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Lopalco A, Manni A, Keeley A, Haider S, Li W, Lopedota A, Altomare CD, Denora N, Tuleu C. In Vivo Investigation of (2-Hydroxypropyl)-β-cyclodextrin-Based Formulation of Spironolactone in Aqueous Solution for Paediatric Use. Pharmaceutics 2022; 14:pharmaceutics14040780. [PMID: 35456614 PMCID: PMC9029429 DOI: 10.3390/pharmaceutics14040780] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023] Open
Abstract
Spironolactone (SPL), a potent anti-aldosterone steroidal drug used to treat several diseases in paediatric patients (e.g., hypertension, primary aldosteronism, Bartter’s syndrome, and congestive heart failure), is not available in child-friendly dosage forms, and spironolactone liquids have been reported to be unpalatable. Aiming to enhance SPL solubility in aqueous solution and overcome palatability, herein, the effects of (2-hydroxypropyl)-β-cyclodextrin (HP-β-CyD) were thoroughly investigated on solubilisation in water and on masking the unpleasant taste of SPL in vivo. Although the complexation of SPL with HP-β-CyD was demonstrated through phase solubility studies, Job’s plot, NMR and computational docking studies, our in vivo tests did not show significant effects on taste aversion. Our findings, on the one hand, suggest that the formation of an inclusion complex of SPL with HP-β-CyD itself is not necessarily a good indicator for an acceptable degree of palatability, whereas, on the other hand, they constitute the basis for investigating other cyclodextrin-based formulations of the poorly water-soluble steroidal drug, including solid dosage forms, such as spray-dried powders and orodispersible tablets.
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Affiliation(s)
- Antonio Lopalco
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.L.); (C.D.A.)
| | - Annachiara Manni
- School of Pharmacy, University College of London, 29/39 Brunswick Square, London WC1N 1AX, UK; (A.M.); (A.K.); (S.H.); (C.T.)
- Food and Drug Department, University of Parma, Parco Area Delle Scienze 27/A, 43124 Parma, Italy
| | - Alexander Keeley
- School of Pharmacy, University College of London, 29/39 Brunswick Square, London WC1N 1AX, UK; (A.M.); (A.K.); (S.H.); (C.T.)
| | - Shozeb Haider
- School of Pharmacy, University College of London, 29/39 Brunswick Square, London WC1N 1AX, UK; (A.M.); (A.K.); (S.H.); (C.T.)
| | - Wenliang Li
- Imperial College London, South Kensington Campus, London SW7 2AZ, UK;
- Cranfield Water Science Institute, School of Water, Environment and Energy, Cranfield University, Cranfield MK43 0AL, UK
| | - Angela Lopedota
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.L.); (C.D.A.)
| | - Cosimo Damiano Altomare
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.L.); (C.D.A.)
| | - Nunzio Denora
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (A.L.); (A.L.); (C.D.A.)
- Correspondence: ; Tel.: +39-080-544-2767
| | - Catherine Tuleu
- School of Pharmacy, University College of London, 29/39 Brunswick Square, London WC1N 1AX, UK; (A.M.); (A.K.); (S.H.); (C.T.)
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Velasquez-Mieyer P, Neira CP, Nieto R, Cowan PA. Review: Obesity and cardiometabolic syndrome in children. Ther Adv Cardiovasc Dis 2016; 1:61-81. [DOI: 10.1177/1753944707082800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The cardiometabolic syndrome is highly prevalent among overweight youth. The risk of developing the cardiometabolic syndrome is likely triggered or exacerbated by concurrent obesity, unhealthy lifestyle/eating habits, and hormonal changes (puberty). Current screening recommendations include measurement of blood pressure, fasting insulin and glucose, and total cholesterol. However, limiting assessments to these measures underestimates cardiometabolic risk in overweight youth, particularly minorities. Early identification of cardiometabolic risk in its incipient stages may justify early and more aggressive intervention to prevent progression and complications. This review provides rationale for additional assessments to determine cardiometabolic risk in overweight youth and recommends treatment options.
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Affiliation(s)
- Pedro Velasquez-Mieyer
- Dept. of Pediatrics LeBonheur Children's Medical Center 50 North Dunlap Memphis, TN 38103
| | | | - Ramfis Nieto
- Department of Physiology, Universidad Centro-Occidental “Lisandro Alvarado” (UCLA). Barquisimeto, Venezuela
| | - Patricia A. Cowan
- Department of Nursing, University of Tennessee Health Science Center, Memphis, TN 38103, USA
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Screening of Visually Impaired Children for Health Problems. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:285-90. [DOI: 10.1016/j.anr.2015.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/18/2015] [Accepted: 06/09/2015] [Indexed: 11/17/2022] Open
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Shamma R, Elkasabgy N. Design of freeze-dried Soluplus/polyvinyl alcohol-based film for the oral delivery of an insoluble drug for the pediatric use. Drug Deliv 2014; 23:489-99. [DOI: 10.3109/10717544.2014.921944] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Highlights for the management of a child with hypertension. Int J Pediatr 2012; 2012:364716. [PMID: 22927864 PMCID: PMC3424789 DOI: 10.1155/2012/364716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022] Open
Abstract
Over the past several decades, childhood hypertension has undergone a considerable conceptual change, as hypertension is a predictor of future development of cardiovascular disease in adults. Childhood hypertension has distinctive features that distinguish it from hypertension in adults. Pediatric hypertension is often secondary. It is widely believed that therapeutic intervention at an early age favorably modifies the long-term outcome of hypertension. Despite its significance as a cause for morbidity, childhood hypertension is underdiagnosed and less studied with many basic issues remaining contentious.
