Structure and thiazide inhibition mechanism of the human Na-Cl cotransporter.

The sodium-chloride cotransporter (NCC) is critical for kidney physiology1. The NCC has a major role in salt reabsorption in the distal convoluted tubule of the nephron2,3, and mutations in the NCC cause the salt-wasting disease Gitelman syndrome4. As a key player in salt handling, the NCC regulates blood pressure and is the target of thiazide diuretics, which have been widely prescribed as first-line medications to treat hypertension for more than 60 years5-7. Here we determined the structures of human NCC alone and in complex with a commonly used thiazide diuretic using cryo-electron microscopy. These structures, together with functional studies, reveal major conformational states of the NCC and an intriguing regulatory mechanism. They also illuminate how thiazide diuretics specifically interact with the NCC and inhibit its transport function. Our results provide critical insights for understanding the Na-Cl cotransport mechanism of the NCC, and they establish a framework for future drug design and for interpreting disease-related mutations.

Continuous manufacturing and analytical characterization of fixed-dose, multilayer orodispersible films.

Various drug therapies require more than one active pharmaceutical ingredient (API) for an effective treatment. There are many advantages, e.g. to improve the compliance or pharmacodynamic response in comparison to a monotherapy or to increase the therapy safety. Until now, there are only a few products available for the paediatric population due to the lack of age appropriate dosage forms or studies proving the efficacy and safety of these products. This study aims to develop orodispersible films (ODFs) in a continuous solvent casting process as child appropriate dosage form containing both enalapril maleate (EM) and hydrochlorothiazide (HCT) separated in different film layers. Furthermore, they should be characterised and the API migration analysed by confocal Raman microscopy (CRM). ODFs were successfully produced in a continuous manufacturing process in form of double- and triple-layer formulations based on hydroxypropylcellulose (HPC) or a combination of HPC and polyvinyl alcohol (PVA). CRM revealed that both APIs migrate within the film layers shortly after manufacturing. PVA inhibits the migration inside the double-layer film, but is not able to prevent the API migration as an interlayer inside a triple-layer ODF. With increasing film layers, the content of residual solvents and the disintegration time increases (mono-layer films: <10 s, triple-layer films: 37 s). In conclusion, it was feasible to produce fixed-dose combinations in therapeutic doses up to 9 mg HCT and 3.5 mg EM for the double-layer film with adequate mechanical properties, which enable coiling up onto jumbo rolls directly after production. The best separation of the two APIs was achieved by casting a double-layer ODF consisting of different film forming polymers, which can be beneficial when processing two incompatible APIs.

Study of the effect of formulation variables on the characteristics of combination tablets containing enalapril maleate and indapamide as active substances using experimental design.

To evaluate the influence of different variables on tablet formulations containing enalapril maleate and indapamide as active substances, two separate experimental designs were employed: one for evaluating powder properties and the other for tablet characteristics. Because of the low active pharmaceutical ingredient content, it was hypothesized that both powder and tablet properties could be determined only by the characteristics of excipients. In order to test this assumption, both experimental designs were done with placebo mixtures. The optimized formulation was then evaluated both with and without APIs. Results indicated that filler and lubricant percentage, along with compression force, were the most important variables during the formulation study. The optimized formulation showed similar characteristics in both cases for all responses, except for angle of repose and friability where only minor differences were observed. The combination of the applied approaches (using placebo composition and fractional experimental design) proved to be efficient, cost effective and time saving.

Interfacing on-line solid phase extraction with monolithic column multisyringe chromatography and chemiluminescence detection: An effective tool for fast, sensitive and selective determination of thiazide diuretics.

A new, multisyringe flow injection set-up has been developed for the completely automated determination of trace thiazide compounds with diuretic action in different types of samples. The proposed instrumental set-up exploits for the first time, a low pressure on-line solid phase extraction-liquid chromatography-chemiluminescence detection method. This novel combination of sample treatments in flow systems expands the current applicability of low pressure liquid chromatography due to the isolation/preconcentration of the target compounds, besides high selectivity and sensitivity. For the determination of three thiazide compounds named hydroflumethiazide, furosemide and bendroflumethiazide, the proposed set-up provided with the preconcentration of only 1mL of sample, limits of detection of 3, 60 and 40microgL(-1), respectively. Furthermore wide linear dynamic ranges of 6-4000, 140-20,000 and 90-40,000microgL(-1), respectively, were obtained. Besides of this, a high injection throughput of 12h(-1) was also achieved. As in sports, thiazide diuretics are prohibited substances, the proposed method has been applied to their determination in urine samples. Furthermore the potential of the proposed method as a fast-screening approach for emerging contaminants in waters has been also tested by applying it to well water and leachates from a solid waste landfill.

