格列奇特(Gliclazide)治疗Ⅱ型糖尿病的临床观察

本文对30例单纯饮食治疗不理想的Ⅱ型糖尿药患者用山东省医药工业研究所提供的新药格列奇特(gliclzzide,甲磺吡脲,国产达美康治疗3～6个月。开始剂量为160mg/d,2～3周后根据血、尿糖情况调整为80～240mg/d。治疗有效者治疗后的空腹血糖、餐后2h血糖、24h尿糖定量及糖化血红蛋白均较冶疗前有明显下降(p【0.01)。

Improvement of Dissolution Rate of Gliclazide Using Solid Dispersions with Aerosil 380 and Its Effect on Alloxan Induced Diabetic Rats

The main objective of this research is to conduct a comprehensive study for enhancing the aqueous solubility of poorly water soluble gliclazide using hydrophilic fumed silica particles (Aerosil®380) and evaluating the influence of silica on drug release profile and pharmacological activity on alloxan induced diabetic rats. Solid dispersions (SD’s) of gliclazide were prepared using solvent evaporation method. The dissolution profiles and solid state characterization of the SD’s prepared were all evaluated. The dissolution rate of gliclazide in the SD’s with fumed silica (weight ratio, 1:1) was approximately 38%, which is about 10 fold higher than that of the pure drug after 30 min. After forming the SD’s, gliclazide changed into an amorphous state, which can infer from differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD). Fourier transform infrared spectroscopy (FTIR) also revealed the formation of weak hydrogen bonding through the interactions between the secondary amine groups of gliclazide and silanol groups of silica particles in the SD’s. The rapid dissolution rate from the SD’s might be attributed to the amorphization of drug, improved specific surface area and wettability than the original drug crystals. Further, we investigated the antidiabetic effects of SD’s of gliclazide in alloxan induced diabetic rats. The SD’s of gliclazide decrease the blood glucose level 64% whereas the conventional gliclazide decreases only 37% in diabetic rats. Lipid profiles, kidney and liver functions are remarkably improved in diabetic rat treated with SD’s of gliclazide than that of conventional gliclazide. These results suggest that SD’s of gliclazide have much more bioavailability and hence are more pharmacologically active than that of conventional gliclazide form.

Comparison of gliclazide vs linagliptin on hypoglycemia and cardiovascular events in type 2 diabetes mellitus: A systematic review

BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular(CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes(T2D).METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease(CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.RESULTS Eight clinical studies were included in the narrative descriptive analysis(gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin(CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D(CAROLINA)trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials,they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out.However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.

Application of D-Optimal Study Design with Contour Surface Response for Designing Sustained Release Gliclazide Matrix Tablets

An optimized formulation of a sustained release tablet of Gliclazide was developed. The use of Doptimal design with a polynomial statistical model to analyze dissolution data reduced the number of laboratory tests required to obtain an optimal dosage form. The final formulation contained 22 mg of Methocel&regE15LV, 16.5 mg Methocel&regE15 and 10.0 mg of Dibasic Calcium Phosphate per 30 mg Gliclazide sustained release tablet. Dissolution studies performed on tablets from 5000 tablet test batches released greater than 90 percent of loaded drug in eight hours. Drug release from the optimized tablets followed a pattern more closely similar to zero-order than other mechanisms of drug release tested. Storage of tablets in accelerated and ambient conditions for 6 and 12 months respectively did not alter any of the physico-chemical properties, drug release or the drug release rate compared to initial observations and dissolution data of the prepared tablets. The addition of potassium phosphate and monosodium phosphate to the tablet reduced the effect pH has on Gliclazide dissolution compared to the commercially available product.

