Stability of Oxytocin Preparations in Malawi and Rwanda: Stabilizing Effect of Chlorobutanol.

Oxytocin is used for the prevention and treatment of postpartum hemorrhage, the leading cause of maternal mortality in low- and middle-income countries. Because of the high instability of oxytocin, most products are labeled for storage at 2-8°C. Some other products are on the market which are labeled for non-refrigerated storage, but independent evaluations of their stability hardly exist. In the present study, seven brands (nine batches) of oxytocin were purchased from wholesalers and medical stores in Malawi and Rwanda and investigated by accelerated stability testing according to the ICH/WHO guidelines. Two oxytocin brands approved by a stringent regulatory authority (SRA) or by the WHO Prequalification of Medicines program and purchased in Europe were used as comparison. All investigated brands which were either produced in countries with SRAs, or were WHO-prequalified products, were labeled for storage at 2-8°C, and all of them passed stability testing with very good results. Even exposure to 25°C or 30°C for several months hardly affected their oxytocin content. However, two other investigated brands were labeled for non-refrigerated storage, and both of them had been produced in countries without SRAs. These two preparations showed not higher but lower stability than the brands labeled for storage at 2-8°C, and, for both of them, noncompliance with pharmacopoeial specifications was found after accelerated stability testing. At 40°C, and in forced degradation studies at 80°C, chlorobutanol showed a remarkable stabilizing effect on oxytocin, which may deserve further investigation. The results of the present study support the policy "Buy Quality Oxytocin, Keep It Cool."

Quantitative characterization of planarian wild-type behavior as a platform for screening locomotion phenotypes.

Changes in animal behavior resulting from genetic or chemical intervention are frequently used for phenotype characterizations. The majority of these studies are qualitative in nature, especially in systems that go beyond the classical model organisms. Here, we introduce a quantitative method to characterize behavior in the freshwater planarian Schmidtea mediterranea. Wild-type locomotion in confinement was quantified using a wide set of parameters, and the influences of intrinsic intra-worm versus inter-worm variability on our measurements was studied. We also examined the effect of substrate, confinement geometry and the interactions with the boundary on planarian behavior. The method is based on a simple experimental setup, using automated center-of-mass tracking and image analysis, making it an easily implemented alternative to current methods for screening planarian locomotion phenotypes. As a proof of principle, two drug-induced behavioral phenotypes were generated to show the capacity of this method.

Interactions at human ether-à-go-go-related gene channels.

Several noncardiovascular drugs have the potential to induce Torsades de Pointes cardiac arrhythmias via blockade of the rapid component of the cardiac delayed rectifier K(+) current (I(Kr)), which is encoded by human ether-à-go-go-related gene (hERG). The aim of the present study was to characterize possible interactions between terfenadine, binding to a site located inside the central cavity, and the following substances with various binding sites: dofetilide, fluvoxamine, chlorobutanol, and a hERG-specific toxin isolated from scorpion venom (CnErg1). The whole-cell configuration of the patch-clamp technique was employed on hERG channels stably expressed in human embryonic kidney 293 cells. Terfenadine does not interact with dofetilide or fluvoxamine at hERG channels. Slight subadditive inhibitory effects on hERG peak tail currents were observed when terfenadine and CnErg1 were administered in combination. Terfenadine and chlorobutanol synergistically inhibit hERG peak tail currents and enhance each other's inhibitory effect in a concentration-dependent way. In conclusion, terfenadine interacts with CnErg1 and chlorobutanol, but not with dofetilide or fluvoxamine, at hERG channels. It is shown that interactions between chlorobutanol and a hERG channel blocker binding inside the central cavity (terfenadine) produce synergistic effects on hERG currents.

Are multidose over-the-counter artificial tears adequately preserved?

