Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 5 uppsatser.

Background: Omeprazole is a proton pump inhibitor used to manage gastrointestinal disorders. Special populations may require omeprazole to be given as an oral suspension. Objective: The purpose of this project was to compare the stability of omeprazole in the FIRST kit product to a traditionally compounded omeprazole suspension, when stored in refrigerated unit-dosed syringes. NG tube delivery of the 2 products was also investigated. Methods: Five batches of compounded omeprazole oral suspension and 5 kits of FIRST-Omeprazole were prepared to an initial concentration of 2 mg/mL. Suspensions were aliquoted into 5-mL doses in clear plastic oral syringes, and stored at 2-8 °C. Syringes from each batch were analyzed at baseline and after 7, 14, 21, and 30 days for omeprazole potency using HPLC. To assess suitability for NG tube administration, 20 mL of each suspension were administered through NG tubes (8Fr, 10Fr, and 18Fr), and percent omeprazole recovery assessed. Results: The chemical potency remained within 90-110% for 14 days and 30 days for compounded samples and FIRST-Omeprazole samples, respectively. There was a statistically significant difference in initial concentration; 1.89 mg/mL versus 1.98 mg/mL for compounded and FIRST-Omeprazole, respectively. After 30 days, FIRST-Omeprazole demonstrated 97.20% API recovery. Neither suspension experienced statistically significant loss of potency following NG tube passage. Conclusion: FIRST-Omeprazole suspension may be stored in refrigerated clear luer-lock oral syringes for 30 days. Traditionally compounded omeprazole suspension should be used within 14 days. Both suspensions are suitable for NG tube administration.

Master of Philosophy / Clozapine is a drug of choice for treatment of refractory schizophrenia, which is primarily metabolized by Cytochrome P450 1A2 (CYP1A2). Norclozapine is its main metabolite. There are reports of wide ranging gastrointestinal side effects associated with clozapine therapy, that result in concomitant administration of proton pump inhibitors to treat acid-related disorders. Omeprazole is an established CYP1A2 inducer, while an in vitro study has shown that rabeprazole is much less potent in this regard. There is no available information about the impact of rabeprazole on CYP1A2 activity in patients. Firstly, this information is essential when prescriptions are changed from omeprazole to rabeprazole to reduce medication costs. Therefore, the aim of this study was to compare the effects of rabeprazole and omeprazole on CYP1A2-mediated clearance (CL/F) of clozapine. Secondly, the effective dosage of clozapine varies widely among patients, making it necessary to individualize drug therapy with clozapine. The reason for dosage variation could be due to the influence of patient-related variables on clozapine plasma concentrations. Therefore, another aim of this study was to investigate the relationship between patient variables, such as age, gender, cigarette smoke, weight and body mass index and clozapine clearance (CL/F). A cross-over study design was used for this study. Twenty patients from Macquarie hospital who were receiving clozapine and rabeprazole (with no other interacting medications) were recruited in this study. Blood samples were taken at 30 min, 1 hr, 2 hr and 12 hr after a dose of clozapine. Rabeprazole was then replaced with omeprazole. After at least 1 month blood samples were again collected at the above corresponding intervals after clozapine. The plasma concentrations of clozapine and norclozapine were determined by high performance liquid chromatography. Abbottbase Pharmacokinetic Systems Software, which utilizes Bayesian forecasting, was used to estimate pharmacokinetic parameters of clozapine. The ratio of plasma norclozapine/clozapine concentrations at trough level was used to reflect CYP1A2 activity. No difference was observed in clozapine clearance (CL/F) and CYP1A2 activity during concurrent therapy with either rabeprazole or omeprazole. According to some studies CYP1A2 induction by omeprazole is dose dependent. Furthermore, since rabeprazole is a weak CYP1A2 inducer in vitro, we conclude that omeprazole and rabeprazole may not induce CYP1A2 activity when used at conventional therapeutic dosage (<40 mg/day). Hence, replacement of omeprazole with rabeprazole at conventional therapeutic dosages (20 or 40 mg daily) offers no advantages in the management of patients with schizophrenia on clozapine and no dose adjustment is required. Consistent with previous studies, clozapine concentrations were found to be significantly lower in cigarette smokers due to CYP1A2 induction. No relationship was found between age, gender, or weight and clozapine clearance (CL/F). However, body mass index showed a significant negative correlation with clozapine clearance (CL/F). Since weight gain and lipid accumulation are common side effects of clozapine they may be associated with a reduction of CYP1A2 activity and clozapine clearance (CL/F). Moreover, high lipoprotein levels may decrease the unbound fraction of clozapine and decrease the availability of clozapine for oxidation by cytochrome P450 enzymes. Therefore, it is concluded that omeprazole and rabeprazole may not induce CYP1A2 activity when used at conventional therapeutic dosage (<40mg/day). Hence, replacement of omeprazole with rabeprazole does not require the dose of clozapine to be adjusted. Moreover, the negative correlation between clozapine clearance (CL/F) and BMI is informative. Further studies are now required to clarify the relationship between BMI, lipoprotein levels and clozapine clearance in patients with schizophrenia.

