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Martchenko Shilman M, Bartolo G, Alameh S, Peterson JW, Lawrence WS, Peel JE, Sivasubramani SK, Beasley DWC, Cote CK, Demons ST, Halasahoris SA, Miller LL, Klimko CP, Shoe JL, Fetterer DP, McComb R, Ho CLC, Bradley KA, Hartmann S, Cheng LW, Chugunova M, Kao CY, Tran JK, Derbedrossian A, Zilbermintz L, Amali-Adekwu E, Levitin A, West J. In Vivo Activity of Repurposed Amodiaquine as a Host-Targeting Therapy for the Treatment of Anthrax. ACS Infect Dis 2021; 7:2176-2191. [PMID: 34218660 PMCID: PMC8369491 DOI: 10.1021/acsinfecdis.1c00190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anthrax is caused by Bacillus anthracis and can result in nearly 100% mortality due in part to anthrax toxin. Antimalarial amodiaquine (AQ) acts as a host-oriented inhibitor of anthrax toxin endocytosis. Here, we determined the pharmacokinetics and safety of AQ in mice, rabbits, and humans as well as the efficacy in the fly, mouse, and rabbit models of anthrax infection. In the therapeutic-intervention studies, AQ nearly doubled the survival of mice infected subcutaneously with a B. anthracis dose lethal to 60% of the animals (LD60). In rabbits challenged with 200 LD50 of aerosolized B. anthracis, AQ as a monotherapy delayed death, doubled the survival rate of infected animals that received a suboptimal amount of antibacterial levofloxacin, and reduced bacteremia and toxemia in tissues. Surprisingly, the anthrax efficacy of AQ relies on an additional host macrophage-directed antibacterial mechanism, which was validated in the toxin-independent Drosophila model of Bacillus infection. Lastly, a systematic literature review of the safety and pharmacokinetics of AQ in humans from over 2 000 published articles revealed that AQ is likely safe when taken as prescribed, and its pharmacokinetics predicts anthrax efficacy in humans. Our results support the future examination of AQ as adjunctive therapy for the prophylactic anthrax treatment.
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Affiliation(s)
- Mikhail Martchenko Shilman
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
- Shield Pharma LLC, 1420 North Claremont Boulevard, Suite 102A, Claremont, California 91711, United States
| | - Gloria Bartolo
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Saleem Alameh
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Johnny W. Peterson
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), 301 University Boulevard, Galveston, Texas 77555, United States
| | - William S. Lawrence
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), 301 University Boulevard, Galveston, Texas 77555, United States
| | - Jennifer E. Peel
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), 301 University Boulevard, Galveston, Texas 77555, United States
| | - Satheesh K. Sivasubramani
- Directorate of Environmental Health Effects Laboratory, Naval Medical Research Unit, Wright-Patterson Air Force Base, 2728 Q Street, Building 837, Wright-Patterson AFB, Ohio 45433, United States
| | - David W. C. Beasley
- Department of Microbiology and Immunology, University of Texas Medical Branch (UTMB), 301 University Boulevard, Galveston, Texas 77555, United States
| | - Christopher K. Cote
- Bacteriology Division, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Maryland 21702, United States
| | - Samandra T. Demons
- Bacteriology Division, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Maryland 21702, United States
| | - Stephanie A. Halasahoris
- Bacteriology Division, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Maryland 21702, United States
| | - Lynda L. Miller
- Bacteriology Division, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Maryland 21702, United States
| | - Christopher P. Klimko
- Bacteriology Division, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Maryland 21702, United States
| | - Jennifer L. Shoe
- Bacteriology Division, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Maryland 21702, United States
| | - David P. Fetterer
- Biostatistics Division, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Maryland 21702, United States
| | - Ryan McComb
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Chi-Lee C. Ho
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles (UCLA), 609 Charles E. Young Drive East, Los Angeles, California 90095, United States
| | - Kenneth A. Bradley
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles (UCLA), 609 Charles E. Young Drive East, Los Angeles, California 90095, United States
| | - Stella Hartmann
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Luisa W. Cheng
- Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, United States Department of Agriculture (USDA), 800 Buchanan Street, Albany, California 94710, United States
| | - Marina Chugunova
- Institute of Mathematical Sciences, Claremont Graduate University (CGU), 150 East 10th Street, Claremont, California 91711, United States
| | - Chiu-Yen Kao
- Department of Mathematical Sciences, Claremont McKenna College (CMC), 888 North Columbia Avenue, Claremont, California 91711, United States
| | - Jennifer K. Tran
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Aram Derbedrossian
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Leeor Zilbermintz
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Emiene Amali-Adekwu
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Anastasia Levitin
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
| | - Joel West
- Henry E. Riggs School of Applied Life Sciences, Keck Graduate Institute (KGI), 535 Watson Drive, Claremont, California 91711, United States
- Shield Pharma LLC, 1420 North Claremont Boulevard, Suite 102A, Claremont, California 91711, United States
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High-throughput quantitation method for amodiaquine and desethylamodiaquine in plasma using supported liquid extraction technology. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1179:122887. [PMID: 34364298 PMCID: PMC8417464 DOI: 10.1016/j.jchromb.2021.122887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022]
Abstract
Amodiaquine is a drug used for treatment of malaria and is often used in combination with artesunate in areas where malaria parasites are still susceptible to amodiaquine. Liquid chromatography tandem-mass spectrometry was used to quantify amodiaquine and its active metabolite, desethylamodiaquine, in plasma samples. A low sample volume of 100 µl, and high-throughput extraction technique using a supported liquid extraction (SLE+) technique on an automated liquid handler platform for faster sample processing are some of the advantages of this method. Separation of amodiaquine from desethylamodiaquine was achieved using a reversed phase Zorbax SB-CN 50 mm × 4.6 mm, I.D. 3.5 µm column with acetonitrile and 20 mM ammonium formate with 1% formic acid pH ~ 2.6 (15-85, v/v) as mobile phase. The absolute recoveries of amodiaquine and desethylamodiaquine were 66% to 76%, and their isotope label internal standard were in the range of 73% to 85%. Validation results of the developed method demonstrated intra-batch and inter-batch precisions within the acceptance criteria range of ± 15.0%. There were no matrix or carry-over effects observed. The lower limit of quantification was 1.08 ng/ml for amodiaquine and 1.41 ng/ml for desethylamodiaquine. The method showed robust and accurate performance with high sensitivity. Thus, the validated method was successfully implemented and applied in the evaluation of a clinical trial where participants received artemether-lumefantrine plus amodiaquine twice daily for three days (amodiaquine dose of 10 mg base/kg/day).
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Martins YA, Gonçalves TM, Lopez RFV. HPLC methods for choloroquine determination in biological samples and pharmaceutical products. Daru 2021; 29:223-239. [PMID: 33738722 PMCID: PMC8149527 DOI: 10.1007/s40199-021-00391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Review and assess pharmaceutical and clinical characteristics of chloroquine including high-performance liquid chromatography (HPLC)-based methods used to quantify the drug in pharmaceutical products and biological samples. EVIDENCE ACQUISITION A literature review was undertaken on the PubMed, Science Direct, and Scielo databases using the following keywords related to the investigated subject: 'chloroquine', 'analytical methods', and 'HPLC'. RESULTS For more than seven decades, chloroquine has been used to treat malaria and some autoimmune diseases, such as lupus erythematosus and rheumatoid arthritis. There is growing interest in chloroquine as a therapeutic alternative in the treatment of HIV, Q fever, Whipple's disease, fungal, Zika, Chikungunya infections, Sjogren's syndrome, porphyria, chronic ulcerative stomatitis, polymorphic light eruption, and different types of cancer. HPLC coupled to UV detectors is the most employed method to quantify chloroquine in pharmaceutical products and biological samples. The main chromatographic conditions used to identify and quantify chloroquine from tablets and injections, degradation products, and metabolites are presented and discussed. CONCLUSION Research findings reported in this article may facilitate the repositioning, quality control, and biological monitoring of chloroquine in modern pharmaceutical dosage forms and treatments.
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Affiliation(s)
- Yugo Araújo Martins
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo (FCFRP-USP), Avenida do Café, s/n, Ribeirao Preto, São Paulo, 14040-903, Brazil
| | - Talita Mota Gonçalves
- School of Pharmaceutical Sciences, Universidade Federal do Vale do São Francisco, Avenida José de Sá Maniçoba, s/n, Petrolina, Pernambuco, 56304-917, Brazil
| | - Renata F V Lopez
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo (FCFRP-USP), Avenida do Café, s/n, Ribeirao Preto, São Paulo, 14040-903, Brazil.
