Informe diário de evidências COVID-19: busca realizada entre 6 e 8 de junho de 2020 / COVID-19 daily evidence report: search conducted between 6 and 8 June 2020

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 13 artigos.

Informe diário de evidências COVID-19: busca realizada em 29 de abril de 2020 / COVID-19 daily evidence report: search conducted on April 29, 2020

Essa é uma produção do Departamento de Ciência e Tecnologia (Decit) da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde (SCTIE) do Ministério da Saúde (Decit/SCTIE/MS), que tem como missão promover a ciência e tecnologia e o uso de evidências científicas para a tomada de decisão do SUS, tendo como principal atribuição o incentivo ao desenvolvimento de pesquisas em saúde no Brasil, de modo a direcionar os investimentos realizados em pesquisa pelo Governo Federal às necessidades de saúde pública. Informar sobre as principais evidências científicas descritas na literatura internacional sobre tratamento farmacológico para a COVID-19. Além de resumir cada estudo identificado, o informe apresenta também uma avaliação da qualidade metodológica e a quantidade de artigos publicados, de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, entre outros). Foram encontrados 13 artigos e 7 protocolos.

Famotidine-induced reversal of meperidine-related serotonin syndrome: a case report / 대한마취과학회지

Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.

Famotidine-induced reversal of meperidine-related serotonin syndrome: a case report / 대한마취과학회지

Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.

Comparison of the effect of pre-operative single oral dose of Tramadol and Famotidine on gastric secretions pH and volume in patients scheduled for laparoscopic cholecystectomy

To evaluate and compare the effects of pre-operative single oral dose of tramadol and famotidine on gastric secretions pH and volume in patients electively scheduled for laparoscopic cholecystectomy. Randomized control trial. Department of Anaesthesia, King Saud University Riyadh, Saudi Arabia, from August 2011 to June 2013. Ninety adult, ASA-I and II patients scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly assigned to receive pre-operatively either placebo [Group-C, n=30], oral tramadol 100 mg [Group-T, n=30] or famotidine 40 mg [Group-F, n=30]. After induction of general anaesthesia, gastric fluid was aspirated through orogastric tube. The gastric secretions volume and pH was measured using pH meter. There was no statistically difference between groups in age, weight and gender. The gastric secretions mean pH was 2.06 +/- 0.22,2.04 +/- 0.20, 5.79 +/- 0.77 and volume was 0.59 +/- 0.17, 0.59 +/- 0.14 and 0.28 +/- 0.16 ml/kg in Group-C, Group-T and Group-F respectively. There was a significant statistical difference in the mean pH values between Group-C vs. Group-F [p < 0.001] and Group-Tvs. Group-F [p < 0.001]. Statistically significant difference was also found in the mean gastric secretions volume between Group - C vs. Group-F [p < 0.001] and Group-Tvs. Group-F [p < 0.001]. There was no significant difference in the mean gastric fluid pH values [p=0.99] and mean gastric secretions volume [p=0.99] between Group-Tand Group-C. As compared to famotidine, pre-operative single oral dose of tramadol was unable to elevate the desired level of gastric fluid pH [> 2.5] and decrease in gastric secretions volume [< 0.4ml/kg]

Famotidine in the treatment oft unctional dyspepsia: a randomized double-blind, placebo-controlled trial

