Nasal Route Of Administration Research Articles

Estimating the dosage and feasibility of intranasal administration of creatine.

Creatine dysregulation is present in many psychiatric and neurocognitive conditions, supporting the notion that oral creatine supplementation could constitute a viable treatment for conditions such as dementia, depression, and concussion. We recently proposed an intranasal route of administration (ROA) of creatine as a means of efficiently dosing creatine to achieve absorption across the blood brain barrier while targeting preferential delivery to the brain. Indeed, a subsequent murine study supports that creatine can be absorbed via the nasal ROA. The objective of this project is to refine this ROA and estimate appropriate dosage for research trials. The amount of creatine needed to directly supply the brain is but a small portion of the dose that is administered orally for whole-body saturation. A single dose of creatine is typically 5 g, which results in a calculated blood concentration of 80 mg/dL based upon average adult blood volume. Evidence suggests this is sufficient to raise brain creatine levels. Given the adult brain blood volume of 100‒130 mL, we estimate that a minimum of 80 mg of nasally-administered creatine would need to pass from the nasal cavity across the blood-brain barrier. Even if the nasal columnar epithelium or mucus were to pose a barrier, doubling or tripling the dose would still represent a relatively modest amount of nasally-delivered creatine (e.g., 160‒240 mg) in solution. We predict that the amount of nasally-administered creatine to theoretically raise brain blood concentration to a therapeutic level would be modest and practical.

FOCUS ON NIOSOMAL–BASED DRUG DELIVERY SYSTEMS FOR NASAL ROUTE: APPLICATIONS AND CHALLENGES

For decades, the nasal route of administration is principally used for many therapeutic applications owing to the non-invasive nature of the nasal pathway. Besides, it circumvents blood-brain-barrier (BBB) and hepatic first-pass effect. Consequently, the nasal route is much preferred over other invasive approaches like intravenous, intracerebral, and transcranial for the systemic delivery of drugs and the treatment of central nervous systems (CNS) disorders such as depression, Alzheimer’s disease (AD), multiple sclerosis, and Parkinson’s disease (PD) via the nose-to-brain pathway. Drug applied via the nasal route displays some difficulty to reach the brain, like the dose limitation of the nasal pathway, mucociliary clearance, etc. The efficiency of the nasal route depends on the application delivery system. Lipidic-based drug delivery systems (liposomes, solid lipid nanoparticles …etc.) have been confirmed for their promising impact on the nasal delivery approach. Furthermore, the sensitivity of the nasal route and the touched-complications of clinical trials in CNS disorders assigns the necessity of consideration to the clinical trials and approval process of the niosomal-based nasal drug delivery approach. This review describes different approaches to nasal delivery, lipidic-based delivery systems with a focus on niosomes as a promising nasal delivery system, along with different formulation methodologies, and applications.

Assessment of Knowledge, Attitudes, and Practices of Traditional Healers toward Dosage Forms and Routes of Administration: A Cross-Sectional Study in Ethiopia.

A cross-sectional study design was conducted on 70 traditional healers from June 1, 2022 to July 25, 2022. The data were collected through structured questionnaires. The data were checked for completeness and consistency and then entered into SPSS version 25.0 for analysis. The results were presented with frequencies and percentages. The association between sociodemographic factors and traditional healers' knowledge of dosage forms and route of administration was determined using the Pearson's chi-squares test. A statistically significant difference was declared if the p value was 0.05 or lower. Most (58.1%) traditional healers had information on dosage forms, especially about solid, semisolid, and liquid dosage forms. In addition, 33 (53.2%) traditional healers had information about rectal, nasal, and oral route of administration. All traditional healers had practiced different dosage forms and route of administration both individually and in combination earlier to date. More than half of the participants agreed on the need for different dosage forms and route of administration. This study result also showed that most (72.6%) traditional healers had gaps in sharing experiences and information with other healers and health professionals. The current study revealed that solid, semisolid, and liquid were the most frequently formulated dosage forms with oral, rectal, and nasal route of administration by traditional healers. The practice of checking the status of the formulations was poor. Traditional healers had a good attitude towards the need for different dosage forms and route of administration. The stakeholders should provide continuous training and exchange of experiences between traditional healers and healthcare professionals to improve the knowledge of traditional healers for appropriate use of dosage forms and route of administration.

