29/Apr/2022

Tamsulosin HCl

Overview:

Tamsulosin is a specialized alpha-1A and alpha-1B sympathomimetic antagonists that works best in the prostate and bladder, where these receptors are found in the highest concentration. It is used to treat the symptoms and signs of prostate enlargement. Antagonism of these receptors causes muscle tissue in the prostate and set of specified muscles in the bladder to relax, improving urine flow. Other alpha-1 sympathomimetic antagonists introduced in the 1980s were less selective, and they were more likely to act on blood vessel muscle tissue, causing hypotension.

Primary Characteristics:

Tamsulosin is a (R)-configured 5-(2-(2-ethoxyphenoxy)ethyl)-2-methoxybenzenesulfonamide. Tamsulosin HCl is a kind of alpha1 adrenoceptor antagonist that used treat prostate enlargement, chronic prostatitis, urine retention, and kidney stone passage. It works as an appropriate remedy and an alpha-adrenergic antagonist. It is a conjugate base of a tamsulosin(1+).

Pharmacology:

Tamsulosin is an alpha adrenoceptor blocker that is selective for two receptor subtypes found in the prostate and submaxillary tissue. Because of this selectivity, a considerable effect on urine flow can be achieved with a lower risk of unwanted effects such orthostatic hypotension.

Mechanism of Action:

Tamsulosin is an adrenoceptor blocker that works on both alpha-1A and alpha-1D receptors. The alpha-1A subtype accounts for over 70% of alpha-1 adrenoceptors in the prostate. Smooth muscle in the prostate relaxes and urine flow improves when these adrenoceptors are blocked. The contraction muscles of the bladder are relaxed when alpha-1D adrenoceptors are blocked, preventing storage symptoms. Tamsulosin’s specificity concentrates the effects on the target region while limiting side effects.

Side Effects:

If you develop any of the following symptoms of a tamsulosin allergy: hives, rash, itching; difficulty breathing; swelling of your face, lips, tongue, or neck, get immediate medical attention.

If you have: Stop taking this drug and see your doctor right away if you have:

a sense of dizziness, as if you’re about to pass out
a painful penile erection that lasts 4 hours or more

Fever, sore throat, swelling of the cheek or tongue, burning in the eyes, and skin discomfort, followed by a red or purple skin rash that spreads (particularly in the face or upper body) then blisters and peels.

The following are some of the most common tamsulosin adverse effects:

low blood pressure
dizziness, sleepiness, and exhaustion
nausea, vomiting, and diarrhea
Headache, chest discomfort
faulty ejaculation, insufficient sperm
back ache
eyesight problems
difficulties with the teeth
Fever, chills, body pains, and flu symptoms are all indications of the flu.
a stuffy or runny nose, sinus discomfort, a sore throat, and a cough
Insomnia (sleep deprivation) or
decreased Interest in sex.

Warning:

Tamsulosin might make you feel dizzy or faint, especially if you’re taking it for the first time or restarting your treatment. During exercise or in hot weather, avoid standing for lengthy periods of time or being overheated. If you’re having cataract surgery, let your eye surgeon know ahead of time that you’ll be taking this medicine. Call your doctor right away if you stop taking this prescription for any reason.

Precautions:

After using tamsulosin, you may experience dizziness, lightheadedness, or fainting. Slowly rising from a seated position may assist to alleviate this issue. If you get a persistent erection while taking this medication, you should seek medical help immediately once. This is a very uncommon side effect that has to be addressed immediately away. Some people taking this drug or who had recently taken this medicine when they had cataract or glaucoma surgery have had a significant eye issue known as Intraoperative Floppy Iris Syndrome (IFIS).

pharmavision

29/Apr/2022

Omeprazole Sodium Sterile

Omeprazole sodium sterile is a proton pump inhibitor, which is a kind of medication (PPIs). This vaccine contains omeprazole and sodium hydrogen carbonate. It is used to treat some stomach and esophageal disorders (such as acid reflux, ulcers). It is also used to prevent internal bleeding in critically unwell prisoners’ abdomens. And it works by reducing the quantity of acid produced by your stomach. It is particularly useful in the treatment of heartburn (heartburn that occurs at least two or more days per week) in adults, as well as in the treatment of stomach acidity and the treatment of gastroesophageal reflux and peptic ulcer infection.

Primary Characteristics:

Omeprazole has a pyramidal tricoordinate sulfinyl Sulphur structure and hence can occur as either the (S)- or (R)-enantiomer. Omeprazole is a racemate, which means it is a 50/50 blend of the two. Both enantiomers are transformed to achiral products (sulfenic acid and sulfonamide configurations) in the acidic canaliculi of parietal cells, which react with a cysteine group in H+/K+ ATPase, reducing the parietal cells’ capacity to create stomach acid.

Pharmacology:

Omeprazole effectively inhibits the enzyme system on parietal cells that is required for stomach acid secretion. It is an H+/K+ ATPase inhibitor. This enzyme is required for the last stage in the production of gastric acid.

Firing Mechanism:

The half-life of omeprazole is less than 1 hour, and it is almost entirely cleared from plasma within 3-4 hours. The absorption of the coated granule formulation dispensed in hard gelatine capsules is slower, with peak concentrations 1-3 hours after dose. About 80% of a given dose is excreted in the urine, and the remainder via the bile.