Master of Philosophy / Clozapine is a drug of choice for treatment of refractory schizophrenia, which is primarily metabolized by Cytochrome P450 1A2 (CYP1A2). Norclozapine is its main metabolite. There are reports of wide ranging gastrointestinal side effects associated with clozapine therapy, that result in concomitant administration of proton pump inhibitors to treat acid-related disorders. Omeprazole is an established CYP1A2 inducer, while an in vitro study has shown that rabeprazole is much less potent in this regard. There is no available information about the impact of rabeprazole on CYP1A2 activity in patients. Firstly, this information is essential when prescriptions are changed from omeprazole to rabeprazole to reduce medication costs. Therefore, the aim of this study was to compare the effects of rabeprazole and omeprazole on CYP1A2-mediated clearance (CL/F) of clozapine. Secondly, the effective dosage of clozapine varies widely among patients, making it necessary to individualize drug therapy with clozapine. The reason for dosage variation could be due to the influence of patient-related variables on clozapine plasma concentrations. Therefore, another aim of this study was to investigate the relationship between patient variables, such as age, gender, cigarette smoke, weight and body mass index and clozapine clearance (CL/F). A cross-over study design was used for this study. Twenty patients from Macquarie hospital who were receiving clozapine and rabeprazole (with no other interacting medications) were recruited in this study. Blood samples were taken at 30 min, 1 hr, 2 hr and 12 hr after a dose of clozapine. Rabeprazole was then replaced with omeprazole. After at least 1 month blood samples were again collected at the above corresponding intervals after clozapine. The plasma concentrations of clozapine and norclozapine were determined by high performance liquid chromatography. Abbottbase Pharmacokinetic Systems Software, which utilizes Bayesian forecasting, was used to estimate pharmacokinetic parameters of clozapine. The ratio of plasma norclozapine/clozapine concentrations at trough level was used to reflect CYP1A2 activity. No difference was observed in clozapine clearance (CL/F) and CYP1A2 activity during concurrent therapy with either rabeprazole or omeprazole. According to some studies CYP1A2 induction by omeprazole is dose dependent. Furthermore, since rabeprazole is a weak CYP1A2 inducer in vitro, we conclude that omeprazole and rabeprazole may not induce CYP1A2 activity when used at conventional therapeutic dosage (<40 mg/day). Hence, replacement of omeprazole with rabeprazole at conventional therapeutic dosages (20 or 40 mg daily) offers no advantages in the management of patients with schizophrenia on clozapine and no dose adjustment is required. Consistent with previous studies, clozapine concentrations were found to be significantly lower in cigarette smokers due to CYP1A2 induction. No relationship was found between age, gender, or weight and clozapine clearance (CL/F). However, body mass index showed a significant negative correlation with clozapine clearance (CL/F). Since weight gain and lipid accumulation are common side effects of clozapine they may be associated with a reduction of CYP1A2 activity and clozapine clearance (CL/F). Moreover, high lipoprotein levels may decrease the unbound fraction of clozapine and decrease the availability of clozapine for oxidation by cytochrome P450 enzymes. Therefore, it is concluded that omeprazole and rabeprazole may not induce CYP1A2 activity when used at conventional therapeutic dosage (<40mg/day). Hence, replacement of omeprazole with rabeprazole does not require the dose of clozapine to be adjusted. Moreover, the negative correlation between clozapine clearance (CL/F) and BMI is informative. Further studies are now required to clarify the relationship between BMI, lipoprotein levels and clozapine clearance in patients with schizophrenia.

