Getting loperamide across the blood-brain barrier

sounds interesting, but i've registered and didn't got any activation mail.. yet :S could you maybe some more information in this topic?

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Hi folks. Anyone who takes a look at this small polar molecule and wonders how to get it into the brain without ps80 coated nano-particles, large doses of quinidine, or some sort of ascorbic acid ester attachment, must inevitably come to the conclusion that a reduction and dehalogenation is in order. As of my 2003 merck index neither the reduced or the reduced and dehalogenated molecules are mentioned. reduced molecule: 4-(4-phenyl)-N,N-dimethyl-a,a-diphenyl-1-piperidinebutanamide reduced/dehalogenated molecule: 4-(4-Chlorophenyl)-N,N-dimethyl-a,a-diphenyl-1-piperidinebutanamide Also various searches on the internet have yielded no results. It appears that these things have never existed. I wonder why to be quite honest. I think it could even be done with the RP/I mechanism (anyone know the difference in elctronegativity between idione and chlorine?). Shit, the reduction alone could probably be done with potassium permangenate. Does anyone have any comments on how worthwhile this new compound could be? SWIM's about ready to run a reaction, buy a couple rodents from the pet store and see how much they appreciate an sc injection.

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As i'm very curious on this theme, too, i been hunting for information for quite a while now, but i couldn't find much - the only thing is an old thread from the hive which didn't sound like it was complete crap (not that i could judge, but the people there did not sound like complete denial), so i hope pasting the whole thread here is excusable (unable to post the link, c&p'ed the text, can't find it anymore), maybe anyone can get something out of it (and post it here, of course - i die if i don't find out how it works soon ...

ok, here it goes:

*****************





kreo
(Stranger)
07-17-02 20:10
No 333910




loperamide question?
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recently swim had a dream. the dream proceeds as follow: swim aquired 6mg loperamide hcl. swim decided to poor 20ml dilute acetic acid ~5% making it a ~1:1 mole ratio. nothing was happening so swim decided to chunk in an acid (ascorbic acid ~125mg), didnt have any sulfuric acid, just for shits and gigles the solution turned a deep orange color. prior knowledge tells swim that the orange is from the precense of dehydroascorbate, the oxidized form of ascorbic acid. the resulting product had strong opiate like effects in the microgram dose. swim would like to know what the hell happened since swim wasnt expecting much. swim thinks it just formed an acetic ester but swims confused on what the ascorbic acid did. would any bee mind helping swim out with his problem?
im an artist. i look at things from a creative perspective.
peace out
Dr_Heckyll
(Stranger)
07-17-02 20:52
No 333927




Question
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the resulting product had strong opiate like effects in the microgram dose.

How did swim determine that?


Dr. Heckyll & Mr. Jive by Men at Work
...tells my tale.










kreo
(Stranger)
07-18-02 10:45
No 334193




swim has EXTREMELY limited improvised resources ...
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swim has EXTREMELY limited improvised resources and equiptment due to a nosy three lettered freind. as for the bioassay swim just railed a tiny tiny line of the crude product ~.025-.05mg its hard for swim to tell by eye especially seeing that an unknown percentage is crude byproducts. the previous dose had effects similer to ~7.5mg hydrocodone not to mention crazy ass itching. swim is cautious of experimenting further without further knowledge on what sort of "frankendrug" was producted, even swims got limits on how far swim pushes swims body.
im an artist. i look at things from a creative perspective.
peace out










foxy2
(Distinctive Doe)
07-18-02 11:34
No 334205




well probably nothing
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I have read an article that stated snorting drugs can directly bypass the blood-brain barrier, to a limited extent.

I forget the details.
Those who give up essential liberties for temporary safety deserve neither liberty nor safety










kreo
(Stranger)
07-18-02 13:38
No 334240




swim says insufflated loperamide is extremely ...
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swim says insufflated loperamide is extremely unpleasant, it takes ~6mg to feel threshold effects, it makes swims nose itch like hell and swell up, and its got a lot of toxic side effects, eg. facial swelling, profuse sweating, itching. swims face and hands were breaking out for about a week while swim only felt threshold effects for the first few hours. maybe it was a placebo but the toxic effects were very real. swims freinds thought swim was being attacked by a flesh eating bacteria.
im an artist. i look at things from a creative perspective.
peace out

oxy2
(Distinctive Doe)
07-18-02 14:16
No 334248




opiate
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Those sound like opiate side effects. Which is typically all you get from loperamide, and thus its otc.

