Gastrointestinal clinical pharmacology of peppermint oil.

In nine studies, 269 healthy subjects or patients underwent exposure to peppermint oil (PO) either by topical intraluminal (stomach or colon) or oral administration by single doses or 2 weeks treatment (n = 19). Methods used to detect effects were oro-cecal transit time by hydrogen expiration, total gastrointestinal transit time by carmine red method, gastric emptying time by radiolabelled test meal or sonography, direct observation of colonic motility or indirect recording through pressure changes or relieve of colonic spasms during barium enema examination. The dose range covered in single dose studies is 0.1-0.24ml of PO/subject. With one exception, which show an unexplained potentiation of neostigmine stimulated colon activity, all other studies result in effects, indicating a substantial spasmolytic effect of PO of the smooth muscles of the gastrointestinal tract. Pharmacokinetic studies reveal that fractionated urinary recovery of menthol is dependent on the kind of formulation used for the application of PO. Optimal pH triggered enteric coated formulations start releasing PO in the small intestine extending release over 10-12 h thus providing PO to the target organ in irritable bowel syndrome, i.e. the colon. The hypothesis is supported by anecdotal observations in patients with achlorhydria or ileostoma, respectively.

Peppermint oil in irritable bowel syndrome.

In a literature search 16 clinical trials investigating 180-200 mg enteric-coated peppermint oil (PO) in irritable bowel syndrome (IBS) or recurrent abdominal pain in children (1 study) with 651 patients enrolled were identified. Nine out of 16 studies were randomized double blind cross over trials with (n = 5) or without (n = 4) run in and/or wash out periods, five had a randomized double blind parallel group design and two were open labeled studies. Placebo served in 12 and anticholinergics in three studies as comparator. Eight out of 12 placebo controlled studies show statistically significant effects in favor of PO. Average response rates in terms of "overall success" are 58% (range 39-79%) for PO and 29% (range 10-52%) for placebo. The three studies versus smooth muscle relaxants did not show differences between treatments hinting for equivalence of treatments. Adverse events reported were generally mild and transient, but very specific. PO caused the typical GI effects like heartburn and anal/perianal burning or discomfort sensations, whereas the anticholinergics caused dry mouth and blurred vision. Anticholinergics and 5HT3/4-ant/agonists do not offer superior improvement rates, placebo responses cover the range as in PO trials. Taking into account the currently available drug treatments for IBS PO (1-2 capsules t.i.d. over 24 weeks) may be the drug of first choice in IBS patients with non-serious constipation or diarrhea to alleviate general symptoms and to improve quality of life.

Pharmacology and preclinical pharmacokinetics of peppermint oil.

The principal pharmacodynamic effect of peppermint oil relevant to the gastrointestinal tract is a dose-related antispasmodic effect on the smooth musculature due to the interference of menthol with the movement of calcium across the cell membrane. The choleretic and antifoaming effects of peppermint oil may play an additional role in medicinal use. Peppermint oil is relatively rapidly absorbed after oral administration and eliminated mainly via the bile. The major biliary metabolite is menthol glucuronide, which undergoes enterohepatic circulation. The urinary metabolites result from hydroxylation at the C-7 methyl group at C-8 and C-9 of the isopropyl moiety, forming a series of mono- and dihydroxymenthols and carboxylic acids, some of which are excreted in part as glucuronic acid conjugates. Studies with tritiated I-menthol in rats indicated about equal excretion in feces and urine. The main metabolite indentified was menthol-glucuronide. Additional metabolites are mono- or di-hydroxylated menthol derivatives.

Kinetics of piretanide tablets, penbutolol tablets and the fixed combination of both drugs in healthy male subjects after a single oral dose.

In an open-labelled cross-over study, ten healthy males received an oral dose of piretanide (6 mg tablet), penbutolol (40 mg film-coated tablet) or the fixed dose combination (film-coated tablet). Serum pharmacokinetics and 48 h urinary excretion of each drug were determined for the three dose regimens. The serum pharmacokinetics and excretion of penbutolol were unchanged in combination with piretanide. In combination with penbutolol the maximum serum concentration (Cmax) of piretanide was lowered by 40% (p less than 0.05) and time to reach Cmax delayed from 1.0 h to 1.6 h (p less than 0.05). However, areas under the serum concentration-time curves over 12 h and excretion of piretanide were unchanged, and its diuretic effect was undiminished. Thus the bioavailability of piretanide was unaffected by combination with penbutolol. The above changes in the pharmacokinetics of piretanide were explained entirely by differences in dissolution of the conventional and film-coated tablets. The drugs were safe and well tolerated.