Pharmacokinetics:

Omeprazole has a half-life of less than an hour and is practically completely eliminated from plasma in 3-4 hours. The liver totally metabolizes omeprazole. The sulphone and hydroxy omeprazole are the two primary plasma metabolites, none of which adds to antisecretory action. Approximately 80% of a given dosage is eliminated in the urine, with the balance passing through the bile. e coated granule formulation in hard gelatin capsules absorbs more slowly, with peak concentrations occurring 1-3 hours after intake.

Contradictions:

Intolerance to omeprazole, substituted benzimidazoles, or any of the excipients. Omeprazole, like other proton pump inhibitors (PPIs), should not be used together nelfinavir.

Side Effects:

Not all of these side effects must be taken, but if they occur, you should see your doctor right away.

headache
abdominal pain
diarrhea
nausea
vomiting
gas (flatulence)
dizziness
upper respiratory infection
acid reflux
constipation
rash
cough

Rare side effects of Omeprazole include:

liver damage
inflammation within the kidneys
pancreatitis
dermatologic disorder, potentially life threatening (toxic epidermal necrolysis)

Precautions:

To treat erosive esophagitis, you may require a lower dose of this medication. Consult your doctor right away if you or your kid gets stomach pains, bloating, watery and severe diarrhea that is occasionally bloody, fever, nausea or vomiting, or unusual fatigue or weakness. Patients using a PPI may develop or worsen cutaneous or systemic lupus erythematosus. This medication may raise your chances of developing fundic gland polyps (abnormal tissue growth in the upper part of your stomach). This is more likely if you have been taking this medication for longer than a year. Do not discontinue taking this medication without first consulting your doctor or unless instructed to do so.

Warning:

This medication contains omeprazole. If you are allergic to omeprazole or any of the substances in this medication, do not use Prilosec or Prilosec OTC.

Children should be kept out of reach. Get medical attention or contact a Poison Control Center right away if you suspect an overdose.

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pharmavision

09/Aug/2021

Duloxetine Hydrochloric Acid

Overview

Duloxetine hydrochloride is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) for oral administration. Its chemical designation is (+)-(S)-N-methyl-?-(1-naphthyloxy)-2-thiophenepropylamine hydrochloride. The empirical formula is C18H19NOS•HCl. Duloxetine hydrochloride is a white to slightly brownish white solid, which is slightly soluble in water.

Primary Characteristics

Duloxetine Hydrochloride is of Synthetic origin. . The Molecular Weight of Duloxetine Hydrochloride is 333.90. It is weakly alkaline drug.

Indications

Indicated for:

1) Management of Major Depressive Disorder.

2) Management of Generalized Anxiety Disorder.

3) Management of diabetic peripheral neuropathy.

4) Management of fibromyalgia.

5) Management of chronic musculoskeletal pain.

6) Management of osteoarthritis of the knee in adults.

7) Management of chronic lower back pain in adults.

8) Management of stress urinary incontinence in adult women.

Off-label uses include:

1) Management of chemotherapy-induced peripheral neuropathy.

2) Management of stress urinary incontinence in adult men after prostatectomy until recovery is complete.

Pharmacodynamics

Duloxetine, through increasing serotonin and norepinephrine concentrations in Onuf’s nucleus, enhances glutamatergic activation of the pudendal motor nerve which innervates the external urethral sphinter. This enhanced signaling allows for stronger contraction. Increased contraction of this sphincter increases the pressure needed to produce an incontinence episode in stress urinary incontinence. Duloxetine has been shown to improve Patient Global Impression of Improvement and Incontinence Quality of Life scores. It has also been shown to reduce the median incontinence episode frequency at doses of 40 and 80 mg.

Action at the dorsal horn of the spinal cord allows duloxetine to strengthen the the serotonergic and adrenergic pathways involved in descending inhibition of pain. This results in an increased threshold of activation necessary to transmit painful stimuli to the brain and effective relief of pain, particularly in neuropathic pain. Pain relief has been noted in a variety of painful conditions including diabetic peripheral neuropathy, fibromyalgia, and osteoarthritis using a range of pain assessment surveys. While duloxetine has been shown to be effective in both animal models of mood disorders and in clinical trials for the treatment of these disorders in humans, the broad scope of its pharmacodynamic effects on mood regulation in the brain has yet to be explained.

Mechanism of action

Duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake and a less potent inhibitor of dopamine reuptake. Duloxetine has no significant affinity for dopaminergic, adrenergic, cholinergic, histaminergic, opioid, glutamate, and GABA receptors.

