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Globally, there have been several reports of natural products contaminated with illegal adulterants that threaten consumer health because of their adverse pharmacological effects. To treat erectile dysfunction in men, herbal medicine is often adulterated with synthetic phosphodiesterase type 5 (PDE-5) inhibitors. Honey, which is popularly used for its health benefits, is subjected to adulteration with PDE-5 inhibitors. In this study, a rapid and reliable analytical method was proposed to determine the level of adulteration in honey samples. A total of 18 honey samples were tested for the presence of PDE-5 inhibitors (sildenafil, tadalafil and vardenafil) using a high-performance liquid chromatographic method coupled with a photodiode array detector (HPLC-PAD). Chromatography was performed using the Agilent ZORBAX SB-C18 column, with acetonitrile and buffer in the ratio of 1:4 as the mobile phase. Sildenafil, tadalafil and vardenafil reference standards were used for calibration. The retention times of the standards were 21.67, 18.15 and 21.30 min respectively. Of the total samples tested, 55% were positive for PDE-5 inhibitors. Six samples contained sildenafil, three samples contained tadalafil and one sample contained vardenafil. The findings from this study demonstrate that the HPLC-PAD method is suitable and economical for screening PDE-5 inhibitors as adulterants in honey samples marketed for use as sexual activity enhancers. Regular inspections of adulterated products are thus warranted to ensure the safety and health of consumers.

Background Objective Materials and methods Results Conclusions Phosphodiesterase 5 inhibitors (PDE5is) represent a first‐line pharmacological therapy for erectile dysfunction (ED). Men could obtain PDE5is for recreational purposes without any proper medical prescription.We aimed to analyze clinical characteristics of patients who already used any PDE5i for ED without previous formal medical prescription.Data from 2012 heterosexual, sexually active men seeking first medical help for ED at our outpatient clinic between 2005 and 2022 were analyzed. All patients were assessed with a comprehensive sexual and medical history and completed the International Index of Erectile Function (IIEF) at baseline. Comorbidities were scored with the Charlson comorbidity index (CCI). Thereof, according to exposure to any PDE5i before their first visit, patients were subdivided into: PDE5i‐naïve and non‐PDE5i‐naïve patients. Descriptive statistics tested the sociodemographic and clinical characteristics of both groups. A logistic regression model predicted the likelihood of being PDE5i‐naïve at the baseline. Linear regression analysis (LRA) estimated the likelihood of being PDE5i‐naïve versus non‐PDE5i‐naïve over the analyzed timeframe. Lastly, local polynomial regression models graphically explored the likelihood of being PDE5i‐naïve at the first clinical assessment over the analyzed timeframe, and the sensitivity analyses tested the probability of being PDE5i‐naïve at baseline.Overall, 1,491 (70.9%) patients were PDE5i‐naïve and 611 (29.1%) were non‐PDE5i‐naïve at the first assessment. PDE5is‐naïve patients were younger, with a lower prevalence of CCI ≥ 1 and of normal erectile function (EF) than non‐PDE5i‐naïve men (all p < 0.05). Multivariable logistic regression found that patients with lower BMI (OR: 0.99), higher IIEF‐EF scores (OR: 1.02), lower rates of severe ED (OR: 0.94), and who had been assessed earlier throughout the study timeframe (OR: 1.27) were less likely to be PDE5i‐naïve at baseline. Univariate LRA revealed that younger patients (Coeff: −0.02), with lower CCI (Coeff: −0.29) and higher alcohol intake per week (Coeff: 0.52) were more likely to be PDE5i‐naïve over the analyzed timeframe. Moreover, for the same IIEF‐EF score, patients with higher CCI had lower probability of being PDE5i‐naïve.Self‐prescription of PDE5is is an attitude presents in the general population, despite this phenomenon has decreased overtime. Current data outline the importance to keep promoting educational campaigns to promote PDE5is as effective and safe medicinal products, while avoiding their improper use. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive disease characterized by high mean pulmonary arterial pressure (≥ 20 mmHg) and remodeling of the vascular arteries. Approved therapies improve symptoms and delay clinical worsening in the long term, but they do not relieve acute exertional symptoms. RT234, a drug/device combination (Respira Therapeutics, Palo Alto, CA, USA) that delivers the phosphodiesterase 5 inhibitor vardenafil to the lungs via inhalation, has been shown to reduce pulmonary vascular resistance in patients with PAH. This study aims to evaluate whether RT234 can increase oxygen capacity during cardiopulmonary exercise testing (CPET) in patients with PAH. METHODS: This prospective, multi-center, open-label, two-cohort, dose-escalation, phase IIb trial in patients with PAH will evaluate the safety and efficacy of RT234 in improving exercise parameters. The trial began in September 2020 and is expected to be completed by early 2024. Patients eligible for enrollment will have a right heart catheterization-confirmed diagnosis of PAH, a 6-minute walking distance of ≥ 150 m, a minute ventilation/carbon dioxide production slope of ≥ 36, and will be on up to three stable oral and/or inhaled (not parenteral) PAH-specific background therapies. The estimated sample size is 86 patients, who will be divided into two dose cohorts. Cohort 1 will receive 0.5 mg RT234, and cohort 2 will receive 1.0 mg RT234. Each cohort will contain two subgroups based on the number of PAH background medications (up to two vs three). The trial will assess patients changes from baseline in peak oxygen consumption (VO2) during CPET 30 minutes after a single dose of 0.5 mg or 1.0 mg RT234, the change in the 6-minute walking distance, and the pharmacokinetics and safety profile of single doses of RT234. CONCLUSION: This is the first trial involving an as-needed medication for PAH. The trial will provide insights into the safety and efficacy of as-needed RT234 in treating the acute symptoms of PAH during exercise and will inform the design of further trials. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier NCT04266197.

Introduction: Tramadol is one of the most common analgesic drugs in chronic pain treatment. Their mechanism of action is through the inhibition of the noradrenaline and serotonin (5-HT) transmission reuptake. Vardenafil is used to treat male sexual function problems like erectile dysfunction. Objective: The present work aimed to evaluate the biochemical and testicular histopathological changes induced by tramadol and/or vardenafil administration in adult male Swiss mice and investigate the associated impact of tramadol and vardenafil on fertility and reproductive performance. Materials and Methods: 24 mature male Swiss mice with a body weight of 30-35 g have been divided into 4 groups. (G1) control, (G2) injected i.p with 4.16 mg/kg of tramadol, (G3) injected i.p with 46.8 mg/kg of vardenafil, and (G4) treated with tramadol followed with vardenafil. Sperm samples were collected from cauda epididymis, semen profile examination and abnormalities were recorded. Hormonal analysis, oxidative stress biomarkers, and histopathological studies have been done. Results: The present study revealed that tramadol and vardenafil synergistically did not altered body weight of mice and not caused change of reproductive organs’ weight. Administration of tramadol and vardenafil revealed reduction in mating index and fetal weight. The results indicated that tramadol and vardenafil have a significantly harmful impact on sperm quality, boosted morphological abnormalities, decreased concentration of reproductive hormones, induced testicular histopathological changes, and affected spermatogenesis cycle, decreasing number of spermatogonia and spermatocytes, altered antioxidants levels and raised MDA activity. Conclusion: Intake of tramadol and vardenafil should be for a short period and necessary because of their serious harmful effects on reproductive performance and fertility. [ABSTRACT FROM AUTHOR]