Waist Circumference-dependent Peripheral Monocytes Change after Gliclazide Treatment for Chinese Type 2 Diabetic Patients

Gliclazide used for the treatment of type 2 diabetes mellitus（T2DM） stimulates insulin secretion and influences peripheral blood monocytes.The roles of gliclazide in peripheral monocytes of newly diagnosed T2 DM patients were investigated in this study.A total of 105 newly diagnosed T2 DM patients with no history of antihyperglycemic medication were treated with gliclazide-modified release for 16 weeks.The total and differential leukocyte profiles of peripheral blood were measured at baseline and week 16.The peripheral blood monocyte count at week 16 was significantly lower than that at baseline（P=0.019）.Peripheral monocytes level at baseline was positively correlated with waist circumference.After gliclazide treatment,the peripheral monocytes were decreased [（320.09±15.13）×10~6/L vs.（294.19±14.22）×10~6/L] in non-abdominal obesity group,but increased in abdominal obesity group [（344.36±17.24）×10~6/L vs.（351.87±16.93）×10~6/L].Compared with non-abdominal obese patients,abdominal obese patients showed higher Δmonocytes（P=0.046） and Δacute insulin secretion（P=0.049）,but lower ΔHb A1c（P=0.047）.There was significantly positive correlation between Δmonocytes and Δacute insulin secretion（P=0.015）,which disappeared after adjusting for age,waist circumference and dosage at baseline.In conclusion,waist circumference is correlated with peripheral monocyte change after gliclazide treatment in Chinese newly diagnosed T2 DM patients.Peripheral monocytes are decreased in non-abdominal obesity group and increased in abdominal obesity group after gliclazide treatment.

Comparison of the Hypoglycemic, Hypolipidemic and Hepatoprotective Effects of<i>Asparagus racemosus</i>Linn. in Combination with Gliclazide and Pioglitazone on Alloxan-Induced Diabetic Rats

In recent years, the popularity of medicinal plants as a remedy has been increased manifold due to having minimal adverse effects. The current study aimed to compare the hypoglycemic, hypolipidemic and hepatoprotective effects of the ethanolic extract of Asparagus racemosus (EEAR) Linn. alone and combinedly with conventional antidiabetic agents (gliclazide and pioglitazone) in alloxan-induced diabetic rats. Diabetes was induced in male Wister albino rats by the administration of single intra-peritoneal injection of alloxan monohydrate (120 mg/kg b.w.). Effect of oral administration of two different doses of EEAR (200 and 400 mg/kg b.w.), gliclazide (10 mg/kg b.w.) and pioglitazone (10 mg/70kg/b.w.) alone for 2 weeks and a combination of EEAR (200 mg/kg b.w.) with either gliclazide (10 mg/kg b.w.) or pioglitazone (10 mg/70kg/b.w.) for 2 weeks were examined on hypoglycemic activity on 0th, 5th, 10th and 14th day of treatment. After 2 weeks of treatment, hypolipidemic and hepatoprotective effects were estimated by serum biochemical markers such as total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), very low density lipoprotein (VLDL), high density lipoprotein (HDL), serum glutamate oxaloacetate transaminases (SGOT), serum glutamate pyruvate trans-aminases (SGPT) and total protein (TP) with the help of commercially available kits. The survival rate, body weight and organ weight were also measured. Alloxan treatment resulted in persistent hyperglycemia, hyperlipidemia and liver dysfunction in rats. Treatment with EEAR at different doses improved hyperglycemia significantly (p th and 14th day of treatment in a dose-dependent mood when compared to the disease control rats, gliclazide treated rats and pioglitazone treated rats. The combination therapy significantly (p th, 10th and 14th day of treatment as compared to that of disease control rats, gliclazide treated rats and pioglitazone treated rats. Proposed adjunct therapy also markedly (p < 0.001;p < 0.01, p < 0.001) improved serum TG, HDL and LDL level with insignificant change in VLDL and TC level while comparing with groups receiving gliclazide treated rats and pioglitazone treated rats. Administration of different doses of EEAR markedly (p < 0.05, p < 0.01, p < 0.001;p < 0.05, p < 0.01;p < 0.05) reduced the activity of TC, TG, LDL, VLDL and HDL cholesterol levels in a dose-dependent approach with respect to that of gliclazide treated rats and pioglitazone treated rats. The effect of combination therapy significantly (p < 0.001;p < 0.001;p < 0.01, p < 0.001) decreased the SGOT, SGPT and TP hepatic enzyme levels when compared to disease control rats, gliclazide treated rats and pioglitazone treated rats indicated improvement in liver dysfunctions. Administration of different doses of EEAR noticeably (p < 0.05, p < 0.01, p < 0.001;p < 0.05, p < 0.01;p < 0.05, p < 0.01) reduced the liver enzymes level including SGOT, SGPT and TP in a dose-dependent manner as compared to the disease control rats, gliclazide treated rats and pioglitazone treated rats. The maximum survival rate (100%) was observed in rats of combination treated rats. No significant changes in the body weight and organ weight to body weight ratio were observed except the groups that were given combined therapy showed improvement in the liver and pancreas weight. Our study suggests that the EEAR potentiates the activity of gliclazide and pioglitazone in controlling blood glucose levels, modifies the lipid profile and improves in liver dysfunction on alloxan-induced diabetic rats.

