Prescripción de metildopa en el tratamiento de pacientes con enfermedad hipertensiva en el embarazo / Methyldopa prescription in patients with hipertensive disease during pregnancy

Se realizó un estudio descriptivo y transversal, de utilización de medicamentos, de tipo indicación-prescripción, de 67 gestantes con enfermedad hipertensiva en el embarazo, atendidas en el Hospital Materno Sur Mariana Grajales Coello de Santiago de Cuba, desde julio de 2015 hasta junio de 2016, con vistas a caracterizar la prescripción de metildopa en estas pacientes. En la casuística predominó el uso de este fármaco en las pacientes que tenían situaciones asociadas con las formas más graves de la enfermedad, tales como la edad avanzada, la nuliparidad y el antecedente de hipertensión arterial. Las principales dificultades correspondieron a la combinación de medicamentos con riesgo de interacciones con la metildopa y al empleo de esta a dosis elevadas

A descriptive cross-sectional indication-prescription study of medications use, of 67 pregnant women with hipertensive disease during pregnancy, assisted in Mariana Grajales Coello Southern Maternal Hospital was carried out in Santiago de Cuba, from July, 2015 to June, 2016, aimed at characterizing methyldopa prescription in these patients. The use of this medicine prevailed in the case material in patients that had situations associated with the most serious forms of the disease, such as advanced age, nonpariity and hypertension history. The main difficulties corresponded to the combination of medicines with risk of methyldopa interactions and its use at a high dose

A study on the knowledge and management practices on hypertension in pregnancy among midwives in the different public health centers of Cebu City / Philippine Journal of Obstetrics and Gynecology

ABSTRACT:BACKGROUND: The Millennium Development Goal (MDG) for 2015 has a target MMR of 52/100,000 live births but this goal been difficult to achieve. In the Philippines, 11 mothers die everyday from pregnancy related complications, a bulk contributed by Hypertension. Public health midwives sometimes attend to these obsterical emergencies often in the absence of a physician. this led to the BEmONC program, which addresses the rising morbidities from far-flung areas where resources are scarce, and helps train midwives in essential obsterical emergency care. The midwives are our allies in providing the best standard of care every mother and child rightfully deserves. Only thru periodic evaluation can we help strengthen BEmONC program, making it crucial to evaluate the midwives' knowledge and management practices in hypertension to help identify the setbacks that have impeded our progress in achieving the MDG.GENERAL OBJECTIVE: To access the knowledge and management practices of midwives in the management of hypertension in pregnancy in accourdance to the BEmONC protocol.STUDY DESIGN: Descriptive StudySTUDY SETTING: The 69 public health centers of Cebu CitySTUDY POPULATION: Public Health MidwivesMETHODOLOGY:This is descriptive study where a survey questionnaire was used and convenience sampling was done. Chi square and Fischer exact tests were employed to compare proportions. Descriptive statistics was used to summarize the data in proportion.RESULT: More than 70% of the midwives were knowledgeable regarding expected competencies, where BEmONC-trained midwives were 5-14x more likely to identity appropriate function. However, Only a dismal 22-36% will actually administer Magnesium Sulfate, which shows that knowledge is not translated into practice. Also, more than 70% were knowledgeable on the risk factors and danger signs of hypertension in pregnancy. It also showed that the midwives agreed to give antihypertensive medications- where Methyldopa was commonly given. Among those who agreed too give Methyldopa, majority were BEmONC-trained. A number also agreed to give hydralazine and diazepam in the setting of sever preeclampsia and eclampsia, where more non-BEmONC midwives agreed. Alarmlingly, only less than 50% will refer to a physician in the management og gestational hypertension and mild preeclampsia, and only 50%-60% agreed to facilitate hospital transport in the setting of severe preeclampsia and eclampsia.CONCLUSION: The BEmONC manual must be updated to keep up with current guidelines and ensure the conversation of knowledge into practice. The BEmONCcoverage of training must also be expanded so that all practicing midwives know the protocol. However, the DOH must further strengthen their role in the active surveillance of public health midwives and review the retention of their skills and regular practice of knowledge. Midwives must also be certified proficient, not merely trained. The must also be consulted to explore their problems in the implementation of current guidelines so we can better understand their situation as to why knowledge is not put into practice. By identifying deficiencies, we can improve and address setbacks that have impeded our progress towards achieving the Millennium Development Goal.

