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Indoprofen and naproxen in the treatment of rheumatoid arthritis: a clinical trial.

Thirty-six patients suffering from rheumatoid arthritis took part in a double-blind crossover trial, in which they received either indoprofen 800 mg/day, naproxen 500 mg/day, or a matching placebo. Indoprofen was shown to be significantly superior as an analgesic and in improving grip strength and the patients preferred it. Adverse effects were comparable, although indigestion was seen slightly more often during indoprofen treatment. Indoprofen is therefore at least as effective as existing anti-inflammatory drugs in rheumatoid arthritis and seems to be better tolerated.

Adult↗

Gastro-intestinal blood loss during administration of indoprofen, aspirin and ibuprofen.

The acute effect of three non-steroidal anti-inflammatory drugs, ibuprofen, acetylsalicylic acid (ASA) and indoprofen, on faecal blood loss was investigated in 15 subjects by means of 51Cr-labelled erythrocytes. Ibuprofen (900 mg/day for 5 days) and indoprofen capsules and tablets (300 mg and 600 mg/day for 5 days, respectively) slightly increased the amount of blood eliminated in faeces. The increase was of the same order of magnitude for both doses of indoprofen. ASA (1,500 mg/day for 5 days) caused about a 6-fold increase in blood loss. Four days after withdrawal of ASA, faecal blood was still about twice as high as in faeces of subjects given ibuprofen and indoprofen. The method appears sensitive and reliable for comparison of the immediate effect of anti-inflammatory drugs on gastro-intestinal mucosa.

Adult↗

The analgesic effect of intravenous indoprofen and lysine acetylsalicylate in patients with postoperative pain.

Indoprofen, as isoindolinyl derivative, was evaluated as a postoperative analgesic in a randomized double-blind, between-patients study on 40 men with postgastrectomy pain. Single intravenous doses of 100 and 300 mg indoprofen and 0.5 and 1.5 Gm lysine acetylsalicylate (ASA) were compared in a four-point assay. The method of evaluation relied on subjective appraisal of pain relief by the patient for 6 hours after medication. The results demonstrate the analgesic efficacy of indoprofen in patients with severe postoperative pain, a dose-dependent effect, and a 13-to-16 potency ratio to ASA as judged from total pain relief.

Adult↗

High-performance liquid chromatographic microdetermination of indoprofen in human milk.

A previously reported high-performance liquid chromatographic (HPLC) method for indoprofen determination in physiological fluids was modified and extended to provide quantitative data on drug concentrations in human milk samples at a low nanogram per milliliter level. The reversed-phase HPLC technique was modified to give a better separation of the drug and milk components. To achieve the necessary cleanup for low level determination, the milk samples required protein precipitation, liquid-liquid drug extraction, and concentration. Excellent indoprofen recovery was obtained with this technique; the average recovery from 20 milk samples spiked with various nanogram drug levels was 95%. The analytical technique showed excellent reproducibility; the calibration solutions over 15 days had a relative standard deviation of 3.2%. Results for indoprofen levels in milk and plasma samples from seven subjects who received either a single or multiple oral drug dose are presented.

Chromatography, High Pressure Liquid↗

Effect of indoprofen on prostaglandin and thromboxane A2 synthesis in the guinea pig lung.

Indoprofen has been studied in vitro as a possible selective inhibitor of thromboxane-synthetase in guinea pig lungs perfused with arachidonic acid. Indoprofen does not show selectivity of action since KB values for prostaglandin and TXA2 synthesis are not significantly different. Indoprofen might therefore act at the cyclooxygenase level as has already been demonstrated for indomethacin.

Animals↗

Evidence of a central component in the analgesic effect of indoprofene.

1. The central nervous system effects of the analgesic antiinflammatory drug, indoprofene were studied. 2. CNS effects were found using EEG in rats and cats. 3. Evoked cortical potentials were studied in cats, and evoked activity in ventroposterolateral thalamic nucleus and laminae V of spinal cord were studied in rats. 4. Indoprofene induced a modification of all the parameters studied. 5. Evoked activity of thalamic nuclei and laminae V were significantly depressed. 6. Central effects were not antagonized by naloxone. 7. It is postulated that indoprofene has a central component in its effect, which would contribute to its strong and rapid analgesic effect.

Analgesics↗

Determination of the enantiomers of indoprofen in blood plasma by high-performance liquid chromatography after rapid derivatization by means of ethyl chloroformate.

A rapid method for the determination of (+)- and (-)-indoprofen in blood plasma has been developed and applied to pharmacokinetic work. By means of ethyl chloroformate, indoprofen is coupled to leucinamide, a reaction which is complete in less than 3 min at room temperature. The diastereoisomeric derivatives are then separated by reversed-phase high-performance liquid chromatography. In two surgical patients given racemic indoprofen intravenously, the pharmacologically active (+)-enantiomer had a lower clearance and a lower distribution volume than the (-)-enantiomer, which gave it a slightly longer half-life.