Age-dependent cognitive decline is associated with a downregulation of the cyclic nucleotide cascade. Through their regulation of the cGMP pathway, phosphodiesterase 5 inhibitors have been proven to enhance episodic memory in rodents and mice and have been proposed as drugs with the potential to counteract aging-dependent cognitive and neurodegenerative disorders. One caveat of this line of research is that these studies have been carried out in male rodents, leaving unknown their effects on female cognition. With the present study, we aim to fill this methodological gap. Twenty-four-month-old female mice were exposed to a continuous 33-day treatment with 2 mg/kg of Vardenafil and tested in the object recognition test, the elevated plus maze, and the open field test. The results show that, compared to females from the control group, Vardenafil-exposed females showed higher discrimination between familiar and novel objects compared to controls both at 1 h and 24 h delays, indicating that Vardenafil enhances episodic memory. No effects of Vardenafil on anxiety-like behaviors were found. [ABSTRACT FROM AUTHOR]

The prevalence of neurocognitive disorders (NCD) increases every year as the population continues to age, leading to significant global health concerns. Overcoming this challenge requires identifying biomarkers, risk factors, and effective therapeutic interventions that might provide meaningful clinical benefits. For Alzheimer's disease (AD), one of the most studied NCD, approved drugs include acetylcholinesterase inhibitors (rivastigmine, donepezil, and galantamine), an NMDA receptor antagonist (memantine), and antiamyloid monoclonal antibodies (aducanumab and lecanemab). These drugs offer limited relief, targeting singular pathological processes of the AD. Given the multifactorial nature of the NCDs, a poly-pharmacological strategy may lead to improved outcomes compared to the current standard of care. In this regard, phosphodiesterase 5 (PDE5) inhibitors emerged as promising drug candidates for the treatment of neurocognitive disorders. These inhibitors increase cGMP levels and CREB signaling, thus enhancing learning, memory and neuroprotection, while reducing Aß deposition, tau phosphorylation, oxidative stress, and neuroinflammation. In the present article, we evaluate the therapeutic potential of different PDE5 inhibitors to outline their multifaceted impact in the NCDs. [ABSTRACT FROM AUTHOR]

Phosphodiesterase 5 inhibitors (PDE5-is) are used worldwide as first line therapy for erectile dysfunction (ED). Current literature reported data on the warning association between PDE5-is use and the development of cutaneous melanoma. However, these data are contrasting, thus we aim to summarise evidence regarding this association. A systematic review of all published articles related to the effects of PDE5-is in the development of cutaneous melanoma was performed. PubMed, EMBASE, and Cochrane library were queried for all the published studies indexed up to the 26th of May 2023. A combination of keywords related to PDE5-is and melanoma were used. Only original studies based on human subjects in the English language were included in the analysis. Of 505 articles identified, only eight original articles were considered for further analysis. Overall, five of the selected articles including 657,984 subjects agrees on an increased risk of developing melanoma in PDE5-is users. On the other hand, three original articles based on data regarding 360,915 subjects, disagree with the previous statement declaring any association between PDE5-i use and melanoma. Current literature still reports contrasting data regarding the association between PDE5-is assumption and increased risk of melanoma, but a possible association is described, bringing attention to higher risk melanoma category of patients. More clinical studies are needed to clarify the impact of PDE5-is in the development and progression of melanoma. [ABSTRACT FROM AUTHOR]

Dysregulation of protein homeostasis, proteostasis, is a distinctive hallmark of many neurodegenerative disorders and aging. Deleteriously, the accumulation of aberrant proteins in Alzheimer's disease (AD) is accompanied with a marked collapse in proteostasis network. The current study explored the potential therapeutic effect of vardenafil (VAR), a phosphodiesterase-5 inhibitor, in AlCl3/d-galactose (d-gal)-induced AD in rats and its possible underlying mechanisms. The impact of VAR treatment on neurobehavioral function, hippocampal tissue architecture, and the activity of the cholinergic system main enzymes were assessed utilizing VAR at doses of 0.3 mg/kg and 1 mg/kg. Additionally, the expression level of amyloid-beta and phosphorylated tau proteins in the hippocampus were figured out. Accordingly, VAR higher dose was selected to contemplate the possible underlying mechanisms. Intriguingly, VAR elevated the cyclic guanosine monophosphate level in the hippocampus and averted the repressed proteasome activity by AlCl3/d-gal; hence, VAR might alleviate the burden of toxic protein aggregates in AD. In addition, a substantial reduction in the activating transcription factor 6-mediated endoplasmic reticulum stress was demonstrated with VAR treatment. Notably, VAR counteracted the AlCl3/d-gal-induced depletion of nuclear factor erythroid 2-related factor 2 level. Moreover, the anti-senescence activity of VAR was demonstrated via its ability to restore the balance of the redox circuit. The modulation of phosphatidylinositol-3-kinase/protein kinase B/p53 pathway and the reduction of nuclear factor kappa B level, the key regulator of senescence-associated secretory phenotype mediators release, with VAR treatment were also elucidated. Altogether, these findings insinuate the possible therapeutic benefits of VAR in AD management. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) has always attracted global attention with its high prevalence, incidence rate, and mortality. Exposure to cigarette smoke is one of main causes of COPD. Therefore, it is still necessary to study its pathogenesis and find new therapeutic strategies for early COPD prevention and treatment. Vardenafil, a type 5 phosphodiesterase (PDE5) inhibitor, is known to have an efficient therapy in some cardiovascular, pulmonary, and vascular diseases, which is an important mechanism for COPD. However, it still loss relevant research on whether vardenafil is effective in COPD and its mechanism. In this study, the cigarette smoke inhalation was performed to establish cigarette smoke-induced COPD model using C57BL/6 mice and 16HBE cells were treated with cigarette smoke extract (CSE). Mice were treated with vardenafil for 30 d. Then condition of lung injury was evaluated using histological analysis. The content of cytokines and the number of inflammatory cells in lung tissues or bronchoalveolar lavage fluid were measured. Additionally, western blot analysis was employed to evaluate the activation of adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK)/mechanistic target of rapamycin (mTOR)-mediated autophagy in vitro. The results showed that vardenafil abolished CSE's effect by activating autophagy via the AMPK/mTOR signalling pathway in vitro. Vardenafil attenuated cigarette smoke-induced lung injury and inflammation response by activating autophagy via the AMPK/mTOR signalling pathway in vivo. These results provide valuable insights into the molecular mechanisms underlying vardenafil's beneficial effects in cigarette smoke-induced COPD treatment. In conclusion, vardenafil alleviates cigarette smoke-induced experimental COPD by activating autophagy via the AMPK/mTOR signalling pathway. [ABSTRACT FROM AUTHOR]