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Saka C. Analytical Methods on Determination in Pharmaceuticals and Biological Materials of Chloroquine as Available for the Treatment of COVID-19. Crit Rev Anal Chem 2020; 52:19-34. [PMID: 32628049 DOI: 10.1080/10408347.2020.1781592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the outbreak caused by the severe acute respiratory syndrome coronavirus (COVID-19), people's health and existing economies on a global scale are seriously threatened. Currently, most of the countries all over the world are studying extensively to better understand the antimalarial chloroquine (CQ) and hydroxychloroquine (HCQ) for therapeutic purposes due to the COVID-19 outbreak. However, CQ and HCQ can have serious side effects, from psychiatric effects to sudden death. Therefore, a faster and more effective detection method is needed to monitor drug concentrations. In this review, a large study was conducted on the detection techniques and quantitative determination methods of CQ and its related metabolites. In this review, chromatography, electrophoresis, electroanalytical, spectroscopic, and immunological methods for CQ and related metabolites are discussed extensively. It is hoped that a better understanding of the CQ used for therapeutic purposes in the COVID-19 outbreak will be provided.
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Affiliation(s)
- Cafer Saka
- Faculty of Health Sciences, Siirt University, Siirt, Turkey
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Chiwunze TE, Palakollu VN, Gill AA, Kayamba F, Thapliyal NB, Karpoormath R. A highly dispersed multi-walled carbon nanotubes and poly(methyl orange) based electrochemical sensor for the determination of an anti-malarial drug: Amodiaquine. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 97:285-292. [DOI: 10.1016/j.msec.2018.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/05/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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High sensitivity methods to quantify chloroquine and its metabolite in human blood samples using LC-MS/MS. Bioanalysis 2019; 11:333-347. [PMID: 30873854 PMCID: PMC6562699 DOI: 10.4155/bio-2018-0202] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Chloroquine is an antimalarial drug used in the treatment of Plasmodium vivax malaria. Three methods to quantify chloroquine and its metabolite in blood matrices were developed and validated. Methodology & results: Different high-throughput extraction techniques were used to recover the drugs from whole blood (50 μl), plasma (100 μl) and dried blood spots (15 μl as punched discs) followed by quantification with LC–MS/MS. The intra- and inter-batch precisions were below 15%, and thus meet regulatory acceptance criteria. Conclusion: The developed methods demonstrated satisfactory validation performance with high sensitivity and selectivity. The assays used simple and easy to automate extraction techniques. All methods were reliable with robust performance and demonstrated to be suitable to implement into high-throughput routine analysis of clinical pharmacokinetic samples.
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Olawoye OS, Adeagbo BA, Bolaji OO. Moringa oleifera leaf powder alters the pharmacokinetics of amodiaquine in healthy human volunteers. J Clin Pharm Ther 2018; 43:626-632. [PMID: 29920710 DOI: 10.1111/jcpt.12725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Moringa oleifera (MO) Lam (Moringaceae) is commonly used as food supplement and as medicine in most African countries where malaria is also endemic. Therefore, co-administration of MO with antimalarials is a possibility. This study investigated the effects of MO leaves powder on the pharmacokinetics of amodiaquine (AQ) in human subjects. METHODS Twenty healthy volunteers were recruited for the 3-period study. In the first period, a single dose of AQ tablet (10 mg/kg) was administered orally after an overnight fast. After a 7-day washout period, AQ was co-administered with MO. For the third period, each subject took 3 g MO once daily for 7 days and on the 8th day, MO was co-administered with AQ. The plasma concentrations of amodiaquine and desethylamodiaquine (DEAQ) were simultaneously determined using a validated HPLC method. RESULTS AND DISCUSSION The results showed a significant decrease (P = .037) in the Cmax of AQ after concurrent administration (CA) with MO, whereas after pretreatment (PT), there was a 32% decrease in the Cmax of AQ. For the metabolite, DEAQ, Cmax increased significantly (P = .006) by 79.36%, and Cmax in PT was significantly higher than (P = .001) that of the CA arm of the study. AUC of DEAQ increased significantly by 40.4% (P = .006) and by 188% (P = .001) after CA and PT, respectively. WHAT IS NEW AND CONCLUSION The study established pharmacokinetic interaction between AQ and MO when given together or following a long period of ingestion of MO. This may have clinical implications for malaria therapy.
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Affiliation(s)
- O S Olawoye
- Department of Pharmaceutical Chemistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - B A Adeagbo
- Department of Pharmaceutical Chemistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - O O Bolaji
- Department of Pharmaceutical Chemistry, Obafemi Awolowo University, Ile-Ife, Nigeria
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Development and validation of an HILIC-MS/MS method by one-step precipitation for chloroquine in miniature pig plasma. Bioanalysis 2016; 8:1159-71. [PMID: 27211608 PMCID: PMC7099630 DOI: 10.4155/bio-2015-0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Quantification of polar compounds such as chloroquine by revered-phase LC is a challenge because of poor retention and silanol interactions with stationary phase. Strong ion-pairing reagents added to mobile phases to improve reversed-phase retention and improve peak shape can be harmful for MS. Results: This new approach provides a rapid and sensitive method for the detection of chloroquine using hydrophilic interaction LC coupled to MS/MS (HILIC–MS/MS). Ammonium formate and formic acid were added to mobile phase to attain good peak shapes and the salified chloroquine as well retained in an HILIC column. Linearity, intra- and inter-day precision, accuracy, recovery, matrix effect and stability were evaluated during the validation process. Conclusion: The validated method has been successfully used in a PK study in miniature pigs, and paves way for future development.
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Rathod DM, Patel KR, Mistri HN, Jangid AG, Shrivastav PS, Sanyal M. Application of an LC–MS/MS method for reliable determination of amodiaquine, N -desethylamodiaquine, artesunate and dihydroartemisinin in human plasma for a bioequivalence study in healthy Indian subjects. J Pharm Biomed Anal 2016; 124:67-78. [DOI: 10.1016/j.jpba.2016.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 02/07/2016] [Accepted: 02/17/2016] [Indexed: 01/08/2023]
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Van Pham T, Pham Nguyen P, Nguyen Duc Khanh T, Nguyen Thanh Thuy N, Nguyen Thuy Nha C, Pouplin T, Farrar J, Thwaites GE, Tran Tinh H. An HPLC method with diode array detector for the simultaneous quantification of chloroquine and desethylchloroquine in plasma and whole blood samples from Plasmodium vivax patients in Vietnam, using quinine as an internal standard. Biomed Chromatogr 2016; 30:1104-1111. [PMID: 26578224 PMCID: PMC4913743 DOI: 10.1002/bmc.3657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/18/2015] [Accepted: 11/10/2015] [Indexed: 12/02/2022]
Abstract
A sensitive, simple method for quantification of chloroquine (CQ) and desethylchloroquine (MCQ) in whole blood and plasma from Plasmodium vivax patients has been developed using HPLC with diode array detection (DAD). Solid‐phase extraction on Isolute‐96‐CBA was employed to process 100 μL of plasma/whole blood samples. CQ, MCQ and quinine were separated using a mobile phase of phosphate buffer 25 mm, pH 2.60–acetonitrile (88:12, v/v) with 2 mm sodium perchlorate on a Zorbax SB‐CN 150 × 4.6 mm, 5 μm column at a flow rate of 1.2 mL/min, at ambient temperature in 10 min, with the DAD wavelength of 343 nm. The method was linear over the range of 10–5000 ng/mL for both CQ and MCQ in plasma and whole blood. The limit of detection was 4 ng/mL and limit of quantification was 10 ng/mL in both plasma and blood for CQ and MCQ. The intra‐, inter‐ and total assay precision were <10% for CQ and MCQ in plasma and whole blood. In plasma, the accuracies varied between 101 and 103%, whereas in whole blood, the accuracies ranged from 97.0 to 102% for CQ and MCQ. The method is an ideal technique with simple facilities and instruments, bringing about good separation in comparison with previous methods. © 2016 The Authors Biomedical Chromatography Published by John Wiley & Sons Ltd
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Affiliation(s)
- Toi Van Pham
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Phuong Pham Nguyen
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tho Nguyen Duc Khanh
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nhien Nguyen Thanh Thuy
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ca Nguyen Thuy Nha
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Thomas Pouplin
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jeremy Farrar
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Guy E Thwaites
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Hien Tran Tinh
- Wellcome Trust Major Overseas Programme, Ho Chi Minh City-In Partnership with Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
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Zilbermintz L, Leonardi W, Jeong SY, Sjodt M, McComb R, Ho CLC, Retterer C, Gharaibeh D, Zamani R, Soloveva V, Bavari S, Levitin A, West J, Bradley KA, Clubb RT, Cohen SN, Gupta V, Martchenko M. Identification of agents effective against multiple toxins and viruses by host-oriented cell targeting. Sci Rep 2015; 5:13476. [PMID: 26310922 PMCID: PMC4550849 DOI: 10.1038/srep13476] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/28/2015] [Indexed: 01/25/2023] Open
Abstract
A longstanding and still-increasing threat to the effective treatment of infectious diseases is resistance to antimicrobial countermeasures. Potentially, the targeting of host proteins and pathways essential for the detrimental effects of pathogens offers an approach that may discover broad-spectrum anti-pathogen countermeasures and circumvent the effects of pathogen mutations leading to resistance. Here we report implementation of a strategy for discovering broad-spectrum host-oriented therapies against multiple pathogenic agents by multiplex screening of drugs for protection against the detrimental effects of multiple pathogens, identification of host cell pathways inhibited by the drug, and screening for effects of the agent on other pathogens exploiting the same pathway. We show that a clinically used antimalarial drug, Amodiaquine, discovered by this strategy, protects host cells against infection by multiple toxins and viruses by inhibiting host cathepsin B. Our results reveal the practicality of discovering broadly acting anti-pathogen countermeasures that target host proteins exploited by pathogens.