Tratamento farmacológico e intervencionista do sistema nervoso simpático / Pharmacological and interventional treatment of sympathetic system

o sistema nervoso autônomo contribui diretamente para uma série de atividades biológicas e está envolvido em inúmeras doenças. A hiperatividade simpática é um dos vários mecanismos envolvidos na patogênese da hipertensão arterial sistêmica (HAS) primária. A transmissão da informação nervosa através de sinapses é mediada por agentes químicos específicos conhecidos como neurotransmissores, representados pela acetilcolina e pelas catecolaminas. O bloqueio dos receptores pré e pós-sinapse permite que a ação de fárrnacos alcance sua plenitude no controle dos portadores de hiperati vidade simpática. Um percentual significativo de hipertensos são resistentes ao tratamento farrnacológico. A denervação simpática renal surgiu como estratégia terapêutica adjunta no controle de hipertensos resistentes ao tratamento clínico. Nos últimos cinco anos, diversos estudos demonstraram resultados consistentes na redução da pressão arterial. Diversas outras condições clínicas associam-se à hiperatividade do sistema adrenérgico, tais como a insuficiência cardíaca, o diabetes mellitus, a doença renal crônica, a síndrome da apneia e hipopneia obstrutiva do sono e as arritmias cardíacas. Nestes contextos, a redução da atividade simpática renal também mostrou-se ser benéfica em estudos clínicos iniciais. Uma variedade de dispositivos dedicados foram e estão sendo desenvolvidos com o objetivo de ampliar a segurança e a eficácia do método, além de facilitar o procedimento. Estudos multicêntricos, prospectivos, randomizados e controlados em andamento investigam desfechos como mortalidade cardiovascular, infarto agudo do miocárdio e acidente vascular cerebral em longo prazo.

The autonomic nervous system contributes directly to a number of biological activities and is involved in numerous diseases. Sympathetic hyperactivity is one of several mechanisms involved in the pathogenesis of primary hypertension. The transmission through the nerve synapses is mediated by specific chemical agents known as neurotransmitters represented by the acetylcholine and catecholarnine. Blockade of specific pre-and post-synapse receptors allows the treatment of patients with sympathetic hyperactivity. A large proportion of hypertensive patients are resistant to pharmacological treatment. Renal sympathetic denervation emerged as adjunctive therapeutic strategy in controlling hypertension resistant to medical treatrnent. ln the last five years, several studies have shown consistent results in lowering blood pressure. Several other clinica! conditions are associated with hyperactivity of the adrenergic system such as heart failure, diabetes mellitus, chronic kidney disease, obstructive sleep apnea, polycystic ovary syndrome and cardiac arrhythrnias. ln these contexts, the reduction in renal sympathetic activity also proved to be beneficial in initial clinical studies. A substantial variety of dedicated devices have been developed in order to reduce variability between operators, reduce renal artery manipulation, improve vessel contact, reduce radiation exposure and procedure time, and therefore improving safety and efficacy. Mu!ticenter, prospective, randomized, controlled trials are ongoing to investigate long term outcomes such as cardiovascular mortality, acute myocardial infarction and stroke.

