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Zhu J, Zhao Z, Chen H, Chen X, Liu J. Surface-regulated injection dose response of ultrasmall luminescent gold nanoparticles. NANOSCALE 2022; 14:8818-8824. [PMID: 35686670 DOI: 10.1039/d2nr01784a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
With the rapid growth of the use of renal-clearable nanomedicines in disease targeting and therapy, a fundamental understanding of their injection dose responses is of great importance for future translation to clinical settings. Using glutathione-coated gold nanoparticles (GS-AuNPs) as a renal-clearable nanomedicine model for the construction of ultrasmall AuNPs with different serum protein binding abilities, we discover that the concentration-dependent serum protein binding capabilities endow GS-AuNPs with a more sensitive response to injection dose than NPs resistant to serum protein binding, resulting in greatly improved tumor-targeting efficiencies during both single and repeated low-dose injections; the performance is also distinct from nonrenal-clearable AuNPs coated with serum protein, which show decreased tumor-targeting efficiency with a decrease in the injection dose.
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Affiliation(s)
- Jiayi Zhu
- Key Laboratory of Functional Molecular Engineering of Guangdong Province, School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou, 510640, China.
| | - Zhipeng Zhao
- Key Laboratory of Functional Molecular Engineering of Guangdong Province, School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou, 510640, China.
| | - Huarui Chen
- Key Laboratory of Functional Molecular Engineering of Guangdong Province, School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou, 510640, China.
| | - Xinglin Chen
- Key Laboratory of Functional Molecular Engineering of Guangdong Province, School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou, 510640, China.
| | - Jinbin Liu
- Key Laboratory of Functional Molecular Engineering of Guangdong Province, School of Chemistry and Chemical Engineering, South China University of Technology, Guangzhou, 510640, China.
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Khader H, Hasoun LZ, Alsayed A, Abu-Samak M. Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e73597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use.
This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs.
The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events.
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4
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Hogan RE, Gidal BE, Koplowitz B, Koplowitz LP, Lowenthal RE, Carrazana E. Bioavailability and safety of diazepam intranasal solution compared to oral and rectal diazepam in healthy volunteers. Epilepsia 2020; 61:455-464. [PMID: 32065672 PMCID: PMC7154760 DOI: 10.1111/epi.16449] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
Objective The study assesses the bioavailability of diazepam after intranasal administration (diazepam nasal spray) in healthy volunteers. Comparative agents were diazepam rectal gel, which served as the regulatory reference product; and oral diazepam, a product with decades of clinical use. Tolerability of diazepam nasal spray was also assessed. Methods This was a phase 1, open‐label, randomized, single‐dose, three‐treatment, three‐period, six‐sequence crossover study in 48 healthy adult subjects that consisted of a screening period, a baseline period, and an open‐label treatment period. Interperiod intervals were at least 28 days. Results Forty‐eight healthy volunteer subjects were enrolled, two of whom discontinued before receiving study medication. For all routes of administration, the onset of diazepam absorption was rapid, with measurable concentrations of drug present by the first sample time point. The tmax (time to reach maximum plasma concentration) was similar for diazepam nasal spray and diazepam rectal gel, both of which were slower than oral diazepam in fasted individuals. Variability (as defined by % coefficient of variation of geometric mean) in peak plasma concentration and area under the curve0‐∞ was lowest with oral diazepam, followed by diazepam nasal spray, with diazepam rectal gel showing the greatest variability. Overall, 131 treatment‐emergent adverse events (TEAEs) were considered mild (42 subjects, 91.3%), four TEAEs were considered moderate (four subjects, 8.3%), and no TEAEs were considered severe. The most commonly reported TEAE was somnolence at 56.5% (26/46) during diazepam nasal spray treatment, 89.1% (41/46) with the rectal diazepam gel treatment, and 82.6% (38/46) with oral diazepam treatment. No nasal irritation was observed for the majority of the subjects at any time point after administration, with no score higher than 2 (“minor bleeding that stops within 1 minute”). Significance Diazepam nasal spray shows predicable pharmacokinetics and represents a potential novel therapeutic approach to control bouts of increased seizure activity (cluster seizures, acute repetitive seizures).
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Affiliation(s)
- R Edward Hogan
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Barry E Gidal
- School of Pharmacy, University of Wisconsin, Madison, Wisconsin
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Zhang H, Lin S, Chen X, Gu L, Zhu X, Zhang Y, Reyes K, Wang B, Jin K. The effect of age, sex and strains on the performance and outcome in animal models of stroke. Neurochem Int 2018; 127:2-11. [PMID: 30291954 DOI: 10.1016/j.neuint.2018.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022]
Abstract
Stroke is one of the leading causes of death worldwide, and the majority of cerebral stroke is caused by occlusion of cerebral circulation, which eventually leads to brain infarction. Although stroke occurs mainly in the aged population, most animal models for experimental stroke in vivo almost universally rely on young-adult rodents for the evaluation of neuropathological, neurological, or behavioral outcomes after stroke due to their greater availability, lower cost, and fewer health problems. However, it is well established that aged animals differ from young animals in terms of physiology, neurochemistry, and behavior. Stroke-induced changes are more pronounced with advancing age. Therefore, the overlooked role of age in animal models of stroke could have an impact on data quality and hinder the translation of rodent models to humans. In addition to aging, other factors also influence functional performance after ischemic stroke. In this article, we summarize the differences between young and aged animals, the impact of age, sex and animal strains on performance and outcome in animal models of stroke and emphasize age as a key factor in preclinical stroke studies.