Action on the external urinary sphincter is mediated via duloxetine’s CNS effects. Increased serotonin and norepinephrine concentrations in Onuf’s nucleus leads to increased activation of 5-HT2, 5-HT3, and ?1 adrenergic receptors. 5-HT2 and ?1 are both Gq coupled and their activation increases the activity of the inositol trisphosphate/phospholipase C (IP3/PLC) pathway. This pathway leads to release of intracellular calcium stores, increasing intracellular calcium concentrations, and facilitating neuronal excitability. 5-HT3 functions as a ligand-gated sodium channel which allows sodium to flow into the neuron when activated. Increased flow of sodium into the neuron contributes to depolarization and activation of voltage gated channels involved in action potential generation. The combined action of these three receptors contributes to increased excitability of the pudendal motor nerve in response to glutamate

Duloxetine side effects

The severe or irreversible adverse effects of Duloxetine Hydrochloride, which give rise to further complications include Hyponatremia, Hyponatremia.

The symptomatic adverse reactions produced by Duloxetine Hydrochloride are more or less tolerable and if they become severe, they can be treated symptomatically, these include Weakness, Thirst, Fatigue, Nausea, Vomiting, Diarrhea, Constipation, Insomnia, Sweating, Blurred vision, Pruritus, Lethargy, Dyspepsia, Weight gain, Somnolence, Tremor, Sexual dysfunction, Syncope, Decrease in libido, dyspepsia.

pharmavision

05/Aug/2021

Lansoprazole

Overview

Lansoprazole is an acid proton pump inhibitor. Lansoprazole is a benzimidazole sulfoxide derivative and produces long lasting inhibition of gastric acid secretion. Lansoprazole is a chiral compound with one chiral center, synthsized as a racemic mixture and both enantiomers are active. Chemically Lansoprazole is identified as 2-[[[3-methyl-4-(2, 2, 2-trifluoroethoxy)-2-pyridinyl] methyl] sulfinyl ]-1H-benzimidazole. Lansoprazole is effective in the treatment of duodenal or gastric ulcer, gastroesophageal reflux disease and in the treatment of zollinger-ellison syndrome. Lansoprazole is administered orally.

Primary Characteristics

It is of Synthetic origin and belongs to Sulphinyl Benzimidazole. It belongs to H/K Atpase proton pump inhibitor pharmacological group on the basis of mechanism of action and also classified in Antacids pharmacological group. The Molecular Weight of Lansoprazole is 369.00.

Its pKa is 8.85.

Indications

Lansoprazole is primarily indicated in conditions like Acid-related dyspepsia, Benign gastric ulcer, Duodenal ulcer, Duodenal ulcer associated with h. Pylori, Esophagitis, Gastric ulcer, Gastro-esophageal reflux disease, Heart burn, Helicobacter pylori positive duodenal ulcer, NSAID-associated gastric and duodenal ulcers, NSAID-associated gastric and duodenal ulcers (prophylaxis), NSAID-associated gastric or duodenal ulcers, Peptic ulcer, Resistant ulcers, Zollinger-ellison syndrome, and can also be given in adjunctive therapy as an alternative drug of choice in GI bleeding.

Pharmacokinetics

Oral absorption of Lansoprazole is found to be 40% ±40. Volume of distribution is found to be 24 ± 8 liter and plasma proteins binding is 97-99%. and metabolism is reported Hepatic(extensively). Renal Excretion accounts for 30% and plasma half life is 1-2 hr.

Pharmacodynamics

Lansoprazole decreases gastric acid secretion by targeting H+,K+-ATPase, which is the enzyme that catalyzes the final step in the acid secretion pathway in parietal cells. Conveniently, lansoprazole administered any time of day is able to inhibit both daytime and nocturnal acid secretion. The result is that lansoprazole is effective at healing duodenal ulcers, reduces ulcer-related pain, and offers relief from symptoms of heartburn Lansoprazole also reduces pepsin secretion, making it a useful treatment option for hypersecretory conditions such as Zollinger-Ellison syndrome.

Mechanism of action

As a PPI, lansoprazole is a prodrug and requires protonation via an acidic environment to become activated. Once protonated, lansoprazole is able to react with cysteine residues, specifically Cys813 and Cys321, on parietal H+,K+-ATPase resulting in stable disulfides. PPI’s in general are able to provide prolonged inhibition of acid secretion due to their ability to bind covalently to their targets.

Side Effects

The severe or irreversible adverse effects of Lansoprazole, which give rise to further complications include Atrophic gastritis, Epidermal necrolysis.

The symptomatic adverse reactions produced by Lansoprazole are more or less tolerable and if they become severe, they can be treated symptomatically, these include Headache, Nausea, Diarrhea, Constipation, Rashes, Pruritus.

Interference in Pathology

Elevations of SGPT and SGOT
Abnormal LFTs
Increased Alkaline Phosphatase Levels
Elevation in ALT or AST
Increased in serum creatinin

pharmavision

02/Aug/2021

Itraconazole

Overview

Itraconazole is a broad-spectrum antifungal agent for oral treatment of vulvovaginal candidiasis, pityriasis versicolor and dermatophytes. Itraconazole is a substituted triazole derivative. Itraconazole active works against many Candida species, endemic mycoses and dermatophytes. Itraconazole is the most potent of available azoles, but effectiveness can be limited by reduced bio availability. The requirement for intravenous administration and the toxicity of the older antifungal agents created a need for antifungal agents with a better therapeutic profile. The relatively non-toxic oral azole medications represent the first major advance in this direction. Since their introduction in the 1980s, these medications have played an increasingly important role in the systemic therapy of fungal diseases.

