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1.
Article in English | MEDLINE | ID: mdl-35032892

ABSTRACT

A sensitive and accurate hydrophilic interaction liquid chromatography - tandem mass spectrometry method (HILIC-MS/MS) was developed and validated for the determination of phenylephrine concentration in Dried Blood Spot (DBS) samples from preterm infants, after ocular administration of an ophthalmic solution with phenylephrine. Sample preparation involved the extraction of the analyte from an 85 µL DBS sample with methanol - acetonitrile (50:50, v/v). Chromatographic separation was achieved on an ACQUITY UPLC BEH AMIDE column, under isocratic conditions within a 5 min run. Detection was achieved with a triple quadrupole MS applying electrospray ionization in positive mode. The method was fully validated and proved precise and accurate with in a linear range of 0.59-3.53 ng/ml in blood. The method was developed to provide insights on the level of exposure of infant population to phenylephrine after ocular administration.


Subject(s)
Chromatography, High Pressure Liquid/methods , Dried Blood Spot Testing/methods , Eye Diseases, Hereditary/diagnosis , Infant, Newborn, Diseases/diagnosis , Infant, Premature/blood , Mydriasis/diagnosis , Mydriatics/blood , Phenylephrine/blood , Tandem Mass Spectrometry/methods , Eye Diseases, Hereditary/blood , Female , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/blood , Male , Mydriasis/blood , Mydriatics/administration & dosage , Ophthalmic Solutions , Phenylephrine/administration & dosage
2.
Biomed Chromatogr ; 34(8): e4843, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32267540

ABSTRACT

In the present study, a rapid derivatization liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated to evaluate phenylephrine in human plasma. The plasma samples were processed to precipitate the proteins, followed by derivatization of the phenylephrine in the plasma with dansyl-chloride solution and extraction with methyl tert-butyl ether-n-hexane (2:1, v/v). The treated samples were analyzed on a Gemini C18 column with 3 min gradient elution, and sensitive detection was achieved with a Waters TQ-s. The method gave linear results over a concentration range from 0.020 to 10.0 ng/ml. The lower limit of quantification was 0.020 ng/ml. Intra- and inter-day precision was <15%, and accuracy was 95.0-105.3%. The validated LC-MS/MS method was successfully applied in the pharmacokinetic analysis of phenylephrine in Chinese subjects with common cold after a single-dose administration of 5, 10 or 20 mg phenylephrine. This pre-column derivatization method may also be applied for the analysis of endogenous hormones such as norepinephrine and adrenaline in a biological matrix.


Subject(s)
Chromatography, High Pressure Liquid/methods , Phenylephrine/blood , Phenylephrine/pharmacokinetics , Tandem Mass Spectrometry/methods , Female , Humans , Linear Models , Male , Phenylephrine/chemistry , Reproducibility of Results , Sensitivity and Specificity
3.
Anesth Analg ; 131(2): 564-569, 2020 08.
Article in English | MEDLINE | ID: mdl-31725021

ABSTRACT

BACKGROUND: Ondansetron has been shown to reduce the incidence of hypotension and vasopressor requirement during spinal anesthesia for obstetric and nonobstetric surgery. However, the magnitude of this effect has not been fully quantified. In this parallel-group, randomized, double-blinded study, we determined the effective dose in 50% of subjects (ED50) of a prophylactic phenylephrine infusion for preventing hypotension in patients who received a single dose of intravenous ondansetron 4 mg or saline control before combined spinal-epidural anesthesia for elective cesarean delivery. ED50 values obtained were compared to estimate the effect of ondansetron versus placebo on vasopressor requirement. METHODS: Sixty parturients were randomly assigned to receive ondansetron (group O) or saline control (group C) 10 minutes before positioning for induction of spinal anesthesia. A prophylactic phenylephrine infusion was used to prevent hypotension. The first patient in each group received a phenylephrine infusion at the rate of 0.5 µg/kg/min. The infusion rate for each subsequent patient was varied with increments or decrements of 0.05 µg/kg/min based on the response of the previous patient, and the effective dose of the phenylephrine infusion for preventing hypotension in 50% of patients (ED50) was calculated for each group and compared using up-down sequential analysis. Probit regression was applied as a backup and sensitivity analysis was used to compare ED50 values for phenylephrine between groups by comparing calculated relative mean potency. RESULTS: The ED50 (mean [95% confidence interval (CI)]) of the rate of phenylephrine infusion was lower in group O (0.24 µg/kg/min [0.10-0.38 µg/kg/min]) compared with group C (0.32 µg/kg/min [0.14-0.47 µg/kg/min]) (P < .001). The total consumption of phenylephrine (mean ± standard deviation [SD]) until delivery was lower in group O (316.5 ± 25.9 µg) than in group C (387.7 ± 14.7 µg, P = .02). The estimate of relative median potency for phenylephrine for group O versus group C was 0.74 (95% CI, 0.37-0.95). CONCLUSIONS: Under the conditions of this study, intravenous ondansetron 4 mg reduced the ED50 of a prophylactic phenylephrine infusion by approximately 26% in patients undergoing cesarean delivery under combined spinal-epidural anesthesia.