Intranasal delivery of mitochondrial protein humanin rescues cell death and promotes mitochondrial function in Parkinson's disease.

Rationale: Mitochondrial dysfunction is a key factor in the pathogenesis of Parkinson's disease (PD). Accordingly, many aspects of mitochondrial function have been studied as a putative therapeutic target. Here we present a novel strategy to promote mitochondrial function and protect against Parkinson's disease by the peptide encoded within mitochondrial genome, mitochondria-derived peptide (MDP) humanin (HN). Methods: To test humanin as a potential biomarker in PD, we measured protein levels of circulating humanin from the plasma of PD patients and transgenic or neurotoxic mouse models of PD. Next, we aimed to identify whether HN peptide treatment can regulate its activity or expression. Using mouse models of PD, we assessed HN delivery to the brain via the nasal route of administration. We further revealed a possible mechanism underlying the therapeutic effectiveness of HN peptide for PD using in vitro and ex vivo model of PD. Results: Although the expression of intracellular HN was not correlated with PD, HN treatment itself could induce intracellular HN expression and enhance mitochondrial biogenesis inducing mitochondrial gene expression. After intranasal administration, HN peptide resulted in neuroprotection and behavioral recovery in an animal model of PD. Interestingly, HN peptide following intranasal delivery was found within the brain, mainly via the trigeminal pathways. Mechanistically, HN treatment induced activation of phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) signaling pathway which led to enhanced mitochondrial biogenesis resulting in upregulation of mitochondrial gene including humanin. Conclusion: These data support a novel role of mitochondrial protein humanin in mitochondrial function and neuronal survival against Parkinson's disease, in which humanin treatment is sufficient for stimulating mitochondrial gene expression.

Drug delivery to the brain via the nasal route of administration: exploration of key targets and major consideration factors.

BackgroundCranial nerve-related diseases such as brain tumors, Alzheimer’s disease, and epilepsy are serious diseases that continue to threaten human. Brain-related diseases are increasing worldwide, including in the United States and Korea, and these increases are closely related to the exposure to harmful substances and excessive stress caused by rapid industrialization and environmental pollution. Drug delivery to the brain is very important for the effective prevention and treatment of brain-related diseases. However, due to the presence of the blood–brain barrier and the extensive first-pass metabolism effect, the general routes of administration such as oral and intravenous routes have limitations in drug delivery to the brain. Therefore, as an alternative, the nasal-brain drug delivery route is attracting attention as a route for effective drug delivery to the brain.Areas coveredThis review includes physiological factors, advantages, limitations, current application status, especially in clinical applications, and the necessary factors for consideration in formulation development related to nasal-brain drug delivery.Expert opinionThe nasal-brain drug delivery route has the advantage of enhancing drug delivery to the brain locally, mainly through the olfactory route rather than the systemic circulation. The nasal-brain lymphatic system has recently attracted attention, and it has been implied that the delivery of anticancer drugs to the brain nervous system is possible effectively. However, there are limitations such as low drug permeability, as well as nasal mucosa and the mucociliary system, as obstacles in nasal-brain drug delivery. Therefore, to overcome the limitations of nasal-brain drug delivery, the use of nanocarriers and mucoadhesive agents is being attempted. However, very few drugs have been officially approved for clinical application via the nasal-brain drug delivery route. This is probably because the understanding of and related studies on nasal-brain drug delivery are limited. In this review, we tried to explore the major considerations and target factors in drug delivery through the nasal-brain route based on physiological knowledge and formulation research information. This will help to provide a mechanistic understanding of drug delivery through the nasal-brain route and bring us one step closer to developing effective formulations and drugs in consideration of the key factors for nasal-brain drug delivery.