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Affiliation(s)
| | | | - Sun-Young Jeong
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305
| | - Megan Sjodt
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, 90095
| | - Ryan McComb
- Keck Graduate Institute, Claremont, CA 91711
| | - Chi-Lee C Ho
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, CA, 90095
| | - Cary Retterer
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD, 21702
| | - Dima Gharaibeh
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD, 21702
| | - Rouzbeh Zamani
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD, 21702
| | - Veronica Soloveva
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD, 21702
| | - Sina Bavari
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD, 21702
| | | | - Joel West
- Keck Graduate Institute, Claremont, CA 91711
| | - Kenneth A Bradley
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, CA, 90095
| | - Robert T Clubb
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, 90095
| | - Stanley N Cohen
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305
| | - Vivek Gupta
- Keck Graduate Institute, Claremont, CA 91711
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Validation and pharmacokinetic application of a high-performance liquid chromatographic technique for determining the concentrations of amodiaquine and its metabolite in plasma of patients treated with oral fixed-dose amodiaquine-artesunate combination in areas of malaria endemicity. Antimicrob Agents Chemother 2015; 59:5114-22. [PMID: 25896711 DOI: 10.1128/aac.04957-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/05/2015] [Indexed: 11/20/2022] Open
Abstract
Artemisinin-based combination therapies (ACTs) have been adopted by most African countries, including Nigeria, as first-line treatments for uncomplicated falciparum malaria. Fixed-dose combinations of these ACTs, amodiaquine-artesunate (FDC AQAS) and artemether-lumefantrine (AL), were introduced in Nigeria to improve compliance and achieve positive outcomes of malaria treatment. In order to achieve clinical success with AQAS, we developed and validated a simple and sensitive high-performance liquid chromatography (HPLC) method with UV detection for determination of amodiaquine (AQ) and desethylamodiaquine (DAQ) in plasma using liquid-liquid extraction of the drugs with diethyl ether following protein precipitation with acetonitrile. Chromatographic separation was achieved using an Agilent Zorbax C18 column and a mobile phase consisting of distilled water-methanol (80:20 [vol/vol]) with 2% (vol/vol) triethylamine, pH 2.2, at a flow rate of 1 ml/min. Calibration curves in spiked plasma were linear from 100 to 1,000 ng/ml (r > 0.99) for both AQ and DAQ. The limit of detection was 1 ng (sample size, 20 μl). The intra- and interday coefficients of variation at 150, 300, and 900 ng/ml ranged from 1.3 to 4.8%, and the biases were between 6.4 and 9.5%. The mean extraction recoveries of AQ and DAQ were 80.0% and 68.9%, respectively. The results for the pharmacokinetic parameters of DAQ following oral administration of FDC AQAS (612/200 mg) for 3 days in female and male patients with uncomplicated falciparum malaria showed that the maximum plasma concentrations (C max) (740 ± 197 versus 767 ± 185 ng/ml), areas under the plasma concentration-time curve (AUC) (185,080 ± 20,813 versus 184,940 ± 16,370 h · ng/ml), and elimination half-life values (T 1/2) (212 ± 1.14 versus 214 ± 0.84 h) were similar (P > 0.05).
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Raut PP, Sharma A, Agarwal G, Charde SY. QUANTITATIVE ESTIMATION OF ARTESUNATE AND AMODIQUINE HCL BY HIGH-PERFORMANCE THIN-LAYER CHROMATOGRAPHY METHOD IN BULK AND PHARMACEUTICAL FORMULATIONS. J LIQ CHROMATOGR R T 2014. [DOI: 10.1080/10826076.2013.803201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Prashant P. Raut
- a Formulation Development and Pharmacokinetic Laboratory, Department of Pharmacy, Faculty Division-III , Birla Institute of Technology and Science , Pilani , Rajasthan , India
| | - Arpit Sharma
- a Formulation Development and Pharmacokinetic Laboratory, Department of Pharmacy, Faculty Division-III , Birla Institute of Technology and Science , Pilani , Rajasthan , India
| | - Govind Agarwal
- a Formulation Development and Pharmacokinetic Laboratory, Department of Pharmacy, Faculty Division-III , Birla Institute of Technology and Science , Pilani , Rajasthan , India
| | - Shrikant Y. Charde
- a Formulation Development and Pharmacokinetic Laboratory, Department of Pharmacy, Faculty Division-III , Birla Institute of Technology and Science , Pilani , Rajasthan , India
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14
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Analytical sample preparation strategies for the determination of antimalarial drugs in human whole blood, plasma and urine. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 962:109-131. [DOI: 10.1016/j.jchromb.2014.02.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 02/06/2023]
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15
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Validation of a method for the simultaneous quantification of chloroquine, desethylchloroquine and primaquine in plasma by HPLC-DAD. J Pharm Biomed Anal 2014; 95:200-6. [PMID: 24682018 DOI: 10.1016/j.jpba.2014.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 11/20/2022]
Abstract
One of the most important aspects regarding the therapeutic efficacy of antimalarials is its quantification in biologic fluids. The detection and measurement of antimalarial drug levels is important for demonstrating (1) adequate absorption of the drug being given, (2) compliance in taking the full regimen required for treatment and (3) the level of drug in the blood at any time during the test period that parasites reappear. There is a lack of validated methods that simultaneously quantify different antimalarials administered at the same time, such as the use of chloroquine (CQ) and primaquine (PQ) in infections caused by Plasmodium vivax. In this study, a bioanalytical method was validated for the simultaneous quantification of primaquine (PQ), chloroquine (CQ) and desethylchloroquine (DSCQ) in human plasma using liquid-liquid extraction and high performance liquid chromatography with a diode array detector (HPLC-DAD). The PQ was evaluated over a concentration range of 100-3000 nM and the CQ and DSCQ was evaluated over a concentration range of 20-2000 nM. The selectivity of the method was verified by checking for interference by commonly used antimalarials and plasma samples. The accuracy and precision of the method was assessed for drugs spiked into human plasma and recoveries of 83.7%, 92.3%, and 76.5% were obtained for CQ, DSCQ, and PQ, respectively. The applicability of this method was also demonstrated with blood samples from patients with vivax malaria that received combination CQ plus PQ treatment. The simultaneous detection and accurate measurement of CQ, DSCQ, and PQ levels in human plasma provides an important and economical method for validating and monitoring sensitivity/resistance of P. vivax to more common treatment regimen.
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16
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Heat stabilization of blood spot samples for determination of metabolically unstable drug compounds. Bioanalysis 2013; 5:31-9. [PMID: 23256470 DOI: 10.4155/bio.12.294] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sample stability is critical for accurate analysis of drug compounds in biosamples. The use of additives to eradicate the enzymatic activity causing loss of these analytes has its limitations. RESULTS A novel technique for sample stabilization by rapid, high-temperature heating was used. The stability of six commercial drugs in blood and blood spots was investigated under various conditions with or without heat stabilization at 95°C. Oseltamivir, cefotaxime and ribavirin were successfully stabilized by heating whereas significant losses were seen in unheated samples. Amodiaquine was stable with and without heating. Artemether and dihydroartemisinin were found to be very heat sensitive and began to decompose even at 60°C. CONCLUSION Heat stabilization is a viable technique to maintain analytes in blood spot samples, without the use of chemical additives, by stopping the enzymatic activity that causes sample degradation.
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Doddaga S, Peddakonda R. Chloroquine-N-oxide, a major oxidative degradation product of chloroquine: identification, synthesis and characterization. J Pharm Biomed Anal 2013; 81-82:118-25. [PMID: 23644906 DOI: 10.1016/j.jpba.2013.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/30/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Abstract
Chloroquine (CQ) (1) which has endured as one of the most powerful antimalarial drugs was subjected to oxidative stress conditions and the degradation profile was studied. The oxidative stress condition of CQ furnished one major degradation product along with other minor degradation products. The unknown major degradation product was identified in HPLC and pure impurity was isolated using column chromatography. The structure of this major product was elucidated using UV, FT-IR, (1)H NMR, (13)C NMR, 2D NMR (HSQC) and mass spectral data. Based on the results obtained from the different spectroscopic studies, it was confirmed that the N-oxide was formed at the tertiary amine nitrogen instead of the pyridine nitrogen. Subsequently, an efficient and simple synthetic approach was developed for the synthesis of chloroquine-N-oxide using a work-up procedure that does not require chromatography techniques for further purification. It was observed that the spectral data of the isolated degradation product coincided appropriately with the synthesized product spectral data.
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Affiliation(s)
- Srinivasulu Doddaga
- Department of Chemistry, Sri Venkateswara University, Tirupati 517 502, India.