Stability of selected chlorinated thiazide diuretics.

In sports, diuretics are used for two main reasons: to flush previously taken prohibited substances with forced diuresis and in sports where weight classes are involved to achieve acute weight loss. A common property observed for thiazides is hydrolysis in aqueous media resulting in the formation of the degradation product aminobenzenedisulphonamide. This degradation product can be observed for several thiazides. Because there is limited information regarding the effect of pH, temperature and light on the stability of thiazides, these parameters were investigated for chlorothiaizide, hydrochlorothiazide and altizide. For all three compounds the degradation product could be detected after incubation at pH 9.5 for 48h at 60 degrees C. At lower pH and temperature the degradation product could not be detected for all compounds. When samples were exposed to UV-light altizide and hydrochlorothiazide were photodegraded to chlorothiazide. When the degradation rate between the different compounds was compared for a given temperature and pH, altizide is the most unstable compound. This study confirms that thiazide degradation products can be formed in urine during transport. Hence doping control laboratories shall include them into their routine testing methods as required by WADA.

Drug-induced subacute cutaneous lupus erythematosus: a paradigm for bedside-to-bench patient-oriented translational clinical investigation.

At least 71 patients have been reported in which their otherwise typical subacute cutaneous lupus erythematosus (SCLE) skin lesions were felt to have been temporally associated with the systemic administration of a drug. The mean age of this cohort of drug-induced SCLE (DI-SCLE) patients was 59 years of age which is somewhat older than the mean age of previously reported idiopathic SCLE patient cohorts. Patients had been taking the suspected triggering drug for weeks to years before the onset of SCLE skin lesions. In addition, it was not unusual for 2-3 months to be required for resolution of the SCLE skin lesions following discontinuation of the triggering drug. A relatively large number of drugs representing different pharmacological classes have been implicated in the induction of SCLE. The drug classes that were more frequently encountered were those used for the treatment of cardiovascular disease, especially hypertension. Calcium channel blockers were especially common in this regard. Elderly individuals being treated for hypertension are often taking multiple classes of drugs that have been implicated in triggering SCLE (thiazide diuretics, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, beta-blockers). An approach to the management of DI-SCLE is presented. Ro/SS-A autoantibodies tended to remain present in the blood after resolution of drug-induced SCLE skin lesions. A common link between the disparate group of drug structures implicated in triggering SCLE is their tendencies to produce photosensitivity and lichenoid drug reactions. This leads to the speculation that DI-SCLE could represent a photo-induced isomorphic/Köebner response in an immunogenetically predisposed host.

A new fractional wavelet approach for the simultaneous determination of ampicillin sodium and sulbactam sodium in a binary mixture.

A new application of the fractional wavelet transform (FWT) was proposed for the simultaneous determination of ampicillin (AP) and sulbactam (SB) in a pharmaceutical combination for injection. FWT approach is a new powerful tool for removing noise and irrelevant information from the absorption spectra. Cardinal information having higher peak amplitude, eliminated noise, sharp peaks with shrinking width of spectral range was obtained by the application of FWT procedure to the original absorption spectra. In this paper, FWT approach was subjected to the data vector of the UV-signals obtained from AP and SB in the wavelength range of 211.5-313.8 nm. Derivative transform was applied to the original absorption signal together with its FWT generalization. The calibration graphs for AP and SB were obtained by measuring the FWT and usual derivative amplitudes at zero-crossing points. The method validation was carried out by using the synthetic mixture analysis. Our proposed FWT approach was compared with the usual derivative spectrophotometry and chemometric methods (CLS, PCR and PLS) and a good agreement was reported.

Interaction of m-nitrophenylfluorone-Mo(VI) complex as a probe with human serum albumin: a fluorescence quenching study.

In this paper, the binding characteristics of human serum albumin (HSA) and m-nitrophenylfluorone (m-NPF)-molybdenum (Mo(VI)) complex have been studied by fluorophotometry. The binding constants are measured at different temperature. Based on the theory of Forster energy transfer, the binding distance and the energy transfer efficiency between m-nitrophenylfluorone-Mo(VI) complex and protein are obtained. According to the thermodynamic parameters, the main sort of binding force can be judged. The results indicate that HSA and m-NPF-Mo(VI) complex have strong interactions. The mechanism of quenching belongs to static quenching and the main sort of binding force is electrostatic gravitation.

Interaction of human serum albumin with bendroflumethiazide studied by fluorescence spectroscopy.