A phase II randomized trial to evaluate the long-term (12-week) efficacy and safety of OC-01 (varenicline solution) nasal spray for dry eye disease: The MYSTIC study

PurposeDry eye disease is characterized by loss of tear film stability. OC-01 (varenicline solution) is a small-molecule nicotinic acetylcholine receptor agonist administered as a nasal spray that stimulates tear production. MethodsIn MYSTIC (NCT03873246) patients aged ≥22 years with dry eye disease were randomized 1:1:1 to OC-01 0.03 mg, OC-01 0.06 mg, or vehicle (n = 41 per group), administered twice daily via intranasal spray, for 12 weeks (84 days). Primary efficacy endpoint was mean change from baseline in anesthetized Schirmer's test score (STS) in study eye at day (D) 84. ResultsPatients receiving OC-01 0.03 and 0.06 mg had statistically significantly increased tear production at D84 versus vehicle; least squares mean changes from baseline in STS were 10.8 mm and 11.0 mm for OC-01 0.03 and 0.06 mg, respectively. A trend toward a higher proportion of patients experiencing ≥10-mm improvement in STS from baseline was observed with OC-01 0.03 mg (36.6%; p > 0.05), and was significant for OC-01 0.06 mg (48.8%; p = 0.024), versus vehicle (24.4%). Non-ocular treatment-emergent adverse events (TEAEs) were reported by 21 patients; the most common was sneezing (OC-01 0.03 mg, 2 [4.9%]; OC-01 0.06 mg, 3 [7.3%]), with similar frequencies between treatment groups. No severe or serious TEAEs were reported. ConclusionsOC-01 (varenicline solution) nasal spray improved tear production in patients with dry eye disease over a long-term (12-week) period, and represents a receptor neuro-activator with a nasal route of administration that spares the ocular surface to stimulate tear production.

Can the Nasal Cavity Help Tackle COVID-19?

Despite the progress made in the fight against the COVID-19 pandemic, it still poses dramatic challenges for scientists around the world. Various approaches are applied, including repurposed medications and alternative routes for administration. Several vaccines have been approved, and many more are under clinical and preclinical investigation. This review aims to systemize the available information and to outline the key therapeutic strategies for COVID-19, based on the nasal route of administration.

Solid Lipid Nanoparticles for nose to Brain delivery: A Review

The global prevalence of neurologic disorders is rising, and yet weare still unable to deliver most drug molecules, in therapeutic quantities, to the brain. The blood brain barrier consists of a tight layer of endothelial cells surrounded by astrocyte foot processes, and these anatomic features constitute a significant barrier to drug transport from the blood to the brain. One way to bypass the blood brain barrier and thus treat diseases of the brain is to use the nasal route of administration and deposit drugs at the olfactory region of the nares, from where they travel to the brain via mechanisms that are still not clearly understood, with travel across nerve fibers and travel via a perivascular pathway both being hypothesized. This article will emphasise on properties of Blood Brain Barrier, strategies to overcome the blood-brain barrier, literature regarding the use of SLNs in various neurological disease states, production methods of SLN and its evaluation. Hence, these solid lipid formulations can be a new form and one of the promising approaches for drug delivery system in future, that have remarkable possibility to cross the BBB.

CRITICAL ANALYSIS OF PURVA KARMA PRIOR TO NASYA W.S.R. SNEHA NASYA

Ayurveda Panchakarmas are an all-time big name for both Ayurveda doctors and patients. Their efficacy of targeting the body holistically and evacuating toxins, thereby, addressing most of the problems of an individual makes it a hit. This paper aims at estimating the contribution of Purva Karma (procedures prior to instillation of medicine) in the outcome, especially in the context of Sneha Nasya (instillation of unctuous medicine). Nasal route of administration may help address the hitches accompanying to poor bioavailability, slow absorption, drug degradation, and possible adverse events in the gastro intestinal tract and avoids the first-pass metabolism in the liver. However, when considering nasal delivery, appropriate measures need to be taken to address the limitations of drug delivery in this region. Purva Karma starts with drug preparation and ends with stage of instillation of medicine (8 check points). The role of each of them on overcoming the limitations and delivering the results is reviewed.

Selection of excipients for the purpose of creating an intranasal gel of interleukin-1 receptor antagonist β (IL-1ra)