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Affiliation(s)
- Hongxia Zhang
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Siyang Lin
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Xudong Chen
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Lei Gu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Xiaohong Zhu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yinuo Zhang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Kassandra Reyes
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Brian Wang
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Kunlin Jin
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
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Xu J, Yu M, Peng C, Carter P, Tian J, Ning X, Zhou Q, Tu Q, Zhang G, Dao A, Jiang X, Kapur P, Hsieh JT, Zhao X, Liu P, Zheng J. Dose Dependencies and Biocompatibility of Renal Clearable Gold Nanoparticles: From Mice to Non-human Primates. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201710584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jing Xu
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Mengxiao Yu
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Chuanqi Peng
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Phoebe Carter
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Jia Tian
- General Research Institute for Nonferrous Metals; 2 Xinjiekou Outer St. Beijing 100088 China
| | - Xuhui Ning
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Qinhan Zhou
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Qiu Tu
- Kunming Institute of Zoology; Chinese Academy of Sciences; 32 Jiaochang Donglu Kunming 650223 China
| | - Greg Zhang
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Anthony Dao
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Xingya Jiang
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
| | - Payal Kapur
- Department of Pathology; The University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd. Dallas TX 75390 USA
- Department of Urology; The University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd. Dallas TX 75390 USA
| | - Jer-Tsong Hsieh
- Department of Urology; The University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd. Dallas TX 75390 USA
| | - Xudong Zhao
- Kunming Institute of Zoology; Chinese Academy of Sciences; 32 Jiaochang Donglu Kunming 650223 China
| | - Pengyu Liu
- General Research Institute for Nonferrous Metals; 2 Xinjiekou Outer St. Beijing 100088 China
| | - Jie Zheng
- Department of Chemistry and Biochemistry; The University of Texas at Dallas; 800 W. Campbell Rd. Richardson TX 75080 USA
- Department of Urology; The University of Texas Southwestern Medical Center; 5323 Harry Hines Blvd. Dallas TX 75390 USA
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7
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Xu J, Yu M, Peng C, Carter P, Tian J, Ning X, Zhou Q, Tu Q, Zhang G, Dao A, Jiang X, Kapur P, Hsieh JT, Zhao X, Liu P, Zheng J. Dose Dependencies and Biocompatibility of Renal Clearable Gold Nanoparticles: From Mice to Non-human Primates. Angew Chem Int Ed Engl 2017; 57:266-271. [PMID: 29160029 DOI: 10.1002/anie.201710584] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/20/2017] [Indexed: 01/05/2023]
Abstract
While dose dependencies in pharmacokinetics and clearance are often observed in clinically used small molecules, very few studies have been dedicated to the understandings of potential dose-dependent in vivo transport of nanomedicines. Here we report that the pharmacokinetics and clearance of renal clearable gold nanoparticles (GS-AuNPs) are strongly dose-dependent once injection doses are above 15 mg kg-1 : high dose expedited the renal excretion and shortened the blood retention. As a result, the no-observed-adverse-effect-level (NOAEL) of GS-AuNPs was >1000 mg kg-1 in CD-1 mice. The efficient renal clearance and high compatibility can be translated to the non-human primates: no adverse effects were observed within 90 days after intravenous injection of 250 mg kg-1 GS-AuNPs. These fundamental understandings of dose effect on the in vivo transport of ultrasmall AuNPs open up a pathway to maximize their biomedical potentials and minimize their toxicity in the future clinical translation.
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Affiliation(s)
- Jing Xu
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Mengxiao Yu
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Chuanqi Peng
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Phoebe Carter
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Jia Tian
- General Research Institute for Nonferrous Metals, 2 Xinjiekou Outer St., Beijing, 100088, China
| | - Xuhui Ning
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Qinhan Zhou
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Qiu Tu
- Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China
| | - Greg Zhang
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Anthony Dao
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Xingya Jiang
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Payal Kapur
- Department of Pathology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Jer-Tsong Hsieh
- Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Xudong Zhao
- Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China
| | - Pengyu Liu
- General Research Institute for Nonferrous Metals, 2 Xinjiekou Outer St., Beijing, 100088, China
| | - Jie Zheng
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA.,Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
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Shahzad D, Faisal M, Rauf A, Huang JH. Synthetic Story of a Blockbuster Drug: Reboxetine, a Potent Selective Norepinephrine Reuptake Inhibitor. Org Process Res Dev 2017. [DOI: 10.1021/acs.oprd.7b00265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Danish Shahzad
- Department
of Chemistry, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Muhammad Faisal
- Department
of Chemistry, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Ameema Rauf
- Department
of Chemistry, University of Wah, Wah Cantt, Pakistan
| | - Jian-hua Huang
- School
of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
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Landow L. Anesthesia for Bedside Procedures. J Intensive Care Med 2016. [DOI: 10.1177/088506669100600102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Within the past 10 years, numerous short-acting anesthetic drugs have been introduced for use in the operating room. This review article will discuss the role of these agents in critically ill patients undergoing bedside procedures. After a brief historical update, the first part of the review will focus on issues related to the pathophysiology and pharmacology of critically ill patients in general, and of specific organ dysfunction in particular. In-appropriate dosing and improper selection of agents will be highlighted. The second part of the article will discuss specific classes of drugs, with reference to their advantages and disadvantages in the ICU population. The article will conclude by emphasizing the potency, safety, and efficacy of these drugs in significantly reducing the pain and suffering experienced by patients with critical illness.
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Affiliation(s)
- Laurence Landow
- Department of Anesthesiology, Division of Critical Care Medicine, University of Massachusetts Medical Center, Worcester, MA 01655
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Pasqualetti G, Tognini S, Calsolaro V, Polini A, Monzani F. Potential drug-drug interactions in Alzheimer patients with behavioral symptoms. Clin Interv Aging 2015; 10:1457-66. [PMID: 26392756 PMCID: PMC4573195 DOI: 10.2147/cia.s87466] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The use of multi drug regimens among the elderly population has increased tremendously over the last decade although the benefits of medications are always accompanied by potential harm, even when prescribed at recommended doses. The elderly populations are particularly at an increased risk of adverse drug reactions considering comorbidity, poly-therapy, physiological changes affecting the pharmacokinetics and pharmacodynamics of many drugs and, in some cases, poor compliance due to cognitive impairment and/or depression. In this setting, drug–drug interaction may represent a serious and even life-threatening clinical condition. Moreover, the inability to distinguish drug-induced symptoms from a definitive medical diagnosis often results in addition of yet another drug to treat the symptoms, which in turn increases drug–drug interactions. Cognitive enhancers, including acetylcholinesterase inhibitors and memantine, are the most widely prescribed agents for Alzheimer’s disease (AD) patients. Behavioral and psychological symptoms of dementia, including psychotic symptoms and behavioral disorders, represent noncognitive disturbances frequently observed in AD patients. Antipsychotic drugs are at high risk of adverse events, even at modest doses, and may interfere with the progression of cognitive impairment and interact with several drugs including anti-arrhythmics and acetylcholinesterase inhibitors. Other medications often used in AD patients are represented by anxiolytic, like benzodiazepine, or antidepressant agents. These agents also might interfere with other concomitant drugs through both pharmacokinetic and pharmacodynamic mechanisms. In this review we focus on the most frequent drug–drug interactions, potentially harmful, in AD patients with behavioral symptoms considering both physiological and pathological changes in AD patients, and potential pharmacodynamic/pharmacokinetic drug interaction mechanisms.
