Explore the vast range of titles available.

A new drug combination of phenylephrine hydrochloride (PHE) and doxylamine succinate (DOX) has been introduced for treating allergic rhinitis. Stability testing is critical for uncovering degradation routes and assessing the stability of combined drugs. This study illustrates the application of two eco-friendly chromatographic techniques which are reversed phase high-performance liquid chromatography (RP-HPLC) and high-performance thin-layer chromatography (HPTLC), for assessing PHE and DOX when DOX oxidative degradation product (DOX DEG) is present. Using liquid chromatography- mass spectroscopy to identify DOX DEG. The HPLC method produced the best separation with isocratic elution and a mobile phase consists of ethanol and 0.01 M phosphate buffer pH = 5.0 (30: 70, v/v), and it was pumped at 1.0 mL/min. The analytes were measured at 260.0 nm using diode array detector (DAD), and the Xterra C 18 column (100 mm × 4.6 mm × 5 m) used as a stationary phase. The method demonstrated a linear response for DOX and PHE across a concentration range of 5.00 to 100.00 µg/mL. The range for DOX DEG was 5.00 to 30.00 µg/mL. The limits of detection (LOD) were determined to be 1.44 for DOX, 1.59 for PHE, and 0.84 µg/mL for DOX DEG. Correspondingly, the limits of quantification (LOQ) were 4.32, 4.77, and 2.52 µg/mL for DOX, PHE, and DOX DEG, respectively. The separation in HPTLC was accomplished by combining ethanol, methylene chloride, and ammonia 30% in ratio 7:2.5:0.5 (v/v/v) as a developing system. The drugs were then quantitatively determined at wavelengths of 260.0 nm using UV detector. The linearity range was 4.00–26.00 (µg/band) for DOX and PHE while it was 0.50–10.00 (µg/band) for DOX DEG. Values of LOD were 0.65 ,0.76 and 0.16 µg/band for PHE, DOX, DOX DEG, respectively. While1.95,2.28 and 0.48 µg/band were values of LOQ. Per ICH guidelines, two analytical methods were validated and proven to be reliable, reproducible, and selective. Additionally, sustainability assessments confirmed their green credentials and practical applicability.

The authors present 3 cases that demonstrate a return to DFC following periods of inactivity. The offences occurred in Paris and its suburbs and in each of the cases there were two distinct periods of activity by the offenders with 2, 8 and 22 victims attributed to each of the perpetrators. To 20 mg of decontaminated and cut hair, 100 pg/mg of clonazepam-d4 was added as internal standard. Hair specimens were extracted with CH 2Cl 2/ether after incubation overnight at 56 °C in pH 7.6 buffer. Extractions were performed on blood and urine using Toxi-tube A ® with 5 ng/mL of clonazepam-d4. The residues were analyzed by LC–ESI-MS/MS. Calibration curves in blood and urine (0.5–500 ng/mL) were prepared by spiking aliquots of blank fluids ( r 2 > 0.9816 for all drugs). LOD in body fluids ranged 0.5–10 ng/mL. Calibration curves in hair (0.5–100 pg/mg) were prepared by spiking aliquots of blank hair ( r 2 > 0.9877 for all drugs). LOD in hair ranged 0.5–5 pg/mg. Case #1: Two young women were raped with an interval of approximately 1 year between the incidents. Lorazepam (present, <2 pg/mg) was detected in hair obtained from the first victim, and zolpidem (19 pg/mg) in hair of the second one. The offender was in jail between the two offences. Case #2: The offender approached a total of 8 men and women who were aged over 50 years. The offender was in jail between the two series of respectively 3 and 5 victims. Zopiclone was detected in victims’ hair ( n = 7) at concentrations 13–42 pg/mg. Case #3: The offender stole thousands of Euros using credit cards obtained from 22 different wealthy victims. He employed a cocktail of up to 6 drugs made up of: flunitrazepam, clonazepam, doxylamine, cyamemazine, zolpidem and lorazepam. Drugs were detected in all victims’ hair ( n = 18) at concentrations in the range 1–81 pg/mg for all drugs. Between the two series (of respectively 4 and 16 victims) the offender spent 6 months in jail, and then police spent 6 months looking for him while he was under judiciary control prior to his judgment. Segmental hair analysis permits retrospective information on drug exposure and should be considered in the investigation of drug-facilitated crimes not only to prove single exposure but also when there has been any appreciable delay in samples being obtained for analysis. Indeed, in 56% cases reported in this paper, due to the long time that elapsed between offences and the opportunity to obtain samples for analysis hair analysis was considered the only viable matrix to investigate the possibility of drug involvement in the crimes. Our experience demonstrates that the incidence of re-offending in DFC after a period of inactivity (often due to imprisonment) may be of concern, notably in big cities.