Formulation Development and Evaluation of Poorly Water Soluble Gliclazide Tablet Containing Aerosil 380 as Carrier

The core objective of the current work was to improve dissolution rate of poorly water-soluble anti-diabetic drug gliclazide by solid dispersions (SDs) technique using fumed silica particles Aerosil 380 as carrier into compressed tablets. Different FGA-1, FGA-2, FGA-3 (Formulated Gliclazide Aerosil;weight ratio, 1:1) and FPG-1, FPG-2 (Formulated Plain Gliclazide) tablet batches were formulated, prepared, evaluated and characterized. All the findings of pre-compression factors were found to be satisfactory and post-com- pression parameters revealed good mechanical integrity and good uniformity in all formulations. All the formulated tablets satisfied the compendia limits of weight variation, friability and the disintegration time. Among all formulations, FGA-3 was optimized based on in vitro drug release findings, disintegration time, hardness and other quality attributes. The percent of drug release from the formulated FGA tablets containing gliclazide loaded aerosil is about 3 fold higher when compared with the tablets formulated and prepared with plain gliclazide (FPG) and the tested commercial brands in first 60 minutes. There was no significant change noted in the drug content and drug release pattern in the FGA tablets batches when stored in 40℃?and 75% RH for three months. It was thus concluded that SDs formulations of gliclazide could be successfully used to design and develop a solid dosage form of the drug, which would have significant benefits over the existing commercial brands.

Formulation and <i>In-Vitro</i>Release Pattern Study of Gliclazide Matrix Tablet

In current decade, pharmaceutical industries of Bangladesh are giving much emphasize on the formulation of time release preparation to treat various chronic diseases in order to decrease the frequency of administration and to improve patient compliance. Objectives: The objective of this investigation is to design and evaluate sustained release matrix tablet of Gliclazide by direct compression method employing polymers of hydroxypropylmethyl cellulose (HPMC) derivatives (K15M CR and K4M CR) and to select the optimized formulations and compression process by performing a comparative release kinetic study with a reference product, Diamicron MR (one of the worldwide brand of Gliclazide sustain released tablet manufactured by Servier one of the French pharmaceutical company) tablet. Methods: Release kinetics of Gliclazide matrix tablets were determined using USP paddle method at Phosphate buffer (pH 7.4). The release mechanism was explored and explained with zero order, first order, Higuchi and Korsmeyer model. Result: It is found that formulation with lower polymeric concentration follows Higuchi release kinetics and that the formulation with higher concentration best fits with zero order release kinetics. Among the formulations, F1 and F6 show almost similar dissolution profile with Diamicron MR Tablet, which can be suitable candidates for further in-vivo bioequivalence study. Conclusion: Findings of this investigation suggest that F1 and F6 formulations are potential candidates for further bioequivalence study among other formulations.