In the present study, we aimed to investigate patients with a documented diagnosis of functional dyspepsia [FD] who had been admitted to our outpatient Gastroenterology Clinic and provided consent to participate in this randomized, double-blind, placebo-controlled trial of the therapeutic impact off amotidine on the symptoms and quality ofl ife of FD patients. A total of 160 patients attending our outpatient clinic with a diagnosis of FD according to Rome III criteria were enrolled in this double-blind study. They were randomized into case [famotidine treatment] and placebo groups; patients were asked to refill the Honk Kong dyspepsia index [a self global assessment tool] before the start of the study as well as after 3 months of treatment. Both famotidine and placebo led to significant improvements in dyspepsia symptoms, except for vomiting in both groups and loss of appetite in the placebo control group. However, the extent of these improvements was not different between the two study groups for most of the study parameters, whereas belching, feeling of acid regurgitation, heartburn, and the total score for the Hong Kong dyspepsia index were significantly more responsive to famotidine than placebo. No significant effectiveness off amotidine therapy was found regarding quality of life. This study showed a significant improvement in the total dyspepsia scores of FD, with a marked effect on belching, heartburn, and the feeling of acid regurgitation. These findings suggest that famotidine may be administered in certain FD patients who have significantly more symptoms of belching, heartburn, and acid regurgitation

Design push-pull osmotic pump tablets of famotidine based on an expert system for the formulation design of osmotic pump of poor water-soluble drug / 药学学报

The purpose of this study is to design push-pull osmotic pump (PPOP) tablets of famotidine using the expert system for the formulation design of osmotic pump of poor water-soluble drug which had been established by the authors. Firstly, the parameters which were requisite of the system input were obtained from literatures and experimental tests. Then the parameters were input into the system, and the program was run. The system displayed the designed formulations sequential. Finally, famotidine PPOP was prepared according to the designed formulations and the in vitro dissolution was carried out. It was found out that the target formulation of famotidine PPOP which could release for 24 hours was obtained in a very short period. Meanwhile, the practicability of the established expert system was proved.

Two Cases of H2-Receptor Antagonist Hypersensitivity and Cross-Reactivity

H2-receptor antagonists, such as cimetidine, ranitidine and famotidine, are some of the most commonly prescribed medications for gastric acid-related disorders. These compounds are generally well-tolerated and anaphylactic reactions to them are rare. Here, we report two cases of H2-receptor antagonist-induced anaphylactic reactions: the first presented with sudden dyspnea, sneezing, urticaria, and swelling of the eyelids after ranitidine intake. The second presented with sudden severe urticaria, facial swelling, chest discomfort, dizziness, and hypotension. Possible cross-reactivity with other H2-receptor antagonists was assessed by oral challenge and skin tests. To date, only a few reports addressing cross-reactivity among H2-receptor antagonists have been published. We review the literature and summarize the data available on drug cross-reactivity in H2-receptor antagonist hypersensitivity.

Effects of Histamine-2 Receptor Antagonists and Proton Pump Inhibitors on the Rate of Gastric Emptying: A Crossover Study Using a Continuous Real-Time 13C Breath Test (BreathID System)

BACKGROUND/AIMS: The effects of Histamine-2 receptor antagonists and proton pump inhibitors on the gastrointestinal motility have not yet been sufficiently investigated. The aim of this study was to determine the effects of intravenous bolus administration of famotidine and omeprazole on the rate of gastric emptying using the continuous 13C breath test (BreathID system, Exalenz Bioscience Ltd, Israel). METHODS: Twelve healthy male volunteers participated in this randomized, 3-way crossover study. After fasting overnight, the subjects were randomly assigned to receive 20 mg of famotidine, 20 mg of omeprazole or 20 mL of saline alone by intravenous bolus injection before a test meal (200 kcal per 200 mL, containing 100 mg of 13C-acetate). Gastric emptying was monitored for 4 hours after the ingestion of test meal by the 13C-acetic acid breath test performed using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, the T1/2, Tlag, GEC, beta and kappa, were observed among the 3 test conditions. CONCLUSIONS: The study revealed that intravenous administration of gastric acid suppressant drugs had no significant influence on the rate of gastric emptying in comparison with that of saline alone as a placebo. Our results indicating the absence of any effect of either famotidine or omeprazole on accelerating the rate of gastric emptying suggest that both medications can be administered safely to patients suffering from hemorrhagic peptic ulcers who need to be kept nil by mouth from the viewpoint of possible acceleration of gastrointestinal motility in the clinical setting.

