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Scientific Reports Aug 2017The aim of the current manuscript was to test the applicability of a nanocomposite system of penetration enhancer vesicles (PEVs) within polymeric in situ forming gel...
Intranasally administered in situ gelling nanocomposite system of dimenhydrinate: preparation, characterization and pharmacodynamic applicability in chemotherapy induced emesis model.
The aim of the current manuscript was to test the applicability of a nanocomposite system of penetration enhancer vesicles (PEVs) within polymeric in situ forming gel network composed of poloxamer and hyaluronic acid for the intranasal delivery of the antiemetic dimenhydrinate (DMH). PEVs were prepared using phospholipids and labrasol/transcutol/PEG 400 as penetration enhancers, and characterized for entrapment efficiency (EE%), particle size, zeta potential and morphology. The nanocomposite in situ forming gel system was characterized for its sol-gel temperature, viscosity and mucoadhesiveness, and was pharmacodynamically tested on a cisplatin induced emesis model in rats in terms of food, water, kaolin intake and stomach weight content. The selected PEVs formula displayed EE% of 83% for DMH, particle size of 121 nm and a surface charge of 0.83 mV. The selected nanocomposite in situ gelling formula showed a viscosity of 2.13 Pa.S, mucoadhesive force of 0.62 N and DMH controlled release over 6 hours. The pharmacodynamic study showed the superiority of the nanocomposite in situ gelling formula; being administered at a lower dose than the oral marketed formula. The described nanocomposite system proved to be successful for the intranasal delivery of DMH, thus presenting a promising delivery modality for similar antiemetics.
Topics: Administration, Intranasal; Animals; Antiemetics; Cisplatin; Dimenhydrinate; Drinking; Drug Compounding; Eating; Gels; Male; Microscopy, Electron, Transmission; Molecular Structure; Nanocomposites; Rats, Wistar; Viscosity; Vomiting
PubMed: 28855590
DOI: 10.1038/s41598-017-10032-7 -
International Journal of Rehabilitation... Dec 2017Vestibular rehabilitation using individualized vibrotactile neurofeedback training (IVNT) can lead to significant improvement in the postural stability of patients with... (Randomized Controlled Trial)
Randomized Controlled Trial
Vestibular rehabilitation using individualized vibrotactile neurofeedback training (IVNT) can lead to significant improvement in the postural stability of patients with vestibular symptoms of different origins. However, some of these patients have complex, severe dizziness, meaning that a pharmacological pretreatment or parallel (to vestibular rehabilitation) treatment can help them perform the rehabilitation exercises. Hence, the present study investigated the influence of a pharmacological treatment on the efficacy of vibrotactile neurofeedback training in patients with chronic, noncompensated vestibulopathies. All participants performed IVNT for ∼10 min each day for 2 weeks. In addition, every second participant was selected randomly to receive oral medication (20 mg cinnarizine and 40 mg dimenhydrinate per tablet), taking three tables per day. Trunk and ankle sway and postural stability were measured. In addition, the dizziness handicap inventory was evaluated immediately before training on the last day of training and 6 months after training. After the 10-day period of IVNT, both groups showed a statistically significant improvement in all parameters tested. A follow-up analysis after 6 months showed a long-term efficacy for the IVNT, that is, the patients remained significantly improved in their postural stability. The antivertiginous therapy did not hinder the efficacy of the IVNT. The present results indicate that IVNT even in combination with an antivertiginous drug therapy is an effective treatment regime for patients with disabling vertigo of different origins.