Thesis (M.S.)--University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed Aug. 29, 2007). Includes bibliographical references.

Orientadores: Nelci Fenalti Hoehr, Alessandra Gambero / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T07:18:18Z (GMT). No. of bitstreams: 1 Marostica_MartaContieri_M.pdf: 4600757 bytes, checksum: 4c8d07137661d1c9c63647c1959bc5bf (MD5) Previous issue date: 2007 / Resumo: O mecanismo pelo qual o H. pylori provoca a inflamação gástrica inclui a secreção de substâncias pró-inflamatórias pela bactéria e a estimulação da liberação de citocinas induzida pelo contato direto entre a bactéria e as células epiteliais gástricas. A resposta inicial à infecção por H. pylori é predominantemente neutrofílica e estes, liberam mediadores inflamatórios e enzimas proteolíticas que induzem o dano gástrico. Estresse oxidativo ocorre em pacientes infectados com H. pylori onde a expressão de enzimas como a óxido nítrico sintase induzida (iNOS), superóxido dismutase e catalase encontram-se aumentadas. A iNOS participa da resposta inflamatória e promove a apoptose de células na mucosa gástrica. Durante a infecção por H. pylori, observa-se níveis reduzidos da expressão de Bcl-2 e o aumento da expressão de Bax na mucosa gástrica, sugerindo que uma tendência pró-apoptótica na infecção. A erradicação pode ser alcançada pela combinação de antibióticos associada a uma droga anti-ácida. As duas maiores classes de inibidores de secreção ácida são: os inibidores de bomba protônica, como o omeprazol, e os antagonistas de receptor de histamina H2, como a ranitidina. Várias evidências experimentais têm mostrado que o omeprazol apresenta efeitos anti-ulcerogênicos adicionais. Deste modo, o objetivo deste trabalho foi avaliar o efeito do tratamento com omeprazol e ranitidina em um modelo animal de infecção por H. pylori, enfocando possíveis propriedades adicionais destes fármacos Para este estudo foram utilizados camundongos machos C57BL/6 com 4 semanas de idade. Os camundongos receberam por via oro-gástrica suspensão de H. pylori. Na 11ª semana de inóculo, os animais foram tratados (i.p.) com omeprazol (100 mg/kg), ranitidina (100 mg/kg) ou veículo (PBS) durante 7 dias sempre no mesmo horário. As duas drogas inibiram a produção de ácido gástrico no tratamento agudo, porém no tratamento por uma semana, apenas o omeprazol inibiu a secreção ácida. Os animais tratados com omeprazol apresentaram um aumento significativo nos níveis de colonização gástrica e elevado nível de MPO. Ambas as drogas diminuíram as lesões da mucosa provocada pela infecção. O tratamento com omeprazol restaurou a produção de Bcl-2 na mucosa gástrica e não alterou a produção de Bax. O omeprazol não protegeu a mucosa gástrica contra o dano ao DNA gerado pela infecção e o tratamento com ranitidina aumentou os níveis de dano oxidativo ao DNA. Não observamos a presença de propriedades anti-neutrofílicas, atribuídas ao omeprazol, após uma semana de tratamento, sugerindo que essas propriedades são restrita a ensaios in vitro. Entretanto, o omeprazol restaurou a produção de Bcl-2 na mucosa gástrica, sugerindo uma atividade anti-apoptótica dessa droga / Abstract: H. pylori induces gastric inflammation characterized by secretion of pro-inflammatory substances by bacteria and the stimulation of cytokine release by the gastric epithelial cells. The initial response to the H. pylori infection is predominantly by neutrophils and these cells liberate inflammatory mediators and enzymes that induce the gastric damage. Oxidative stress also occurs in infected patients where induced nitric oxide sintase (iNOS), superoxide dismutase and catalase expression were increased. Nitric oxide participates in the inflammatory response and promotes apoptosis of gastric mucosa cells. Eradication therapy can be achieved with antibacterial agents in association with anti-acid drugs. There are two major classes of gastric acid inhibitors: the proton pump inhibitors, such as omeprazole, and the histamine H2 receptor antagonists, such as ranitidine. Some experimental evidence demonstrates that omeprazole has additional pharmacological properties. Thus, the aim of this