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Affiliation(s)
- Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Tognini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Polini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Ascenzi P, Leboffe L, di Masi A, Trezza V, Fanali G, Gioia M, Coletta M, Fasano M. Ligand binding to the FA3-FA4 cleft inhibits the esterase-like activity of human serum albumin. PLoS One 2015; 10:e0120603. [PMID: 25790235 PMCID: PMC4366387 DOI: 10.1371/journal.pone.0120603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/24/2015] [Indexed: 12/19/2022] Open
Abstract
The hydrolysis of 4-nitrophenyl esters of hexanoate (NphOHe) and decanoate (NphODe) by human serum albumin (HSA) at Tyr411, located at the FA3-FA4 site, has been investigated between pH 5.8 and 9.5, at 22.0°C. Values of Ks, k+2, and k+2/Ks obtained at [HSA] ≥ 5×[NphOXx] and [NphOXx] ≥ 5×[HSA] (Xx is NphOHe or NphODe) match very well each other; moreover, the deacylation step turns out to be the rate limiting step in catalysis (i.e., k+3 << k+2). The pH dependence of the kinetic parameters for the hydrolysis of NphOHe and NphODe can be described by the acidic pKa-shift of a single amino acid residue, which varies from 8.9 in the free HSA to 7.6 and 7.0 in the HSA:NphOHe and HSA:NphODe complex, respectively; the pK>a-shift appears to be correlated to the length of the fatty acid tail of the substrate. The inhibition of the HSA-Tyr411-catalyzed hydrolysis of NphOHe, NphODe, and 4-nitrophenyl myristate (NphOMy) by five inhibitors (i.e., diazepam, diflunisal, ibuprofen, 3-indoxyl-sulfate, and propofol) has been investigated at pH 7.5 and 22.0°C, resulting competitive. The affinity of diazepam, diflunisal, ibuprofen, 3-indoxyl-sulfate, and propofol for HSA reflects the selectivity of the FA3-FA4 cleft. Under conditions where Tyr411 is not acylated, the molar fraction of diazepam, diflunisal, ibuprofen, and 3-indoxyl-sulfate bound to HSA is higher than 0.9 whereas the molar fraction of propofol bound to HSA is ca. 0.5.
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Affiliation(s)
- Paolo Ascenzi
- Interdepartmental Laboratory of Electron Microscopy, Roma Tre University, Via della Vasca Navale 79, I-00146 Roma, Italy
| | - Loris Leboffe
- Department of Sciences, Roma Tre University, Viale Guglielmo Marconi 446, I-00146 Roma, Italy
| | - Alessandra di Masi
- Department of Sciences, Roma Tre University, Viale Guglielmo Marconi 446, I-00146 Roma, Italy
| | - Viviana Trezza
- Department of Sciences, Roma Tre University, Viale Guglielmo Marconi 446, I-00146 Roma, Italy
| | - Gabriella Fanali
- Biomedical Research Division, Department of Theoretical and Applied Sciences, University of Insubria, Via Alberto da Giussano 12, I-21052 Busto Arsizio (VA), Italy
| | - Magda Gioia
- Department of Clinical Sciences and Translational Medicine, University of Roma “Tor Vergata”, Via Montpellier 1, I-00133 Roma, Italy
- Interuniversity Consortium for the Research on the Chemistry of Metals in Biological Systems, Via Celso Ulpiani 27, I-70126 Bari, Italy
| | - Massimo Coletta
- Department of Clinical Sciences and Translational Medicine, University of Roma “Tor Vergata”, Via Montpellier 1, I-00133 Roma, Italy
- Interuniversity Consortium for the Research on the Chemistry of Metals in Biological Systems, Via Celso Ulpiani 27, I-70126 Bari, Italy
| | - Mauro Fasano
- Biomedical Research Division, Department of Theoretical and Applied Sciences, University of Insubria, Via Alberto da Giussano 12, I-21052 Busto Arsizio (VA), Italy
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Abstract
Pharmacotherapy of the elderly is very complex due to age-related physiologic changes, multiple comorbidities, multiple medications (prescription, over-the counter, and herbal), and multiple providers (prescribers and pharmacies). Age-related physiologic changes and disease-related changes in organ function affect drug handling (pharmacokinetics) and response (pharmacodynamics). In addition, patients' cognitive impairment, functional difficulties, as well as caregiver issues play a large role in errors and compliance. Many older adults have several chronic conditions, and they stand to benefit the most from best practice guidelines. However, they are also at risk of toxicity given our increasingly complex pharmacopoeia and potential adverse effects that can cause morbidity and mortality. It is imperative that physicians learn how to minimize side effects and interactions. Potentially inappropriate medications (medications that pose more risk than benefit to the patient) are among the most important causes of adverse drug reactions, independent of the number of medications and other confounding factors. Many of these adverse drug reactions could be predicted from the known pharmacology of the drug and therefore could be potentially avoidable. To prescribe appropriately, we need to consider not only the pharmacological properties of the drugs, but also clinical, epidemiological, social, cultural, and economic factors. Elders' adherence to prescribed medications is also complex and depends on medical, personal, and economic factors; cognitive status; and relationship with the physician. Detection of nonadherence is a necessary prerequisite for adequate treatment, and patient education is a cornerstone in achieving medication adherence. Finally, appropriate prescribing should include a consideration of life expectancy and goals of care.
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Reidenberg MM. Drug discontinuation effects are part of the pharmacology of a drug. J Pharmacol Exp Ther 2011; 339:324-8. [PMID: 21849624 DOI: 10.1124/jpet.111.183285] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Most reviews of drug withdrawal effects focus on drugs of potential abuse such as opioids, benzodiazepines, etc. Abrupt discontinuation of many other drugs used in medicine cause withdrawal syndromes, some of which can be fatal. Discontinuation of a number of cardiovascular drugs can increase risk of cardiovascular events above that of people not taking these drugs. These include β-adrenergic receptor antagonists, aspirin, HMG-CoA reductase inhibitors (statins), and heparin. Rebound hypertension occurs after abrupt cessation of many antihypertensive drugs. The possibility of discontinuation syndromes has usually been neglected until adverse clinical events force them to be noticed. Attention to the possibility of drug discontinuation effects is an important part of drug safety evaluation.
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Reidenberg MM. From Adverse Drug Reactions to Drug Disposition to WHO and Essential Medicines to Our Discipline of Clinical Pharmacology. Clin Pharmacol Ther 2010; 87:163-5. [DOI: 10.1038/clpt.2009.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Mamun K, Lim JKH. Association between falls and high-risk medication use in hospitalized Asian elderly patients. Geriatr Gerontol Int 2009; 9:276-81. [DOI: 10.1111/j.1447-0594.2009.00533.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holmberg L, Böttiger LE. The drug-consuming patient and his drugs. I. The patient. ACTA MEDICA SCANDINAVICA 2009; 213:205-9. [PMID: 6846064 DOI: 10.1111/j.0954-6820.1983.tb03718.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient characteristics and pre-hospital drug consumption have been studied in 506 consecutive patients acutely admitted to a department of medicine. Women were older (median 69 years) than men (median 63 years) and weighed less (mean 60 vs. 74 kg). Serum creatinine values were above the normal limits in 110 patients (22%). Forty-eight per cent of men and 26% of women were smokers. Heavy alcohol intake was found in 12% of men and 4% of women. It is concluded that a typical patient group shows much greater variations in age, weight, renal function, smoking and drinking habits--factors all known to influence the results of drug treatment--than is generally taken into account when routine drugs are prescribed.
