Assessing the accuracy of intracameral phenylephrine preparation in cataract surgery.

PURPOSE: Unpreserved phenylephrine is often used as an off-licence intracameral surgical adjunct during cataract surgery to assist with pupil dilation and/or stabilise the iris in floppy iris syndrome. It can be delivered as a neat 0.2 ml bolus of either 2.5 or 10% strength, or in a range of ad-hoc dilutions. We wished to assess the accuracy of intracameral phenylephrine preparation in clinical practice. METHODS: Phenylephrine 0.2 ml was analysed both neat (2.5 and 10%) and in diluted form (ratio of 1:1 and 1:3). Samples were analysed using the validated spectrophotometric method. RESULTS: A total of 36 samples were analysed. The standard curve showed linearity for phenylephrine (R2 = 0.99). Wide variability was observed across all dilution groups. There was evidence of significant differences in the percentage deviations from intended results between dilutions (p < 0.001). Mean percentage deviation for 1:3 dilution was significantly greater than neat (p = 0.003) and 1:1 dilution (p = 0.001). There was no evidence of a significant difference between 1:1 and neat (p = 0.827). CONCLUSIONS: Current ad-hoc dilution methods used to prepare intracameral phenylephrine are inaccurate and highly variable. Small volume 1 ml syringes should not be used for mixing or dilution of drug. Commercial intracameral phenylephrine products would address dosage concerns and could improve surgical outcomes in cases of poor pupil dilation and/or floppy iris syndrome.

[The distribution of 2-(dimethylamino)ethyl-(1-hydroxycyclopentyl)(phenyl)acetate in the organism of the warm-blooded animals after its intra-gastric administration]. / Raspredelenie 2-(dimetilamino)étil-(1-gidroksitsiklopentil)(fenil)atsetata v organizme teplokrovnykh zhivotnykh pri vnutrizheludochnom vvedenii.

The objective of the present study was to elucidate the distribution of 2-(dimethylamino)ethyl-(1-hydroxycyclopentyl)(phenyl)acetate in the organism of the warm-blooded animals after its intra-gastric administration. The methods applied in the study included thin layer chromatography in silicagel, aci-nitroprosalt staining reaction, UV-spectrophotometry,, and GC-mass spectrometry. The identification and the quantitation of 2-(dimethylamino)ethyl-(1-hydroxycyclopentyl)(phenyl)acetate in the organs and blood of the warm-blooded animals were carried out within 20, 150, and 360 min after a single intra-gastric administration of 1300 ml of this poisonous substance. It was shown that the largest amounts of 2-(dimethylamino)ethyl-(1-hydrpxycyclopentyl)(phenyl)acetate at the above time-points were present in the tissue of the stomach and small intestine, brain, muscles, spleen, and lungs of the animals.

Stability of extemporaneously prepared ophthalmic solutions for mydriasis.

PURPOSE: Results of an evaluation of the physical and chemical stability of extemporaneously prepared adult and pediatric ophthalmic solutions containing combinations of phenylephrine, tropicamide, and cyclopentolate are reported. METHODS: A stability study was conducted to help determine the feasibility of innovative formulations to meet an unmet clinical need for combination mydriatic ophthalmic eyedrops. An adult mydriatic ophthalmic solution containing phenylephrine hydrochloride 2.5% and tropicamide 1.0% and a pediatric formulation containing phenylephrine hydrochloride 2.5%, tropicamide 0.5%, and cyclopentolate hydrochloride 0.5% were prepared using proper aseptic techniques. Triplicate samples of each formulation were stored for 60 days at refrigeration temperatures (2-8 °C) and analyzed on day 0 and days 7, 14, 28, and 60. At each time point, the stability samples were assessed by visual inspection, pH measurement, and stability-indicating high-performance liquid chromatography (HPLC) analysis. RESULTS: Over the 60-day storage period, there was no significant change in the visual appearance or pH level of any of the adult or pediatric solution samples. The results of HPLC analysis indicated that all samples retained 97-102% of the initial drug concentrations for up to 60 days. CONCLUSION: Both adult and pediatric ophthalmic formulations containing combinations of phenylephrine, tropicamide, and cyclopentolate were stable physically and chemically for up to 60 days when stored at refrigeration temperatures (2-8 °C).

Formulation and stability study of a pediatric 2% phenylephrine hydrochloride eye drop solution.