There is a negative dynamic of the spread of cerebrovascular diseases, which often lead to disability or death in patients in the world, today. Such diseases are characterized by acute disorders of cerebral metabolism and blood circulation, against the background of other chronic pathologies. More than one hundred thousand cases of stroke are registered in Ukraine every year, with more than thirty percent of patients dying within the first month of the disease according to the Center for Medical Statistics of the Ministry of Health of Ukraine. The nasal route of administration is a promising method of transporting active substances for systemic action, various pharmacotherapeutic groups, both small and large molecules. The created nasal preparations of hormones, antibiotics, analgesics, exhibit a quick therapeutic effect due to the branched capillary system in the nasal cavity. In addition, the nasal route of administration is the most promising non-invasive method for delivering active substances to the brain for cerebroprotective drugs, due to the anatomical features of the location of the nerves. According to published data, the researchers found that the receptor antagonist of interleukin-1 (IL-1ra) exhibits neuroprotective properties in brain ischemia by blocking excess IL-1 and activating the anti-inflammatory cytokine cascade, in order to reduce local inflammation and neuronal loss. Therefore, in order to expand the range of pharmacotherapeutic drugs – neuroprotectors, the development of a new intranasal form with the active pharmaceutical ingredient - receptor antagonist interleukin-1 (IL-1ra) is an urgent problem of modern medicine and pharmacy. The aim of work was to substantiate the choice of excipients for the new intranasal gel of the receptor antagonist of interleukin-1 (IL-1ra). Materials and methods. The studies were carried out according to the plan of two-way analysis of variance with repeated observations. Factors that were investigated: factor A (type of polymer) – A1 – chitosan 3 %, A2 – sodium carboxymethyl cellulose 0.3 %, A3 – sodium hyaluronate 0.7 %, A4 – sodium alginate 0.5 %; factor B (type of alcohol): B1 – without alcohol, B2 – sorbitol, B3 – glycerin, B4 – D-panthenol. A prefabricated solution of the receptor antagonist of interleukin-1 (IL-1ra) was used as an active substance. A portion of the active substance was taken considering the calculations, to ensure a concentration of 0.5 % IL-1ra in each composition. The release of the active pharmaceutical ingredient was determined by equilibrium dialysis according to Kruvchinsky at 37.0 ± 0.5 °C through a semi-permeable membrane – “Cuprofan” for all compositions. Dialysis was performed in Franz cells at a nine-position station (PermeGear, Inc., USA). The concentration of IL-1ra, after 30 minutes, was determined by UV spectrophotometry at a wavelength of 280 nm on a UV-2600 spectrophotometer (Shimadzu Corporation, Japan). Results. We studied the effect of pharmaceutical factors (polymers and alcohols) on the intensity of the release of IL-1ra from the nasal form to justify the choice of excipients for the nasal gel of the receptor antagonist interleukin-1 β. The results of the analysis of variance of pharmaceutical factors (polymers and alcohols) showed that hydrophilic polymers and humectants had a significant effect on the release of the active substance from the experimental compositions. It is advisable to use a mucoadhesive polymer – sodium salt of carboxymethylcellulose, as well as alcohol-moisturizer D-panthenol for the new nasal form of IL-1ra, as excipients. Conclusions . Excipients were selected for a liquid intranasal gel with the receptor antagonist interleukin-1 (IL-1ra). It was found that the type of mucoadhesive polymers and alcohols, to moisten the mucous membrane, had a significant effect on the release of the active pharmaceutical ingredient from nasal dosage forms. As a result of research, it was found that the optimal release of IL-1ra from nasal compositions was provided by excipients - hydrophilic mucoadhesive component - sodium carboxymethylcellulose with the addition of humectant alcohol – D-panthenol.

Aerosol vaccines – perspectives and therapeutic impact

Introduction: Aerosol vaccination is a promising non-injectable method that provides immune resistance to pathogens since it follows the natural route of transmission of many infectious agents. The immune response, occurring after intranasal or respiratory vaccine administration, provides credible protection due to the common mucosal immune system, excellent blood supply, and lung permeability. Aim: The study aims to highlight the unconventional and perspective application use of aerosol dosage forms as a technological approach for vaccine drug delivery. Materials and Methods: A detailed literature survey in scientific databases such as PubMed, ScienceDirect, ResearchGate has been conducted, and the relevant information has been summarized and interpreted. Results: The aerosol vaccination method, as an alternative to the subcutaneous, intramuscular or intradermal application route, ensures defense against the inhaled pathogens, avoiding at the same time drawbacks associated with the injection administration such as the risk of reuse of disposable medical consumables, potential spreading of blood-borne diseases and the necessity of qualified medical personnel. Additionally, aerosol vaccination is an easier and more practical approach for patients, leading to improved compliance. Vaccines applied by the inhalation or nasal route of administration could be a successful approach for the treatment of diseases such as measles, tuberculosis, or influenza A, that although preventable, remain a global challenge. Conclusion: The aerosol method is promising for vaccine delivery with the potential to be fully evaluated in the upcoming years.