Maybee whatever you insuffelated with it caused the permiability of your membranes to increase.

Or your full of shit.
I'll flip a coin.

Tails, I think your full of shit.

The scientific method at its finest
Those who give up essential liberties for temporary safety deserve neither liberty nor safety










carboxyl
(Hive Bee)
07-18-02 14:49
No 334269




am i getting this right?
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so you took some otc loperamide, tossed it in some vinegar, threw in some vitamin c, and got a compound active at
.025-.05 mg??? Doesn't it sound a little bit far fetched? I think I'm with foxy on this one, but please correct me if i'm wrong
The above post is purely fictional. Any resemblance to "real-life" is purely coincidental.










kreo
(Stranger)
07-18-02 16:01
No 334312




yeah dude swim thought it was pretty far fetched ...
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yeah dude swim thought it was pretty far fetched too. swim cant really rule out that there might have been impurities in the reaction vessel or that swim has abnormal sensitivity to certain chemicals. so swim was hoping someone on the forum might be able to duplicate the result seeing that niether chemistry nor psychoactive substances are swims area of expertise. swim let it react in room temperature for two days.
im an artist. i look at things from a creative perspective.
peace out










kreo
(Stranger)
07-18-02 16:17
No 334320




swim doesnt think swim made 'swimself' clear but ...
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swim doesnt think swim made 'swimself' clear but on the post where swim was describing effects, swim was refering to insufflated loperamide NOT 'frankendrug'. swim wants some feedback on this. maybe a response of a more chemical or biological nature would be a little more helpful.
im an artist. i look at things from a creative perspective.
peace out

Dr_Heckyll
(Stranger)
07-18-02 19:45
No 334395




Shit or not shit?
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foxy2: Tails, I think your full of shit.

Somehow I tend to second foxy2:

as for the bioassay swim just railed a tiny tiny line of the crude product ~.025-.05mg its hard for swim to tell by eye especially seeing that an unknown percentage is crude byproducts.

You cannot see 0.05 mg with your bare eye, much less rail a tiny tiny line from it. You don't have your facts straight.

But assuming that there is some truth to your story, not quantitatively, but qualitatively, what could have happened? The only moiety of loperamide with which the vitamin C could have possible reacted is the diphenylamido. Is there any precedence or possibility that ascorbic acid could reduce an amide to an alpha-hydroxy alkylamine?



Dr. Heckyll & Mr. Jive by Men at Work
...tells my tale.










vetya
(Stranger)
08-18-02 16:57
No 346529




ascorbic acid and the blood brain barrier
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While browsing swim found this article related to this recipe.
http://www.nmafaculty.org/news/ascorbic.htm
Claiming "According to Dr. Manfredini, 'Ascorbic acid works like a sort of shuttle. Theoretically it could transport onto the brain any compound.'"

Real question is how to cleave the ascorbic unto the loperamide.

Also, seem to recall that alcohols in general increase permeability of the BBB and perhaps it's worth trying the ascorbic/loperamide combo in other solvents. Unfortunately swim's background is focused on theoretical neurobio not the chem side.

Would appreciate comments (dried up opioids can be the mother of invention it seems).

_Heckyll
(Hive Bee)
08-19-02 22:17
No 346969




Looks like they are refering to 11806707 . Hmm.
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Looks like they are refering to Medline (PMID=11806707). Hmm. Did kreo somehow attach the ascorbic acid, possibly as ester, to the available hydroxy of loperamide and thereby shuttled it into his CNS? So many questions and no answers...


http://lyricsdomain.com/lyrics/26021/










eugene
(Stranger)
08-26-02 00:52
No 349112




Getting loperamide across the blood-brain barrier
(Rated as: excellent)
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This looks interesting:

Pharm Res 1997 Mar;14(3):325-328 Delivery of loperamide across
the blood-brain barrier with polysorbate 80-coated
polybutylcyanoacrylate nanoparticles.

Alyautdin RN, Petrov VE, Langer K, Berthold A, Kharkevich DA,
Kreuter J

Department of Pharmacology, Sechenov Medical Academy, Moscow,
Russia.