Simultaneous Determination of Verapamil Hydrochloride and Gliclazide in Synthetic Binary Mixture and Combined Tablet Preparation by Chemometric-Assisted Spectroscopy

In this study, the simultaneous determination of verapamil hydrochloride and gliclazide in pharmaceuticals by chemometric approaches using UV spectrophotometry has been reported. Verapamil hydrochloride (VER) (Benzeneacetonitrile, α-[3-[[2-(3,4-dimethoxyphenyl) ethyl] methylamino]propyl]-3, 4-dimethoxy-α-(1-methylethyl) hydrochloride) is an L-type calcium channel blocker of the phenylalkylamine class. It has been used in the treatment of hypertension, angina pectoris, and cardiac arrhythmia. Gliclazide (GLZ) (1-(Hexahydrocyclopenta[c]pyrrol-2(1H)-yl)-3-[(4-methylphenyl) sulphonyl]urea) is an oral hypoglycaemic (anti-diabetic) drug and is classified as a second generation sulfonylurea. Spectra of VER and GLZ were recorded at several concentrations within their linear ranges between wavelengths of 200 nm to 400 nm in 0.1N HCl. Partial least squares regression (PLS) and principle components regression (PCR) were used for chemometric analysis of data and the parameters of the chemometric procedures were optimized. The recoveries were satisfactory and statistically comparable. The method was successfully applied to pharmaceutical formulation, tablet, with no interference from excipients as indicated by the recovery study results. The proposed methods are simple, rapid and can be easily used in the quality control of drugs as alternative analysis tools.

Effect of repaglinide and gliclazide on glycaemic control, early-phase insulin secretion and lipid profiles in newly diagnosed type 2 diabetics

Background Both repaglinide and gliclazide are insulin secretagogues widely used in the treatment of type 2 diabetes.They stimulate insulin secretion through distinct mechanisms and may benefit patients from different aspects.The present study was to evaluate the effects of repaglinide or gliclazide on glycaemic control,insulin secretion,and lipid profiles in type 2 diabetes patients.Methods A total of 47 newly diagnosed type 2 diabetes patients were randomized 1：1 to receive a 4-week treatment with repaglinide or gliclazide.The standard mixed meal tolerance test was performed before and after the treatment.Plasma glucose （PG）,insulin concentration,and lipid profiles were measured.The area under insulin concentration curve （AUCins） and the early-phase insulin secretion index （△I30/△G3o） were calculated.Results After the trial,fasting and postprandial PG and postprandial insulin improved significantly in both groups （P〈0.05）.The maximum insulin concentration occurred earlier in the repaglinide group than that in the gliclazide group.AUCins increased in both groups （P 〈0.05）,but no significant difference was found between groups.△I30/△G30 increased in both groups （P 〈0.05）,especially in the repaglinide group （P 〈0.05）.Triglyceride and total cholesterol decreased significantly in the repaglinide group in some time points,while no significant change was observed in the gliclazide group.Conclusions Repaglinide and gliclazide had similar effects on glycaemic control and total insulin secretion,while repaglinide had more effects on improvements in β-cell function and lipid metabolism.

Effects of gliclazide on myocardial protection of isolated type 2 diabetic rat heart afforded by ischemic preconditioning

