Successful buprenorphine transition while overlapping with a full opioid agonist to treat chronic pain: a case report.

Buprenorphine is a partial mu opioid agonist that has been increasingly utilized to treat patients with chronic pain and opioid use disorder (OUD). The drug has proven to provide significant chronic pain relief at low doses ranging from 75 to 1800 mcg. The conventional buprenorphine transitional process delays its introduction until patients begin withdrawal. However, this process can pose a barrier to both patients and providers due to some patients' inability to tolerate traditional prerequisite withdrawal. To our knowledge, this is a rare reported case to describe a transitional process utilizing buccal buprenorphine in which a patient with chronic pain simultaneously tapered completely off an extended-release (ER) full opioid agonist and uptitrated buprenorphine. The patient was weaned from oxycodone ER 30 mg every 12 h and oxycodone/acetaminophen 10/325 mg 3x/day for breakthrough pain utilizing an unconventional approach. Tapering down to oxycodone ER 20 mg 2x/day for the first 2 weeks was successful. However, reducing to oxycodone ER 10 mg 2x/day for the following 2 weeks presented adherence difficulty and increased breakthrough pain. At this time, buccal buprenorphine was added at 300 mcg daily for 3 days. From days 4 to 6, buprenorphine was increased to 300 mcg 2x/day and oxycodone ER decreased to 10 mg daily. Six days later, oxycodone ER was discontinued and oxycodone/acetaminophen continued as needed. The patient exhibited no signs of withdrawal and adequate relief of symptoms through this tapering process. At the 1-month follow-up, the patient was doing well and was being treated solely with buprenorphine and oxycodone/acetaminophen to control her breakthrough pain. After 5 months, buprenorphine was increased to 600 mcg 2x/day and her oxycodone/acetaminophen decreased to 5/325 mg 3x/day as needed. From the start of the patient's taper to her current transition, the patient reduced her morphine milligram equivalent (MME) dosage from 135 MME to 22.5 MME. The Clinical Opioid Withdrawal Scale (COWS), which measures the severity of a patient's opioid withdrawal symptoms, was consistently less than 5. This buprenorphine schedule demonstrated a successful tapering approach for this patient because she had reported improved quality of life and function. A patient-centered osteopathic treatment approach was utilized when the patient presented with mid-taper adherence difficulty. Transitioning patients from full to partial opioid agonists could become an important practice standard for patient safety not only for formal pain management practices but also in primary care, family practice, and even geriatric offices.

Development of olmesartan medoxomil optimized nanosuspension using the Box-Behnken design to improve oral bioavailability.

The aim of the present investigation was to enhance the oral bioavailability of olmesartan medoxomil by improving its solubility and dissolution rate by preparing nanosuspension (OM-NS), using the Box-Behnken design. In this, four factors were evaluated at three levels. Independent variables include: concentration of drug (X1), concentration of surfactant (X2), concentration of polymer (X3) and number of homogenization cycles (X4). Based on preliminary studies, the size (Y1), zeta potential (ZP) (Y2) and % drug release at 5 min (Y3) were chosen as dependent responses. OM-NS was prepared by high pressure homogenization method. The size, PDI, ZP, assay, in vitro release and morphology of OM-NS were characterized. Further, the pharmacokinetic (PK) behavior of OM-NS was evaluated in male wistar rats. Statistically optimized OM-NS formulation exhibited mean particle size of 492 nm, ZP of -27.9 mV and 99.29% release in 5 min. OM-NS showed more than four times increase in its solubility than pure OM. DSC and XRD analyses indicated that the drug incorporated into OM-NS was in amorphous form. The morphology of OM-NS was found to be nearly spherical with high dispersity by scanning electron microscopic studies. The PK results showed that OM lyophilized nanosuspension (NS) exhibited improved PK properties compared to coarse powder suspension and marketed tablet powder suspension (TS). Oral bioavailability of lyophilized NS was increased by 2.45 and 2.25 folds when compared to marketed TS and coarse powder suspension, respectively. Results of this study lead to conclusion that NS approach was effective in preparing OM formulations with enhanced dissolution and improved oral bioavailability.

Fermentation, isolation, purification and characterization of an antitubercular antibiotic from Streptomyces luridus MTCC 4402.