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18
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do Nascimento TG, de Jesus Oliveira E, Basílio Júnior ID, de Araújo-Júnior JX, Macêdo RO. Short-term stability studies of ampicillin and cephalexin in aqueous solution and human plasma: Application of least squares method in Arrhenius equation. J Pharm Biomed Anal 2013; 73:59-64. [DOI: 10.1016/j.jpba.2012.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
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19
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Wahajuddin, Raju KSR, Taneja I. Bioanalysis of antimalarials using liquid chromatography. Trends Analyt Chem 2013. [DOI: 10.1016/j.trac.2012.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Cheomung A, Na-Bangchang K. HPLC with ultraviolet detection for the determination of chloroquine and desethylchloroquine in whole blood and finger-prick capillary blood dried on filter paper. J Pharm Biomed Anal 2011; 55:1031-40. [DOI: 10.1016/j.jpba.2011.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
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21
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Assay for screening for six antimalarial drugs and one metabolite using dried blood spot sampling, sequential extraction and ion-trap detection. Bioanalysis 2011; 2:1839-47. [PMID: 21083492 PMCID: PMC7099628 DOI: 10.4155/bio.10.147] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND More parasites are becoming resistant to antimalarial drugs, and in many areas a change in first-line drug treatment is necessary. The aim of the developed assay is to help determine drug use in these areas and also to be a complement to interviewing patients, which will increase reliability of surveys. RESULTS This assay detects quinine, mefloquine, sulfadoxine, pyrimethamine, lumefantrine, chloroquine and its metabolite desethylchloroquine in a 100-µl dried blood spot. Most of the drugs also have long half-lives that make them detectable at least 7 days after administration. The drugs are extracted from the dried blood spot with sequential extraction (due to the big differences in physicochemical properties), solid-phase extraction is used as sample clean-up and separation is performed with gradient-LC with MS ion-trap detection. CONCLUSION Detection limits (S/N > 5:1) at 50 ng/ml or better were achieved for all drugs except lumefantrine (200 ng/ml), and thus can be used to determine patient compliance. A major advantage of using the ion-trap MS it that it will be possible to go back into the data and look for other drugs as needed.
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Aguirre-Cruz L, Torres KJ, Jung-Cook H, Fortuny C, Sánchez E, Soda-Mehry A, Sotelo J, Reyes-Terán G. Short communication: preferential concentration of hydroxychloroquine in adenoid tissue of HIV-infected subjects. AIDS Res Hum Retroviruses 2010; 26:339-42. [PMID: 20334568 DOI: 10.1089/aid.2009.0129] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hydroxychloroquine (HCQ) anti-HIV activity is well documented. To evaluate its distribution in lymphoid tissues, which are considered sanctuaries of HIV reservoirs and targets of early massive depletion of CD4(+) T cells, we assessed HCQ concentrations in adenoid tissue and plasma of HIV-infected subjects. A daily oral dose of 400 or 800 mg of HCQ was administered to eight HIV-infected subjects for 8 days. HCQ concentrations were measured in plasma and adenoid tissue by high-performance liquid chromatography. Mean concentrations of HCQ in adenoid tissue of subjects treated with 400 and 800 mg were 87,210 +/- 17,817 and 167,472 +/- 93,793 ng/g, respectively. In plasma, these values corresponded to 329 +/- 133 and 278 +/- 68 ng/g, respectively. HCQ concentrations were significantly higher in adenoid tissue than in plasma in both groups. The potential use of HCQ as adjuvant in the therapy of HIV deserves to be explored, as the drug accumulates in relevant tissues for HIV replication and immunopathogenesis.
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Affiliation(s)
- Lucinda Aguirre-Cruz
- Departamento de Inmunología, Instituto Nacional de Neurología y Neurocirugía, México, D.F., México
| | - Klintsy J. Torres
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, México, D.F., México
| | - Helgi Jung-Cook
- Departamento de Inmunología, Instituto Nacional de Neurología y Neurocirugía, México, D.F., México
| | - Carlos Fortuny
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, México, D.F., México
| | - Eder Sánchez
- Departamento de Inmunología, Instituto Nacional de Neurología y Neurocirugía, México, D.F., México
| | - Antonio Soda-Mehry
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, México, D.F., México
| | - Julio Sotelo
- Departamento de Inmunología, Instituto Nacional de Neurología y Neurocirugía, México, D.F., México
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, México, D.F., México
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Dried Blood Spot Methods in Therapeutic Drug Monitoring: Methods, Assays, and Pitfalls. Ther Drug Monit 2009; 31:327-36. [DOI: 10.1097/ftd.0b013e31819e91ce] [Citation(s) in RCA: 399] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Ntale M, Obua C, Mukonzo J, Mahindi M, Gustafsson LL, Beck O, Ogwal-Okeng JW. Field-adapted sampling of whole blood to determine the levels of amodiaquine and its metabolite in children with uncomplicated malaria treated with amodiaquine plus artesunate combination. Malar J 2009; 8:52. [PMID: 19331684 PMCID: PMC2678144 DOI: 10.1186/1475-2875-8-52] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 03/30/2009] [Indexed: 01/19/2023] Open
Abstract
Background Artemisinin combination therapy (ACT) has been widely adopted as first-line treatment for uncomplicated falciparum malaria. In Uganda, amodiaquine plus artesunate (AQ+AS), is the alternative first-line regimen to Coartem® (artemether + lumefantrine) for the treatment of uncomplicated falciparum malaria. Currently, there are few field-adapted analytical techniques for monitoring amodiaquine utilization in patients. This study evaluates the field applicability of a new method to determine amodiaquine and its metabolite concentrations in whole blood dried on filter paper. Methods Twelve patients aged between 1.5 to 8 years with uncomplicated malaria received three standard oral doses of AQ+AS. Filter paper blood samples were collected before drug intake and at six different time points over 28 days period. A new field-adapted sampling procedure and liquid chromatographic method was used for quantitative determination of amodiaquine and its metabolite in whole blood. Results The sampling procedure was successively applied in the field. Amodiaquine could be quantified for at least three days and the metabolite up to 28 days. All parasites in all the 12 patients cleared within the first three days of treatment and no adverse drug effects were observed. Conclusion The methodology is suitable for field studies. The possibility to determine the concentration of the active metabolite of amodiaquine up to 28 days suggested that the method is sensitive enough to monitor amodiaquine utilization in patients. Amodiaquine plus artesunate seems effective for treatment of falciparum malaria.
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Affiliation(s)
- Muhammad Ntale
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda.
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25
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Rivas-Granizo P, Jorge Santos SRC, Ferraz HG. Development of a Stability-Indicating LC Assay Method for Determination of Chloroquine. Chromatographia 2009. [DOI: 10.1365/s10337-009-0985-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Lai CS, Nair N, Muniandy A, Mansor S, Olliaro P, Navaratnam V. Validation of high performance liquid chromatography–electrochemical detection methods with simultaneous extraction procedure for the determination of artesunate, dihydroartemisinin, amodiaquine and desethylamodiaquine in human plasma for application in clinical pharmacological studies of artesunate–amodiaquine drug combination. J Chromatogr B Analyt Technol Biomed Life Sci 2009; 877:558-62. [DOI: 10.1016/j.jchromb.2008.12.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 11/18/2008] [Accepted: 12/16/2008] [Indexed: 10/21/2022]
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27
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Daneshfar A, Khezeli T, Manafi MH. Determination of anti-malaria agent chloroquine using single drop liquid-liquid-liquid microextraction. J Sep Sci 2009; 32:511-6. [DOI: 10.1002/jssc.200800483] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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28
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Obua C, Ntale M, Lundblad MS, Mahindi M, Gustafsson LL, Ogwal-Okeng JW, Anokbonggo WW, Hellgren U. Pharmacokinetic interactions between chloroquine, sulfadoxine and pyrimethamine and their bioequivalence in a generic fixed-dose combination in healthy volunteers in Uganda. Afr Health Sci 2009; 6:86-92. [PMID: 16916298 PMCID: PMC1831981 DOI: 10.5555/afhs.2006.6.2.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
BACKGROUND A pre-packaged fixed-dose formulation of chloroquine (CQ) and sulfadoxine/pyrimethamine (S/P) combination (Homapak) is widely used for the treatment of falciparum malaria in Ugandan children. It is however a product whose pharmacokinetics and interactions have not been studied. OBJECTIVES To explore possible pharmacokinetic interactions between CQ and S/P during co-administration, and to determine their bioavailability in the locally made Homapak compared to the Good Manufacturing Practice (GMP) made formulations. METHODS Thirty-two adult healthy volunteers were randomized into four groups and given single oral doses of fixed-dose CQ+S/P combination (Homapak), or GMP formulations of S/P (Fansidar), CQ (Pharco), or their combination. Plasma samples were followed for 21 days, analysed by HPLC-UV methods, with pharmacokinetic modeling using the WinNonlin software. RESULTS Sulfadoxine in Homapak was more rapidly absorbed (ka = 0.55 h(-1)) than in Fansidar + CQ (ka = 0.27 h(-1), p=0.004), but not more than S in Fansidar alone group (ka = 0.32 h(-1), p=0.03). No significant differences were observed in the other pharmacokinetic parameters of S, P and CQ when given together or separately. The relative bioavailability of CQ and S in Homapak showed bioequivalence to reference formulations. CONCLUSIONS There were no pharmacokinetic interactions between CQ, S and P when the compounds were given together, however, more investigations would be needed to explore this further. Compared with GMP made drugs, both S and CQ are bioequivalent in Homapak, the Ugandan made fixed-dose formulation. Furthermore, the absorption of S was more rapid which could be advantageous in malaria treatment.