INTRODUCTION: We present formulation and stability evaluation of a 2% (w/v) phenylephrine hydrochloride biocompatible eye drop solution, routinely prepared in hospital pharmacy under aseptic conditions, for retinal examination of neonates and premature infants. MATERIALS AND METHODS: Eye drop solution was formulated by dissolution of phenylephrine hydrochloride and disodium hydrogen phosphate as buffering agent in sterile water for injection and sodium chloride for injection as isotonic agent. The previous solution was sterile filtered through under aseptic conditions, in an iso class 5 air quality clean room under horizontal laminar airflow hood. Physical stability (visual inspection, osmolality measurements), chemical stability (pH measurement, phenylephrine assay by liquid chromatography coupled with an ultra-high resolution and accurate mass) and sterility evaluation of phenylephrine eye drop solution stored at ambient temperature were studied during 60 days. RESULTS AND DISCUSSION: The formulated eye drop solution had a pH of 6.90±0.05 and an osmolality of 285±2 mOsm/kg. Throughout the 60 days study the solutions remained clear without any precipitation or color modification, sterility was maintained, pH and osmolality were not significantly modified and no significant loss of product was detected using liquid chromatography coupled with an ultra-high resolution and accurate mass instrument suggesting the lack of degradation. CONCLUSION: These results indicate that 2% phenylephrine hydrochloride eye drop solutions were physically, chemically and microbiologically stable for at least 60 days when stored in type I amber glass vials at room temperature, allowing the compounding of higher batch sizes.

Evaluation of tropicamide-loaded tamarind seed xyloglucan nanoaggregates for ophthalmic delivery.

The present study was aimed to prepare tamarind seed nanoaggregates and its evaluation for ophthalmic delivery. The preparation of tropicamide-loaded tamarind seed xyloglucan nanoaggregates was optimized using face centred central composite experimental design, employing the concentrations of tamarind seed xyloglucan and Poloxamer-407, as independent variables. The results revealed that concentration of TSX has a significant antagonistic effect on particle size, while poloxamer displayed a significant synergistic effect on encapsulation efficiency. The optimal concentrations of TSX and poloxamer were found to be 0.45% (w/v) and 0.5% (w/v) respectively. The optimized formulation of tropicamide-loaded TSX nanoaggregates showed a significantly higher corneal permeation of tropicamide across the isolated goat cornea compared to commercial conventional aqueous formulation. The results revealed excellent mucoadhesive properties of TSX nanoaggregates. Further, the tropicamide-loaded TSX nanoaggregates formulation showed excellent ocular tolerance and biocompatibility as determined by hen's egg test chorioallantoic membrane and resazurin assay on Vero cell lines.

Anaphylactic reaction due to cyclopentolate in a 4-year-old child.

Ophthalmologists frequently use mydriatics both for diagnosis (retinal exploration, refraction tests) and for treatment. Cyclopentolate is used to induce quick and successful mydriasis for pediatric eye examination. Hypersensitivity reaction to cyclopentolate is very uncommon, especially in children. We report the case of a child who experienced a hypersensitivity reaction to cyclopentolate during preparation for an eye examination under cycloplegia.

Determination of tropicamide and its major impurity in raw material by the HPLC-DAD analysis and identification of this impurity using the off-line HPLC-FT-IR coupling.

This study presents TLC, HPLC-DAD and HPLC-FT-IR analyses concerning the detection, identification and determination of organic impurities of commercial tropicamide ((R,S)-N-ethyl-3-hydroxy-2-phenyl-N-(4-pyridylmethyl)propanamide) as a medical substance designed for the production of eye drops. In the examined samples from several random production batches, only one impurity (defined by Ph. Eur. 6th Ed.) was discovered in the amount sufficient for the quantitative analysis. On the basis of comparison of retention times, UV and IR spectra of the impurity and its synthesized standard, this impurity was identified as apotropicamide (N-ethyl-2-phenyl-N-(4-pyridylmethyl)prop-2-enamide). For the chemical identification of organic compounds occurring in the tropicamide samples, an off-line coupling of HPLC with FT-IR was used. The structure of a standard of apotropicamide was confirmed by (1)H NMR and (13)C NMR analysis. Validation of the HPLC-DAD method of determination both tropicamide and apotropicamide in the tropicamide medical substance was performed. This method is suitable for use in the quality control of tropicamide during its production.

