A indústria farmacêutica tem como principal objetivo planejar, sintetizar e caracterizar compostos químicos que possuam atividade biológica e que sejam úteis no controle e combate de doenças e sintomas que acometem as populações. Estes compostos são referidos como ingredientes farmacêuticos ativos e podem, no estado sólido, apresentar diferentes arranjos de suas moléculas dentro de um cristal (polimorfismo). A cada um desses arranjos estão associadas propriedades físico-químicas que são de fundamental importância para o efeito terapêutico dos fármacos. Nesse contexto, este estudo teve como objetivo caracterizar as propriedades de estado sólido de novas formas cristalinas de três compostos farmacêuticos, Clorpropamida (CPA), Nevirapina (NVP) e Dietilcarbamazina (DEC). A CPA trata-se de um hipoglicemiante oral, utilizado no tratamento da Diabetes mellitus tipo II, apresentando na literatura cinco polimorfos conformacionais, dos quais dois foram caracterizados nesse estudo: as Formas IV e VI. A Forma IV cristaliza-se grupo espacial não centrossimétrico monoclínico P21, com Z = 2 e a Forma VI no grupo espacial centrossimétrico ortorrômbico Pbca, com Z = 8. Ambas apresentaram o mesmo padrão de interações intermoleculares clássicas, sendo que a principal diferença entre elas reside nas interações intermoleculares não clássicas, que levam a diferentes empacotamentos cristalinos. Por fim, as conformações moleculares dos cinco polimorfos da CPA foram comparadas entre si e as informações foram racionalizadas tomando como base os resultados provenientes de cálculos teóricos, que também indicaram a possibilidade de existência de novos polimorfos. A NVP, fármaco antiretroviral não nucleosídeo utilizado no tratamento da AIDS, também apresenta casos de polimorfismo na literatura. Neste trabalho, obteve-se um solvato não estequiométrico de butanol desse composto, que cristaliza no grupo espacial centrossimétrico triclínico P-1, com Z = 2, no qual as moléculas de butanol acomodaram-se em canais infinitos rodeados por moléculas de NVP. Esse tipo de empacotamento cristalino, diferente do reportado na literatura até o presente momento, possibilitou-nos propor que novos solvatos poderiam ser obtidos variando-se o solvente, proposta tal confirmada posteriormente. A DEC é amplamente utilizada na forma de um sal de citrato no tratamento da filariose linfática, não apresentado na literatura nenhuma caracterização de estado sólido. Assim, caracterizou-se não somente o sal utilizado nas formulações (DEC citrato), como também o composto puro (DEC). A forma pura, instável à temperatura ambiente, cristaliza no grupo espacial centrossimétrico P21/n à 250K. O sal, preferido como API por sua estabilidade, cristaliza à temperatura ambiente no grupo P21/c, porém com presença de desordem nas cadeias etílicas das moléculas de DEC. Para reduzir essa desordem, efetuou-se um estudo em função da temperatura, que acabou revelando a presença de três transições de fase sólido-sólido, gerando quatro fases cristalinas diferentes. Duas das transições exibiram efeito de histerese de acordo com a direção da rampa de temperatura. A terceira transição só foi obtida por resfriamento rápido do sistema. Estes dados foram comparados com os obtidos por DSC e espectroscopia Raman / One of the main goals of the pharmaceutical industry is to plan, synthesize and characterize chemical compounds with biological activity that can be useful in controlling diseases and symptoms that affect populations. These compounds are referred to as active pharmaceutical ingredients and may, in the solid state, present different crystal arrangements of its molecules (polymorphism). To each one of these crystalline arrays are associated physicochemical properties that are of fundamental importance for the therapeutic effect of the pharmaceutical drugs. In this context, the focus of this study was to characterize the solid state properties of new crystalline forms of three pharmaceutical compounds, Chlorpropamide (CPA), Nevirapine (NVP) and Diethylcarbamazine (DEC). CPA is an oral hypoglicemiant used in the treatment of type II Diabetes mellitus, and presents five conformational polymorphs reported in the literature, two of which were characterized in this study: Forms IV and VI. Form IV crystallizes in the monoclinic non-centrosymmetric space group P21, with Z = 2 and the Form VI in the orthorrombic centrosymmetric space group Pbca, with Z = 8. Both exhibited the same classical intermolecular interaction pattern; the main difference between them lay in the non-classical intermolecular interactions, which leads to different crystal packing. Finally, the molecular conformations of the five polymorphs of CPA were compared to each other