Doxylamine is an antihistamine of the ethanolamine class. It is used primarily as a sleep-inducing agent. Only a few reports can be found in the literature about lethal intoxications with doxylamine, but many with combined intoxications. Doxylamine is, aside from diphenhydramine, the only chemically defined active ingredient in some sleeping medications which is available without a prescription in the Federal Republic of Germany. Two cases of doxylamine poisoning are presented, in which high doxylamine concentrations were found in the blood and organs. Doxylamin, ein Antihistaminikum vom Ethanolamin-Typ wird hauptsächlich als schlaf-induzierendes Medikament genutzt. Neben Diphenhydramin ist es der einzige chemisch definierte Wirkstoff, der in der Bundesrepublik als Schlafmittel rezeptfrei zu erhalten ist. In der forensischen Literatur finden sich wenig Darstellungen über reine Doxylaminintoxikationen, häufiger werden Kombinationsvergiftungen beschrieben. Es sollen zwei Fälle vorgestellt werden, bei denen besonders die extrem hohen Doxylaminkonzentrationen bemerkenswert sind.

The SeDeM-ODT expert system is designed to assess the suitability of the pharmaceutical ingredients for their conversion into an orodispersible formulation by direct compression. The tool can be utilized to select the most appropriate excipients that improve the compressibility and buccodispersibility of the formulation. This study aimed to utilize the SeDeM-ODT expert system to evaluate the performance of superdisintegrants and select an appropriate superdisntegrant for Doxylamine Succinate orodispersible formulation. The SeDeM-ODT expert system scrutinized the excipients to develop an orodispersible Doxylamine Succinate formulation. Among the 15 parameters of the tool, some of them were determined through experimental work, while the remaining were calculated through the experimental values of other parameters. The central composite design approach was used for formulation development. The prepared powder blends were compressed using the direct compression method and evaluated for different parameters (hardness, thickness, diameter, friability, weight variation, water absorption ratio, wetting time, and disintegration time). The results of the SeDeM-ODT expert system were correlated with the values obtained by the post-compression tests. The Crospovidone formulation (F7) was found to be an optimized formulation as it disintegrated quickly compared with the other formulations containing other superdisintegtrants. The results perfectly endorsed the SeDeM-ODT expert system evaluation, as Crospovidone showed the highest IGCB value of 6.396. The study observed the effectiveness of the expert system in accurately examining the performance of disintegrating agents. The study observed the effectiveness of the expert system in accurately examining the performance of disintegrating agents. The assessment proved Crospovidone to produce quicker disintegration in Doxylamine Succinate orodispersible formulation.

To the Editor: Dr. Fleckenstein, reporting on a case of acute hepatic necrosis and Nyquil (July 4 issue),* stated that this product contains, among other ingredients, promethazine. According to the 1985 Physician's Desk Reference for Nonprescription Drugs , Nyquil contains acetaminophen, doxylamine succinate, pseudoephedrine hydrochloride, and dextromethorphan hydrobromide. It also contains alcohol and tartrazine. Promethazine is not listed as one of the ingredients. We would also like to point out that promethazine is a prescription product and is unlikely to be found in over-the-counter remedies. Unfortunately, errors such as this one are perpetuated in computerized data bases. No extract is available for articles shorter than 400 words.

We report information about an unpublished 1970s study (\"8-way\" Bendectin Study) that aimed to evaluate the relative therapeutic efficacy of doxylamine, pyridoxine, and dicyclomine in the management of nausea and vomiting during pregnancy. We are publishing the trial's findings according to the restoring invisible and abandoned trials (RIAT) initiative because the trial was never published. Double blinded, multi-centred, randomized placebo-controlled study. 14 clinics in the United States. 2308 patients in the first 12 weeks of pregnancy with complaints of nausea or vomiting were enrolled. Each patient was randomized to one of eight arms: placebo, doxylamine/pyridoxine/dicylcomine, doxylamine/pyridoxine, dicylomine/pyridoxine, doxylamine, dicyclomine/pyridoxine, pyridoxine and dicyclomine. Each patient was instructed to take 2 tablets at bedtime and 1 additional tablet in the afternoon or morning if needed, for 7 nights. Reported outcomes included the number of hours of nausea reported by patients, the frequency of vomiting reported by patients and the overall efficacy of medication as judged by physicians. Data from 1599 (69% of those randomized) participants were analyzed. Based on the available summary data of physician evaluation of symptoms and ignoring missing data and data integrity issues, the proportion of participants who were \"evaluated moderate or excellent\" was greater in each of the seven active treatment groups when compared with placebo (57%): doxylamine/pyridoxine/dicylcomine (14% absolute difference versus placebo; 95% CI: 4 to 24), doxylamine/pyridoxine (21; 95% CI 11 to 30), dicylomine/pyridoxine (21; 95% CI 11 to 30), doxylamine (20; 95% CI 10 to 29), dicyclomine/pyridoxine (4; 95% CI -6 to 14), pyridoxine (9; 95% CI -1 to 19) and dicyclomine (4; 95% CI -6 to 14). Based on incomplete information, the most common adverse events were apparently drowsiness and fatigue. There is a high risk of bias in these previously unpublished results given the high attrition rate in a 7 day trial, the lack of prespecified outcomes or analyses, and the exclusion of some data because of questionable data integrity. The available information about this \"8-way Bendectin\" trial indicates it should not be used to support the efficacy of doxylamine, pyridoxine or dicyclomine for the treatment of nausea and vomiting during pregnancy because of a high risk of bias. Not registered.