PURPOSE: To investigate artificial tears containing different preservatives for antimicrobial efficacy. Based on the challenge test outlined in the European Pharmacopoeia, products were tested in their original containers to see whether their component preservative had sufficient activity. METHODS: Five brands of over-the-counter artificial tears each containing different preservatives (benzalkonium chloride/EDTA, parabens, chlorobutanol, silver chloride complex, and Purite-stabilized oxychloro complex) were inoculated with test microorganisms (Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans). Changes in the microbial start concentration with time were followed by plating onto growth media to provide a measure of the preservative efficacy. In another test, artificial tears were applied to paper disks that were then placed onto agar growth media seeded with microorganisms. Zones of inhibition were measured after incubation. RESULTS: Only the brand of artificial tears containing benzalkonium chloride/EDTA satisfied the major criteria for antimicrobial preservation for all the test microorganisms. Only a benzalkonium chloride/EDTA-containing disk placed on agar seeded with S. aureus produced a zone of inhibition in the agar diffusion test. CONCLUSION: The brand of artificial tears containing benzalkonium chloride/EDTA is suitable for sale in countries adopting the monographs of the European Pharmacopoeia. Other brands would only be suitable for sale if justified reasons for not meeting the major criteria for preservative efficacy can be provided.

4-Chlorobutanol induces unusual reversible and irreversible thermal unfolding of ribonuclease A: thermodynamic, kinetic, and conformational characterization.

The thermal denaturation of ribonuclease A has been studied by differential scanning calorimetry in the presence of 4-chlorobutan-1-ol. The thermal transitions were observed to be reversible at pH 5.5 in the presence of low concentration (up to 50 mM) of the alcohol, irreversible in the intermediate (50 mM < c < mM) and again reversible in the presence of 250 mM and higher concentrations of 4-chlorobutan-1-ol. In the presence of 50 mM 4-chlorobutan-1-ol, ribonuclease A is present in two conformational states unfolding at different temperatures. The reversible thermal transitions have been fitted to a two-state native-to-denatured mechanism. Irreversible thermal transitions have been analyzed according to two-state irreversible native-to-denatured kinetic model. Using the irreversible model, rate constant as a function of temperature and energy of activation of the irreversible process have been calculated. Circular dichroism and fluorescence spectroscopic results corroborate the DSC observations and indicate a protein conformation with poorly defined tertiary structure and high content of secondary structure in the presence of 50 mM 4-chlorobutan-1-ol at a temperature corresponding to the second transition. Similar results have been observed at pH 3.9.

Rapid stimulation of free glucuronate formation by non-glucuronidable xenobiotics in isolated rat hepatocytes.

Vitamin C synthesis in rat liver is enhanced by several xenobiotics, including aminopyrine and chloretone. The effect of these agents has been linked to induction of enzymes potentially involved in the formation of glucuronate, a precursor of vitamin C. Using isolated rat hepatocytes as a model, we show that a series of agents (aminopyrine, antipyrine, chloretone, clotrimazole, metyrapone, proadifen, and barbital) induced in a few minutes an up to 15-fold increase in the formation of glucuronate, which was best observed in the presence of sorbinil, an inhibitor of glucuronate reductase. They also caused an approximately 2-fold decrease in the concentration of UDP-glucuronate but little if any change in the concentration of UDP-glucose. Depletion of UDP-glucuronate with resorcinol or d-galactosamine markedly decreased the formation of glucuronate both in the presence and in the absence of aminopyrine, confirming the precursor-product relationship between UDP-glucuronate and free glucuronate. Most of the agents did not induce the formation of detectable amounts of glucuronides, indicating that the formation of glucuronate is not due to a glucuronidation-deglucuronidation cycle. With the exception of barbital (which inhibits glucuronate reductase), all of the above mentioned agents also caused an increase in the concentration of ascorbic acid. They had little effect on glutathione concentration, and their effect on glucuronate and vitamin C formation was not mimicked by glutathione-depleting agents such as diamide and buthionine sulfoximine. It is concluded that the stimulation of vitamin C synthesis exerted by some xenobiotics is mediated through a rapid increase in the conversion of UDP-glucuronate to glucuronate, which does not apparently involve a glucuronidation-deglucuronidation cycle.

Effects of chlorobutanol on primary and secondary endings of isolated cat muscle spindles.