Subject(s)
Anesthesia, Spinal/adverse effects , Cesarean Section/methods , Hypotension/prevention & control , Ondansetron/administration & dosage , Phenylephrine/administration & dosage , Pre-Exposure Prophylaxis/methods , Adult , Antiemetics/administration & dosage , Antiemetics/blood , Dose-Response Relationship, Drug , Double-Blind Method , Drug Synergism , Female , Humans , Hypotension/blood , Hypotension/chemically induced , Infusions, Intravenous , Ondansetron/blood , Phenylephrine/blood , Pregnancy , Prospective Studies , Treatment Outcome , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/blood
4.
Mater Sci Eng C Mater Biol Appl ; 105: 110112, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31546445

ABSTRACT

In this study, a new nanocomposite consists of magnetic graphene oxide (GO/Fe3O4), poly-methyldopa (PMDA) and Pd nanoparticle was prepared and utilized for constructing an electrochemical sensor to determine acetaminophen (AC) and phenylephrine (PHE). The structure of nanocomposite has been characterized by Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy (EDX). The effects of various parameters with effective on the sensor response are optimized. In a range, 5 nM to 2.5 µM for AC and 50 nM to 3 µM for PHE the designed sensor had a response linearly reliant on the AC and PHE concentration respectively by differential pulse voltammetry. Also, the limits of detection for AC and PHE with this sensor were 2.1 nM and 7.8 nM, respectively. It successfully employed for the determination of trace amounts of the AC and PHE in pharmaceutical combination and human serum samples.


Subject(s)
Acetaminophen/analysis , Biosensing Techniques/methods , Electrochemical Techniques/methods , Ferric Compounds/chemistry , Graphite/chemistry , Methyldopa/chemistry , Nanoparticles/chemistry , Phenylephrine/analysis , Acetaminophen/blood , Carbon/chemistry , Electrodes , Nanocomposites/chemistry , Nanocomposites/ultrastructure , Nanoparticles/ultrastructure , Oxidation-Reduction , Palladium/chemistry , Phenylephrine/blood , Reproducibility of Results , Spectroscopy, Fourier Transform Infrared , X-Ray Diffraction
5.
J Chromatogr Sci ; 57(7): 592-599, 2019 Aug 01.
Article in English | MEDLINE | ID: mdl-30994892

ABSTRACT

Two chromatographic methods (high performance thin layer chromatography (HPTLC) and high performance liquid chromatography-diode array detector (HPLC-DAD)), were addressed for the analysis of a mixture consisted of phenylephrine hydrochloride and ibuprofen in two forms bulk and their combined dosage form. This binary mixture is considered to be a challenging one as the two drugs differ greatly in their chemical and physical properties. Not only this affects their simultaneous analysis, but also hinders their simultaneous extraction from biological fluids as plasma. That is the reason the literature lacks any report for the simultaneous extraction and analysis of these drugs from biological fluids. The concentration ranges of both drugs were 0.1-2.5 µg/spot and 0.1-100 µg/mL by HPTLC and HPLC, respectively. Not only was the HPLC-DAD method applied to the investigated drugs determination in pharmaceutical preparations, but also in spiked human plasma. Extensive study was conducted to optimize their simultaneous extraction from plasma as it was a crucial step for the in vivo analysis. The results obtained by proposed methods and a reference one were statistically comparable by analysis of variance test. No significant difference was recorded between the mean percent levels determined by the proposed methods and the reference one.


