Effectiveness and follow-up of depot medroxyprogesterone acetate in postpartum and postabortal patients

Background: Contraception is the intentional use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. Progesterone only injectables are highly effective in preventing in pregnancy as they do not rely on daily usage of contraceptions as such as oral contraceptive pills and barrier methods. Injection depot-medroxyprogesterone acetate (DMPA) is an effective contraceptive method in lactating mother and postabortal patients. Aims and Objectives: The aims of this study were to study utilization pattern, acceptance, effectiveness, and adverse effects of DMPA in postpartum and postabortal women. Materials and Methods: It was a prospective and observational single-center study and was conducted at tertiary care teaching hospital. The data were collected in patient received Inj. DMPA 150 mg intra muscularly immediately after abortion and delivery before discharge. The follow-up was done after administration of DMPA (usually every 3 months). Results: In this study, 56 (53.34%) patients were in the age group of 18–25 years, while 38 (36.19%) patients were 26–35 years whereas 11 (10.47%) were more than 36 years. Out of 105 patients, 12 patients were administered only one injection, 16 patients administered two injections and 16 patients given three injections of DMPA. Common adverse effects of DMPA are irregular bleeding (43.8%), amenorrhea (22.8%), and heavy bleeding (5.7%). Out of 24 patient who developed amenorrhea after injections of DMPA, total 11 patients had amenorrhea after fourth injection, 5 patients after first injection, and 2 patients after second injection of DMPA. Average time for return of fertility after last injection of DMPA was 9 months. Conclusion: DMPA is very effective contraceptive and apart from menstrual troubles that there are no significant major side (weight gain, mood changes, etc.) effects related to its use. DMPA may cause a delay in the return of fertility, the return of fertility takes 7–10 months from date of last injection, but it is completely reversible.

Supramolecular approaches for insulin stabilization without prolonged duration of action

Aggregation represents a significant challenge for the long-term formulation stability of insulin therapeutics. The supramolecular PEGylation of insulin with conjugates of cucurbit[7]uril and polyethylene glycol (CB[7]‒PEG) has been shown to stabilize insulin formulations by reducing aggregation propensity. Yet prolonged in vivo duration of action, arising from sustained complex formation in the subcutaneous depot, limits the application scope for meal-time insulin uses and could increase hypoglycemic risk several hours after a meal. Supramolecular affinity of CB[7] in binding the B1-Phe residue on insulin is central to supramolecular PEGylation using this approach. Accordingly, here we synthesized N-terminal acid-modified insulin analogs to reduce CB[7] interaction affinity at physiological pH and reduce the duration of action by decreasing the subcutaneous depot effect of the formulation. These insulin analogs show weak to no interaction with CB[7]‒PEG at physiological pH but demonstrate high formulation stability at reduced pH. Accordingly, N-terminal modified analogs have in vitro and in vivo bioactivity comparable to native insulin. Furthermore, in a rat model of diabetes, the acid-modified insulin formulated with CB[7]‒PEG offers a reduced duration of action compared to native insulin formulated with CB[7]‒PEG. This work extends the application of supramolecular PEGylation of insulin to achieve enhanced stability while reducing the risks arising from a subcutaneous depot effect prolonging in vivo duration of action.

Prescripción de antipsicóticos de depósito en la policlínica del Hospital Vilardebó / Prescripción de antipsychotics deposito in the polyclinic of the Hospital Vilardebó