The effects of the preservative chlorobutanol on primary and secondary endings of muscle spindles isolated from the tenuissimus muscle of the cat were investigated in this study. Chlorobutanol was applied to the bathing solution in final concentrations of between 10 and 100 microg/ml. It induced a reversible and dose dependent decrease in the discharge frequency of both types of ending without any visible length change in the sensory region of the receptor. The initial activity, the peak dynamic discharge, the maximum static discharge value and the final static discharge value were evaluated from an ending's discharge pattern obtained during ramp-and-hold stretches. These four basic discharge frequencies decreased in parallel with increasing concentrations of chlorobutanol. Their sensitivities to chlorobutanol were similar (mean values: -0.11 to -0.29 imp/s per microg/ml chlorobutanol) and were independent of the amplitude of stretch. The dynamic response and the static response of both primary and secondary endings remained unchanged, indicating that the sensitivity of the spindle to stretch was not influenced by chlorobutanol. Chlorobutanol also reduced the discharge activity of the muscle spindle afferents during sinusoidal stretches. The amplitude of the receptor potential (AC component) remained unchanged under chlorobutanol. With the available recording technique it was not possible to measure slow shifts of the membrane potential. However, a hyperpolarization of the ending's membrane might explain why the afferent discharge frequency is reduced by chlorobutanol. The calcium dynamics of the spindle do not appear to be altered by CB, as the effect exerted on the afferent discharge by a change in the extracellular calcium concentration and a blockage of calcium channels was different from the CB effect. As the inhibitory effect of CB was reduced by ouabain, it is possible that CB activates the electrogenic Na/K pump or affects a mechanism that is closely related to the activity of the pump. The properties of the axonal membrane appear not to be altered, as chlorobutanol did not change the shape of action potentials.

Practice tip. Which cerumenolytic?

AIM: To test the in vitro dispersion of ear wax by four commonly used cerumenolytics. METHOD: Equal parts of the same piece of ear wax were covered with 10 mL of each preparation and observed for up to 30 days. RESULTS: Sodium bicarbonate and Waxsol dispersed wax within 2 hours, Cerumol was much slower and olive oil had no effect. CONCLUSIONS: The cheapest and most effective cerumenolytic is a solution of sodium bicarbonate.

The survival of herpes simplex virus in multidose office ophthalmic solutions.

PURPOSE: To determine the survival of herpes simplex virus type 1 (HSV-1) in several multidose ophthalmic solutions. METHODS: In three separate trials, 10 aliquots of 5 ml each of three common multidose topical ophthalmic solutions, sodium fluorescein, proparacaine, and nonpreserved artificial tears, were inoculated with 10(5), 10(4), and 10(3) pfu per ml of HSV-1. All samples were titered on A549 cells at various time points for surviving HSV-1. RESULTS: Herpes simplex virus type 1 was not recovered from the fluorescein and proparacaine solutions at 1 hour or any time thereafter, regardless of inoculation titer. Herpes simplex virus type 1 was recovered from the artificial tears up to 7 days. CONCLUSION: Unlike adenovirus, HSV-1 does not survive in preserved fluorescein and proparacaine multidose solutions; therefore, office transmission is highly unlikely.

Adsorption of calcitonin to glass.

Surface adsorption of calcitonin on soda lime silica glass was investigated. An attempt was also made to examine the effect of additives on the inhibition of calcitonin adsorption. Results showed that the adsorption isotherms were of the Langmuir and Freundlich type, depending on pH. Less adsorption was found for calcitonin at pH 4.3. The addition of nonionic surfactants such as Pluronic F68 and Tween 80 to the calcitonin solutions demonstrated inhibition of absorption and reduction of adsorption rate. The addition of chlorobutanol also showed the effect of minimizing adsorption.

The effect of oxytocin on the contractile force of human atrial trabeculae.

UNLABELLED: We performed an in vitro examination of the inotropic effect of oxytocin, chlorobutanol, and their combination to assess the effect of these drugs on the contractile force of human atrial trabeculae. Right atrial tissue samples were obtained during cardiac surgery with cardiopulmonary bypass. Trabeculae of the atrial appendage were dissected and mounted on muscle stands in a modified Krebs-Henseleit buffer bath. This isometric atrial trabecula preparation was subjected to a cumulative pharmacological protocol of either pure oxytocin, pure chlorobutanol, or a combination of the two drugs until no further change occurred in either developed force or resting force of the atrial trabeculae. A "no drug" buffer solution was used to assess the effect of time on the natural decay of the atrial preparation. The relative developed force of oxytocin plus chlorobutanol solution and pure chlorobutanol were similar in magnitude and lower than that in control experiments (P < 0.001) Pure oxytocin did not change the contractile force of atrial tissue. We conclude that pure oxytocin does not have a cardiodepressive effect in this human atrial preparation. Chlorobutanol has a negative inotropic effect, which is of a magnitude similar to a combined solution of chlorobutanol and oxytocin. Therefore, chlorobutanol added as a preservative to the commercial synthetic oxytocin solution may contribute to hypotension observed in patients after an intravenous bolus injection. IMPLICATIONS: We obtained specimens of heart tissue from patients undergoing cardiac surgery and conducted a laboratory study of the effects of oxytocin and its preservative (chlorobutanol) on these tissue samples. Chlorobutanol decreased the ability of the heart to contract, while as pure oxytocin had no effect. This explains why maternal blood pressure may decrease and provides impetus to produce oxytocin with another, safer preservative.