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Pollock B, Forsyth C, Bies R. The critical role of clinical pharmacology in geriatric psychopharmacology. Clin Pharmacol Ther 2008; 85:89-93. [PMID: 19037202 DOI: 10.1038/clpt.2008.229] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bg Pollock
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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19
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20
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Fahey JM, Pritchard GA, Reddi JM, Pratt JS, Grassi JM, Shader RI, Greenblatt DJ. The effect of chronic lorazepam administration in aging mice. Brain Res 2006; 1118:13-24. [PMID: 16989785 DOI: 10.1016/j.brainres.2006.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 02/14/2006] [Accepted: 08/05/2006] [Indexed: 11/21/2022]
Abstract
To assess benzodiazepine tolerance in aged animals, lorazepam or vehicle was administered chronically to male Crl: CD-1(ICR)BR mice. Pharmacodynamic and neurochemical endpoints were examined on days 1 and 14 of drug administration. There was no age-related significant difference in plasma lorazepam levels. Young and middle-aged animals demonstrated behavioral tolerance to lorazepam, while the aged animals showed a similar trend which failed to reach significance. In addition, aged animals also showed a trend toward tolerance to the anticonvulsant effects of lorazepam. There were no changes in alpha1 mRNA levels in cortex or hippocampus following administration of lorazepam when compared to vehicle-treated animals in any age group. Aged animals, however, had an initial increase in alpha1 mRNA expression in cortex and hippocampus on day 1 of vehicle treatment followed by decreased expression on day 14. These age-related changes were abolished by lorazepam administration. In summary, age-related sensitivity to the effects of lorazepam was not demonstrated in the present study. However, comparison of these data to other studies indicates that the effect of chronic benzodiazepine treatment may be specific to the benzodiazepine administered, the technique used to quantify mRNA expression changes, the subunits of the GABA(A) receptor investigated and the brain region analyzed. The phenomenon of benzodiazepine sensitivity in the elderly is an area of research which remains controversial and may well be compound specific. Determining benzodiazepines that do not produce pharmacodynamic sensitivity, such as lorazepam, may allow more careful prescribing and dosing of these drugs, and perhaps even the development of specific agents which could avoid this sensitivity.
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Affiliation(s)
- Jeanne M Fahey
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine and the Division of Clinical Pharmacology, Tufts-New England Medical Center, Boston, MA 02111, USA.
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21
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Jjemba PK. Excretion and ecotoxicity of pharmaceutical and personal care products in the environment. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2006; 63:113-30. [PMID: 16399163 DOI: 10.1016/j.ecoenv.2004.11.011] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 10/26/2004] [Accepted: 11/29/2004] [Indexed: 05/03/2023]
Abstract
The presence and fate of pharmaceutical and personal care products (PPCPs) in the environment is undergoing increasing scrutiny. The existing clinical pharmacokinetics and pharmacodynamics data for 81 common compounds were examined for cues of ecotoxicity. Of these the proportions excreted were available for 60 compounds (i.e., 74%). The compounds had a low (< or =0.5%), a moderately low (6-39%), a relatively high (40-69%), or a high (> or =70%) proportion of the parent compound excreted. More than half of the compounds evaluated have low or moderately low proportions of the parent compound excreted. However, the proportions excreted were negatively but moderately correlated (r = -0.50; n = 13; P = 0.08) with the concentrations of the compounds in the aquatic environment, suggesting that the compounds that have low proportions excreted may also have inherently low degradability in the environment. Solubility, logK(ow), and pKa work well in predicting the behavior of PPCPs under clinical conditions and have been used in the environmental assessment of PPCPs prior to approval. However, these parameters did not correlate with the proportion of PPCPs excreted in the environment or their concentration in the environment, underscoring the need for research into the behavior of PPCPs in the environment. PPCPs occur in low concentrations in the environment and are unlikely to elicit acute toxicity. An ecotoxicity potential that is based on chronic toxicity, bioavailability, and duration of exposure to nontarget organisms is described as a guide in assessing the potency of these compounds in the environment.
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Affiliation(s)
- Patrick K Jjemba
- Biological Sciences Department, University of Cincinnati, P.O. Box 210006, Cincinnati, OH 45221-0006, USA.
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Affiliation(s)
- Robert C Young
- Payne Whitney Westchester and Institute of Geriatric Psychiatry, Weill Medical College of Cornell University, White Plains, NY, USA.
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Nakazono K, Watanabe Y, Nakaya S, Asami Y, Masuhara K, Itoh F, Ogata H. Impairment state of cognitive performance and the affecting factors in outpatients following gastrointestinal endoscopy after single-dose diazepam. YAKUGAKU ZASSHI 2005; 125:307-14. [PMID: 15738630 DOI: 10.1248/yakushi.125.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diazepam is commonly used as premedicant for endoscopic procedures. Wide interindividual differences have been observed in the residual cognitive effects of the drug after gastrointestinal endoscopy. Our aim was to clarify the major factors, including pharmacokinetic factors, contributing to this wide variation in residual cognitive effect after gastrointestinal endoscopy in the study. Sixty-one outpatients undergoing gastrointestinal endoscopy participated in the study. Cognitive effects were evaluated in the diazepam group (n=52) by the digit symbol substitution test (DSST) twice before and 30 min after an intravenous administration of 5 mg diazepam; in the intervening time gastrointestinal endoscopy was performed. Plasma concentrations of diazepam were determined by HPLC. The control group (n=9) was tested by DSST in the same manner. The cognitive effects according to the change in DSST score was significantly decline in the diazepam group compared with the control group (by 0.2 versus -4.6; P=0.014). This prospective study confirmed that cognition was significantly impaired after gastrointestinal endoscopy by premedication to subjects with 5 mg diazepam. There were very wide variations in change in DSST score. However we could not identify the independent variables that best predicted DSST score difference in a multiple regression analysis for age, plasma albumin level, and plasma diazepam concentration 30 min after intravenous administration. We should pay attention to patients' individual states in cognitive performance following gastrointestinal endoscopy after single-dose diazepam.