Development and validation of a simple spectrophotometric method for the determination of methyldopa in both bulk and marketed dosage formulations

A simple, precise, sensitive, rapid, specific and economical spectrophotometric method was developed to determine methyldopa (MTD) content in bulk and pharmaceutical dosage formulations. The proposed method was based on the formation of a colored product from the nitrosation reaction of MTD with sodium nitrite in an acid medium. The resultant nitroso derivative species reacts further with sodium hydroxide and is converted it into a more stable compound. This yellow nitrosation product exhibited an absorption maximum at 430 nm. Beer's Law was obeyed in a concentration range of 6.37 to 82.81 μg mL-1 MTD with an excellent coefficient of determination (R 2 = 0.9998). No interference was observed from common excipients in formulations. The results showed the method to be simple, accurate and readily applied for the determination of MTD in pure form and in pharmaceutical preparations. The analytical results obtained for these products using the proposed method are in agreement with those of the Brazilian Pharmacopoeia procedure at a 95% confidence level.

Desenvolveu-se método espectrofotométrico simples, preciso, sensível, rápido, específico e econômico para a determinação do teor de metildopa (MTD) em matéria-prima e em formulações farmacêuticas. O método proposto baseia-se na formação de um produto colorido resultante da reação de nitrosação da MTD com nitrito de sódio em meio ácido. A espécie resultante (nitroso derivado) reage com hidróxido de sódio e é convertida a um composto mais estável de cor amarela. Este produto exibiu máximo de absorção a 430 nm. A lei de Beer foi obedecida na faixa de concentração de 6,37 a 82,81 μg mL-1 de MTD com excelente coeficiente de determinação (R 2 = 0,9998). Não se observou interferência de excipientes comumente encontrados em formulações farmacêuticas comerciais. Os resultados demonstraram que o método proposto apresenta simplicidade, excelentes precisão e exatidão e pode ser aplicado para a determinação de MTD na sua forma pura e em preparações farmacêuticas. Os resultados analíticos obtidos pelo método proposto estão de acordo com aqueles obtidos pelo método oficial descrito na Farmacopéia Brasileira, a um nível de confiança de 95%.

Antihypertensive drug procurement trends from 1995 to 2004: transition over a decade

To evaluate antihypertensive procurement trends in Bahrain from 1995 to 2004. Pharmacology and Therapeutics, Arabian Gulf University/Directorate of Material Management, Ministry of Health. A retrospective audit study based on the data from the Directorate of Material Management, Ministry of Health [MOH], Bahrain. A review of the annual antihypertensive drug procurement data from 1995 to 2004 was performed. The procurement rate of angiotensin converting enzyme inhibitors [ACEIs], diuretics and alpha-blockers, significantly increased while the rate of calcium channel blockers [CCBs], methyldopa and hydralazine declined during this decade. Beta-blockers were the top-ranked agents in both 1995 and 2004. Significant interclass changes were evident: increase in procurement of long-acting ACEIs, CCBs and indapamide associated with a decline in short-acting ACEIs, CCBs and thiazide and thiazide-like diuretics in 2004. Angiotensin-II receptor blocker [ARB] - valsartan was introduced in 1999. The procurement of fixed-dose combinations [FDCs] increased from 0.9% in 1995 to 3.4% in 2004, associated with a significant decline in Moduretic and Brinerdin and by introduction of Co-Diovan, Preterax and Bi-Preterax. High cost due to renin-angiotensin-aldosterone inhibitors [ACEIs and ARBs] accounted for approximately half of the total antihypertensive drugs budget. According to Ministry of Health budget, the annual drug budget for antihypertensive drugs increased from 6.7% in 1995 to 14.1% in 2004. During that decade, there was a rapid annual growth rate for diuretics, CCBs and FDCs. The antihypertensive procurement strategy has qualitatively improved; there is a shift towards selection of more rational long-acting antihypertensives and FDC products. Analysis of drug procurement trend should be a critical component of national drug policy

Different culture media containing methyldopa for melanin production by Cryptococcus species / Avaliação de diferentes meios de cultura contendo metildopa para a produção de melanina por espécies de Cryptococcus

