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The Science of the Total Environment Jul 2016The impact of residual pharmaceuticals on the aquatic environment has gained widespread attention over the past years. Various studies have established the occurrence of...
The impact of residual pharmaceuticals on the aquatic environment has gained widespread attention over the past years. Various studies have established the occurrence of pharmaceutical compounds in different water bodies throughout the world. In view of the absence of occurrence data in a number of developing world countries, and given the limited availability of analytical resources in these countries, it is prudent to devise methodologies to prioritize pharmaceuticals for environmental monitoring purposes that are site specific. In this work, several prioritization approaches are used to rank the 88 most commonly consumed pharmaceuticals in Lebanon. A simultaneous multi-criteria decision analysis method utilizing the exposure, persistence, bioaccumulation, and toxicity (EPBT) approach is applied to a smaller subset of the original list (69 pharmaceuticals). Several base cases are investigated and sensitivity analysis is applied to one of these base case runs. The similarities and differences in the overall ranking of individual, and classes of, pharmaceuticals for the base cases and the sensitivity runs are elucidated. An environmental risk assessment (ERA), where predicted environmental concentrations (PEC) and risk quotients (RQ) are determined at different dilution factors, is performed as an alternative method of prioritization for a total of 84 pharmaceuticals. The ERA results indicate that metformin and amoxicillin have the highest PECs while 17β-estradiol, naftidrofuryl and dimenhydrinate have the highest RQs. The two approaches, EPBT prioritization and ERA, are compared and a priority list consisting of 26 pharmaceuticals of various classes is developed. Nervous system and alimentary tract and metabolism pharmaceuticals (9/26 and 5/26 respectively) constitute more than half of the numbers on the priority list with the balance consisting of anti-infective (4/26), musculo-skeletal (3/26), genito-urinary (2/26), respiratory (2/26) and cardiovascular (1/26) pharmaceuticals. This list will serve as a basis for the selection of candidate compounds to focus on for future monitoring campaigns.
Topics: Developing Countries; Environmental Monitoring; Environmental Pollutants; Pharmaceutical Preparations; Risk Assessment; Water Pollutants, Chemical
PubMed: 26994791
DOI: 10.1016/j.scitotenv.2016.03.023 -
Journal of Advanced Research Jan 2016A novel simple, direct and selective gas chromatography-mass spectrometry (GC/MS) procedure was developed for the determination of the antihistamine drug dimenhydrinate...
A novel simple, direct and selective gas chromatography-mass spectrometry (GC/MS) procedure was developed for the determination of the antihistamine drug dimenhydrinate (DMH) in presence of six of its related substances and potential impurities, namely, diphenylmethane, diphenylmethanol, benzophenone, orphenadrine, caffeine and 8-chlorocaffeine. The method involved resolution of the underivatized compounds using a trifluoropropylmethyl polysiloxane (Rtx-200) capillary column and the mass spectrometric detection was carried out in the electron-impact (EI) mode. Excellent baseline separation of DMH and the cited related substances was achieved in less than 15 min. Quantification of the parent drug DMH was based on measuring its peak area. The reliability and analytical performance of the proposed method were validated with respect to linearity, range, precision, accuracy, specificity, robustness, detection and quantification limits. Calibration curve of DMH was linear over the range 50-500 μg/mL with determination coefficient (R (2)) = 0.9982. The proposed method was successfully applied for the assay of DMH in tablets dosage form with recoveries >96.80%.
PubMed: 26843970
DOI: 10.1016/j.jare.2015.01.010 -
Oman Medical Journal Jan 2016One of the major causes of mortality in children is acute gastroenteritis. Vomiting is common in early stages of the disease. The aim of this study was to determine the...
OBJECTIVES
One of the major causes of mortality in children is acute gastroenteritis. Vomiting is common in early stages of the disease. The aim of this study was to determine the effect of oral dimenhydrinate (DH) in the control of vomiting in cases of acute gastroenteritis in children.
METHODS
This double-blind, randomized, clinical trial was conducted in a university-affiliated hospital in a western province of Iran. Two hundred children aged one to 12 years old were randomly assigned to either drug or placebo groups. Children in the drug group received oral DH as four doses of 1 mg/kg every six hours (maximum 200 mg), and children in the placebo group received a placebo drug. The patients variables were compared 24 hours after receiving the first dose and at seven and 14 days after discharge.
RESULTS
The mean number of episodes of vomiting was 4.4±2.5 in the drug group versus 4.4±2.1 in the placebo group, which was not statistically significant (p<0.050). The mean number of episodes of diarrhea was 7.4±3.2 and 10.1±2.8 in the drug and placebo groups, respectively, (p<0.050). The duration of diarrhea, side effects, need to revisit, and parent's satisfaction in both groups were also significantly different (p>0.050).