The interactions between bendroflumethiazide (BFTZ) and human serum albumin (HSA) have been studied by fluorescence spectroscopy. Binding constants for drug attachment to the various binding sites of HSA have been measured at different temperatures in physiological buffer solution. The effect of metal ions on BFTZ interaction with HSA was also investigated. The thermodynamic parameters, DeltaH and DeltaS, have been calculated to be 49.28kJmol(-1)>0, and 258.83Jmol(-1)K(-1)>0, respectively. The distance between HSA and BFTZ, r, was determined to be 1.47nm based on Förster's non-radiative energy transfer theory. The experimental results reveal that BFTZ has a strong ability to quench the intrinsic fluorescence of HSA through a static quenching mechanism. Furthermore, the binding constants between BFTZ and HSA are remarkably independent of temperature, and decrease in the presence of various ions, usually by about 30-55%. Hydrophobic interaction occurs between BFTZ and the sub-domain II A of HSA.

Physicochemical evaluation of PVP-thiazide diuretic interactions in co-spray-dried composites--analysis of glass transition composition relationships.

The aim of this study was to evaluate the possible interactions in the solid state between the thiazide diuretics: bendroflumethiazide (BFMT), hydroflumethiazide (HFMT) and hydrochlorothiazide (HCT) and polyvinylpyrrolidone (PVP) following processing. The glass transition temperatures (T(g)s) of a range of binary co-spray-dried PVP-thiazide composites were determined and compared to the predictions of the Gordon-Taylor, Fox, Couchman-Karasz, Kwei and Schneider equations. The solid composites of the thiazide diuretics and PVP were prepared by a spray drying technique. Properties of composites were determined with the use of helium pycnometry and FTIR spectroscopy. For many systems studied the experimentally detected T(g)s exhibited large positive deviations when compared with the values predicted by the Gordon-Taylor, Fox and Couchman-Karasz equations. The data was better fitted by the Schneider equation consistent with a drug-polymer interaction. FTIR analysis revealed that strong hydrogen bonding between the sulphonamide groups of the thiazide diuretics and the PVP molecule was responsible for the increase in the T(g)s. Additionally, in the case of BFMT-PVP composites, an interaction between the phenyl group and polymer ring was apparent. Glass transition-composition behaviour for amorphous drug-PVP composites deviated from the predictions of the commonly used Gordon-Taylor equation. Deviations were consistent with interactions between the components in the amorphous mixtures. The Schneider equation may be successfully applied to fit the Tg-composition profiles obtained, where other models fail to give good predictions.

Chiral separation of thiazide diuretics by HPLC on Chiralcel OD-RH, Chiralcel OJ-R and Chirobiotic-T phases.

This contribution deals with comparative studies on the chiral separation of thiazide diuretics using cellulose tris(3,5-dimethylphenylcarbamate) (Chiralcel OD-RH), cellulose tris(4-methylbenzoate) (Chiralcel OJ-R) and teicoplanin (Chirobiotic T) phases. All columns showed good chiral recognition ability for this class of compounds. Out of seven compounds investigated, six were resolved with baseline resolution with at least one of the three columns.

Mass spectrometric behavior of thiazide-based diuretics after electrospray ionization and collision-induced dissociation.

The mass spectrometric behavior of 21 thiazide-based compounds after electrospray ionization in the negative ion mode and collision-induced dissociation was investigated on a triple-stage quadrupole mass spectrometer. The mass spectra show individual and common fragmentation patterns, the generations of which are discussed based on comparable molecular structures of commercially available substances and the synthesis of unlabeled, deuterated, and 15N-labeled analogues. The synthesis of deuterated thiazides is perfomed by condensation of 4-amino-6-chloro-1,3-benzenedisulfonamide with appropriately labeled aldehydes, while the introduction of 15N into the sulfonamide groups of thiazides was achieved by the synthesis of 4-amino-6-chloro-1,3-benzenedisulfonamide(15N2) from 3-chloroaniline via 4-amino-6-chloro-1,3-benzenedisulfonyl chloride. The most common fragments determined are m/z 269, 205, and 126 for 6-chloro-7-sulfamoyl-3-alkyl-3,4-dihydro-1,2,4-benzothiadiazine-1,1-dioxides and m/z 303, 239, and 160 for 6-trifluoromethyl-7-sulfamoyl-3-alkyl-3,4-dihydro-1,2,4-benzothiadiazine-1,1-dioxides. Individual fragmentation behaviors were found that mainly depended on the C-3-linked side chain.

Spectrophotometric simultaneous determination of triamterene and hydrochlorothiazide in triamterene-H tablets by multivariate calibration methods.

