluorimetric method for the determination of furosemide using zinc(II)-1,4-bis(imidazol-1-ylmethyl)benzene complexes.

A novel spectrofluorometric method for the determination of furosemide (FUR) is described. The method is based on enhancement of fluorescence emission of FUR in the presence of zinc (II) complexes of 1,4-bis(imidazol-1-ylmethyl)benzene. Under optimum conditions, the enhanced fluorescence intensity is linearly related to the concentration of FUR. The proposed method has been successfully applied to the determination of FUR in pharmaceutical preparations. The possible mechanism of this reaction is discussed briefly based on data from fluorescence spectroscopy, UV-vis absorption and infrared spectroscopy.

Mono- and dinuclear Ru(II) complexes of 1,4-bis(3-(2-pyridyl)pyrazol-1-ylmethyl)benzene): synthesis, structure, photophysical properties and electrochemiluminescent determination of diuretic furosemide.

Mononuclear ruthenium complex 1 and dinuclear complex 2 were synthesized by reaction of the appropriate bidentate pyrazolyl-pyridyl-based ligand L (L = 1,4-bis(3-(2-pyridyl)pyrazol-1-ylmethyl)benzene) with cis-Ru(bipy)(2)Cl(2)·2H(2)O. They were characterized by elemental analyses, ESI-MS, (1)H spectroscopy, and X-ray crystallography for 2. Compounds 1 and 2 both emit strongly in solid states and in solutions at 298 K with the lifetimes in the microsecond range. Electrogenerated chemiluminescence (ECL) of complexes 1 and 2 in the absence or presence of coreactant tri-n-propylamine (TPrA) or 2-(dibutylamino)ethanol (DBAE) at different working electrodes in acetonitrile and phosphate buffer solutions (PBS, pH 7.5) was studied. The ECL spectra are identical to the photoluminescence spectra, indicating that the ECL emissions are due to the metal to ligand charge transfer (MLCT). In all cases, ECL quantum efficiencies of dinuclear complex 2 are higher than those of mononuclear complex 1, and ECL quantum efficiencies of complexes 1 and 2/TPrA system are higher than those of DBAE system. It is noted that diuretic furosemide tends to decrease the ECL intensity of complex 2/TPrA system in PBS (pH 7.5) at GC working electrode. A novel ECL method for the determination of diuretic furosemide was developed with a linear range between 2.0 × 10(-7) mol L(-1) and 1.0 × 10(-6) mol L(-1), and a detection limit of 1.2 × 10(-8) mol L(-1) based on 3 times the ratio of signal-to-noise.

Stability of furosemide and aminophylline in parenteral solutions / Estabilidade de furosemida e aminofilina em soluções parenterais

Parenteral solutions (PS) are one of the most commonly used drug delivery vehicles. Interactions among the drug, components in the drug's formulation, and the PS can result in the formation of inactive complexes that limit efficacy or increase side effects. The aim of this work was to evaluate possible interactions between the drugs and PS, assess drug stability and to identify degradation products after 20 h at room temperature. Furosemide (FSM) and Aminophylline (APN) were added to PS containing either 20 percent mannitol or 0.9 percent NaCl at pH 6.5-7.5 and 10-11. Their behavior was studied individually and as an admixture, after 1 h oxidation with H2O2, using a spectrophotometer and HPLC. Individually, FSM and APN added to 20 percent mannitol and 0.9 percent NaCl solutions had the highest stability at pH 10-11. When FSM and APN were combined, the behavior of FSM was similar to the behavior observed for the drug individually in the same solutions. With the drugs combined in 20 percent mannitol pH 10-11, HPLC showed that both drugs were stable after a 20 h period yielding two distinct peaks; in oxidized samples, the elution profile showed four peaks with retention times unrelated to the untreated samples.