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Affiliation(s)
- Kenichi Nakazono
- Course of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, Meiji Pharmaceutical University, Tokyo 204-8588, Japan
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Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004; 57:6-14. [PMID: 14678335 PMCID: PMC1884408 DOI: 10.1046/j.1365-2125.2003.02007.x] [Citation(s) in RCA: 994] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2002] [Accepted: 02/27/2003] [Indexed: 12/18/2022] Open
Abstract
Advancing age is characterized by impairment in the function of the many regulatory processes that provide functional integration between cells and organs. Therefore, there may be a failure to maintain homeostasis under conditions of physiological stress. The reduced homeostatic ability affects different regulatory systems in different subjects, thus explaining at least partly the increased interindividual variability occurring as people get older. Important pharmacokinetic and pharmacodynamic changes occur with advancing age. Pharmacokinetic changes include a reduction in renal and hepatic clearance and an increase in volume of distribution of lipid soluble drugs (hence prolongation of elimination half-life) whereas pharmacodynamic changes involve altered (usually increased) sensitivity to several classes of drugs such as anticoagulants, cardiovascular and psychotropic drugs. This review focuses on the main age-related physiological changes affecting different organ systems and their implications for pharmacokinetics and pharmacodynamics of drugs.
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Affiliation(s)
- A A Mangoni
- Department of Health Care of the Elderly, Guy's, King's, and St Thomas' School of Medicine, King's College London, London.
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Abstract
With the dramatic demographic change that has resulted in the "graying of the population" has come a compelling interest in the health and health concerns of older adults. The increasing incidence and prevalence of systemic diseases, especially chronic diseases, among older adults, and the concomitant increase in medication use, have provided impetus for the subspecialty of geriatric pharmacology. This article reviews the physiologic changes, nonphysiologic aspects, and pharmacologic changes associated with aging and their implications for dental practice.
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Affiliation(s)
- Marc W Heft
- Claude D. Pepper Center for Research on Oral Health in Aging, 1600 Southwest Archer Road, Gainesville, FL, USA.
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27
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Margolis SA, Carter T, Reed RL. Prescribing behavior for the elderly in the United Arab Emirates: psychotropic medication use remains low despite rising overall appropriate and inappropriate medication use. Arch Gerontol Geriatr 2002; 35:35-44. [PMID: 14764342 DOI: 10.1016/s0167-4943(01)00211-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2001] [Revised: 11/06/2001] [Accepted: 11/07/2001] [Indexed: 10/18/2022]
Abstract
Inappropriate prescribing, especially for psychotropic agents, is a common and significant cause of morbidity in older people. This cross sectional survey was conducted in the United Arab Emirates (UAE), a country with a rapidly developing economy. Prescribing behavior for people aged 65+ years acutely admitted via a university teaching hospital was examined for 1994 and 1999. All 474 patients (which resulted in 627 acute admissions; 194 in 1994 and 433 in 1999) were included. The patients had a mean age of 74.1 +/- 7.6, mean annual admission rate of 1.3 +/- 0.8 and a female:male ratio of 0.46 in 1994 rising to 0.73 in 1999 (P=0.04). Pre-admission use of five or more medications as recorded in the admission notes increased from 12% in 1994 to 23% in 1999 (P=0.001), while on discharge rose from 26 to 45% (P<0.001). There was a rise in low dose aspirin use, an indicator of appropriate prescribing, both pre-hospital (13-21%, P=0.03) and on discharge (19-29%, P=0.007). There was also a significant rise in pre-hospital inappropriate prescribing from 5 to 13% of patients demonstrating at least 1 of 144 inappropriate medications or combinations looked for (P=0.002) and at discharge from 9 to 19% (P=0.001). The rate of psychotropic medication usage (pre-hospital 0.1 per person: at discharge 0.25) was low compared to western countries and showed no significant change over time. These findings show rises in both appropriate and inappropriate prescribing with the exception of psychotropic medications during a 5-year period, which corresponded to rapid development in the health care system.
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Affiliation(s)
- Stephen Andrew Margolis
- Faculty of Medicine, Department of Family Medicine, United Arab Emirates University PO Box 17666 Al Ain United Arab Emirates.
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Abstract
The elderly take more antiepileptic drugs (AEDs) than all other adults. This extensive use directly correlates with an increased prevalence of epilepsy in a growing population of older people, as well as other neuropsychiatric conditions such as neuropathic pain and behavioral disorders associated with dementia and for which AEDs are administered. The agents account for nearly 10% of all adverse drug reactions in the elderly and are the fourth leading cause of adverse drug reactions in nursing home residents. Numerous factors associated with advanced age contribute to the high frequency of untoward drug effects in this population; however, strategies are available to ensure optimal outcomes.
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Affiliation(s)
- Thomas E Lackner
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, Institute for the Study of Geriatric Pharmacotherapy, University of Minnesota, Minneapolis 55455, USA
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Nikaido AM, Ellinwood EH, Heatherly DG, Gupta SK. Age-related increase in CNS sensitivity to benzodiazepines as assessed by task difficulty. Psychopharmacology (Berl) 2001; 100:90-7. [PMID: 1967500 DOI: 10.1007/bf02245796] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The differential sensitivity of young and elderly healthy adults to the impairment effects of benzodiazepines was assessed by tasks with several levels of difficulty. Using a double-blind procedure, single doses of placebo, alprazolam (0.75 and 1.5 mg) and triazolam (0.25 and 0.5 mg) were ingested orally by 10 young men, 9 young women, 7 elderly men, and 10 elderly women. Order of drug administration was determined by a random Latin square design. Different versions of the subcritical tracking and digit symbol substitution tasks were characterized by three difficulty levels. Assessments of task performance were conducted at varying intervals for 7 h after drug administration. Both drugs induced a rapid initial onset of impairment in the two age groups. Evidence of increased drug sensitivity in the elderly was provided by the more prolonged duration of the pharmacologic effect in the older than young subjects, especially for the harder versions of the SCT and DSS tasks. In summary, the data provide support for the hypothesis of an age-related decline in the adaptive capacity to inhibit adverse drug effects.