PURPOSE: The possibility of using polysorbate 80-coated
nanoparticles for the delivery of the water insoluble opioid
agonist loperamide across the blood-brain barrier was
investigated. The analgesic effect after i.v. injection of the
preparations was used to indicate drug transport through this
barrier. METHODS: Loperamide was incorporated into PBCA
nanoparticles. Drug-containing nanoparticles were coated with
polysorbate 80 and injected intravenously into mice. Analgesia
was then measured by the tail-flick test. RESULTS: Intravenous
injection of the particulate formulation resulted in a long and
significant analgesic effect. A polysorbate 80 loperamide
solution induced a much less pronounced and very short analgesia.
Uncoated nanoparticles loaded with loperamide were unable to
produce analgesia. CONCLUSIONS: Polysorbate 80-coated PBCA
nanoparticles loaded with loperamide enabled the transport of
loperamide to the brain.

PMID: 9098875, UI: 97253432


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Life Sci 1983;33 Suppl 1:315-318 Loperamide: evidence of
interaction with mu and delta opioid receptors.

Giagnoni G, Casiraghi L, Senini R, Revel L, Parolaro D, Sala M,
Gori E

Loperamide was tested on electrically-evoked contractions using a
series of "in vitro" isolated preparations, in comparison with
morphine, met-enkephalin, beta-endorphin, ethylketocyclazocine
used as representative agonists of mu, delta, epsilon, kappa
receptors respectively. The IC50 of loperamide on myenteric
plexus longitudinal muscle of guinea pig ileum was found to be
1.90 X 10(-7)M and equal to that of morphine. The IC50 on mouse
vas deferens was found to be 13.02 X 10(-7)M. In this tissue,
loperamide resulted as active as morphine, but 54 times less
active than met-enkephalin (IC50 0.24 X 10(-7)M). On the rat vas
deferens where, as expected, beta-endorphin was strongly active
(IC50 1.38 X 10(-7)M), morphine exerted a stimulatory action
within the range 10(-5)M-10(-4)M and loperamide was only poorly
depressive. The Ke value of naloxone, a specific mu receptor
antagonist, against loperamide in the guinea pig ileum was 3.83
nM, and in the mouse vas deferens was 82.87 nM indicating that
loperamide in the guinea pig ileum acts on mu receptors while in
the mouse vas deferens on another opiate receptor.

PMID: 6319884, UI: 84116593

morpheus
(Hive Bee)
08-29-02 02:50
No 350368




Not shit
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Swim remembers reading somewhere(maybee PDR for otc drugs)
that loperamide given to opiate addicted rhesus monkeys
stopped or eased their withdrawl.Since monkeys can't
talk, don't ask me how they arrived at this conclusion.
Apparently besides helping your lower GI tract and constipating you,in large enough doses it has some opiate qualities.Unfortunatly in large doses you may end up with
an impacted bowel or colon.

ambientia
(Stranger)
09-24-02 06:17
No 359944




p-glycoprotein and loperamide
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What are P-glycoproteins?
http://www.mhc.com/PGP/PgpMain.HTML

Increased drug delivery to the brain by P-glycoprotein inhibition.
http://www.ncbi.nlm.nih.gov:80/entr...ve&db=PubMed&list_uids=11014404&dopt=Abstract

Interaction of morphine, fentanyl, sufentanil, alfentanil, and loperamide with the efflux drug transporter P-glycoprotein.
http://www.ncbi.nlm.nih.gov:80/entr...ve&db=PubMed&list_uids=11964599&dopt=Abstract

Ritonavir increases loperamide plasma concentrations without evidence for P-glycoprotein involvement.
http://www.ncbi.nlm.nih.gov:80/entr...ve&db=PubMed&list_uids=11719726&dopt=Abstract

Comparative studies to determine the selective inhibitors for P-glycoprotein and cytochrome P4503A4.
http://www.ncbi.nlm.nih.gov:80/entr...ve&db=PubMed&list_uids=11741214&dopt=Abstract

Modulation of P450 CYP3A4-dependent metabolism by P-glycoprotein: implications for P450 phenotyping.
http://www.ncbi.nlm.nih.gov:80/entr...ve&db=PubMed&list_uids=11160617&dopt=Abstract

