Simultaneous determination of paracetamol, dextromethorphan, chlorpheniramine, pseudoephedrine and major impurities of paracetamol and pseudoephedrine by using capillary electrophoresis

Abstract A capillary electrophoresis method was developed for the first time and optimized for the determination of paracetamol, pseudoephedrine, dextromethorphan, chlorpheniramine, 4-aminophenol and ephedrine in tablet formulation. Optimum electrophoretic conditions were achieved by using a background electrolyte of 75 mmol L-1 sodium borate buffer at pH 8.0, a capillary temperature of 30°C, a separation voltage of 30 kV and a pressure injection of the sample at 50 mbar for 10 s. Calibration graphs showed a good linearity with a coefficient of determination (R2) of at least 0.999 for all compounds. Intraday and interday precision (expressed as relative standard deviation (RSD) %) were lower than 1.39% for capillary electrophoresis method. The developed method was demonstrated to be simple and rapid for the determination of paracetamol, pseudoephedrine, dextromethorphan, chlorpheniramine, 4-aminophenol and ephedrine in tablet formulation providing recoveries in the range between 99.62 and 100.57% for all analytes.

Comparison of safety and efficacy of dextromethorphan and levocloperastine in treatment of dry cough: a randomized open label phase IV clinical trial

Background: To compare safety and efficacy of dextromethorphan and levocloperastine in treatment of dry cough.Methods: Patients fulfilling the selection criteria were randomized into two groups. Patients in group A were administered dextromethorphan cough lozenges (5 mg) thrice daily for 7 days. Patients in group B were administered syrup levocloperastine (20 mg/5 ml) 5 ml thrice daily for 7 days. Severity and frequency of cough, and Leicester Cough Questionnaire (LCQ) score were assessed at the end of day 7.Results: Levocloperastine significantly decreased (p<0.5) severity and frequency of cough compared to dextromethorphan at day 7. Levocloperastine also significantly increased LCQ score compared to dextromethorphan at day 7.Conclusions: Levocloperastine is significantly more effective compared to dextromethorphan in treatment of dry cough.

Uso de coadyuvantes en dolor postoperatorio / Use of adjuvants in postoperative pain

Resumen: Los analgésicos coadyuvantes son compuestos que tienen una baja potencia analgésica. Sin embargo, la sinergia con opioides incrementa su efecto y favorece una reducción en los eventos adversos de los narcóticos para el control del dolor postoperatorio. Las estrategias ahorradoras de opioides están relacionadas con el efecto de una variedad de receptores, de los cuales podemos nombrar: los antagonistas NMDA como la ketamina, magnesio y dextrometorfano, los agonistas α-2 como la clonidina y la dexmedetomidina, los inhibidores de la subunidad α-2δ de los canales de calcio como la pregabalina y la gabapentina, los bloqueadores de los canales de sodio como la lidocaína y, finalmente, los glucocorticoides. En esta revisión se describirán las características, indicaciones, dosis y niveles de evidencia del uso de los coadyuvantes de uso intravenoso y regional en el contexto perioperatorio. (visite http://www.painoutmexico.com para ver artículo completo y Tablas).

Abstract: The adjuvant analgesics are compounds that have a low analgesic potency. However, with these compounds, the adverse effects of opioids may be diminished for the control of postoperative pain. Opioid-sparing strategies are related to the effect on a variety of receptors, of which we should name: the NMDA antagonists such as ketamine, magnesium and dextromethorphan, the α-2 agonists such as clonidine and dexmedetomidine, subunit α-2δ of calcium channels inhibitors; such as pregabalin and gabapentin, sodium channels blockers such as lidocaine and finally glucocorticoids. In this review we describe the characteristics, indications, doses and levels of evidence of use of adjuvants in the perioperative context (visit http://www.painoutmexico.com to see the full article and Tables).