and the information was rationalized taking as basis the results from theoretical calculations, which also indicated the possible existence of new polymorphs. NVP, a non-nucleoside antiretroviral pharmaceutical compound used in the treatment of AIDS, also presents polymorphism cases reported in the literature. In this study, we obtained a non-stoichiometric buthanol solvate of this compound, which crystallizes in the triclinic centrosymmetric space group P-1, with Z = 2, in which the buthanol molecules are positioned in infinite channels surrounded by NVP molecules. This kind of crystal packing, which is different from the one reported in the literature until now, has allowed us to propose that new solvates could be obtained by varying the solvent, being this proposal subsequently confirmed. DEC is largely used as a citrate salt form in the treatment of the lymphatic filariasis, not having any solid state characterization in the literature. Thus, we characterized not just the salt (DEC citrate) used in the formulation, but also the pure compound (DEC). The pure form, unstable at room temperature, crystallizes in the monoclinic centrosymmetric space group P21/n at 250K. The salt, preferred as API because of its stability, crystallizes at room temperature in the monoclinic centrosymmetric space group P21/c, but with the presence of disorder in the ethyl chains of the DEC molecules. To reduce this disorder, we performed a study in function of temperature, which revealed the presence of three solid-solid structural phase transitions, generating four different crystalline phases. Two of these transitions showed a hysteresis effect according to the direction of the temperature ramp. The third transition was only obtained by fast cooling of the system. These data where compared with the ones obtained by DSC and Raman spectroscopy.

Nevirapine (NVP) can cause serious skin rashes and hepatotoxicity. It also causes an immune-mediated skin rash in rats but not hepatotoxicity. There is strong evidence that the rash is due to 12-hydroxynevirapine (12-OH-NVP), which is further metabolized to a reactive benzylic sulfate in the skin. This could both act as a hapten and induce a danger signal. In contrast, most of the covalent binding in the liver appears to involve oxidation of the methyl group leading to a reactive quinone methide. In this study we examined the effects of NVP and 12-OH-NVP on gene expression in the liver and skin. Both NVP and 12-OH-NVP induced changes in the liver, but the list of genes was different, presumably reflecting different bioactivation pathways. In contrast, many more genes were up-regulated in the skin by 12-OH-NVP than by NVP, which is consistent with the hypothesis that the 12-hydroxylation pathway is involved in causing the rash. Some genes up-regulated by 12-OH-NVP were Trim63, S100a7a, and IL22ra2, etc. Up-regulation of genes such as S100a7a, which is considered a danger signal, supports the danger hypothesis. Up-regulation of genes such as the ubiquitin ligase and Trim63 are consistent with protein-adduct formation. Up-regulation of IL-22ra2 gene suggests an immune response. These results provide important clues to how NVP causes induction of an immune response, in some cases leading to an idiosyncratic drug reaction.

Nevirapine (NVP) can cause serious skin rashes and hepatotoxicity. It also causes an immune-mediated skin rash in rats but not hepatotoxicity. There is strong evidence that the rash is due to 12-hydroxynevirapine (12-OH-NVP), which is further metabolized to a reactive benzylic sulfate in the skin. This could both act as a hapten and induce a danger signal. In contrast, most of the covalent binding in the liver appears to involve oxidation of the methyl group leading to a reactive quinone methide. In this study we examined the effects of NVP and 12-OH-NVP on gene expression in the liver and skin. Both NVP and 12-OH-NVP induced changes in the liver, but the list of genes was different, presumably reflecting different bioactivation pathways. In contrast, many more genes were up-regulated in the skin by 12-OH-NVP than by NVP, which is consistent with the hypothesis that the 12-hydroxylation pathway is involved in causing the rash. Some genes up-regulated by 12-OH-NVP were Trim63, S100a7a, and IL22ra2, etc. Up-regulation of genes such as S100a7a, which is considered a danger signal, supports the danger hypothesis. Up-regulation of genes such as the ubiquitin ligase and Trim63 are consistent with protein-adduct formation. Up-regulation of IL-22ra2 gene suggests an immune response. These results provide important clues to how NVP causes induction of an immune response, in some cases leading to an idiosyncratic drug reaction.