Vasodilator responses to desmopressin and its diluent, chlorobutanol, in the hindquarters vascular bed of the cat.

Desmopressin is a synthetic analog of vasopressin used to promote hemostasis and reduce postoperative blood loss. Recent studies have shown that desmopressin decreases arterial blood pressure in the anesthetized rat and relaxes isolated segments of aorta and pulmonary artery. Responses to a clinical preparation of desmopressin were investigated in the hindquarters vascular bed of the cat under constant flow conditions so that changes in perfusion pressure directly reflect changes in vascular resistance. Responses to desmopressin and its vehicle, and the effect of receptor antagonists, inhibitors of prostaglandin, and nitric oxide synthesis inhibitors, were investigated.

Total bilirubin level in relation to excipients in parenteral morphine sulfate administered to seriously ill newborn infants.

We examined exposure to excipients in different morphine sulfate preparations in relation to maximum total bilirubin level during the first 5 days of life among 155 infants admitted to a newborn intensive care unit. Sixty-six (43%), 47 (30%), and 42 (27%) newborns were exposed to chlorobutanol, phenol and neither excipient, respectively. Mean maximum total bilirubin in the first 5 days of life among newborns not exposed to chlorobutanol or phenol was 10.8 mg/dL (184 mumol/L). After adjusting for birthweight, race, sex, and use of phototherapy, the maximum total bilirubin level among newborns exposed to phenol was 1.4 mg/dL (24 mumol/L) higher than the maximum level among newborns exposed to neither excipient (P < 0.05); the corresponding difference associated with chlorobutanol exposure was 1.6 mg/dL (27 mumol/L) (P < 0.02). Further adjustment for potential confounding by the major risk factors for hyperbilirubinaemia did not materially change the results. While unconfirmed, these findings support the growing concern that excipients added to parenteral medications may not be 'inactive' as is often assumed, and that the safety of such exposures in seriously ill newborn infants needs to be studied further.

Dual effects of chlorobutanol on secretory response and intracellular Ca2+ dynamics in isolated pancreatic acini of the rat.

1. The effects of chlorobutanol, a widely used drug preservative, on exocrine response and intracellular Ca2+ dynamics were examined in isolated pancreatic acini of the rat. 2. Chlorobutanol (1 mg ml-1) markedly inhibited the secretory response to cholecystokinin octapeptide (CCK-8), carbamylcholine chloride (carbachol), or sodium fluoride, a direct G-protein activator. However, chlorobutanol itself induced a maximal release of amylase when the dose was increased to 4 mg ml-1. 3. An oscillatory fluctuation of cytoplasmic Ca2+ concentration, [Ca2+]c, induced by 5 pM CCK-8 or 0.3 microM carbachol was totally abolished in the presence of 1 mg ml-1 chlorobutanol. 4. A biphasic change in [Ca2+]c induced by 100 pM CCK-8, a rapid rise followed by a gradual decay, was transformed to an oscillatory fluctuation by the preservative. 5. Chlorobutanol inhibited 13 pM [125I]-CCK-8 or 0.5 nM [3H]-methylscopolamine chloride binding to the acinar cells in a dose-dependent manner. 6. These results indicate that chlorobutanol produces discernible pharmacological effects on the secretory response in rat pancreatic acinar cells through changes in the Ca2+ dynamics. Possible sites of action could be at a binding process of secretagogues to their receptors, at an activation process of a G-protein located in the plasma membrane, or at the processes following G-protein activation. However, the possibility that the preservative may distort the Ca(2+)-transport function of the plasma membrane or the membrane of intracellular organella, especially Ca(2+)-sequestering pools, cannot be excluded.

An in vitro study to determine efficacy of different wax-dispersing agents.

An in vitro study was performed to compare the relative efficacy of a number of aqueous- and organic-based wax-dispersing preparations. Water, which was originally intended to be a control, surprisingly proved to be the most effective, whilst olive oil appeared to be almost totally ineffective as a wax dispersant. In view of the relatively high cost of commercially available preparations, these results have significant clinical potential.