INTRODUCTION: Melanin production by species of Cryptococcus is widely used to characterize C. neoformans complex in mycology laboratories. This study aims to test the efficacy of methyldopa from pharmaceutical tablet as a substrate for melanin production, to compare the production of melanin using different agar base added with methyldopa, and to compare the melanin produced in those media with that produced in Niger seed agar and sunflower seed agar by C. neoformans, C. laurentii, and C. albidus. Two isolates of each species, C. neoformans, C. laurentii, and C. albidus, and one of Candida albicans were used to experimentally detect conditions for melanin production. METHODS: The following media were tested: Mueller-Hinton agar (MHA), brain and heart infusion agar (BHIA), blood agar base (BAB), and minimal medium agar (MMA), all added with methyldopa, and the media Niger seed agar (NSA) and sunflower seed agar (SSA). RESULTS: All isolates grew in most of the culture media after 24h. Strains planted on media BAB and BHIA showed growth only after 48h. All isolates produced melanin in MMA, MHA, SSA, and NSA media. CONCLUSIONS: Methyldopa in the form pharmaceutical tablet can be used as a substrate for melanin production by Cryptococcus species; minimal medium plus methyldopa was more efficient than the BAB, MHA, and BHIA in the melanin production; and NSA and SSA, followed by MMA added with methyldopa, were more efficient than other media studied for melanin production by all strains studied.

INTRODUÇÃO: A produção de melanina por espécies de Cryptococcus é uma característica amplamente utilizada em laboratórios de micologia para caracterização do complexoC. neoformans. O objetivo deste estudo foi verificar a eficácia da metildopa na forma farmacêutica de comprimido, como substrato para a produção de melanina por Cryptococcus, comparar diferentes bases de meios de cultura acrescidas de metildopa para produção de melanina e comparar o pigmento produzido nestes meios com o produzido em ágar Níger e ágar girassol por C. neoformans, C. laurentii e C. albidus. MÉTODOS: Foram testados dois isolados de cada uma das espécies, C. neoformans, C.laurentii e C.albidus, e um de C. albicans para avaliar a produção de melanina nos meios de cultura ágar Müeller-Hinton (MH), ágar brain heart infusion (BHI), ágar base sangue (BS), meio mínimo (MM), todos acrescidos de metildopa, e ainda ágar girassol e ágar Níger. RESULTADOS: Todos os isolados cresceram na maioria dos meios após 24h. O crescimento nos meios BS e BHI somente ocorreu após 48h. Todos os isolados produziram melanina nos meios MM, MH, girassol e Niger. CONCLUSÕES: A metildopa de origem farmacêutica pode ser utilizada como substrato para a produção de melanina por espécies de Cryptococcus; o MM acrescido de metildopa mostrou-se mais eficiente na produção de melanina do que os meios BS, MH e BHI; ágar girassol e ágar Níger seguidos de MM acrescido de metildopa foram os mais eficientes na produção de melanina pelos isolados estudados.

Anemia hemolítica secundaria a metildopa / Hemolytic secondary anemia to methyldopa

Se presentó el caso de una paciente de sesenta y dos años, hipertensa esencial desde hace veinte años. Después de recibir tratamiento con metildopa, dos gramos diarios durante cuatro meses, presenta anemia hemolítica y trombocitopenia, con prueba de Coombs directa positiva. Se discutieron los mecanismos fisiopatológicos posibles, y se reseñaron las drogas capaces de producir esta enfermedad, así como los mecanismos de acción de la metildopa y los efectos hematológicos adversos.