Soluções parenterais de grande volume são frequentemente utilizadas no ambiente hospitalar para a veiculação de fármacos. No entanto, possíveis incompatibilidades entre as estruturas dos fármacos, em diferentes veículos de administração, podem gerar possíveis associações antagônicas ou sinérgicas, resultando em alterações das propriedades físico-químicas, consequentemente, dos efeitos farmacológicos e das respostas clínicas esperadas. Este artigo avaliou a estabilidade e a possível formação de produtos de degradação entre os fármacos furosemida e aminofilina quando estes foram veiculados em soluções parenterais, após o preparo e após o período de 20 h. Furosemida e aminofilina foram adicionadas às soluções de 20 por cento manitol e 0,9 por cento NaCl nos valores de pH 6,5-7,5 e 10-11. A estabilidade dos fármacos foi avaliada individualmente, combinada e após degradação com peróxido de hidrogênio através de espectrofotometria de UV e HPLC. Furosemida e aminofilina individualmente avaliadas mostraram alta estabilidade em ambas as soluções estudadas nos valores de pH 10-11. Quando os fármacos foram combinados o comportamento da furosemida foi similar ao observado na ausência de aminofilina. Os fármacos combinados em 20 por cento manitol pH10-11 por HPLC foram estáveis após o período de 20 h. Após degradação o perfil de cromatograma encontrado foi diferente do observado na ausência de degradação mostrando que o método é indicativo de estabilidade.

Concurrent determination of topotecan and model permeability markers (atenolol, antipyrine, propranolol and furosemide) by reversed phase liquid chromatography: utility in Caco-2 intestinal absorption studies.

A simple, sensitive, specific and high-resolution reversed-phase liquid chromatographic method utilizing ultraviolet detection has been developed and validated for simultaneous determination of topotecan and four intestinal permeability markers (atenolol, antipyrine, propranolol and furosemide) as suggested by US-FDA. Chromatography was carried out on C-18 column with mobile phase comprising water (pH 3.0) and acetonitrile gradient pumped at a flow rate of 1 ml min(-1). The validation parameters included specificity, accuracy, precision, sensitivity and stability studies. Topotecan, an anti-cancer drug widely used in metastatic carcinoma, is a P-glycoprotein substrate having oral bioavailability of 30% with large inter-patient variability. The present method was successfully applied for demonstrating P-gp mediated transport of topotecan and its inhibition using verapamil in Caco-2 cell monolayer. The method can be used in identification of novel P-gp inhibitors for topotecan and estimating the contribution of P-gp in affecting oral bioavailability of topotecan. The other applications of method include its use in validation of Caco-2 monolayer assay for getting biowaiver based on Biopharmaceutic Classification System and its extrapolation to in situ and/or in vivo studies.

Nível de tiamina no miocárdio, área transversa e número de núcleos de cardiomiócitos de ratos em uso de furosemida / Myocardial thiamine level, cardiomyocyte cross-sectional area and nuclei number in furosemide-treated rats

Objetivo: Avaliar os níveis miocárdicos de tiamina e área transversa e número de núcleos de cardiomiócitos de ratos em uso de furosemida. Métodos: 24 ratos foram estratificados em 4 grupos: 2 grupos receberam furosemida por via intraperitoneal e 2 receberam solução salina, por 21 dias. Dois destes grupos receberam ração-padrão, e 2 ração pobre em tiamina. Os níveis miocárdicos de tiamina foram avaliados por: dosagem de tiamina pirofosfato (TPP) por HPLC, e medidas de atividade da transcetolase miocárdica(ATm) e do efeito da tiamina pirofosfato (ETPP). Métodos estereológicos foram utilizados para a obtenção da área transversa (Acmy) e número de núcleos (Ncmy) dos cardiomiócitos. Resultados: as médias e desvios-padrão de TPP, ATm, ETPP, Acmy e Ncmy foram, respectivamente: Grupo 1 - 133,7 maior ou menor que 17,9ng/100 microlitro de tecido homogeneizado; 173 maior ou menor que 20 micrograma.hexose/ml/h; 3,6 maior ou menor que 1,9 por cento; 808 maior ou menor que 8 milhões; Grupo 2 - 160,2 maior ou menor que 23,2ng/100 microlitro de tecido homogeneizado; 1634 maior ou menor que 137 micrograma.hexose/ml/h; 2,2 maior ou menor que 1,4 por cento; 961 maior ou menor que 59 micrometro2; 63 maior ou menor que 2 milhões; Grupo 3 - 73,5 maior ou menor que 8,6ng/100 microlitro de tecido homogeneizado; 715 maior ou menor que 123 micrograma.hexose/ml/h; 39,8 maior ou menor que 9,8 milhões por cento; 963 maior ou menor que 2 micrometro2; 59 maior ou menor que 4 milhões Grupo 4 - 82,1 maior ou menor que 9ng/100 microlitro de tecido homogeneizado; 863 maior ou menor que 75 micrograma.hexose/ml/h; 26,2 maior ou menor que 11,9 por cento; 1061 maior ou menor que 33 micrometro2; 63 maior ou menor que 5 milhões. Conclusão: A furosemida não reduziu o nível de tiamina no miocárdio, nem alterou a área transversa e o número de núcleos de cardiomiócitos nos animais estudados.