Subject(s)
Chromatography, High Pressure Liquid/methods , Chromatography, Thin Layer/methods , Ibuprofen/analysis , Phenylephrine/analysis , Drug Combinations , Humans , Ibuprofen/blood , Ibuprofen/chemistry , Ibuprofen/isolation & purification , Limit of Detection , Linear Models , Phenylephrine/blood , Phenylephrine/chemistry , Phenylephrine/isolation & purification , Reproducibility of Results , Solid Phase Extraction , Tablets
6.
Spectrochim Acta A Mol Biomol Spectrosc ; 210: 387-397, 2019 Mar 05.
Article in English | MEDLINE | ID: mdl-30503784

ABSTRACT

Two sensitive, rapid, and accurate derivative emission spectrofluorimetric methods applying zero crossing techniques were developed for simultaneous determination of binary mixtures of ibuprofen (IBU) and phenylephrine hydrochloride (PHE) in pure powder, synthetic mixture and combined tablets. The proposed methods were performed via measuring the intersected drug derivative amplitude of one drug at the zero crossing points for the other one and vice versa. The two methods rely on the measurement of the combined drugs native fluorescence after excitation at 270 nm in methanol directly, followed by differentiation using first (D1) and second derivative (D2) techniques. Applying the D1, IBU was measured quantitatively at 293.1 nm at zero crossing of PHE, on the other side; PHE was measured quantitatively at 300.7 nm at zero crossing of IBU. By the same way, applying the D2, the wavelengths selected were 303.5 nm for IBU and 312.9 nm for PHE. The concentration plots of derivative fluorescence intensity were rectilinear over the range of 0.5-10 µg/mL and 0.025-0.5 µg/mL for IBU and PHE, respectively. The results obtained with average % recoveries ±â€¯RSD are 99.73 ±â€¯0.72 (IBU, D1), 99.49 ±â€¯0.95 (PHE, D1), 99.79 ±â€¯0.47 (IBU, D2), and 99.88 ±â€¯0.34 (PHE, D2) were in good agreement with the comparison method. The proposed methods offer high sensitivity that enable direct analysis of IBU and PHE in spiked human plasma. The proposed methods were entirely validated in terms of ICH guidelines.


Subject(s)
Ibuprofen/analysis , Phenylephrine/analysis , Spectrometry, Fluorescence/methods , Tablets/analysis , Calibration , Drug Combinations , Humans , Hydrogen-Ion Concentration , Ibuprofen/blood , Limit of Detection , Phenylephrine/blood , Reproducibility of Results , Sensitivity and Specificity , Surface-Active Agents/chemistry
7.
Regul Toxicol Pharmacol ; 95: 333-338, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29635061

ABSTRACT

Phenylephrine hydrochloride (HCl) is a decongestant available in over-the-counter (OTC) medicines. Previously marketed prescription products contained phenylephrine tannate, an extended-release salt, which allowed dosing every 8-12 h. Given the regulatory history that cold medicines marketed before 1962 had limited supporting clinical data, and with widespread replacement of pseudoephedrine by phenylephrine in OTC products over the last ten years, the need for contemporary studies grew. This exploratory crossover study evaluated effects of salt form, acetaminophen, and food on phenylephrine pharmacokinetics and metabolites in healthy adults. Test treatments were 25 mg phenylephrine tannate (equivalent to 10 mg phenylephrine HCl) combined with 200 mg guaifenesin, fasted; 10 mg phenylephrine HCl combined with 650 mg acetaminophen, fasted; and 10 mg phenylephrine HCl, fed. The reference treatment was 10 mg phenylephrine HCl, fasted. Plasma phenylephrine pharmacokinetics and urine metabolites were determined. Although the tannate salt slowed phenylephrine absorption compared with the HCl salt, terminal concentrations were similar, suggesting that products containing the tannate salt should not be dosed less frequently than those containing the HCl salt. The premise that acetaminophen increases phenylephrine bioavailability by competition for presystemic sulfation was corroborated by increased phenylephrine sulfate in urine. Food delayed phenylephrine absorption, but not the total amount absorbed.


Subject(s)
Acetaminophen/pharmacology , Analgesics/pharmacology , Nasal Decongestants/pharmacokinetics , Phenylephrine/pharmacokinetics , Adult , Cross-Over Studies , Drug Interactions , Fasting/metabolism , Female , Food , Humans , Intestinal Absorption , Male , Middle Aged , Nasal Decongestants/blood , Nasal Decongestants/urine , Phenylephrine/blood , Phenylephrine/urine , Salts , Young Adult
8.
Ther Deliv ; 9(1): 17-27, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29076771

ABSTRACT

AIM: Conventional eyedropper-delivered volumes (25-50 µl) exceed the eye's usual tear-film volume (7 µl) and precorneal reservoir capacity, risking overflow and ocular/systemic complications. Piezoelectric high-precision microdosing may circumvent these limitations. Results & methodology: In this masked, nonrandomized, cross-over study, subjects (n = 12) underwent pupil dilation with topical phenylephrine (PE) administered by 32-µl eyedropper (2.5% or 10% formulation) and 8-µl electronic microdosing (10% formulation). Microdosing with PE-10% achieved comparable peak dilation as 10% eyedropper-delivery and superior dilation to 2.5% eyedropper-delivery (p = 0.009) at 75 min. Microdosing significantly reduced 20-min plasma PE levels versus PE10% eyedropper; neither treatment altered heart rate/blood pressure. Eye irritation occurred significantly less frequently with microdosing than PE10% eyedrops. CONCLUSION: Piezo-ejection PE microdosing achieves comparable biological effect as eyedropper dosing; reduced systemic absorption may decrease risk of systemic side effects.