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Affiliation(s)
- A M Nikaido
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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30
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Caligiuri MR, Jeste DV, Lacro JP. Antipsychotic-Induced movement disorders in the elderly: epidemiology and treatment recommendations. Drugs Aging 2000; 17:363-84. [PMID: 11190417 DOI: 10.2165/00002512-200017050-00004] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We reviewed the epidemiological aspects of antipsychotic-induced movement disorders as they pertain to older patients. The incidence and prevalence of drug-induced parkinsonism and tardive dyskinesia (TD) are significantly greater in the older patient than in the younger patient whereas akathisia seems to occur evenly across the age spectrum and dystonia is uncommon among older patients. The literature on risk factors associated with treatment-emergent movement disorders is highly variable. Treatment practices vary across the age range and the interaction between age and antipsychotic dosage confounds our understanding of the relative importance of treatment-related risk factors. However, there is general agreement that pre-existing extrapyramidal signs (EPS) increase the vulnerability of the patient to developing significant drug-induced movement disorders. Elderly patients with dementia are at greater risk than patients without dementia for persistent drug-induced EPS. Management of drug-induced movement disorders in the older patient requires careful consideration of the contraindications imposed by such agents as anticholinergics and beta-blockers. At present, well-controlled double-blind studies of second-generation antipsychotics such as clozapine, risperidone. olanzapine or quetiapine for reducing the risk of treatment-emergent movement disorders in the elderly have not been published. However, open-label studies of atypical antipsychotics demonstrate a markedly lower incidence of both EPS and TD compared with conventional antipsychotic treatment in the elderly. There is emerging literature in support of atypical antipsychotics for the treatment of existing drug-induced movement disorders. More controversial is the use of adjunctive antioxidants in newly treated patients who are vulnerable to drug-induced movement disorders. While the evidence is mixed in support of antioxidants for the treatment of TD, the possibility remains that prophylactic use of antioxidants may help reduce the incidence of TD. The development of a drug-induced movement disorder often reduces the quality of life in an elderly patient. Effective pharmacological management requires cooperation from the patient and family, which can be fostered early in the patient's care through proper informed consent. The risks and benefits of antipsychotic treatment in the elderly patient need to be communicated to the patient and family. At the present time, there is no consistently effective treatment for patients with TD once it develops. Therefore, attention should focus on its prevention and close monitoring.
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Affiliation(s)
- M R Caligiuri
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093, USA.
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31
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Hämmerlein A, Derendorf H, Lowenthal DT. Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clin Pharmacokinet 1998; 35:49-64. [PMID: 9673834 DOI: 10.2165/00003088-199835010-00004] [Citation(s) in RCA: 201] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Age-related changes in pharmacokinetics principally affect drug absorption, distribution, metabolism and elimination. Changes in pharmacodynamics are primarily seen in the cardiovascular and neuroendocrine system. Age-dependent changes in the kinetics and dynamics of drugs acting on the cardiovascular system and central nervous system are common, and this review, while by no means exhaustive of the effects of drugs on all organ systems, is reflective of the principles and gives examples of the effects of age on these 2 major systems. While pharmacokinetic changes in the elderly are usually well characterised, pharmacodynamic changes are understood only in the most preliminary way. There has been relatively little research in this area of geriatric clinical pharmacology, and pharmacodynamic changes are still an area of investigation.
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Affiliation(s)
- A Hämmerlein
- Department of Pharmaceutics, University of Florida, Gainesville, USA
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32
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Kaplan GB, Greenblatt DJ, Ehrenberg BL, Goddard JE, Harmatz JS, Shader RI. Single-dose pharmacokinetics and pharmacodynamics of alprazolam in elderly and young subjects. J Clin Pharmacol 1998; 38:14-21. [PMID: 9597554 DOI: 10.1002/j.1552-4604.1998.tb04370.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The pharmacokinetics and pharmacodynamics of the benzodiazepine anxiolytic alprazolam (1 mg orally) were compared between young and elderly healthy volunteers. Eight young subjects (mean age 29.8 years) and eight elderly volunteers (mean age 68.4 years) received oral placebo and alprazolam (1.0 mg) in a randomized, double-blind, single-dose crossover study. In the elderly subjects, plasma concentrations were higher, although not significantly so, than in young volunteers 0.25, 0.5, and 0.75 hours after dosage. Apparent elimination half-life, time of maximum concentration, maximum concentration, volume of distribution, and apparent clearance were similar for the two groups. In both groups, alprazolam treatment (versus placebo) produced significant changes in typical benzodiazepine agonist effects, such as increased sedation and fatigue, reduced excitement, increased feelings of spaciness, and perception of thinking slowed. For some measures, the alprazolam-placebo difference was greater in young than in elderly subjects. In both groups, alprazolam significantly impaired performance on the digit-symbol substitution test (DSST). EEG studies indicated significant increases in relative beta amplitude (13-30 Hz range) after alprazolam compared to placebo. Percent DSST decrement and percent EEG change were highly correlated with plasma alprazolam concentrations for both groups. There were modest increases in alprazolam plasma concentration in the elderly compared to the younger group shortly after drug administration, but there was no evidence of increased sensitivity to the pharmacodynamic effects of alprazolam in the elderly.
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Affiliation(s)
- G B Kaplan
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, Massachusetts, USA
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33
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Catterson ML, Preskorn SH, Martin RL. Pharmacodynamic and pharmacokinetic considerations in geriatric psychopharmacology. Psychiatr Clin North Am 1997; 20:205-18. [PMID: 9139291 DOI: 10.1016/s0193-953x(05)70401-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Age-associated decreases in metabolism and elimination of drugs are sufficient to give one pause before prescribing drugs in the elderly particularly if multiple drugs are to be used. When one factors in concomitant drugs that may inhibit P450-mediated metabolism of other more toxic drugs, genetic deficiency of P450 enzymes, and medical illnesses such as liver and renal failure that will lead to further elevation of drug levels and delay in drug clearance, the likelihood of adverse events when multiple drugs are used in the elderly becomes truly dizzying. In consideration of the pharmacologic principles discussed, when prescribing drugs in the elderly, one might add to the often heard recommendation, "Start low and go slow," a third admonition, "Keep it as simple as possible!"
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Affiliation(s)
- M L Catterson
- Psychiatric Research Institute, Wichita, Kansas, USA
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Weinbroum A, Rudick V, Sorkine P, Fleishon R, Geller E. Long-term intravenous and oral flumazenil treatment of acute diazepam overdose in an older patient. J Am Geriatr Soc 1996; 44:737-8. [PMID: 8642175 DOI: 10.1111/j.1532-5415.1996.tb01850.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Beizer JL. Hypnotic Use in the Elderly. J Pharm Pract 1995. [DOI: 10.1177/089719009500800504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances are a common complaint in the geriatric population. Studies have shown that older people have a different sleep architecture as compared with that of younger people. Older patients with sleep complaints should be evaluated for underlying causes of sleep disturbances such as medication use, medical or psychiatric illnesses. Common sleep disorders in the elderly include sleep apnea, nocturnal myoclonus, restless leg syndrome, and insomnia. To treat insomnia, initial therapy should be nonpharmacological measures such as good sleep hygiene. If pharmacological treatment is necessary, a short course with a low dose of a short or intermediate-acting benzodiazepine or Zolpidem can be attempted. Because of pharmacokinetic and pharmacodynamic alterations, elderly patients are particularly susceptible to the central nervous systemic side effects of hypnotic agents and should be closely monitored.
