Controlled Drug Release from Gels Using Surfactant Aggregates. II. Vesicles Formed from Mixtures of Amphiphilic Drugs and Oppositely Charged Surfactants

Purpose. The aim of this study was to control the release of charged drugs from gels by adding surfactants that can interact with the drug and polymer matrix. Methods. The in vitro release from gels was measured by using 6-mL gel holders immersed in 250 mL of simulated tear fluid and detecting the ultraviolet absorbance on-line. Gels were characterized by using a controlled rate rheometer, and surfactant aggregates were characterized by using cryo-transmission electron microscopy. Results. The diffusion coefficient of alprenolol was 2.8 · 10^–6 cm²/s in a lipophilically modified poly(acrylic acid) gel without surfactants present and 0.14 · 10^–6 cm²/s when formulated with 1% sodium dodecyl sulfate. For fluvastatin, the diffusion coefficient changed from 3.0 · 10^–6 cm²/s to 0.07 · 10^–6 cm²/s in the presence of 0.2% benzyldimethyldodecyl-ammonium bromide. Alprenolol, betaxolol, metoprolol, diphenhydramine, and fluvastatin formed vesicles with oppositely charged surfactants in physiologic salt conditions. Conclusions. In this article we show that it is feasible to control the release of charged drugs from gels by using surfactants. Vesicles are generally formed when surface active drugs are mixed with oppositely charged surfactants in physiologic conditions. The strongest effects on the release rate are seen for lipophilically modified polymer gels in which the drug and the oppositely charged surfactant form vesicles, but systems with micelles also give a slower release.     

Antimuscarinic activity of oxybutynin in the human plasma quantitated by a radioreceptor assay

The antimuscarinic activity of oxybutynin was measured as oxybutynin equivalents by a radioreceptor assay (RRA). The activity was studied in plasma samples of five volunteers after a single oral dose (10 mg) or after a single intravenous dose (28 micrograms/kg) of oxybutynin hydrochloride. The results were compared to the concentrations of the drug measured by gas liquid chromatography (GLC). Following oral administration, the maximum concentration measured by RRA was significantly higher (706 nmol/l) than that by GLC (38 nmol/l). In contrast, equal concentrations were measured after intravenous administration by both methods. Metabolites with antimuscarinic activity are possibly formed through first-pass metabolism after orally administered oxybutynin. The total antimuscarinic activity of oxybutynin and its metabolites are measured by RRA, but only the parent drug by GLC.     

New insights in the metabolism of oxybutynin: evidence of N-oxidation of propargylamine moiety and rearrangement to enaminoketone

1. Oxybutynin hydrochloride is an antimuscarinic agent prescribed to patients with an overactive bladder (OAB) and symptoms of urinary urge incontinence. Oxybutynin undergoes pre-systemic metabolism, and the N-desethyloxybutynin (Oxy-DE), is reported to have similar anticholinergic effects.

2. We revisited the oxidative metabolic fate of oxybutynin by liquid chromatography–tandem mass spectrometry analysis of incubations with rat and human liver fractions, and by measuring plasma and urine samples collected after oral administration of oxybutynin in rats. This investigation highlighted that not only N-deethylation but also N-oxidation participates in the clearance of oxybutynin after oral administration.

3. A new metabolic scheme for oxybutynin was delineated, identifying three distinct oxidative metabolic pathways: N-deethylation (Oxy-DE) followed by the oxidation of the secondary amine function to form the hydroxylamine (Oxy-HA), N-oxidation (Oxy-NO) followed by rearrangement of the tertiary propargylamine N-oxide moiety (Oxy-EK), and hydroxylation on the cyclohexyl ring.

4. The functional activity of Oxy-EK was investigated on the muscarinic receptors (M_1-3) demonstrating its lack of antimuscarinic activity.

5. Despite the presence of the α,β-unsaturated function, Oxy-EK does not react with glutathione indicating that in the clearance of oxybutynin no reactive and potentially toxic metabolites were formed.     