Protective effects of famotidine and vitamin C against radiation induced cellular damage in mouse spermatogenesis process

Radioprotective effect of famotidine was previously shown on radiation induced micronuclei and chromosomal aberrations in human peripheral lymphocytes and mouse bone marrow cells; however, its radioprotective property has never been studied in mouse spermatogenesis. It was also shown that vitamin C as an antioxidant also exert its radioprotective effect on many biological systems, but in some studies no protective effect is reported. Mice were injected by small and nontoxic amount of vitamin C and famotidine [3 and 2 micro g] inter-testicular 2 hours before irradiating by gamma ray. 29 days after irradiation, mice were sacrificed and testes were removed, weighed and either fixed for histological study or homogenized in 1.5 mL de-ionized water and 0.5 mL SDS solution. Sperm head count was done under a light microscope. Survival fractions were calculated and plotted as a function of dose of gamma rays. The sperm head count in groups treated with vitamin C and famotidine before gamma irradiation show significant increase compared to groups only irradiated by gamma rays [p<0.01]. Values of calculated dose reduction factor [DRF] are 2 and 2.68 for vitamin C and famotidine respectively. Both vitamin C and famotidine could reduce radiation induced pathological alterations in seminiferous tubules. These results suggest that vitamin C and famotidine have radioprotective property and could reduce cytotoxic effect of radiation in mouse spermatogenesis, one of the most radiosensitive biological systems. The possible mechanism of protection by famotidine and vitamin C might be radical scavenging. The radioprotection index for famotidine was found to be more than vitamin C

Rebamipide May Be Comparable to H2 Receptor Antagonist in Healing Iatrogenic Gastric Ulcers Created by Endoscopic Mucosal Resection: A Prospective Randomized Pilot Study

Endoscopic mucosal resection (EMR) results in the formation of iatrogenic gastric ulcers and the optimal treatments for such ulcers are still unclear. We aimed to evaluate the efficacy of rebamipide in the management of EMR-induced ulcers by comparing it with an H2 receptor antagonist. After EMR, patients were randomly assigned into either rebamipide or famotidine groups. All patients received a one-week lansoprazole 30 mg q.d. therapy followed by three-week famotidine (20 mg b.i.d.) or rebamipide (100 mg t.i.d.) therapy. Four weeks after the treatments, ulcer sizes, stages, bleeding rates, and ulcer-related symptoms were compared using endoscopy and a questionnaire. A total of 63 patients were enrolled in this study. Finally, 51 patients were analyzed, 26 in rebamipide and 25 in famotidine group. Baseline characteristics were not significantly different between the two groups. Four weeks after EMR, the two groups were comparable in terms of ulcer reduction ratio (P=0.297), and ulcer stage (P=1.000). Moreover, no difference was observed with regard to ulcer-related symptoms, drug compliance, adverse drug event rates, and bleeding rates. Our data suggest that rebamipide is not inferior to famotidine in healing iatrogenic gastric ulcers, and could be a therapeutic option in the treatment of such ulcers.

Effects of the histamine H2 receptor antagonist famotidine on the healing of colonic anastomosis in rats

BACKGROUND: Failure of anastomotic healing is one of the major complications in colorectal surgery. Because histamine plays an important role in immune and inflammatory reactions, we demonstrate the effects of famotidine on the healing of colonic anastomosis in rats. METHODS: Twenty-eight Sprague-Dawley rats were used in the study. Excision and end-to-end anastomosis was performed in the distal colon of the rat. The Famotidine Group received 2 mg/kg/day famotidine; the Control Group received the same amount of saline. Bursting pressure of anastomoses and hydroxyproline content of perianastomotic tissues were evaluated on the third and seventh days following surgery. RESULTS: Bursting pressures and hydroxyproline contents for the Famotidine Group were significantly lower than the equivalent parameters for the Control Group on both the third and seventh days post-surgery. CONCLUSIONS: According to our findings, famotidine exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.