The aim of the study was to quantify the risk of major congenital malformations (MCM) associated with first-trimester exposure to antiemetics. Using the Quebec Pregnancy Cohort (1998–2015), first-trimester doxylamine–pyridoxine, metoclopramide, and ondansetron exposures were assessed for their association with MCM. Generalized estimating equations were used to estimate odds ratios (OR), adjusting for potential confounders (aOR). Within 17 years of follow-up, the prevalence of antiemetic use during pregnancy increased by 76%. Within our cohort, 45,623 pregnancies were exposed to doxylamine–pyridoxine, 958 to metoclopramide, and 31 to ondansetron. Doxylamine–pyridoxine and metoclopramide use were associated with an increased risk of overall MCM (aOR 1.07, 95% confidence interval [CI]: 1.03–1.11; 3,945 exposed cases) and (aOR 1.27, 95% CI: 1.03–1.57; 105 exposed cases), respectively. Doxylamine–pyridoxine exposure was associated with increased risks of spina bifida (aOR 1.87, 95% CI: 1.11–3.14; 23 exposed cases), nervous system (aOR 1.25, 95% CI: 1.06–1.47; 225 exposed cases), and musculoskeletal system defects (aOR 1.08, 95% CI: 1.02–1.14; 1,735 exposed cases). Metoclopramide exposure was associated with an increased risk of genital organ defects (aOR 2.26, 95% CI: 1.14–4.48; 10 exposed cases). No statistically significant association was found between ondansetron exposure and the risk of overall MCM. First-trimester doxylamine–pyridoxine and metoclopramide exposure was associated with a significantly increased risk of overall and specific MCM.

Doxylamine-pyridoxine is recommended as a first line treatment for nausea and vomiting during pregnancy and it is commonly prescribed. We re-analysed the findings of a previously reported superiority trial of doxylamine-pyridoxine for the treatment of nausea and vomiting during pregnancy using the clinical study report obtained from Health Canada. We re-analysed individual level data for a parallel arm randomized controlled trial that was conducted in six outpatient obstetrical practices in the United States. Pregnant women between 7 and 14 weeks of gestation with moderate nausea and vomiting of pregnancy symptoms. The active treatment was a tablet containing both doxylamine 10 mg and pyridoxine 10 mg taken between 2 and 4 times per day for 14 days depending on symptoms. The control was an identical placebo tablet taken using the same instructions. The primary outcome measure was improvement in nausea and vomiting of symptoms scores using the 13-point pregnancy unique quantification of emesis scale between baseline and 14 days using an ANCOVA. 140 participants were randomized into each group. Data for 131 active treatment participants and 125 control participants were analysed. On the final day of the trial, 101 active treatment participants and 86 control participants provided primary outcome measures. There was greater improvement in symptoms scores with doxylamine-pyridoxine compared with placebo (0.73 points; 95% CI 0.21 to 1.25) when last observation carried forward imputation was used for missing data but the difference is not statistically significant using other approaches to missing data (e.g. 0.38; 95% CI -0.08 to 0.84 using complete data). There is a trend towards efficacy for nausea and vomiting symptoms with doxylamine-pyridoxine compared with placebo but the statistical significance of the difference depends on the method of handling missing data and the magnitude of the difference suggests that there is no clinically important benefit employing the prespecified minimal clinically important difference or \"expected difference\" of 3 points. Clinical Trial NCT00614445.

Background Nausea and vomiting of pregnancy (NVP) affects up to 80% of expecting mothers. In April 2013 the FDA approved the delayed-release combination of doxylamine succinate and pyridoxine hydrochloride (Diclegis®) for NVP, based in part, on the results of a phase III randomized trial demonstrating the efficacy of this drug combination [study drug marketed under the trade name Diclectin® in Canada and Diclegis® in the United States] compared to placebo in pregnant women. Study drug dosing occurred for 14 days, which is substantially longer than what has been performed in similar studies. The objective of this study was to evaluate, through secondary analysis, whether the primary measure of efficacy can be demonstrated after five days of treatment. Methods Women suffering from NVP were randomized to receive Diclegis® ( n  = 131) or placebo ( n  = 125) for 14 days at doses ranging from two to four tablets a day, based on a pre-specified titration protocol. The primary efficacy endpoint was the change in the validated Pregnancy-Unique Quantification of Emesis (PUQE) score at baseline versus Day 15 between Diclegis®-treated and placebo-treated women. For the present study, the change in PUQE score between baseline and Day 15 (end of the study) was compared to the changes observed for Days 3, 4, and 5. Results The use of delayed-release doxylamine succinate and pyridoxine hydrochloride tablets show improved NVP symptom control as compared to placebo on Days 3,4 and 5, with sustained efficacy until the end of the trial. Conclusion A four day study drug dosing trial with Diclegis® is sufficient to document efficacy, as the results are similar to those achieved after 14 study drug dosing days. The benefit seen at the earlier time validates drug efficacy and minimizes the natural course of improvement. Trial registration CTR No. NCT006 14445 2007.