Los medicamentos en su formulación de depósito son utilizados como una intervención para la adherencia cuando se dificulta el cumplimiento vía oral. Es frecuente la baja adherencia a los tratamientos por vía oral en las personas con enfermedades crónicas. Se llevó a cabo un estudio observacional, descriptivo de corte transversal, de una muestra aleatorizada de los pacientes que reciben antipsicóticos de depósito, asistidos en la Policlínica del Hospital Vilardebó en el año 2014. El objetivo fue describir las características de la población que tiene prescripto antipsicótico de depósito en la consulta ambulatoria y conocer los hábitos prescriptivos de estos para favorecer su uso racional. La patología psiquiátrica más prevalente fue la esquizofrenia con 56,4 %, donde se usó con más frecuencia la pipotiazina, siendo este más oneroso que el tratamiento con haloperidol y con un perfil de seguridad y efectividad similar. No se encontraron diferencias entre el uso de anticolinérgicos para los efectos extrapiramidales. Más de dos tercios de los pacientes (69,7 %) estuvieron con polifarmacia antipsicótica y un cuarto de los pacientes (24,7 %) con más de 2 antipsicóticos, a pesar de que en las pautas internacionales no recomiendan tratamientos que justifiquen el uso de más de dos antipsicóticos, dado que no existe evidencia que avale esta práctica, además del riesgo aumentado de reacciones adversas. Un bajo porcentaje (20 %) recibió la medicación de depósito todos los meses del año, resultando de vital importancia evaluar en estudios posteriores las causas intervinientes.

Depot formulation drugs are used as an adherence intervention when oral adherence is difficult to achieve. Low adherence to oral drugs is commonly observed in people with chronic diseases. An observational, descriptive, cross-sectional study was carried out on a randomized sample of patients receiving depot antipsychotics, treated at Hospital Vilardebó Outpatient Clinic in 2014. The aim was to describe this population's characteristics and prescription habits at the clinic in order to promote rational use. The most prevalent disorder was Schizophrenia (56.4%); pipothiazine was the most frequently used drug. It is more expensive than haloperidol with similar safety and efficacy profiles. There was no difference in the use of anticholinergic drugs to prevent extrapyramidal side effects. More than two thirds of the patients (69.7%) received antipsychotic polypharmacy and a fourth of the patients (24.7%) received more than two antipsychotics in spite of the fact that international treatment guides do not recommend the use of more than two because of lack of benefit evidence and increased risk of adverse reactions. Only 20 % of the patients received the depot every month of the year, being of vital importance to evaluate in subsequent studies the intervening causes.

Formulation development and pharmacokinetic studies of long acting in situ depot injection of risperidone

Abstract Risperidone is an atypical antipsychotic drug widely prescribed all over the world due to its clinical advantages. The currently available long acting marketed depot formulation of risperidone is a microsphere based preparation using poly-[lactide-co-glycolide] (PLGA) as drug release barrier. It is however, a cold chain product due to thermal instability of PLGA at room temperature. After beginning the depot injection therapy it is administered every two weeks but associated with another drawback of about 3 weeks lag time due to which its tablets are also administered for three weeks so as to attain and maintain therapeutic drug concentration in the body. The present work attempts to develop a long acting depot delivery system of risperidone for once a month administration based on the combination of sucrose acetate isobutyrate and polycaprolactone dissolved in benzyl benzoate to provide an effective drug release barrier for one month without any lag time and which can be stored at room temperature precluding the requirement of cold supply chain. The developed depot formulation showed a sustained in vitro drug release profile with 88.95% cumulative drug release in 30 days with little burst release. The in vivo pharmacokinetic studies of the developed formulation conducted on rats showed attainment of mean peak plasma drug concentration of 459.7 ng/mL in 3 days with a mean residence time of 31.2 days, terminal half-life of 20.6 days, terminal elimination rate constant of 0.0336 per day, and a good in vitro- in vivo correlation.