Topics: Aged; Antiemetics; Cinnarizine; Dimenhydrinate; Female; Humans; Male; Middle Aged; Neurofeedback; Vertigo
PubMed: 28777127
DOI: 10.1097/MRR.0000000000000245 -
Medycyna Pracy May 2017The phenomenon of stupefying by the use of available over-the-counter drugs (OTC) among adolescents is an essential problem in both Poland and throughout the world.... (Review)
Review
The phenomenon of stupefying by the use of available over-the-counter drugs (OTC) among adolescents is an essential problem in both Poland and throughout the world. Popular analgesics, cold medicine and antihistamines contain psychedelic substances, such as dextromethorphan (DXM), pseudoephedrine/ephedrine, codeine (methylmorphine), dimenhydrinate, paracetamol (acetaminophren) and others. Cases of fatal addiction to dextromethorphan, one of the active substances contained in medicines, e.g., the common cold, have been reported. The test results cited by the authors clearly indicate that the use of OTC drugs, whose turnover is not controlled is a domain of females. The extent of use of drugs not prescribed by a doctor has remained for many years at a constant level. The most common poisonings with OTC drugs are caused by those that affect the respiratory system or exert analgesic or antipyretic effects. They are also used in attempted suicides, especially among females. Analyzing poisonings caused by OTC medications their seasonality has been observed. Their number increases during spring-autumn. A territorial differentiation in areas of OTC drug trade in terms of their quantities, with the predominance of southern regions is also noted. Intoxication with psychoactive substances causes the deterioration of relations between young people. In the reviewed studies there is no detailed information on the composition of non-prescription medicines. Moreover, young people have easy access to mushroom fungi, growing in nearby forests and meadows that may have hallucinogenic effects and are available in pharmacies and on the Internet. Med Pr 2017;68(3):413-422.
Topics: Adolescent; Agaricales; Female; Humans; Male; Nonprescription Drugs; Poland; Substance-Related Disorders
PubMed: 28512368
DOI: 10.13075/mp.5893.00245 -
Aesthetic Plastic Surgery Feb 2017Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients,... (Comparative Study)
Comparative Study Randomized Controlled Trial
INTRODUCTION
Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone-dimenhydrinate and dexamethasone-ondansetron combinations in prevention of nausea and vomiting in postoperative patients.
METHOD
Sixty 18-65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone-dimenhydrinate group (group DD) and dexamethasone-ondansetron group (group DO). All patients received dexamethasone 8 mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air-oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4 mg iv and group DD received dimenhydrinate 1 mg/kg iv. For postoperative analgesia tramadol (1.5 mg/kg) iv, tenoksikam (20 mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24 h. Total amount of tramadol was recorded. All results were statistically evaluated.
OBSERVATIONS
Demographics and Apfel risk scores of both groups were similar. Surgical operation duration (p = 0.038) and total preoperative remifentanil consumption were higher in group DD (p = 0.006). In group DO, nausea at 30 and 60 min (p = 0.001, p = 0.007), retching at 30 and 60 min (p = 0.002, p = 0.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30 min (p = 0.001). Postoperative analgesic consumption was similar in both groups.
RESULT
Our study revealed that dexamethasone-dimenhydrinate combination was more effective than dexamethasone-ondansetron in prevention of nausea and vomiting after rhinoplasty operations.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Adult; Aged; Anesthesia, General; Dexamethasone; Dimenhydrinate; Double-Blind Method; Drug Therapy, Combination; Elective Surgical Procedures; Female; Follow-Up Studies; Humans; Middle Aged; Ondansetron; Postoperative Nausea and Vomiting; Prospective Studies; Rhinoplasty; Risk Assessment; Treatment Outcome; Young Adult
PubMed: 28039501
DOI: 10.1007/s00266-016-0772-0 -
Spectrochimica Acta. Part A, Molecular... Feb 2017Three chemometric methods namely, concentration residual augmented classical least squares (CRACLS), spectral residual augmented classical least squares (SRACLS) and...
Full spectrum and selected spectrum based chemometric methods for the simultaneous determination of Cinnarizine and Dimenhydrinate in laboratory prepared mixtures and pharmaceutical dosage form.
Three chemometric methods namely, concentration residual augmented classical least squares (CRACLS), spectral residual augmented classical least squares (SRACLS) and partial least squares (PLS) were applied for the simultaneous quantitative determination of Cinnarizine and Dimenhydrinate in their binary mixtures. All techniques were applied with and without variable selection using genetic algorithm (GA) resulting in six models (CRACLS, GA-CRACLS, SRACLS, GA-SRACLS, PLS, GA-PLS). These models were applied for the simultaneous determination of the drugs in their laboratory prepared mixtures and pharmaceutical dosage form via handling their UV spectral data. It was found that GA based models are simpler and more robust than those built with the full spectral data. The proposed models were found to be simple, fast and require no preliminary separation steps; so they can be used for the routine analysis of this binary mixture in quality control laboratories.
Topics: Algorithms; Cinnarizine; Dimenhydrinate; Spectrophotometry, Ultraviolet
PubMed: 27837737
DOI: 10.1016/j.saa.2016.10.055 -
Journal of Obstetrics and Gynaecology... Aug 2016The purpose of this study was to assess the efficacy and outcomes of preoperative prophylactic metoclopramide and dimenhydrinate use in elective cesarean births.