Thesis (D.P.H.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed on June 25, 2009). Includes bibliographical references.

A indústria farmacêutica tem como principal objetivo planejar, sintetizar e caracterizar compostos químicos que possuam atividade biológica e que sejam úteis no controle e combate de doenças e sintomas que acometem as populações. Estes compostos são referidos como ingredientes farmacêuticos ativos e podem, no estado sólido, apresentar diferentes arranjos de suas moléculas dentro de um cristal (polimorfismo). A cada um desses arranjos estão associadas propriedades físico-químicas que são de fundamental importância para o efeito terapêutico dos fármacos. Nesse contexto, este estudo teve como objetivo caracterizar as propriedades de estado sólido de novas formas cristalinas de três compostos farmacêuticos, Clorpropamida (CPA), Nevirapina (NVP) e Dietilcarbamazina (DEC). A CPA trata-se de um hipoglicemiante oral, utilizado no tratamento da Diabetes mellitus tipo II, apresentando na literatura cinco polimorfos conformacionais, dos quais dois foram caracterizados nesse estudo: as Formas IV e VI. A Forma IV cristaliza-se grupo espacial não centrossimétrico monoclínico P21, com Z = 2 e a Forma VI no grupo espacial centrossimétrico ortorrômbico Pbca, com Z = 8. Ambas apresentaram o mesmo padrão de interações intermoleculares clássicas, sendo que a principal diferença entre elas reside nas interações intermoleculares não clássicas, que levam a diferentes empacotamentos cristalinos. Por fim, as conformações moleculares dos cinco polimorfos da CPA foram comparadas entre si e as informações foram racionalizadas tomando como base os resultados provenientes de cálculos teóricos, que também indicaram a possibilidade de existência de novos polimorfos. A NVP, fármaco antiretroviral não nucleosídeo utilizado no tratamento da AIDS, também apresenta casos de polimorfismo na literatura. Neste trabalho, obteve-se um solvato não estequiométrico de butanol desse composto, que cristaliza no grupo espacial centrossimétrico triclínico P-1, com Z = 2, no qual as moléculas de butanol acomodaram-se em canais infinitos rodeados por moléculas de NVP. Esse tipo de empacotamento cristalino, diferente do reportado na literatura até o presente momento, possibilitou-nos propor que novos solvatos poderiam ser obtidos variando-se o solvente, proposta tal confirmada posteriormente. A DEC é amplamente utilizada na forma de um sal de citrato no tratamento da filariose linfática, não apresentado na literatura nenhuma caracterização de estado sólido. Assim, caracterizou-se não somente o sal utilizado nas formulações (DEC citrato), como também o composto puro (DEC). A forma pura, instável à temperatura ambiente, cristaliza no grupo espacial centrossimétrico P21/n à 250K. O sal, preferido como API por sua estabilidade, cristaliza à temperatura ambiente no grupo P21/c, porém com presença de desordem nas cadeias etílicas das moléculas de DEC. Para reduzir essa desordem, efetuou-se um estudo em função da temperatura, que acabou revelando a presença de três transições de fase sólido-sólido, gerando quatro fases cristalinas diferentes. Duas das transições exibiram efeito de histerese de acordo com a direção da rampa de temperatura. A terceira transição só foi obtida por resfriamento rápido do sistema. Estes dados foram comparados com os obtidos por DSC e espectroscopia Raman / One of the main goals of the pharmaceutical industry is to plan, synthesize and characterize chemical compounds with biological activity that can be useful in controlling diseases and symptoms that affect populations. These compounds are referred to as active pharmaceutical ingredients and may, in the solid state, present different crystal arrangements of its molecules (polymorphism). To each one of these crystalline arrays are associated physicochemical properties that are of fundamental importance for the therapeutic effect of the pharmaceutical drugs. In this context, the focus of this study was to characterize the solid state properties of new crystalline forms of three pharmaceutical compounds, Chlorpropamide (CPA), Nevirapine (NVP) and Diethylcarbamazine (DEC). CPA is an oral hypoglicemiant used in the treatment of type II Diabetes mellitus, and presents five conformational polymorphs reported in the literature, two of which were characterized in this study: Forms IV and VI. Form IV crystallizes in the monoclinic non-centrosymmetric space group P21, with Z = 2 and the Form VI in the orthorrombic centrosymmetric space group Pbca, with Z = 8. Both exhibited the