study was to evaluate the effect of omeprazole and ranitidine treatment on H. pylori-infected mice, focusing on possible additional pharmacological properties. For this study, male C57BL/6 mice that received H. pylori suspension were used. After the 11th week, the mice were treated intraperitoneally (i.p.) with omeprazole (100 mg/kg), ranitidine (100 mg/kg) or vehicle (PBS) for 7 days. Both drugs inhibited the gastric acid production after acute administration; however after one week of treatment just omeprazole inhibited gastric acid secretion. Omeprazole-treated mice presented an increase in H. pylori and MPO levels in gastric mucosa. Both drugs reduced the mucosa damage provoked by H. pylori infection. Omeprazole treatment restored the Bcl-2 production in the gastric mucosa and did not modify Bax production. Omeprazole did not reduce the DNA damage in the gastric mucosa while ranitidine treatment increased it. We conclude that some additional omeprazole-related properties, such as antineutrophil properties, were not observed in H. pylori-infected mice after one week of treatment. However, the antiapoptotic activity of omeprazole could be attributed to an ability to modify the protein expression of Bcl-2, decreased by H. pylori infection / Mestrado / Patologia Clinica / Mestre em Ciências Médicas

Since their introduction in the late 1980s, proton pump inhibitors (PPI) have demonstrated gastric acid suppression superior to that of histamine H2-receptor blockers. This class of drugs has improved the treatment of various acid-peptic disorders, including gastroesophageal reflux disease, peptic ulcer disease, and nonsteroidal anti-inflammatory drug-induced gastropathy. PPIs have minimal side effects and few significant drug interactions. They are generally considered safe for long-term treatment. We present a rare side effect, acute pancreatitis, occurring in a patient who was treated with the proton pump inhibitor omeprazole.

Orientadores: Cesar Costapinto Santana, Quezia Bezerra Cass / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Quimica / Made available in DSpace on 2018-08-13T23:12:40Z (GMT). No. of bitstreams: 1 Freitas_AlessandraFerraiolode_D.pdf: 3156949 bytes, checksum: bbcb73e35f211a07f6b4ff3c0740867c (MD5) Previous issue date: 2009 / Resumo: O objetivo deste trabalho foi a síntese, em larga escala, da fase estacionária quiral tris(3,5-dimetilfenilcarbamato) de amilose e posterior investigação desta na separação preparativa dos enantiômeros do omeprazol por cromatografia líquida de alta eficiência. O carbamato de amilose, caracterizado por análise elementar e espectroscopia na região do infravermelho, apresentou valores experimentais de CHN próximos aos valores teóricos e absorções no infravermelho próximas a 1720 cm-1, referente ao grupo C=O, a 1220 cm-1, referente à ligação C-N e em 3294 cm-1, referente à ligação N-H. Experimentos de pulsos com soluções do traçador e da mistura racêmica, em diferentes temperaturas e vazões da fase móvel, foram realizados para avaliar a homogeneidade das colunas e sua influência no processo de separação, os coeficientes de dispersão axial e de tranferência de massa e o comportamento termodinâmico da adsorção. Uma análise estatística dos dados de porosidade foi realizada através dos testes t e F mostrando que, com um nível de confiança de 95%, apenas algumas colunas apresentam porosidades equivalentes embora os erros cometidos na determinação da porosidade total e no processo de empacotamento sejam os mesmos. A recuperação do enantiômero de interesse, S-(-)-omeprazol, variou de 10-100% quando a porosidade total sofreu variações da ordem de 3%. Os gráficos de van Deemter mostraram uma relação linear entre a altura equivalente a um prato e a velocidade superficial da fase móvel. O enantiômero S-(-)- apresentou maiores coeficientes de transferência de massa e o enantiômero R-(+)- maiores constantes de Henry. O fator de separação e a resolução apresentaram valores iguais a 1,30 e 1,96, respectivamente, a 40 °C e 1,0 mL/min. Observou-se um decréscimo nos valores desses parâmetros após um determinado tempo de uso da coluna. Os valores negativos de 0 S D e 0 H D indicam