Stability of Extemporaneously Prepared Rufinamide Oral Suspensions

Background: Rufinamide is an oral antiepileptic drug indicated for adjunctive therapy in treating generalized seizures associated with Lennox-Gastaut syndrome. Currently, rufinanide is available as 200-mg and 400-mg tablets. A liquid dosage form does not exist at the present time. Lack of a suspension formulation may present an administration problem for many children and adults who are unable to swallow tablets. The availability of a liquid dosage form will provide an easy and accurate way to measure and administer the medication. Objective: To determine the stability of both sugar-containing and sugar-free rufinamide suspensions over a 90-day period. Methods: A suspension of rufinamide 40 mg/mL was prepared by grinding twelve 400-mg tablets of rufinamide tablets in a glass mortar. Sixty milliliters of Ora-Plus and 60 mL of either Ora-Sweet or Ora-Sweet SF (sugar free) were mixed and added to the powder to make a final volume of 120 mL. Three identical samples of each formulation were prepared and placed in 60-mL amber plastic bottles and were stored at room temperature. A 1-mL sample was withdrawn from each of the 6 bottles with a micropipette immediately after preparation and at 7, 14, 28, 56, and 90 days. After further dilution to an expected concentration of 0.4 mg/mL, the samples were assayed using high-performance liquid chromatography. Stability was defined as the retention of at least 90% of the initial concentration. Results: At least 90% of the initial rufinamide concentration remained throughout the 90-day study period in both preparations. There were no detectable changes in color, odor, taste, and pH and no visible microbial growth. Conclusions: Extemporaneously compounded suspensions of rufinamide 40 mg/mL in a 1:1 mixture of Ora-Plus and Ora-Sweet or Ora-Sweet SF were stable for at least 90 days when stored in 59-mL amber polypropylene plastic bottles at room temperature

An unlikely hero? : challenging stigma through community engagement

Purpose � The purpose of this paper is to describe a high-profile social enterprise in Blackpool, England, called Jobs, Friends and Houses (JFH) that has created a visible social identity of recovery and meaningful activity, to assess how stigma is challenged through active and visible community engagement

Motivations for change in drug addiction recovery:turning points as the antidotes to the pains of recovery

Painful life events have been highlighted as being instrumental in promoting change during drug addiction recovery. This paper attempts to integrate the ‘pains of desistance’ approach into a recovery capital framework. It explores the life courses of 30 people in drug addiction recovery who had previously had a problem with an illicit substance to explore the role of the pains of recovery (potential push factors) alongside different forms of recovery capital (pull factors) at key turning points of change during recovery. Findings demonstrate that pull factors linked to CHIME were significant in promoting positive changes. Turning points acted as antidotes to pains experienced in early recovery. Three antidotes appeared to be gender specific. Implications highlight the need for greater access to community capital pathways. It advocates the need to dispel the myth for a rock bottom moment and for a more macro conceptualisation of drug addiction recovery

Detoxification in rehabilitation in England: effective continuity of care or unhappy bedfellows?

There is evidence that residential detoxification alone does not provide satisfactory treatment outcomes and that outcomes are significantly enhanced when clients completing residential detoxification attend rehabilitation services (Gossop, Marsden, Stewart, & Rolfe, 1999; Ghodse, Reynolds, Baldacchino, et al., 2002). One way of increasing the likelihood of this continuity of treatment is by providing detoxification and rehabilitation within the same treatment facility to prevent drop-out, while the client awaits a rehabilitation bed or in the transition process. However, there is little research evidence available on the facilities that offer both medical detoxification and residential rehabilitation. The current study compares self-reported treatment provision in 87 residential rehabilitation services in England, 34 of whom (39.1%) reported that they offered detoxification services within their treatment programmes. Although there were no differences in self-reported treatment philosophies, residential rehabilitation services that offered detoxification were typically of shorter duration overall, had significantly more beds and reported offering more group work than residential rehabilitation services that did not offer detoxification. Outcomes were also different, with twice as many clients discharged on disciplinary grounds from residential rehabilitation services without detoxification facilities. The paper questions the UK classification of residential drug treatment services as either detoxification or rehabilitation and suggests the need for greater research focus on the aims, processes and outcomes of this group of treatment providers

Community recovery as a public health intervention: The contagion of hope

There is a growing evidence base for recovery as a journey that involves reduced relapse risk, improved citizenship, and better global health and well-being. Although this is the case, there is a risk of omitting one of the prime benefits of a diverse range of recovery activities—the impact on families and the wider community. What the current article does is to summarize evidence around the “social contagion” of recovery through communities and its potential role in transmitting hope and the belief that recovery is possible even to those who are not yet ready to commit to abstinence. And further, that in doing so, visible recovery increases community cohesion and challenges stigmatisation and exclusion of recovery populations. The implications for public health from an emerging visible and high-profile social identity of recovery is discussed

Cerebral small vessel disease and intracranial bleeding risk: prognostic and practical significance

Balancing the risks of recurrent ischaemia and antithrombotic-associated bleeding, particularly intracranial haemorrhage (ICH), is a key challenge in the secondary prevention of ischaemic stroke and transient ischaemic attack. In hyperacute ischaemic stroke, the use of acute reperfusion therapies is determined by the balance of anticipated benefit and the risk of ICH. Cerebral small vessel disease (CSVD) causes most spontaneous ICH. Here, we review the evidence linking neuroimaging markers of CSVD to antithrombotic and thrombolytic-associated ICH, with emphasis on cerebral microbleeds (CMB). We discuss their role in the prediction of ICH, and practical implications for clinical decision making. Although current observational data suggests CMB presence should not preclude antithrombotic therapy in patients with ischaemic stroke or TIA, they are useful for improving ICH risk prediction with potential relevance for determining the optimal secondary prevention strategy, including the use of left atrial appendage occlusion. Following ICH, recommencing antiplatelets is probably safe in most patients, while the inconclusive results of recent randomised controlled trials of anticoagulant use makes recruitment to ongoing trials (including those testing left atrial appendage occlusion) in this area a high priority. Concern regarding CSVD and ICH risk after hyperacute stroke treatment appears to be unjustified most patients, though some uncertainty remains regarding patients with very high CMB burden and other risk factors for ICH. We encourage careful phenotyping for underlying CSVD in future trials, with potential to enhance precision medicine in stroke