Determination of rifampicin in human plasma by high-performance liquid chromatography coupled with ultraviolet detection after automatized solid-liquid extraction.

A precise and accurate high-performance liquid chromatography (HPLC) quantification method of rifampicin in human plasma was developed and validated using ultraviolet detection after an automatized solid-phase extraction. The method was validated with respect to selectivity, extraction recovery, linearity, intra- and inter-day precision, accuracy, lower limit of quantification and stability. Chromatographic separation was performed on a Chromolith RP8 column using a mixture of 0.05 m acetate buffer pH 5.7-acetonitrile (35:65, v/v) as mobile phase. The compounds were detected at a wavelength of 335 nm with a lower limit of quantification of 0.05 mg/L in human plasma. Retention times for rifampicin and 6,7-dimethyl-2,3-di(2-pyridyl) quinoxaline used as internal standard were respectively 3.77 and 4.81 min. This robust and exact method was successfully applied in routine for therapeutic drug monitoring in patients treated with rifampicin.

Effects of nifedipine on responses to exercise in normal subjects.

The responses to sublingual nifedipine (20 mg) and placebo were compared in normal subjects during two studies on cycle ergometer [progressive exercise and constant work-load exercise at approximately 60% of maximal O2 consumption (VO2max)]. The use of nifedipine did not modify maximal power, ventilation (VE), VO2, and heart rate (HR) at the end of the multistage progressive exercise (30-W increments every 3 min). Over the 45 min of the constant-load exercise and the ensuing 30-min recovery we observed with nifedipine compared with placebo 1) no differences in VO2, VE, respiratory exchange ratio, and systolic arterial blood pressure; 2) a higher HR (P less than 0.001) and lower diastolic arterial blood pressure (P less than 0.01); 3) a greater and more prolonged rise in norepinephrine (P less than 0.01) and growth hormone (P less than 0.001); 4) no significant differences in epinephrine and insulin and a lesser increase in glucagon during recovery (P less than 0.01); and 5) a lesser fall in blood glucose (P less than 0.01) and greater increase in acetoacetate (P less than 0.001), beta-hydroxybutyrate (P less than 0.05), and blood lactate (P less than 0.001). Our data do not support the hypothesis that nifedipine reduces hormonal secretions in vivo and are best explained by an enhanced secretion of catecholamines compensating for the primary vasodilator effect of nifedipine.

Systemic morphine pharmacokinetics after ocular administration.

Pharmacokinetics of a single dose of morphine ocularly applied is reported in rabbits before and after lacrimal canaliculi ligature. Our investigations are based on a sensitive reversed-phase ion-pair chromatographic determination of morphine. This study describes the various resorption sites of morphine when administered through the conjunctiva. After ocular administration, morphine rapidly reaches high blood levels compatible with pharmacological activity. Ocular bioavailability of morphine is higher than after non-parenteral routes. Canaliculi ligature modifies the morphine pharmacokinetic profile without significant modification of drug bioavailability. Our results suggest a great capacity of drug resorption for the conjunctiva, and indicate the major role of nasal mucosa in physiological conditions.

[Clinical pharmacology of calcium inhibitors]. / Pharmacocinétique clinique des inhibiteurs calciques.

The pharmacokinetics of the commercially available calcium antagonists, diltiazem (Tildiem), nifedipine (Adalate), perhexiline (Pexid), and verapamil (Isoptine) are well known; the pharmacokinetics of bepridil (Cordium) need further study. The properties of nicarpidine, a molecule currently being tested, will also be described. These products are well absorbed from the gastrointestinal tract but undergo variable degrees of transformation during the first passage through the liver. The bioavailabilities of bepridil, diltiazem and nifedipine are of the order of 40 to 60%; those of verapamil and nicarpidine are lower, 10-20% and 15-30%, respectively. The rates of absorption vary according to the derivatives and galenic preparations; in general, they are rapid; peak plasma concentrations are usually obtained one to four hours after administration. Protein binding is high but does not interfere in the distribution; the volumes of distribution of bepridil, diltiazem and verapamil are large (4-5 l/kg); those of nifedipine and nicardipine are smaller (l l/kg). The halflives of diltiazem, nifedipine, nicardipine and verapamil are short (1 to 5 hours); those of bepridil and perhexiline are longer (2 to 3 days). The main method of elimination is by hepatic transformation with high plasma clearance rates: diltiazem and verapamil have pharmacologically active derivatives whose contributions to the overall activities of the drugs are not fully understood. Physiopathological changes of the pharmacokinetic properties of diltiazem and verapamil (elderly patients, hepatic failure) have been described.

[Human pharmacokinetics of molsidomine]. / Pharmacocinétique humaine de la molsidomine.