um aumento na ordem do sistema cromatográfico e que a adsorção dos enantiômeros da fase móvel na fase estacionária é entalpicamente favorável. O modelo de isoterma de Langmuir foi bem correlacionado aos dados experimentais de equilíbrio no intervalo de concentração analisado. Palavras-chave: fase estacionária quiral, omeprazol, cromatografia líquida de alta eficiência / Abstract: The aim of this work was the synthesis, in large scale, of the amylose tris(3,5- dimethylphenylcarbamate) chiral stationary phase and further evaluate in the omeprazole enantiomer preparative separation by high performance liquid chromatography. The amylose carbamate, characterized by elemental analysis and infrared spectroscopy, showed CHN experimental values close to theoretical values and infrared absorptions at 1720 cm-1 which is assigned to C=O group, at 1220 cm-1 which is assigned to C-N bond and at 3294 cm-1 which is assigned to N-H bond. Pulse experiments with solutions of the inert and racemic mixture at different flow rates and temperature were carried out to evaluate column homogeneity and its influence on separation process, axial dispersion and mass transfer coefficients and adsorption thermodynamic behavior. A statistical analysis of the porosity data was performed through of the t and F tests showing that with 95% confidence level only some columns presented equivalent porosities although the errors made in the total porosity determination and packing process are equal. The recovery of the interest enantiomer, S-(-)-omeprazole, varied of 10 until 100% when total porosity varied in the order of 3%. The van Deemter plots showed a linear dependence between height equivalent to a theoretical plate and mobile phase superficial velocity. S-(-)- enantiomer presented higher values of mass transfer coefficients and the enantiomer R-(+)-omeprazole presented higher values of Henry constants. The separation factor and resolution values were 1.30 and 1.96 at 40 °C and 1.0 mL/min, respectively. It was observed a decrease of these parameter values after a use time of the column. The negative values of 0 S D and 0 H D indicates an increase in the order of chromatographic system and that the enantiomer adsorption from the mobile phase to stationary phase is enthalpically favorable. The Langmuir isotherm model was well correlated to equilibrium experimental data in the range of investigated concentration. Key-words: chiral stationary phase, omeprazole, high performance liquid chromatography / Doutorado / Desenvolvimento de Processos Biotecnologicos / Doutor em Engenharia Química

O citalopram (CITA), inibidor seletivo da recaptação da serotonina, é disponível na clínica como mistura racêmica dos enantiômeros (+)-(S) e (-)-(R) ou como enantiômero puro (+)-(S)-CITA. O CITA é metabolizado pelo CYP2C19, CYP2D6 e CYP3A ao desmetilcitalopram (DCITA) e pelo CYP2D6 ao didesmetilcitalopram. O estudo investiga a influência de inibidores enzimáticos no metabolismo enantiosseletivo do CITA em ratos e em voluntários sadios. Os ratos machos Wistar (n=6 para cada grupo) foram tratados com dose única de 20 mg/Kg de CITA (grupo controle) ou pré-tratados com 80 mg/Kg de quinidina (grupo quinidina), 10 mg/Kg de fluvoxamina (grupo fluvoxamina) ou 50 mg/Kg de cetoconazol (grupo cetoconazol). As amostras de sangue foram colhidas dos ratos até 20 h após a administração do CITA. Os voluntários sadios fenotipados como metabolizadores extensivos (EM) do CYP2C19 (omeprazol como fármaco marcador), EM do CYP2D6 (debrisoquina como fármaco marcador) e com atividade normal do CYP3A (midazolam como fármaco marcador) receberam dose única p.o. de 20 mg de CITA racêmico associado ou não ao omeprazol (20 mg/dia durante 18 dias). Os enantiômeros do CITA e do DCITA foram analisados no sistema LC-MS/MS, com a coluna quiral Chiralcel OD-R e fase móvel constituída por acetonitrila:metanol:água (30:30:40 v/v/v) contendo 0,05 % de dietilamina. O método foi linear no intervalo de concentrações de 0,1 20 ng de cada enantiômero do CITA e DCITA/mL de plasma humano e de de 0,1 500 ng de cada enantiômero do CITA e DCITA/mL de plasma de rato. Os coeficientes de variação obtidos nos