Subject(s)
Ophthalmic Solutions/administration & dosage , Phenylephrine/administration & dosage , Administration, Topical , Adult , Blood Pressure/drug effects , Cross-Over Studies , Drug Carriers/chemistry , Drug Compounding , Female , Heart Rate/drug effects , Humans , Male , Ophthalmic Solutions/adverse effects , Pain/etiology , Phenylephrine/adverse effects , Phenylephrine/blood , Phenylephrine/pharmacology , Respiratory Tract Infections/etiology , Young Adult
9.
Paediatr Anaesth ; 27(7): 768-773, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28504321

ABSTRACT

INTRODUCTION: Intranasal phenylephrine, an alpha-1 adrenergic agonist, causes vasoconstriction of the nasal mucosa and is used to reduce bleeding associated with nasotracheal intubation or endoscopic sinus surgery. The purpose of this study was to describe the hemodynamic effects associated with plasma phenylephrine concentrations following topical intranasal administration of 0.25% and 0.5% phenylephrine in children. METHODS: After Institutional Review Board and parental approval, 77 children between the ages of 2 and 12 years were studied in a prospective, double-blind manner and randomized into three groups. Group 1 received intranasal saline, while groups 2 and 3 received 0.1 mL/kg of 0.25% or 0.5% phenylephrine, respectively. All received the same anesthetic of halothane, N2 O, O2 , and vecuronium. After inhalation induction, endtidal halothane and PaCO2 were maintained at 1.5% and 35 mm Hg, respectively. Heart rate and rhythm, systolic, diastolic, and mean, noninvasive arterial blood pressures were recorded and venous blood was obtained for measurement of plasma phenylephrine concentration by high-performance liquid chromatography at baseline and at 2, 5, 10, and 20 minutes following intranasal spray application of the study drug. Nasotracheal intubation was performed immediately following the 5-minute measurements, and the presence of bleeding was assessed. Hemodynamic data were compared by analysis of variance for repeated measures. Bleeding and arrhythmia incidence among groups were analyzed using chi-squared tests. Phenylephrine levels were correlated with hemodynamic values via regression analysis. RESULTS: Fifty-two patients received intranasal phenylephrine. Increases in blood pressure correlated with increasing plasma phenylephrine concentration. Systolic blood pressure increased 8%, and mean blood pressure increased 14%, which were statistically significant but clinically insignificant. Heart rate did not change, and the incidence of arrhythmia was low and similar among groups. Bleeding following nasotracheal intubation was less frequent in Group 3 (11/27 subjects) than in Group 1 (17/25). Peak plasma phenylephrine concentrations were observed by 14±7 minutes following intranasal administration, and were highly variable among individuals (37.8±39.7 and 49.6±93.9 ng/mL [mean±SD] in Groups 2 and 3). DISCUSSION: Administration of intranasal phenylephrine, 0.25% and 0.50%, results in rapid but highly variable systemic absorption that is associated with mild increases of blood pressure that are clinically insignificant. Bleeding associated with nasotracheal intubation was less following administration of 0.5% intranasal phenylephrine than following intranasal saline.


Subject(s)
Hemodynamics/drug effects , Phenylephrine/blood , Phenylephrine/pharmacology , Vasoconstrictor Agents/pharmacology , Administration, Intranasal , Anesthesia, General , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/epidemiology , Blood Pressure/drug effects , Child , Child, Preschool , Chromatography, High Pressure Liquid , Double-Blind Method , Female , Heart Rate/drug effects , Humans , Infant , Male , Nasal Sprays , Phenylephrine/administration & dosage , Prospective Studies , Vasoconstrictor Agents/administration & dosage
10.
Eur J Clin Pharmacol ; 71(8): 931-8, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26022219