same classical intermolecular interaction pattern; the main difference between them lay in the non-classical intermolecular interactions, which leads to different crystal packing. Finally, the molecular conformations of the five polymorphs of CPA were compared to each other and the information was rationalized taking as basis the results from theoretical calculations, which also indicated the possible existence of new polymorphs. NVP, a non-nucleoside antiretroviral pharmaceutical compound used in the treatment of AIDS, also presents polymorphism cases reported in the literature. In this study, we obtained a non-stoichiometric buthanol solvate of this compound, which crystallizes in the triclinic centrosymmetric space group P-1, with Z = 2, in which the buthanol molecules are positioned in infinite channels surrounded by NVP molecules. This kind of crystal packing, which is different from the one reported in the literature until now, has allowed us to propose that new solvates could be obtained by varying the solvent, being this proposal subsequently confirmed. DEC is largely used as a citrate salt form in the treatment of the lymphatic filariasis, not having any solid state characterization in the literature. Thus, we characterized not just the salt (DEC citrate) used in the formulation, but also the pure compound (DEC). The pure form, unstable at room temperature, crystallizes in the monoclinic centrosymmetric space group P21/n at 250K. The salt, preferred as API because of its stability, crystallizes at room temperature in the monoclinic centrosymmetric space group P21/c, but with the presence of disorder in the ethyl chains of the DEC molecules. To reduce this disorder, we performed a study in function of temperature, which revealed the presence of three solid-solid structural phase transitions, generating four different crystalline phases. Two of these transitions showed a hysteresis effect according to the direction of the temperature ramp. The third transition was only obtained by fast cooling of the system. These data where compared with the ones obtained by DSC and Raman spectroscopy.

>Magister Scientiae - MSc / Adverse effects are a significant factor that determine how long patients will tolerate a given antiretroviral drug regimen. They also influence treatment options, and play an important role in the much needed adherence to treatment by patients on Highly Active Antiretroviral Therapy (HAART). This study is aimed at understanding adverse effects experienced by patients on the first line antiretroviral therapy at Keetmanshoop Hospital in Namibia. Methods : A retrospective quantitative method was used to review records of patients on first line antiretroviral treatment who started treatment between November 1st 2007 and December 1st, 2008 and followed up until they reached 36 – 48 months on treatment. Records of 94 patients were found eligible to be included in the study. Data was analysed using Stata 12 data analysis software. Results : The most reported adverse effect was musculoskeletal disorders (25%) whereas headache (16%) was the least reported. Low haemoglobin (78%) was the most common recorded hematologic adverse effect whereas low red cell distribution width and low mean platelet volume were the least recorded adverse effects (0%). A Male patient was more likely to experience a low haemoglobin levels compared to a female patient (adjusted OR: 3.29, 95% CI: 1.3 – 8.3). A male patient was found to be 64% times less likely to experience a higher mean cell haemoglobin compared to a female patient (adjusted OR. 0.31, 95% CI: 0.11 – 0.87). A patient on nevirapine was more likely to experience an elevated creatinine level compared to a patient on efavirenz (adjusted OR; 36.0, 95%CI: 2.02 – 62.5). At baseline, a patient who had prior exposure to ART had an 81 times (adjusted OR: 81.4, 95%CI: 5.3 – 119, p-value=0.00) increased odds of experiencing a high mean cell volume (MCV) compared to a patient with no ART exposure. A patient with a higher CD4 count was also less likely to experience a low hemoglobin compared to a patient with low CD4 count (adjusted OR; 0.31, 95% CI: 0.12 – 0.77). The author recommends further studies with higher sample size to confirm whether higher creatinine levels are more prevalent in patients on nevirapine compared to patients on efavirenz; this will have clinical implications especially in patients with impaired renal system. Antiretroviral treatment increases chances of developing macrocytosis anaemia; clinical implication of this condition may need to be investigated.