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Affiliation(s)
- C Obua
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda.
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29
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Phadke MU, Jadhav VK, Jadhav RK, Dave SS, Patil DS. Simultaneous RP-LC Determination of Artesunate and Amodiaquine in Pharmaceutical Preparations. Chromatographia 2008. [DOI: 10.1365/s10337-008-0800-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Walter-Sack I, Rengelshausen J, Oberwittler H, Burhenne J, Mueller O, Meissner P, Mikus G. High absolute bioavailability of methylene blue given as an aqueous oral formulation. Eur J Clin Pharmacol 2008; 65:179-89. [DOI: 10.1007/s00228-008-0563-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 08/27/2008] [Indexed: 11/24/2022]
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31
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Obua C, Hellgren U, Ntale M, Gustafsson LL, Ogwal-Okeng JW, Gordi T, Jerling M. Population pharmacokinetics of chloroquine and sulfadoxine and treatment response in children with malaria: suggestions for an improved dose regimen. Br J Clin Pharmacol 2008; 65:493-501. [PMID: 18294337 DOI: 10.1111/j.1365-2125.2007.03050.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Both chloroquine (CQ) and sulfadoxine/ pyrimethamine (SDx/PYR) remain important drugs in the control of malaria. * The available data on CQ, SDx and PYR are summary pharmacokinetic parameters based on classical/traditional methods, mostly in adults. * No study has described the population pharmacokinetics of a fixed-dose CQ + SDx/PYR combination in children with falciparum malaria. WHAT THIS STUDY ADDS * This study presents population pharmacokinetic data on CQ and SDx in children with uncomplicated falciparum malaria. * The study demonstrates that in age-based fixed-dose regimens with CQ and SDx, drug exposures and outcomes may be correctly predicted, although correlation with body weight is poor. * The study proposes dose modification to improve response with the CQ + SDx/PYR combination. AIMS To describe the pharmacokinetics of chloroquine (CQ) and sulfadoxine (SDx), and to identify predictors of treatment response in children with malaria given the CQ + SDx and pyrimethamine (PYR) combination. METHODS Eighty-six Ugandan children with uncomplicated falciparum malaria, 6 months to 5 years old, were randomly treated with prepacked fixed-dose CQ + SDx/PYR. The youngest children (<24 months) received half strength and the older (>24 months) full strength treatment. The reported day 14 failure rates were 48% and 18%, respectively. Capillary blood (100 microl) applied on to filter paper was collected on eight occasions during 28 days of follow up. Concentrations of CQ and SDx were determined. A population approach was used for the pharmacokinetic analysis. RESULTS A two-compartment model adequately described the data for both CQ and SDx. For CQ, the typical apparent clearance (CL/F) and volume of distribution (V(C)/F) values were estimated to be 2.84 l h(-1) and 230 l. The typical CL/F for SDx was 0.023 l h(-1), while the factor relating its V(C)/F to normalized body weight was 1.6 l kg(-1). Post hoc parameter estimates for both drugs showed lower maximum concentrations (C(max)) and concentration-time curve areas (AUC(0,336 h)) in younger children. The AUC(0,336 h) for SDx and CQ were independently significant factors for prediction of cure. Simulations suggest that giving the higher dose to the youngest children would result in higher CQ and SDx concentrations and improved outcome. CONCLUSIONS The study results suggest that full-strength combination to all children would improve the cure rate.
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Affiliation(s)
- Celestino Obua
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
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Dravid PV, Frye RF. Determination of N-desethylamodiaquine by hydrophilic interaction liquid chromatography with tandem mass spectrometry: Application to in vitro drug metabolism studies. J Chromatogr B Analyt Technol Biomed Life Sci 2008; 863:129-34. [DOI: 10.1016/j.jchromb.2008.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 12/17/2007] [Accepted: 01/13/2008] [Indexed: 12/18/2022]
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Ntale M, Mahindi M, Ogwal-Okeng JW, Gustafsson LL, Beck O. A field-adapted HPLC method for determination of amodiaquine and its metabolite in whole blood dried on filter paper. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 859:137-40. [PMID: 17904919 DOI: 10.1016/j.jchromb.2007.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 09/06/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
Abstract
A reversed-phase high performance liquid chromatographic method was developed and validated for the quantitative determination of amodiaquine (AQ) and its metabolite desethylamodiaquine (DAQ) in whole blood collected on filter paper. The structure analogue 4-(4-dimethylamino-1-methylbutylamino)-7-chloroquinoline was used as internal standard. Upon collection, blood was added to 10% phosphoric acid in a 1:1 ratio and then spotted onto filter paper. The samples were alkalinized (pH approximately 9.2) with potassium hydroxide at the time of assay and the compounds were extracted together with internal standard into di-isopropyl ether and then re-extracted into an aqueous phase with 0.1M phosphate buffer at pH 4. The chromatographic analysis was performed using an Agilent Technologies ChemStation LC System. The absorbance of the compounds was monitored at 333 nm. Mean extraction recoveries of AQ and DAQ were 49 and 48%, respectively. Intra-day and inter-day coefficients of variation were <10.5%. The limit of quantification was 50 nM for both compounds (sample size 100 microl). Both AQ and DAQ that were previously reported to be unstable have been stored on filter paper for at least 19 weeks. The method was applied on samples from healthy volunteers.
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Affiliation(s)
- M Ntale
- Department of Pharmacology and Therapeutics, Makerere University, 7062 Kampala, Uganda.
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Atemnkeng MA, Chimanuka B, Plaizier-Vercammen J. Quality evaluation of chloroquine, quinine, sulfadoxine-pyrimethamine and proguanil formulations sold on the market in East Congo DR. J Clin Pharm Ther 2007; 32:123-32. [PMID: 17381662 DOI: 10.1111/j.1365-2710.2007.00797.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Drug quality may be poor in many regions of the world. Our first aim was to verify whether the dose of the active compounds in various antimalarial medicines on the market in East Congo conforms to the quality requirements of the European Pharmacopoeia (Ph. Eur.). The second aim was to check the extent to which simple methods of analysis could be used to evaluate drug quality. METHODS The formulations analysed included tablets, injections and syrups of chloroquine (CQ), quinine, sulfadoxine-pyrimethamine (SP) and proguanil. Ultraviolet (UV) spectrophotometry was used to quantify CQ and quinine in tablets and injections. Thin layer chromatography was used to identify the preservative(s) in the syrups. As the drug form (base or salt) in the tablets, is rarely declared, the estimated dose was calculated using both forms. High-performance liquid chromatography (HPLC) was used to check for assay interference and for measuring SP combinations. RESULTS AND DISCUSSION When the dose declaration on the label was assumed to be of the salt form, 33% of CQ batches were underdosed and two of eight batches of quinine were underdosed by about 25% and 15% respectively. When the base form was assumed, only one batch of CQ tablets conformed. The underdosed batches contained about 50-66% of the claimed amount for CQ. The dose of quinine in the different batches of tablets was in the range 62-86%. For the CQ syrup, interference by the preservative Nipagin, confirmed by HPLC-UV, was observed with UV-spectrophotometry at 257 nm but not at 342 nm. The results for CQ syrup using UV-spectrophotometry at 342 nm and HPLC-UV at 257 nm were comparable and showed compliance with the European Pharmacopoeia limits of 95-105%. One of two batches of CQ injections and one of four batches of quinine injections were overdosed by about 14% and 8% respectively. The SP tablets were analysed by using HPLC-UV only. All five batches were underdosed in sulfadoxine (91-94%) but still met the United States Pharmacopeial (USP) limit of 90-110%. Two batches were slightly overdosed in pyrimethamine (106% and 108% respectively) while one batch contained neither active ingredient. The one batch of proguanil analysed, met the Ph. Eur. quality requirement (98.7%). CONCLUSION Simple methods of analysis like UV-spectrophotometry can be used to check drug quality routinely. A substantial proportion of the antimalarial drugs sold on the Congo DR market is of poor quality. Some batches contain little or no drug. This is a serious threat to public health in the region of Congo DR.
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Affiliation(s)
- M A Atemnkeng
- Pharmaceutical Technology and Physical Pharmacy Department, Pharmaceutical Institute, Vrije Universiteit Brussel, Brussels, Belgium
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35
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Huang Y, Pan W, Guo M, Yao S. Capillary electrophoresis with end-column electrochemiluminescence for the analysis of chloroquine phosphate and the study on its interaction with human serum albumin. J Chromatogr A 2007; 1154:373-8. [PMID: 17498727 DOI: 10.1016/j.chroma.2007.02.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 02/08/2007] [Accepted: 02/09/2007] [Indexed: 11/20/2022]
Abstract
This paper describes a novel and sensitive method for the estimation of chloroquine phosphate (CQ) using capillary electrophoresis with end-column electrochemiluminescence (ECL) detection. Under the optimized condition, linear calibration curve was obtained for the system over two orders of magnitude with a detection limit of 3x10(-7) M (S/N=3). The relative standard deviations of the ECL intensity and the migration time were 1.4% and 0.05%, respectively (n=6, 5x10(-5) M CQ). Successful separation of chloroquine phosphate, difenidol hydrochloride and clomifene citrate was obtained at pH 7.0. Using the proposed electrochemiluminescence system, a simple method was proposed to study the interaction between chloroquine phosphate and human serum albumin (HSA), and the number of binding sites and binding constant were estimated to be 32.6 and 7.7x10(3) M(-1), respectively.