ABSTRACT

BACKGROUND: Increased bioavailability of phenylephrine is reported when combined with paracetamol in over-the-counter formulations for the symptomatic treatment of the common cold and influenza. Such formulations could increase phenylephrine-related cardiovascular adverse events particularly in susceptible individuals. Quantification of the effect of phenylephrine concentration on blood pressure allows simulation of potential adverse combination therapy effects. METHODS: MEDLINE and EMBASE databases were searched for papers discussing or describing any adverse effect, hypersensitivity or safety concerns related to phenylephrine alone or in combination with other drugs. The pharmacodynamic relationship between plasma phenylephrine concentration and mean arterial blood pressure was characterized using published observations of blood pressure changes after ophthalmic eye drops. The resulting pharmacokinetic and pharmacodynamic parameters were then used to predict mean arterial blood pressure (MAP) changes in that population if given an oral combination of phenylephrine and paracetamol. RESULTS: There were 1172 papers identified for examination. Forty-seven reports fulfilled the inclusion criteria. Increases in blood pressure and decreases in heart rate have been reported with doses over 15 mg. It has been estimated that a 20-mmHg increase in systolic blood pressure would occur with an oral dose of 45 mg phenylephrine in normotensive healthy people. Those taking monoamine oxidase inhibitors report increased systolic blood pressure of greater than 60 mmHg. Blood pressure and heart rate changes are potentiated in patients with underlying hypertension. Simulation showed a modest increase in MAP when phenylephrine 10 mg was co-administered with paracetamol 1 g (4.2 vs 12.3 mmHg). CONCLUSIONS: Combination paracetamol phenylephrine oral therapy has potential to increase blood pressure more than phenylephrine alone in those with cardiovascular compromise.


Subject(s)
Acetaminophen/pharmacology , Adrenergic alpha-1 Receptor Agonists/adverse effects , Analgesics, Non-Narcotic/pharmacology , Phenylephrine/adverse effects , Acetaminophen/therapeutic use , Adrenergic alpha-1 Receptor Agonists/blood , Adrenergic alpha-1 Receptor Agonists/pharmacokinetics , Adrenergic alpha-1 Receptor Agonists/therapeutic use , Analgesics, Non-Narcotic/therapeutic use , Arterial Pressure/drug effects , Drug Interactions , Drug Therapy, Combination , Heart Rate/drug effects , Humans , Phenylephrine/blood , Phenylephrine/pharmacokinetics , Phenylephrine/therapeutic use
11.
Anaesth Intensive Care ; 43(1): 74-80, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25579292

ABSTRACT

The efficacy of phenylephrine might be improved by giving doses higher than that traditionally used (100 µg). This study compared the effects of three initial bolus doses of intravenous phenylephrine; 100 µg (group P100), 125 µg (group P125) and 150 µg (group P150), for the treatment of post-spinal hypotension in patients undergoing elective caesarean delivery. If hypotension was not corrected by this dose, additional boluses of 25 µg were given every minute. Further hypotensive episodes were treated with half the initial bolus dose, followed by 25 µg boluses, as required. Umbilical arterial and venous blood samples were obtained for blood gas analysis and Apgar scores recorded. One hundred and twenty subjects (40 per group) who developed post-spinal hypotension (75%) were included in this randomised, double blind trial. Although systolic blood pressure was higher at certain time-points after 150 µg phenylephrine, there were no statistically significant differences in the effectiveness of the first bolus of phenylephrine to treat hypotension (85%, 95% and 95% in groups P100, P125 and P150, respectively, P=0.215); the additional dose of phenylephrine after the first bolus (P=0.810); the number of additional boluses (P=0.318) or of hypotensive episodes (P=0.118). There were no significant differences in the number of patients developing reactive hypertension or bradycardia, in maternal side-effects or in neonatal outcomes. Although the study may have been underpowered, initial phenylephrine bolus doses of 100 µg, 125 µg and 150 µg did not significantly differ in efficacy to treat post-spinal hypotension in these patients.


Subject(s)
Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Cesarean Section/methods , Hypotension/drug therapy , Phenylephrine/administration & dosage , Vasoconstrictor Agents/administration & dosage , Adult , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods , Apgar Score , Blood Gas Analysis/methods , Blood Pressure/drug effects , Dose-Response Relationship, Drug , Double-Blind Method , Elective Surgical Procedures/methods , Female , Humans , Hypotension/blood , Injections, Intravenous , Phenylephrine/blood , Treatment Outcome , Vasoconstrictor Agents/blood , Young Adult
12.
Eur J Clin Pharmacol ; 71(2): 151-8, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25475358