Improved Bulbar Function in Amyotrophic Lateral Sclerosis after Nuedexta (Dextromethorphan and Quinidine) Treatment

Nuedexta (dextromethorphan and quinidine) is an Food and Drug Administration approved medication for pseudobulbar affect. Interestingly, this drug was recently reported to improve speech, swallowing, and the ability to handle oral secretions along with emotional lability in amyotrophic lateral sclerosis (ALS) patients with bulbar symptoms. We report a Korean ALS patient whose bulbar function improved after administering Nuedexta for 6 months, extending therapeutic choice of approach in treating ALS patients.

Antidepressant effect of dextromethorphan and its mechanism / 中国病理生理杂志

AIM:To investigate the antidepressant effect of dextromethorphan(DXM)and its mechanism. METHODS:The antidepressant effect of DXM was observed by the methods of forced swimming test,tail suspension test and open field test.The N-methyl-D-aspartate(NMDA)receptor activity in brain,and the effects of total nitric oxide syn-thases(NOS)and various types of NOS were examined by molecular biology methods.The mice pretreated with NMDA re-ceptor antagonist MK-801(MK),NMDA,NO precursor L-arginine(L-ARG),endothelial NOS(eNOS)inhibitor Nω-ni-tro-L-arginine methyl ester(L-NAME),inducible NOS(iNOS)inhibitor aminoguanidine(AG),neuronal NOS(nNOS) inhibitor 7-nitroindole(7-NI)or phosphodiesterase 5 inhibitor sildenafil were given DXM to explore the mechanism of DXM as an antidepressant.RESULTS: DXM had a dose-dependent antidepressant effect.DXM inhibited the activity of brain NMDA receptor in a dose-dependent manner, and inhibited the expression of eNOS and nNOS.MK, L-NAME and 7-NI were able to promote the antidepressant effect of DXM.NMDA,L-ARG and sildenafil were able to inhibit the antidepres-sant effect of DXM.AG did not influence the antidepressant effect of DXM.CONCLUSION:DXM has an antidepressant effect,and NMDA receptor and L-ARG-NO-cGMP signaling pathways are involved in this process.

Clinical study of dextromethorphan in treatment of patients with poststroke pseudobulbar affect symp-toms / 实用医学杂志

Objective To evaluate the clinical effect of dextromethorphan and its effect on daily living of patients with poststroke pseudobulbar affect. Methods Sixty patients with poststroke pseudobulbar affect admitted in our hospital from May 2013 to October 2016 were enrolled. Then they were randomly divided into the control group and the treatment group,with 30 patients in each group.Patients in the control group were treated with fluox-etine therapy and patients in the treatment group were treated with dextromethorphan therapy.The center for neuro-logic study lability scale(CNS-LS)and activity of daily living(Barthel index,BI)before and 30 days after the treat-ments in the two groups had been accessed. Results Thirty days after the treatment,CNS-LS of the treatment group had obvious improvement compared with that before treatment(P < 0.01),but CNS-LS of the control group had no obvious improvement compared with that before treatment(P > 0.05). And significant improvement has been found 30 days after the treatment between the two groups(P<0.01).Furthermore,significant difference was found on BI between these two groups(P<0.05).Conclusions Dextromethorphan is effective in treatment of pa-tients with poststroke pseudobulbar affect and it can improve the activity of daily living of these patients.

Effect of wet mass on dextromethorphan hydrobromide matrix pellets

Dextromethorphan hydrobromide (DM) sustained release matrix pellets containing 10% w/w drug were prepared by an extrusion/spheronization technique. The effect of mixing different concentrations of ethyl cellulose (EC), hydroxypropyl methylcellulpse (HPMC K10), and Carbopol 934 with Avicel PH101 on the rheological properties of pellet wet mass was evaluated using mixer torque rheometry (MTR). The prepared pellets were characterized for size, drug content, and in-vitro DM release rate. The results showed that increasing the concentration of the hydrophobic polymer (EC) with Avicel PH101 decreased wet mass consistency, represented by mass mean line torque. Lower binder ratio was required for optimum wet massing, while mixing with swellable polymers (HPMC and Carbopol) caused a noticeable increase in both mean line torque and binder ratio. Combinations of HPMC and Carbopol at higher concentrations resulted in controlled in vitro release of DM from the prepared pellets. Furthermore, mathematical treatment of the in vitro release data of DM from the prepared pellets showed that all formulations except those containing 5% Carbopol plus 5% HPMC (F10) follow first order release. n values of these formulation were in the range of 0.09-0.40, which support an anomalous non-Fickian release.