Patient subjective experience of treatment with long-acting injectable antipsychotics: a systematic review of qualitative studies / Experiência subjetiva do paciente no tratamento com antipsicóticos injetáveis de ação prolongada: uma revisão sistemática de estudos qualitativos

ABSTRACT Objective: To gain a better understanding of how long-acting injectable antipsychotic (LAI) therapy is perceived by patients. Methods: A search for qualitative studies has been carried out on PubMed, Google Scholar, PsycINFO and PsycArticles, yielding 11 studies suitable for a review of qualitative studies. The reporting approach chosen was meta-ethnography, following the ENTREQ statement recommendations. Key concepts common to the different studies were extrapolated and then analysed in a systematic and comparative way. Results: Some recurrent issues were associated with LAIs, such as fear of coercion, fear of needles and lack of knowledge about depot therapy. These topics are linked to each other and the patients most concerned about the disadvantages of LAIs are those who are less informed about them, or who have experienced coercion and trauma during hospitalisation. On the other hand, patients who had already received LAIs, and those who had a good therapeutic relationship with their healthcare providers expressed satisfaction with this form of treatment and its continuation. Conclusion: Long-acting injectable antipsychotics are a tool in the management of mental disorders, and a viable alternative to oral medication. Patients show curiosity towards this method of administration, but lack of knowledge is a common finding. Shared decision making about the use of LAIs antipsychotics requires that patients receive accurate information and support for their decision regarding medication.

RESUMO Objetivo: Compreender melhor de que forma a terapia com antipsicóticos injetáveis de ação prolongada (IAP) é percebida pelos pacientes. Métodos: Uma pesquisa por estudos qualitativos foi conduzida em PubMed, Google Scholar, PsycINFO e PsyArticles, resultando em 11 estudos adequados para desenvolver uma revisão de estudos qualitativos. A abordagem escolhida foi a metaetnografia, seguindo as recomendações da diretriz ENTREQ. Conceitos-chave comuns aos diferentes estudos foram extrapolados e analisados de forma sistemática e comparativa. Resultados: Alguns problemas recorrentes foram associados aos IAPs, como medo de coerção, medo de agulhas e falta de conhecimento sobre a terapia com medicação depot. Esses tópicos se conectam uns aos outros: os pacientes mais preocupados com as desvantagens dos IAPs são os menos informados a seu respeito ou aqueles que passaram por coação e traumas durante a hospitalização. Por outro lado, os pacientes que já receberam IAPs e aqueles que apresentam boa relação terapêutica com seus prestadores de assistência médica demonstraram satisfação com essa forma de tratamento e sua continuidade. Conclusão: Os antipsicóticos injetáveis de ação prolongada são um instrumento para a gestão de transtornos mentais e uma alternativa viável à medicação oral. Pacientes demonstram curiosidade em relação a esse método de administração, mas a falta de conhecimento é um fator comumente encontrado. A tomada de decisão compartilhada sobre o uso de antipsicóticos IAPs requer que os pacientes recebam informações precisas e apoio em suas decisões em relação à medicação.

Depot medroxyprogesterone: the way forward

India has a high rate of unintended pregnancies and abortions contribute to 8% of maternal mortality. The addition of injection depot medroxyprogesterone (DMPA) to the basket of contraceptives has allowed women to use a long-term contraceptive which does not require any user action to maintain efficacy and whose effect is easily reversible. Injectable progestins are now estimated to be used by 6% women globally.

A prospective study to know the efficacy of short-term use of injectable depot medroxy progesterone acetate for contraception in tertiary care hospital from North West Rajasthan, India

Background: Population explosion is a major issue especially in our country with the second largest population in world next only to china starting the use of contraception in postpartum period is an effective method of increasing the gap between two pregnancies and hence reducing the family size. Objective was to study the efficacy of DMPA injection in postpartum period for contraception.Methods: The study was a prospective study conducted on 100 patients during June 2018 to May 2019 in the department of obstetrics and gynaecology, S. P. Medical College Associate A. G. H., Bikaner, Rajasthan, India.Results: In present study mild irregular bleeding was present in 21, 35 and 38 cases at initial visit, at 3 months and at 6 months follow up respectively. Moderate irregular bleeding was present in 8 cases at initial visit, 27 cases at 3 months and 18 cases at 6 months follow up while 37 and 43 cases had severe irregular bleeding at 3 and 6 months follow up respectively. At baseline, 89 and 10 and 1 cases had their blood sugar <100, 100-120 and >120 respectively, at 3 months follow-up, 94, 6 and 0 cases had their blood sugar level <100, 100-120 and >120 respectively while at 6 months follow-up 97, 3 and 1 cases had their blood sugar level <100, 100-200 and >200 respectively.Conclusions: Injection DMPA use in postpartum period is safe, effective and reversible method with no deleterious metabolic effects and do not need special training to administer to it, so it is a good option of contraception for women who are lactating.