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Affiliation(s)
- Judith L. Beizer
- Department of Clinical Pharmacy Practice, College of Pharmacy & Allied Health Professions, St. John's University, Jamaica, NY
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McGaughy J, Sarter M. Behavioral vigilance in rats: task validation and effects of age, amphetamine, and benzodiazepine receptor ligands. Psychopharmacology (Berl) 1995; 117:340-57. [PMID: 7770610 DOI: 10.1007/bf02246109] [Citation(s) in RCA: 233] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An operant task for the measurement of sustained attention or vigilance in rats was characterized. The task requires the animals to respond to the presentation of visual signals (presented for 25, 50, or 500 ms) by operating one lever ("hits") and to the absence of a signal by operating the opposite lever ("correct rejection"). Incorrect responses ("misses" and "false alarms", respectively) were not rewarded. Performance in this task is a function of signal length, i.e., the shorter the signals the higher the number of misses. An increase in "background noise" by flashing the chamber houselight (at 0.5 Hz) impaired the animals' ability to discriminate between signal and non-signal events. Also flashing the houselight augmented the vigilance decrement observed for shortest signals. An increase in the event-rate also resulted in a vigilance decrement. Finally, the inability of the animals to time signals was examined by testing the effects of an increase in event asynchrony. In a second experiment, the performance of differently aged rats (6- and 20 month-old male BNNia/F344 rats) was studied. Compared to young animals, 20-month-old rats showed a decrease in their ability to discriminate between shortest signals (25 ms) and non-signal events but did not differ in their ability to correctly reject non-signal trials. Administration of the benzodiazepine receptor (BZR) agonist chlordiazepoxide (CDP; 3, 5, 8 mg/kg) resulted in an impairment of the animals' ability to discriminate between signal and non-signal events and, similar to the effects of age, this effect was exclusively due to an increase in the number of misses. CDP generally produced potent effects while affecting the aged animals to a greater degree. BZR-ligands with weak or "selective" inverse agonist properties (ZK 93426; beta-CCtB) did not affect vigilance performance. The BZR partial inverse agonist RU 33965 (0.1, 0.5 mg/kg) dose-dependently impaired vigilance performance. The administration of amphetamine (0.4, 0.8 mg/kg) also impaired performance, but these impairments were possibly based on effects unrelated to attentional mechanisms. The finding that performance in this task revealed the interactions between the effects of age and BZR agonists on attentional abilities further supports the validity of measures of performance generated by this task.
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Affiliation(s)
- J McGaughy
- Department of Psychology, Ohio State University, Columbus 43210, USA
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41
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Abstract
The fatal toxicity indices of benzodiazepines during the 1980s were calculated from national prescribing data and mortality statistics. The overall rate was 5.9 deaths per million prescriptions for benzodiazepines taken alone or with alcohol only, anxiolytics being less toxic than hypnotics. Diazepam appeared more toxic than average among anxiolytics (P < 0.05), and flurazepam and temazepam more toxic than average among hypnotics (both P < 0.001). It was shown that the finding for diazepam was probably explained by concurrent use of alcohol, which implies that other anxiolytics may be safer in cases where there is alcohol misuse; but the greater toxicity of flurazepam and temazepam remained unexplained. Benzodiazepines are indeed much less toxic than the barbiturates they superseded, but they are not innocuous and temazepam in particular requires further evaluation.
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Affiliation(s)
- M Serfaty
- Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne
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42
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Sonne J. Factors and conditions affecting the glucuronidation of oxazepam. PHARMACOLOGY & TOXICOLOGY 1993; 73 Suppl 1:1-23. [PMID: 8415417 DOI: 10.1111/j.1600-0773.1993.tb01924.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of the present work was to investigate the impact of disease states and environmental and host factors on the glucuronidation of oxazepam. Glucuronidation represents quantitatively one of the most important metabolic conjugation pathways (phase II) in man for the inactivation and detoxication of xenobiotics and endogenous compounds and the liver is the major site for it to take place. Far less attention has been paid to the conjugation reactions in previous clinical research in this field compared to the immense interest in the oxidative biotransformation pathways (phase I). This fact is mainly due to the latter giving rise to active or reactive metabolites with a toxicological potential. The metabolism of oxazepam expresses exclusively the capacity for glucuronide formation. It was a prerequisite to establish the bioavailability of oxazepam prior to succeeding studies on the oral disposition of the drug. A preparation for intravenous administration was created. Clearance was chosen as measurement of the capacity to glucuronidate oxazepam. Severe decompensated liver disease was associated with a significant decrease in oxazepam clearance, that became even more obvious when corrected for by a diminished binding to plasma proteins. This increase in free fraction of oxazepam was substantial and could mainly be accounted for by low plasma albumin values. The results are in part a settlement with earlier studies on glucuronidation in liver disease and they may undoubtedly be ascribed to the severe degree of liver disease. For the first time it was shown that hypothyroidism led to a decline in the clearance and metabolism of oxazepam and paracetamol that is mainly biotransformed by glucuronidation. It was concluded that the enzymes responsible for glucuronidation in hypothyroidism are under the influence of thyroid hormones as is the case with oxidative enzymes. Further studies focused on the effect of host and environmental factors on glucuronidation. A commercially available very low calorie product for the treatment of obesity resulted in a decrease in oxazepam clearance and a lack of co-factors as a consequence of the low calorie intake was explanatorily proposed. Beta-adrenoceptor antagonists are often prescribed together with other drugs and close knowledge on interactions is mandatory but insufficient in regard of drugs being glucuronidated. Despite the mutual metabolic pathway labetalol exerted no dispositional alterations concerning oxazepam. It was moreover suggested that very elderly subjects between the age of 80 to 94 years had a reduced clearance of oxazepam.(ABSTRACT TRUNCATED AT 400 WORDS)
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45
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Affiliation(s)
- L Kragie
- Department of Biological Sciences, Faculty of Natural Sciences and Mathematics, State University of New York, Buffalo 14260
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46
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Moore H, Dudchenko P, Bruno JP, Sarter M. Toward modeling age-related changes of attentional abilities in rats: Simple and choice reaction time tasks and vigilance. Neurobiol Aging 1992; 13:759-72. [PMID: 1362798 DOI: 10.1016/0197-4580(92)90100-c] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Fischer-344 rats aged 4, 12, or 18 months were trained in a simple or choice reaction time task (SRTT; CRTT). Animals were required to detect a brief (50 ms), rarely, and unpredictably occurring signal that was presented either at the central panel light (SRTT) or above one of the two levers (CRTT). Animals reported detection by pressing either lever (SRTT) or the cued lever (CRTT) within 3 s. False alarm rates were obtained from a nonsignal 3-s bin. In comparison to younger animals, 18-month-old animals showed a reduced signal detectability, and this effect did not interact with practice. These results suggest that age affected vigilance and practice did not attenuate this effect. The benzodiazepine receptor agonist chlordiazepoxide (at subsedative doses; 1, 3, and 5 mg/kg) and the beta-carboline ZK 93 426 (1, 3, and 5 mg/kg) failed to affect signal detectability. Scopolamine HBr and MBr impaired detectability and responsivity to a similar extent. However, scopolamine MBr, unlike the tertiary compound, failed to affect response accuracy in the CRTT. It is speculated that the failure of chlordiazepoxide to affect performance was related to low processing demands of both tasks. Although these behavioral models show good face validity, they do not allow determination of the major components of attentional processes (perceptual sensitivity, response criterion, processing capacity). Animal behavioral paradigms that allow determination of such components are required for the investigation of the neuronal basis of age-related changes in attentional abilities.