role of central endogenous histamine and H[1], H[2] and H[3] receptors on food intake in broiler chickens

The role of endogenous histamine and H[1], H[2] and H[3] central receptors on food intake in broiler chickens was investigated. For this purpose, a probe was used to manipulate the concentration of endogenous histamine by intracerebroventricular [ICV] injection of thioperamide, an H[3] receptor antagonist, and R-alpha-methylhistamine, an H[3] receptor agonist and subsequently the effects of brain histaminergic system on food intake was assessed. Moreover, to determine the receptors involved in histamine-induced feeding behaviour changes, H[1], and H2 blockers were administered to thioperamide-treated chickens. Injection of thioperamide [600 and 300 nmol] decreased food intake dose-dependently [P<0.05]. On the contrary, ICV injection of R-alphamethylhistamine [400 and 200 nmol] increased food intake [P<0.05]. Chlorpheniramine [128 and 256 nmol], a H[1] receptor antagonist, increased food intake [P<0.05]. Famotidine, a H[2] receptor antagonist at 74 or 148 nmol had no effect on food intake but at 296 nmol significantly decreased food intake [P<0.05]. Pretreatment with chlorpheniramine [256 nmol] significantly attenuated thioperamide effects [600 nmol] on food intake [P<0.05]. In conclusion, the results of the present study demonstrated that histamine exerts anorexigenic effects through H[1], but not H[2] receptors in broiler chickens. Furthermore, it was shown that thioperamide through stimulation of synthesis and release of endogenous neuronal histamine can decrease food intake in broiler chickens

Hernia hiatal gigante: reporte de un caso / Giant hiatal hernia: a case report

La hernia de hiato es una situación patológica que se da cuando parte del estómago se introduce hacia el tórax. El esófago entra en el abdomen desde el tórax a través de un agujero o hiato que se encuentra en el diafragma. El estómago protruye a través de este hiato debilitado y produce ardores (pirosis) y dolor torácico. La persistencia en el tiempo de esta hernia, puede provocar una metaplasia de la mucosa esofágica dando al lugar al esófago de Barret el cual puede malignizar produciéndose cáncer de esófago. (1) La hernia de hiato es relativamente frecuente, afectando hasta un 20 por ciento de la población. Del total de pacientes con el trastorno, cerca del 10 por ciento son asintomáticos, dependiendo del grado de protrución estomacal y de que tanto esté afectado el esfinter esofágico inferior (EEI). Un 40 por ciento de las hernias de hiato son hernias deslizantes, en las que el EEI protruye conjuntamente con una porción del estómago y solo un 5 por ciento son paraesofágicas, en la que solo una porción del estómago se hace intratorácica mientras tanto que el EEI permanece intraabdominal. Los síntomas más comunes de una hernia de hiato incluyen pirosis, dolor torácico, disfagia, palpitaciones y ocasionalmente regurgitación o reflujo gastroesofágico. El diagnóstico de una hernia hiatal comienza con el éxamen físico por razón de la sintomatología. Los estudios radiográficos y la endoscopia digestiva demuestran la hernia hiatal y ayudan a descartar otras causas de molestias digestivas altas. (2) Se recomienda un procedimiento quirúrgico conocida como fundoplicación de Nissen, (3) Cuando los síntomas causados por una hernia de hiato son tan severas que pueden resultar en lesiones al esófago o incluso cáncer del esófago. (6) Se trata de lactante mayor de seis meses de edad quien es natural de la localidad y procedente de Cordero, quien inicia enfermedad actual el día de hoy en la madrugada según refiere la madre, caracterizado por vómitos en número incontables.