Magister Pharmaceuticae - MPharm / The author’s objective was to follow the product life-cycle process of a novel antiretroviral, nevirapine formulation in South Africa, to generate and compile data to pursue market registration. Five supramolecular co-crystals, viz. nevirapine-saccharin (NVSC), nevirapine-DL-tartaric acid (NVTTA), nevirapine-maleic acid (NVMLE), nevirapine-glutaric acid (NVGLT) and nevirapine-salicylic acid (NVSLI) were reproduced and confirmed by powder X-ray diffraction (PXRD). A pre-formulation study ensued to identify the most appropriate co-former candidate to formulate a tablet dosage form comparative to the proprietor brand, Viramune®. The co-crystals were synthesized by the co-precipitation and solvent-drop grinding techniques and identified by hot stage microscopy (HSM), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), fourier transform infra-red spectrophotometry (FTIR), PXRD and single X-ray diffraction (SXRD). The solubility, dissolution and antiviral activity profiles of these co-crystals were assessed and compared to pure NV and NV:co-former mixtures in a 1:1 ratio. The preliminary dissolution analysis applied the BP 2005 rotating-basket method with water as dissolution medium. Initially, the dissolution samples were assayed with UV/VIS spectrophotometry which led to a more convincing quantitative approach where dissolution samples were assayed by HPLC. Solubility data revealed a fivefold increase in solubility of NV co-crystallized with maleic acid. Dissolution data, however revealed NVGLT as the best performing co-crystal with a 59 % NV drug release in water (dissolution media) with the remaining 4 co-crystals all indicating an enhanced aqueous solubility of NV. The antiviral activity of all 5 co-crystals performed by the National Institute of Communicable Diseases of South Africa determined whether the co-crystals had an improved antiviral activity against HIV-1 compared to pure NV. The results indicated that NVSC and NVSLI had the greatest antiviral activity compared to pure NV and the remaining co-crystals. The pre-formulation results formed the basis for the selection of the best co-former candidate for a NV co-crystal tablet formulation by direct compression. All solid dosage form quality control tests according to the USP 364 was performed on the prototype co-crystal tablet and the Viramune® tablet. Comparative dissolution analysis to evaluate bioequivalence was conducted and assayed by HPLC. The dissolution analysis utilized 3 media, viz. HCl buffer (pH 1.2), acetate buffer (pH 4.5) and a phosphate buffer (pH 6.8) which displayed no similarity in the dissolution profile of the prototype and the proprietor brand. Solution stability of NV in these buffered media was assessed after 4 weeks exposure of the dissolution samples to cold chain (2 - 8 °C, 0 % RH) and accelerated environmental conditions (40 °C, 75 % RH). The results indicated no significant degradation of NV in the prototype co-crystal tablet and the proprietor brand during the accelerated stability tests. Cytotoxicity against a host cell 293T and antiviral activity against the pseudo-HIV-1 virus of the prototype and proprietor brand was further determined. The antiviral activity results were favourable for both the prototype co-crystal and the proprietor brand tablet.

Background: The vertical transmission of HIV from mother to child ranges from 15 to 40%. The preventing mothers to child transmission programme (PMTCT) services have been introduced during the past five years in South Africa; however vertical transmission of HIV remains high. Objectives: The objectives of the study were: 1. To describe the clinical and demographic characteristics of women attending the ANC clinic and delivering at the Germiston Hospital; 2. To determine the proportion of women who were offered voluntary counselling and testing (VCT) in 2004; 3. To determine the proportion of women who subsequently received PMTCT. Methods: This is a cross-sectional study I which a sample of 776 patient files were retrospectively, systematically and randomly sampled from 1, 500 antenatal files for the period 2004 (Jan-Dec), in an urban district hospital in the Gauteng Province. A checklist was used to extract specific information. Data was entered into EpiData and analysed using STATA version 8. Pearson's chi-square test was used to obtain measures of association for all categorical variables. The multiple logistic regression method was used to investigate predictors for missed PMTCT opportunities. Results: The pre_yalence proportion of syphilis was 14.19% {95%CI (11.81-16.85)}; prevalence