Profile and compliance of recipients of injection depot medroxy progesterone acetate as a contraceptive method in the government tertiary care hospital in Mandya, South Karnataka, India

Background: The advanced contraceptive devices available nowadays have minimal side effects and utmost efficacy. The use of safe and effective contraception is the need of the hour in India. Inj. Depot medroxy progesterone (DMPA) has been found to provide effective, long acting and reversible contraception in lactating mother and post-abortal patients. Objective of this study was to describe the profile of women utilizing inj. DMPA as a contraceptive, to determine its compliance and to assess the factors affecting discontinuation of inj. DMPA (Anthara) at the government tertiary care institute in Mandya.Methods: The present study was a record-based study of 18 months (January 2018 to June 2019). The records of 266 women who utilized inj. DMPA as contraception in our institution was analysed.Results: It was observed that out of 266 women 48.5% were from age group of 21-25 years and 64.3% were primipara. Most of the women who initiated inj. DMPA (Anthara) were in the lactational period (56.0%). Most common side effect was irregular bleeding (54.8%). Discontinuation rate was 55.6% after first injection and 16.9% after second injection and gradually reduced with subsequent injections. The most common reason for discontinuation was irregular spotting per vagina (53.9%).Conclusions: Inj. DMPA is a safe, effective, long acting contraceptive taken once in three months. Many women in early reproductive age and lactational period are using inj. DMPA (Anthara) for contraception because of its convenience of dosing and is easily made available at government health care centres free of cost and has no effect on lactation. Discontinuation rate can be reduced by proper counselling.

Differences of blood glucose and insulin in childbearing aged women acceptors of depo medroxy progesterone acetat with non acceptors in Padang City 2017

Background: Contraception was the way to prevent pregnancy, both temporarily and permanently. Depot Medroxyprogesterone Acetate (DMPA) is a contraceptive injection of synthetic progesterone hormone and is injected every three months, which is most commonly used currently, but that emerging consequences of long time usage of contraception, especially the hormonal one, cannot be denied. This research was aimed to see difference in blood sugar, insulin and lipid profile in childbearing aged women who used DMPA injection and Non-Acceptors.Methods: The study was observational with the comparative cross sectional approach. Research was conducted in the Biomedical Laboratory in Andalas University and Regional Technical Service Unit (UPTD) Laboratory in West Sumatera Province. Data was taken from December 2017 until June 2018. The research sampled 48 DMPA acceptors and 48 non-Acceptors. Sampling technique used stratified random sampling. Examination of blood glucose was carried out by the enzymatic method of GOD-PAP, ELISA for insulin. Data were analyzed using independent T-test and if the data was not normal, non parametric Mann-Whitney test was used. The differences were considered statistically significant if the value of p<0.05.Results: The mean blood glucose acceptors 91.27mg/dl, non acceptors 88.83mg/dl and mean Insulin acceptors 23.63mIU/L, non akseptor 24.63mIU/L. The results showed that there were no significant differences between DMPA acceptors and non acceptors (p>0.05) in blood glucose (0.059) and insulin (p = 0.603).Conclusions: There were no significant differences in blood glucose and insulin levels between DMPA acceptors and non acceptors.

