Indacaterol and salmeterol in COPD patients: a comparative study of efficacy and safety

Background: Chronic obstructive pulmonary disease (COPD) is an airway disorder characterized by airflow limitation that is not fully reversible. Indacaterol is a novel, inhaled, once-daily, ultra-long-acting β2-agonist bronchodilator recently approved in India for the treatment of chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the efficacy and safety of indacaterol compared to twice-daily β2-agonist, salmeterol, as an active control. Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a 12 week period. A total of 60 patients with moderate-to-severe COPD were randomised to treatment either with indacaterol (150 μg once daily) or with salmeterol (50 μg twice daily) and 51 (85%) patients completed the study. The efficacy parameters were change in FEV1, health related quality of life by measuring St George’s Respiratory Questionnaire (SGRQ) total score and severity of dyspnoea as measured by Transition Dyspnoea Index (TDI) score which were assessed at baseline first and at weeks 4, 8 and 12. Results: Indacaterol increased FEV1 at week 4 by 50 ml, at week 8 and at week 12 by 60 ml over salmeterol and the increase was highly significant (p<0.001) at all stages of the study. Both treatments improved health status (SGRQ total score) and dyspnoea (TDI score), with differences between them favouring indacaterol. Safety profiles were similar across the treatment groups, and both indacaterol and salmeterol were well tolerated without any severe adverse events. Conclusions: Once-daily treatment with 150 μg indacaterol had a significant and clinically relevant bronchodilator effect and improved health status and dyspnoea to a greater extent than twice-daily 50 μg salmeterol. Indacaterol should prove a useful addition in the treatment of patients with COPD

ANTILITHIATIC EFFECT OF CISSAMPELOS PAREIRA LEAVES IN AMMONIUM CHLORIDE AND ETHYLENE GLYCOL INDUCED UROLITHISIS IN RATS

  Objective: To study the antilithiatic activity of ethanolic extract of leaves of Cissampelos pareira (EELCP) in 2% ammonium chloride (AC) and 0.75% ethylene glycol (EG) induced urolithiasis in albino rats.Methods: Kidney stones were induced in rats by feeding drinking water mixed with 2% (AC) and 0.75% (EG) for 10 days. Stones were confirmed by the increased urinary levels of calcium, uric acid and decreased levels of magnesium and increased levels of serum creatinine and calcium. The rats were treated with 03 doses of EELCP i.e. 100 mg/kg, 200 mg/kg, 400 mg/kg respectively, orally in different groups of albino rats once daily for 10 days along with 2% (AC) and 0.75% (EG) containing drinking water. On 11th day, 3 rats from each group were kept in one metabolic cage and urine (pooled) collected for 24 hrs was subjected for assessment of various biochemical parameters. Blood was collected on the same day and analyzed for various parameters. Kidneys were observed for the histopathological changes.Results: Rats treated with 03 doses of EELCP significantly (p≤0.05) decreases the urinary calcium, uric acid and enhanced urinary magnesium levels, decreased serum calcium, creatinine and enhanced serum magnesium. Histopathology of kidneys in groups treated with EELCP at 200 mg/kg and 400 mg/kg doses revealed less tissue damage and the cytology of nephrotic tissue was almost similar to the control Group I rats.Conclusion: Results showed EELCP has shown significant antilithiatic effect against chemical induced urolithiasis in rats.Keywords: Cissampelos pareira, Leaf extract, Antilithiatic activity, Urolithiasis, Ethylene glycol