ABSTRACT

PURPOSE: Over-the-counter combinations containing acetaminophen and phenylephrine for treatment of the common cold and influenza are widespread, but there are few data about pharmacokinetics of these two drugs used in combination. We aimed to investigate pharmacokinetic interactions between acetaminophen and phenylephrine. METHODS: A series of four randomised, open-label, crossover studies investigating phenylephrine and acetaminophen combination pharmacokinetics were undertaken (n = 28, 30, 6 and 26) using standard non-compartmental analyses. Time-concentration observations from these four studies were pooled to examine the interaction between these two compounds. Data were analysed using non-linear mixed effects models. RESULTS: Non-compartmental analyses showed an approximate doubling of phenylephrine plasma concentration when the standard 10-mg dose was administered in combination with acetaminophen. Population analysis was based on data from 90 subjects with 2050 observations. The relative bioavailability of phenylephrine 10 mg was doubled (Fbio 2.11, 95%CI 1.89, 2.31) when combined with acetaminophen 1000 mg, while the absorption half-time was reduced by 50 %. When combined with 500 mg of acetaminophen, bioavailability increased by 64 % (Fbio 1.64). Phenylephrine 5 mg in combination with acetaminophen 1000 mg produced a phenylephrine plasma time-concentration profile similar to that seen with phenylephrine 10 mg administered alone. CONCLUSIONS: The relative bioavailability of phenylephrine was increased when co-administered with acetaminophen.


Subject(s)
Acetaminophen/pharmacology , Phenylephrine/pharmacokinetics , Acetaminophen/administration & dosage , Administration, Oral , Adult , Alleles , Arylsulfotransferase/genetics , Biological Availability , Cross-Over Studies , Drug Combinations , Drug Interactions , Genotype , Healthy Volunteers , Humans , Ibuprofen/administration & dosage , Male , Models, Biological , Phenylephrine/administration & dosage , Phenylephrine/blood , Young Adult
14.
J Int Med Res ; 42(2): 347-59, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24553480

ABSTRACT

OBJECTIVES: The primary objective of this study was to compare the bioavailability of paracetamol, phenylephrine hydrochloride and guaifenesin in a new oral syrup with an established oral reference product. The secondary objective was to compare the safety of the new syrup and the reference product. METHODS: This was a single-centre, open-label, randomized, reference-replicated, crossover study. Healthy adult volunteers received one dose of syrup and two separate doses of a reference oral liquid formulation in a randomized sequence over three study periods, with a washout interval of ≥ 7 days between study periods. Blood samples were taken regularly postdose and analysed for paracetamol, phenylephrine hydrochloride and guaifenesin concentrations; adverse events were recorded. RESULTS: This study enrolled 45 subjects. For paracetamol and guaifenesin, the syrup and reference product were considered to be bioequivalent. Bioequivalence was not shown for phenylephrine hydrochloride. All adverse events were mild or moderate, most of which were considered formulation related. CONCLUSIONS: The syrup did not reach bioequivalence with the reference product, as bioequivalence could not be shown for phenylephrine hydrochloride. This may be due to differences in the excipients between the two products. Both the syrup and the reference product had a good safety profile and were well tolerated.


Subject(s)
Acetaminophen/pharmacokinetics , Guaifenesin/pharmacokinetics , Phenylephrine/pharmacokinetics , Acetaminophen/blood , Adolescent , Adult , Analgesics, Non-Narcotic/blood , Analgesics, Non-Narcotic/pharmacokinetics , Biological Availability , Cross-Over Studies , Drug Combinations , Expectorants/pharmacokinetics , Female , Humans , Male , Middle Aged , Nasal Decongestants/blood , Nasal Decongestants/pharmacokinetics , Phenylephrine/blood , Young Adult
15.
Paediatr Anaesth ; 24(4): 400-5, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24354865

ABSTRACT

BACKGROUND: Phenylephrine eye drops are widely used as mydriatic agent to reach the posterior segment of the eye. In literature, many reports suggest a systemic absorption of this agent as a source of severe adverse drug reactions. Hence, we reviewed our experience with topical phenylephrine in ophthalmic surgery. METHODS: In May 2006, following US guidelines publication, a standard operating procedure was issued in our operating rooms to standardize the use of phenylephrine eye drops in our practice. Two years later, after the occurrence of a cluster of serious adverse drug reactions in infants undergoing surgery, a review of phenylephrine safety and systemic complications incidence was performed. RESULTS: We observed 451 pediatric patients, and 187 met the inclusions criteria: Among them, 4 experienced hemodynamic complications due to phenylephrine eye drops. The incidence of major complications was 2.1%. CONCLUSIONS: Two different patterns of side effects occurred. The first one was a cardiovascular derangement with severe hypertension and heart rate alterations; the other one involved exclusively pulmonary circuit causing early edema. These clinical manifestations, their duration, and treatment responses are all explainable by alfa1-adrenergic action of phenylephrine. This hypothetic pathogenesis has been confirmed also by the usefulness of direct vasodilators (anesthetic agents) and by the negative outcome occurred in the past with the use of beta-blockers.