Spatial Distribution of (R)-salbutamol in Rat Brain Following Nasal and Intravenous Administration Using DESI-MS.

Recent studies have shown that β2-Adrenoreceptor is a regulator of the a-synuclein gene driving risk of Parkinson’s disease. The β2-AR agonist (R)-salbutamol, eutomer of rac-salbutamol, may hold therapeutic potential for Parkinson’s disease (PD) following nasal administration. In this study, we use desorption electrospray ionization mass spectrometry (DESI-MS) to analyze spatial distribution of (R)-salbutamol in rat brain following nasal and intravenous administration. Here, we report that (R)-salbutamol efficiently deliver to the brain and had more drug dosage exposure in rat’s brain through nasal route administration than that of intravenous route administration. In conclusion, administering (R)-salbutamol through nasal route of administration may hold advantages in improving spatial distribution and increased exposure of drug in brain.

Recent Advances and Novel Approaches for Nose to Brain Drug Delivery for Treatment of Migraine

Background:Nasal drug delivery has been used since ancient times for therapeutic and recreational purposes. For the last decades, nasal drug delivery has been extended for drug delivery to the brain. Therefore, it is important to understand the several physiological and physicochemical factors of the nose for brain drug delivery.Objective:A major highlight of the present review article is the several aspects of the nose to brain delivery for migraine treatment. This review will help to understand different factors which are needed to be considered for intra-nasal formulations to achieve the desired therapeutic effects.Method:There are different drug delivery routes available for migraine treatment. Nasal route of administration may be optimal for migraine treatment which has better drug concentration in the brain. These approaches may be associated with limiting the adverse effects of drug therapeutics.Results:A list of total FDA approved approaches has been provided. Novel approaches used for drug targeting to get maximum drug concentration in the brain have been highlighted. Several novel drug delivery approaches such as nanoparticle, nanoemulsion, microspheres, etc. have been reported and better therapeutic effects have been observed. Among the novel approaches, some of them are currently under either Phase II or Phase III development but may prove to offer better clinical effects. These approaches would become the alternate choice for migraine treatment with patients experiencing symptoms consistent with gastrointestinal dysfunction associated with migraine.Conclusion:Intra-nasal administration of drugs for migraine treatment may offer an interesting alternative for achieving therapeutic effects of drugs which are comparable to the parenteral route. Nasal drug delivery can be an alternative route of drug administration for migraine treatment to achieve better bioavailability.

Nose-to-Brain Delivery.

The global prevalence of neurologic disorders is rising, and yet we are still unable to deliver most drug molecules, in therapeutic quantities, to the brain. The blood brain barrier consists of a tight layer of endothelial cells surrounded by astrocyte foot processes, and these anatomic features constitute a significant barrier to drug transport from the blood to the brain. One way to bypass the blood brain barrier and thus treat diseases of the brain is to use the nasal route of administration and deposit drugs at the olfactory region of the nares, from where they travel to the brain via mechanisms that are still not clearly understood, with travel across nerve fibers and travel via a perivascular pathway both being hypothesized. The nose-to-brain route has been demonstrated repeatedly in preclinical models, with both solution and particulate formulations. The nose-to-brain route has also been demonstrated in human studies with solution and particle formulations. The entry of device manufacturers into the arena will enable the benefits of this delivery route to become translated into approved products. The key factors that determine the efficacy of delivery via this route include the following: delivery to the olfactory area of the nares as opposed to the respiratory region, a longer retention time at the nasal mucosal surface, penetration enhancement of the active through the nasal epithelia, and a reduction in drug metabolism in the nasal cavity. Indications where nose-to-brain products are likely to emerge first include the following: neurodegeneration, post-traumatic stress disorder, pain, and glioblastoma.