Prediction and visualization of CYP2D6 genotype-based phenotype using clustering algorithms

This study focused on the role of cytochrome P450 2D6 (CYP2D6) genotypes to predict phenotypes in the metabolism of dextromethorphan. CYP2D6 genotypes and metabolic ratios (MRs) of dextromethorphan were determined in 201 Koreans. Unsupervised clustering algorithms, hierarchical and k-means clustering analysis, and color visualizations of CYP2D6 activity were performed on a subset of 130 subjects. A total of 23 different genotypes were identified, five of which were observed in one subject. Phenotype classifications were based on the means, medians, and standard deviations of the log MR values for each genotype. Color visualization was used to display the mean and median of each genotype as different color intensities. Cutoff values were determined using receiver operating characteristic curves from the k-means analysis, and the data were validated in the remaining subset of 71 subjects. Using the two highest silhouette values, the selected numbers of clusters were three (the best) and four. The findings from the two clustering algorithms were similar to those of other studies, classifying *5/*5 as a lowest activity group and genotypes containing duplicated alleles (i.e., CYP2D6*1/*2N) as a highest activity group. The validation of the k-means clustering results with data from the 71 subjects revealed relatively high concordance rates: 92.8% and 73.9% in three and four clusters, respectively. Additionally, color visualization allowed for rapid interpretation of results. Although the clustering approach to predict CYP2D6 phenotype from CYP2D6 genotype is not fully complete, it provides general information about the genotype to phenotype relationship, including rare genotypes with only one subject.

Antipyretic effects of Paracetamol Tablets, Compound Paracetamol and Amantadine Hydrochloride Tablets, Compound Dextromethorphan Hydrobromide Tablets, and Chaiqin Qingning capsules on rat model with LPS and dry yeast induced fever / 药物评价研究

Objective To study the antipyretic effect of Paracetamol Tablets,Compound Paracetamol and Amantadine Hydrochloride Tablets,Compound Dextromethorphan Hydrobromide Tablets,and Chaiqin Qingning Capsules on the fever model induced by LPS and dry yeast in rats.Methods Fever was induced by ip injecting LPS (100 μg/kg) or sc injecting dry yeast (20％) in rats.We observed the changes of temperature of the rats after administration of Paracetamol Tablets,Compound Paracetamol and Amantadine Hydrochloride Tablets,Compound Dextromethorphan Hydrobromide Tablets (the acetaminophen contents were 205.67,102.83,and 51.42 mg/kg)and Chaiqin Qingning Capsules (1110.60,555.30,and 277.65 mg/kg).Maximum temperature rise height (△T) and temperature response index (TRI) were calculated,and the curve of average rise in temperature was drawn.Results Each dose group of Paracetamol Tablets,Compound Paracetamol and Amantadine Hydrochloride Tablets,Compound Dextromethorphan Hydrobromide Tablets,and Chaiqin Qingning Capsules had obvious antipyretic effect on the fever model induced by LPS and dry yeast in rats,and there was a certain dose-effect relationship.Conclusion Paracetamol Tablets,Compound Paracetamol and Amantadine Hydrochloride Tablets,Compound Dextromethorphan Hydrobromide Tablets,and Chaiqin Qingning Capsules has certain antipyretic effect on LPS and dry yeast fever model in rats,and on the whole,the Western medicine acts rapid but continue for a short time,while the traditional Chinese medicine acts slow but continues for a long time.