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I am very well aware of this old hive thread, and it did give some some ideas in my earlier stages of thinking. I have developed a mechanism for attaching ascorbic acid as an ester onto loperamide. It would be an effective carrier to the brain. I am highly doubtful however that this person's experiment managed to do this with the ascorbic acid. I have explored every avenue of delivery really. I am personally only interested in the reduction and dehalogenation at this point because it seems to be the best unexplored route to producing an active molecule. I can't afford ps80 coated nano nothing, and the ascorbic acid mechanism a friend and I developed is more time consuming than a simple reduction. I am 95% sure that reduced/dehalogenated loperamide, 4-(4-Chlorophenyl)-N,N-dimethyl-a,a-diphenyl-1-piperidinebutanamide would be a highly active brain penetrant . I base this assumption on the fact that it is the opposite end of the molecule that provides activity. I am actually acutely aware of why nobody in the legitimate scientific community has never explored this new compound. It would be a contribution damaging to ones career, as this molecule would be used almost exclusively for abusive purpouses. Domestic heroin produced by the same idiots that bring you speed. I'm even starting to think that bee's may very well be doing this and just not telling anybody (why else would they never even talk about a reduction, if only to explain why it's a bad idea?!) The silence around loperamide is certainly uncharacteristic of the-hive.

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Hm, even if it sounds like paranoia at the first glance i must say it would explain why there is nothing to find anywhere on that ... (of course it might also be possible that there is simply nothing to say, but i doubt that. Again, not that i could judge ...) Reminds me of another story - Silentium post Clamores, Post 120 Anos patebo nothing, and so on ... Crap, must be swim's destiny - always too late ... The Sisters M. are really jealous and unforgiving lovers sometimes, once one leaves them they might not be easy to reconquer - god, how poetic (*puke*)

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Article any drug and ascorbic acid (need full text)

How to make a complex loperamide and ascorbic acid ?

Design, Synthesis and Activity of Ascorbic Acid Prodrugs of Nipecotic, Kynurenic and Diclophenamic Acids, Liable to Increase Neurotropic Activity

Stefano Manfredini,* Barbara Pavan, Silvia Vertuani, Martina Scaglianti, Donatello Compagnone, Carla Biondi, Angelo Scatturin, Sergio Tanganelli, Luca Ferraro, Puttur Prasad, and Alessandro Dalpiaz

Department of Pharmaceutical Sciences, via Fossato di Mortara 19, 44100 Ferrara, Italy, Department of Biology, General Physiology Section, via Borsari 46, 44100 Ferrara, Italy, and Department of Experimental Clinical Medicine, Pharmacology Section, via Fossato di Mortara 19, 44100 Ferrara, Italy, and Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, GA

Received July 26, 2001

Abstract:

To improve the entry of certain drugs into brain, ascorbic acid (AA) conjugates of these drugs were synthesized and their capacity to interact with SVCT2 ascorbate transporters was explored. Kinetic studies clearly indicate that all of the conjugates were able to competitively inhibit ascorbate transport in human retinal pigment epithelial cells (HRPE). In vivo studies, in a mouse model system, demonstrate that conjugate 3 is better absorbed compared to the nonconjugated parent drug.

http://pubs.acs.org/cgi-bin/abstract.cgi/jmcmar/2002/45/i03/abs/jm015556r.html

Research Article

Transporter-mediated effects of diclofenamic acid and its ascorbyl pro-drug in the in vivo neurotropic activity of ascorbyl nipecotic acid conjugate
Alessandro Dalpiaz 1 *, Barbara Pavan 2, Martina Scaglianti 1, Federica Vitali 1, Fabrizio Bortolotti 1, Carla Biondi 2, Angelo Scatturin 1, Sergio Tanganelli 3, Luca Ferraro 3, Puttur Prasad 4, Stefano Manfredini 1
1Department of Pharmaceutical Chemistry, via Fossato di Mortara 19, 44100, Ferrara University, I-44100 Ferrara, Italy
2Department of Biology, General Physiology Section, via Borsari 46, Ferrara University, I-44100 Ferrara, Italy
3Department of Clinical and Experimental Medicine, Pharmacology Section, via Fossato di Mortara 19, 44100, Ferrara University, I-44100 Ferrara, Italy
4Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, Georgia

email: Alessandro Dalpiaz ([email protected])