Efeitos cardiovasculares e midriáticos da fenilefrina tópica a 2,5 e a 10,0 por cento em voluntários sadios / Cardiovascular and pupillary effects of topical ophthalmic 2.5 and 10.0 percent phenylephrine in healthy volunteers

OBJETIVO: Comparar os efeitos cardiovasculares e midriáticos da fenilefrina tópica nas concentrações de 2,5 e 10,0 por cento. MÉTODOS: Ensaio clínico do tipo caso controle, randomizado, com auto-emparelhamento. Foram monitoradas a freqüência cardíaca (FC), a pressão arterial (PA) e a midríase em voluntários sadios, com idade entre 18 e 45 anos, após a instilação da fenilefrina a 2,5 e a 10,0 por cento em duas ocasiões diferentes. RESULTADOS: A amostra foi constituída de 28 voluntários, sendo 17 do sexo masculino e 11 do sexo feminino, com a idade média de 26,5 anos. Não foi verificado nenhum padrão de mudanças com relação à freqüência cardíaca e à pressão arterial sistólica. Com relação à pressão arterial diastólica média dos indivíduos, não foi encontrada variação significativa após a instilação da fenilefrina a 2,5 por cento nos tempos de um, cinco, dez e 30 minutos, o que se revelou bem diferente quando do uso da fenilefrina a 10,0 por cento, com a qual houve aumento da pressão arterial diastólica média após cinco e dez minutos, e subseqüente queda após 30 minutos, porém sem significância estatística. A midríase foi maior com a fenilefrina a 10,0 por cento nos dois olhos, sendo a diferença estatisticamente significativa. CONCLUSÕES: Observou-se maior efeito midriático da fenilefrina a 10,0 por cento, quando comparada a 2,5 por cento, com significância estatística. Já com relação aos efeitos cardiovasculares não houve diferença estatística entre as duas concentrações.

PURPOSE: To compare the cardiovascular and mydriatic effects of 2.5 percent and 10.0 percent phenylephrine. METHODS: A case-control, randomized, crossover clinical trial study. We monitored heart rate (HR), blood pressure (BP) and mydriasis in healthy volunteers aged 18-45 years after the instillation of 2.5 percent and 10.0 percent phenylephrine in two different occasions. RESULTS: The sample comprised 28 healthy volunteers, 17 male and 11 female, with a mean age of 26.5 years. No changes in heart rate and systolic blood pressure were observed. No significant variation of the mean diastolic blood pressure was found after 1, 5, 10 and 30- minute instillation of 2.5 percent phenylephrine. However, with 10.0 percent phenylephrine, there was an increase in mean diastolic blood pressure after five and ten minutes, followed by a drop after 30 minutes, which was not statistically significant. Mydriasis was more marked in both eyes with a statistically significant difference after instillation of 10.0 percent phenylephrine. CONCLUSIONS: The mydriatic effect was greater with 10.0 percent phenylephrine than with 2.5 percent phenylephrine and the difference was statistically significant. No statistically significant difference was found in relation to cardiovascular effects in both phenylephrine concentrations.

[Cardiovascular and pupillary effects of topical ophthalmic 2.5 and 10.0% phenylephrine in healthy volunteers]. / Efeitos cardiovasculares e midriáticos da fenilefrina tópica a 2,5 e a 10,0% em voluntários sadios.

PURPOSE: To compare the cardiovascular and mydriatic effects of 2.5% and 10.0% phenylephrine. METHODS: A case-control, randomized, crossover clinical trial study. We monitored heart rate (HR), blood pressure (BP) and mydriasis in healthy volunteers aged 18-45 years after the instillation of 2.5% and 10.0% phenylephrine in two different occasions. RESULTS: The sample comprised 28 healthy volunteers, 17 male and 11 female, with a mean age of 26.5 years. No changes in heart rate and systolic blood pressure were observed. No significant variation of the mean diastolic blood pressure was found after 1, 5, 10 and 30- minute instillation of 2.5% phenylephrine. However, with 10.0% phenylephrine, there was an increase in mean diastolic blood pressure after five and ten minutes, followed by a drop after 30 minutes, which was not statistically significant. Mydriasis was more marked in both eyes with a statistically significant difference after instillation of 10.0% phenylephrine. CONCLUSIONS: The mydriatic effect was greater with 10.0% phenylephrine than with 2.5% phenylephrine and the difference was statistically significant. No statistically significant difference was found in relation to cardiovascular effects in both phenylephrine concentrations.

Ophthalmic vehicles containing polymer-solubilized tropicamide: "in vitro/in vivo" evaluation.