This study aimed to develop and verify a simple HPLC-based quantitative approach to simultaneously determine the phosphodiesterase-5 inhibitors (PDE5Is) sildenafil, vardenafil, udenafil, avanafil, and tadalafil in a tablet dosage form mixed with honey obtained form Jordanian market in rat plasma. PDE5Is block phosphodiesterase-5 (PDE-5). This blockage, in turn, triggers vasodilation by phosphorylating downstream effector molecules. Chromatographic separation was performed on a HypersilTM C18 column (150 mm × 4.6 mm, 5 µm, Thermo Fisher Inc., Waltham, MA, USA). An acetonitrile:10% Triethylamine solution (57:43) at pH 5.5 (adjusted with orthophosphoric acid), 20 µL injection volume, 1 mL/min flow rate, 25 °C temperature, and eluent monitoring at 250 nm was used to execute the current approach. Linearity was observed in the 9.6–14.4 µg/mL concentration ranges for sildenafil, udenafil, avanafil, and tadalafil, and 2.4–3.6 µg/mL for vardenafil. Each dosage form was recovered within acceptable limits at three distinct concentrations, and the assay selectivity indicated no interference from the inactive substances in the formulation. Sildenafil, vardenafil, udenafil, avanafil, and tadalafil had retention times of 3.5, 4.3, 6.2, 9.7, and 12.8 min, respectively, and tadalafil was 12.8 min. The present analytical method is comprehensive and universal for measuring the five drugs. Such an analytical method can be routinely used to detect the combination of these drugs. [ABSTRACT FROM AUTHOR]

Background: Phosphodiesterase type 5 inhibitors (PDE5Is) are generally well tolerated but have been associated with uncommon and significant adverse events (AEs). Aim: This study aims to investigate and compare the characteristics of AEs associated with PDE5Is used for erectile dysfunction and identify any safety signals in a postmarketing surveillance database between 2010 and 2021. Methods: A descriptive analysis was conducted for all AEs reported to the Food and Drug Administration Adverse Event Reporting System for 4 PDE5Is—avanafil, sildenafil, tadalafil, and vardenafil—indicated for erectile dysfunction between January 2010 and December 2021. The frequency of the most reported AEs and outcomes were identified. A disproportionality analysis based on proportional reporting ratio (PRR) and reporting odds ratio (ROR) was conducted for the most common and clinically important AEs to identify signals to gain insights into potential differences in safety profiles. Outcomes: The outcome measures of the study are frequency of reported AEs and outcomes following AE. Results: A total of 29 236 AEs were reported for PDE5Is during the study period. The most reported AE was "drug ineffective" with 7115 reports (24.3%). Eight safety signals were detected across the 4 drugs. Key signals were sexual disorders (PRR, 3.13 [95% CI, 2.69-3.65]; ROR, 3.24 [95% CI, 2.77-3.79]) and death (PRR, 3.17 [2.5-4.01]; ROR, 3.211 [2.52-4.06]) for sildenafil, priapism (PRR, 3.63 [2.11-6.24]; ROR, 3.64 [2.12-6.26]) for tadalafil, and drug administration error (PRR, 2.54 [1.84-3.52]; ROR, 2.6 [1.86-3.63]) for vardenafil. The most reported outcomes were other serious events with 6685 events (67.2%) and hospitalization with 1939 events (19.5%). Clinical Implications: The commonly reported AEs and detected signals may guide clinicians in treatment decision making for men with erectile dysfunction. Strengths and Limitations: This is the first comprehensive report and disproportionality analysis on all types of AEs associated with PDE5Is used for erectile dysfunction in the United States. The findings should be interpreted cautiously due to limitations in the Adverse Event Reporting System, which includes self-reports, duplicate and incomplete reports, and biases in reporting and selection. Therefore, establishing a causal relationship between the reported AEs and the use of PDE5Is is uncertain, and the data may be confounded by other medications and indications. Conclusion: PDE5Is demonstrate significantly increased risks of reporting certain clinically important AEs. While these events are not common, it is imperative to continually monitor PDE5I use at the levels of primary care to national surveillance to ensure safe utilization. [ABSTRACT FROM AUTHOR]

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Abstract Background Esophageal motility disorders are a group of disorders associated with dysfunctional swallowing resulting from impaired neuromuscular coordination. Phosphodiesterase 5 (PDE-5) inhibitors induce smooth relaxation and are proposed as a treatment option for esophageal motility disorders such as achalasia. Methods This study is conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched MEDLINE/ PubMed, Scopus, EMBASE, and Web of Science databases for esophageal outcomes of individuals treated with PDE5 inhibitors. A random effect meta-analysis was conducted. Results A total of 14 studies were included. They were conducted in different countries, with Korea and Italy having the highest number of articles. The main drug assessed was sildenafil. PDE-5 inhibitors resulted in a significant reduction in lower esophageal sphincter pressure (SMD − 1.69, 95% CI: -2.39 to -0.99) and the amplitude of contractions (SMD − 2.04, 95% CI: -2.97 to -1.11). Residual pressure was not significantly different between the placebo and sildenafil groups (SMD − 0.24, 95% CI: -1.20 to 0.72). Furthermore, a recent study reported contractile integral, stating that ingestion of sildenafil leads to a significant reduction in distal contractile integral and a significant increase in proximal contractile integral. Conclusion PDE-5 inhibitors significantly reduce LES resting pressure and esophageal peristaltic vigor, decreasing esophageal body contractility and contraction reserve. Therefore, using these drugs in patients affected by esophageal motility disorders may potentially improve their condition regarding symptom relief and prevention of further associated complications. Future reports investigating larger sample size is necessary in order to establish definite evidence regarding the efficacy of these drugs.