*Correspondence to Alessandro Dalpiaz, Department of Pharmaceutical Chemistry, via Fossato di Mortara 19, 44100, Ferrara University, I-44100 Ferrara, Italy. Telephone: 390532-291273; Fax: 390532-291296

Keywords
active transport • ascorbic acid • CNS • diclofenamic acid • nipecotic acid • prodrugs • stability • SVCT2 • transporters

Abstract
Continuing our studies on SVCT2 ascorbic acid (AA) transporter-mediated drug delivery of neurotropic agents, we have now investigated the in vitro intracellular uptake of Diclofenac (Diclo) and its conjugate (AA-Diclo), both characterized by high affinity for the SVCT2 transporter. We have also investigated the in vivo uptake mechanism of AA-conjugate of Nipecotic acid (AA-Nipec) and the implication of the transporter-mediated effects of Diclo and AA-Diclo. Diclo resulted as a noncompetitive inhibitor of AA transport, but also showed a sodium-dependent and ascorbate-independent uptake, thus implying the possible involvement of specific transporters in the delivery to the brain of Diclo. This result opens a perspective in the discovery of new strategies in the targeting of this drug to the brain. Inhibitory effects of Diclo and AA-Diclo on the SVCT2 transporter were used to study anticonvulsant effects of AA-Nipec, confirming our hypothesis of an SVCT2-mediated transport in its neurotropic activity. AA-Diclo stability has been also investigated: it is hydrolyzed following a first-order kinetics in buffer, plasma (t1/2 at about 10 h) and whole blood (t1/2 at about 3 h), suggesting AA-Diclo as a potential candidate to enhance the short half-life of Diclo in vivo. © 2004 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 93:78-85, 2004
Received: 18 May 2003; Revised: 28 July 2003; Accepted: 28 July 2003

Digital Object Identifier (DOI)

10.1002/jps.10532 About DOI

http://www3.interscience.wiley.com/cgi-bin/abstract/106561774/ABSTRACT

European Journal of Pharmaceutical Sciences
Volume 24, Issue 4 , March 2005, Pages 259-269

doi:10.1016/j.ejps.2004.10.014
Copyright © 2004 Elsevier B.V. All rights reserved.

Ascorbic and 6-Br-ascorbic acid conjugates as a tool to increase the therapeutic effects of potentially central active drugs

Alessandro Dalpiaza, , , Barbara Pavanb, Silvia Vertuania, Federica Vitalia, Martina Scagliantia, Fabrizio Bortolottia, Carla Biondib, Angelo Scatturina, Sergio Tanganellic, Luca Ferraroc, Giuliano Marzolac, Puttur Prasadd and Stefano Manfredinia

aDepartment of Pharmaceutical Sciences, Ferrara University, via Fossato di Mortara 19, 44100 Ferrara, Italy
bDepartment of Biology, General Physiology Section, via Borsari 46, 44100 Ferrara, Italy
cDepartment of Experimental Clinical Medicine, Pharmacology Section, via Fossato di Mortara 19, 44100 Ferrara, Italy
dDepartment of Obstetrics and Gynecology, Medical College of Georgia, Augusta, GA, USA

Received 14 April 2004; revised 15 October 2004; accepted 25 October 2004. Available online 18 December 2004.



Abstract

Ascorbic acid (AA) or 6-Br-ascorbate (BrAA) conjugation has been investigated as a tool to improve brain drug delivery by the Vitamin C transporter SVCT2. To this aim, the effects of AA- or BrAA-conjugation on drug affinity and uptake have been assessed in vitro, by using human retinal pigment epithelium (HRPE) cells, and compared in vivo on mice. Nipecotic, kynurenic and diclofenamic acids were chosen as model drugs. Kinetic and inhibition experiments referred to [14C]AA uptake into HRPE cells showed that nipecotic and kynurenic acids became able to interact with SVCT2, as competitive inhibitors, only when conjugated to AA or BrAA. Surprisingly, diclofenamic acid itself appeared able to interact with SVCT2, with an affinity that was significantly increased or decreased by AA or BrAA conjugation, respectively. HPLC analysis, performed on HRPE cells, confirmed the SVCT2 mediated transport for the BrAA-conjugate of nipecotic acid, whereas kynurenic acids conjugates although interacting with the transporter did not enter the cells. In accordance, only the nipecotic acid conjugates showed anticonvulsant activity after systemic injection in mice.

http://www.sciencedirect.com/scienc...serid=10&md5=a30836763475b4e119918190da0d22ca

: Int J Pharm. 2005 Mar 3;291(1-2):171-81. Epub 2004 Dec 30.