Preparation and Characterization of Large Unilamellar Vesicles Mixed With Trimethylchitosan (TMC): The Effect of Polyelectrolyte Concentration

Background: The effect of different concentrations of the absorption enhancer Trimethyl Chitosan (TMC) to the physicochemical properties of Large Unilamellar Vesicles (LUV) comprised of L-a-Phospahtidyl Choline (PC) were investigated in the current study. Methods: The Degree of Quartenization (DQ) of trimethylchitosan was assessed with nuclear magnetic resonance (1H NMR). The vesicles were characterized by means of Dynamic Light Scattering (DLS), ζ-potential, Differential Scanning Calorimetry (DSC) and Contact Angle Goniometry (CAG) measurements. Results: The data showed that the surface charge of the PC liposomes was significantly altered as a function of the TMC concentration, giving evidence of presence of the polyelectrolyte to the liposome’s membrane. Varying the concentration of TMC affected the phase Transition Temperature (Tm) of the lipid, verifying the miscibility of the polyelectrolyte with the lipid bilayer. The association of the polymer with the liposomes was related to the amount of the polyelectrolyte present, reflecting changes to the wettability of the dispersion as measured by CAG. Conclusion: The results demonstrated that presence of TMC significantly modified the physical properties of liposomes. Such systems might have a potential use for mucosal delivery (e.g. nasal route of administration).

Freeze-Dried K-Carrageenan/Chitosan Polyelectrolyte Complex-Based Insert: A Novel Intranasal Delivery System for Sumatriptan Succinate.

Intranasal route, ensuring suitable bioavailability of medicines under circumvention of the gastrointestinal degradation and hepatic first-pass elimination, has been a popular choice for drug delivery. Among nasal dosage forms, mucoadhesive solid inserts have been shown to resist mucociliary clearance and provide a prolonged nasal residence time. Hence, the purpose of this study was the preparation and characterization of nasal inserts composing of polyelectrolyte complexes (PECs) based on k-carrageenan (k-CA) and chitosan (CS) to boost therapeutic efficacy of sumatriptan succinate in the treatment of migraine headache. k-CA/CS PECs were developed in different molar ratios, subjected to lyophilization in small inserts in the presence of sumatriptan succinate, and finally investigated for water uptake ability, mucoadhesive potential, and drug release profile. The formation of PEC between the two polymers was affirmed by Fourier transform infrared spectroscopy (FTIR). Based on the results, it was revealed that the polyanion/polycation molar ratio plays a critical role in modulating the characteristics of the inserts, and among all the formulations, the one comprising k-CA/CS PEC with molar ratio of (4:1), (k-CA/CS (4:1)), demonstrated the highest water uptake ability and mucoadhesive potential and provided a more controlled release of sumatriptan succinate. This study illustrates the potential of the lyophilized inserts based on the k-CA/CS PECs, especially k-CA/CS (4:1), for efficient delivery of sumatriptan succinate via the nasal route of administration and suggests a potential therapeutic approach for the termination of migraine attacks.

Assessment and treatment of breakthrough cancer pain: from theory to clinical practice

Breakthrough cancer pain (BTcP) is a common condition in oncological patients. However, its management is still suboptimal. Improved knowledge of BTcP and its management in clinical practice may have immediate importance for all physicians involved in the supportive care of cancer patients. This review critically discusses the most important concepts for the correct diagnosis of BTcP and presents some intriguing cases of the management of this condition in clinical practice. Overall, the most appropriate therapeutic choice appears to be a rapid-onset opioid (ROO), and in particular, the nasal route of administration is the quickest and most convenient mode of administration for the management of BTcP, especially when the patient needs rapid resolution of pain. To this end, intranasal fentanyl spray may have a particular relevance in clinical practice. Future research should focus on accepted definitions of BTcP to investigate the optimal management of this highly heterogeneous pain condition. Therapeutic decision-making of patients, clinicians, and payers will likely be driven from results of well-designed clinical trials of ROOs.

Using Social Listening Data to Monitor Misuse and Nonmedical Use of Bupropion: A Content Analysis.

