A Review on Complications of the Prolonged Use of Proton Pump Inhibitors (PPIs) and Presenting a Case of Barrett’s Esophagus

Background: Gastroesophageal reflux disease (GERD) is the most common among gastric disorders and treated by antacids especially proton pump inhibitors (PPIs). Though symptoms are reported to be controlled by PPIs, however the complications like barrettes esophagus, Cancers at GE junction are not studied and reported extensively. In view of symptomatic relief, the long, non-supervised, over the counter medication use has increased. Safety of such long-term has been attempted with the review of available evidence and presentation of a case.Aim: To update available literature on the long-term use of PPIs and possible mechanisms behind adverse events.Materials and Methods: A case of Barrette’s esophagus was presented, with long-term use of PPIs. Detailed history taking of the case was done and another evidence synthesis was done on the effects of the long and short-term use of PPIs. The literature search using Medline, Scopus, Scholar on adverse effects of the use of PPIs was done which were language and date unrestricted.Results: Studies report many adverse effects on short-term (up to 5 years of use, namely: clostridium associated diarrhea, bacterial peritonitis, cholecystitis, pyogenic liver, liver cirrhosis, pneumonia, esophageal inflammations, nocturnal breakthrough acid reflux, interstitial nephritis, drug interaction and nutritional deficiencies mainly of Vitamin B 12 and iron) and long-term use, namely: Concomitant dyspepsia, Barrettes esophagus, osteoporosis, dementia, hypomagnesia, cancers at GE junction.Conclusion: The health care providers and community should be made cautious, larger cohort observational studies are also recommended for more evidence

FORMULATION AND EVALUATION OF SUBLINGUAL TABLET FOR NARATRIPTA

Naratriptan is used for the treatment of migraine. Formulation and Evaluation of sublingual tablets of Naratriptan for pre and post Compression parameters was undertaken.  The tablets were prepared by direct compression method using super disintegrates. After selection of superdisintegrants tablets were prepared by using polymer for reducing the flushing action of saliva and provide enough time for drug absorbed. The prepared tablets were evaluated for their physical and chemical property. The permeation study was performed on Goat mucosa for optimized batch. No interactions were found between drug and excipients. Formulation F2 containing Crosspovidone shows immediate drug release. Formulation F6 containing Chitoson shows fast drug release as compared to superdisintegrants alone. Sublingual tablets were prepared by direct compression method using Crosspovidone as a superdisintegrants. But it is more effective in combination with Chitoson. As a result, sublingual tablet administration of Naratriptan formulated with appropriate excipients and especially with Chitoson seems promising alternative to traditional routes. Keyword:-Sublingual delivery, Naratriptan, Superdisintegrants, Chitoson, Permeability, Migraine, Crosspovidon

FORMULATION AND EVALUATION OF BILAYERED FLOATING TABLET OF DILTIAZEM DRUG

Aim of study was to develop bilayered floating drug delivery for treatment of hypertension by delivering loading and maintenance dose for fast achievement of peak plasma concentration and maintaining the same respectively. The prepared drug loaded bilayered floating tablets were evaluated for pre and post compression parameters. Stability study of the promising formulation was also performed. The tablets were prepared by direct compression method. The loading dose was delivered in the form of immediate release layer prepared by different super-disintegrations and maintenance dose was delivered through sustained release layer prepared by using polymers like HPMC K15M and Carbopol 934P. Both the immediate release layer and sustained release layers were separately optimized and then combined to optimize the bilayered floating tablets. No interactions were found between drug and excipients. Formulation containing crosscarmellose sodium shows immediate drug release. Formulation Containing HPMC K15M shows sustained release action and bilayered formulations FB7 shows releases up to 12 hours with good buoyancy and total floating time. All the Bilayered floating formulations buoyant up to 12 hrs. Bilayered floating tablets with release characteristics offer critical advantages such as, site specificity with improved absorption and efficacy. This technology can be inculcated to various medicaments which have stomach as the major site of absorption. Key words: Diltiazem, Bilayered floating tablet, sustain release table