Oral phosphodiesterase inhibitors have emerged as a game changer for the treatment of erectile dysfunction (ED) since attaining FDA approval for its first member, sildenafil, in 1998. Topical penile therapy could be a viable replacement for oral medication that would transform the treatment of ED for many decades to come. This innovative idea could offer a safer topical alternative with less vision and cardiovascular side effects than the oral route. This work aims at developing proniosomal gels for three selected members (sildenafil, vardenafil, and tadalafil) and investigating the proniosomal gels on a rodent model. Niosomes derived from the parent proniosomal gels were characterized for entrapment efficiency (EE%), size, polydispersity index (PDI), zeta potential, and morphology. Proniosomal gels were evaluated for skin permeation, in vivo mating behaviors, and biochemical assays of nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) post penile topical administrations. The optimized proniosomes loaded with tadalafil (F1-T) were compared with oral tablets (Cialis®). Proniosomal gels demonstrated significant enhancement of skin penetration by up to 5.5-fold, compared to control topical suspension. Tadalafil-loaded proniosomes showed superior skin permeability over sildenafil- and vardenafil-loaded proniosomes. In addition, significant improvement was noticed regarding intromission number, intromission ratio, NO, and cGMP for the proniosomal gel F1-T, compared to the untreated control. No statistically significant (p > 0.05) differences in sexual performance or biochemical parameters (NO and cGMP levels) were recorded among orally and topically (tadalafil proniosomal gel) administered groups. These findings support tadalafil topical penile therapy as a promising alternative to the oral route. [ABSTRACT FROM AUTHOR]

Background: Oral vardenafil (VDF) tablet is an effective treatment for erectile dysfunction (ED), but intranasal administration with a suitable formulation can lead to a faster onset of action and offer more convenient planning for ED treatment. Aim: The primary purpose of the present pilot clinical study was to determine whether intranasal VDF with an alcohol-based formulation can result in more "user-friendly pharmacokinetics" as compared with oral tablet administration. Methods: This single-dose randomized crossover study was conducted in 12 healthy young volunteers receiving VDF as a 10-mg oral tablet or 3.38-mg intranasal spray. Multiple blood concentrations were obtained, and VDF concentrations were determined with a liquid chromatography–tandem mass spectrometry assay. Pharmacokinetic parameters following each treatment were compared and adverse events assessed. Outcomes: Pharmacokinetic parameters were obtained: apparent elimination rate constant, elimination half-life, peak concentration, peak time, total area under the curve, and relative bioavailability. Results: Although mean apparent elimination rate constant, elimination half-life, peak concentration, and total area under the curve were similar between intranasal and oral administration, the median peak time from intranasal was much shorter (10 vs 58 minutes, P < .001, Mann-Whitney U test). The variability of the pharmacokinetic parameters was also less with intranasal than oral administration. The relative bioavailability of intranasal to oral was 1.67. Intranasal VDF caused transient but tolerable local nasal reactions in 50% of subjects. Other adverse events (eg, headache) were similar between the treatments. The incidence of adverse events was, however, significantly less in the second treatment after initial exposure to VDF. No serious adverse events were noted. Clinical Implications: Intranasal VDF potentially offers a more timely and lower dose for the treatment of ED in patients who can tolerate the transient local adverse reactions. Strengths and Limitations: The strength of this study is its randomized crossover design. Because the study was conducted in 12 healthy young subjects, the results may not reflect those observed in elderly patients who may be likely taking VDF for ED. Nevertheless, the changes of pharmacokinetic parameters in the present study are likely a reflection of the differences between intranasal and oral administration of the formulations. Conclusion: Our study indicated that the present VDF formulation, when administered intranasally, can achieve a more rapid but similar plasma concentration with only about one-third dose when compared with the oral administration. [ABSTRACT FROM AUTHOR]

Background: Esophageal motility disorders are a group of disorders associated with dysfunctional swallowing resulting from impaired neuromuscular coordination. Phosphodiesterase 5 (PDE-5) inhibitors induce smooth relaxation and are proposed as a treatment option for esophageal motility disorders such as achalasia. Methods: This study is conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched MEDLINE/ PubMed, Scopus, EMBASE, and Web of Science databases for esophageal outcomes of individuals treated with PDE5 inhibitors. A random effect meta-analysis was conducted. Results: A total of 14 studies were included. They were conducted in different countries, with Korea and Italy having the highest number of articles. The main drug assessed was sildenafil. PDE-5 inhibitors resulted in a significant reduction in lower esophageal sphincter pressure (SMD − 1.69, 95% CI: -2.39 to -0.99) and the amplitude of contractions (SMD − 2.04, 95% CI: -2.97 to -1.11). Residual pressure was not significantly different between the placebo and sildenafil groups (SMD − 0.24, 95% CI: -1.20 to 0.72). Furthermore, a recent study reported contractile integral, stating that ingestion of sildenafil leads to a significant reduction in distal contractile integral and a significant increase in proximal contractile integral. Conclusion: PDE-5 inhibitors significantly reduce LES resting pressure and esophageal peristaltic vigor, decreasing esophageal body contractility and contraction reserve. Therefore, using these drugs in patients affected by esophageal motility disorders may potentially improve their condition regarding symptom relief and prevention of further associated complications. Future reports investigating larger sample size is necessary in order to establish definite evidence regarding the efficacy of these drugs. [ABSTRACT FROM AUTHOR]

Epigallocatechin 3-O-gallate (EGCG) is a predominant component in green tea with various health benefits. The 67 kDa laminin receptor (67LR) is a nonintegrin cell surface receptor that is overexpressed in various types of cancer; 67LR was identified a cell surface EGCG target that plays a pivotal role in tumor growth, metastasis, and resistance to chemotherapy. However, the plasma concentration of EGCG is limited, and its molecular mechanisms remain unelucidated in colon cancer. In this study, we found that the phosphodiesterase 5 (PDE5) inhibitor, vardenafil (VDN), potentiates EGCG-induced apoptotic cell death in colon cancer cells. The combination of EGCG and VDN induced apoptosis via activation of the endothelial nitric oxide synthase/cyclic guanosine monophosphate/protein kinase Cδ signaling pathway. In conclusion, the PDE5 inhibitor, VDN, may reduce the intracellular PDE5 enzyme activity that potentiates EGCG-induced apoptotic cell death in Caco-2 cells. These results suggest that PDE5 inhibitors can be used to elevate cGMP levels to induce 67LR-mediated, cancer-specific cell death. Therefore, EGCG may be employed as a therapeutic candidate for colon cancer.

The study of the genital system' vessels in patients with erectile disfunction and chronic prostatitis was accomplished using ultrasound Dopplerography and pharmacological testing by phosphodiesterase inhibitors of 5th type (PDEI-5). The positive impact of PDEI-5 (such as Sildenafil, Vardenafil, Udenafil and Tadalafil) on organs' blood supply was revealed. The changes of USDG parameters were found comparable and, at the same time, individual. For patient-specific choosing the medicinal agent it is advisable to perform the pharmacological tests for each patient. The choice of the medicine for treating erectile disfunction and chronic prostatitis should be made on the basis of the results of ultrasound Dopplerography and pharmacological testing for each selected and tested medicine. For this purpose it is preferably to choose the medicine, which improves the blood flow in penis and, at the same time, in prostate gland and in testes.