A case of a sixty two year-old patient, essential hypertensive for twenty years is presented. After receiving treatment with methyldopa, two daily grams during four months, showed hemolytic anemia and thrombocytopenia, with the positive direct Coombs´test. Possible physiopathologic mechanisms were discussed, the drugs able to produce this disease, the action mechanisms of methyldopa and the hematologic side effects were pointed out.

new spectrophotometric method for the determination of methyldopa

A new, simple and low cost spectrophotometric method for the determination of methyldopa in pharmaceutical preparations was developed. The method was based on the coupling of methyldopa with 2,6-dichloroquinone-4-chlorimide [DCQ]. The absorbance maximum [lambda max] of the resulted colored product was at 400nm. Different buffers were used to determine the optimal pH for the reaction. 1% w/v acetate buffer with pH 8.0 gave the optimal pH required for the reaction. Of the different solvents tried, water and ethanol were found to be the most suitable solvents. Beer's law was obeyed in concentration range of 4-20 micro g/ml methyldopa. The correlation coefficient was found to be [r=0.9975]. The limit of detection and limit of quantification were 1.1 micro g/ml and 3.21 micro g/ml, respectively. The reaction ratio between methyldopa and DCQ was studied and found to be 1:3. The work included the study of the possible interference of hydrochlorothiazide found in combination with methyldopa tablets. The method was validated and results obtained for the assay of two different brands of methyldopa tablets were compared with the B.P. method [colorimetric]. The repeatability and reproducibility of the developed method were evaluated and the obtained results quoted. The derivative formed as a result of the reaction of methyldopa with DCQ was isolated and its possible mechanistic pathway was suggested

Alpha-methyldopa hepatotoxicity in pregnancy

12-week pregnant, 33-year-old African American female, presented with jaundice and change in urine colour. Liver function tests revealed raised transamines and normal alkaline phosphatase. She was started on methyldopa 6 weeks prior to presentation. After initial negative investigations including viral and autoimmune hepatitis, she was given prednisone for methyldopa induced hepatitis. Two weeks later, repeat enzymes revealed normal values. Important clinical and management points related to methyldopa induced hepatotoxicity are discussed

Tratamento anti-hipertensivo na gravidez baseado em evidências / Evidence-based anti-hypertensive treatment in pregnancy

As síndromes hipertensivas representam uma das alterações que ocorrem com maior freqüência na gravidez, encontrando-se entre as principais causas de morte materna e perinatal no mundo. A terapêutica anti-hipertensiva neste grupo de pacientes ainda permanece incerta. Realizou-se uma revisão da literatura com o objetivo de descrever as peculiaridades do tratamento anti-hipertensivo na gravidez baseado nas evidências científicas disponíveis. Nas gestantes com hipertensão/pré-eclâmpsia leve, recomenda-se a não utilização de drogas anti-hipertensivas de manutenção, mesmo nas pacientes com hipertensão crônica leve sabidamente conhecida antes da gestação e que faziam uso da terapia. Nas pacientes hipertensas com fatores de risco associados, a terapia anti-hipertensiva de manutenção é recomendada. Na emergência hipertensiva, é consenso que o tratamento deva ser instituído, embora não exista consenso sobre a melhor droga a ser utilizada com essa finalidade. Da mesma forma, não está estabelecida a real necessidade do tratamento anti-hipertensivo de manutenção, ou seja, diário, nas gestantes com pré-eclâmpsia grave, em termos de efeitos benéficos para o binômio mãe-feto.

The hypertensive syndromes are one of the most common disorders of pregnancy and are one of the main causes of maternal and perinatal death around the world. Anti-hypertensive treatment in this group of patients remains unclear. A literature review was performed with the objective of describing the singularities of anti-hypertensive treatment in pregnancy based on current scientific evidence. In pregnant women with mild hypertension or preeclampsia the use of anti-hypertensive drugs is not recommended, even in patients with mild chronic hypertension diagnosed before pregnancy that previously used these drugs. In hypertensive pregnant women with associated risk factors the therapy is recommended. There is consensus about the need of treatment of hypertensive emergencies but there is no agreement on which drug should be used. In addition, the need of daily anti-hypertensive treatment in patients with severe preeclampsia is not established in terms of real beneficial effects for mothers and fetuses.