Controlled release of furosemide from the ethylene-vinyl acetate matrix.

The ethylene-vinyl acetate (EVA) matrix containing furosemide was prepared by the casting method and the release patterns were observed. The solubility of furosemide was determined as a function of volume fraction of polyethylene glycol 400. The release of drug from the matrix was studied as a function of temperature and drug concentration. Plasticizers such as the citrates and the phthalates were added for preparing the membrane to increase the flexibility of the EVA matrix. The solubility of furosemide was the highest when the concentration of PEG 400 was 40% (v/v). The release rate of drug from the EVA matrix increased with increasing temperature and drug loading doses. A linear relationship was found between the release rate and the square root of the loading dose. The activation energy (Ea), which was measured from the slope of the logP versus 1000/T plots, was 12.33 kcal/mol for the 0.5% loading dose, and 11.58 kcal/mol for the 1.0% loading dose, and 11.00 kcal/mol for the 1.5% loading dose. Among the plasticizers used such as the citrates and the phthalates groups, diethyl phthalate showed the best enhancing effects in drug release. In conclusion, the application of an EVA matrix containing a plasticizer might be useful in the development of a controlled drug delivery system.

La segunda bomba de sodio: de la proteína al gen / The second sodium pump: from protein to gene

En la membrana laterobasal del epitelio del intestino delgado y del túbulo renal proximal han sido descrito dos mecanismos diferentes de transporte activo primario de Na+: (1) uno dependiente de K+, sensible a la ouabaina e insensible a la furosemida, correspondiente a la bomba de Na+/K+; y (2) otro independiente de K+, insensible a la ouabaina pero inhibida por furosemida, el cual es referido como la segunda bomba de sodio. De igual modo, dos actividades ATPásicas, dependientes de Mg2+, estimuladas por Na+ e inhibidas por vanadato, han sido descritas en esta membrana: (1) una dependiente de K+, sensible a la ouabaina e insensible a la furosemida, correspondiente a la ATPasa de Na+/K+; y (2) otra independiente de K+, insensible a la iuabaina pero inhibida por furosemida, la cual ha sido denominada como la ATPasa de Na+. Dadas las similitudes bioquímicas, se considera que la bomba de Na+/K+ y la segunda bomba de sodio están asociadas con las ATPasas de Na+/K+ y de Na+, respectivamente, como una entidad bioquímica única. No obstante, no había sido posible la separación óptima de ambas enzimas. Recientemente, se logró solubilizar ambas ATPasas utilizando un detergente no-iónico (C12E9), preservando sus actividades, y purificar la ATPasa de Na+ por selección negativa a través de una cromatografía de afinidad con Concanavalina-A-sefarosa. La ATPasa de Na+ esta constituida por dos subunidades: una subunidad alfa de 98 KDa y una subunidad beta de 50 KDa. La subunidad alfa fue parcialmente secuenciada por espectrometría de masa en serie, identificándose tres péptidos que están presentes en la subunidad alfa1 de la ATPasa de Na+/K+. La formación de intermediarios fosforilados durante el ciclo de reacción de la ATPasa de Na+, así como su dependencia de Mg2+ y sensibilidad a vanadato, identifican a esta enzima como integrante de las ATPasas tipo P.