Primary Characteristics

Itraconazole is also known as Oriconazole. It is of Synthetic origin and belongs to Triazole. It belongs to Antifungals pharmacological group. The Molecular Weight of Itraconazole is 705.60.

Its pKa is 3-4.

Indications

Itraconazole is primarily indicated in conditions like Advanced breast or prostate cancer, Antifungal prophylaxis, Candidiasis, Cryptcoccal meningitis, Dermatophytic infections, Histoplasmosis, Oculomycoses, Onychomycoses, Oral candidiasis, Oropharangeal candidiasis, Orophyrangeal candidiasis, Pityriasis versicolor, Sporotrichosis, Superficial candidiasis, Systemic mycoses, Tinea pedis, Tinae manuum, To reduce intestinal secretions and vomiting, To reduce intestinal secretions and vomiting (palliative care), and can also be given in adjunctive therapy as an alternative drug of choice in Cushing`s syndrome due to malignant disease, Fungal keratitis, Leishmaniasis, Vulvo-vaginal candidosis.

Pharmacokinetics

Oral absorption of Itraconazole is found to be 42.5% ±42.5. Volume of distribution is found to be 10.7 l/kg and plasma protien binding is 99.8%. Presystemic metabolism is noted to be 22.5% ±22.5 and metabolism is reported Hepatic. Renal Excretion accounts for 40% (inactive metabolite) and plasma half life is 20 hr.

Mechanism of action

Itraconazole interacts with 14-? demethylase, a cytochrome P-450 enzyme necessary to convert lanosterol to ergosterol. As ergosterol is an essential component of the fungal cell membrane, inhibition of its synthesis results in increased cellular permeability causing leakage of cellular contents. Itraconazole may also inhibit endogenous respiration, interact with membrane phospholipids, inhibit the transformation of yeasts to mycelial forms, inhibit purine uptake, and impair triglyceride and/or phospholipid biosynthesis

Side Effects

The severe or irreversible adverse effects of Itraconazole, which give rise to further complications include Hypotension, Hepatitis, Hypotension.

Itraconazole produces potentially life-threatening effects which include Dysrhythrics. which are responsible for the discontinuation of Itraconazole therapy.

The signs and symptoms that are produced after the acute overdosage of Itraconazole include Constipation, Gastritis, Depression.

The symptomatic adverse reactions produced by Itraconazole are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Vertigo, Headache, Fatigue, Nausea, Vomiting, Diarrhea, Abdominal pain, Pruritus, Hallucination, Somnolence, Hair loss, Edema, Photophobia, Vasculitis, dizziness.

Warning / Precautions

Itraconazole should be used with caution in patients with liver disease, heart rhythm disorders (arrhythmias) and of any drug allergies. It should be used with caution while engaging in activities requiring alertness because this medication causes dizziness or drowsiness. It should be used only when clearly needed during pregnancy or lactation. Safe use of itraconazole in the children under the age 16 has not been established. The drug should be used with caution in the patients with azole hypersensitivity. Patients who develop abnormal liver function tests during itraconazole therapy should be monitored and therapy discontinued if symptoms of the liver disease develop. Should not be administered to treat onchonycosis in pateints with ventricular dysfurution.

Storage Conditions

Capsules:

Store Between 15°C-30°C. Protect from Sunlight, Moisture and Heat.

Solution:

Store at room temperature, Below 25°C. Do not Freeze. Protect from Sunlight and Heat.

Interference in Pathology

Elevated liver enzymes

pharmavision

29/Jul/2021

Azithromycin

The antimicrobial agents or antibiotics develops during the last 60 years are among the most dramatic examples of the advances of science. The remarkably powerful and specific activity of antimicrobial drug is due to their selectivity for highly specific targets that are either unique to micro-organism or much more important in them than in humans. Azithromycin belongs to a macrolide antibiotic. Azithromycin is a 15-atom lactone macrolide ring compound. Azithromycin is a semisynthetic derivative of Erythromycin obtained by the addition of methylated nitrogen into the lactone ring of Erythromycin. Azithromycin is effective against gram positive bacteria. Antibiotics require constant drug level in body for therapeutic effect. This is achieved by taking the medication at regular interval of time throughout the day and night as prescribed. Azithromycin is important to take the drug for the full time period as prescribed. If you discontinue the therapy, it may result in ineffective treatment.

Primary Characteristics

It is of Semi Synthetic origin and belongs to Azalide. It belongs to Antibacterial (Protein synthesis inhibitor) pharmacological group on the basis of mechanism of action and also classified in Antibiotics pharmacological group. The Molecular Weight of Azithromycin is 785.00.

Indications

Azithromycin is primarily indicated in conditions like Cervicitits, Lower respiratory tract infections, Multiple myeloma, Otitis media, Reversal of excessive bradycardia, Rtis, otitis media, Skin and soft tissue infections, Soft tissue and skin infections, Status epilepticus (unlicensed use), Upper respiratory tract infections, Urethritis.

Pharmacokinetics

Oral absorption of Azithromycin is found to be 34% ±19. Volume of distribution is found to be 31.1 l/kg and plasma proteins binding is 51%. Renal Excretion accounts for < 10% unchanged. Also excreted in bile and plasma half life is 68%.