Autoimmune hepatitis and thyroiditis associated with antituberculous medications: A case report / 소아과

Drug-induced toxic hepatitis is a relatively common hepatic disease in children, and it is usually self-limiting upon cessation of the offending drugs. Antituberculous drugs are well known for inducing hepatitis. Some cases of drug-induced hepatitis with autoimmune features have been reported; in these cases, the offending drugs were usually methyldopa, nitrofurantoin, minocycline, and interferon. The authors report the first case in Korea of drug-induced autoimmune hepatitis associated with thyroiditis and multiple autoantibodies that was induced by the antituberculous drugs isoniazid and rifampin.

Efetividade do tratamento de gestantes hipertensas / Perinatal outcome in the different clinical forms of hypertension during pregnancy

OBJETIVO: Comparar as intercorrências clínicas materno-fetais e a efetividade do tratamento entre grupos das síndromes hipertensivas na gestação (SHG). MÉTODOS: Foram revisados 200 prontuários de gestantes com SHG, sendo avaliados as intercorrências fetais, a classificação da síndrome hipertensiva e o uso de anti-hipertensivos. RESULTADOS: Entre as intercorrências maternas, 85 (42,5 por cento) das pacientes foram classificadas no grupo controle; 32 (16 por cento) apresentaram hipertensão gestacional (HG); 67 (33,5 por cento) PE; 6 (3 por cento) hipertensão crônica; e 10 (5 por cento) pré-eclâmpsia sobreposta a hipertensão crônica (PSHC). Os menores valores para a idade gestacional, peso dos recém-nascidos e para o índice de Apgar foram observados nos grupos de pacientes com PE e PSHC. A utilização do tratamento não alterou os parâmetros perinatais em relação aos grupos com HG. O grupo de pacientes com PE apresentou a menor idade gestacional e o menor índice de Apgar quando comparado ao grupo controle. CONCLUSÃO: A introdução da terapia anti-hipertensiva durante a gestação foi de fundamental importância para o atendimento à gestante com SHG, embora tenha proporcionado poucos avanços em relação à prevenção das intercorrências perinatais, pois não houve alteração dos parâmetros gestacionais nos casos em que se comparou a utilização do tratamento. A medicação utilizada pouco interfere no fluxo sangüíneo materno-fetal, e conseqüentemente, nas condições de nascimento da criança.

OBJECTIVE: To compare the maternal-fetal clinical intercurrences and the effectiveness of treatment in the different clinical forms of hypertensive syndromes during pregnancy (HSP). METHODS: Medical records of 200 pregnant women with HSP were reviewed to appraise fetal intercurrences, classification of the hypertensive syndrome and use of antihypertensives. RESULTS: Of the 200 patients analyzed, 85 (42.5 percent) were controls; 32 (16 percent) presented gestational hypertension (GH), 67 (33.5 percent) had Pre-eclampsia (PE), 6 (3 percent) had chronic hypertension and 10 (5 percent) cases had PE superimposed chronic hypertension (PSCH). The lowest values for gestational age, weights of the newborn and for the Apgar index were observed in the patients with PE and PSCH. Treatment did not alter the Apgar index in relation to control and non-treated GH patients. Patients with PE presented the lowest gestational age and the smallest Apgar index when compared to controls. CONCLUSION: Introduction of an antihypertensive therapy during gestation was of fundamental importance for health improvement and pressure control of the pregnant woman with HSP. Nevertheless, it has been of little help for prevention of perinatal intercurrences. This was substantiated by the absence of improvement in the gestational conditions between the treated group when compared to the non-treated. Medication did not significantly improve the maternal-fetal blood flow and consequently in the birth condition of the child.