Tuberculosis, caused by Mycobacterium tuberculosis, continues to be a serious public health problem around the world, and it urges the need for development of new antitubercular drugs. An antibiotic producing strain, Streptomyces luridus (MTCC 4402) was earlier isolated from soil by our group. In this work, the phylogenic status was established by 16S rRNA gene sequence analysis. The strain was found to be active against clinically resistant strains. The culture was grown in shake flasks in a medium containing cornsteep liquor, glucose, CaCO(3), soyabean meal and starch. Antibiotic production reached maximum at the end of 72 h. and fermentation profile was obtained. The active compound was extracted into ethyl acetate and was subjected to activity guided purification by column chromatography using silica gel, TLC and HPLC methods. The pure compound eluted at 16.7 min. by gradient elution was subjected to (1)H, (13)C NMR and mass spectral analyses. The acquired data was compared with that of natural products' data base and found to be a known antibiotic, spiramycin. The purified compound was studied for mutagenic, cytotoxicity, antitubercular activities. It was non mutagenic at the concentration of 1000 µg/mL, non cytotoxic and active as antitubercular agent at a concentration of 64 mg/mL and was comparable to rifampicin.

Heterozygous loss-of-function mutations in YAP1 cause both isolated and syndromic optic fissure closure defects.

Exome sequence analysis of affected individuals from two families with autosomal-dominant inheritance of coloboma identified two different cosegregating heterozygous nonsense mutations (c.370C>T [p.Arg124*] and c. 1066G>T [p.Glu356*]) in YAP1. The phenotypes of the affected families differed in that one included no extraocular features and the other manifested with highly variable multisystem involvement, including hearing loss, intellectual disability, hematuria, and orofacial clefting. A combined LOD score of 4.2 was obtained for the association between YAP1 loss-of-function mutations and the phenotype in these families. YAP1 encodes an effector of the HIPPO-pathway-induced growth response, and whole-mount in situ hybridization in mouse embryos has shown that Yap1 is strongly expressed in the eye, brain, and fusing facial processes. RT-PCR showed that an alternative transcription start site (TSS) in intron 1 of YAP1 and Yap1 is widely used in human and mouse development, respectively. Transcripts from the alternative TSS are predicted to initiate at codon Met179 relative to the canonical transcript (RefSeq NM_001130145). In these alternative transcripts, the c.370C>T mutation in family 1305 is within the 5' UTR and cannot result in nonsense-mediated decay (NMD). The c. 1066G>T mutation in family 132 should result in NMD in transcripts from either TSS. Amelioration of the phenotype by the alternative transcripts provides a plausible explanation for the phenotypic differences between the families.

Transbuccal delivery of chlorpheniramine maleate from mucoadhesive buccal patches.

This article describes buccal permeation of chlorpheniramine maleate (CPM) and its transbuccal delivery using mucoadhesive buccal patches. Permeation of CPM was calculated in vitro using porcine buccal membrane and in vivo in healthy humans. Buccal formulations were developed with hydroxyethylcellulose (HEC) and evaluated for in vitro release, moisture absorption, mechanical properties, and bioadhesion, and optimized formulation was subjected for bioavailability studies in healthy human volunteers. In vitro flux of CPM was calculated to be 0.14 +/- 0.03 mg.h(-1).cm(-2) and buccal absorption also was demonstrated in vivo in human volunteers. In vitro drug release and moisture absorbed were governed by HEC content and formulations exhibited good tensile and mucoadhesive properties. Bioavailability from optimized buccal patch was 1.46 times higher than the oral dosage form and the results showed statistically significant difference.

Development of carvedilol transdermal patches: evaluation of physicochemical, ex vivo and mechanical properties.

Monolithic matrix-type transdermal drug delivery systems for carvedilol were prepared using a film casting technique involving hydroxypropyl methylcellulose (HPMC), hydroxypropyl cellulose (HPC), Eudragit RS 100 (ERS 100), and Eudragit RL 100 (ERL 100) as matrix-forming polymers. The prepared transdermal drug delivery systems were extensively evaluated for in vitro release, ex vivo permeation through rat abdominal skin, moisture absorption, moisture content, water vapor transmission, stability, and mechanical properties. Formulations F2, F3, and F5 were composed of a 4:1 ratio of HPMC, ERS 100; HPMC, HPC; and HPMC, ERL 100, respectively, whereas F4, F6, and F7 were composed of 3:0.5:0.5 of HPMC, ERS 100, HPC; HPMC, HPC, ERL 100; and HPMC, ERS 100, ERL 100. Formulation F1 was composed of HPMC polymer. All formulations carried 8% v/w of d-limonene as a penetration enhancer and 20% v/w of dibutylphthalate as a plasticizer. The physicochemical interaction between carvedilol and polymers were investigated by Fourier transform infrared spectroscopy and differential scanning calorimetry. Formulation F5 showed both maximum drug release (12.31 mg) and permeation (2987.67 microg/cm2) in 24 h, which differed significantly (P < 0.05) among all the formulations. Formulation F5 showed maximum flux (32.80 microg/h/cm2), which meets the flux requirements, and differed significantly (P < 0.05) among all the formulations with a permeation coefficient of 0.82 x 10(-2) cm/h. Fourier transform infrared spectroscopy and differential scanning calorimetry studies showed no evidence of interaction between the drug and polymers. The formulations mechanical properties, tensile strength and elastic modulus (5.89 kg/cm2 for formulation F5) reveal that they are strong but not brittle. A shelf life of 2 years was predicted for the transdermal drug delivery systems. Carvedilol monolithic matrix-type transdermal therapeutic systems could be prepared having both the required flux and suitable mechanical properties.