Preoperative Use of 10-mg Metoclopramide and 50-mg Dimenhydrinate in the Prophylaxis of Postoperative Nausea and Vomiting in Elective Caesarean Births: A Prospective Randomized Clinical Study.
BACKGROUND
The purpose of this study was to assess the efficacy and outcomes of preoperative prophylactic metoclopramide and dimenhydrinate use in elective cesarean births.
METHODS
Participants (n = 84) scheduled for elective cesarean births were randomized equally into placebo (10 cc 0.9 % NaCl), 10-mg metoclopramide or 50-mg dimenhydrinate groups. Oral alimentation was prohibited 8 h before the surgery; however, patients continued drinking water until 4 h before surgery. Placebo and antiemetics were administered 1 h before the anticipated procedure in a 5-ml syringe. In metoclopramide and dimenhydrinate group, an ampoule of the agents was completed to 5 ml by adding 0.9 % NaCl. In the control group 5 ml of 0.9 % NaCl was used. All prophylactic agents were administered intramuscularly. All patients received a general anesthesia. The placebo group (control group) was compared with the metoclopramide and dimenhydrinate groups.
RESULTS
Demographic data including maternal age, height, weight, body mass index, gravidity, parity, miscarriage, induced abortion, the number of offspring, and the medical history did not show significant differences among the three groups. Postoperative nausea, vomiting, and the use of rescue medication ratios were significantly lower in metoclopramide and dimenhydrinate groups compared with the placebo group (p < 0.05); however, the difference between the metoclopramide and dimenhydrinate groups was not significant (p > 0.05).
CONCLUSION
Dimenhydrinate and metoclopramide significantly decrease postoperative nausea, vomiting, and the need for rescue antiemetic medication. Both agents have similar efficacy and may be used as an alternative to each other.
PubMed: 27382219
DOI: 10.1007/s13224-015-0679-8 -
Clinical Neurophysiology : Official... Jun 2016Seasickness is a widespread problem among naval crew, and has a major impact on their performance at sea. The three pharmacological agents most commonly employed in the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Seasickness is a widespread problem among naval crew, and has a major impact on their performance at sea. The three pharmacological agents most commonly employed in the treatment of seasickness are dimenhydrinate, cinnarizine, and scopolamine. At present, the effectiveness of anti-seasickness drugs is tested by a process of "trial and error", while sailing and exposed to sea conditions. A physiological test to evaluate the action of a drug might save crew members long periods of suffering, as well as simplifying the procedure of selecting the appropriate treatment for each individual. The cervical vestibular evoked myogenic potentials (cVEMP) test has come to be recognized as a reliable procedure for the objective evaluation of saccular function. It was the hypothesis of the present study that cVEMP otolith responses may be affected by anti-motion sickness drugs, which might thus make cVEMP a useful clinical neurophysiological tool for the assessment of drug absorption and efficacy.
METHODS
Thirty male sailors who regularly took medication for the treatment of seasickness participated in the study. Participants underwent the cVEMP test pre- and 1h post-drug administration.
RESULTS
A statistically significant decrease in p13 latency was found after administration of scopolamine compared with baseline (14.46ms vs. 15.09ms, p=0.0049), with significant prolongation of the binaural average inter-latency in this group. No differences were found in the dimenhydrinate and cinnarizine study groups.
CONCLUSIONS
This study demonstrated that scopolamine absorption can be verified by changes in cVEMP latencies.
SIGNIFICANCE
The potential of the cVEMP test for predicting action of scopolamine on the vestibular system.
Topics: Adult; Humans; Male; Motion Sickness; Reaction Time; Scopolamine; Vestibular Evoked Myogenic Potentials; Vestibule, Labyrinth
PubMed: 27178852
DOI: 10.1016/j.clinph.2016.03.010 -
Nature Reviews. Disease Primers May 2016Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is... (Review)
Review
Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.
Topics: Antiemetics; Audiometry; Benzodiazepines; Catheter Ablation; Dimenhydrinate; Ear, Inner; Endolymph; Ganglia, Sensory; Hearing Loss; Humans; Magnetic Resonance Imaging; Meclizine; Meniere Disease; Promethazine; Quality of Life; Tinnitus; Vertigo
PubMed: 27170253
DOI: 10.1038/nrdp.2016.28 -
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