Contraindications

Azithromycin is contraindicated in conditions like Hepatic impairment, Hypersensitivity.

Drug Interactions

Azithromycin is known to interact with other drugs, the details of drug interactions is as follows:

Severity

Triazolam, Aluminium Hydroxide and Oxide, Cyclosporin, Terfenadine, Theophylline, Ergotamine (Tartrate), Ibrutinib

Moderate

Astemizole, Digoxin.

These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Side Effects

The severe or irreversible adverse effects of Azithromycin, which give rise to further complications include Maculopapular rash, Cholestasis, Pseudomembranous colitis, Jaundice.

Azithromycin produces potentially life-threatening effects which include Anaphylaxis, Angioneurotic edema. which are responsible for the discontinuation of Azithromycin therapy.

The signs and symptoms that are produced after the acute over dosage of Azithromycin include severe nausea, Severe diarrhoea, Severe vomiting, Hearing loss.

The symptomatic adverse reactions produced by Azithromycin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Flatulence, Dizziness, Vertigo, Headache, Fatigue, Nausea, Vomiting, Diarrhoea, Palpitation, Abdominal pain, Rashes, Photosensitivity, Deafness, GI disturbance.

High Risk Groups

Drug should not be given to Pregnant Mothers, patients suffering from Kidney dysfunction, patients suffering from Liver Malfunction, and Neonates.

If prescribing authority justifies the benefits of the drug against the possible damages he/she should re-evaluate them and consult the reference material and previous +

studies.

Warning / Precautions

Azithromycin should be used with caution in patients with illness or any allergy, especially allergies to drugs, liver disease, jaundice, history of colitis or stomach problems or kidney disease. This drug should be used only if clearly needed during pregnancy or lactation.

Storage Conditions

Tab, Caps, Oral Suspension

Store Below 40°C. Protect from Sunlight and Moisture.

Interference in Pathology

The use of Azithromycin may show false elevated serum aspartate.

pharmavision

26/Jul/2021

Clarithromycin

Clarithromycin is a macrolide antibiotic. Macrolides are compounds characterized by a macrocyclic lactone ring to which deoxy sugars are attached. Clarithromycin is a semisynthetic derivative of Erythromycin obtained by the addition of methyl group to hydroxyl group at carbon 6. Clarithromycin is effective against gram positive bacteria. Antibiotics require constant drug level in body for therapeutic effect. This is achieved by taking the medication at regular interval of time throughout the day and night as prescribed. Clarithromycin is important to take the drug for the full time period as prescribed. If you discontinue the therapy, it may result in ineffective treatment.

Primary Characteristics

clarithromycin is of Semi Synthetic origin and belongs to Hexopyranosyl. It belongs to Antibacterial (Proetin synthesis inhibitor) pharmacological group on the basis of mechanism of action and also classified in Antibiotics pharmacological group. The Molecular Weight of Clarithromycin is 748.00.

Indications

Clarithromycin is primarily indicated in conditions like Chronic bronchitis, Metastatic germ cell cancer, Mycobacterial infection, Otitis media, Pharyngitis, Pneumonia, Respiratory tract infections, Rtis, otitis media, Sinusitis, Skin infections, Soft tissue infections, To counteract the folate-antagonist action of methotrexate, Tonsillitis, and can also be given in adjunctive therapy as an alternative drug of choice in Duodenal ulcer, Endocarditis.

Pharmacokinetics

Oral absorption of Clarithromycin is found to be 50% ±50. Volume of distribution is found to be 250 litre and plasma protien binding is 80%. Presystemic metabolism is noted to be 20% ±20 and metabolism is reported via liver. Renal Excretion accounts for 20-30%(unchanged) 10-15%(metabolite) and plasma half life is 2.9-9.2 hr.

Pharmacodynamics

Clarithromycin is a macrolide antibiotic whose spectrum of activity includes many gram-positive (Staphylococcus aureus, S. pneumoniae, and S. pyogenes) and gram-negative aerobic bacteria (Haemophilus influenzae, H. parainfluenza, and Moraxella catarrhalis), many anaerobic bacteria, some mycobacteria, and some other organisms including Mycoplasma, Ureaplasma, Chlamydia, Toxoplasma, and Borrelia. Other aerobic bacteria that clarithromycin has activity against include C. pneumoniae and M. pneumoniae. Clarithromycin has an in-vitro activity that is similar or greater than that of erythromycin against erythromycin-susceptible organisms. Clarithromycin is usually bacteriostatic, but may be bactericidal depending on the organism and concentration of drugs.

Mechanism of action

Clarithromycin is first metabolized to 14-OH clarithromycin, which is active and works synergistically with its parent compound. Like other macrolides, it then penetrates bacteria cell wall and reversibly binds to domain V of the 23S ribosomal RNA of the 50S subunit of the bacterial ribosome, blocking translocation of aminoacyl transfer-RNA and polypeptide synthesis. Clarithromycin also inhibits the hepatic microsomal CYP3A4 isoenzyme and P-glycoprotein, an energy-dependent drug efflux pump.