proportion ofHIV was 33.76% {95% CI (27.53-37.13)}. The mean age ofthe sample population was 26.37 years (min=22, max=30). Forty eight per cent of the sample had registered late in the third trimester of pregnancy. Pregnant women presenting with syphilis were more likely to have a missed PMTCT opportunity {OR=2.2, 95%CI (1.16- 4.20), p=0.02}. Women having made fewer than two ANC visits were more likely to have a missed PMTCT/VCT opportunity than women having made more than two visits {OR=O.Sl, 95%CI (0.30-0.86), p=O.Ol}. Conclusions: The prevalence proportion of HIV is high in this setting (33%) and the prevalence of syphilis is seven times greater than the national prevalence. Every antenatal care visit is an opportunity for the healthcare worker to offer voluntary counselling and testing. All women identified as having syphilis infection are at high risk of acquiring HIV. Therefore every woman identified and treated for syphilis should be counselled and tested for HIV. Women must be offered HIV and AIDS education at every ANC visit. Routine opt-out counselling should be offered at every ANC visit for those who have not been previously tested. Recommendation: In order to increase the uptake of the PMTCT programme healthcare workers should have training and re-orientation on: 1. The need to use every opportunity in antenatal care and maternity wards to offer HIV counselling and testing to mothers; 2. HIV and AIDS in pregnancy, PMTCT, as well as the treatment and care of pregnant women. / Dissertation (MPH)--University of Pretoria, 2006. / School of Health Systems and Public Health (SHSPH) / MPH / Unrestricted

The population pharmacokinetics and pharmacodynamics (PK/PD) of nevirapine (NVP), zidovudine (ZDV), and didanosine (ddI) were evaluated in 432 pediatric patients with HIV, randomized to receive either a double-therapy of ZDV + ddI or NVP + ddI; or triple-therapy of NVP + ZDV + ddI as a substudy of the AIDS Clinical Trials Group Protocol 245 in 2 phases. In phase 1, nonlinear mixed-effect modeling (NONMEM) analysis was employed for population pharmacokinetics (PPK) study for ZDV, ddI and NVP. One-compartment model with first-order input and first-order elimination was fitted to the NVP, ZDV and ddI data. Final PPK models were as follows: ZDV; CL (1/hr, without nevirapine coadministration) = 52.4 × BSA, CL (1/hr, with nevirapine coadministration) = 65.0 × BSA, Vd/F(1) = 116 × BSA, ddI; CL (1/hr) = 73.4 × BSA + 69.9, Vd/F(1) = 132, and NVP; CL (1/hr) = 2.30 × BSA, Vd/F(1) = 120. In phase 2, the relationship between the predicted serum concentrations of ZDV, ddI, and NVP and pharmacodynamic responses were evaluated via S-Plus ® exploratory data analysis. No apparent relationship between average steady-state serum concentrations and pharmacodynamic variables, such as HIV-1 RNA(RNA) levels, CD4 + count was found. However, the responses of RNA level and CD4 + count to the double therapy (ddI/NVP) versus triple therapy (ddI/NVP/ZDV) were significantly different after 4 weeks of therapy ( P = 0.0014 for RNA level at week 4, P = 0.0454 for CD4 + count at week 12). No significantly different responses were found in weight changes ( P > 0.25 at all weeks). Also, the maximum drop of RNA level throughout the treatment period had a strong relationship to the decline slope of RNA at week 4 as follows: Maximum drop of RNA = 3.1139 × RNA decline slope at week 4 - 0.411. Nevirapine dosing regimens were compared using simulation via Trial Simulator™. Both ACTG regimen (body surface area based) and manufacture's regimen (age and weight based) produced similar concentrations at lower end concentration but manufacture's regimen produce higher concentration at upper end with 1000 simulated patients (ACTG regimen; 2150, 3827, and 4992 ng/ml, manufacturer's regimen; 2066, 4130, and 6568 ng/ml, for 10 th , 50 th , and 96 th percentile, respectively). It is suggested to use body surface area based dosing regimen for NVP.

This study compare immunological and virological outcomes in antiretroviral therapy naïve patients exposed to Isoniazid prevention treatment.Medical records of antiretroviral naïve patients managed in the public sector from 1st January 2006 to 31st December 2006 were analysed.Multivariate analysis of variance showed that each treatment group achieved statistically significant increases in CD4+ cell count and viral load decay at each follow-up time point. Pairwise post hoc contrast tests showed patients in NVPipt-past group and EFVipt-past group to have superior immunological and virological outcomes respectively. / Health Studies / M.A. (Public health)