Dietary intake and eating behavior in depot medroxyprogesterone acetate users: a systematic review

Because of weight gain, women often discontinue hormonal contraception, especially depot medroxyprogesterone acetate (DMPA). Our objective was to conduct a systematic review of studies describing dietary intake or eating behavior in DMPA users to understand whether the use of DMPA is associated with changes in dietary habits and behaviors leading to weight gain. We searched the PubMed, POPLINE, CENTRAL Cochrane, Web of Science, and EMBASE databases for reports published in English between 1980 and 2017 examining dietary intake or eating behavior in healthy women in reproductive age and adolescents using DMPA (150 mg/mL). Of the 749 publications screened, we excluded 742 due to duplicates (96), not addressing the key research question (638), not reporting dietary intake data (4), and not evaluating the relationship of body weight and dietary or eating behaviors (4). We identified seven relevant studies, including one randomized placebo-controlled trial, one non-randomized paired clinical trial, and five cohort studies. The randomized trial found no association and the other reports were inconsistent. Findings varied from no change in dietary intake or eating behavior with DMPA use to increased appetite in the first six months of DMPA use. Few studies report dietary intake and eating behavior in DMPA users and the available data are insufficient to conclude whether DMPA use is associated with changes in dietary habits or behavior leading to weight gain.

Body composition, resting energy expenditure and inflammatory markers: impact in users of depot medroxyprogesterone acetate after 12 months follow-up

ABSTRACT Objective The aim of this study was to evaluate for 12 months the changes of body weight using Depot Medroxyprogesterone Acetate (DMPA) and if these changes are related to inflammatory markers. Subjects and methods Twenty women of childbearing age who chose the DMPA, without previous use of this method, BMI < 30 kg/m2, and 17 women using IUD TCu 380A, participated in the study. At the baseline and after one year, changes in weight gain, body composition by the bioimpedance electric method, resting energy expenditure (REE) by the indirect calorimetry method, inflammatory markers and HOMA-IR were assessed. Results After 12 months of evaluation, we could observe a significant increase in the DMPA group in weight (3,01 kg) and BMI, while the IUD group’s only significant increase was observed in the BMI. Relative to REE there was an increase of basal metabolic rate (BMR) in both groups after one year. The sub-group DMPA that gained < 3 kg had increased significant weight, BMI and body surface (BS) with respiratory quotient (RQ) reduction, while the sub-group that gained ≥ 3 kg had a significant increase in weight, BMI, BS, fat-free mass, fat mass, BMR, Leptin, HOMA-IR and waist circumference, with RQ significantly reduced. Conclusion Our study found significant changes in weight, body composition and metabolic profile of the population studied in the first 12 months of contraceptive use. These changes mainly increased body weight, leptin levels and HOMA-IR which can contribute to the development of some chronic complications, including obesity, insulin resistance and diabetes mellitus.

A Rapid, Stability Indicating RP-UPLC Method for Determination of Paliperidone Palmitate in a Depot Injectable Formulation.

A rapid, stability-indicating reversed phase ultra-performance liquid chromatographic (RP-UPLC) method was developed for the determination of paliperidone palmitate (PP), in depot injectable dosage form. The chromatographic separation was achieved on an Acquity BEH C18 (50 mm × 2.1 mm, 1.7 μm) column, with a mobile phase consisting of ammonium acetate buffer, and acetonitrile at a ratio of 10:90 (v/v) and a flow rate of 0.6 mL/min. The eluted compound was monitored at a wavelength of 238 nm using a UV detector. The method described herein separated paliperidone palmitate from all other formulation components and two major known degradation products (N-Oxide and paliperidone) within a run time of 2.5 min. The method also generated linear results over a PP concentration range of 156 to 468 μg/mL. The stability indicating capability of the method was established by performing forced degradation experiments. The RP-UPLC method that was developed was validated according to the International Conference on Harmonization (ICH) guidelines. This method was successfully applied in the quantitative determination of PP in a stability study of paliperidone palmitate depot injection. The procedure described herein is simple, selective, and reliable for routine quality control analysis as well as stability testing.

A study of deterioration of pulmonary function parameters among smokers and recovery among ex-smokers in bus depot workers.