Side Effects

The severe or irreversible adverse effects of Clarithromycin, which give rise to further complications include Renal failure, Interstitial nephritis, Pseudomembranous colitis.

Clarithromycin produces potentially life-threatening effects which include cerebial hemorrhage. which are responsible for the discontinuation of Clarithromycin therapy.

The signs and symptoms that are produced after the acute overdosage of Clarithromycin include Hypoxia, Hypokalemia.

The symptomatic adverse reactions produced by Clarithromycin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Headache, Nausea, Vomiting, Diarrhea, Abdominal pain, Phlebitis, Glossitis, StomatitisX, Elevation of liver enzymes, Taste perversion, Increased intracranial pressure, Hypoglycemia.

Warning / Precautions

Clarithromycin should be used with caution in patients with other illnesses or any allergy, especially allergies to drugs, arrythmias ,liver disease, jaundice (yellowing of the skin or eyes), kidney disease , or a history of colitis or stomach problems. This drug should be used only if clearly needed during pregnancy or lactation.

Storage Conditions

Oral suspension (reconstituted)

Store at room temperature. Refrigeration and Freezing is not recommended. Protect from Sunlight. Use within 14 days if kept at room temperature.

Tablets:

Store in a well closed container, Below 40°C. Protect from Sunlight and Moisture.

Interference in Pathology

Elevations of SGPT and SGOT

Alkaline phosphatase levels are elevated.

Serum creatinine raised.

Interference with serum aspartate amino transferase, urinary catecholamine and 17- hydroxy corticosteroids.

pharmavision

13/Jul/2021

Omeprazole

Omeprazole is a an oral antiulcer agent. Omeprazole is characterized as a gastric acid pump inhibitor because it blocks the final step of gastric acid production. It has a long duration of action and is very potent, allowing for once-daily administration. Despite its potency, it must be used in combination with antibiotics to be effective against Helicobacter pylori. Due to concern regarding long-term use, it was originally approved by the FDA in September 1989 for acute treatment only. In December 1994, an FDA advisory committee recommended it be approved for maintenance therapy of healed erosive esophagitis. In April 1996, it was approved for the treatment of H. pylori-associated duodenal ulcer. Belongs to a new class of ant secretory agents, the substituted benzimidazoles, which suppress gastric acid secretion by inhibiting the H+/K+ ATPase enzyme system of parietal cells. it, following activation in an acidic pH, binds irreversibly to the H+/K+ ATPase pump on the secretory surface of the parietal cell membrane. Subsequently, the secretion of hydrogen ions into the gastric lumen is inhibited. it inhibits both basal and stimulus-induced acid secretion.

Primary Characteristics

Omeprazole is also known as Proton pump Inhibitor. It is of Synthetic origin and belongs to Benzimidazol. It belongs to H/K At pase proton pump inhibitor pharmacological group on the basis of mechanism of action and also classified in Antacids pharmacological group. The Molecular Weight of Omeprazole is 345.40.

Its pKa is 4.0, 8.7.

Indications

Omeprazole is primarily indicated in conditions like Acid reflux disease (long-term management), Benign gastric and duodenal ulceration, Benign gastric and duodenal ulcers, Benign gastric ulcer associated with H.pylori, Duodenal errosions, Duodenal or benign gastric ulcer associated with H.pylori, Duodenal ulcer, Duodenal ulcer associated with h. Pylori, Gastric acid reduction during anaesthesia, Gastric acid reduction during general anesthesia, Gastric ulcer, Gastro-esophageal reflux disease, Gastro-o esophageal reflux disease, Gastro-esophageal reflux disease (refractory to other treatment), Maintenance of recurrent duodenal ulcers, Non-ulcer dyspepsia, NSAID-associated gastric and duodenal ulcers, NSAID-associated gastric and duodenal ulcers (prophylaxis), NSAID-associated gastric and duodenal ulcers and duodenal erosions, NSAID-associated gastric or duodenal ulcers, NSAID-associated gastric or duodenal ulcers (prophylaxis), Prevention of relapse in duodenal ulcer, Prophylaxis for NSAID-associated gastric and duodenal ulcers, Prophylaxis of acid aspiration, Reflux esophagitis, Resistant ulcers, Severe or recurrent duodenal and gastric ulceration, Zollinger-Ellison syndrome, and can also be given in adjunctive therapy as an alternative drug of choice in Acid aspiration syndrome prevention, GI bleeding.

Pharmacokinetics

Oral absorption of Omeprazole is found to be 57.5% ±7.5. Volume of distribution is found to be 0.3 – 0.4 l/kg and plasma proteins binding is 95%. Pre systemic metabolism is noted to be 20% and metabolism is reported Hepatic. Renal Excretion accounts for 80% and plasma half life is 1 hr.

Mechanism of action

Hydrochloric acid (HCl) secretion into the gastric lumen is a process regulated mainly by the H(+)/K(+)-ATPase of the proton pump , expressed in high quantities by the parietal cells of the stomach. ATPase is an enzyme on the parietal cell membrane that facilitates hydrogen and potassium exchange through the cell, which normally results in the extrusion of potassium and formation of HCl (gastric acid) .