Vitamin C and 6-amino-vitamin C conjugates of diclofenac: synthesis and evaluation.

Dalpiaz A, Pavan B, Scaglianti M, Vitali F, Bortolotti F, Biondi C, Scatturin A, Manfredini S.

Dipartimento di Scienze Farmaceutiche, Universita di Ferrara, via Fossato di Mortara 19, 44100 Ferrara, Italy. [email protected]

Diclofenac (Diclo), its ascorbic acid (AA) or 6-amino-AA (AA-NH2) pro-drugs (AA-Diclo or AA-NH-Diclo) were prepared and evaluated on human retinal pigment epithelium (HRPE) cells to investigate their ability to interact with the vitamin C transporter SVCT2 and their cellular uptake. Furthermore, stabilities in physiological fluids of these compounds were investigated. For kinetic experiments, AA-Diclo was incubated in Tris-HCl buffer, human plasma or whole blood. The extracted samples were analysed by HPLC. AA-Diclo was hydrolysed following first order kinetics in buffer, plasma (t1/2 about 10 h) and whole blood (t1/2 about 3.5 h). Transport and inhibition assays were performed by adding [14C]AA and the above-mentioned unlabelled compounds to plated HRPE cells. Intracellular accumulation was measured incubating HRPE cells with increasing concentrations of unlabelled compounds, following by HPLC analysis. Diclo resulted as a non-competitive inhibitor of AA-transport, showing a Na+-dependent and ascorbate-independent uptake. AA-Diclo behaved as a competitive inhibitor, but it was not transported into cells, whereas its analogue AA-NH-Diclo showed a decreased inhibitory activity. Stability studies suggest AA-Diclo as a potential candidate to enhance the Diclo short half life in vivo. The discovery of a Na+-dependent transporter for Diclo on HRPE cells opens new perspectives for targeting diclofenac into the brain.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15707744

J Pharm Sci. 2004 Jan;93(1):78-85.

Transporter-mediated effects of diclofenamic acid and its ascorbyl pro-drug in the in vivo neurotropic activity of ascorbyl nipecotic acid conjugate.

Dalpiaz A, Pavan B, Scaglianti M, Vitali F, Bortolotti F, Biondi C, Scatturin A, Tanganelli S, Ferraro L, Prasad P, Manfredini S.

Department of Pharmaceutical Chemistry, via Fossato di Mortara 19, 44100, Ferrara University, I-44100 Ferrara, Italy. [email protected]

Continuing our studies on SVCT2 ascorbic acid (AA) transporter-mediated drug delivery of neurotropic agents, we have now investigated the in vitro intracellular uptake of Diclofenac (Diclo) and its conjugate (AA-Diclo), both characterized by high affinity for the SVCT2 transporter. We have also investigated the in vivo uptake mechanism of AA-conjugate of Nipecotic acid (AA-Nipec) and the implication of the transporter-mediated effects of Diclo and AA-Diclo. Diclo resulted as a noncompetitive inhibitor of AA transport, but also showed a sodium-dependent and ascorbate-independent uptake, thus implying the possible involvement of specific transporters in the delivery to the brain of Diclo. This result opens a perspective in the discovery of new strategies in the targeting of this drug to the brain. Inhibitory effects of Diclo and AA-Diclo on the SVCT2 transporter were used to study anticonvulsant effects of AA-Nipec, confirming our hypothesis of an SVCT2-mediated transport in its neurotropic activity. AA-Diclo stability has been also investigated: it is hydrolyzed following a first-order kinetics in buffer, plasma (t(1/2) at about 10 h) and whole blood (t(1/2) at about 3 h), suggesting AA-Diclo as a potential candidate to enhance the short half-life of Diclo in vivo. Copyright 2004 Wiley-Liss, Inc.


PMID: 14648638 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14648638

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Chemethist said:

we all know Loperamide Hydrochloride is an opiate used in OTC medicines. It does not cross the blood brain barrier (BBB) so it does not create opiate effects.

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Chemethist said:

We have all probably also seen this...

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