In vitro permeation of carvedilol through porcine skin: effect of vehicles and penetration enhancers.

This investigation studied the effect of vehicles on the in vitro permeation of carvedilol from saturated solutions across porcine skin and selected appropriate penetration enhancers. Labrasol, Transcutol, polyethylene glycol 400, propylene glycol, ethanol, oleic acid, isopropyl myristate, and phosphate buffered saline (pH 7.4) containing 40% v/v polyethylene glycol 400 as control, were used as vehicles; limonene, carvone, camphor, menthol, Transcutol, and Labrasol at 5% w/v concentrations were used as penetration enhancers. Skin permeation studies were conducted in Franz diffusion cells using excised porcine ear skin. Solubility was highest (369.13 mg/mL) in Transcutol, whereas isopropyl myristate showed the lowest solubility (0.79 mg/mL) among all the vehicles. The flux of carvedilol from Transcutol, Labrasol, polyethylene glycol 400, ethanol, and oleic acid was 10.5, 8.6, 4.2, 2.9, and 1.5 times higher, respectively, than that observed with control. The flux obtained using Transcutol was significantly higher (P < 0.05) than the flux obtained using the other vehicles. However, the flux values of carvedilol using isopropyl myristate (P < 0.01) and propylene glycol (P < 0.05) were significantly lower than that of the control. Solutions containing 5% w/v camphor showed maximum permeation (232.54 microg) in 24 h with a flux of 3.19 microg/cm2/h, which was significantly different (P < 0.05) than the flux obtained using other permeation enhancers. The control sample showed lowest permeation (30.50 microg), with a flux of 0.33 microg/cm2/h. The flux of carvedilol from the solutions containing 5% w/v camphor, limonene, Transcutol, carvone, Labrasol, and menthol were 9.7, 7.6, 7.6, 6.3, 4.7, and 2.3 times higher, respectively, than that observed using the control. The present study suggests that Transcutol, Labrasol, and polyethylene glycol 400 may be used as potential vehicles and camphor, limonene, and Transcutol at a 5% w/v level as penetration enhancers.

Development of nitrendipine transdermal patches: in vitro and ex vivo characterization.

OBJECTIVE: The aim of the investigation was to develop and evaluate matrix type transdermal drug delivery systems (TDDS) of nitrendipine (NTDP). EXPERIMENTAL: The matrix type TDDS of NTDP were prepared by solvent evaporation technique. Ten formulations (composed of Eudragit RL 100 and Hydroxypropyl methyl cellulose in the ratios of 5:0, 4:1, 3:2, 2:3, 1:4 in formulations A1, A2, A3, A4, A5 and Eudragit RS 100 and Hydroxypropyl methyl cellulose in the same ratios in formulation B1, B2, B3, B4, B5 respectively) were prepared. All formulations carried 6 % v/w of carvone as penetration enhancer and 15% v/w of propylene glycol as plasticizer in dichloromethane and methanol as solvent system. The prepared TDDS were evaluated for in vitro release, ex vivo permeation, moisture absorption, moisture content and mechanical properties. The physicochemical interactions between nitrendipine and polymers were investigated by Fourier Transform Infrared (FTIR) Spectroscopy. RESULTS: The maximum drug release in 24 hrs for A series formulations was 89.29% (A4) and 86.17% for B series (B5), which are significantly (p < 0.01) different to the lowest values (57.58 for A1 and 50.64 for B1). Again formulations A4 (flux 23.51 microg/hr/cm(2)) and B5 (flux 22.98 microg/hr/cm(2)) showed maximum skin permeation in the respective series. The flux obtained with formulation A4 and B5 meets the required flux (19.10 microg/hr/cm(2)). The mechanical properties, tensile strength, elastic modulus (3.42 kg/mm(2) for A4 and 4.25 kg/mm(2) for B5) reveal that the formulations were found to be strong but not brittle. FTIR studies did not show any evidence of interaction between the drug and the polymers. CONCLUSION: Nitrendipine matrix type transdermal therapeutic systems could be prepared with the required flux having suitable mechanical properties.