The myocardial protection afforded by ischernic preconditioning （IPC） can alleviate ischemi- a-repel-fusion injury in normal rat heart. However, this myocardial protection is seldom studied in the type 2 diabetic rat with myocardial ischemia disease. In this study, we aimed to evaluate the effects of ATP-sensitive potassium channels （KATP channels） on IPC in the isolated type 2 diabetic rat heart and the role of the sul- fonylurea gliclazide. Methods Streptozotocin（STZ）-induced type 2 diabetic male Wistar rats with or without gliclazide （64 mg/kg body weight, orally） and age-matched non-diabetic control rats were used for all studies. The isolated hearts were perfused with Langendorff＇s system under the constant flow, pressure and tempera- ture conditions with Kreb＇s-Henseleit solution （K-H）. After 5 minutes of balance peffusion, these rats were randomly divided into six groups： non-diabetic control rats without IPC （CIR） ; non-diabetic control rats with IPC （CIP）; diabetic rats without 1PC （DIR）; diabetic rats with IPC （DIP）; gliclazide-treated diabetic rats without IPC （GIR）; and gliclazide-treated diabetic rats with IPC （GIP）. Groups CIR, DIR, and GIR were subjected to 30-rain global ischemia and 60-rain reperfusion for induction of ischemia/reperfusion injury. Groups CIP, DIP, and GIP were given three cycles of 5-min ischemia and 5-rain reperfusion as IPC, and then ischemia/reperfusion injury program was implemented. Extent of ischemia/reperfusion injury was measured in terms of the release of lactate dehydrogenase （LDH）, creatine kinase （CK）, and creatin kinase-MB （CK- MB） in coronary effluent. After perfusion, Kir6.2 and SUR2A mRNA expressions in the myocardial tissue were characterized by fluorescent quantitative real-time PCR method, and Kir6.2 and SUR2A protein expres- sions were assessed by immunohistochemistry. Result In non-diabetic control rats, the release of LDH, CK, and CK-MB in coronary effluent markedly decreased with IPC compared with No-IPC （P 〈 0.05）, but not in diabetic rats. However, in gliclazide-treated diabetic rats, IPC-induced decrease in the release of LDH, CK, and CK-MB was restored compared with No-IPC （P 〈 0.05）. The expressions of Kir6.2 both at mRNA and protein levels in CIP were significantly higher than those in CIR. There was no significant difference in theexpression of Kir6.2 and SUR2A both at mRNA and protein levels between DIP and DIR. However, the expression of Kir6.2 both at mRNA and protein levels was significantly higher in GIP than in GIR. No significant difference was detected in the mRNA expression level of SUR2A between the six groups. The expression of SUR2A at protein level was significantly higher in CIP than in CIR and in GIP than in GIR. Conclusions The cardioprotective effect of IPC is abolished in the isolated type 2 diabetic rats compared with non-diabetic control rats. However, to some extent, gliclazide can improve the myocardial protection of IPC against ischemia/reperfusion injury, thus suggesting that it is mediated mainly by KATP channels at mRNA or protein level, which provides a basis for further investigating the effects of KATP channels on IPC.

Simultaneous determination of asenapine and valproic acid in human plasma using LC-MS/MS:Application of the method to support pharmacokinetic study

Combination of asenapine with valproic acid received regulatory approval for acute treatment of schizophrenia and maniac episodes of bipolar disorders. A simple LC-MS/MS method was developed and validated for simultaneous quantification of asenapine and valproic acid in human plasma. Internal standards were added to 300 ~L of plasma sample prior to liquid-liquid extraction using methyl tertiary butyl ether （MTBE）. Chromatographic separation was achieved on Phenomenex C18 column （50 mm ~ 4.6 mm, 5 pm） in isocratic mode at 40 ~C. The mobile phase used was 10 mM ammonium formate-acetonitrile （5：95, v/v） at a constant flow rate of 0.8 mL/min monitored on triple quadrupole mass spectrometer, operating in the multiple reaction monitoring （MRM） mode. The injection volume used for LC-MS/MS analysis was 15 taL and the run time was 2.5 min. These low run time and small injection volume suggest the high efficiency of the proposed method. The method was validated over the concentration range of 0.1-10.02ng/mL and 10-20,000ng/mL for asenapine and valproic acid respectively. The method recoveries of asenapine （81.33%）, valproic acid （81.70%）, gliclazide （78.45%） and benzoic acid （79.73） from spiked plasma samples were consistent and reproducible. The application of this method was demonstrated by a pharmacokinetic study in 8 healthy male volunteers with 5 mg asenapine and 250 mg valproic acid administration.