An understanding of drug product degradation issues is needed to advise stable formulation and provide a reasonable shelf‐life evaluation for all drug products. For this purpose, we have developed and validated a novel HPLC method for assessing the stability of vardenafil and dapoxetine in a combined pharmaceutical dosage form. The chromatographic separation was accomplished on a ProntoSIL C18 KROMA PLUS column (250×4.6 mm, 5 μm). The column was run under isocratic conditions with a 2.0 mL/min flow rate. The mobile phase was made up of methanol and 20 mM potassium dihydrogen phosphate at 45 : 55 (v/v), which was adjusted to pH 3.0 with phosphoric acid; these two drugs were eluted at retention times of 5.33 and 9.91 min for vardenafil and dapoxetine, respectively. The proposed method shows a linearity of 1–50 ug/ml with a regression of 0.9999 for both drugs. The method was validated for accuracy, precision, linearity, specificity, and sensitivity. The developed HPLC method has been successfully implemented to analyse dapoxetine and vardenafil in tablets. Furthermore, the stress degradation experiments were conducted on the bulk powder of vardenafil and dapoxetine following the International Council for Harmonization (ICH) recommendations. [ABSTRACT FROM AUTHOR]

A method was developed for the simultaneous determination and analysis of sildenafil, vardenafil, and tadalafil in honey-mixed herbal sachets using high-performance liquid chromatography with a UV detector (HPLC–UV). This method eliminates the employment of complex procedures and abolishes time-consuming and labour-intensive pre-treatment processes. In ten minutes, the separation process (at 25oC) of sildenafil, vardenafil, and tadalafil using a C18 150 mm × 4.6 mm x 5 μm column (Shim-pack GIST) was successful with high selectivity and sensitivity. The mobile phase was a 60:40 (v/v) mixture of 0.1 percent formic acid in water and 0.1 percent formic acid in acetonitrile. Using the mobile phase as an extraction mixture, it gave recoveries in the range of 93.0-103.3% at spike levels of 50–150 mg/kg with relative standard deviations (RSDs) lower than 10%. The intra-day and interday precision results were in the range of 0.4–0.8% and 1.0–1.7%. Furthermore, the retention times for sildenafil acid, vardenafil acid, and tadalafil were 1.93, 2.47, and 9.62 minutes, respectively, and the limits of detection (LOD) were 1.70, 2.16, and 1.03 mg/L, while the limits of quantification (LOQ) were 5.65, 7.21, and 3.42 mg/L. [ABSTRACT FROM AUTHOR]

Background and objectives: Taking into consideration the confirmed role of oxidative stress in ischemia/reperfusion injury and the insufficiency in knowledge regarding the phosphodiesterase 5 (PDE5)-mediated effects on the cardiovascular system, the aim of our study was to investigate the influence of two PDE5 inhibitors, tadalafil and vardenafil, with or without the addition of N(G)-nitro-L-arginine methyl ester (L-NAME), on oxidative stress markers, coronary flow and left ventricular function, both ex vivo and in vivo. Methods: This study included 74 male Wistar albino rats divided into two groups. In the first, 24 male Wistar rats were orally treated with tadalafil or vardenafil for four weeks in order to perform in vivo experiments. In the second, the hearts of 50 male Wistar albino were excised and perfused according to the Langendorff technique in order to perform ex vivo experiments. The hearts were perfused with tadalafil (10, 20, 50 and 200 nM), vardenafil (10, 20, 50 and 200 nM) and a combination of tadalafil/vardenafil and L-NAME (30 μM). The CF and oxidative stress markers, including nitrite bioaviability (NO2−), superoxide anion radical (O2−), and the index of lipid peroxidation, were measured in coronary effluent. Results: The L-arginin/NO system acts as the mediator in the tadalafil-induced effects on the cardiovascular system, while it seems that the vardenafil-induced increase in CF was not primarily induced by the NO system. Although tadalafil induced an increase in O2− in the two lowest doses, the general effects of both of the applied PDE5 inhibitors on oxidative stress were not significant. The ejection function was above 50% in both groups. Conclusions: Our results showed that both tadalafil and vardenafil improved the coronary perfusion of the myocardium and LV function by increasing the EF. [ABSTRACT FROM AUTHOR]

Age-dependent cognitive decline is associated with a downregulation of the cyclic nucleotide cascade. Through their regulation of the cGMP pathway, phosphodiesterase 5 inhibitors have been proven to enhance episodic memory in rodents and mice and have been proposed as drugs with the potential to counteract aging-dependent cognitive and neurodegenerative disorders. One caveat of this line of research is that these studies have been carried out in male rodents, leaving unknown their effects on female cognition. With the present study, we aim to fill this methodological gap. Twenty-four-month-old female mice were exposed to a continuous 33-day treatment with 2 mg/kg of Vardenafil and tested in the object recognition test, the elevated plus maze, and the open field test. The results show that, compared to females from the control group, Vardenafil-exposed females showed higher discrimination between familiar and novel objects compared to controls both at 1 h and 24 h delays, indicating that Vardenafil enhances episodic memory. No effects of Vardenafil on anxiety-like behaviors were found.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with complex etiology. In this study, we aimed to determine the ameliorating effects of vardenafil in the ASD rat model induced by propionic acid (PPA) in terms of neurobehavioral changes and also support these effects with histopathological changes, brain biochemical analysis and magnetic resonance spectroscopy (MRS) findings. Twenty-one male rats were randomly assigned into three groups. Group 1 (control, 7 rats) did not receive treatment. Rats in groups 2 and 3 were given PPA at the dose of 250 mg/kg/day intraperitoneally for 5 days. After PPA administration, animals in group 2 (PPAS, 7 rats) were given saline and animals in group 3 (PPAV, 7 rats) were given vardenafil. Behavioral tests were performed between the 20th and 24th days of the study. The rats were taken for MRS on the 25th day. At the end of the study, brain levels of interleukin-2 (IL-2), IL-17, tumor necrosis factor-α, nerve growth factor, cGMP and lactate levels were measured. In the cerebellum and the CA1 and CA3 regions of the hippocampus, counts of neurons and Purkinje cells and glial fibrillary acidic protein (associated with gliosis) were evaluated histologically. Three chamber sociability and passive avoiding test, histopathological results, lactate levels derived from MRS, and biochemical biomarkers revealed significant differences among the PPAV and PPAS groups. We concluded that vardenafil improves memory and social behaviors and prevent loss of neuronal and Purkinje cell through its anti-inflammatory and neuroprotective effect. [ABSTRACT FROM AUTHOR]