BackgroundThe nonmedical use of pharmaceutical products has become a significant public health concern. Traditionally, the evaluation of nonmedical use has focused on controlled substances with addiction risk. Currently, there is no effective means of evaluating the nonmedical use of noncontrolled antidepressants.ObjectiveSocial listening, in the context of public health sometimes called infodemiology or infoveillance, is the process of identifying and assessing what is being said about a company, product, brand, or individual, within forms of electronic interactive media. The objectives of this study were (1) to determine whether content analysis of social listening data could be utilized to identify posts discussing potential misuse or nonmedical use of bupropion and two comparators, amitriptyline and venlafaxine, and (2) to describe and characterize these posts.MethodsSocial listening was performed on all publicly available posts cumulative through July 29, 2015, from two harm-reduction Web forums, Bluelight and Opiophile, which mentioned the study drugs. The acquired data were stripped of personally identifiable identification (PII). A set of generic, brand, and vernacular product names was used to identify product references in posts. Posts were obtained using natural language processing tools to identify vernacular references to drug misuse-related Preferred Terms from the English Medical Dictionary for Regulatory Activities (MedDRA) version 18 terminology. Posts were reviewed manually by coders, who extracted relevant details.ResultsA total of 7756 references to at least one of the study antidepressants were identified within posts gathered for this study. Of these posts, 668 (8.61%, 668/7756) referenced misuse or nonmedical use of the drug, with bupropion accounting for 438 (65.6%, 438/668). Of the 668 posts, nonmedical use was discouraged by 40.6% (178/438), 22% (22/100), and 18.5% (24/130) and encouraged by 12.3% (54/438), 10% (10/100), and 10.8% (14/130) for bupropion, amitriptyline, and venlafaxine, respectively. The most commonly reported desired effects were similar to stimulants with bupropion, sedatives with amitriptyline, and dissociatives with venlafaxine. The nasal route of administration was most frequently reported for bupropion, whereas the oral route was most frequently reported for amitriptyline and venlafaxine. Bupropion and venlafaxine were most commonly procured from health care providers, whereas amitriptyline was most commonly obtained or stolen from a third party. The Fleiss kappa for interrater agreement among 20 items with 7 categorical response options evaluated by all 11 raters was 0.448 (95% CI 0.421-0.457).ConclusionsSocial listening, conducted in collaboration with harm-reduction Web forums, offers a valuable new data source that can be used for monitoring nonmedical use of antidepressants. Additional work on the capabilities of social listening will help further delineate the benefits and limitations of this rapidly evolving data source.

ADVANCES IN NIOSOME AS A DRUG CARRIER: A REVIEW

I n recent years a comprehensive research car r ied over niosome as a drug car r iers. Var ious drugs are enlisted and tried in niosome surfactant vesicles. Niosomes proved to be a promising drug carrier and has potent ial to reduce the side effects of drugs and increased therapeut ic effect iveness in var ious diseases. As of today more than fifty drugs are tried in niosomal formulations by intravenous route, per oral administ rat ion, t ransdermal route of administ rat ion, and inhalat ion preparat ion, ocular & nasal route of administration

The international survey on the management of allergic rhinitis by physicians and patients (ISMAR)

Epidemiologic studies suggest that the prevalence of allergic rhinitis (AR) is rising worldwide. Several reports, in fact, indicate increasing trends in the prevalence of AR especially in developing countries, likely related to the environment and climate changes and the adoption of an urbanized Western lifestyle. The primary objective of the present study was to collect information about management in real-life settings, including a characterization of typical patients’ profile referring to physicians, the disease features, the common approaches to diagnostic assessments and therapeutic decisions. This was an international, multicenter, cross-sectional study conducted in adults or children (≥6 years) suffering from rhinitis confirmed by physician's diagnosis for at least one year. The 234 physicians who participated in the study included a total of 2778 patients in Egypt, Mexico, Brazil, Colombia, Guatemala, Iran, Venezuela, Argentina, Israel, Kuwait and United Arab Emirates. It was found that clinical history was the selected tool to diagnose and categorize AR patients (97.1%), with less than half of patients undergoing allergy testing, may be explaining the scarce use of immunotherapy on management of disease. Out of 2776 patients, 93.4% had somehow received a recommendation to avoid allergens and irritant agent exposure. Notably, 91.4% were receiving at least one treatment at the time of the survey, mostly oral antihistamines (79.7%) and intranasal corticosteroids (66.3%). Oral antihistamines, intranasal steroids and decongestants were considered both safe and effective by patients and physicians, preferring oral and nasal route of administration. The ISMAR registry was designed according to the most accepted epidemiological recommendations, and provides interesting information regarding the management of rhinitis from a patient and physician points of view, with many similarities between the participating countries. Further efforts are required to better manage AR and its comorbidities.