Determination of Glimepiride in Rat Serum by Rp-Hplc Method

A simple and sensitive reverse phase high performance liquid chromatography (RP-HPLC) method was developed for the determination of glimepiride in rat serum. The assay involves one step liquid-liquid extraction with methanol. Gliclazide was used as an internal standard. Chromatographic separation was performed on a C18 column using a mobile phase of methanol: 10mM phosphate buffer (80:20 v/v) adjusted to pH 3.0 with orthophosphoric acid, at a flow rate of 1.0 ml/min and UV detection at 230 nm. The retention time of glimepiride and gliclazide was found to be 5.5 and 4.0 min and separation was complete in less than 10 min. The method was validated for linearity, accuracy and precision were found to be acceptable over the range of 0.5 - 500 μg/mL for glimepiride. The method was found suitable to analyse rat serum samples for application in pharmacokinetic, pharmacodynamic, bioavailability/bioequivalence studies.

Determination of Amlodipine in Human Plasma by LC-MS/MS and Its Bioequivalence Study in Healthy Chinese Subjects

A sensitive and reproducible liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-MS/MS) method was developed and validated for the quantification of amlodipine in human plasma, with gliclazide as an internal standard (IS). The analyte was extracted with ethyl acetate and analyzed on a Diamond C18 (150 mm× 4.6 mm, 5 μm) column. The mobile phase was composed of methanol ?10 mM ammonium acetate with gradient flow rates and gradient conditions. Amlodipine and IS were ionized by positive ion pneumatically assisted electrospray and detected in the multi-reaction monitoring (MRM) mode using precursor→productions of m/z 409.2→238.1, 294.1 and m/z 324.2→127.3, respectively. The specificity, matrix effect, recovery, sensitivity, linearity, accuracy, precision, and stabilities were all validated over the concentration range of 0.05 - 12 ng/mL. The 90% confidence interval (CI) for AUC0-t, AUC0-∞ and Cmax ratios (test: reference) were all within 80% - 125% interval proposed by FDA. It is concluded that the validated method can successfully fulfill the requirement of clinical bioequivalence study of amlodipine in healthy Chinese subjects after administration of amlodipine/losartan combination tablets and amlodipine tablets, and the test and reference tablets were bioequivalent.

Formulation and characterization of extruded and spheronized pellets using pectin and crosslinking agents

The aim of this study was to prepare pellets of gliclazide by extrusion spheronization process by use of two methods in situ cross linking method and interfacial complexation method and to study the effect of different cross linking agents on the formed pellets. Extrusion/spheronization being an established technique for producing spherical pellets so this technique was used to prepare pellets. The gliclazide pellets prepared by extrusion-spheronization techniques and then the formed pellets were coated with pectin solution by interfacial complexation method. The effect of cross-linkers calcium chloride and aluminium chloride concentration, by in situ cross linking on properties of gliclazide pellets like swelling and drug release were studied. The formed pellets were subjected to swelling, analysis of morphology, in dissolution and vivo studies. Most of the pellets were of acceptable shape. From the results calcium chloride when coated with pectin, retarded drug release. As the concentration of calcium chloride increased, it led to slow release of the drug. This may be due to the water solubility of calcium salt, which induced cross linking with pectin. Thus pellets with calcium chloride cross linked with pectin were beneficial, because it retarded the release of the drug. Though the release from interfacial coated pellets was retarded, it was less as compared to the in situ formed pellets. The in vivo studies on alloxan-induced diabetic rats indicated the significant hypoglycemic effect that was observed 24 h after oral administration of optimized pellets. Thus, the developed and optimized pellets were suitable for prolonged systemic absorption of gliclazide to maintain lower blood glucose level and improved patient compliance. The results suggested that the in situ cross linking pellets were able to retard the release of gliclazide greater than the interfacial complexation method. Therefore, this approach has been effectively achieved.