OBJECTIVE A combination of esomeprazole, amoxicillin and clarithromycin may be used for Helicobacter pylori eradication. We explored the potential for interactions between these drugs. METHODS In 2 randomized, 4-way crossover studies, healthy CYP2C19 extensive metabolizers (EMs) received esomeprazole 40 mg once daily (n = 20) or 20 mg twice daily (b.i.d.) (n = 20), clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d. or the combination of the 3 drugs for 7 days. In a third randomized, 2-way, crossover study, 6 healthy CYP2C 19 poor metabolizers (PMs) received esomeprazole 40 mg once daily with and without clarithromycin 500 mg b.i.d. for 1 week. RESULTS Triple therapy with esomeprazole 40 mg increased the area under the plasma concentration-time curve during the dosing interval (AUCtau) from 13.31 micromol x h/l (11.12-15.93) for esomeprazole alone to 22.69 micromol x h/l (18.94-27.17) for triple treatment. Respective AUCtau values with esomeprazole 20 mg b.i.d. were 4.97 micromol.h/l (3.97-6.21) and 11.29 micromol x h/l (9.03-14.12). Clarithromycin and amoxicillin plasma levels were largely unchanged by combination therapy. In PMs, the esomeprazole AUC also approximately doubled when administered in combination with clarithromycin. All treatments were well tolerated. CONCLUSION Clarithromycin decreases the metabolism rate of esomeprazole, leading to approximately doubled AUC values, both in EMs and PMs.

Modern liquid chromatography has been developing very fast during the last ten years by significant progresses in both column technology and instrumentation. However, the increased interest and efforts in chemical manipulation of the phase systems have also to a great extent contributed to this tremendous development.

Possible arrhythmogenic side-effects of the positive inotropic agent prenalterol were studied in conscious dogs, three to four days after coronary artery ligation. Prenalterol showed a propensity to cause arrhythmias in one out of eight dogs, thereby confirming published data from clinical studies.

Apomorphine is extracted from plasma or tissue homogenate with ethyl acetate. After back-extraction into hydrochloric acid, the apomorphine is extracted as an ion pair with 3,5-di-tert.-butyl-2-hydroxybenzen sulphonate into a small volume of methylene chloride and the solution is injected into the chromatographic column. Apomorphine is separated on microporous silica with a mixture of aqueous perchloric acid, methanol and methylene chloride as the mobile phase. With absorbance measurement of the eluent at 254 nm the method permits the determination of 15 pmol of apomorphine in 1 ml of plasma or in a rat brain. The coefficient of variation was 4% at the 100 pmol level.

A selective analytical method for the determination of methylguanidine in plasma in biological fluids has been developed. Methylguanidine is extracted in a column to dichloromethane as an ion pair with hexanitrodiphenylamine (dipicrylamine). It is isolated from coextracted compounds by partition chromatography as the picrate ion-pair. The methylguanidine fraction is collected and after reextraction to a buffer solution the methylguanidine content is quantitatively determined photometrically as picrate. An absolute recovery of 95 +/- 5% was obtained in the concentration range 1.5-10 microgram/ml plasma. The concentration of methylguanidine in plasma was higher in uremic patients, (44.4 +/- 5.71 mumol/l in conservatively-treated and 42.4 +/- 7.87 mumol/l in dialysis-treated patients) than in normal subjects, (4.0 mumol/l), but still lower than reported by other investigators using non-specific methods and also lower than the concentrations found to be toxic in experimental animals. There was a significant correlation between methylguanidine and creatinine concentration but no correlation between methylguanidine and urea concentration in plasma. No obvious relation was found between plasma methylguanidine concentration and various uremic symptoms, mode of treatment or protein intake.

A simple and sensitive method for determination of procainamide and its N-acetylated metabolite in plasma and urine has been developed. After extraction from alkalified biological samples the amines are separated by liquid chromatography on microporous silica particles and quantified by UV-detection. Concentrations down to 0.4 nmol/ml (100 ng/ml) of plasma can be determined but the sensitivity can be increased to 0.04 nmol/ml by concentration of the extract before injection.

Liquid-liquid chromatography based on the ion-pair partition technique gives separation systems of high efficiency when silica micro-particles are used as the support for the stationary phase. With 10-μm particles, plate heights of the order of 40–70 μm have been achieved with a linear velocity of 0.25 cm/sec. The retention in ion-pair partition systems is determined by the nature and concentration of the counter ion, and the properties of the mobile phase also have a major influence. It is often possible to predict the selectivity, and this can be controlled by varying the composition of the mobile phase.

A method for determination of acetylcholine in small, discrete biological objects by use of ion-pair technique has been developed. Acetylcholine is extracted as an ion pair with 3,5-di-t-butyl-2-hydroxybenzenesulphonate and separated from co-extracted components by ion-pair partition chromatography with picrate as the counter ion and porous cellulose as support. The quantitative evaluation is made from the acetylcholine peak in the chromatogram obtained by ultraviolet detection. Acetylcholine has been analysed in 1 cm large pieces of rat sciatic nerve containing about 60 pmol (10 ng). The overall recovery of the method is 100 +/- 10% at the 120 pmol level of acetylcholine in a sample.

Emepronium bromide, an anticholinergic quaternary ammonium compound, was determined quantitatively in human urine by an ion-pair extraction method. This was constructed by the use of a theoretical approach, and favorable conditions were calculated from extraction constants and constants for side reactions. The principle of choosing selective extraction conditions is discussed on a theoretical basis; it has a general application in drug isolation from samples of such a complicated nature as biological objects. The present method includes extraction of the drug as perchlorate ion pair, purification of the extract, and determination with bromthymol blue. Using a concentration step in the method, a minimum concentration of 0.2 mcg./ml. urine could be determined with an absolute recovery of 98 ± 3%. Utilizing this method, the excretion of emepronium bromide in urine was followed after oral and rectal administration.