Basolateral plasma membranes of small intestine and proximal renal tubule present two active Na+-transportmechanisms: (1) The Na+/K+-pump, which depends on K+, is inhibited by ouabain but insensitive to furosemide and (2) The Second sodium pump, which is K+-independent, insensitive to ouabain but inhibited by furosemide. Thse two transport mechanisms have been associated with two different Mg2+-dependent Na+-ATPases, inhibited by vanadate: (1) The K+-dependent Na+/K+-ATPase, sensitive to ouabain and insensitive to furosemide, and (2) The K+ independent, Na+-ATPase, which is inhibitable by furosemide and insensitiveto ouabain. There exist multiple biochemical and functional evidences indicating that these two ATPases are different but only recently it has been possible to identify the Na+-ATPase as a unique biochemical entity. Both ATPases can be solubilized in an active form using C12E9 as detergent and separated by exclusion chromatography in sepharose 6-B and affinity chromatography in concanavalinA-sepharose. The Na+-ATPase is constituted by two sub-units: an alpha subunit of 98 KDa and a beta subunit of 50 KDa. The alpha subunit was partially sequenced by Tandem Mass Spectrometry, evidenced three peptides that are also present in the alpha1 subunit of the Na+/K+-ATPase. Na+-ATPase is Mg2+-dependent, inhibited by vanadate and forms phosphorylated intermediate during its reaction cycle ATP, indicating that it si a P-type ATPase. These facts induced us to design degenerated primers against the most preserves motifs present in these ATPases and to intent the cloning of the Na+-ATPase. Thus, we identified a cDNA for a new P-type ATPase probably related with this enzyme.

Interactions of human organic anion transporters with diuretics.

The tubular secretion of diuretics in the proximal tubule has been shown to be critical for the action of drugs. To elucidate the molecular mechanisms for the tubular excretion of diuretics, we have elucidated the interactions of human organic anion transporters (hOATs) with diuretics using cells stably expressing hOATs. Diuretics tested were thiazides, including chlorothiazide, cyclothiazide, hydrochlorothiazide, and trichlormethiazide; loop diuretics, including bumetanide, ethacrynic acid, and furosemide; and carbonic anhydrase inhibitors, including acetazolamide and methazolamide. These diuretics inhibited organic anion uptake mediated by hOAT1, hOAT2, hOAT3, and hOAT4 in a competitive manner. hOAT1 exhibited the highest affinity interactions for thiazides, whereas hOAT3 did those for loop diuretics. hOAT1, hOAT3, and hOAT4 but not hOAT2, mediated the uptake of bumetanide. hOAT3 and hOAT4, but not hOAT1 mediated the efflux of bumetanide. hOAT1 and hOAT3, but not hOAT2 and hOAT4 mediated the uptake of furosemide. In conclusion, it was suggested that hOAT1 may play an important role in the basolateral uptake of thiazides, and hOAT3 in the uptake of loop diuretics. In addition, it was also suggested that bumetanide taken up by hOAT3 and/or hOAT1 is excreted into the urine by hOAT4.

Continuous intravenous furosemide in haemodynamically unstable children after cardiac surgery.

OBJECTIVE: The commonly used continuous intravenous (i.v.) furosemide dosing schedule after cardiac surgery in children is largely empirical and may not be optimal. This may even be more marked in children after cardiac surgery who are haemodynamically unstable, and in whom transient renal insufficiency may occur. A study was performed to obtain an impression regarding which clinically applicable measures may be used to design a rational scheme for continuous i.v. furosemide therapy in children after cardiac surgery. SUBJECTS AND METHODS: Twelve paediatric patients (5F/7 M, age 0-33 weeks) post-cardiac surgery, who were to receive 3 days of continuous i.v. furosemide treatment, were included in an open study. Blood and urine samples were taken for furosemide, creatinine, and electrolyte levels, and fractionated urinary output was measured. Furosemide in blood and urine was measured using high performance liquid chromatography (HPLC). RESULTS: The mean starting dose of continuous i.v. furosemide was 0.093 (+/- 0.016) mg/kg per hour. The mean dose was increased to 0.175 (+/- 0.045) mg/kg per hour per hour on day 2, and changed to 0.150 (+/- 0.052) mg/kg per hour on day 3. Infusion rates were increased from day 1 to day 2 in ten cases, and decreased from day 2 to day 3 in three cases. Serum furosemide levels never exceeded ototoxic levels. The urinary furosemide excretion rate was inversely related to serum creatinine levels. CONCLUSIONS: This study extends the observation of the beneficial effects of continuous i.v. furosemide also to those children who are haemodynamically unstable after cardiac surgery. However, as the effects of furosemide are dependent on renal function, it can be hypothesised that the dosing schedule may be optimised. Contrary to the currently used dosage schedule in which the dose of furosemide is gradually increased over time, it may be more rational to start with a higher dose and adapt this dose (downward) guided by the observed effect (urine output). Because the infusion rate was increased to 0.2 mg/kg per hour in nine out of 12 patients on day 2 and was never increased further, this suggests that a starting rate of 0.2 mg/kg per hour may be optimal.