Influence of experimental rhinitis on the gonadotropin response to intranasal administration of buserelin.

The influence of experimental rhinitis on the absorption of buserelin, measured as the serum luteinizing hormone (LH) response, has been investigated. A single dose of 200 micrograms buserelin was given to 24 healthy male volunteers after induction of experimental rhinitis with histamine and after use of a saline spray (placebo control). Except on one occasion, when the pump-spray apparently was incorrectly operated, serum LH concentration rose after buserelin. There was no difference in the LH response between histamine-induced rhinitis and saline controls. It was concluded that intranasal application of buserelin represents a reliable mode of application and that modification of the administration route or a change in the dosage schedule during naturally-occurring nasal inflammations, such as the common cold and allergic rhinitis, is unnecessary in patients undergoing chronic treatment with intranasal buserelin, e.g. for prostatic cancer, endometriosis, precocious puberty, and contraception.

Kinetics of piretanide absorption from the gastrointestinal tract.

In a recent report, it was shown that the loop diuretic piretanide is rapidly absorbed after placement of a piretanide solution in the duodenum, while the rate of absorption is definitely slower when the drug is instilled into the ascending colon (5). When piretanide is instilled into the stomach, the absorption process does not differ significantly from that after placement in the duodenum, neither with respect to amount nor rate (5). However, it was not clear from this study whether piretanide is directly absorbed from the stomach or rapidly released into the duodenum. In a study with five volunteers piretanide was instilled into the stomach via a gastroscope. The volunteers took part in two trial phases in a randomized cross-over design: in one phase the administration of 6 mg piretanide was preceded by intravenous administration of 40 mg hyoscine-N-butylbromide (HNB) to immobilize the stomach while in the alternative phase this coadministration of HNB was omitted. Furthermore, the volunteers were lying on their left side to avoid the gastric fluid leaking out into the intestine by gravity. From the concentration-time-curves monitored it can be concluded that piretanide is absorbed directly from the stomach for almost all subjects but with different rates. The rate of absorption increases clearly when the immobilizing effect of HNB disappears. It is most probable that returning peristaltic waves and succeeding gastric emptying results in enhanced absorption from the upper intestinal tract. Furthermore, a pharmacokinetic model which takes into account the differences in the rate of absorption along the gastrointestinal tract was adjusted to the data.(ABSTRACT TRUNCATED AT 250 WORDS)

A new aspect of serum protein binding of tolbutamide.

Tolbutamide is known to bind highly to serum proteins. Quite different values have, however, been reported for binding, ranging from 80 to 99 percent. In this study, in vivo and in vitro binding of increasing concentrations of tolbutamide to human serum proteins were evaluated. In vitro studies were done serum from three healthy males and for in vivo studies serum samples from eight healthy males who had received 1,000 mg tolbutamide were used. Protein binding was determined by equilibrium dialysis, using DIANORM system. Tolbutamide concentrations were determined by HPLC method of Uihlein and Hack. The results suggest that there is an increase in percent tolbutamide bound with increasing concentrations of tolbutamide. Generally, an inverse relationship between the total concentration of a drug in serum and its bound fraction is observed. Our findings seem to be contrary to this, at least within the concentration range studied. There exist at least two binding sites on albumin with different affinities for tolbutamide and most probably, at low concentrations, the drug binds mainly to the high affinity sites, whereas at higher concentrations additional drug will bind to the lower affinity sites leading to the observed increase in fraction bound with concentration. In conclusion it may be said that serum protein binding is a much more complicated phenomenon than generally stated and that the normal observations are only true for some ideal compounds where only one site of adsorption has to be taken into account.

The absorption of piretanide from the gastro-intestinal tract is site-dependent.