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Affiliation(s)
- Yan Huang
- College of Chemistry & Chemical Engineering, Hunan University, Changsha, China
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36
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Ibrahim H, Bouajila J, Siri N, Rozing G, Nepveu F, Couderc F. Very small injected samples to study chloroquine and quinine in human serum using capillary-LC and native fluorescence. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 850:481-7. [PMID: 17227720 DOI: 10.1016/j.jchromb.2006.12.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 12/15/2006] [Accepted: 12/18/2006] [Indexed: 11/20/2022]
Abstract
A comparison between HPLC with conventional fluorescence detection and capillary-LC (microHPLC) with native laser-induced fluorescence (LIF) detection was done to determine chloroquine (CQ) and quinine (Q) in human serum. HPLC experiments were run with parameters of the conventional fluorimeter set at the highest level of sensitivity. Results were compared with those obtained on microHPLC coupled to a ZETALIF (He-Cd 325 nm) detector which provided a 50-fold increase in sensitivity. In microHPLC-LIF injection volumes were 200 nL instead of 10 microL in conventional HPLC. The separation was completed within 3 min (6 min on HPLC). The limit of detection on microHPLC-LIF was 1.9 and 1.3 fmol for CQ and Q, respectively. Both experiments were validated on serum samples. The mean recovery was more than 95% for CQ and Q. The intra- and inter-day precision and accuracy were found to be within the acceptable limits (<10%).
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Affiliation(s)
- H Ibrahim
- UMR 152-IRD-Université Paul Sabatier, Toulouse 3, 31062 Toulouse Cedex 9, France
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Eriksen J, Tomson G, Mujinja P, Warsame MY, Jahn A, Gustafsson LL. Assessing health worker performance in malaria case management of underfives at health facilities in a rural Tanzanian district. Trop Med Int Health 2007; 12:52-61. [PMID: 17207148 DOI: 10.1111/j.1365-3156.2006.01753.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the quality of malaria case management of underfives at health facilities in a rural district, 2 years after the Tanzanian malaria treatment policy change in 2001. METHODS Consultations of 117 sick underfives by 12 health workers at 8 health facilities in Mkuranga District, Tanzania were observed using checklists for history taking, counselling and prescription. Diagnoses and treatment were recorded. Exit interviews were performed with all mothers/guardians and blood samples taken from the underfives for the detection of malaria parasites and antimalarial drugs. Quality of care was measured using indicators adopted from the integrated management of childhood illnesses multi-country evaluation. RESULTS Quality of care measured by indicator scores averaged 31% of what was considered optimal. The poorest results were for history taking. Nevertheless, 89% of febrile children were treated with antimalarials, in line with national guidelines for fever treatment. Of these, 61% had a parasitaemia > or =2000/microl. There was no difference in treatment given to those with parasitological malaria compared with those without parasites. Pre-treatment levels of chloroquine and sulphadoxine/pyrimethamine were low and detected in 2% and 13%, respectively. CONCLUSION Although most febrile children were given antimalarial treatment, quality of care in terms of history taking and counselling was sub-optimal. Despite this, the study community had changed behaviour from self-treatment to seeking care at health facilities. This is encouraging for introduction of artemisinin-based combination therapies policies as one could focus resources into improving care at health facilities and still reach out with treatment to most febrile children.
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Affiliation(s)
- J Eriksen
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.
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Abstract
Malaria is a major infectious disease. In the last 10 years it has killed more than 20 million people, mainly small children in Africa. The highly efficacious artemisinine combination therapy is being launched globally, constituting the main hope for fighting the disease. Amodiaquine is a main partner in these combinations. Amodiaquine is almost entirely metabolized by the polymorphic cytochrome P450 (CYP) isoform 2C8 to the pharmacologically active desethylamodiaquine. The question remains whether the efficacy of amodiaquine is affected by the gene polymorphism. Genotype-inferred low metabolizers are found in 1-4% of African populations, which corresponds to millions of expected exposures to the drug. In vivo pharmacokinetic data on amodiaquine is limited. By combining it with published in vitro pharmacodynamic and drug metabolism information, we review and predict the possible relevance, or lack of, of CYP2C8 polymorphisms in the present and future efficacy of amodiaquine. Chloroquine and dapsone, both substrates of CYP2C8, are also discussed in the same context.
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Affiliation(s)
- J P Gil
- Karolinska Institute, Malaria Research Unit, Division of Infectious Diseases, Department of Medicine, Karolinska University Hospital, M9:02, KS 17176 Stockholm, Sweden.
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Singhal P, Gaur A, Behl V, Gautam A, Varshney B, Paliwal J, Batra V. Sensitive and rapid liquid chromatography/tandem mass spectrometric assay for the quantification of chloroquine in dog plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 852:293-9. [PMID: 17317340 DOI: 10.1016/j.jchromb.2007.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 11/17/2006] [Accepted: 01/19/2007] [Indexed: 10/23/2022]
Abstract
A simple, sensitive and rapid liquid chromatography/tandem mass spectrometric (LC-MS/MS) method was developed and validated for quantification of chloroquine, an antimalarial drug, in plasma using its structural analogue, piperazine bis chloroquinoline as internal standard (IS). The method is based on simple protein precipitation with methanol followed by a rapid isocratic elution with 10 mM ammonium acetate buffer/methanol (25/75, v/v, pH 4.6) on Chromolith SpeedROD RP-18e reversed phase chromatographic column and subsequent analysis by mass spectrometry in the multiple reaction monitoring mode (MRM). The precursor to product ion transitions of m/z 320.3-->247.2 and m/z 409.1-->205.2 were used to measure the analyte and the IS, respectively. The assay exhibited a linear dynamic range of 2.0-489.1 ng/mL for chloroquine in dog plasma. The limit of detection (LOD) and lower limit of quantification (LLOQ) were 0.4 and 2.0 ng/mL, respectively in 0.05 mL plasma. Acceptable precision and accuracy were obtained for concentrations over the standard curve range of 2.0-489.1 ng/mL. A run time of 2.0 min for a sample made it possible to achieve a throughput of more than 400 plasma samples analyzed per day. The validated method was successfully used to analyze samples of dog plasma during non-clinical study of chloroquine.
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Affiliation(s)
- Puran Singhal
- Metabolism and Pharmacokinetic Department, Ranbaxy Research Laboratories, Plot # 20, Sector-18, Udhyog Vihar Industrial Area, Gurgaon, Haryana 122015, India
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Lejeune D, Souletie I, Houzé S, Le bricon T, Le bras J, Gourmel B, Houzé P. Simultaneous determination of monodesethylchloroquine, chloroquine, cycloguanil and proguanil on dried blood spots by reverse-phase liquid chromatography. J Pharm Biomed Anal 2007; 43:1106-15. [PMID: 17097257 DOI: 10.1016/j.jpba.2006.09.036] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 09/20/2006] [Accepted: 09/22/2006] [Indexed: 11/18/2022]
Abstract
A method for simultaneous analysis of chloroquine, proguanil and their metabolites from a whole blood sample (80 microL) dried on a filter paper was developed. Sample preparation included a liquid extraction from the filter paper, followed by a solid-phase extraction (C18 Bond Elut cartridge). Separation was obtained by reverse-phase liquid chromatography (HPLC) using a gradient elution on an X-Terra column; UV detection was made at 254 nm. This assay was linear between 150 and 2500 ng mL(-1) for chloroquine (and metabolite) and 300 and 2500 ng mL(-1) for proguanil and cycloguanil. The lower limit of quantification was close to 50 ng mL(-1) for chloroquine (and its metabolite) and 100 ng mL(-1) for proguanil (and its metabolite). No chromatographic interference from endogenous compounds or other tested anti-malarial drugs was evidenced. Chromatographic separation takes about 40 min with a coefficient of variation below 10.3% for within- and between-batch precision. The paper sampling method was validated in 10 healthy subjects treated by Savarine. The stability of compounds and metabolites on the filter paper was evaluated at four temperatures (-20, +4, 20 and 50 degrees C) and for 1, 5 and 20 days. Cycloguanil concentrations were not influenced by storage conditions, whereas, high temperatures and prolonged storage decreased chloroquine and proguanil levels. The proposed HPLC assay is accurate, precise and cost-effective; it can be used for pharmacokinetic and epidemiological studies on anti-malarial treatments.