CONCLUSIONS
Oral DH in children with acute gastroenteritis does not reduce the number and duration of vomiting. However, our results showed that consumption of DH in acute gastroenteritis patients was effective in reducing the frequency and duration of diarrhea and further investigation into this is warranted.
PubMed: 26813018
DOI: 10.5001/omj.2016.04 -
Deutsches Arzteblatt International Nov 20151.7% of children taking medication on an outpatient basis in Germany have at least one adverse drug reaction (ADR). The corresponding figure for hospitalized children is... (Review)
Review
BACKGROUND
1.7% of children taking medication on an outpatient basis in Germany have at least one adverse drug reaction (ADR). The corresponding figure for hospitalized children is estimated at 10% .
METHODS
This review is based on pertinent literature retrieved by a selective search in PubMed.
RESULTS
According to reports submitted to the Drug Commission of the German Medical Association (Arzneimittelkommission der deutschen Ärzteschaft, AkdÄ), serious ADRs can arise, for example, after the administration of dimenhydrinate, α-adrenergic nose drops, enemas containing phosphate, ACE inhibitors, angiotensin-2-receptor antagonists (sartans), and methylphenidate. The causes of ADRs include overdoses, drug administration despite contraindications, and inadequate monitoring of long-term treatment. Errors can also be made in communication, labeling, and drug administration. The risk of ADRs is especially high in off-label use. Computerized physician order entry systems, individual packaging and labeling of single doses, and the use of bar codes for patient and drug identification can help prevent such errors.
CONCLUSION
The process of drug administration should be optimized through suitable interventions and electronic support, with due consideration of local circumstances. Clinical trials on children should be encouraged as a means of improving drug safety, and additional financial incentives should be created for trials concerning drugs that are off-patent. Physicians and pharmacists should take care to report adverse reactions as they are required to do by professional code, particularly in the case of new drugs, off-label use, or medication errors. A recognized national standard for dosing that can be implemented in computerized physician order entry systems is needed so that evidence-based pediatric dosages can be calculated.
Topics: Child; Child, Preschool; Drug Monitoring; Drug-Related Side Effects and Adverse Reactions; Germany; Hospitalization; Humans; Incidence; Infant; Infant, Newborn; Medication Errors; Off-Label Use; Patient Safety; Risk Factors
PubMed: 26806565
DOI: 10.3238/arztebl.2015.0781 -
Pediatric Neurology Mar 2016Paroxysmal movement disorders including paroxysmal tonic upward gaze of infancy and paroxysmal dystonia of infancy are benign but uncommon movement disorders seen in...
BACKGROUND
Paroxysmal movement disorders including paroxysmal tonic upward gaze of infancy and paroxysmal dystonia of infancy are benign but uncommon movement disorders seen in young children. Although symptoms are intermittent and resolve spontaneously, they can cause discomfort and distress for the child. Current treatment options are limited to dopaminergic agents or anticonvulsants with limited efficacy.
PATIENT DESCRIPTION
The authors present a child with paroxysmal tonic upward gaze of infancy and another with paroxysmal dystonia of infancy, both of whom responded successfully to treatment with low-dose dimenhydrinate or diphenhydramine, respectively.
DISCUSSION
Dimenhydrinate and diphenhydramine both exert anticholinergic activity and have limited toxicity at low doses. This property makes either compound an attractive therapeutic option for paroxysmal movement disorders in infancy. These agents are generally well tolerated.