Commercial 1.0% aqueous tropicamide (TR) eyedrops are buffered to pH 4.4-5.0 to produce sufficiently stable solutions of the weakly basic, poorly soluble drug. These acidic solutions, however, are irritants and may induce copious lachrimation, thus reducing the drug bioavailability. The aim of the present study was to evaluate some solubilizing agents for the preparation of 1.0% TR ophthalmic solutions adjusted at physiologically compatible pH, potentially showing increased eye tolerance, activity, and stability when compared with standard commercial eyedrops. The tested solubilizers were two non-ionic surfactants-Tyloxapol (TY) and Cremophor EL (CR) and one polymer, Pluronic P85 (PL). Four stable 1% TR formulations, containing 3% TY, 7.5% CR, 15% PL, or 5% CR + 10% PL were submitted to mydriatic activity tests in rabbits. They improved to a small but statistically significant extent the AUC for mydriatic effect of TR in the test animals when compared with commercial 1.0% TR eyedrops.

Locomotor stimulant effects of novel phenyltropanes in the mouse.

With the hypothesis that 3-phenyltropane analogs of cocaine might be useful as cocaine medications, 17 analogs (RTI-51, RTI-55, RTI-108, RTI-112, RTI-113, RTI-116, RTI-120, RTI-121, RTI-126, RTI-139, RTI-141, RTI-150, RTI-171, RTI-177, RTI-199, RTI-204, and RTI-219) were characterized for their potency and selectivity at the monoamine transporters in a previous study. Based on their affinities to the transporters in this earlier study, the analogs were classified as nonselective (cocaine, RTI-51, RTI-55, RTI-108, RTI-112, RTI-116, RTI-126, and RTI-139) or dopamine transporter (DAT) selective (RTI-113, RTI-120, RTI-121, RTI-141, RTI-150, RTI-171, RTI-177, RTI-199, RTI-204, and RTI-219). In the present study, the locomotor stimulating effects of these analogs were compared to those of cocaine to obtain a measure of in vivo activity. Each analog was more potent than cocaine in the in vivo assay, as observed in the earlier in vitro studies. Most of these compounds were as efficacious as cocaine, but RTI-51, RTI-108, RTI-113, RTI-121, RTI-139, RTI-141, RTI-177, RTI-204, and RTI-219 were longer acting. Although no correlation between chemical structure and transporter selectivity was found, the short-acting DAT-selective analogs, RTI-120, RTI-150, RTI-171, and RTI-199, all contained a methyl group in the X position of the WIN 35,065-2 molecule. The positive correlation of the IC(50)s for the DAT to potencies for increasing locomotor activity suggested that binding to DAT was responsible for some, if not most, of the locomotor effects of these compounds. Several compounds, including RTI-113 and RTI-177, exhibited properties ideal for medications for cocaine abusers, such as an equivalent efficacy, a higher potency, and a longer duration of action as compared to cocaine.

Solubilization of tropicamide by hydroxypropyl-beta-cyclodextrin and water-soluble polymers: in vitro/in vivo studies.

1% (w/v) aqueous solutions of tropicamide (TR), a poorly water-soluble mydriatic-cycloplegic drug, are usually obtained by adjusting the pH to approximately 5.0, at the expense, however, of ocular tolerance and bioavailability. The capacity of hydroxypropyl-beta-cyclodextrin (HP-beta-CD) to solubilize TR in pH 7.4 0.02 M phosphate buffer was investigated in the absence and presence of hydrophilic polymers (PVP, CMC and HPMC). Approximately 3.5% (w/v) HP-beta-CD was required to solubilize 1% (w/v) TR in pH 7.4 buffer at room temperature. The required amount was reduced to 0.9% (w/v) by heating at 120 degrees C in the presence of 0.1% (w/v) HPMC. Mydriatic activity tests in rabbits showed an improved bioavailability and maximal mydriatic response for two CD formulations, with and without HPMC, when compared to standard 1% (w/v) TR eyedrops, buffered at pH 5.0. The improved in vivo behaviour of the CD formulations are likely due to their physiological pH, resulting in a reduced irritant effect, although an effect of HP-beta-CD on corneal permeability cannot be dismissed a priori.

Chemical delivery systems: evaluation of physicochemical properties and enzymatic stability of phenylephrone derivatives.