Omeprazole is a member of a class of anti secretory compounds, the substituted benzimidazoles, that stop gastric acid secretion by selective inhibition of the H+/K+ ATPase enzyme system. Proton-pump inhibitors such as omeprazole bind covalently to cysteine residues via disulfide bridges on the alpha subunit of the H+/K+ ATPase pump, inhibiting gastric acid secretion for up to 36 hours . This anti secretory effect is dose-related and leads to the inhibition of both basal and stimulated acid secretion, regardless of the stimulus .

Mechanism of H. pylori eradication

Peptic ulcer disease (PUD) is frequently associated with Helicobacter pylori bacterial infection (NSAIDs) . The treatment of H. pylori infection may include the addition of omeprazole or other proton pump inhibitors as part of the treatment regimen. H. pylori replicates most effectively at a neutral pH . Acid inhibition in H. pylori eradication therapy, including proton-pump inhibitors such as omeprazole, raises gastric pH, discouraging the growth of Pylori . It is generally believed that proton pump inhibitors inhibit the urease enzyme, which increases the pathogenesis of H. pylori in gastric-acid related conditions .

Side Effects

The severe or irreversible adverse effects of Omeprazole, which give rise to further complications include Interstitial nephritis.

Omeprazole produces potentially life-threatening effects which include Anaphylaxis. which are responsible for the discontinuation of Omeprazole therapy.

The signs and symptoms that are produced after the acute over dosage of Omeprazole include Tachycardia, Drowsiness, Drowsiness, Headache.

The symptomatic adverse reactions produced by Omeprazole are more or less tolerable and if they become severe, they can be treated symptomatically, these include Flatulence, Dizziness, Headache, Fatigue, Nausea, Diarrhea, Myalgia, Constipation, Insomnia, Abdominal pain, Dry mouth, Urticaria, Pruritus, Photosensitivity, Skin rash, Impotence, Depression, Arthralgia, Myopathy, Gynecomastia, Agitation, Dry mouth, dizziness.

pharmavision

09/Jul/2021

Esomeprazole Magnesium

Esomeprazole is an ulcer-healing drug, that inhibits gastric acid by blocking the proton-pump (Hydrogen-Potassium at pase enzyme system) of the gastric perital cells. Esomeprazole is used for the short-term treatment of gastric and duodenal ulcers and in gastro-oesophageal reflux disease with severe symptoms. Also used in combination with anti bacterial for the eradication of Helicobacter pylori.

Primary Characteristics

Esomeprazole Magnesium trihydrate is the derivative of Esomeprazole. It is of Synthetic origin and belongs to Sulphinyl Benzimidazol. . The Molecular Weight of Esomeprazole is 345.40.

Indications

Esomeprazole is indicated for the treatment of acid-reflux disorders including healing and maintenance of erosive esophagitis, and symptomatic gastroesophageal reflux disease (GERD), pepticulcer disease, Hpylorieradication, prevention of gastrointestinal bleeds with NSAID use, and for the long-term treatment of pathological hypersecretory conditions including Zollinger-Ellison Syndrome

Pharmacokinetics

Oral absorption of Esomeprazole found to 69.5% ±19.5. Plasma protien binding is 97%. and metabolism is reported Liver. Renal Excretion accounts for Urine and plasma half life is 1.2hour.

Mechanism of action

Esomeprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cells. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. As the binding of esomeprazole to the (H+, K+)-ATPase enzyme is irreversible and new enzyme needs to be expressed in order to resume acid secretion, esomeprazole’s duration of anti secretory effect that persists longer than 24 hours.

Side Effects

The severe or irreversible adverse effects of Esomeprazole, which give rise to further complications include Liver damage.

The signs and symptoms that are produced after the acute over dosage of Esomeprazole include Ataxia, Tremor, Change in respiratory frequency, Intermediate Chronic Convulsion.

The symptomatic adverse reactions produced by Esomeprazole are more or less tolerable and if they become severe, they can be treated symptomatically, these include Flatulence, Dizziness, Headache, Fatigue, Diarrhea, Myalgia, Constipation, Abdominal pain, Dry mouth, Blurred vision, Rashes, Pruritus, Malaise, Arthralgia, Nausea and vomiting, Musculoskeletal pain, Dry mouth, dizziness, subacute myopathy, athralgia.

Warning / Precautions

Esomeprazole should be given with caution in patients with renal impairment, liver disease, in pregnancy and in breast-feeding. Proton-pump inhibitors may mask symptoms of gastric cancer, particular care required in those whose symptoms change and in those over 45 years of age the presence of gastric malignancy should excluded before treatment.

Storage Conditions

Store at room temperature, . Protect from Sunlight

pharmavision

05/Jul/2021

Dexlansoprazole (DDR)

Dexlansoprazole is a new generation proton pump inhibitor (PPI) used for the management of symptoms associated with gastroesophageal reflux disease (GERD) and erosive esophagitis. Dexlansoprazole the R-enantiomer of Lansoprazole, which is composed of a racemic mixture of the R- and S-enantiomers. Compared to the older generation of PPIs (which includes Pantoprazole, Omeprazole, and Lansoprazole) , dexlansoprazole MR has a unique pharmacokinetic profile due to its delayed-release and dual-delivery release system. The active ingredient is released in two phases at different pH values and at different time points, resulting in two peak concentrations in the blood; 25% of the dose is released at pH 5.5 in the proximal duodenum, while the remaining 75% is released at pH 6.75 in the distal small intestine . As a result, dexlansoprazole has a peak concentration within 1-2 hours after dosing and another within 4-5 hours . Dexlansoprazole’s unique pharmacokinetics addresses limitations of the older generation PPIs including short plasma half-life, break-through symptoms, and need for meal-associated dosing . These characteristics make dexlansoprazole a good option for people who struggle with adherence and strict dosage timing before meals.