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Affiliation(s)
- Delphine Lejeune
- Laboratoire de Biochimie A, Hôpital Saint Louis (AP-HP), 1 Avenue Claude Vellefaux, 75010 Paris, France
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Wennerholm A, Nordmark A, Pihlsgård M, Mahindi M, Bertilsson L, Gustafsson LL. Amodiaquine, its desethylated metabolite, or both, inhibit the metabolism of debrisoquine (CYP2D6) and losartan (CYP2C9) in vivo. Eur J Clin Pharmacol 2006; 62:539-46. [PMID: 16783563 DOI: 10.1007/s00228-006-0121-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the extent of in vivo inhibition by the antimalarial drug amodiaquine, its active metabolite N-desethylamodiaquine, or both, of the metabolism of four probe drugs of the enzymes CYP2D6, CYP2C19, CYP2C9 and CYP1A2. METHODS Twelve healthy Swedish volunteers received a cocktail of four probe drugs (debrisoquine, omeprazole, losartan and caffeine) to determine their baseline metabolic capacities. After a washout period, they received a 600 mg oral dose of amodiaquine hydrochloride; and 2-3 h later the cocktail was administered again. One week after the intake of amodiaquine, the subjects received the cocktail a third time. The levels of probe drugs and their metabolites as well as amodiaquine and its metabolite were determined by HPLC. RESULTS Plasma levels of amodiaquine and N-desethylamodiaquine could be followed in all subjects for 6 h and 28 days, respectively. Among the 12 subjects, a 3-fold variation in amodiaquine AUC and a 2-fold variation in N-desethylamodiaquine AUC, were observed. The CYP2D6 and CYP2C9 activities of the subjects were measured by debrisoquine and losartan phenotyping tests, respectively. There were significant mean increases in debrisoquine metabolic ratio (MR) between baseline and the second cocktail [MR(2 h)-MR(baseline) 1.426 (95% confidence interval 1.159, 1.755), P=0.002; ANOVA, Fisher LSD test] and in mean losartan MR between baseline and the second cocktail [MR(2 h)-MR(baseline) 1.724 (95% confidence interval 1.076, 2.762), P=0.026; ANOVA, Fisher LSD test]. The effects on CYP2D6 and CYP2C9 activities subsided within a week after intake of amodiaquine as tested by the phenotyping cocktail. The changes in omeprazole MRs and caffeine MRs were not statistically significant between any of the study phases. CONCLUSION A single dose of amodiaquine decreased CYP2D6 and CYP2C9 activities significantly compared to baseline values. Amodiaquine has the potential to cause drug-drug interactions and should be further investigated in malarial patients treated with drug combinations containing amodiaquine.
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Affiliation(s)
- Agneta Wennerholm
- Division of Clinical Pharmacology C1:68, Karolinska University Hospital - Huddinge, SE-141 86, Stockholm, Sweden
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Blessborn D, Neamin G, Bergqvist Y, Lindegårdh N. A new approach to evaluate stability of amodiaquine and its metabolite in blood and plasma. J Pharm Biomed Anal 2006; 41:207-12. [PMID: 16307860 DOI: 10.1016/j.jpba.2005.10.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 10/14/2005] [Accepted: 10/16/2005] [Indexed: 10/25/2022]
Abstract
A stability study for amodiaquine (AQ) and desethylamodiaquine (AQm) in whole blood and plasma is reported. AQ, AQm and chloroquine (CQ) were simultaneously analysed and the ratios AQ/CQ and AQm/CQ were used to ensure correct interpretation of the stability results. CQ was stable in whole blood and plasma at all tested temperatures enabling it to be a stability marker in stability studies. Simultaneous analysis of compounds, of which at least one is already known to be stable, permits a within sample ratio to be used as a stability indicator. The new approach significantly reduced bias when compared to the traditional approach. AQ and AQm were stable in plasma at -86 degrees C and -20 degrees C for 35 days, at 4 degrees C for 14 days and at 22 degrees C for 1 day. AQ and AQm were stable in blood at -86 degrees C and 4 degrees C for 35 days, at -20 degrees C and 22 degrees C for 7 days and at 37 degrees C for 1 day.
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Affiliation(s)
- D Blessborn
- Dalarna University College, S-781 88 Borlänge, Sweden
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Malongo TK, Blankert B, Kambu O, Amighi K, Nsangu J, Kauffmann JM. Amodiaquine polymeric membrane electrode. J Pharm Biomed Anal 2006; 41:70-6. [PMID: 16303276 DOI: 10.1016/j.jpba.2005.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 10/06/2005] [Accepted: 10/07/2005] [Indexed: 10/25/2022]
Abstract
The construction and electrochemical response characteristics of two types of poly(vinyl chloride) (PVC) membrane sensors for the determination of amodiaquine hydrochloride (ADQ.2HCl) are described. The sensing membrane comprised an ion-pair formed between the cationic drug and sodium tetraphenyl borate (NaTPB) or potassium tetrakis(4-chlorophenyl) borate (KTCPB) in a plasticized PVC matrix. Eight PVC membrane ion-selective electrodes were fabricated and studied. Several plasticizers were studied namely, dioctyl phthalate (DOP), 2-nitrophenyl octyl ether (NPOE), dioctyl phenylphosphonate (DOPP) and bis(2-ethylhexyl)adipate (EHA). The sensors display a fast, stable and near-Nernstian response over a relative wide ADQ concentration range (3.2 x 10(-6) to 2.0 x 10(-2) M), with slopes comprised between 28.5 and 31.4 mV dec(-1) in a pH range comprised between pH 3.7 and 5.5. The assay of amodiaquine hydrochloride in pharmaceutical dosage forms using one of the proposed sensors gave average recoveries of 104.3 and 99.9 with R.S.D. of 0.3 and 0.6% for tablets (Malaritab) and a reconstituted powder containing ADQ.2HCl, respectively. The sensor was also used for dissolution profile studies of two drug formulations. The sensor proved to have a good selectivity for ADQ.2HCl over some inorganic and organic compounds, however, berberine chloride interfered significantly. The results were validated by comparison with a spectrophotometric assay according to the USP pharmacopoeia.
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Affiliation(s)
- T Kimbeni Malongo
- Université Libre de Bruxelles, Institute of Pharmacy, Bd. du Triomphe, Campus Plaine, C.P. 205/6, 1050 Brussels, Belgium
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Mårtensson A, Strömberg J, Sisowath C, Msellem MI, Gil JP, Montgomery SM, Olliaro P, Ali AS, Björkman A. Efficacy of Artesunate Plus Amodiaquine versus That of Artemether-Lumefantrine for the Treatment of Uncomplicated Childhood Plasmodium falciparum Malaria in Zanzibar, Tanzania. Clin Infect Dis 2005; 41:1079-86. [PMID: 16163624 DOI: 10.1086/444460] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 05/30/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND This is the first clinical trial comparing the efficacy of artesunate plus amodiaquine (ASAQ) and artemether-lumefantrine (AL)--the major artemisinin-based combination therapy (ACT) candidates for treatment of malaria in Africa--that involved an extended, 42-day follow-up period, polymerase chain reaction-adjusted parasitological cure rates (PCR APCRs), and systematic analyses of genetic markers related to quinoline resistance. METHODS. A total of 408 children with uncomplicated Plasmodium falciparum malaria in Zanzibar, Tanzania, were enrolled. Children who were 6-8 months of age and/or who weighed 6-8 kg were assigned to receive ASAQ for 3 days. Children who were 9-59 months of age and who weighted > or =9 kg were randomly assigned to receive either ASAQ or AL for 3 days in standard doses. Intention-to-treat analyses were performed. RESULTS Age- and weight-adjusted PCR-APCRs by follow-up day 42 were 91% (188 of 206 patients) in the ASAQ group and 94% (185 of 197 patients) in the AL group (odds ratio [OR] for the likelihood of cure, 2.07; 95% confidence interval [CI], 0.84-5.10; P=.115). A total of 5 and 7 recrudescences occurred after day 28 in the ASAQ and AL groups, respectively. On the assumption that 10 malaria episodes with uncertain PCR results were recrudescences, PCR-APCRs decreased to 88% in the ASAQ group and to 92% in the AL group. Unadjusted cure rates by day 42 were 56% (116 of 206 patients) in the ASAQ group versus 77% (151 of 197 patients) in the AL group (OR, 2.55; 95% CI, 1.66-3.91; P<.001). Rates of reinfection by day 42 were 36% (65 of 181 patients) in the ASAQ arm versus 17% (31 of 182 patients) in the AL arm (OR, 0.37; 95% CI, 0.22-0.60; P<.001). A significant selection of P. falciparum multidrug resistance gene 1 allele 86N was found in isolates associated with reinfection after AL treatment, compared with isolates at baseline (2.2-fold increase; P<.001). CONCLUSIONS Both treatments were highly efficacious, but AL provided stronger prevention against reinfection. The high proportion of recrudescences found after day 28 and the genetic selection by the long-acting partner drug underlines the importance of long follow-up periods in clinical trials. A long follow-up duration and performance of PCR genotyping should be implemented in programmatic surveillance of antimalarial drugs.