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Stephens MM, Fox BA, Maxwell L. Therapeutic options for the treatment of hypertension in children and adolescents. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2012; 6:13-25. [PMID: 22408373 PMCID: PMC3296488 DOI: 10.4137/ccrpm.s7602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.
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Affiliation(s)
- Mary M Stephens
- Department of Family and Community Medicine Christiana Care Health System
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Wells T, Blumer J, Meyers KEC, Neto JPR, Meneses R, Litwin M, Vande Walle J, Solar-Yohay S, Shi V, Han G. Effectiveness and safety of valsartan in children aged 6 to 16 years with hypertension. J Clin Hypertens (Greenwich) 2011; 13:357-65. [PMID: 21545397 DOI: 10.1111/j.1751-7176.2011.00432.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The effectiveness and safety of valsartan have not been assessed in hypertensive children. Therefore, hypertensive patients aged 6 to 16 years (n=261) were randomized to receive weight-stratified low- (10/20 mg), medium- (40/80 mg), or high-dose (80/160 mg) valsartan for 2 weeks. After 2 weeks, patients were randomized to a 2-week placebo-controlled withdrawal phase. Dose-dependent reductions in sitting systolic blood pressure (SSBP) and sitting diastolic blood pressure (SDBP) were observed after 2 weeks (low dose, -7.9/-4.6 mm Hg; medium dose, -9.6/-5.8 mm Hg; high dose, -11.5/-7.4 mm Hg [P<.0001 for all groups]). During the withdrawal phase, SSBP and SDBP were both lower in the pooled valsartan group than in the pooled placebo group (SSBP, -2.7 mm Hg [P=.0368]; SDBP, -3.0 mm Hg [P=.0047]). Similar efficacy was observed in all subgroups. Valsartan was well tolerated and headache was the most commonly observed adverse event during both the double-blind and 52-week open-label phases.
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Affiliation(s)
- Thomas Wells
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
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Paize F, Isherwood D, Honour J, Jones CA. Abnormal urinary steroid profiles in four hypertensive obese children. J Pediatr Endocrinol Metab 2010; 23:237-44. [PMID: 20480722 DOI: 10.1515/jpem.2010.23.3.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a poorly understood association between obesity and hypertension. We demonstrated abnormalities of adrenal androgen and cortisol metabolites in four hypertensive obese children. PATIENTS Four males (aged 10 to 15 years) were evaluated for systolic blood pressures consistently above the 99.6th percentile. All were overweight with BMI ranging from 27-35. Clinical examinations, renal ultrasound and DMSA scans were normal. Plasma electrolytes, renin, aldosterone, cortisol, testosterone, ACTH and TSH were normal. 24-Hour urinary steroid profiles showed a generalised excess of adrenal androgen and cortisol metabolites in all cases. Relevant recognised disorders of adrenal androgen and cortisol metabolism were excluded. CONCLUSION There is no clinical condition explaining these abnormal urinary steroid profiles. These results support previous findings and provide new data on abnormal urinary adrenal androgen excretion in obese hypertensive patients. Further studies may determine the relationship between obesity, hypertension and the observed abnormalities of urinary steroid excretion.
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Affiliation(s)
- F Paize
- Institute of Child Health, University of Liverpool, Royal Liverpool Children's Hospital, Liverpool, UK.
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Hausner E, Fiszman ML, Hanig J, Harlow P, Zornberg G, Sobel S. Long-term consequences of drugs on the paediatric cardiovascular system. Drug Saf 2009; 31:1083-96. [PMID: 19026026 DOI: 10.2165/0002018-200831120-00005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Many pharmacological and toxicological actions of drugs in children cannot be fully predicted from adult clinical experience or from standard non-clinical toxicology studies. Numerous drugs have direct or indirect pharmacological effects on the heart and are prescribed for children of all ages. Toxicity or secondary effects may be immediate or delayed for years after drug exposure has ceased. Originally, the aim of this review was to compile information on the effect of specific drugs on the post-natal development of the cardiovascular system and to examine long-term follow-up of the use of cardio-active drugs in children. The limited database of published information caused the original question to evolve into an examination of the medical literature for three areas of information: (i) whether vulnerable developmental windows have been identified that reflect the substantial functional development that the cardiovascular system undergoes after birth; (ii) what is known about pharmacological perturbation of development; and (iii) what the likelihood is of drug exposure during childhood. We examined different scenarios for exposure including random, isolated exposure, conditions historically associated with adults, primary or secondary cardiac disease, psychiatric and neurological conditions, asthma, cancer and HIV. Except for random, isolated drug exposures, each category of possible exposure contained numerous drugs known to have either primary or secondary effects on the cardiovascular system or to influence factors associated with atherosclerosis. It is likely that a significant number of children will be prescribed drugs having either direct or indirect effects upon the immature cardiovascular system. A confounding factor is the simultaneous use of over-the-counter medications and herbal or nutraceutical preparations that a patient, parent or guardian does not mention to a prescribing physician. Metabolism is also important in assessing drug effects in children. Differences in body water : body fat ratio, age-related gastrointestinal absorption, distribution, excretion, renal function and drug metabolizing capabilities make it possible for children to have a different metabolite profile for a drug compared with adults. There is little examination of drug effects on the interdependent processes of cardiac maturation and less examination of metabolite effects. It is difficult to identify delayed toxicities in children as these adverse events may take years to manifest with many patients lost to follow-up. Clearly this is an area of study where intermediate endpoints and surrogate markers would be of great benefit. Pharmacogenomics may be useful in providing markers of increased risk or susceptibility. A perspective must be kept in balancing the possibility of a problem with the very real benefits that many children experience from the use of these pharmaceuticals.
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