Pharmacological effects of darifenacin on human isolated urinary bladder

Darifenacin [(S)-2--2,2-diphenylacetamide] is a novel antimuscarinic drug currently undergoing phase III trials for the treatment of overactive bladder. We investigated the functional antagonist potency of darifenacin, and the antimuscarinic drugs propiverine, oxybutynin and atropine, on human detrusor smooth muscle. Urinary bladder specimens were obtained from 20 patients who underwent total cystectomy for malignant bladder tumor. Using an organ-bath technique, the effects of the compounds on carbachol-, KCl-, CaCl(2)- or electrical field stimulation (EFS)-induced contractions of the tissues were evaluated. The order of antagonist potency (pA(2 )values) at the muscarinic M(3) receptors was: darifenacin (9.34) > atropine (9.26) > oxybutynin (7.74) > propiverine (7.68). Darifenacin and atropine, at concentrations up to 10(-6) mol/l, did not inhibit the KCl- and CaCl(2)-induced contractions (concentrations 80 and 5 mmol/l, respectively), while propiverine and oxybutynin (10(-5) mol/l) significantly inhibited these contractions. Pretreatment with darifenacin (10(-9)-10(-6) mol/l), propiverine (10(-8)- 10(-5) mol/l), oxybutynin (10(-8)-10(-5) mol/l) and atropine (10(-9)-10(-6) mol/l) significantly inhibited maximum EFS-induced contractions. Darifenacin inhibited contractions of human detrusor smooth muscle only through its antimuscarinic action, while propiverine and oxybutynin had both antimuscarinic and Ca(2+) channel antagonist actions. These findings indicate that darifenacin is a potent antagonist at the M(3) receptor and support its use as a treatment for overactive bladder.     

Nanostructured liquid-crystalline particles for drug delivery

Introduction: Nanostructured lyotropic liquid crystal particles (LLC NPs) have proven to be extremely useful tools for applications in drug delivery. These structured nanoparticles are formed by amphiphilic molecules and contain internal water channels, which are not in contact with external water, and where polar drugs can situate; on the other hand, apolar drugs can be loaded in the lipophilic part of the structure and the amphiphilic drugs can locate at the polar/apolar interfaces.

Areas covered: A revision of the most relevant results published in the field of LLC NPs has been made. The first section discusses the most common compounds used in these nanoparticles and their preparation and characterization. A summary of recent and relevant results including the composition and type of nanoparticles used, the illness treated, the administration via and some special features in each case have been summarized in a table.

Expert opinion: LLC NPs are highly versatile drug delivery systems, which can be applied by topical, oral and intravenous treatments. Especially relevant is their use for the release of anticancer drugs, biomolecules and vaccines. Nevertheless a number of critical points need to be solved in order to attain practical applications.     

盐酸羟考酮缓释片体外一致性评价研究

目的 建立盐酸羟考酮缓释片释放曲线测定方法和有关物质检测方法,评价自制制剂和原研制剂释放曲线的相似性和有关物质杂质谱的一致性。方法 用4种释放介质[水、盐酸（pH 1.2）、乙酸盐缓冲液（pH 4.0）和磷酸盐缓冲液（pH 6.8）]分别考察自制盐酸羟考酮缓释片和原研制剂的释放情况,并通过计算相似因子（f₂）评价溶出曲线的相似性;优化有关物质检查色谱条件,使14-羟可待因酮、氢可酮达到基线分离,对比研究自制盐酸羟考酮缓释片与原研制剂的有关物质,进行杂质谱研究。结果 自制制剂与原研制剂在4种释放介质中释放曲线的f₂均>50,表明2种制剂体外释放行为相似,且两者的有关物质杂质谱基本一致,表明2种制剂质量基本一致。结论 建立的释放曲线、有关物质测定方法准确、可靠,可为盐酸羟考酮缓释片的仿制药一致性评价提供参考。     

Characterization of the effects of drug addition on the structure of glyceryl monoolein/water gel systems using low frequency dielectric spectroscopy.