The physicochemical properties and enzymatic stability of esters of phenylephrone, synthesized on the basis of the chemical delivery system (CDS) concept, were studied as a new class of mydriatic agents. Potentiometrically determined ionization constants (pKa) of the novel compounds were in the range 7.19-7.21. The three esters of phenylephrone (isovaleryl, phenylacetyl, and pivalyl) were more lipophilic than phenylephrone as indicated by n-octanol/pH 7.4 buffer partition coefficients (log Papp) and the chromatographic capacity factors (log k'). The chemical stability of the esters of phenylephrone was evaluated in hydrochloric acid, citrate, and phosphate buffers (with pH ranging between 2.0 and 8.0), and the enzymatic hydrolysis in rat and human plasma. The samples were analyzed using HPLC assay procedures. The phenylephrone esters were found to undergo comparatively slow hydrolytic degradation in buffer with pH 3.0 and 4.0, with half-lives ranging from 1136 to 1980 hr at 37 degrees C. The novel esters were readily hydrolyzed in human plasma with half-lives ranging between 16.2 and 47.8 min. The hydrolytic degradation rates were higher in rat plasma than in human plasma, in which the half-lives were in the range of 9.8-38.3 min. In the present investigations, only phenylephrone, not the active species phenylephrine, was detected. Among the esters studied, isovaleryl ester was the most labile. Pivalyl ester, having a tertiary carbon, showed relatively high resistance to chemical and enzymatic hydrolysis because of the steric hindrance, followed by phenyl and isovaleryl esters. The results suggest that the duration of action of the phenylephrone CDS can be controlled with proper chemical manipulations.

Particle size and drug interactions of injectable corticosteroids used in ophthalmic practice.

PURPOSE: The aim of this study is to compare the particle sizes of commercially available corticosteroids for intralesional injection to manufacturers' specifications and to evaluate changes in size when mixed with other steroids and other commonly used solutions. METHODS: The particle sizes of dexamethasone sodium phosphate, methylprednisolone acetate, triamcinolone acetonide, and betamethasone sodium phosphate and beta-methasone acetate were measured with the Coulter counter. Each steroid was mixed with each of the others, lidocaine, and lidocaine with epinephrine, then measured immediately and after 1 hour to determine the effect on particle size. RESULTS: All steroids showed accurate manufacturer specifications. Dexamethasone showed an increase in particle size when mixed with lidocaine alone, immediately and after 1 hour. Triamcinolone showed an increase in particle size only after 1 hour after mixture with lidocaine alone. Triamcinolone, dexamethasone, and methylprednisolone particles increased in size when mixed with lidocaine and epinephrine. Dexamethasone and triamcinolone showed an additional increase in size when allowed to sit for 1 hour after mixture with lidocaine and epinephrine. Mixing steroids caused no increase in particle size. CONCLUSION: Because an increase in the number of particles greater than 20 microns in a solution also increases the likelihood of vascular occlusion, the authors urge care in the mixing of these drugs, especially with lidocaine and epinephrine. If mixture is necessary, the authors recommend that injection take place immediately subsequent.

A comparative study of the efficacy of 2.5% phenylephrine and 10% phenylephrine in pre-operative mydriasis for routine cataract surgery.

It is common practice in many ophthalmic units to administer multiple applications of 10% phenylephrine in combination with an anti-cholinergic agent to ensure adequate pupil mydriasis prior to routine cataract surgery. Phenylephrine is a pure alpha-1 adrenoreceptor agonist known to produce marked systemic vasoconstriction and associated hypertension with occasional profound reflex bradycardia. Many reviews have suggested caution in the use of 10% phenylephrine in the elderly or hypertensive patient. In a prospective, randomised trial we have assessed pupil dilation comparing the efficacy of 10% phenylephrine (53 patients) versus 2.5% phenylephrine (62 patients). When administered in conjunction with 1% cyclopentolate four times over 1 hour pre-operatively, 2.5% phenylephrine was found to be as effective as 10% phenylephrine in the initiation and maintenance of mydriasis during both extracapsular and phacoemulsification cataract extraction.

Soft drugs--XIV. Synthesis and anticholinergic activity of soft phenylsuccinic analogs of methatropine.

Three soft drug analogs and a metabolite of methatropine based on phenylsuccinic structural moiety were synthesized and tested for activity. In an in vivo assay, the soft drugs were found to be two orders of magnitude less potent than methatropine while the carboxylate metabolite was found to be one order of magnitude less potent than the soft drugs. A structural isomer of compound 4a was found to be less potent. All the soft drugs tested elicited shorter durations of mydriatic action in rabbit eyes compared to atropine. The untreated eye was dilated in the atropine treated animals while no dilation occurred in the soft drug treated animals indicating facile systemic metabolism of the soft drugs to inactive moieties, possibly the carboxylate metabolite. In in vitro stability studies, the soft drugs have been found to be more hydrolytically labile than atropine. The shorter duration of mydriatic action of compound 4a coupled with increased hydrolytic lability make this a candidate for further study.