Effect of clarithromycin on the pharmacokinetics of tolbutamide.

The aim of this 2 x 2 randomized double blind crossover study was to evaluate the effect of a single dose of clarithromycin on the pharmacokinetics of tolbutamide in nine healthy male volunteers. Each volunteer received orally 500 mg of tolbutamide, or 500 mg of tolbutamide and 250 mg of clarithromycin. The washout period between the two treatments was 7 days. Serum levels of tolbutamide were determined by HPLC. Serum profiles were analysed using a non-compartmental model. Blood glucose levels were also estimated using a glucometer (Ames) and Glucostix (Bayer). There was approximately 20% increase in mean absorption rate constant and 26% increase in mean bioavailability of tolbutamide in the presence of clarithromycin. A hypoglycemic effect was reported upon co-administration of the two drugs.

Molecular cloning, nucleotide sequence, and promoter structure of the Acinetobacter calcoaceticus trpFB operon.

The trpFB operon from Acinetobacter calcoaceticus encoding the phosphoribosyl anthranilate isomerase and the beta-subunit of tryptophan synthase has been cloned by complementation of a trpB mutation in A. calcoaceticus, identified by deletion analysis, and sequenced. It encodes potential polypeptides of 214 amino acids with a calculated molecular weight of 23,008 (TrpF) and 403 amino acids with a molecular weight of 44,296 (TrpB). The encoded TrpB sequence shows striking homologies to those from other bacteria, ranging from 47% amino acids identity with the Brevibacterium lactofermentum protein and 64% identity with the Caulobacter crescentus protein. The encoded TrpF sequence, on the other hand, is much less homologous to the ones from other species, ranging between 27% identity with the Bacillus subtilis enzyme and 36% identity with the C. crescentus enzyme. The homologies of both polypeptides are evenly distributed over the entire sequences. The codon usage shows the strong preference for A and T in the third positions typical for A. calcoaceticus genes. The trpFB operon appears to be unlinked to trpA. The trpFB promoter has been determined by primer extension analysis of RNA synthesized from the chromosomally and plasmid-encoded trpFB operons. The starting nucleotides are identical in both cases and define the first promoter from A. calcoaceticus. Potential regulatory features are implied by a palindromic element overlapping the -35 consensus box of the promoter.

Analysis and nucleotide sequence of an origin of DNA replication in Acinetobacter calcoaceticus and its use for Escherichia coli shuttle plasmids.

A shuttle plasmid for Acinetobacter calcoaceticus and Escherichia coli has been constructed from a cryptic A. calcoaceticus lwoffi plasmid and pBR322. It is transformed to A. calcoaceticus BD413 by natural competency, yielding about 10(6) transformants per microgram of plasmid DNA. The ApR and TcR genes of pBR322 are functional in A. calcoaceticus. A gene bank was constructed from chromosomal A. calcoaceticus DNA and the shuttle plasmid. Direct transformation to A. calcoaceticus yielded about 95% recombinants, indicating a sixfold enrichment of recombinant plasmids compared to E. coli. One clone complementing a trpE mutation carried a 20-kb insertion and transformed with a 30-fold higher efficiency when compared to the vector. A deletion analysis of the shuttle plasmid indicates that 2.2 kb is necessary for autonomous replication and stable maintenance in A. calcoaceticus. No rearrangements of the DNA or loss of plasmids are found in that organism, even in the absence of selective pressure, when this sequence is present. A further insertional inactivation analysis creating lacZ transcriptional fusions suggests that the origin of replication (ori) is contained within about 1350 bp. Analysis of beta-galactosidase production in A. calcoaceticus indicates that only a weak promoter activity is directed out of one end of this ori. Its sequence contains A + T-rich regions, an 18-bp element with nearly perfect palindromic symmetry and eleven repeats of the consensus sequence, AAAAAATAT, eight of which are clustered within 360 bp. However, no open reading frames or significant homologies to other ori were found.