Efficacy and safety of famotidine for the treatment of stress ulcers in neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of famotidine treatment for stress ulcers in neonates.</p><p><b>METHODS</b>Fifty-four neonates with stress ulcers from 2001 to 2006 were enrolled. Seven cases were confirmed with stress ulcers by gastroscopy. Famotidine was administered intravenously at a dosage of 0.5 mg/kg every other 12 hrs. After cessation of hematemesis and vomiting, famotidine was administered once a day for two days. Primary diseases and complications were concurrently treated. Clinical symptoms and gastric pH were assessed before and after famotidine treatment. Possible adverse effects of famotidine treatmentdouble ended arrowrelated were observed.</p><p><b>RESULTS</b>After 24 hrs of famotidine treatment, hematemesis and vomiting ceased in 52 patients (96.3%). Clinical symptoms disappeared in all of the 54 patients 48 hrs after famotidine treatment. Gastric pH value increased 6, 12, 24, 36 and 48 hrs after famotidine treatment from 2.07+/-0.22 (before treatment) to 5.01-5.15 (P<0.01). All of the 54 patients were successfully treated. Famotidine treatment did not lead to abnormal respiration, heart rate and blood pressure. Loss of appetite, nausea, vomiting, diarrhea, constipation and rashes were not seen after famotidine treatment. There were significant differences in white cell count, platelet count and hepatic enzyme levels before and after famotidine treatment. An augmented side effect of the other drugs concurrently used due to famotidine treatment was not noted.</p><p><b>CONCLUSIONS</b>Famotidide is effective and safe for the treatment of stress ulcers in neonates.</p>

Famotidine versus Pantoprazole for the Prevention of Delayed Bleeding and Healing of Iatrogenic Ulcers after Endoscopic Mucosal Resection / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) currently serves as the minimally invasive treatment of choice for early gastric cancer and premalignant lesions of the stomach. There have been few studies addressing whether a proton pump inhibitor or a histamine 2-receptor antagonist is the most effective treatment for iatrogenic ulcers after EMR. We compared the effectiveness of pantoprazole and famotidine in treating iatrogenic ulcers and preventing bleeding after EMR without endoscopic submucosal dissection. METHODS: Between March 2006 and April 2007, we retrospectively analyzed the effect of famotidine (40 mg/day) and pantoprazole (40 mg/day) on the healing of iatrogenic ulcers and control of bleeding after EMR. RESULTS: During the study period, 126 patients underwent EMR. Eighty-one received famotidine, and 45 received pantoprazole. The mean duration of drug therapy was 44 days in each group. The stages of ulcers at 1 to 3 months after EMR were mostly scar stage, and there was no specific difference between the groups. Delayed bleeding was seen after EMR in one patient (1.2%) from the famotidine group and in one patient (2.2%) from the pantoprazole group. There were no other major complications after EMR. CONCLUSIONS: Famotidine was no different than pantoprazole in its effectiveness toward preventing delayed bleeding and promoting healing of iatrogenic ulcers after EMR.

Promotion of cutaneous wound healing by famotidine in Wistar rats.

BACKGROUND & OBJECTIVE: Drugs like famotidine, omeprazole and sucralfate which have been reported to promote the healing of gastric ulcers, may have the same effect on cutaneous wounds. Due to paucity of information in this regard, the present study was planned to investigate the effect of these drugs on resutured incision, excision and dead space wounds in Wistar rats. METHODS:Resutured incision, excision and dead space wounds were inflicted under light ether anaesthesia aseptically. Control animals received vehicle and other groups received famotidine, omeprazole and sucralfate orally for a period of 10 days in the incision and dead space wounds, whereas in excision wounds till complete closure. On the 11th day after estimating breaking strength of the resutured incision wounds, animals were sacrificed and granulation tissue removed from dead space wounds to estimate the breaking strength and hydroxyproline content. Quantification of granulation tissue and histological studies were also carried out. Wound closure rate, epithelization time and scar features were studied in the excision wound models from the day of famotidine till complete closure of the wound. RESULTS: Only famotidine significantly promoted the healing process in all the three wound models studied. Histopathological studies revealed increased collagen content and granulation tissue in famotidine treated group compared to control. INTERPRETATION & CONCLUSION: In all the three wound models studied famotidine promoted wound healing whereas omeprazole and sucralfate did not do so. The pro healing effect of famotidine needs to be explored clinically.