The absorption of piretanide was investigated after placing the drug in the stomach, duodenum and ascending colon under visual control. The relative amounts absorbed and the rates of absorption were estimated from the area under the curve and the total mean time, respectively. Similar amounts of piretanide were absorbed and at almost the same rate after placement in the stomach and duodenum; the area under the curve for the stomach was 250 ng h/ml and for the duodenum 243 ng h/ml, the mean absorption times being 1.97 h and 1.51 h respectively. A marked difference was observed in the rate of from the ascending colon; the area amounted to 66 ng h/ml and the mean time to 3.99 h. Although area values for the colon were significantly different from those observed with the stomach and duodenum, it must be emphasised that the amount absorbed depends on the time the drug is in contact with the absorbing surface. There is discussion of whether the differences in absorption between the duodenum and colon can be explained by the physico-chemical properties of the drug alone, or whether the results reflect a saturable transport mechanism.

Cefodizime penetration into skin suction blister fluid following a single intravenous dose.

Cefodizime pharmacokinetics was investigated, evaluating drug concentrations in serum, skin suction blister fluid (SBF), saliva and urine in six healthy male subjects who were administered a 1-g dose intravenously. Serum levels in five subjects can be described according to a two-compartment open model; terminal half-life is 181 +/- 14 min. Volume of distribution (Vd beta) amounts to 15.3 +/- 1.61, serum clearance to 59 +/- 6 ml/min, renal clearance to 33 +/- 3 ml/min. Of the administered dose, 54% is renally excreted unchanged within 27 h. Unbound drug fraction in serum is 19.0% and in SBF 38.4%. Thus renal clearance of free cefodizime amounts to 172 ml/min, Vdss to 68.9 l (free drug). Whereas cefodizime has not been detected in saliva samples, SBF concentration 3-9 h post administration parallel serum levels, amounting to 40% of the respective serum concentration. At 9 h, unbound cefodizime concentrations in SBF amount to 1.4 +/- 0.4 micrograms/ml, this value being well above the MIC90% values of many clinically relevant bacteria.

Effects of piretanide on potassium balance in hypertension.

Ten hypertensive patients completed a trial lasting 12 weeks to measure the effect of long-term treatment with piretanide, a new, powerful 'loop' diuretic, on total body potassium (TBK). After 2 weeks of placebo treatment, they received 6 mg piretanide twice daily. This dose was increased to 6 mg 3 times a day if blood pressure was not satisfactorily lowered after 4 weeks. Blood pressure and plasma potassium levels were measured weekly. The TBK was measured fortnightly. In this study potassium balance was not significantly affected by the administration of piretanide.

Absorption of glibenclamide from different sites of the gastro-intestinal tract.

In a study of eight volunteers and six patients, glibenclamide was placed at different sites of the gastro-intestinal tract under visual control. The dose was instilled once into the stomach and once into the duodenum of the eight volunteers in a randomized crossover design. The six patients underwent diagnostic colonoscopy, and the dose was placed into the ascending colon if pathological findings were not present. The area under the concentration-time curve, completed by extrapolation, and the mean residence time of the drug in the body were calculated. These pharmacokinetic characteristics were examined using a Jonckheere test for ordered alternatives and a Wilcoxon signed rank pair test. The means of the areas under the curve were 477 +/- 131 ng . h ml-1 for the stomach, 475 +/- 142 ng . h ml-1 for the duodenum and 486 +/- 301 ng . h ml-1 for the colon. The mean residence time changed from 2.67 +/- 0.35 h for the stomach to 2.42 +/- 0.48 h for the duodenum and 3.55 +/- 0.68 h for the colon. These results indicate that although glibenclamide is absorbed from all three sites of the gastro-intestinal tract to the same extent, the rates of absorption are different. It is discussed whether these findings really confirm the pH-partition hypothesis in drug absorption. Since glibenclamide--a weak acid--has a pK-value of about 6.5, these data seem to confirm the pH-partition hypothesis of drug absorption.

[Effect of forskolin eyedrops on intraocular pressure in healthy males]. / Uber die Wirkung von Forskolin-Augentropfen auf den Augeninnendruck gesunder männlicher Personen.