Effects of L-arginine oral supplements in pregnant spontaneously hypertensive rats

OBJETIVO: Avaliar os efeitos da oferta oral de L-arginina em ratas prenhas espontaneamente hipertensivas (SHR).MÉTODOS: 30 SHR e 10 Wistar-EPM-1 ratas virgens foram utilizadas no estudo. Antes da distribuição, as fêmeas foram acasaladas com machos da mesma linhagem (3:1); a prenhez foi confirmada pela presença de espermatozóides no esfregaço vaginal. As ratas Wistar-EPM-1 foram utilizadas como controles. As ratas SHR foram aleatoriamente distribuídas em 4 grupos (n=10): Grupo Controle-2, não-tratado; Grupo L-Arginina, tratado com L-arginina; Grupo Alfa-metildopa, tratado com alfa-metildopa; Grupo L-Arginina+Alfa-metildopa, tratado com arginina+Alfa-metildopa. L-arginina (2%) foi oferecida ad libitum na água de beber e a Alfa-metildopa (33 mg/Kg) foi administrada por gavagem, duas vezes ao dia, durante toda a prenhez (20 dias). Aferição da pressão arterial (PA) foi realizada por pletismografia da cauda, nos dias 0 e 20 e dos pesos nos dias 0-10-20. Resultados foram expressos como média±DP (Desvio Padrão). Testes estatísticos apropriados (ANOVA unidirecional/Tukey ou Kruskal-Walli/Dunn) foram utilizados para comparações intergrupais. P<0,05 foi considerado significante.RESULTADOS: Não houve ganho de peso significante nas ratas tratadas com L-arginina. A PA média diminuiu no Grupo L-Arginina comparado ao Grupo Controle-2. CONCLUSÃO: A oferta oral de L-arginina reduz a PA em ratas SBP durante a prenhez.

Farmacoterapia en el curso del embarazo y lactancia. Parte IV. Fármacos de su uso cardiovascular / Pharmacotherapy in pregnancy and breast feedind. Part IV. Cardiovascular drugs

En este artículo se desarrollas el tema de la farmacoterapia cardiovascular en el curso del embarazo y la lactancia. Se exponen los fármacos de uso más frecuente usados en la hipertensión arterial como la alfametildopa y la hidralazina así como los betabloqueantes, calcioantagonistas y diuréticos. Tambien se mencionan por sus efectos adversos, los Inhibidores de la Enzima Convertidora de Angotensina (IECA) y Antagonistas de Receptores de la Angiotensina II (ARA II). Luego se abordan los restantes fármacos utilizados con mayor frecuencia en los distintos cuadros de naturaleza cardiovascular como los antiarrítmicos, la digoxina y los nitratos. Por último se destaca y se dan pautas elementales de farmacoterapia de algunas complicaciones frecuentes como arritmias, fiebre reumática, valvulopatías, insuficiencia cardíaca y cardiopatía isquémica.

Spectrophotometric determination of levodopa, carbidopa and alpha-methyldopa

The dopamine derivatives participate in the regulation of a wide variety of physiological functions in human body and in medication life. A sensitive spectrophotometric method is developed for the determination of levodopa [LD], carbidopa [CD] and alpha methyldopa [MD]. It proposed on the bases of metal complex formation of these compounds with copper tetramine then coupling with 4-aminoantipyrine. The optimum conditions [pH, time, ratio and sequence of addition] are established. The method permits the determination of LD, CD and MD as a rectlinear relation in calibration curve over a concentration range 19.72 to 69.02, 13.79 to 63.34 and 31.24 to 98.94 micro g ml -1, respectively. The obtained data of SD [0.174 to 0.59], CV [0.68 to 1.16%] and correlation coefficient [0.995 to 0.999] reflect the reliability, reproducibility and accuracy of this procedure. The method is applicable to the assay of LD and MD in pharmaceutical drugs [Levocare and Aldomet respectively], and the results are in a good agreement with those obtained by the official method. The method was simple, rapid, reproducible and accurate to follow of medication of schizophrenic patient

Spectrophotometric assay of levodopa and alpha-methyldopa in pharmaceutical products and in biological samples of schizophrenic patients using copper complex and tri-iodide reagent