Subject(s)
Anesthesia, General/adverse effects , Mydriatics/adverse effects , Ophthalmologic Surgical Procedures/adverse effects , Phenylephrine/adverse effects , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Hemodynamics/drug effects , Humans , Incidence , Infant , Male , Mydriatics/administration & dosage , Mydriatics/blood , Ophthalmic Solutions/adverse effects , Phenylephrine/administration & dosage , Phenylephrine/blood , Postoperative Complications/chemically induced , Postoperative Complications/epidemiology , Retrospective Studies
16.
Article in English | MEDLINE | ID: mdl-23314401

ABSTRACT

This paper described a sensitive and rapid method based on ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) for the determination of phenylephrine in human plasma. Plasma samples were pre-purified by solid-phase extraction (SPE). The chromatographic separation was achieved with BEH HILIC column using a mixture of 10mM pH 3.5 ammonium formate and acetonitrile (10:90, v/v) under isocratic conditions at a flow rate of 0.4 mL/min. The mass spectrometry was carried out using positive electrospray ionization (ESI) and data acquisition was carried out in the multiple reaction monitoring (MRM) mode. The method was fully validated over the concentration range of 10.0-5000 pg/mL. The lower limit of quantification (LLOQ) was 10.0 pg/mL. Inter- and intra-batch precision was less than 15% and the accuracy was within 85-115%. Extraction recovery was 78.5%. Selectivity, matrix effects and stability were also validated. The method was applied to the pharmacokinetic study of phenylephrine hydrochloride in Chinese subjects.


Subject(s)
Chromatography, High Pressure Liquid/methods , Phenylephrine/blood , Tandem Mass Spectrometry/methods , Acetonitriles/chemistry , Drug Stability , Formates/chemistry , Humans , Least-Squares Analysis , Phenylephrine/chemistry , Phenylephrine/pharmacokinetics , Reproducibility of Results , Sensitivity and Specificity , Solid Phase Extraction
17.
Anesthesiology ; 111(3): 506-12, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19672175

ABSTRACT

BACKGROUND: Use of ephedrine in obstetric patients is associated with depression of fetal acid-base status. The authors hypothesized that the mechanism underlying this is transfer of ephedrine across the placenta and stimulation of metabolism in the fetus. METHODS: A total of 104 women having elective Cesarean delivery under spinal anesthesia randomly received infusion of phenylephrine (100 microg/ml) or ephedrine (8 mg/ml) titrated to maintain systolic blood pressure near baseline. At delivery, maternal arterial, umbilical arterial, and umbilical venous blood samples were taken for measurement of blood gases and plasma concentrations of phenylephrine, ephedrine, lactate, glucose, epinephrine, and norepinephrine. RESULTS: In the ephedrine group, umbilical arterial and umbilical venous pH and base excess were lower, whereas umbilical arterial and umbilical venous plasma concentrations of lactate, glucose, epinephrine, and norepinephrine were greater. Umbilical arterial Pco2 and umbilical venous Po2 were greater in the ephedrine group. Placental transfer was greater for ephedrine (median umbilical venous/maternal arterial plasma concentration ratio 1.13 vs. 0.17). The umbilical arterial/umbilical venous plasma concentration ratio was greater for ephedrine (median 0.83 vs. 0.71). CONCLUSIONS: Ephedrine crosses the placenta to a greater extent and undergoes less early metabolism and/or redistribution in the fetus compared with phenylephrine. The associated increased fetal concentrations of lactate, glucose, and catecholamines support the hypothesis that depression of fetal pH and base excess with ephedrine is related to metabolic effects secondary to stimulation of fetal beta-adrenergic receptors. Despite historical evidence suggesting uteroplacental blood flow may be better maintained with ephedrine, the overall effect of the vasopressors on fetal oxygen supply and demand balance may favor phenylephrine.