estudos da precisão e a inexatidão foram inferiores a 15 % para plasma humano e plasma de ratos. A disposição cinética do CITA é enantiosseletiva nos ratos dos grupos controle (razão de AUCS/R de 0,4), quinidina (razão de AUCS/R de 0,5) e cetoconazol (razão de AUCS/R de 0,8). A inibição do CYP2D pela quinidina resultou em inibição do metabolismo do CITA e do DCITA de maneira não enantiosseletiva. A inibição do CYP2C pela fluvoxamina e do CYP3A pelo cetoconazol resultou em inibição somente do metabolismo do (+)-(S)-CITA. A disposição cinética do CITA em voluntários sadios é enantiosseletiva na ausência de tratamento com o omeprazol com observação de maior proporção plasmática do enantiômero (-)-(R)-CITA. A razão de AUCS/R obtida para o CITA foi de 0,56 e para o metabólito DCITA foi de 1,06. A administração de CITA racêmico a voluntários sadios em tratamento com o omeprazol exibe perda da enantiosseletividade na farmacocinética do CITA. A razão de AUCS/R foi de 0,96 para o CITA e de 0,92 para o DCITA. A administração de omeprazol em doses múltiplas a voluntários sadios inibe de maneira enantiosseletiva o metabolismo do eutômero (+)-(S)-CITA com aumento das concentrações plasmáticas em aproximadamente 140%. / Citalopram (CITA), a selective serotonin reuptake inhibitor, is available for clinical use as a racemic mixture of the (+)-(S) and (-)-(R) enantiomers or as the pure (+)-(S)-CITA enantiomer. CITA is metabolized by CYP2C19, CYP2D6 and CYP3A to demethylcitalopram (DCITA) and by CYP2D6 to didemethylcitalopram. The present study investigated the influence of enzyme inhibitors on the enantioselective metabolism of CITA in rats and healthy volunteers. Male Wistar rats (n=6 for each group) received a single dose of 20 mg/kg CITA (control group) or were pretreated with 80 mg/kg quinidine (quinidine group), 10 mg/kg fluvoxamine (fluvoxamine group), or 50 mg/kg ketoconazole (ketoconazole group). Blood samples were collected from the animals up to 20 h after the administration of CITA. Healthy volunteers phenotyped as extensive metabolizers of CYP2C19 (omeprazole as marker drug) and of CYP2D6 (debrisoquine as marker drug) and those with normal CYP3A activity (midazolam as marker drug) received a single oral dose of 20 mg racemic CITA combined or not with omeprazole (20 mg/day for 18 days). The CITA and DCITA enantiomers were analyzed by LC-MS/MS using a Chiralcel OD-R chiral column and a mobile phase of acetonitrile:methanol:water (30:30:40, v/v/v) containing 0.05% diethylamine. The method was linear in the concentration range of 0.1-20 ng of each CITA and DCITA enantiomer/mL human plasma and of 0.1-500 ng of each CITA and DCITA enantiomer/mL rat plasma. Accuracy and precision were below the acceptance limits of 15% for human and rat plasma. The kinetic disposition of CITA was enantioselective in rats of the control (AUCS/R ratio = 0.4), quinidine (AUCS/R ratio = 0.5) and ketoconazole (AUCS/R ratio = 0.8) groups. The inhibition of CYP2D by quinidine resulted in the non-enantioselective inhibition of the metabolism of CITA and DCITA. The inhibition of CYP2C by fluvoxamine and of CYP3A by ketoconazole only inhibited the metabolism of (+)-(S)-CITA. The kinetic disposition of CITA in healthy volunteers was enantioselective in the absence of treatment with omeprazole, with the observation of a higher plasma proportion of the (-)-(R)-CITA enantiomer. The AUCS/R ratio was 0.56 for CITA and 1.06 for the DCITA metabolite. The administration of racemic CITA to healthy volunteers treated with omeprazole showed a loss of enantioselectivity in the pharmacokinetics of CITA. The AUCS/R ratio was 0.96 for CITA and 0.92 for DCITA. The administration of multiple doses of omeprazole to healthy volunteers enantioselectively inhibited the metabolism of the (+)-(S)-CITA eutomer, with an approximately 140% increase of plasma concentrations