The influence of propantheline bromide incorporation on the phase structure of glyceryl monoolein/water systems has been investigated using low-frequency dielectric spectroscopy over a frequency range of 10(-2) to 10(6) Hz at 20 degrees C. The responses of glyceryl monoolein systems composed of 10% and 30% w/w were measured and the spectra modeled using an equivalent circuit based on the Maxwell-Wagner theory.1,2 Marked changes in the dielectric responses of the systems were noted on addition of the propantheline bromide at concentrations up to 10% w/w. For the lamellar (10% w/w water) glyceryl monoolein systems, an increase in the imaginary permitivity was seen, corresponding to an increase in conductivity due to the presence of additional ionic species within the system. Evidence was also obtained for the incorporation of the drug directly into the lipid bilayers, particularly at higher concentrations (10% drug) at which dielectric behavior corresponding to bilayer disruption was seen. Incorporation of 3% and 5% w/w drug into the cubic phase systems (30% w/w water) resulted in a change to the lamellar phase. However, circuit modeling indicated that the system formed structures which showed features of both the lamellar and cubic phases at 3% w/w drug loadings. The study has therefore demonstrated that dielectric analysis may provide a novel means of studying the effects of drug incorporation on the phase behavior of complex gel systems.     

Itraconazole moderately increases serum concentrations of oxybutynin but does not affect those of the active metabolite

Objective: Oxybutynin has low oral bioavailability due to an extensive presystemic metabolism. It has been suggested that the biotransformation of oxybutynin is dependent on CYP3A. Because itraconazole, a widely used mycotic, is a potent inhibitor of CYP3A4, we wanted to study a possible interaction between oxybutynin and itraconazole. Methods: In this double-blind, randomized, two-phase cross-over study, ten healthy volunteers received either 200 mg itraconazole or placebo for 4 days. On day 4, each volunteer ingested a single dose of 5 mg oxybutynin. Serum concentrations of oxybutynin, its active metabolite N-desethyloxybutynin, and itraconazole were monitored over 24 h. Results: Itraconazole significantly increased both the area under the serum drug concentration-time curve (AUC_0–t) and the peak concentration of oxybutynin twofold. The AUC_0–t and the peak concentration of N-desethyloxybutynin were not significantly affected by itraconazole. Itraconazole did not change the peak time or the elimination half-life of either oxybutynin or N-desethyloxybutynin. The occurrence of adverse events after oxybutynin administration was not increased by itraconazole. Conclusions: Itraconazole moderately increases serum concentrations of oxybutynin, probably by inhibiting the CYP3A-mediated metabolism. However, the concentrations of N-desethyloxybutynin were practically unchanged. Since about 90% of the antimuscarinic activity of oxybutynin is attributable to N-desethyloxybutynin, any interaction of oxybutynin with CYP3A4 inhibiting drugs has only minor clinical significance. Received: 29 October 1996 / Accepted in revised form: 13 February 1997     

Pharmacokinetics of propantheline bromide in normal man

1 Six normal men were administered propantheline bromide (15 mg) in single doses intravenously, and as an oral solution in a balanced random crossover study.

2 Plasma concentrations and urinary excretion of the drug were measured after each treatment, using a stable isotope dilution assay.

3 Initial plasma concentrations of propantheline bromide ranged from 494 to 1310 ng ml^-1 3 min after the intravenous dose. Plasma levels of the drug decreased rapidly to reach concentrations of 4.5 to 27.2 ng ml^-1 4 h after dosage. A total of 17.3% (range 8.73 to 23.69%) of the intravenous propantheline bromide was eliminated by excretion in urine.

4 Pharmacokinetic analysis of these data indicated mean biological half-lives of 3.2 min (range 1.2 to 4.2 min; distribution phase) 57.9 min (range 12.6 to 106.2 min; fast elimination phase) and 2.93 h (range 2.16 to 3.69 h; slow elimination phase).

