Off-label and unlicensed drugs in the pediatric field : a descriptive review of the last ten years

A falta de medicamentos contendo bulas prevendo o tratamento de pacientes pediátricos representa um problema frequentemente observado em hospitais, principalmente nos setores de unidade de terapia intensiva (UTI) pediátrica e neonatais. Sabe-se que, para que um tratamento seja considerado seguro e eficaz, uma série de estudos clínicos são necessários, no entanto, relata-se um baixo número dessas pesquisas envolvendo crianças, principalmente devido a questões éticas que dificultam a condução das mesmas. Assim, poucos são os medicamentos que provam ser adequados para o tratamento desses pacientes, tornando necessário recorrer ao uso de medicamentos off-label e não licenciados. Os medicamentos são classificados como off-label quando seu uso se dá de maneira que difere de suas especificações aprovadas, por sua vez, produtos não licenciados são classificados desta forma por não possuírem aprovação para sua comercialização no país ou não possuírem comprovação de segurança e eficácia. O preparo de protocolos de estudo organizados, relato de informações aos pais e à criança de maneira clara e objetiva, aproximação entre pesquisadores e pais para o estabelecimento de uma relação de confiança e a condução das pesquisas em momentos de disponibilidade da família demonstram-se estratégias importantes para facilitar a realização dos ensaios clínicos.The lack of medicines containing drug information leaflets considering the treatment of pediatric patients is a problem frequently observed in hospitals, especially in the pediatric and neonatal intensive care unit (ICU) sectors. It is known that, for a treatment to be considered safe and effective, a series of clinical studies are necessary; however, a low number of these studies involving children are reported, mainly due to ethical issues that make conducting them difficult. Thus, few drugs prove to be suitable for treating these patients, making it necessary to resort to using off-label and unlicensed drugs. Drugs are classified as off-label when their use differs from their approved specifications, in turn, unlicensed products are classified in this way due to not having approval for marketing in the country or do not have proof of safety and efficacy. Preparation of organized study protocols, reporting information to parents and the child in a clear and objective way, bringing researchers and parents closer to establish a relationship of trust and conducting research at moments when the family is available are important strategies to facilitate conducting clinical trials

Study of flavonoids presente in Pomelo (Citrus máxima) by DSC, UV-VIS, IR, 1H and 13C NMR and MS

Flavonoids are among the most important plant metabolites. Due to their potential benefits, there is a considerable interest in this natural product. In genus Citrus, some plants have not yet been much exploited in Brazil, as in the case of grapefruit (Citrus maxima), whose main flavonoids are naringin and their aglycone naringenin. The physico-chemical characteristics are important pre-requisites of reference chemical in future studies. In this context, the objective of this study was to determine the characterization of naringin and naringenin by melting point, DSC, UV-VIS, 1H and 13C NMR, IR and MS. Results revealed that, naringin and naringenin after characterization, can be used in future studies and contribute to seeking possible technological applications

Acetato de dexametasona : validação de método por CLAE para análise da forma farmacêutica creme

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BIOTRANSFORMATION OF METRONIDAZOLE BY CUNNINGHAMELLA ELEGANS ATCC 9245

Drug biotransformation studies appear as an alternative to pharmacological studies of metabolites, development of new drug candidates with reduced investment as well as the most efficient production of chemical structures involves and drug quality control studies. A wide range of reactions in biotransformations process is catalyzed by microorganisms. Fungi can be considered as a promising source of new biotransformation reactions. The aim of this study was to evaluate the capacity of metronidazole biotransformation through the filamentous fungus Cunninghamella elegans ATCC 9245. The monitoring of metabolite formation was performed by high-performance liquid chromatography (HPLC) coupled to ultraviolet (UV) spectrophotometry. The results of the biotransformation of metronidazole showed drug consumption in culture and the formation of four new chromatographic peaks of chemical structures not elucidated. The method showed it became linear over 10-70 μg/mL (r = 0.999953). Accuracy, precision and stability studies agree with international guidelines.  Results are consistent in accordance with the principles of green chemistry as the experimental conditions had a low environmental impact, and few solvents use. 

UV spectrophotometric method for quantitative determination of agomelatine in coated tablets

UV spectrophotometry is an analytical technique used routinely for qualitative and quantitative assay due the low cost and reliability during analysis. In this work, it was validated a quantitative UV method for determination of agomelatine in coated tablets. The parameters specificity, linearity, precision, accuracy and robustness were evaluated according to official guidelines. Methanol was selected as solvent and the maximum wavelength for drug analysis was 230 nm. The purposed assay showed to be specific and the linearity was proved in a range of 0.5 - 2.5 μg/mL. The RSD values obtained during precision assay (inter-day RSD = 1.75%) indicated the method reproducibility, and the accuracy testing showed good results from recovery test. Robustness assay was complementary and showed that the purposed method is adequate for drug quantitation in commercial samples, being a reliable alternative to chromatographic assay

Alkaloids in erythrina by UPLC-ESI-MS and in vivo hypotensive potential of extractive preparations

Erythrina species are used in popular medicine as sedative, anxiolytic, anti-inflammatory, and antihypertensive. In this work, we investigated the chemical composition of extracts obtained from leaves of E. falcata and E. crista-galli. The hypotensive potential of E. falcata and the mechanism of action were also studied. The extracts were obtained by maceration and infusion. The total content of phenolic compounds and flavonoids was estimated by spectrophotometric methods. The chemical constituents were studied performing a chromatographic analysis by UPLC-ESI-MS. For in vivo protocols, blood pressure and heart rate were measured by the invasive hemodynamic monitoring method. Different concentrations of extracts and drugs such as L-NAME, losartan, hexamethonium, and propranolol were administrated i.v.The results of total phenolic contents for E. falcata and E. cristagalli were 1.3193–1.4989mgGAE/mL for maceration and 0.8771–0.9506mgGAE/mL for infusion. In total flavonoids, the content was 7.7829–8.1976mg RE/g for maceration and 9.3471–10.4765 REmg/g for infusion. The chemical composition was based on alkaloids, suggesting the presence of erythristemine, 11-methoxyglucoerysodine, erysothiopine, 11-hydroxyerysodine-glucose, and 11-hydroxyerysotinone-rhamnoside. A potent dose-dependent hypotensive effect was observed for E. falcata, which may be related to the route of -adrenergic receptors