More about Dexlansoprazole

Dexlansoprazole exerts its stomach acid-suppressing effects in the same way as other drugs in the PPI family by inhibiting the final step in gastric acid production. Dexlansoprazole targets the (H+, K+)-ATPase enzyme, which is involved in the secretion of hydrochloric acid through the exchange of H+ ions from the cytoplasm for K+ ions. Normally functioning (H+, K+)-ATPase stimulates hydrochloric acid secretion into the gastric lumen thereby increasing stomach acidity and lowering pH. Once absorbed into circulation, dexlansoprazole covalently binds to the sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cells, which leads to inhibition of both basal and stimulated gastric acid secretion. Despite dexlansoprazole’s unique pharmacokinetic profile, efficacy in management of GERD symptoms is considered similar to other medications within the PPI class including Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole, and Rabeprazole.

Due to their good safety profile and as several PPIs are available over the counter without a prescription, their current use in North America is widespread. Long term use of PPIs such as dexlansoprazole have been associated with possible adverse effects, however, including increased susceptibility to bacterial infections (including gastrointestinal C. difficile), reduced absorption of micronutrients including iron and B12, and an increased risk of developing hypomagnesemia and hypocalcemia which may contribute to osteoporosis and bone fractures later in life PPIs such as dexlansoprazole have also been shown to inhibit the activity of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme necessary for cardiovascular health. DDAH inhibition causes a consequent accumulation of the nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA), which is thought to cause the association of PPIs with increased risk of cardiovascular events in patients with unstable coronary .

Dexlansoprazole doses should be slowly lowered, or tapered, before discontinuing as rapid discontinuation of PPIs such as dexlansoprazole may cause a rebound effect and a short term increase in hypersecretion .

Weight

Average: 369.36
Monoisotopic: 369.075882366

Chemical Formula

C16H14F3N3O2S

Indication

Dexlansoprazole is indicated for healing all grades of erosive esophagitis (EE), maintaining and healing of EE and relief of heartburn, and treating heartburn associated with symptomatic non-erosive gastroesophageal reflux disease (GERD).

Pharmacodynamics

Dexlansoprazole is a proton pump inhibitor (PPI) and is included in the drug class of antisecretory compounds. It blocks the final step of gastric acid secretion by specific inhibition of the (H+, K+)-ATPase at the secretory surface of the parietal cells on gastric mucosa.

Mechanism of action

Dexlansoprazole inhibits the H/K ATPase enzyme, which is involved in the secretion of hydrochloric acid, hydrolyzing ATP and exchanging H+ ions from the cytoplasm for K+ ions in the secretory canaliculus, which results in HCl secretion into the gastric lumen. Dexlansoprazole inhibits this effect of H/K ATPase by demonstrating a high degree of activation in the acidic environment. After passing through the liver and reaching the gastric parietal cells activated by a meal, PPIs undergo protonation in the acidic pH environment, followed by conversion to sulphenamide which represents the active form of the drug. Sulphenamide inhibits the activity of the proton pump and hence the transport of hydrogen ions into the gastric lumen via covalent binding to the SH groups of the cysteine residues of H/K ATPase 2. The delivery technology of dexlansoprazole MR is designed to release the drug in two separate pH-dependent phases, the first in the proximal duodenum (25% of total drug dose) and the second (75% of total drug dose) in the more distal small intestine. Dexlansoprazole reduces both basal and stimulated gastric acid secretion.

Route of elimination

Dexlansoprazole is cleared from the body by either fecal excretion (50.7%) or renal excretion (47.6%) following oral ingestion, with no unchanged drug detected in the urine.

Half-life

Dexlansoprazole is eliminated with a half-life of approximately one to two hours in healthy subjects and in patients with symptomatic GERD.

Clearance

Apparent clearance (CL/F) in healthy subjects was 11.4 to 11.6 L/hour, respectively, after five days of 30 or 60 mg once daily administration

Adverse Effects

Most commonly reported adverse reactions are diarrhea, abdominal pain, nausea, upper respiratory tract infection, vomiting, and flatulence. There are no reports of significant overdose but serious adverse events of hypertension have been reported in association with twice daily doses of DEXILANT 60 mg. Nonclicnial toxicology of dexlansopraole was assessed using lansoprazole studies. In two 24-month carcinogenicity studies involving rats, lansoprazole induced dose-related gastric ECL cell hyperplasia and ECL cell carcinoids and increased the incidence of intestinal metaplasia of the gastric epithelium in both sexes of rats. Dexlansoprazole is expected to have no effect on fertility and the reproductive system.

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