"Experimental study on ""dose-time-toxicity"" relationship of hepatotoxicity in mice with multiple administration of cold medicine containing acetaminophen and Chaiqin Qingning Capsules" / 药物评价研究

Objective To study the dose-time-toxicity relationship of hepatotoxicity in mice with multiple administration of Paracetamol Tablets (PT),Compound Paracetamol and Amantadine Hydrochloride Tablets (CPAH),Compound Dextromethorphan Hydrobromide Tablets (CDH),and Chaiqin Qingning capsules (CQC).Methods Mice were randomly divided into control,PT,CPAH,CDH,and CQC high,medium,and low dose groups.The acetaminophen contents of high,medium,and low doses were 266.24,425.98,and 681.57 mg/kg in PT,CPAH,and CDH groups,and the doses of CQC group were 1437.70,2300.31,and 3 680.50 mg/kg,ig administration,once daily for 5 d.General state and toxicity of mice were observed.The changes of ALT,AST,AKP,TBIL,and ALB levels in serum and organ indexes of liver,spleen,thymus,and kidney were tested on day 1,3,7,11,and 14 after multiple administration.Results CQC with the dosage range of 1 437.70-3 680.50 mg/kg to mice within 14 d,has not yet induced the increase of AST,ALT,AKP,TBIL,and ALB levels and changes of organ indexes of liver,thymus spleen,and kidney compared with normal control (P ＞ 0.05).PT,CPAH,and CDH with repeated dose of 425.98-681.57 mg/kg could induce significant increase of the levels ofALT,AST,AKP,and TBIL which reached the peak on day 1 (P ＜ 0.05),and then gradually decreased on day 3-14.The level of ALB significant decreased on day 1-11 (P ＜ 0.05),and then gradually recovered on day 11-14.The liver index significant increased on day 1-3 (P ＜ 0.05),and recovered on day 7-14.Conclusion Multiple administration of CQC could not induce liver injury in mice within 14 d,while multiple administration ofPT,CPAH,and CDH could induce hepatotocixity in mice with a certain dose,and show an obvious dose-time-toxicity relationship.

"Experimental study on ""Dosage-Time-Toxicity"" relationship of hepatotoxicity induced by cold medicine containing acetaminophen and Chaiqin Qingning Capsules with single administration in mice" / 药物评价研究

Objective To study the time-toxicity and dose-toxicity relationship of hepatotoxicity induced by Paracetamol Tablets (PT),Compound Paracetamol and Amantadine Hydrochloride Tablets (CPAH),Compound Dextromethorphan Hydrobromide Tablets (CDH),and Chaiqin Qingning Capsules (CQC) with single dose in mice.Methods In the Time-Toxicity relationship study,Kunming mice were randomly divided into control,PT,CPAH,CDH,and CQC group,and mice of.each drug administration group were randomly divided into nine subgroups according to the time (1,2,4,8,12,24,48,72 and 96 h after administration) of blood collection.The acetaminophen contents in PT,CPAH,and CDH groups were 425.98 mg/kg,and the dose of CQC group was 3 680.50 mg/kg.In the Dosage-Time relationship study,mice were randomly divided into control,PT,CPAH,CDH,and CQC high,medium and low dose group.The acetaminophen contents of high,medium,and low dose were 266.24,425.98,and 681.57 mg/kg in PT,CPAH,and CDH group,and the dose of CQC group was 1437.70,2300.31,and 3680.50 mg/kg,10 mice in each group,sex in half.Blood was collected 12 h after administration.Animal behavior was observed every day,blood and organs were collected at the corresponding time points,serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),and alkaline phosphatase (ALP) level were detected,and the organs index of spleen and thymus,liver were calculated.Results There were no significant changes of ALT,AST,ALP,and organs index after once ig administration of CQC at dosage of 1437.70 mg/kg to 3680.50 mg/kg in mice.The study on time-toxicity relationship indicated that,after once administration of PT,CPAH,and CDH at 425.98 mg/kg,mice showed toxic symptom such as hypokinesia,dry hair and so on,12 h was the most obvious,24 ～ 72 h disappeared.The level of ALT,AST,and ALP in serum increased and reached to the peak at 12 h and then restored near normality after 72,24,and 24 h in PT,CPAH,and CDH group.Their organ index of liver,spleen and thymus all had no significant changes.The study on the dosage-toxicity relationship indicated that,there were no significant changes of animal behavior,ALT,AST,ALP,and organs index after once ig administration of PT,CPAH,and CDH at 266.24 mg/kg.Obvious liver injury can be induced by the three drugs with dosage of 425.98 to 681.57 mg/kg and the level of ALT,AST,and ALP increased significantly with the increase of dosage.Their liver index increased significantly with dosage of 681.57 mg/kg,but the organs index of spleen,thymus had no significant changes.Conclusion There was no hepatotoxicity after once ig administration of CQC with dosage of 3680.50 mg/kg in mice.Mice were once ig administration ofPT,CPAH,and CDH with a large dose,may induce acute liver injury and show obvious time-toxicity and dose-toxicity relationships.