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Affiliation(s)
- Andreas Mårtensson
- Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
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Eriksen J, Nsimba SED, Minzi OMS, Sanga AJ, Petzold M, Gustafsson LL, Warsame MY, Tomson G. Adoption of the new antimalarial drug policy in Tanzania - a cross-sectional study in the community. Trop Med Int Health 2005; 10:1038-46. [PMID: 16185239 DOI: 10.1111/j.1365-3156.2005.01486.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the diffusion of the change of first line antimalarial drug from chloroquine (CQ) to sulphadoxine/pyrimethamine (SP) at household level in a rural district of Tanzania less than a year after the policy implementation. METHODS Caretakers in 729 households were interviewed on knowledge of the new policy, home stocking of antimalarials, home-treatment practices of children younger than 5 years with fever, health-seeking behaviour and experience of SP. SP and CQ levels in blood were analysed from 328 children younger than 5 years in the households. Twelve focus group discussions (FGD) were performed with mothers, fathers and health workers. RESULTS About 51% of the population knew that SP was the first line antimalarial. Only 8% of mothers stocked antimalarials, and only 4% stated self-treatment as the first action. We estimated that 84% of the children who had had fever during the last 4 weeks sought care at public health facilities. SP was detectable in 18% of the total child population and in 32% of those with reported fever, CQ in only 5% and 7%, respectively. The FGDs revealed negative perceptions of SP and fear of severe adverse reactions with mass media reported as key informant. CONCLUSION The policy had diffused to the communities in the sense that CQ had been changed to SP, which was well known as first line treatment. Moreover, there was a reported dramatic change from self-treatment with CQ to seeking care at public health facilities where SP was given under observation.
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Affiliation(s)
- Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden.
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Saad B, Zin ZM, Jab MS, Rahman IA, Saleh MI, Mahsufi S. Flow-through Chloroquine Sensor and Its Applications in Pharmaceutical Analysis. ANAL SCI 2005; 21:521-4. [PMID: 15913140 DOI: 10.2116/analsci.21.521] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Poly (vinyl chloride) membrane electrodes that responded selectively towards the antimalarial drug chloroquine are described. The electrodes were based on the use of the lipophilic potassium tetrakis(4-chlorophenyl)borate as ion-exchanger and bis(2-ethylhexyl)adipate (BEHA), or trioctylphosphate (TOP) or dioctylphenylphosphonate (DOPP) as plasticizing solvent mediator. All electrodes produced good quality characteristics such as Nernstian- and rapid responses, and are minimally interfered with by the alkali and alkaline earth metal ions tested. The membranes were next applied to a flow-through device, enabling it to function as flow-injection analysis (FIA) detector. The performance of the sensor after undergoing the FIA optimization was further evaluated for its selectivity characteristics and lifetime. Results for the determination of chloroquine in synthetic samples that contained common tablet excipients such as glucose, starch, and cellulose, and other foreign species such as cations, citric acid or lactic acid were generally satisfactory. The sensor was also successfully used for the determination of the active ingredients in mock tablets, synthetic fluids and biological fluids. The sensor was applied for the determination of active ingredients and the dissolution profile of commercial tablets was also established.
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Affiliation(s)
- Bahruddin Saad
- School of Chemical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
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Mariga ST, Gil JP, Sisowath C, Wernsdorfer WH, Björkman A. Synergism between amodiaquine and its major metabolite, desethylamodiaquine, against Plasmodium falciparum in vitro. Antimicrob Agents Chemother 2004; 48:4089-96. [PMID: 15504826 PMCID: PMC525449 DOI: 10.1128/aac.48.11.4089-4096.2004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro activity of the prodrug amodiaquine and its metabolite monodesethyl-amodiaquine has been studied for three strains of Plasmodium falciparum: LS-2, LS-3, and LS-1. Both compounds showed significant activity against all three strains; the activity of amodiaquine was slightly higher than that of the metabolite. By use of a checkerboard design, interaction studies with both compounds yielded evidence of significant synergism; means of the sums of the fractional inhibitory concentrations were 0.0392 to 0.0746 for strain LS-2, 0.1567 to 0.3102 for strain LS-3, and 0.025 to 0.3369 for strain LS-1. In further investigations, the interaction of amodiaquine with monodesethyl-amodiaquine was tested at clinically relevant concentrations of both compounds. In these studies, involving amodiaquine at picomolar and femtomolar concentrations, the compound was found to exert high potentiating activity on monodesethyl-amodiaquine. This interaction produced mean ratios of observed to expected activity of 0.0505 to 0.0642 for strain LS-2, 0.0882 to 0.3820 for strain LS-3, and 0.0752 to 0.2924 for strain LS-1. The synergistic activity was most marked at monodesethyl-amodiaquine/amodiaquine ratios up to 100,000:1 but was still evident at higher ratios.
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Affiliation(s)
- S T Mariga
- Department of Infectious Diseases, Karolinska Hospital, Stockholm 17176, Sweden
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Rengelshausen J, Burhenne J, Fröhlich M, Tayrouz Y, Singh SK, Riedel KD, Müller O, Hoppe-Tichy T, Haefeli WE, Mikus G, Walter-Sack I. Pharmacokinetic interaction of chloroquine and methylene blue combination against malaria. Eur J Clin Pharmacol 2004; 60:709-15. [PMID: 15619134 DOI: 10.1007/s00228-004-0818-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Accepted: 07/13/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The combination of chloroquine and methylene blue is potentially effective for the treatment of chloroquine-resistant malaria caused by Plasmodium falciparum. The aim of this study was to investigate whether methylene blue influences the pharmacokinetics of chloroquine. METHODS In a randomized, placebo-controlled, parallel group design, a 3-day course of therapeutic oral doses of chloroquine (total 2.5 g in male, 1.875 g in female participants) with oral co-administration of placebo or 130 mg methylene blue twice daily for 3 days was administered to 24 healthy individuals. Chloroquine, desethylchloroquine, and methylene blue concentrations were determined by means of HPLC/UV or LC/MS/MS assays in whole blood, plasma, and urine for 28 days after the last dose. RESULTS During methylene blue exposure, the area under the chloroquine whole blood concentration-time curve normalized to body weight (AUC(0-24 h)/BW) yielded a trend of reduction (249+/-98.2 h mug l(-1) kg(-1) versus 315+/-65.0 h mug l(-1) kg(-1), P=0.06). The AUC(0-24 h)/BW of desethylchloroquine was reduced by 35% (104+/-40.3 h mug l(-1) kg(-1) versus 159+/-66.6 h mug l(-1) kg(-1), P=0.03), whereas the metabolic ratio between chloroquine and desethylchloroquine remained unchanged (2.25+/-0.49 versus 1.95+/-0.42, P=0.17). The renal clearance of chloroquine and the ratio between chloroquine in whole blood and plasma remained unchanged (P>0.1). CONCLUSION Oral co-administration of methylene blue appears to result in a small reduction of chloroquine exposure which is not expected to be clinically relevant and thus represents no concern for further development as an anti-malarial combination.
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Affiliation(s)
- Jens Rengelshausen
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Minzi OMS, Moshi MJ, Hipolite D, Massele AY, Tomson G, Ericsson O, Gustafsson LL. Evaluation of the quality of amodiaquine and sulphadoxine/pyrimethamine tablets sold by private wholesale pharmacies in Dar Es Salaam Tanzania. J Clin Pharm Ther 2003; 28:117-22. [PMID: 12713608 DOI: 10.1046/j.1365-2710.2003.00470.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There are several independent reports in Tanzania of treatment failures with commercially available sulphadoxine/pyrimethamine (SP) and amodiaquine (AQ) brands. The aim of this work was to assess the quality of SP and AQ tablets marketed by wholesale pharmacies in Dar Es Salaam, Tanzania. METHODS All eight wholesale pharmacies authorized to import medicines and located in Dar Es Salaam were included in the study. From each pharmacy, samples of all SP and AQ brands available at the time of sampling were bought, provided they had a shelf-life of at least 1 year. A sample was either an intact box of 100 tablets or a sealed tin of 100 tablets. To ensure blinding, 30 tablets of each sample were removed from their original containers, coded and sent to the quality control laboratory for analysis. The name, strength, batch number, manufacturer and the expiry dates of the tablets were recorded. In total 15 AQ and 18 SP samples were collected. Identity, assay for content of active ingredients and dissolution assay were performed as described in the United States Pharmacopoeia (USP). RESULTS All samples passed the identity test. Among the AQ samples collected, two of 15 (13%) failed the dissolution test but all passed the assay for content, whereas two of 18 (11%) and eight of 18 (44%) SP samples failed the assay for content and dissolution tests, respectively. None of the pharmacies stocked all AQ and SP brands. CONCLUSION This work reveals the availability of poor quality antimalarial drugs on the Tanzanian market. Use of substandard drugs could have serious clinical consequences to patients. The results support the need for continuous monitoring of the quality of marketed drugs to ensure safety and efficacy of these products in the treatment of malaria in endemic areas.
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Affiliation(s)
- O M S Minzi
- Clinical Pharmacology Department, Faculty of Medicine, Muhimbili University College of Health Sciences (MUCHS), Dar Es Salaam, Tanzania.
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