Search

Purpose: Use of aprepitant for chemotherapy-induced nausea and vomiting prophylaxis in patients unable to swallow capsules is hindered by the lack of a commercially available oral liquid formulation in many jurisdictions. A stable oral suspension can be extemporaneously prepared using commercially available capsules. We aimed to determine the bioavailability of this aprepitant suspension relative to the capsule., Methods: This two-period crossover study enrolled 17 healthy adult volunteers. Volunteers received a single 125 mg aprepitant dose during each study period. Order of formulation presentation (capsule vs suspension first) was randomized. Thirteen blood samples were collected over a 48-h period. Aprepitant plasma concentrations were determined using liquid chromatography-mass spectroscopy. Relative bioavailability was defined as the geometric least squares mean ratio for area under the concentration versus time curve (AUC) from time zero to infinity of the aprepitant suspension versus the capsule. Bioequivalence, defined as per Health Canada guidelines, was assessed as a secondary aim., Results: Relative bioavailability of the aprepitant suspension was 82.3% (90% CI: 69.09-98.00%). Bioequivalence was not established: geometric least squares mean ratios (suspension/capsule) for AUC time zero to 48 h and maximum concentration were 87.8% (90% CI: 75.48-102.16%) and 86.1% (90% CI: 75.59-98.16%), respectively. No serious adverse events were observed., Conclusions: With a relative bioavailability of 82.3%, the extemporaneous aprepitant oral suspension was well-absorbed relative to the capsule. Though not bioequivalent to the oral capsule, the clinical use of this aprepitant oral suspension in adult and pediatric patients unable to swallow capsules is likely to be effective and safe.

Burn patients are at high risk for infections; however, common indicators of infection are unreliable in this population and can lead to unnecessary use of antibiotics. The study objective was to determine if predictors of early infection in adult acute burn patients are identified to provide clinicians with a practical tool to aid in the diagnosis of infection, thereby minimizing unnecessary exposure to antimicrobials. A retrospective chart review of all adult acute burn injury patients admitted over a 1 year period to the burn centre at Sunnybrook Health Sciences Centre was conducted. Early infection was defined as one that occurred within the first 10 days after injury and in accordance with American Burn Association guidelines. Those without infection were compared to patients with infection generally and also to patients with sepsis specifically. The period prevalence of early infection and sepsis in our patients was 50% (56/111) and 16% (18/111), respectively. It was determined that heart rate ≥110 bpm, systolic blood pressure ≤100 mmHg and intubation were the best predictors of sepsis (p<0.05); and fraction of inhaled oxygen >25% and maximum temperature ≥39 °C were the best predictors of infection (p<0.05). This pilot project identified significant predictors of early infection and sepsis in acute burns and will be validated in a prospective study., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Context: The use of herbal medications and supplements has been growing worldwide with over four billion dollars a year spent on alternative medicines in the United States. St John's wort herbal preparations are generally standardized to "total hypericins" as a means of illustrating a degree of quality control to the consumer. This standardization has been based on a nonspecific method that overestimates and sums the two major naphthodianthrone compounds (hypericin and pseudohypericin) that are found in these products., Objective: To use a more specific and sensitive method to accurately determine the total hypericin content (sum of hypericin and pseudohypericin) in commercially available St John's wort herbal preparations., Design: The current standard method for determining the naphthodianthrone content is a spectrophotometric method specified in the United States Pharmacopeia. Compounds other than hypericin and pseudohypericin can contribute falsely to the naphthodianthrone concentration, reducing this methods specificity., Setting: Fifty-four commercially available St John's wort products were purchased in Canada and the United States., Main Outcome Measures: A specific and sensitive liquid chromatographic method with fluorescent detection was used to specifically quantify the hypericin and pseudohypericin content in commercially purchased St John's wort products., Results: Analysis revealed large variations in total naphthodianthrone content, with the percentage of label claim varying from 0% to 108.62% for capsules, and from 31.34% to 80.18% for tablets. The content of tinctures varied from zero to 118.58 microg/ml. Only two products were observed to have a total naphthodianthrone concentrations within 10% of their label claim., Conclusions: When the active or marker compounds in an herbal or alternative medicine have been identified, standardization is an important step to ensure consistency from batch to batch. However, consistency is not apparent between brands and most products have inaccurate label claims. On average, most labels overestimate the hypericin and pseudohypericin content by a factor of almost two.