Clinical study on the efficacy and safety of Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup on eliminating or relieving the symptoms of acute upper respiratory infection in children / 临床儿科杂志

Objective To evaluate the efficacy and safety of Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup on eliminating or relieving the symptoms of acute upper respiratory infections in children, by comparing with Guaifenesin, Dextromethorphan Hydrobromide, Methylephedrine Hydrochloride, and Chlorphenamine Maleate Syrup. Methods Random, blind and parallel control method was adopted. A total of 253 pediatric patients were recruited in 11 clinical research centers; 127 patients were assigned in experimental group and finally 118 patients were included in the program set analysis (PPS); 126 patients were assigned into control group and finally 116 patients were included in PPS. The experimental group took Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup and control group took Guaifenesin, Dextromethorphan Hydrobromide, Methylephedrine Hydrochloride, and Chlorphenamine Maleate Syrup. All of the patients took as prescribed at least for 3 days but not more than 7 days. Results There was no significant differences in age, sex, and acute upper respiratory tract infection scores between the two groups (P?>?0.05). PPS showed the median time of symptom relief of acute upper respiratory tract infection in experimental group was 51.0 h (95%CI: 43.0-62.0 h) and 56.0 h (95%CI: 48.0-64.0 h) in control group. There was no difference between two groups (P?>?0.05). After calibration of center and baseline effects, the experimental group was not worse than the control group. There was no difference in the score of acute upper respiratory tract infection between two groups (F=0.14, P=0.710). The individual symptoms disappear rate of acute upper respiratory tract infection and the compliance between two groups were similar (P all?>?0.05). Both groups had 7 cases of adverse events, and one case of adverse drug reactions each. Thus, the adverse reaction rates in two groups were 0.8% each. Conclusions Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup can effectively relieve symptoms rapidly in the treatment of children with acute upper respiratory tract infection, and its efficacy and safety were non worse than traditional Guaifenesin, Dextromethorphan Hydrobromide, Methylephedrine Hydrochloride, and Chlorphenamine Maleate Syrup.

Dextromethorphan for tardive dyskinesia.

Aims: To report three cases of successful treatment of tardive dyskinesia (TD) with dextromethorphan. Study Design: Retrospective chart review. Place and Duration of Study: Private outpatient practice in Syracuse, NY. Methodology: A retrospective chart review of patients with TD who were treated with dextromethorphan between 2003 and 2013 was conducted. Results: Three consecutive patients experienced marked improvement of TD with dextromethorphan. Conclusion: Dextromethorphan may be a useful drug for treating TD. Further prospective studies are needed.