The multivariate calibration methods of partial least-square regression and principal component regression were applied for the simultaneous spectrophotometry determination of triamterene (TRM) and hydrochlorothiazide (HYD) in their mixtures. The parameters of the chemometric procedure were optimized, and the proposed methods were validated with synthetic samples and applied to analyze these drugs in pharmaceutical products with good accuracy and precision. The results were compared with those given by the British Pharmacopoeia (BP) method. The square of the correlation coefficients (R(2)) for predicted TRM and HYD with the proposed method in a test sample were 0.9994 and 0.9992, respectively. The relative standard deviation for commercial tablets in the proposed method and BP standard method were 0.405 and 2.142%, respectively.

Increased phototoxicity of hydrochlorothiazide by photodegradation.

The photodegradation products of hydrochlorothiazide produced by ultraviolet (UV) radiation were investigated for their phototoxicity utilizing the photohemolysis and Candida albicans tests. Hydrochlorothiazide was irradiated for 30, 60, 90 and 120 min with a 250 W xenon arc lamp using a WG295 cut-off filter. Irradiation of hydrochlorothiazide resulted in the gradual decrease of all three absorption bands (225, 270 and 320 nm), the blue shift of the 225 nm band, and the appearance of a new band around 290 nm. Since previous results demonstrated that photosubstitution of chloride could occur, the main product of this photolysis most likely is ethoxyhydrochlorothiazide. The photohemolysis test revealed a significant increase in photohemolysis observed in the photodegradation products produced after 60, 90 and 120 min of UV irradiation. This increase in hemolysis value directly correlated with the UV-irradiation time. However, there was no significant phototoxic killing of yeast in the Candida albicans test. This suggests photodegradation products of hydrochlorothiazide may play an important role in phototoxicity by acting on the cell membrane, but not on DNA. Considering the high in vitro phototoxicity observed in bendroflumethiazide and the data presented here, substitution of chloride seems to be responsible for the increased phototoxicity of hydrochlorothiazide.

Liquid chromatography-mass spectrometry and proton nuclear magnetic resonance characterization of trace level condensation products formed between lactose and the amine-containing diuretic hydrochlorothiazide.

Trace levels of condensation products between lactose and the amine-containing diuretic hydrochlorothiazide are formed when a mixture of the two solids containing 30% weight water is heated at 60 degrees C for 2 weeks. The two most abundant condensation products were characterized by liquid chromatography-mass spectrometry (LC-MS) and proton nuclear magnetic resonance ((1)H NMR) spectroscopy. Under these relatively mild conditions of formation, the amine-lactose reaction products are limited to those involving the elimination of only a single molecule of water, rather than the multiple-water eliminations associated with later stages of the Maillard reaction. The spectroscopic data clearly show that the primary condensation products are cyclic N-substituted glycosylamines rather than Schiff base, 1,2-enolic forms, or Amadori rearrangement products of identical mass. In solution, the two most abundant N-substituted glycosylamines are shown to be in a kinetically slow equilibrium with each other, most likely through a mutarotation involving the intermediate formation of the acyclic Schiff base.

Liquid chromatographic separation of the stereoisomers of thiazide diuretics.

A number of racemic thiazide diuretics and analogues were resolved on two diastereomeric chiral stationary phases (CSPs) prepared from (S)- or (R)-alpha-[1-(6,7-dimethyl)naphthyl]-10-dodecenylamine and (S)-2-phenylpropanoic acid. Of the two diastereomeric CSPs, the (S,S) and the (R,S), the former is found to be better than the latter in separating the enantiomers of the racemic thiazide diuretics and their analogues with complete separation being observed on the (S,S)-CSP. Chiral recognition is controlled principally by the (R)- or (S)-alpha-[1-(6,7-dimethyl)naphthyl]-10-dodecenylamine portion of the CSPs. The second stereogenic center of the CSP provides but secondary effects on the chiral recognition presumably involving, in the case of the (S,S)-CSP, face-to-edge pi-pi interaction between the aromatic ring of the analytes and the phenyl on the second stereogenic center.

Dissolution tests of benazepril-HCl and hydrochlorothiazide in commercial tablets: comparison of spectroscopic and high performance liquid chromatography methods.