5 Total plasma clearance was calculated as 79.2 l h^-1 (range 28.1 to 137.7 l h^-1) and the renal clearance was 11.5 l h^-1 (range 6.7 to 15.7 l h^-1) demonstrating the importance of extra-renal routes in the elimination of propantheline bromide.

6 Following the oral dose of propantheline bromide plasma concentrations of the drug were at or below the precision level of the assay (5 ng ml^-1) at all times after dosage. A total of 1.08% (range 0.33 to 2.05%) of the propantheline bromide administered was excreted in urine.

7 The results of this study show that propantheline bromide was rapidly distributed and eliminated in man, and that extra-renal routes (probably metabolism) were the major pathways of elimination. Comparison of the data obtained following oral and intravenous administration indicate a low systemic availability of orally administered propantheline bromide. This may reflect the importance of the extra-renal routes of elimination in a `first-pass' effect for the drug.

     

Pharmacological effects of solifenacin on human isolated urinary bladder

To investigate the effects of solifenacin on human detrusor smooth muscles, we evaluate the effects of solifenacin on the contractions induced by carbachol, KCl, CaCl2 and electrical field stimulation (EFS), and the EFS-induced acetylcholine release from detrusor smooth muscle strips by using the muscle bath and microdialysis technique. The effects of solifenacin were also compared with effects of other antimuscarinic agents (atropine, oxybutynin and propiverine). Pretreatment with various antimuscarinic agents caused parallel shifts to the right of the concentration-response curves to carbachol. The pA2 value of the Schild plots for solifenacin was similar to that for oxybutynin. Atropine did not inhibit the KCl- and CaCl2-induced contractions, while solifenacin, oxybutynin and propiverine significantly inhibited these contractions. EFS-induced contractions were inhibited by various antimuscarinic drugs in a concentration-dependent manner. In the presence of atropine, solifenacin tended to inhibit the residual atropine-resistant contractions induced by EFS, but it was not significant. However, oxybutynin and propiverine inhibited them under the same conditions. Although pretreatment with atropine and propiverine did not cause significant changes in EFS-induced acetylcholine release, solifenacin and oxybutynin caused significant decreases in acetylcholine release. The present results suggest that solifenacin inhibits contractions of human detrusor smooth muscles mainly by the antimuscarinic action and that the high concentration of solifenacin has Ca2+ channel antagonist action. Moreover, solifenacin may block not only postjunctional receptors, but also prejunctional receptors to modulate acetylcholine releases in cholinergic nerve endings in human detrusor smooth muscles. The findings support that muscarinic-receptor-inhibitory actions in human bladder mainly contribute to the usefulness of solifenacin as a therapeutic drug for overactive bladder.     

Enhancement of Nasal Delivery of a Renin Inhibitor in the Rat Using Emulsion Formulations

Nasal absorption of O-(N-morpholino-carbonyl-3-L-phenylaspartyl-L-leucinamide of (2S,3R,4S)-2-amino-1-cyclohexyl-3,4-dihydroxy-6-methylheptane (I), a renin inhibitor, was evaluated in two rat nasal models, one involving surgery and the other requiring no surgical intervention. Oleic acid/monoolein emulsion formulations were tested along with a control PEG 400 solution. The percent absolute bioavailability of the compound was enhanced from 3–6% (PEG 400 solution) to 15–27% when the emulsion formulations were used. The different nasal model techniques (with and without surgery) did not produce any statistical difference in the absolute bioavailability values for I. Emulsion formulations did not produce appreciable damage as assessed morphologically. It is suggested that emulsion formulations containing membrane adjuvants such as oleic acid and monoolein can be used to enhance the nasal delivery of low-bioavailable, lipid-soluble drugs.____________________     