Topics: Dimenhydrinate; Diphenhydramine; Electroencephalography; Histamine H1 Antagonists; Humans; Infant; Male; Movement Disorders
PubMed: 26726052
DOI: 10.1016/j.pediatrneurol.2015.10.019 -
Prescrire International Nov 2015
Topics: Dimenhydrinate; Diphenhydramine; France; Histamine H1 Antagonists; Humans; Substance-Related Disorders
PubMed: 26688907
DOI: No ID Found -
Wiener Klinische Wochenschrift May 2016The efficacy and safety of the fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg in the treatment of vertigo of various origins have been investigated in... (Observational Study)
Observational Study
The efficacy and safety of the fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg in the treatment of vertigo of various origins have been investigated in a prospective, noninterventional study involving private practices throughout Germany. A total of 1275 patients with an average age of 61.2 years participated in the study. The vertigo symptoms, measured by a validated mean vertigo score (primary efficacy endpoint) improved by 61 % in the course of the observational period (median: 6 weeks). Concomitant symptoms frequently associated with vertigo such as nausea, vomiting and tinnitus were also markedly reduced by 84, 85 and 51 %, respectively. Overall efficacy has been rated by the physicians as 'very much improved' or 'much improved' in 95 % of the patients. A total of 47 patients (3.7 %) reported 51 adverse drug reactions (all nonserious). The results indicate a good tolerability and efficacy of the fixed combination of cinnarizine and dimenhydrinate in the treatment of vertigo in daily medical practice, which is in line with previous findings of numerous interventional, randomised, double-blind, controlled clinical trials.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Antiemetics; Cinnarizine; Dimenhydrinate; Drug-Related Side Effects and Adverse Reactions; Female; Germany; Histamine H1 Antagonists; Humans; Male; Middle Aged; Prevalence; Risk Factors; Sex Distribution; Treatment Outcome; Vertigo; Young Adult
PubMed: 26659910
DOI: 10.1007/s00508-015-0905-5 -
Clinical Therapeutics Nov 2015We undertook a preliminary assessment of the efficacy of administering intravenous dexamethasone (DEX) for relieving the nausea and dizziness accompanying vestibular... (Comparative Study)
Comparative Study Randomized Controlled Trial
PURPOSE
We undertook a preliminary assessment of the efficacy of administering intravenous dexamethasone (DEX) for relieving the nausea and dizziness accompanying vestibular neuritis (VN).
METHODS
Between November 2013 and October 2014, 26 patients with VN were prospectively enrolled in this study. The patients were randomly assigned to treatment with a combination of 20 mg/d of intravenous metoclopramide, 100 mg of oral dimenhydrinate, and 5 mg/d of intravenous DEX or 20 mg/d of intravenous metoclopramide, 100 mg of oral dimenhydrinate, and intravenous normal saline as a placebo therapy. Patients' subjective assessments of the severity of their nausea and dizziness were recorded using a visual analog scale on the day of admission and 2 days, 3 days, 1 month, and 3 months thereafter. Bedside examinations consisted of spontaneous nystagmus (SPN) assessment, the head shaking nystagmus test, and the head impulse test, which were performed at every follow-up visit.
FINDINGS
The severity of nausea and dizziness was significantly reduced over time (both P < 0.05). However, there was no significant effect of DEX injection on the severity of nausea or dizziness (P > 0.05). The presence of SPN was solely associated with nausea (hazard ratio = 3.34; 95% CI, 1.85-6.02).
IMPLICATIONS
The administration of intravenous DEX did not relieve nausea or dizziness any better than a placebo treatment. However, further research is required to confirm whether there is a dose-dependent effect of DEX on the control of nausea or dizziness in VN.
Topics: Administration, Intravenous; Adult; Aged; Aged, 80 and over; Dexamethasone; Dizziness; Female; Humans; Male; Metoclopramide; Middle Aged; Nausea; Prospective Studies; Vestibular Neuronitis
PubMed: 26475420
DOI: 10.1016/j.clinthera.2015.09.010 -
Drug Development and Industrial Pharmacy 2016Dimenhydrinate (DMH)-loaded buccal bioadhesive films for the prevention and treatment of motion sickness were prepared and optimized. This study examines the rate of...
Dimenhydrinate (DMH)-loaded buccal bioadhesive films for the prevention and treatment of motion sickness were prepared and optimized. This study examines the rate of drug release from the films for prolonged periods of time to reduce or limit the frequency of DMH administration. Based on preliminary studies using various polymers and concentrations, hydroxyethylcellulose (2.5, 3.0, and 3.2%), and xanthan gum (2.8%) were chosen as matrix polymers. The films were analyzed with respect to their mechanical, physicochemical, bioadhesive, swelling, and in-vitro release properties. In in-vivo pharmacokinetic studies, xanthan gum-based DMH buccal film was associated with significantly increased DMH plasma levels between 1 h and 5 h after DMH dosing when compared with an oral drug solution. The area under the curve AUC0-7 h value of the mucoadhesive buccal film was two-fold higher than the oral DMH solution. Histological analysis revealed that DMH films cause mild morphological and inflammatory changes in rabbit buccal mucosa. The DMH buccal film is effective for approximately 7 h, thus representing an option for single-dose antiemetic therapy. This dosage regimen could be particularly beneficial for chain travelers who travel for long periods of time.
Topics: Adhesives; Administration, Buccal; Animals; Area Under Curve; Biological Availability; Cellulose; Chemistry, Pharmaceutical; Dimenhydrinate; Male; Mouth Mucosa; Polysaccharides, Bacterial; Rabbits; Surface Properties
PubMed: 26460061
DOI: 10.3109/03639045.2015.1091470