Suspensions of Forskolin in concentrations of 0.3; 0.6; and 1.0% decreased effectively the intraocular pressure of healthy subjects when instillated in the conjunctival sac. The suspensions were compared with placebo in double blind studies. The maximum effect was reached 3 hours after application of the 0.3% (22.8%) and 0.6% (27.8%) suspensions and 4 hours after the 1.0% (26.5%) suspension. The higher concentrations decreased the intraocular pressure to the same extent as the lowest concentration but the effect lasted longer: 4 hours after instillation of the 0.3% suspension, 5 hours after instillation of the 0.6% suspension and 7 hours after the 1.0% suspension. The suspensions were well tolerated. Subjective sensations like burning, itching and augmentated lacrimation were observed only in a minor amount and for a short period of time.

Effects of tendamistate on postprandial plasma glucose, free fatty acid and triglyceride levels.

A dose of 400 mg tendamistate or a placebo was given to 10 volunteers in order to investigate its effects on plasma glucose, free fatty acid and triglyceride levels after a porridge meal. Each subject participated in two phases, in each of which they ate porridge prepared from 100 g maize meal together with either placebo or tendamistate 400 mg. Serial blood specimens for plasma glucose determinations were taken up to 3 hours after the meal, and those for free fatty acid and triglyceride determinations up to 14 hours after the meal. Side-effects (flatulence and bulky stools) were not severe and were reported after both treatments. Tendamistate administration significantly attenuated postprandial glycaemia; it had no effect on postprandial triglyceride levels and was associated with a reduction in free fatty acid levels.

Effects of tendamistate (an alpha-amylase inactivator), guar and placebo on starch metabolism.

Nine volunteers participated in a double-blind, cross-over study to compare the effects of tendamistate (HOE 467), guar and placebo on starch metabolism. In each phase of the trial they received a maize-meal porridge breakfast. They either received 5 g guar granules before the porridge or 100 mg tendamistate mixed with the porridge, or porridge alone. Sequential plasma glucose concentrations served as a criterion of starch digestion. The area under the plasma glucose curve and maximal glucose concentrations after administration of tendamistate with the starch were significantly lower (P less than 0,05) than after guar and placebo. No significant differences were found between placebo and guar. We concluded that tendamistate effectively attenuates starch digestion and is superior to guar in reducing postprandial glycaemia.

Pharmacodynamics and tolerability of low doses of tendamistate given with starch.

Six healthy male volunteers participated in a double-blind cross-over study in which 12,5 mg, 25 mg, or 50 mg tendamistate (HOE 467), an alpha-amylase inactivator, or placebo were administered with 100 g maize meal, which contains 85,5 g pure starch. Serial blood specimens for measurement of plasma glucose concentrations, which served as a criterion of starch absorption, were taken up to 3 hours after each starch meal, and side-effects were recorded. The administration of HOE 467 with a starch meal resulted in a significant inhibition of starch absorption. Side-effects were not severe. Flatulence occurred in the placebo phase as well as after administration of the active drug. Loose stools were reported by 1 subject after 25 mg tendamistate.

Inhibition of starch absorption by tendamistate (an alpha-amylase inactivator).

Tendamistate (HOE 467) is an alpha-amylase inactivator. Doses of 100 and 200 mg and a placebo were administered to 6 volunteers in order to investigate the effect of the drug on plasma glucose levels after a bread meal. Each subject participated in three phases, in each of which they received a meal consisting of 200 g white bread together with either placebo or tendamistate 100 or 200 mg. Serial blood specimens for plasma glucose determinations were taken up to 3 hours after the meal. Plasma glucose concentrations served as a criterion of starch absorption. Side-effects (flatulence and/or diarrhoea) were reported after each of the three treatments. The administration of tendamistate together with the bread meal resulted in significant inhibition of starch absorption.

The use of renal enzymes as early indication of renal toxicity after multiple-dose administration of aspirin.

Ten volunteers participated in a study comparing the effects on renal enzymes of multiple oral doses of aspirin relative to no treatment. The total urinary output was collected daily for 21 days from all subjects. The first 7 days were treatment-free. During the second 7-day period the subjects received aspirin 1500 mg 3 times daily. This was followed by another treatment-free period of 7 days. The activity of the enzymes alanine aminopeptidase and N-acetyl-beta-glucosaminidase were determined in each daily urine specimen. Statistical analysis revealed that aspirin significantly increased the output of both enzymes.