Subject(s)
Anesthesia, Spinal , Cesarean Section , Ephedrine/adverse effects , Ephedrine/pharmacokinetics , Fetus/metabolism , Maternal-Fetal Exchange , Phenylephrine/adverse effects , Phenylephrine/pharmacokinetics , Vasoconstrictor Agents/adverse effects , Vasoconstrictor Agents/pharmacokinetics , Adult , Apgar Score , Biomarkers , Blood Gas Analysis , Blood Glucose/metabolism , Double-Blind Method , Ephedrine/blood , Female , Fetus/drug effects , Fluid Therapy , Hemodynamics/drug effects , Hemodynamics/physiology , Humans , Infant, Newborn , Lactic Acid/blood , Phenylephrine/blood , Pregnancy , Vasoconstrictor Agents/blood
18.
Bioanalysis ; 1(6): 1057-66, 2009 Sep.
Article in English | MEDLINE | ID: mdl-21083074

ABSTRACT

Validation of LC-MS/MS assays includes an assessment of matrix effects. Hemolysis effect, a special type of matrix effect, can also have an impact on analyte quantitation. In situations where the hemolysis effect is marginal, this can be resolved simply by dilution of hemolyzed samples with plasma prior to analysis. However, in some cases, the impact can be so dramatic that analytes are completely immeasurable. In such situations, modification to the bioanalytical method will be required, including, but not limited to, adjusting the chromatographic conditions to separate interferences present in hemolyzed samples; additional sample clean-up techniques such as protein precipitation in combination with SPE or a change in extraction technique such as from SPE to a liquid-liquid extraction method. Here, we report examples from four bioanalytical methods, where the presence of hemolyzed blood in plasma was found to have an impact on analyte quantitation and a description of the solutions adopted to resolve this are provided.


Subject(s)
Blood/metabolism , Chemistry Techniques, Analytical/methods , Chromatography, Liquid/methods , Pharmaceutical Preparations/blood , Solid Phase Extraction/methods , Spectrometry, Mass, Electrospray Ionization/methods , Atorvastatin , Benzodiazepines/blood , Carbazoles/blood , Carvedilol , Hemolysis , Heptanoic Acids/blood , Microfluidics , Olanzapine , Phenylephrine/blood , Propanolamines/blood , Pyrroles/blood
19.
J Chromatogr B Analyt Technol Biomed Life Sci ; 858(1-2): 263-8, 2007 Oct 15.
Article in English | MEDLINE | ID: mdl-17900999

ABSTRACT

A sensitive and reliable method was developed to quantitate phenylephrine in human plasma using liquid chromatography-electrospray tandem mass spectrometry. The assay was based on solid-phase extraction with C18 cartridges and hydrophilic interaction chromatography performed on a pentafluorophenylpropylsilica column (50 mm x 4 mm, 3 microm particles), the mobile phase consisted of methanol-10 mM ammonium acetate (90:10, v/v). Quantification was through positive-ion mode and selected reaction monitoring at m/z 168.1-->135.0 for phenylephrine and m/z 182.1-->135.0 for internal standard etilefrin, respectively. The lower limit of quantitation was 51 pg/ml using 0.25 ml of plasma and linearity was observed from 51 to 5500 pg/ml. Within-day and between-day precision expressed by relative standard deviation was less than 12% and inaccuracy did not exceed 8% at all levels. The assay was applied to the analysis of samples from a pharmacokinetic study.


Subject(s)
Chromatography, Liquid/methods , Phenylephrine/blood , Tandem Mass Spectrometry/methods , Adrenergic alpha-Agonists/blood , Adrenergic alpha-Agonists/pharmacokinetics , Humans , Molecular Structure , Phenylephrine/pharmacokinetics , Phenylephrine/standards , Reference Standards , Reproducibility of Results , Solvents/chemistry , Spectrometry, Mass, Electrospray Ionization/methods
20.
Article in English | MEDLINE | ID: mdl-15686980

ABSTRACT

The development of new pharmaceutical forms with classical active compounds generates new analytical problems. That is the case of sugar-free sachets of cough-cold products containing acetaminophen, phenylephrine hydrochloride and chlorpheniramine maleate. Two cyanopropyl stationary phases have been employed to tackle the problem. The Discovery cyanopropyl (SUPELCO) column permitted the separation of the three actives, maleate and excipients (mainly saccharine and orange flavour) with a constant proportion of aqueous/ organic solvent (95:5, v/v) and a pH gradient from 7.5 to 2. The run lasted 14 min. This technique avoids many problems related to baseline shifts with classical organic solvent gradients and opens great possibilities to modify selectivity not generally used in reversed phase HPLC. On the other hand, the Agilent Zorbax SB-CN column with a different retention profile permitted us to separate not only the three actives and the excipients but also the three known related compounds: 4-aminophenol, 4-chloracetanilide and 4-nitrophenol in an isocratic method with a run time under 30 min. This method was validated following ICH guidelines and validation parameters showed that it could be employed as stability-indicating method for this pharmaceutical form.


Subject(s)
Acetaminophen/blood , Chlorpheniramine/blood , Chromatography, High Pressure Liquid/instrumentation , Phenylephrine/blood , Chromatography, High Pressure Liquid/methods , Humans , Reference Standards
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