Thermally reversible xyloglucan gels as vehicles for nasal drug delivery

The aim of this study was to investigate the potential application of thermosensitive gels formed by a xyloglucan polysaccharide derived from tamarind seed for nasal drug delivery. Xyloglucan that had been partially degraded by β-galactosidase to eliminate 45% of galactose residues formed gels at concentrations of 2.5% w/w at gelation temperatures decreasing over the range 27–28°C. The in vitro release of ondansetron hydrochloride from the enzyme-degraded xyloglucan gels followed higuchi kinetics over a period of 5?h at 34°C by anomalous transport mechanism. The ex vivo permeation of ondansetron hydrochloride from the gels was sustained. Histological examination of nasal mucosa following a single administration of the gels showed no evidence of mucosal damage. Finally, the bioavailability study in rabbits revealed that the absolute bioavailability of ondansetron hydrochloride was significantly increased from 28.64% in the case of the oral drug solution to 52.79% in the case of the nasal in situ gel. The results of this study suggest the potential of the enzyme-degraded xyloglucan gels as vehicles for nasal delivery of drugs.     

Aggregation of antiacetylcholine drugs in aqueous solution: monomer concentrations in non-micellar drug systems.

The self-association of the antiacetylcholine drugs, propantheline bromide, methantheline bromide and methixene hydrochloride in aqueous solution, has been examined by surface tension, light scattering and conductimetric methods. Surface tension graphs were similar to those of conventional surfactants, showing apparent critical micelle concentrations (cmc) at distinct inflection points. Surface tension measurements in the presence of increasing amounts of electrolyte indicated a decrease in the apparent cmc with increase in electrolyte concentration for propantheline bromide. Light scattering curves for propantheline bromide in electrolyte solution showed no significant discontinuity attributable to a cmc. A mode of self association involving aggregate growth by the stepwise addition of monomers was assumed and equilibrium constants for the initial stages of the association were evaluated. An increase in the magnitude of the stepwise association constants with increase in electrolyte concentration was noted. Integration of the light scattering data according to 1n x = oo [(M/Mapp) - 1] dln c (where M and M app are the monomer and apparent aggregate weights respectively and x is the weight fraction of monomers) showed an asymptotic increase in monomer concentration towards a limiting concentration, as the solution concentration, c was increased. Limiting monomer concentrations determined by this method were in reasonable agreement with the apparent cmcs from surface tension studies. It was not possible to detect a cmc for methantheline or propantheline bromide from conductivity measurements.     

pH敏感型盐酸左氧氟沙星眼用即型凝胶的制备及其体外释放考察

目的研制具有缓释作用的pH敏感型盐酸左氧氟沙星眼用即型凝胶。方法以卡波普为凝胶基质,以羟丙甲基纤维素为增稠剂,以溶液的粘度、即型凝胶形成能力及盐酸左氧氟沙星含量为评价指标,确定制备处方和工艺,并以优选处方进行体外释放考察。结果经实验,其优选处方为盐酸左氧氟沙星0.1 g,羟丙甲基纤维素E 50 LV 2.0 g,卡波普9 400.3g,磷酸氢二钠0.35 g,磷酸二氢钠0.45 g,氯化钠0.50 g,尼泊金乙酯0.03 g,加水共制成100 ml。体外释放结果显示其释药平缓,具有较好的缓释特征。结论优选处方工艺稳定,质量控制方法可靠,适用于pH敏感型盐酸左氧氟沙星眼用即型凝胶的制备和评价。     

Analogues of oxybutynin. Synthesis and antimuscarinic and bladder activity of some substituted 7-amino-1-hydroxy-5-heptyn-2-ones and related compounds