O nitrito pode ser reduzido a NO de forma dependente do pH ácido do estômago ou por enzimas com atividade nitrito-redutase. O tratamento com omeprazol, previne parte dos efeitos anti-hipertensivos do nitrito administrado por via oral por aumentar o pH gástrico. Contudo, nenhum estudo até o momento avaliou se, assim como o omeprazol, a ranitidina também é capaz de atenuar os efeitos anti-hipertensivos do nitrito de sódio por aumentar o pH gástrico. Nesse estudo, examinamos se a administração oral de ranitidina poderia prejudicar os efeitos anti-hipertensivos do nitrito de sódio administrados por via oral, por interferir na formação de NO e espécies nitrosiladas a partir do nitrito. A fim de verificar a influência da ranitidina no efeito hipotensor do nitrito de sódio, utilizamos animais tratados agudamente com LNAME pré-tratados com ranitidina, omeprazol e veículo e, posteriormente, com nitrito de sódio 15mg/kg. Como esperado, o tratamento com L-NAME resultou em aumento na pressão arterial média (PAM). O pH gástrico foi diferente entre os grupos, tendo um aumento no pH dos animais tratados com ranitidina e omeprazol, quando comparado ao veículo, e os tampões tinham o mesmo pH do veículo e das drogas. O nitrito de sódio exerceu efeitos anti-hipertensivos significativos nos grupos estudados. No entanto, foram observadas menores diminuições na PAM em ratos tratados com omeprazol e ranitidina em comparação aos ratos que receberam veículo. Esses achados foram associados a diminuições nas concentrações gástricas de NO e diminuições nos níveis plasmáticos de espécies nitrosiladas. Além disso, houve aumento nas concentrações de nitrito no estômago. Não foram observadas diferenças nas concentrações de nitrito no plasma. Além disso, não foram observadas diferenças nos níveis de NOx no plasma e estômago entre os grupos do estudo. Os animais tratados com tampão apresentaram resultados similares aos tratados com as drogas. Nossos resultados sugerem que a ranitidina, ao aumentar o pH gástrico, afeta as respostas anti-hipertensivas ao nitrito de sódio oral por diminuir a formação de NO e espécies nitrosiladas. Este fato é reforçado pelo aumento do nitrito no estômago, sugerindo uma diminuição na conversão de nitrito a NO e espécies nitrosiladas no ambiente gástrico. / Nitrite can be reduced to NO depending on acidic pH of the stomach or by enzymes with nitrite reductase activity. Treatment with omeprazole attenuates the antihypertensive effects of oral nitrite by increasing of gastric pH. However, studies are still necessary to further evaluate wheter ranitidine is also able to attenuate the antihypertensive effects of sodium nitrite by increasing gastric pH. In this study, we examined whether oral administration of ranitidine could impair oral antihypertensive effects of sodium nitrite by interfering with the formation of NO and nitrosylated species from nitrite. In order to analyze the influence of ranitidine under hypotensive effect of sodium nitrite, rats were treated with L-NAME and pretreated with ranitidine, omeprazole, vehicle or buffer, subsequently all the groups were treated with sodium nitrite 15 mg/kg. The L-NAME treatment increase mean arterial pressure (MAP). The gastric pH was different among the groups, there was an increased in rats gastric pH treated with ranitidine and omeprazole compared to the vehicle. The buffer group had the same pH of vehicle and drugs treatment. Sodium nitrite exerted significant antihypertensive effects in the groups studied. However, lesser decreases in MAP were observed in rats treated with omeprazole and ranitidine compared to rats that received vehicle. These findings were associated with a lower NO gastric concentrations as well as nitrosylated species plasma levels. In addition, there was an increased in nitrite concentrations in the stomach. No differences were observed in plasma nitrite levels. Moreover, there was not any significant difference in plasma and stomach NOx levels among the studied groups. The rats treated with buffer showed similar results to those treated with the drugs. Together these data demonstrated that ranitidine, through increased gastric pH, affects antihypertensive responses to oral sodium nitrite by reducing the formation of NO and nitrosylated species. This fact is reinforced by higher levels in nitrite concentrations in the stomach, thereby it suggests a lower conversion of nitrite to NO and nitrosylated species in the gastric environment.