In vitro toxic evaluation of two gliptins and their main impurities of synthesis

Background: The presence of impurities in some drugs may compromise the safety and efficacy of the patient’s treatment. Therefore, establishing of the biological safety of the impurities is essential. Diabetic patients are predisposed to tissue damage due to an increased oxidative stress process; and drug impurities may contribute to these toxic effects. In this context, the aim of this work was to study the toxicity, in 3 T3 cells, of the antidiabetic agents sitagliptin, vildagliptin, and their two main impurities of synthesis (S1 and S2; V1 and V2, respectively). Methods: MTT reduction and neutral red uptake assays were performed in cytotoxicity tests. In addition, DNA damage (measured by comet assay), intracellular free radicals (by DCF), NO production, and mitochondrial membrane potential (ΔψM) were evaluated. Results: Cytotoxicity was observed for impurity V2. Free radicals generation was found at 1000 μM of sitagliptin and 10 μM of both vildagliptin impurities (V1 and V2). A decrease in NO production was observed for all vildagliptin concentrations. No alterations were observed in ΔψM or DNA damage at the tested concentrations. Conclusions: This study demonstrated that the presence of impurities might increase the cytotoxicity and oxidative stress of the pharmaceutical formulations at the concentrations studied

Validação de métodos analíticos e estudo da estabilidade de rabeprazol sódico

Neste trabalho, foram desenvolvidos e validados métodos qualitativos e quantitativos para o controle de qualidade de rabeprazol sódico, um inibidor da bomba de prótons. O fármaco apresenta eficácia comprovada na cicatrização, alívio de sintomas e prevenção de recidivas de úlceras pépticas e doença do refluxo gastroesofágico. A substância química de referência utilizada nas análises foi caracterizada por espectrofotometria no infravermelho e por espectroscopia de ressonância magnética nuclear. A análise qualitativa foi realizada por cromatografia em camada delgada, espectrofotometria no ultravioleta (UV), cromatografia líquida de alta eficiência (CLAE) e eletroforese capilar (EC), possibilitando a identificação das amostras. Os métodos quantitativos validados foram: UV, espectrofotometria ultravioleta derivada de primeira ordem, CLAE e EC. Todos demonstraram ser específicos, lineares, precisos, exatos e sensíveis. Além disso, o teste de dissolução para os comprimidos revestidos contendo rabeprazol foi desenvolvido e validado, obtendo-se um perfil de dissolução satisfatório. Outro objetivo deste trabalho foi o estudo da estabilidade de rabeprazol. Os fatores de degradação avaliados foram a temperatura (50 e 80 ºC), a hidrólise em meio ácido (HCl 0,01-0,1M), a oxidação por peróxido de hidrogênio e a luz (UVC-254 nm e metal haleto). De modo geral, o fármaco demonstrou ser sensível a todos os fatores, principalmente quando em solução, mas de forma mais intensa frente à acidez e luz. A cinética de fotodegradação em metanol frente à lâmpada UVC foi determinada, indicando tratar-se de uma reação de ordem zero. Três produtos da fotodegradação foram isolados e identificados por ressonância magnética nuclear: 1H-benzimidazol, 1,3-diidro-benzimidazol-2-ona e [4-(3-metoxipropoxi)- 3-metil-piridina-2-il]metanol. Alguns resultados sugerem que o 1,3-diidrobenzimidazol- 2-ona também é formado na degradação em meio ácido.In this work, qualitative and quantitative methods were developed and validated for the quality control of rabeprazole sodium, a proton pump inhibitor. The drug has proven efficacy in healing, symptoms relief and prevention of relapse of gastric ulcer and gastro-oesophageal reflux disease. The substance used as reference standard in the analysis was characterized by infrared spectroscopy and nuclear magnetic resonance. The qualitative analysis was performed by thin layer chromatography, UV spectrophotometry, high performance liquid chromatography (HPLC) and capillary electrophoresis (CE), allowing the identification of samples. The quantitative methods validated were: UV, first-order derivative spectrophotometry, HPLC and CE. All of them demonstrated to be specific, linear, precise, accurate and sensitive. Besides, the dissolution test for rabeprazole coated tablets was developed and validate, obtaining a satisfactory dissolution profile. Another objective of this work was the study of rabeprazole stability. The degradation factors evaluated were the temperature (50 and 80 ºC), the acid (HCl 0.01-0.1 M), the oxidation by hydrogen peroxide and light (UVC-254 and metal halide). In general, the drug demonstrated to be sensitive to all factors studied, mainly in solution, but in a more intensive way front to acid and light. The photodegradation kinetics in methanol, front to UVC light was determined, indicating a zero-order reaction. Three photodegradation products were isolated and identified by nuclear magnetic resonance: 1H-benzimidazole, 1,3-diidro-benzimidazole-2-one and [4-(3-methoxypropoxy)- 3-methyl-pyridin-2-yl]methanol. Some results suggest that the 1,3-diidrobenzimiazole- 2-one is also formed in the acidic degradation

Aplicação do método de espectroscopia ultravioleta derivada na determinação de rabeprazol em comprimidos revestidos

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