Pulsed ultrafiltration mass spectrometry: a new method for screening combinatorial libraries.

In response to the need for rapid screening of combinatorial libraries to identify new lead compounds during drug discovery, we have developed an on-line combination of ultrafiltration and electrospray mass spectrometry, called pulsed ultrafiltration mass spectrometry, which facilitates the identification of solution-phase ligands in library mixtures that bind to solution-phase receptors. After ligands contained in a library mixture were bound to a macromolecular receptor, e.g., human serum albumin or calf intestine adenosine deaminase, the ligand-receptor complexes were purified by ultrafiltration and then dissociated using methanol to elute the ligands into the electrospray mass spectrometer for detection. Ligands with dissociation constants in the micromolar to nanomolar range were successfully bound, released, and detected using this method, including warfarin, salicylate, furosemide, and thyroxine binding to human serum albumin, and erythro-9-(2-hydroxy-3-nonyl)adenine binding to calf intestine adenosine deaminase. Repetitive bind- and-release experiments demonstrated that the receptor could be reused. Thus, pulsed ultrafiltration mass spectrometry was shown to provide a simple and powerful new method for the screening of combinatorial libraries in support of new drug discovery.

Determination of furosemide in plasma and urine by gas chromatography/mass spectrometry.

A new method for the determination of furosemide (CAS 54-31-9) in plasma and urine by gas chromatography/mass spectrometry (GC/MS) has been developed. After acidification the samples were extracted by ethyl acetate and methylated by methyl iodide. The chromatography was carried out on a fused-silica capillary column with SE-54 stationary phase. Detection was performed by selected ion monitoring (ions 81 and 372 were monitored for furosemide and ions 363 and 406 for internal standard bumetanide). Limit of quantitation was 10 ng/ml for plasma and 40 ng/ml for urine and the calibration curves were linear up to 100,000 ng/ml.

The in-vitro pH-dissolution dependence and in-vivo bioavailability of frusemide-PVP solid dispersions.

The dependence of the dissolution rate on the pH of the buffered medium, using constant surface area discs, has been examined for crystalline frusemide, a semi-crystalline frusemide-polyvinylpyrrolidone (PVP) solid dispersion and an X-ray amorphous frusemide-PVP dispersion. The marked changes observed in the pH-dissolution profiles indicate that differing dissolution mechanisms operate in the amorphous regions. This conclusion was further supported by the comparison of pH-dissolution and pH-equilibrium solubility profiles that suggested a supersaturation effect to be the relevant term in describing the dissolution enhancing effects of amorphous regions. A marked dissolution enhancement, relative to crystalline frusemide, was shown by the X-ray amorphous solid dispersion in weakly acidic solutions. A similar effect was observed in the dissolution characteristics of gelatin capsule formulations in simulated gastric and intestinal media. In a human bioavailability study, the X-ray amorphous frusemide-PVP solid dispersion exhibited a significant reduction in the time for maximum effect in comparison to crystalline frusemide and a semi-crystalline solid dispersion. This effect, demonstrated by the primary end organ response in seven healthy subjects, concurred with the in-vitro prediction of dissolution enhancement in weakly acidic media.