Effect of desmopressin acetate on hindlimb perfusion pressure in rats: what is the mechanism?

Desmopressin acetate (DDAVP) is a synthetic analogue of vasopressin used to promote hemostasis and reduce postoperative blood loss. Desmopressin acetate can cause hypotension in humans. Our study evaluated the hemodynamics of rapid administration of DDAVP into the isolated hindlimb in live rats and assessed this response after pretreatment with various antagonists. Thirty male Sprague-Dawley rats (350-450 g) were given intraperitoneal pentobarbital anesthesia (50 mg/kg). Perfusion was set at a rate that gave a control mean hindlimb perfusion pressure (HPP) of 100-120 mm Hg. Rats were assigned to five groups (N = 5, each group), with each rat serving as its own control. As a control, saline solution (in volumes equivalent to those used for the antagonists) was injected into the hindlimb preparation before the agonist injections. Each group received both the clinical preparation of DDAVP (i.e., with preservative) and a laboratory preparation of DDAVP in doses of 0.3-3 ng. Group 1 was tested before and after injection of saline solution control; group 2, before and after propranolol (0.5 mg/kg); group 3, before and after meclofenamate (1.5 mg/kg), a cyclooxygenase inhibitor; group 4, before and after nitroarginine (5 mg/kg) an inhibitor of nitric oxide synthesis; and group 5, before and after atropine sulfate (1 mg/kg). Chlorobutanol (25-75 micrograms), the preservative in the clinical preparation of DDAVP, was tested for changes in HPP in five rats similarly prepared. Systemic mean arterial pressure remained constant during the study. The HPP decreased with increasing doses of the clinical preparation of DDAVP, compared with saline solution controls, whereas no change occurred with the laboratory preparation of DDAVP.(ABSTRACT TRUNCATED AT 250 WORDS)

A non-bronchoconstrictor, bacteriostatic preservative for nebuliser solutions.

We have studied the bacteriostatic and airways effects of the preservatives chlorocresol and chlorbutol, to assess if they may be safely used in nebuliser solutions. The bacteriostatic study was carried out according to standard techniques, and the preservatives were able to inhibit the growth of a range of bacteria and yeasts for a period of 28 days. The airways effects were studied in eight asthmatic subjects, who were challenged with either the preservatives or saline (as placebo). Pulmonary function was followed as FEV1 for 60 min after inhalation, and there was no change in FEV1 following inhalation. We conclude that these preservatives may be used safely in nebuliser solutions.

Effect of preservatives in artificial tear solutions on tear film evaporation.

It has been suggested that certain preservatives in artificial tears may affect the stability of the tear film lipid layer. In the present study, tear film evaporation rate (TER) was measured with a modified Servomed Evaporimeter to determine whether preservatives affected tear stability. Two solution combinations were compared in a cross-over study of eight non-contact lens wearers. These combinations consisted of identical solutions, one preserved with either benzalkonium chloride (0.004%) or chlorobutanol (0.5%), the other non-preserved. Grouped data analysis showed no significant difference in TER with either solution combination. Individuals showed differences, but these were not related to the preservative. It is suggested that these concentrations of chlorbutanol and benzalkonium chloride did not affect the stability of the tear film lipid layer as indicated by an altered TER.

Chlorobutanol, a preservative of desmopressin, inhibits human platelet aggregation and release in vitro.

Therapeutic preparations of desmopressin for parenteral use contain the preservative chlorobutanol (5 mg/ml). We show here that chlorobutanol is a potent inhibitor of platelet aggregation and release. It exhibited a significant inhibitory activity toward several aggregation inducers in a concentration- and time-dependent manner. Thromboxane B2 formation, ATP release, and elevation of cytosolic free calcium caused by collagen, ADP, epinephrine, arachidonic acid and thrombin respectively were markedly inhibited by chlorobutanol. Chlorobutanol had no effect on elastase-treated platelets and its antiplatelet effect could be reversed. It is concluded that the antiplatelet effect of chlorobutanol is mainly due to its inhibition on the arachidonic acid pathway but it is unlikely to have a nonspecific toxic effect. This antiplatelet effect of chlorobutanol suggests that desmopressin, when administered for improving hemostasis, should not contain chlorobutanol as a preservative.