Oxybutynin chloride [4-(diethylamino)-2-butynyl alpha-cyclohexyl-alpha-hydroxybenzeneacetate hydrochloride, Ditropan] is widely used for the relief of symptoms in neurogenic bladder. This is a result of its combined anticholinergic, antispasmodic, and local anesthetic activities. In a study directed toward development of agents possessing the beneficial properties of oxybutynin, but having a longer duration of action, a series of metabolically more stable keto analogues of the parent ester, i.e. substituted 7-amino-1-hydroxy-5-heptyn-2-ones along with some analogues and derivatives, was prepared and evaluated for in vitro and in vivo antimuscarinic action in guinea pig preparations. Several members of the series were potent antimuscarinics having a longer duration of activity than that of oxybutynin in a guinea pig cystometrogram model. On the basis of its in vitro and in vivo antimuscarinic activity, coupled with a 5-fold greater duration of action than that of oxybutynin, 1-cyclobutyl-7-(dimethylamino)-1-hydroxy-1-phenyl-5-heptyn-2-one (14b) was selected for clinical evaluation.     

Receptor Binding Studies of the Flavone,REC 15/2053, and Other Bladder Spasmolytics

The new flavone derivative REC 15/2053, a compound with spasmolytic activity on the lower urinary tract, was examined for its in vitro interaction with alpha- and beta-noradrenergic receptors, dopaminergic, muscarinic, serotoninergic, and opiate receptors, and calcium-channel binding sites labeled with 1,4-dihydropyridines from normal rat brain. All the investigated receptors are directly or indirectly involved in the nervous control of the lower urinary tract functions. The activity of REC 15/2053 on these receptors was studied in comparison to the most common drugs used in the management of urinary bladder disorders such as flavoxate, emepronium bromide, oxybutynin, terodiline, and imipramine. REC 15/2053 showed only weak binding to [³H]nitrendipine sites (IC₅₀ =14 µM) and muscarinic receptors (IC₅₀ = 18 µM), whereas flavoxate was slightly active only at muscarinic receptors (IC₅₀ = 12.2 µM). Emepronium bromide, oxybutynin, and terodiline were active only at muscarinic receptors, with IC₅₀ values of 236, 5.4, and 588 nM, respectively. Oxybutynin showed a weak affinity to [³H]nitrendipine binding sites (IC₅₀ = 44.4 µM). Imipramine was active at alpha 1-adrenergic and muscarinic receptors (IC₅₀ = 248 and 653 nM, respectively). The activity of REC 15/2053 at muscarinic receptors and 1,4-dihydropyridine binding sites seems too low to account for its mechanism of action.     

Comparative studies for ciprofloxacin hydrochloride pre-formed gels and thermally triggered (in situ) gels: in vitro and in vivo appraisal using a bacterial keratitis model in rabbits

Abstract

This article reports on comparative in vitro characterization and in vivo evaluation of pre-formed cellulose-based gels, methylcellulose (MC) and carboxymethylcellulose sodium (CMC) and in situ gel-forming Pluronic F127 (PL) for ocular delivery of ciprofloxacin hydrochloride (Cipro) by using a bacterial keratitis model and histological corneal examination. Drug–polymer interactions were studied employing thermal analysis. Further, different concentrations (1–3% w/w or 10–30% w/w) of gels depending on the nature of the polymer used were prepared, characterized for clarity, pH, rheology and in vitro release. Selected gel formulations were evaluated for ocular delivery to Staphylococcus aureus-infected rabbit corneas; and ocular toxicity through histological examination of the cornea. The results demonstrated no Cipro-polymers physicochemical interactions and pseudoplastic flow for all gels used at 35?°C. Both polymer concentrations and drug solubility in the gels are dominantly the rate-determining factors for in vitro drug release. The corneal healing rate for all gel-based formulations was significantly faster (p?<?0.05) than that for Cipro solution-treated rabbits. PL-based gel induced significant swelling/edema of the corneal stroma, compared with MC- and CMC-based gels. In conclusion, cellulose-based polymers have superior ocular tolerability/dramatically less irritant; and superior efficacy with more convenient administration compared with PL and Cipro solution, respectively.     

Variation in Cardiovascular Risk Related to Individual Antimuscarinic Drugs Used to Treat Overactive Bladder: A UK Cohort Study

Background

Blocking muscarinic receptors could have an effect on cardiac function, especially among elderly patients with overactive bladder (OAB).