Two simple, rapid and sensitive spectrophotometric methods are proposed for the determination of levodopa [LD] I, and alpha-methyldopa [alpha -MD] II. The first method is based on coupling of 4-aminoantipyrine [4-AAP] with LD and a alpha -MD to give new ligands that react with copper-tetramine complex to give intense colored chelates of ratios [1:1:1, LD or alpha -MD: 4-AAP: copper tetramine]. The colored products are quantified spectrophotometrically at 520 and 545 nm for LD and a alpha -MD, respectively. The optimization of the experimental conditions is described. The method has been used for the determination of 19.72-69.02 and 31.24-98.94 micro g ml[-1] of drugs I and II, respectively. The accuracy of the method is indicated by the values of recovery [100 +/- 0.2%] and the precision is supported by the low standard deviation [SD 0.17-0.22] and relative standard deviation [RSD=0.59-1.54%]. The second method is based on the formation of ion-pair iodinated inner sphere or outer sphere colored complexes between the drug and iodine or tri-iodide negative ions at pH 5 and room temperature [25 +/- 3°C]. This method has been used for the determination of LD within the concentration range 39.44-78.88 micro g ml[-1] with SD=022-0.24 and recovery percent=100 +/- 0.3%. The sensitivity of the two methods is indicated by Sandell factor of 0.014- 0.016 g cm[2]. The results of the two methods are compared with those of the official method. The interference from common drug additives, degradation products and excepients was also studied. The proposed methods were applied successfully to the determination of LD and alpha-MD in dosage forms. The second method was also successfully applied for the analysis of LD and carbidopa [CD] synthetic mixture of concentration of these drugs similar to that of Aldomost drug form of LD, and also the determination of these drugs in urine of some schizophrenic patients with good precision and accuracy. The reliability of the methods was established by parallel determinations against the official British pharmacopoeia method

comparative study of a new spectrophtometeric assay of alpha-methyldopa tablets manufactured by different companies

Many spectrophotometeric methods have been described for the determination of alpha-Methyldopa powder and tablets. However, most of these methods suffer from extraction, heating, time consuming for developing colour. The objective of this study is to eliminate previous factors and to determine a simple and sensitive Spectrophtometeric method. A simple, and sensitive Spectrophtometeric method is proposed for the analysis of reference standard and four commercial brands of alpha-Methyldopa. The method is based on the oxidation of alpha-Methyldopa by 0.25% K2CrO4, followed by oxidative coupling with 0.5% sulphanilic acid, to yield greenish-yellow product having maximum absorbance at 400 nm, and the absorptions were taken after 5 minutes. The system obeyed Beer's law over the concentration 10-175 mcg/ml. The relationship between absorbance and concentration was linear by applying regression linear equation. We calculated the concentration of the drug from the calibration curve. The common excipients and additives did not interfere with their determinations. The results obtained by the proposed method were compared statistically with official method [USP]. There were no significant differences in precision between them [p = 0.011]. The method was successfully used for the determination of alpha- methyldopa powder and tablets

Methyldopa supplement for resistant essential hypertension: a prospective randomized placebo control crossover study.

BACKGROUND: Resistant hypertension is an important public health problem, its prevalence varies between 30 to 50 per cent. However, there is no definite recommendation for the treatment of resistant hypertension (HT). MATERIAL AND METHOD: A prospective randomized placebo control crossover study in resistant HT was designed to compare safety and efficacy between methyldopa 250 mg twice daily and placebo using ambulatory blood pressure monitoring. RESULTS: 87 from 1,112 cases (7.82%) from the hypertension clinic of Vajira Hospital were found to have clinical resistant HT and 40 cases were accepted to enrolled in the study. 23 cases of true resistant HT proceeded to the treatment phase of the study and all of them completed the study. Methyldopa reduced systolic blood pressure (BP) from 153.67 to 135.23 mmHg, or -18.44 mmHg (95% confidence interval 15.13-21.75). Diastolic BP was reduced from 86.42 to 74.90 mmHg, or -11.52 mmHg (95% confidence interval 9.41-13.63). CONCLUSION: The addition of methyldopa to the optimal medical therapy contributed to the improvement of BP control among patients with resistant HT.