Determination of Two Components and Preservative in Compound Dextromethorphan Hydrobromide Syr-ups by HPLC / 中国药师

Objective:To establish an HPLC method for the determination of two components and the preservative in compound dextromethorphan hydrobromide syrups. Methods:An Agilent Zobax SB-C18 column(250 mm × 4. 6 mm,5 μm) was used with meth-anesulfonic acid solution (adding 4. 8g methanesulfonic acid and 10ml triethylamine into 750ml water,and adjusting the pH value to 3. 5 by phosphoric acid)-acetonitrile (75∶25) as the mobile phase at the flow rate of 1. 0 ml·min-1 and 280nm as the detection wave-length. Results:The calibration curve was linear within the range of 102-1 025μg·ml-1 for guaifenesin,15-619μg ·ml-1 for dextro-methorphan hydrobromide and 10-407μg·ml-1 for benzoic acid. The average recovery of guaifenesin, dextromethorphan hydrobromide and benzoic acid was 100. 0% (RSD=0. 35%), 100. 1%(RSD=0. 77%)and 100. 8%(RSD=0. 49%), respectively. Conclusion:The method is simple,rapid and accurate,and suitable for the quality assessment of compound dextromethorphan hydrobromide syrups.

Effect of sarpogrelate hydrochloride on cytochrome P450 2D1/2 in rats / 中国药理学通报

Aim To investigate the influence of sarpog-relate hydrochloride (SH)on the pharmacokinetic pro-file of dextromethorphan (DM),the typical substrate of CYP2D1 /2,in rats when they were administered co-instantaneously.Methods A total of 1 2 SD rats were randomly divided into two groups:the control group (DM,1 0 mg·kg-1 )and the sarpogrelate group (SH, 1 0 mg·kg-1 ;DM,1 0 mg·kg-1 ),which received in-tragastric administration.Plasma samples were collected immediately before and at different time points after drug administration.A LC-MS /MS method was used to determine the concentrations of DM in rat plasma. Pharmacokinetic parameters were analyzed using Drug and Statistics (DAS 2.0).Results There were signif-icant differences in the pharmacokinetic parameters of DM,including T1 2 (2.49 h ±0.93 h vs 1 .47 h ±0.20 h,P <0.05 ),Cmax (325.7 μg·L -1 ±1 33.2 μg· L -1 vs 1 04.5μg·L -1 ±52.4 μg·L -1 ,P <0.05), AUC0 -t(785.5 μg·L -1 ·h ±451 .9 μg·L -1 ·h vs 244.8 μg·L -1 ·h ±1 68.3μg·L -1 ·h,P <0.05) and AUC0 -∞(804.7 μg·L -1 ·h ±445.6 μg·L -1 ·h vs 251 .4 μg·L -1 ·h ±1 73.4 μg·L -1 ·h,P<0.05 )between the two groups.Conclusion SH could significantly inhibit the elimination of DM,the substrate of CYP2D1 /2 in rats.

Serotonin Syndrome After an Overdose of Dextromethorphan and Chlorpeniramine: Two Case Reports

Dextromethorphan and chlorpeniramine are common ingredients of over-the-counter (OTC) cough pills. They are known to be safe when used alone, however, combination with other serotonergic drugs or use of an overdose can cause serotonergic toxicity. We report on a 43-year-old male and a 57-year-old female who ingested an overdose of antitussive drugs containing dextromethorphan and chlorpeniramine. They commonly presented with altered mentality and hyperreflexia on both upper and lower extremities. After conservative therapies, they were discharged with alert mentality. These cases are meaningful in that there are few cases of serotonin syndrome with an overdose of a combination of dextromethorphan and chlorpeniramine. Careful use with medication counseling for OTC cough pills is needed in order to prevent overdose of these ingredients.

Screening of codeine, dextromethorphan & dextropropoxyphene for their genotoxicity in swiss albino mice.