Study Objective

To investigate the risk of cardiovascular (CV) events in users of antimuscarinic drugs to treat OAB.

Design, Setting, and Participants

Cohort study of new users of darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium, 18 years or older, in the United Kingdom's Clinical Practice Research Datalink (CPRD), 2004–2012.

Outcome Measurements and Main Results

Using tolterodine as the reference, we estimated propensity‐score–stratified incidence rate ratios (IRRs) for acute myocardial infarction, stroke, CV mortality, major adverse cardiac events (MACE, a combined end point of the previous three), and all‐cause death for individual antimuscarinic drugs. The study cohort included 119,912 new users of OAB drugs. The mean age at cohort entry was 62 years, 70% were female, and the mean follow‐up was 3.3 years. The adjusted IRR for MACE and current use of oxybutynin compared with current use of tolterodine was 1.14 (95% confidence interval [CI] 1.01–1.30). In contrast, the IRR was 0.65 (CI 0.56–0.76) for current use of solifenacin compared with tolterodine. In this study, performed with health care data, the distribution of risk factors was relatively similar across users of different OAB drugs and, although our analyses controlled for a range of measured potential confounders, residual confounding cannot be ruled out.

Conclusions

In an observational comparative study of users of medications to treat OAB conducted in routine clinical practice, the risk for CV side effects was increased in users of oxybutynin and decreased in users of solifenacin compared with users of tolterodine.     

Catanionic Drug–Surfactant Mixtures: Phase Behavior and Sustained Release from Gels

Purpose. To study mixtures of SDS and the drugs diphenhydramine, tetracaine, and amitriptyline to compile phase diagrams and to investigate the use of interesting phases for sustained release from gels. Methods. Phase diagrams were composed by studying large numbers of different compositions of negatively charged SDS and positively charged drug compounds visually, rheologically, and by cryo-transmission electron microscopy. Drug release from Carbopol 940 and agar gels containing interesting phases, e.g., vesicle and branched micelle phases, was measured in vitro by the USP paddle method. Results. Vesicles and elongated and branched micelles were formed on the SDS-rich side in all three systems examined. The tetracaine system differed from the other two in that it showed a vesicle area in the drug-rich side. Release of diphenhydramine from Carbopol 940 gels was slowed by at least a factor of 10 when in the form of vesicles or branched micelles. The same delay was found for both drug-rich and SDS-rich tetracaine vesicles. Conclusions. Mixtures of SDS and positively charged drugs form the same interesting phases as traditional catanionic mixtures. This may prove useful in obtaining functional controlled-release systems when using gels as drug carriers.     

Oxybutynin for treatment of urge urinary incontinence and overactive bladder: an updated review

Urge urinary incontinence (UUI) and overactive bladder are common conditions often associated with profound impairment of the health and quality of life of the patient. Antimuscarinic medications have been the mainstay of treatment for these disorders. Oxybutynin hydrochloride, one of the most widely used antimuscarinic agents, has attracted considerable interest from both clinicians and pharmacologists over the last three decades. Although efficacy of this drug has been proven to be high, its use is limited by antimuscarinic adverse effects, possibly related to its active metabolite N-desethyloxybutynin (N-DEO). The extended-release form of oxybutynin uses a push-pull osmotic release system which has significantly improved its tolerability and safety profile. A transdermal transport system has also been developed, bypassing the first-pass metabolism in the liver and gut. This system is associated with significant reduction in the production of the primary metabolite and additional improvement in the tolerability profile of the drug. Intravesical instillation of oxybutynin has been reported although the efficacy and safety of this delivery system has yet to be determined. This article comprehensively reviews the contemporary literature on the pharmacology, clinical efficacy and adverse reactions of oxybutynin in its various delivery forms, and compares them to other frequently used medications for UUI and overactive bladder.