Vardenafil (VDF) is a relatively new phosphodiesterase-5 inhibitor that has limited oral bioavailability (≈15%). The objective of this study was to develop bilosome-based mucoadhesive buccal sponge for augmenting the oral bioavailability of VDF. VDF-loaded bilosomes were fabricated and optimized using a Box-Behnken design. The optimized VDF-loaded bilosomal formulation was assessed for surface morphology, particle size, thermal characteristics, and in vitro release. Afterwards, the optimized bilosomal formulation was incorporated into a cellulose-based matrix to obtain buccal sponge, which was evaluated for ex vivo permeation studies, in vivo oral bioavailability, and in vivo serum concentration of cyclic guanosine monophosphate (cGMP). The mean particle size and entrapment efficiency (%) of optimized bilosome formulation were 282.6 ± 9.5 nm and 82.95 ± 3.5%, respectively. In vitro release studies at pH 6.8 emphasized the potential of optimized bilosomal formulation to sustain VDF release for 12 h. Ex vivo permeation study using sheep buccal mucosa indicated significant enhancement in penetration of VDF from bilosomal buccal sponge compared to plain VDF gel. Pharmacokinetic study in Albino rats showed ~5 fold increase in relative bioavailability with bilosomal buccal sponge, compared to VDF suspension. In addition, VDF-loaded bilosomal buccal sponge triggered higher serum levels of cGMP, a biomarker of VDF in vivo efficacy, compared to oral VDF suspension. To sum up, bilosomes might represent a potential nanocarrier for buccal delivery of VDF, enhancing its oral bioavailability and therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Three simple, sensitive, precise, and rapid spectrophotometric methods are developed and optimized for the assay of vardenafil in pharmaceutical formulations. The procedures are ascertained on the oxidation of vardenafil with a slight excess of N-bromosuccinimide (NBS), and the unreacted oxidant is estimated by evaluating the amount of the unconsumed NBS by reacting with a fixed amount of safranin (method A), crystal violet (method B), and aniline blue (method C) in an acidic medium by measuring the absorbance at 530, 600, and 610 nm, respectively. In all the methods, the amount of NBS consumed corresponds to the amount of the drug. Beer's law range, Sandell's sensitivity, and the corresponding molar absorptivity values of 1.1104 × 104, 1.0305 × 104, and 6.217 × 103 L/mol × cm for methods A, B, and C are calculated. The limits of detection and quantification are evaluated. The methods are also evaluated statistically by means of Student's t-test and F-test. The results show excellent agreement and insignificant difference between the proposed methods and the reference method. The developed methods are successfully applied to the assay of Vardenafil in pure and dosage forms, and no interference is observed from common excipients present in pharmaceutical formulations. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS); a widespread disorder in gastrointestinal tract especially in children, burdens their healthcare systems and upsets families. Great attention was paid to understand the pathophysiological cause of disorder. However, developing a convenient treatment especially for children remains a challenge. Phosphodiesterase inhibitors were recently introduced for IBS management. Vardenafil (VDF), a phosphodiesterase-5 inhibitor, exhibiting limited bioavailability when taken orally due to extensive first-pass effect, was the choice for study. This study aimed to formulate VDF jellies as a buccal dosage form to improve pediatric compliance and achieve maximum drug efficacy. VDF oral jellies were prepared by heat and congeal method, and were evaluated for their pH, content uniformity, physical stability, general appearance, and in-vitro drug release. VDF jellies (F1), with satisfactory organoleptic properties and highest percent of drug released compared to other formulations was selected as a master formula for further study to ensure in-vivo efficacy. cyclic Guanosine Mono Phosphate (cGMP), used as indicator of VDF concentration in blood, was highly increased after administration of VDF jellies (F1), compared to oral VDF suspension. Increased defecation with improved fecal consistency strongly favored oral jellies as a potential alternative route for VDF for IBS management with high pediatric acceptance.

The potential renoprotective effects of vardenafil (VAR) have been evaluated in a very limited number of studies using acute kidney injury animal models other than contrast-induced nephropathy (CIN) with promising results, while avanafil (AVA) has not been evaluated in this respect before. The purpose of this study was to evaluate for the first time the potential renoprotective effect of VAR and AVA in a rat model of CIN. Twenty-five male Wistar rats were equally assigned into five groups: control, CIN, CIN+N-acetyl cysteine (NAC) (100 mg/kg/day) as a positive control, CIN+VAR (10 mg/kg/day) and CIN+AVA (50 mg/kg/day). CIN was induced by dehydration, inhibition of prostaglandin and nitric oxide synthesis as well as exposure to the contrast medium (CM). Serum Cr (sCr) levels were measured at 24 and 48 h after CIN induction. At 48 h of CM exposure, animals were sacrificed. Matrix metalloproteinase (MMP) 2 (MMP-2) and MMP-9, kidney injury molecule 1 (KIM-1) and cystatin-C (Cys-C) were measured on renal tissue. Histopathological findings were evaluated on kidney tissue. All treatment groups had close to normal kidney appearance. sCr levels subsided in all treatment groups compared to CIN group at 48 h following CIN induction. A significant decline in the levels of MMP-2, MMP-9, KIM-1 and Cys-C compared to CIN group was observed. These results provide emerging evidence that VAR and AVA may have the potential to prevent CIN. [ABSTRACT FROM AUTHOR]

Phosphodiesterase (PDE) inhibitors – such as vardenafil – are used primarily for treating erectile dysfunction via increasing cyclic guanosine monophosphate (cGMP) levels. Recent studies have also demonstrated their significant cardioprotective effects in several diseases, including diabetes, upon long-term, continuous application. However, PDE inhibitors are not specific for PDE5 and also inhibit the retinal isoform. A sustained rise in cGMP in photoreceptors is known to be toxic; therefore, we hypothesized that long-term vardenafil treatment might result in retinotoxicity. The hypothesis was tested in a clinically relevant animal model of type 2 diabetes mellitus. Histological experiments were performed on lean and diabetic Zucker Diabetic Fatty rats. Half of the animals were treated with vardenafil for six months, and the retinal effects were evaluated. Vardenafil treatment alleviated rod outer segment degeneration but decreased rod numbers in some positions and induced changes in the interphotoreceptor matrix, even in control animals. Vardenafil treatment decreased total retinal thickness in the control and diabetic groups and reduced the number of nuclei in the outer nuclear layer. Müller cell activation was detectable even in the vardenafil-treated control animals, and vardenafil did not improve gliosis in the diabetic group. Vardenafil-treated animals showed complex retinal alterations with improvements in some parameters while deterioration in others. Our results point towards the retinotoxicity of vardenafil, even without diabetes, which raises doubts about the retinal safety of long-term continuous vardenafil administration. This effect needs to be considered when approving PDE inhibitors for alternative indications. • The toxicity of long-term continuous vardenafil administration was studied. • Vardenafil-treated animals showed deterioration of some retinal parameters. • Our results raise doubts about the retinal safety of long-term application. [ABSTRACT FROM AUTHOR]