Background & objectives: It is mandatory for all new drugs to be tested for their potential genotoxicity in addition to general toxicity testing. Some old drugs have not been tested adequately for their genotoxic effects as these were in use before the regulations were enforced. The present study therefore aims to explore the genotoxic potential of some commonly used opioids like codeine, dextromethorphan and dextropropoxyphene in swiss albino mice. Methods: Therapeutic equivalent doses of codeine, dextromethorphan and dextropropoxyphene were given orally. Single dose for acute study and multiple doses (repeated every 24 h for 7 times) in additional groups of mice (n=5 in each) for subacute study. Cyclophosphamide served as positive control while normal saline as negative control. About 0.5 ml of blood was collected by retroorbital sinus for comet assay and later the mice were sacrifi ced to aspirate the femoral bone marrow for micronucleus test. Percentage of micronucleated polychromatic erythrocytes (MnPCE) and comet tail length were calculated in micronucleus assay and comet assay respectively, which served as markers of genotoxicity. Results: Signifi cant Signififi (P<0.001) increase in comet tail length and % MnPCE was observed in both acute and subacute studies of cyclophosphamide group, whereas codeine, dextromethorphan and dextropropoxyphene treated groups did not show any signifi cant changes. Interpretation & conclusion: The results indicated that codeine, dextromethorphan and dextropropoxyphene were devoid of genotoxicity in mice.

Comparison of analgesic effect of morphine alone and combination of morphine with dextromethmorphan / 肿瘤

Objective: To standardize the method for morphine dose titration and investigate the synergistic effect of dextromethorphan with morphine on cancer pain. Methods: Eighty six adult patients with severe cancer pain were selected. The experiment was divided into two stages: the stage of morphine dose titration and random double-blind contrast test. At the stage of morphine dose titration the patients were administered morphine 5 mg/4 h at baseline and given "as needed" morphine palliative treatment at 10% total daily dosage when abrupt pain occurred till the patients gained stable pain. At the stage of random double-blind contrast test the dosage of morphine was reduced by 30% and dextromethorpban or its analogue tablets (dose ratio 1: 1) was added. Morphine dose titration was performed again till pain relief. Results: During the stage of morphine dose titration the dose of morphine was increased from the second day. The dose of morphine was stabilized on the fourth day. Morphine was given to the patients at the stable dose continuously. The minimum pain-relieving dose of morphine was 30 mg and the maximum dose was 160 mg. The pain intensity of the patients began weaker from the third day and kept stable during the treatment. The life qualities of the patients were obviously improved. During contrast test stage the total dose of morphine was reduced in both groups. The dose of morphine was reduced a little more after addition of dextromethorphan compared with the control group. But there was no significant difference between the two groups. The pain intensity kept stabilized during the treatment. Conclusion: Standardized morphine dose titration achieved satisfactory effects on cancer pain. Addition of dextromethorphan tended to reduce the total dose of morphine.

Optimization of the Formulation of Dextromethorphan Hydrobromide Sustained-release Tablets by Orthogonal Test / 中国药房

OBJECTIVE:To optimize the formulation of dextromethorphan hydrobromide sustained-release tablets. METHODS: The dextromethorphan hydrobromide sustained-release tablets were prepared with HPMC as sustained release matrix. Orthogonal test was performed to optimize the formulation with in vitro accumulative drug release rate as index and the amount of HPMC and lactose as well as ethylcellulose (EC) concentration as factors. Then verification test on the in vitro drug release characteristics of the optimized tablets were performed and the influencing factors (high temperature,high light,and high moisture) were investigated as well. RESULTS: The optimized formulation of dextromethorphan hydrobromide sustained-release tablets was as follows: 30 mg HPMC,50 mg lactose,and 8% EC. The accumulative drug release rate at 8 h was above 70%. In the influencing factor test,the tablets were stable under all conditions except at high moisture condition. CONCLUSION: The optimized formulation of dextromethorphan hydrobromide sustained-release tablets is feasible.

Preemptive analgesia of dextromethorphan and tramadol for postoperative soreness / 中国基层医药

Objective To investigate the clinical effect of intramuscular dextromethorphan and tramadol premedication for postoperative analgesia.Methods 60 cases of ASA Ⅰ～Ⅱ underwent surgical procedures of extremitas inferior were divided into 3 groups randomly.Patients in every group were provided with dextromethorphan 20mg,tramadol 2mg/kg and normal sodium 4ml(control group) respectively.All patients received PCEA analgesia postoperatively.The postoperative visual analogue scale(VAS),ramay score,consumption of paregonic and adverse reactions were observed.Results After operation,VAS score in group of dextromethorphan was lower than that in control group significantly(P