Simple, rapid and reliable spectroscopic methods (absorbance ratio and Vierordt) were compared with HPLC for quantitative determination in dissolution tests of benazepril-HCl (BNZ) and hydrochlorothiazide (HCT) in commercial tablets. A 249 nm wavelength was chosen as the isosbestic point in the absorbance ratio method, and the absorbance ratios A236/A249 nm for BNZ and A269/A249 nm for HCT were used for calculation of regression equations. For the Vierordt method, A1(1) values (%1.1 cm) obtained at 236 and 269 nm for both substances were used for quantitative analyses of BNZ and HCT. In the HPLC method, simultaneous determination of BNZ and HCT from dissolution medium was achieved using the mobile phase containing phosphate buffer (0.01 M, pH 6.2) and acetonitrile (65:35) on a Supelcocil LC-18 (4.6 x 250, 5.6 mm) reversed phase column. Dissolution tests of commercial tablets were carried out according to USP XXII paddle method in 0.1 N HCl at 50 rpm at 37 +/- 0.5 degrees C. Comparison of the dissolution data from the HPLC and two spectroscopic methods indicated that spectroscopic and HPLC methods were in good correlation with each other. Therefore, it was concluded that both spectroscopic methods as well as HPLC can be used in routine analyses of BNZ and HCT in dissolution tests of commercial tablets.

Bioadhesive delivery of hydrochlorothiazide using tacca starch/SCMC and tacca starch/Carbopols 940 and 941 admixtures.

Tacca starch and its admixtures with Carbopols 940 and 941; and sodium carboxymethylcellulose (SCMC) were evaluated for bioadhesive delivery of hydrochlorothiazide into the gastrointestinal tract (GIT). The bioadhesive properties were evaluated using the adhesion of polymer-coated glass beads on the antrum region of the porcine gastrointestinal tract and Lecomte Du Nouy tensiometer. The swellings and release characteristics of the films/hydrogels of tacca starch and its admixtures were also studied. Results of the bioadhesive properties indicated that although tacca starch is a poor bioadhesive biopolymer at low concentration, the admixtures showed improved bioadhesive properties. The swelling and the release characteristics also confirmed that the admixtures could be used for bioadhesive drug delivery into the GIT.

Age- and gender-related use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose.

OBJECTIVES: Low-dose drug therapy is promoted as a way to maximize benefit and minimize adverse drug effects when prescribing for older adults. This population-based study evaluates the age and sex-related use of two common therapies: thiazide diuretics, where evidence supports the use of low-dose therapy, and beta-blockers, where trials have not evaluated the minimum effective dose. DESIGN: Using linked administrative databases we identified all of the 120,613 persons dispensed a thiazide diuretic therapy and 12,908 myocardial infarction survivors dispensed beta-blocker therapy in Canada's largest province. We used logistic regression models to study the association of age and sex with dispensing of low-dose thiazide diuretic and beta-blocker therapy at doses lower than evaluated in trials. RESULTS: Of 120,613 older people dispensed a thiazide diuretic, 32,372 (26.8%) were dispensed a low dose. Patients 85 years of age or older, relative to the youngest group, were 30% more likely to be dispensed low-dose therapy (OR=1.31; 95% CI, 1.27 to 1.36; P < .001). Women were 8% more likely than men to be dispensed a low-dose thiazide diuretic (OR=1.08; 95% CI, 1.05 to 1.11; P < .001). Of 10,991 myocardial infarction survivors dispensed atenolol, metoprolol, propranolol, or timolol, 9458 (86.1%) were dispensed a lower-than-evaluated dose. Patients 85 years of age or older, relative to those in the youngest group, were more than twice as likely to be dispensed a lower-than-evaluated beta-blocker therapy dose (OR=2.28; 95% CI, 1.74 to 3.04; P < .001). No difference was noted in the use of beta-blocker therapy dose by sex (OR=1.0; 95% CI, .89 to 1.15; P = .95). CONCLUSIONS: Low-dose thiazide diuretic therapy prescribed widely to older people, particularly those of advanced age and women. The vast majority of myocardial infarction survivors were dispensed beta-blocker therapy at lower-than-evaluated doses. These findings highlight the need to manufacture low-dose thiazide diuretic therapy and to evaluate the minimum effective dose of beta-blocker therapy.

Interactions of diuretics with a neutral temperature-responsive polymer: study by capillary electroporesis and dynamic light scattering.

Interactions between diuretics and a recently synthesized temperature-responsive neutral copolymer, poly(N-isopropyl acrylamide) (PNIPA) grafted with poly(ethyleneoxide) (PEO) (PNIPA-g-PEO) were investigated by capillary electrophoresis and dynamic light scattering (DLS). At ambient temperatures, the copolymer takes an open, random coil conformation, but above the lower critical solution temperature (LCST), the polymer shrinks and forms large, stable aggregates. Among the diuretics studied, hydrochlorothiazide was detected to bind to PNIPA-g-PEO.