Background and objectives: Taking into consideration the confirmed role of oxidative stress in ischemia/reperfusion injury and the insufficiency in knowledge regarding the phosphodiesterase 5 (PDE5)-mediated effects on the cardiovascular system, the aim of our study was to investigate the influence of two PDE5 inhibitors, tadalafil and vardenafil, with or without the addition of N(G)-nitro-L-arginine methyl ester (L-NAME), on oxidative stress markers, coronary flow and left ventricular function, both ex vivo and in vivo. Methods: This study included 74 male Wistar albino rats divided into two groups. In the first, 24 male Wistar rats were orally treated with tadalafil or vardenafil for four weeks in order to perform in vivo experiments. In the second, the hearts of 50 male Wistar albino were excised and perfused according to the Langendorff technique in order to perform ex vivo experiments. The hearts were perfused with tadalafil (10, 20, 50 and 200 nM), vardenafil (10, 20, 50 and 200 nM) and a combination of tadalafil/vardenafil and L-NAME (30 μM). The CF and oxidative stress markers, including nitrite bioaviability (NO2−), superoxide anion radical (O2−), and the index of lipid peroxidation, were measured in coronary effluent. Results: The L-arginin/NO system acts as the mediator in the tadalafil-induced effects on the cardiovascular system, while it seems that the vardenafil-induced increase in CF was not primarily induced by the NO system. Although tadalafil induced an increase in O2− in the two lowest doses, the general effects of both of the applied PDE5 inhibitors on oxidative stress were not significant. The ejection function was above 50% in both groups. Conclusions: Our results showed that both tadalafil and vardenafil improved the coronary perfusion of the myocardium and LV function by increasing the EF.

Oral, quick response, and on demand, also known as a spontaneous oral treatment for erectile dysfunction, is highly needed by both patients and physicians. Vardenafil is selective (fewer side effects) and more effective in difficult-to-treat conditions than sildenafil. This study aims at fostering the dual objectives of using biomolecules such as artificial sweetening agents to solubilize and mask the bitterness of vardenafil loaded on biodegradable polymeric materials (PVA, MC, SA, and PVP K30) to fabricate oral, fast-dissolving films (vardenafil ODFs) in the mouth without the need for water to ingest the dosage form. Furthermore, coprecipitated-dispersed mixtures of vardenafil and three sweeteners (sorbitol, acesulfame K, and sucralose) were prepared and characterized using FTIR, DSC, and solubility studies. Moreover, eight different vardenafil ODFs were prepared using the solvent-casting method. Modified gustatory sensation test, in vitro disintegration, and release studies were performed. In addition, the optimized ODF (F8) was compared with the commercial film-coated tablets pharmacokinetically (relative bioavailability, onset, and duration of actions were estimated). The results indicated that the three sweetening agents had comparable solubilizing capacity. However, both sucralose- and acesulfame K-based ODFs have a more enhanced sweet and palatable taste than sorbitol-sweetened ODF. The SA- and PVP K30-based ODFs showed significantly faster disintegration times and release rates than MC. In conclusion, PVA has good film-forming properties, but a higher ratio of PVA adversely affected the disintegration and release characteristics. The % relative bioavailability for ODF was 126.5%, with a superior absorption rate constant (Ka) of 1.2-fold. The Cmax and estimated Tmax were compared to conventional film-coated tablets. [ABSTRACT FROM AUTHOR]

Comparative study was made between three designs of vardenafil ion (Vr)-selective electrodes: a poly vinyl chloride (PVC) membrane (liquid inner contact) called electrode A, copper-coated (solid contact) called electrode B and a modified carbon paste electrode (CPE) called electrode C based on vardenafil - tetraphenylborate (Vr-TPB) as ion-exchanger complex. Electrode A has a linear dynamic range from 4.5X10-6 – 1.0X10-2 ​M, with a Nernstian slope of 51.8 mV/ decade and a detection limit of 1.6X10-6 ​M. Electrode B shows linearity over the concentration range from 8.0X10-6 - 1.0X10-2, with a Nernstian slope of 55.8 ​mV/decade and a limit of detection of 4.3X10-6 ​M. Electrode C exhibits linearity over the concentration range from 8.0X10-6 - 1.0X10-2 ​M, with a Nernstian slope of 61.3 mV/decade and a limit of detection of 4.0X10-6 ​M. These sensors exhibited a fast response time (about 2 ​s) and good stability. Selectivity coefficients, determined by modified separate solution method (MSSM) and separate solution method (SSM), showed high selectivity for vardenafil hydrochloride (VrCl) over a large number of inorganic cations, organic cations, sugars, urine components, and some common drug excipients. The proposed sensors were applied for determination of VrCl in tablets and in spiked urine samples using potentiometric determination and the calibration curve methods. The results obtained were satisfactory with excellent percentage recovery comparable and sometimes better than those obtained by other routine methods for the assay. The CPE is more suitable for commercialization owing to its attractive properties. [ABSTRACT FROM AUTHOR]

Nowadays bioanalytical techniques including liquid and gas chromatography combined with different types of detectors are largely introduced in a practice. They are largely used for detection and control of substances and for monitoring of the whole production process. The type of detector depends on necessary levels of detection, but also on the matrix where aimed compounds have to be determined. Herein are summarized data from the last ten years related to determination of six main prohibited substances sildenafil, tadalafil, vardenafil, dapoxetine, yohimbine and sibutramine as well as their derivatives in food supplements using high performance liquid chromatography combined with mass spectrometric or UV detection. All these compounds are in a large interest because they are introduced often in products freely distributed in the internet market. [ABSTRACT FROM AUTHOR]

Abstract Background Urolithiasis is considered one of the most common diseases in urological practice. Its prevalence is about 1% to 15% with 30 years old as the peak age of incidence. Medical expulsive therapy (MET) has been used as a conservative treatment for patients with ureteral stones. Nitrergic fibers have been identified to have a relaxant effect on the distal ureteral smooth musculature. The objective of our study was to evaluate the efficacy and safety of the combination of silodosin and vardenafil as a medical expulsive therapy in comparison with each drug alone. Methods One hundred and two male patients with uncomplicated distal ureteric stone 6–10 mm were enrolled in the study. The patients were randomly divided into 3 equal groups, and each one consists of 34 patients. Group I received silodosin 8 mg once daily, group II vardenafil 5 mg once daily and group III combination of silodosin 8 mg and vardenafil 5 mg once daily. The treatment was given for all the patients until stone expulsion or a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and the secondary endpoints were time to stone expulsion, number of hospital visits for pain, amount of analgesic required and side effects associated with MET. Results Our study showed that the stone expulsion rate was higher in combination = 90.0% than silodosin = 76.7% and vardenafil groups = 60.0% (P = 0.025), the time to stone expulsion was significantly shorter in combination = 11.23 ± 3.14 than silodosin = 12.50 ± 1.66 and vardenafil groups 14.67 ± 1.24 days (P