ABOLITION OF SEIZURE PROVOKING EFFECT OF SUMATRIPTAN BY FLUOXETINE IN PENTYLENETETRAZOL INDUCED SEIZURES IN RATS

  Objectives: The objective was to evaluate the seizure provoking effect of sumatriptan, and its abolition with fluoxetine in the pentylenetetrazol-induced seizures in rats.Methods: 100 Sprague-Dawley rats of either sex were randomized into 10 groups with each group consisting 10 rats. The first group was taken as a control group which received distilled water. The second group and the third group were evaluated with standard anticonvulsant drug sodium valproate in the dose of 200 mg/kg and 250 mg/kg, respectively. The fourth group received sumatriptan in the dose 6 mg/kg. The fifth and sixth groups were evaluated for effect of fluoxetine in the dose of 6 mg/kg and 10 mg/kg, respectively. The seventh group was evaluated for the combined effect of sumatriptan 6 mg/kg and sodium valproate 200 mg/kg. The eighth group was administered fluoxetine 6 mg/kg and sodium valproate 200 mg/kg. The ninth group was evaluated for a combined effect of fluoxoetine 6 mg/kg and sumatriptan 6 mg/kg. The tenth group was evaluated for the combined effect of three drugs fluoxetine 6 mg/kg, sumatriptan 6 mg/kg, and sodium valproate 200 mg/kg. The rats were screened for the effect of various drugs by inducing seizures with pentylenetetrazol. The rats were analyzed for the parameters, i.e., the time for the onset of seizures, duration of tonic-clonic seizures, and for post seizure mortality up to 24 hrs.Results: Sumatriptan reduced the seizure threshold in rats, and it has abolished the seizure protective effect of sodium valproate. Sodium valproate and fluoxetine had dose dependent seizure protective effect. Fluoxetine abolished the seizure threshold lowering effect of sumatriptan. Fluoxetine and sodium valproate combination produced additive seizure productive effect. The combination of sumatriptan, fluoxetine, and sodium valproate also raised the seizure threshold.Conclusion: The seizure threshold lowering effect of sumatriptan was abolished by co-administration of fluoxetine.Keywords: Fluoxetine, Sumatriptan, Pentylenetetrazol, Seizures

DRUG UTILIZATION STUDY AMONG GERIATRIC PATIENTS IN A TERTIARY CARE TEACHING HOSPITAL IN SOUTH INDIA

Objectives: The objective of our study is to evaluate the drug utilization pattern among geriatric patients in a tertiary care teaching hospital in South India and analyze the prescription pattern. Methods: &nbsp;Retrospective medical record analysis was performed for indoor cases of the geriatric patients (aged ≥65 years) admitted in medicine wards of Raichur Institute of Medical Sciences teaching hospital, Raichur, from June 2015 to May 2016. They were analyzed for demo graphics, disease pattern&nbsp; by&nbsp; system&nbsp; involved,&nbsp; disease&nbsp; diagnosed,&nbsp; comorbidity&nbsp; pattern,&nbsp; most&nbsp; commonly&nbsp; prescribed&nbsp; drugs,&nbsp; distribution&nbsp; of&nbsp; drugs&nbsp; according&nbsp; to&nbsp; their&nbsp; therapeutic class, evaluation of polypharmacy, route of administration, fixed-dose combinations, and the World Health Organization core prescribing indicators. Results: A total of 400 prescriptions of geriatrics patients admitted in inpatient medicine department were randomly selected and all the required data for the study were collected and evaluated. The majority of patients were found to be in the age group of 65–70 years (70.25%). It was noticed that females (51.75%) were more compared to males (48.25%). The drugs prescribed were analyzed. Ranitidine, ceftriaxone, theophylline, and salbutamol were prescribed to majority of the patients in this study group. The average number of drugs per prescription was 7.42; drugs prescribed by generic name were 33.62%. Among the drugs prescribed, 88.69% were from the National List of Essential Medicines. Total encounters having inject table &nbsp;preparations were 100% and total encounters having antibiotic prescribed were 91%. The prevalence of cardiovascular disorders (32.5%) was high followed by respiratory disorders (32.25%). Conclusion: This study provides insight into the patterns of drug use in our tertiary care hospital on geriatric patients as well as various diseases prevalent&nbsp; among&nbsp; geriatric&nbsp; patients.&nbsp; Widespread&nbsp; polypharmacy,&nbsp; high&nbsp; use&nbsp; of&nbsp; antibiotics&nbsp; and&nbsp; injections,&nbsp; and&nbsp; lack&nbsp; of&nbsp; generic&nbsp; prescribing&nbsp; are&nbsp; some&nbsp; concerns that need to be addressed to promote rational usage of drugs