Smoking has deleterious effects on Pulmonary Function Test (PFT) parameters; however, evidences about recovery in ex-smokers are ambiguous. Therefore present study was conducted to quantify relative deterioration of PFT parameters and to assess reversibility of the same. A cross-sectional study was conducted on 84 bus-depot workers consisting of equal number of smokers, ex-smokers and non-smokers. PFT observations were obtained using Medspiror following standard methods and precautions. Comparisons among three groups were performed employing one-way ANOVA and post-hoc tests. There were substantial effects of smoking on PFT parameters (deterioration was up-to half). Partial recovery was found in all the parameters of ex-smokers. Frequency and duration of smoking were negatively correlated with some of the parameters. In conclusion, present study has demonstrated considerable deterioration of PFT parameters in smokers and indications of recovery in ex-smokers. Further detailed study with larger sample size and stricter definition of ex-smokers is recommended.

Treatment Challenges In The Management Of Bipolar Disorder: A Case Report

Objective: This case report highlights on the challenges in the management of people with bipolar disorder. Method: We report a case of 36 year-old lady living with this disorder and her journey in a search for a meaningful life. Result: Adherence to treatment is a major determinant of outcome in bipolar patient like Ms WMY. Poor insight, negative attitudes towards treatment and poor understanding of medications and the illness can all lead to reduced adherence. Conclusion: This case demonstrates on how poverty of insight, poor social support, on-going stressors with significant life events and poor compliance to treatment create a series of stumbling blocks in recovery from bipolar disorder.

A Case of an Adolescent with Paraphilia with Depot GnRH Analogue (Goserelin) / 대한정신약물학회지

Paraphilia was a very treatment resistant psychiatric disorder. But new treatment strategies to paraphilia have been introduced recently. We report and review the effect of depot analogue (goserelin) administration in a 18 year-old adolescent with paraphilia. We administered goserelin 3.6 mg/month to him for 3 months, there were changes of scores in Clinical Global Improvement, Sex Addiction Screening Test, Freund Paraphilia Scales.

Synergistic effect of synthetic conjugated linoleic acid & non fat milk on fat deposition & lipid metabolism in mice.

Background & objectives: Conjugated linoleic acid (CLA) reduces fat deposition in the body, but the mechanism of action is not clear. The present study was conducted to investigate the effects of CLA on body fat metabolism. Since milk fat is the best natural source of dietary CLA, intervention of non-fat milk constituents on CLA treatment was also investigated. Methods: Diets containing CLA (1%) with or without skim milk powder (SMP) was fed to male Swiss albino mice for 60 days. Adipose depots weight, faecal fat and the activities of selected enzymes of lipid metabolism were determined. Results: The mice on CLA and CLA+SMP diets gained weight similar to those on control diet, despite higher feed intake in the former two groups. Total fat pad mass was significantly (P<0.05) less in CLA group than in control group, and inclusion of SMP in the diet enhanced the fat reducing effect of CLA. Adiposity index was also less on CLA and CLA+SMP diets than on control diet, and CLA+SMP was more efficacious in reducing adiposity index. The weight of liver and spleen was increased by CLA, and this effect was eliminated by inclusion of SMP in the diet. The fatty acid synthase (FAS) activity in liver and retroperitoneal adipose tissue decreased substantially on CLA and CLA+SMP diets compared to that on control diet. Interpretation & conclusions: Our preliminary data show that dietary CLA reduces body fat mass by decreasing fatty acid biosynthesis, and the effect is enhanced by inclusion of SMP in the diet.

Design of RFID system and its application in depot management of hospital / 医疗卫生装备

A system adapted for depot management in hospital based on RFID technology is introduced. With resolution of RFID from PHILIPS and RF transmission from Nordic VLSI Norway, the storage of medical materials and medical equipments can be identified, labeled and statistically controlled accurately and expediently. The system can not only save a mass of work force, but also improve work efficiency.