Development of an LC-MS/MS method for determining the pharmacokinetics of clonidine following oral administration of Zhenju antihypertensive compound.

Zhenju antihypertensive compound (ZJAHC) is a combined Chinese-Western medicine formula including clonidine (CLO), hydrochlorothiazide (HCT), rutin, Chrysanthemum indicum extract and pearl powder. Compared with CLO preparations, ZJAHC shows improved activities and decreased adverse effects. It is believed that the side effects of CLO are caused by its high peak plasma concentration. Hence, study of the influence of ZJAHC on the pharmacokinetic behaviors of clonidine seems essential. In present study, the plasma concentrations of CLO were determined with a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The MS/MS transitions monitored for clonidine and internal standard were 230.2 → 213.1 and 152.2 → 110.2, respectively. The analyte was quantified in a single run within 3 min. The pharmacokinetic study showed that the area under the plasma concentration-time curve of CLO in ZJAHC (60 µg/kg CLO) was similar to that of CLO-HCT-high (120 µg/kg CLO) but the peak concentration was much lower than that in CLO-HCT-high. ZJAHC could enhance the bioavailability without greatly increasing peak concentration of clonidine. This comprehensive effect of enhancing the bioavailability and avoiding the high peak plasma concentration for CLO might mainly result from the co-contribution of Western medicine and traditional Chinese medicine (TCM), while the effect of TCM was stronger than that of Western medicine.

Curso de Atualização em emergências médicas: aula 2: Urgências e emregências hipertensivas / Medical emergencies actualization course: class 2: hypertensive urgencies and emergencies

A hipertensão arterial é uma condição clínica com alta prevalência em todo o mundo, sendo fundamental estar atento às suas possíveis complicações. As emergências hipertensivas são condições associadas a risco iminente de vida, associadas à perda rápida da função de órgãos-alvo. Nesses casos a redução da pressão arterial deve ser imediata, em horas ou minutos. Nas urgências hipertensivas esse risco também existe, mas a redução da pressão arterial pode ser mais gradual, em cerca de 24 horas.

Chronic ethanol-clonidine hemodynamic interaction in telemetered spontaneously hypertensive rats.

Our previous studies have established that ethanol, administered acutely or chronically, attenuates the hypotensive action of the centrally acting drug clonidine. In this study, we employed the radiotelemetry technique to evaluate the long-term hemodynamic interaction between the two drugs administered simultaneously to spontaneously hypertensive rats (SHRs). Changes in blood pressure (BP), heart rate (HR), and their variability was determined in pair-fed rats receiving ethanol (5%, w/v), clonidine pellets (10 mg/pellet, s.c.), or their combination for 28 days. Ethanol feeding caused significant decreases and increases in BP and HR, respectively. The time-domain variability indices of BP and HR were also reduced by ethanol. Clonidine produced significant reductions in BP and HR that were evident for only 1-2 days and disappeared thereafter. In rats receiving the combined ethanol and clonidine treatment, hemodynamic changes were identical to those produced by ethanol alone. These findings suggest (i) long-term exposure of SHRs to moderate amounts of ethanol reduces HR variability, possibly due to diminished cardiac vagal modulation, and (ii) the lack of a maintained hypotensive response to clonidine, administered via timed-release pellets, made the evaluation of its chronic interaction with ethanol unfeasible.

Fluvoxamine drastically increases concentrations and effects of tizanidine: a potentially hazardous interaction.

OBJECTIVE: Our objective was to study the effect of fluvoxamine on the pharmacokinetics and pharmacodynamics of tizanidine, a centrally acting skeletal muscle relaxant. METHODS: In a double-blind, randomized, 2-phase crossover study, 10 healthy volunteers took 100 mg fluvoxamine or placebo orally once daily for 4 days. On day 4, each ingested a single 4-mg dose of tizanidine. Plasma concentrations of tizanidine and fluvoxamine and pharmacodynamic variables were measured. A caffeine test was performed on day 3 to examine the role of cytochrome P450 (CYP) 1A2 in tizanidine pharmacokinetics. RESULTS: On average, fluvoxamine increased the total area under the concentration-time curve [AUC(0- infinity )] of tizanidine 33-fold (range, 14-fold to 103-fold; P =.000002) and the peak plasma concentration 12-fold (range, 5-fold to 32-fold; P =.000001). The mean elimination half-life of tizanidine was prolonged from 1.5 to 4.3 hours (P =.00004) by fluvoxamine. The AUC(0- infinity ) of tizanidine and its increase by fluvoxamine correlated with the caffeine/paraxanthine ratio and its increase, respectively (P <.03). All pharmacodynamic variables revealed a significant difference between the fluvoxamine and placebo phases, eg, in the maximal effects on systolic blood pressure (-35 mm Hg, P =.000009), diastolic blood pressure (-20 mm Hg, P =.00002), heart rate (-4 beats/min, P =.007), Digit Symbol Substitution Test (P =.0003), subjective drug effect (P =.0000001), and drowsiness (P =.0002). In particular, the decrease in systolic blood pressure, to the level of 80 mm Hg or even less, was an alarming finding. CONCLUSIONS: Fluvoxamine seriously affects the pharmacokinetics of tizanidine and increases the intensity and duration of its effects. Inhibition of tizanidine-metabolizing enzyme(s), mainly CYP1A2, by fluvoxamine seems to explain the observed interaction. Because of the potentially hazardous consequences, the concomitant use of tizanidine with fluvoxamine, or other potent inhibitors of CYP1A2, should be avoided.

Testing of controlled-release transdermal dosage forms. Product development and clinical trials.

In vitro techniques have been developed that are predictive of drug permeation through skin. Methods also have been developed to determine the skin irritation potential of a drug substance during the preclinical stages of transdermal dosage form development. Clinical studies are performed to test for skin irritation, contact sensitization, plasma levels of drug, and efficacy of the dosage form. In theory, these studies should be predictive of a dosage form's performance in routine clinical use. This may not be the case, however; contact sensitization cannot be predicted with absolute certainty beforehand in animals. This article discusses various aspects of testing transdermal dosage forms and how the results of these tests correlate with what happens when a transdermal dosage form is put into routine clinical use.