Molsidomine is well absorbed by the gastro-intestinal tract and is taken up by the liver during the first passage. Its bioavailability is 60 per cent. Digestive or sublingual absorption is rapid: maximal plasma concentrations are obtained 0.5 to 1.0 hours after administration. Molsidomine is minimally bound by plasma proteins and is distributed in a volume of 1 litre/kg. The excretion is essentially extrarenal: less than 2 per cent of the administered dose is excreted in the form of unchanged molsidomine. Molsidomine is metabolized in the liver to two pharmacologically active metabolites which spontaneously and rapidly breakdown into inactive metabolites which are excreted by the kidneys. The plasma half-life of molsidomine is 1 to 2 hours: it is not modified in patients with renal failure, but it is prolonged in patients with hepatic failure. The kinetics are linear and independent of the route of administration and the dose. There is a correlation between the plasma concentration and the pharmacological effect: the minimal effective concentration is about 5 ng/ml. At the usual dose of 2 mg three times a day, there is no accumulation of the drug.

Chemical stability of bupivacaine in pH-adjusted solutions.

Recent clinical studies have suggested that alkalinization of bupivacaine may shorten the time to onset and lengthen its duration of action. However, addition of sodium bicarbonate to commercially manufactured bupivacaine can rapidly produce precipitation. This study was performed to study the stability and precipitation of bupivacaine solutions 0.25% and 0.50% with and without epinephrine 1:200,000 after alkalinization. The results indicate that alkalinization does not increase precipitation above recommended limits and that the concentration of bupivacaine in solutions is maintained at least 6 h after alkalinization.

Binding of 3-carbethoxipsoralen to human serum albumin and human serum: influence of free fatty acids.

Characteristics of the binding of 3-carbethoxipsoralen (3CPS) to human serum albumin (HSA) and serum proteins have been studied. An electrophoretic study showed that the predominant binding protein fraction was albumin, with small binding to globulins. Binding to HSA, studied by equilibrium dialysis, is 75% and characterized by a small saturable number of binding sites (N = 0.27) with a moderate affinity constant (K = 8 X 10(4) M-1). Free fatty acids were shown to decrease 3CPS binding to HSA by a non competitive process.

Haemodialysis does not affect the pharmacokinetics of nifedipine.

To establish dosage recommendations in patients with end-stage renal disease undergoing chronic haemodialysis, nifedipine kinetics were studied between and during haemodialysis sessions. In eight patients, during the interdialytic period, peak plasma concentrations of nifedipine (29-332 ng/ml) were reached 0.5-1.0 h after administration of a single 10 mg oral dose. Elimination half-life and oral plasma clearance were respectively 2.6 +/- 0.5 h and 1 176 +/- 412 ml/min. Nifedipine plasma protein binding was decreased in uraemic patients (88.8 +/- 0.3% vs 94.4 +/- 0.1%) but not affected by haemodialysis. Removal by haemodialysis was low: the dialyser extraction ratio and the dialysis clearance were respectively 2.3 +/- 0.8% and 2.8 +/- 0.9 ml/min.

Diuretic effect and pharmacokinetic data observed at different stages of chronic renal failure with 240 mg of muzolimine.

Muzolimine (240 mg) was administered orally to 24 patients with chronic renal failure. In five patients with creatinine clearance ranging between 10 and 30 ml/min and five others with creatinine clearance lower than 10 ml/min, urinary output was measured in periods of 24 hours before, and 0 to 4, 4 to 10, 10 to 24, 24 to 48, 48 to 72 hours after administration of the drug. The amounts of sodium, chloride, potassium and urea excreted in each sample were determined. Our results show that the diuretic activity of muzolimine 240 mg in these patients is excellent, especially in the first four hours after its administration. Pharmacokinetic data observed in advanced renal failure (creatinine clearance between 10 and 30 ml/min) are similar to those observed in healthy subjects or patients with normal renal function. However, attention should be paid to possible accumulation of the drug in terminal renal failure (creatinine clearance lower than 10 ml/min) because a significant increase of the terminal half-life of the drug is observed in these patients. Dialysibility of the drug in haemodialysis and during chronic ambulatory peritoneal dialysis is poor.

Ganciclovir ophthalmic gel in herpes simplex virus rabbit keratitis: intraocular penetration and efficacy.

A chronic administration of three ganciclovir gels (0.2%, 0.05%, 0.0125%) was compared with a placebo gel and a 3% acyclovir ophthalmic ointment in the treatment of HSV-1 rabbit keratitis. All the ganciclovir gels showed a clinical efficacy: a significant reduction of the corneal ulcer area, clouding and vascularization (p < 0.05) and a fast inhibition of HSV isolates into tear film with the 0.2% and 0.05% ganciclovir gels. However the efficacy was slower than using acyclovir ointment. No significant difference could be shown between the 0.2% and 0.05% ganciclovir gels or the 0.05% ganciclovir gel and the acyclovir treatment on viral isolation, when it was performed on pooled samples. The distribution of ganciclovir and acyclovir into the rabbit eyes (HPLC methods), were similar but markedly higher in solid tissues than ocular fluids. It might explain the recovery from tissue damages. The mean corneal ganciclovir concentrations were largely higher than ED 50 of ganciclovir for HSV-1. No toxicity was expected, due to very limited systemic availability. This study suggests a comparable activity on HSV-1 superficial keratitis between 0.05%, 0.2% ganciclovir gels and 3% acyclovir ointment. Higher concentration of ganciclovir gels are probably necessary in order to treat the HSV-1 kerato-uveitis.