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Affiliation(s)
- H Moore
- Department of Psychology, Ohio State University, Columbus 43210
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47
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Stijnen AM, Postel-Westra I, Langemeijer MW, Hoogerkamp A, Voskuyl RA, van Bezooijen CF, Danhof M. Pharmacodynamics of the anticonvulsant effect of oxazepam in aging BN/BiRij rats. Br J Pharmacol 1992; 107:165-70. [PMID: 1330159 PMCID: PMC1907588 DOI: 10.1111/j.1476-5381.1992.tb14481.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
1. The purpose of this investigation was to examine the influence of increasing age on the pharmacokinetics and the time course of the anticonvulsant response of oxazepam in BN/BiRij rats as an animal model of aging. 2. Oxazepam was administered intravenously in a dose of 12 mg kg-1 body weight and the anticonvulsant effect intensity was measured as elevation above baseline of a threshold for induction of localized seizure activity (TLS). Direct cortical stimulation with ramp shaped electrical pulse trains of increasing intensity was used to determine this threshold. 3. The pharmacological effect vs. time profile showed in young rats an anticonvulsant component followed by proconvulsant component which is suggestive for the occurrence of acute tolerance and/or withdrawal syndrome. With increasing age the proconvulsant component disappeared, resulting in a monophasic effect profile (anticonvulsant effect only) at the age of 35 months with significantly higher anticonvulsant effect intensity immediately following drug administration. No age-related changes in the pharmacokinetic parameters of oxazepam were observed. 4. In five animals of each age group, benzodiazepine receptor binding characteristics were determined in vitro with [3H]-flunitrazepam as a ligand. Both receptor density and affinity did not show age-related changes. Available literature data on post-receptor events do not indicate conclusive age-related changes. 5. It is concluded, that the observed change in the pharmacodynamics of anticonvulsant effect of oxazepam can be explained by the disappearance of the tolerance/withdrawal phenomenon. This is compatible with a decreased efficiency of homeostatic control mechanisms in the elderly.
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Affiliation(s)
- A M Stijnen
- Center for Bio-Pharmaceutical Sciences, University of Leiden, The Netherlands
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48
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Wachtel RE, Wegrzynowicz ES. Kinetics of nicotinic acetylcholine ion channels in the presence of intravenous anaesthetics and induction agents. Br J Pharmacol 1992; 106:623-7. [PMID: 1380387 PMCID: PMC1907569 DOI: 10.1111/j.1476-5381.1992.tb14385.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
1. Single channel currents activated by 250 nM acetylcholine were recorded from cell-attached patches of BC3H1 mouse tumour cells grown in culture. Channels were recorded in the absence and presence of alphaxalone, diazepam, etomidate, fentanyl, ketamine, meperidine, or propofol. 2. All of the anaesthetics tested shortened channel open time but did not alter single channel current amplitude. Drug concentrations calculated to reduce the time constant of open-time distributions by 50% were 99 microM alphaxalone, 66 microM diazepam, 57 microM etomidate, 26 microM fentanyl, 15 microM ketamine, 16 microM meperidine, or 81 microM propofol. 3. Ketamine, meperidine, and propofol reduced channel open time at concentrations comparable to plasma levels attained during therapeutic use of these agents, while alphaxalone, diazepam, etomidate, and fentanyl reduced channel open time only at levels higher than those encountered clinically. 4. The potency of these drugs in decreasing channel open time appears to be directly correlated with their octanol/buffer partition coefficients. In contrast to expectations, however, agents with higher partition coefficients were less potent in altering channel open time. 5. Ketamine and meperidine produced a prominent third component in closed-time distributions, which were otherwise well described by the sum of two exponential components. Alphaxalone, diazepam, and etomidate also produced a small third component, while no additional component was seen with propofol or fentanyl. These additional components probably arise from creation of an additional closed state of the channel. 6. We conclude that these agents are not altering channel properties merely by exerting non-specific effects via the lipid bilayer and that they are probably not all acting by similar mechanisms.
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Affiliation(s)
- R E Wachtel
- Department of Veterans Affairs Medical Center, Iowa City, IA 52246
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49
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Greenblatt DJ, Harmatz JS, Shader RI. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly. Therapeutic considerations (Part II). Clin Pharmacokinet 1991; 21:262-73. [PMID: 1684744 DOI: 10.2165/00003088-199121040-00003] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Part I of this article, which appeared in the previous issue of the Journal, discussed the scope of and scientific basis for special pharmacokinetic studies of anxiolytic and hypnotic drugs in the elderly, and examined the methodology and results of such studies and the prediction of pharmacokinetic changes. In Part II the authors continue their review, focusing on age-related pharmacodynamic changes in the effects of these drugs, the attempts to correlate pharmacokinetic with pharmacodynamic findings, and the clinical applications of these data.
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Affiliation(s)
- D J Greenblatt
- Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts
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50
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Holmes D, Nuesch E, Houle JM, Rosenthaler J. Steady state pharmacokinetics of hydrolysed bopindolol in young and elderly men. Eur J Clin Pharmacol 1991; 41:175-8. [PMID: 1683836 DOI: 10.1007/bf00265913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Steady-state pharmacokinetic parameters of the new, long-acting beta-adrenoceptor blocker bopindolol have been measured in 17 young and 20 elderly healthy men. The t 1/2 beta and the AUC(0----24 h) of hydrolysed bopindolol (the active metabolite) were both increased (40% and 26%, respectively) in the elderly subjects but tmax, Cmax and CL/f were not altered. However, after adjusting the parameters to allow for the different average body weights of the two groups, Cmax and CL/f became significantly different (+29% and -30%, respectively). AUC(0----24 h) was increased by 41%. The changes of up to 41% in pharmacokinetic parameters were smaller than the alterations of 50-100% usually seen when titrating doses of antihypertensive drugs. The clinical relevance of the effects was not examined, but similar changes have been reported for other beta-blockers which did not appear to be clinically relevant and did not affect the dosage required to treat hypertension.
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Affiliation(s)
- D Holmes
- Clinical Research Department, Sandoz Pharma Ltd., Basel, Switzerland
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