The maternal innate immune system plays a central role in preeclampsia (PE). Toll-like receptors (TLRs) are innate immune system receptors that recognize characteristics of extracellular endogenous ligands or pathogens, and their activation leads to a pro-inflammatory immune response. We and others have reported that excessive activation of TLRs causes pregnancy-dependent hypertension in animals and is associated with PE in women. Activation of TLR3 by poly I:C mimics the innate immune system activation by viruses that women who develop PE encounter during pregnancy. Vardenafil was approved by the FDA for erectile dysfunction but has recently been examined as a potential PE medication due to studies done with a similar drug, sildenafil. Preclinical as well as recent clinical studies demonstrate the potential effectiveness of sildenafil for PE. However, vardenafil is more potent than sildenafil and acts by increasing expression of placental growth factor in addition to increasing cGMP levels. We hypothesized that vardenafil will be more potent and effective in reducing the negative health effects in a mouse model of virus-induced PE. Pregnant mice were injected with the TLR3 agonist poly I:C (PPIC) on gestational days 13, 15, and 17. We treated PPIC mice with a high dose of vardenafil (50 mg human equivalent), a lower dose of vardenafil (20 mg human equivalent), or sildenafil (50 mg human equivalent) on gestational days 15–17 after hypertension was established. Daily i.p. injections of either high dose or low dose vardenafil significantly decreased systolic blood pressure in PPIC mice whereas sildenafil had no effect. There were no differences in body weight between the groups. The splenomegaly induced in PPIC mice was ameliorated in high dose vardenafil-treated PPIC mice, while low dose vardenafil-treated and sildenafil-treated PPIC mice still exhibited splenomegaly. High dose vardenafil-treated PPIC mice also did not exhibit any fetal demise characteristic of PPIC mice, while low dose vardenafil-treated and sildenafil-treated PPIC mice still had significantly increased incidences of fetal demise. These data support the notion that high dose vardenafil may be safe and effective at reducing blood pressure during a virus-associated hypertensive pregnancy.

Vardenafil (VDF) is a relatively new phosphodiesterase-5 inhibitor that has limited oral bioavailability (≈15%). The objective of this study was to develop bilosome-based mucoadhesive buccal sponge for augmenting the oral bioavailability of VDF. VDF-loaded bilosomes were fabricated and optimized using a Box-Behnken design. The optimized VDF-loaded bilosomal formulation was assessed for surface morphology, particle size, thermal characteristics, and in vitro release. Afterwards, the optimized bilosomal formulation was incorporated into a cellulose-based matrix to obtain buccal sponge, which was evaluated for ex vivo permeation studies, in vivo oral bioavailability, and in vivo serum concentration of cyclic guanosine monophosphate (cGMP). The mean particle size and entrapment efficiency (%) of optimized bilosome formulation were 282.6 ± 9.5 nm and 82.95 ± 3.5%, respectively. In vitro release studies at pH 6.8 emphasized the potential of optimized bilosomal formulation to sustain VDF release for 12 h. Ex vivo permeation study using sheep buccal mucosa indicated significant enhancement in penetration of VDF from bilosomal buccal sponge compared to plain VDF gel. Pharmacokinetic study in Albino rats showed ~5 fold increase in relative bioavailability with bilosomal buccal sponge, compared to VDF suspension. In addition, VDF-loaded bilosomal buccal sponge triggered higher serum levels of cGMP, a biomarker of VDF in vivo efficacy, compared to oral VDF suspension. To sum up, bilosomes might represent a potential nanocarrier for buccal delivery of VDF, enhancing its oral bioavailability and therapeutic efficacy.

[Display omitted] Irritable bowel syndrome (IBS); a widespread disorder in gastrointestinal tract especially in children, burdens their healthcare systems and upsets families. Great attention was paid to understand the pathophysiological cause of disorder. However, developing a convenient treatment especially for children remains a challenge. Phosphodiesterase inhibitors were recently introduced for IBS management. Vardenafil (VDF), a phosphodiesterase-5 inhibitor, exhibiting limited bioavailability when taken orally due to extensive first-pass effect, was the choice for study. This study aimed to formulate VDF jellies as a buccal dosage form to improve pediatric compliance and achieve maximum drug efficacy. VDF oral jellies were prepared by heat and congeal method, and were evaluated for their pH, content uniformity, physical stability, general appearance, and in-vitro drug release. VDF jellies (F1), with satisfactory organoleptic properties and highest percent of drug released compared to other formulations was selected as a master formula for further study to ensure in-vivo efficacy. cyclic Guanosine Mono Phosphate (cGMP), used as indicator of VDF concentration in blood, was highly increased after administration of VDF jellies (F1), compared to oral VDF suspension. Increased defecation with improved fecal consistency strongly favored oral jellies as a potential alternative route for VDF for IBS management with high pediatric acceptance. [ABSTRACT FROM AUTHOR]

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Background: RT234 (vardenafil inhalation powder) is being developed for pulmonary administration "as needed", to acutely improve exercise tolerance and symptoms in patients with pulmonary arterial hypertension (PAH). Methods: This single-center, open-label, randomized study in 32 healthy adult subjects evaluated single and multiple inhalation doses of RT234, for safety, tolerability, and pharmacokinetics (PKs). Results: RT234 was generally safe and well tolerated at single doses of 0.2–2.4 mg and after repeated dose administration of up to 2.4 mg q4h for four doses daily for 9 days. The most common treatment-emergent adverse events were mild-to-moderate headaches. There was no evidence of pulmonary irritation or inflammation. Vardenafil was absorbed very rapidly after inhalation as RT234, independent of dose level and number of doses administered. The tmax occurred at the time that the first blood sample following completion of dosing. After Cmax was achieved, plasma vardenafil concentrations declined rapidly in an exponential fashion that appeared to be parallel among dose levels. Vardenafil plasma concentrations and PK parameters increased in a dose-proportional manner. Vardenafil systemic exposure was notably greater after oral administration of 20 mg vardenafil tablets (Levitra®) than after administration of any dose level of RT234. During repeated dose administration of RT234, Cmax was attained rapidly following each dose and in a pattern similar to that observed after single-dose administration. Minor accumulation, characterized by very low mean morning predose vardenafil concentrations (<0.5 ng/mL), occurred after q4h dosing of up to four doses per day for 9 days. Taken together, these findings show that no clinically important vardenafil accumulation is likely after repeated-dose administration of RT234. Mean vardenafil t1/2 values were comparable after single- and repeated-dose administration. Conclusions: Comparative plasma vardenafil bioavailability data from this study provide scientific justification for reliance on Food and Drug Administration findings for Levitra tablets. These findings support further evaluation of RT234 for as-needed treatment of patients with PAH. The Clinical Trials Registration number is ACTRN12618001077257. [ABSTRACT FROM AUTHOR]