A Prospective Randomized Trial of Either Famotidine or Pantoprazole for the Prevention of Bleeding after Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) has been reported to have a higher bleeding rate than conventional methods. However, there are few reports on whether a proton pump inhibitor or a histamine2-receptor antagonist is the more effective treatment for preventing bleeding after ESD. In a prospective trial, patients undergoing ESD due to gastric adenoma or adenocarcinoma were randomly assigned to pantoprazole or famotidine. Both drugs were given intravenously for the first 2 days, thereafter by mouth. Eighty-five in the pantoprazole group and 79 in the famotidine group were included for analysis. Primary outcome measure was the delayed bleeding rate. Clinical characteristics were not different between the two groups. The delayed bleeding rate was significantly lower in the pantoprazole group compared with the famotidine group (3.5% vs. 12.7%, p=0.031). On multivariate analysis, the preventive use of pantoprazole (relative hazard: 0.220, 95% CI: 0.051- 0.827, p=0.026) and the specimen size (> or =34 mm, relative hazard: 4.178, 95% CI: 1.229-14.197, p=0.022) were two independent factors predictive of delayed bleeding. There were no significant differences in en bloc and complete resection rate between the two groups. In conclusion, pantoprazole is more effective than famotidine for the prevention of delayed bleeding after ESD.

In vitro availability studies of enoxacin in presence of H[2] receptor antagonists

Enoxacin is a second-generation quinolone with increased antibacterial activity both in potency as well as in terms of broad spectrum against a wide range of clinically important pathogens over the first generation quinolones and produces its effect by inhibiting bacterial enzyme DNA gyrase. There are a number of drug interactions reported for enoxacin. On the other hand H[2]-receptor antagonists block gastric acid secretion and some cardiovascular effects of histamine. As the later drug are used for a long-term therapy, they may be coadministered with other drugs. In present study in vitro release of enoxacin in presence of cimetidine, ranitidine and famotidine has been studied on a B.P. 2003 dissolution test and compared with the availability of enoxacin and H[2]-receptor antagonists alone. The interacting drugs were analyzed spectrophotometrically. These studies were carried out in simulated gastric juice, simulating empty stomach, simulated intestinal juice [pH 9] and buffers of pH 7.4 simulating blood pH at 37 degree C. In order to support these interaction studies, the effect of H[2]-receptor antagonists on the antibacterial efficacy [MIC] of enoxacin was also studies by turbidity method and compared with parent drug against Staphylococcus aureus, Staphylococcus pyogens, Staphylococcus pneumonia, Enterococcus, Escherichia coli, Salmonella typhi, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis and Bacillus subtilis. On the basis of these results, it is suggested that enoxacin should be coadministered with care along with H[2]-receptor antagonists especially in case of ranitidine; although chances of adverse reactions are rare but decrease in MIC of enoxacin may result in delayed effect or require prolonged use of the drug

In vitro interactions of captopril with H[2] receptor antagonists

Captopril is effective in the treatment of hypertension of all grades of severity. H2-receptors antagonists block gastric acid secretion and some cardiovascular effects of histamine. In view of the fact that, simultaneous administration of both drugs may alter the antihypertensive effect of captopril, present paper deals with the in vitro availability studies of captopril in presence of commonly used H2-receptor antagonists like cimetidine, ranitidine and famotidine. In order to simulate various pH levels in GI tract and to find out the kinetics and energetics of captopril-H2 -receptor antagonist interactions, these studies were carried out in buffers of pH 4, 7.4 and 9 at 37°C and at elevated temperatures. These studies clearly indicate that most of the H2-receptor antagonists bind to captopril, forming charge-transfer complexes. As a result, the availability of captopril was affected by the concurrent administration of H2- receptor antagonists. Accordingly coadministration of both the drugs should be avoided