Chemical Phenomena↗

Computer simulation of the interaction of non-steroidal anti-inflammatory drugs: indoprofen and NS398 with cyclooxygenase.

We have applied computer simulation technique to study interaction of two anti-inflammatory drugs (NSAIDs) indoprofen and NS398 with cyclooxygenase (COX-1 and COX-2) enzymes. We have also investigated conformational flexibility of the two drugs by systematic search and simulated annealing molecular dynamics (SAMD) methods. Both the drugs were docked in the cyclooxygenase channel using in house docking program IMF1. The complexes were energy minimised by molecular mechanics (MM) method. These were heated for 30 picoseconds (ps), equilibrated for 110 ps at 300K and subjected to 'production simulation' for 110 ps by molecular dynamics (MD) method using Sanderís module of AMBER 5.0 package and united atom force field mostly from PARM96.DAT. Integration was carried out with time step of 0.001 ps, distance dependent di-electric constant with scaling factor 2.0 for 1-4 interaction and cut-off distance for non-bonded pair-list equal to 8A. The non-bonded pair-list was upgraded after every 20 cycles. The coordinate output from MD trajectories is analysed using analysis package of AMBER 5.0, MOLMOL, P-CURVES 3.0 and in house packages: ANALMD, ANALP1. We have observed perturbative changes in COX-1 and COX-2 structures due to indoprofen and NS398. In case of indoprofen specific changes between COX-1 and COX-2 were noted in helix D, H6, S6 and helix H8 in the cyclooxygenase cavity. In case of NS398 these were in helix B in membrane binding domain, helix H6, S8 and S10 in cyclooxygenase cavity and helices H14-H16 in small lobe close to haem binding region. Implications of these results in enzyme selectivity by NSAIDs is discussed here.

Anti-Inflammatory Agents, Non-Steroidal↗

A comparison of indoprofen and indomethacin in the supportive treatment of soft-tissue injuries in football players: a pilot study.

Twenty-four professional footballers suffering from recent soft-tissue injuries were included in a double-blind pilot trial comparing the efficacy and tolerability of indoprofen 800 mg/day and indomethacin 80 mg/day. Twelve subjects were allocated at random to each of the two drugs. Mean reduction of pain and swelling by the 3rd day of treatment was greater in the indoprofen group, as was the rate of disappearance of these symptoms, calculated in terms of t 1/2. A statistically significant (p less than 0.05) superiority of indoprofen versus indomethacin was, however, reached only for pain elicited by active movement. No adverse reactions were recorded with either drug.

Adolescent↗

Indoprofen versus indomethacin in acute painful shoulder and other soft-tissue rheumatic complaints.

In a double-blind, parallel-group study indoprofen 800 mg daily was compared with indomethacin 100 mg daily in forty patients suffering from acute painful shoulder and other soft-tissue rheumatic complaints. Both drugs were administered orally for 14 days. Clinical assessments, carried out at baseline and on days 4, 8 and 15, included pain (at rest, upon pressure, on motion under load), quality of sleep, range of active motion and patient's opinion. A significant improvement in all variables was found for both indoprofen and indomethacin at each time of observation, almost reaching its maximum within the first week. Excellent or good results, as judged by the patients, were obtained in 90% of case in both treatment groups. No significant differences were observed between the two drugs. One patient taking indomethacin developed headache and dizziness, requiring discontinuation of treatment; three patients on indoprofen complained of mild or moderate gastric pain.

Adult↗

Adverse reactions to indoprofen: a survey based on a total of 6764 patients.

Safety data on indoprofen are presented, deriving from three sources: the first was a phase 4 multicentre clinical study based on 4042 patients suffering from osteoarthritis and treated with 400-800 mg daily by mouth for about 4 weeks; the second was a survey based on a heterogeneous series of 2722 subjects belonging to phase 1, 2 and 3 investigations, and treated with 200 to 1200 mg daily by the oral and/or parenteral route for from 1 to more than 180 days; the third was a safety laboratory study conducted in 472 patients, most of whom had participated in the first study, while the remainder were included in the second. Adverse events of any type occurred in 22% of patients in the first study and in 13% in the second, but treatment had to be withdrawn for drug-related reasons in less than 5% in both. Potentially life-threatening events were rare, overall including 16 instances of clinically overt gastro-intestinal bleeding and 2 anaphylactic reactions. Unfavourable laboratory changes, i.e. shifting from normal to abnormal values, were recorded in about 10% of the series studied. The adverse reaction profile of indoprofen was similar to that of most NSAIDs, with gastro-intestinal troubles prevailing over the other events, a distribution which, however, was clear-cut only with oral indoprofen. Tolerability problems appeared to be dose-related up to some point between 400 and 600 mg daily plateauing thereafter, and were less frequent following parenteral than following oral administration.

Adult↗

Plasma and synovial fluid pharmacokinetics and prostaglandin inhibitory effect of indoprofen in patients with rheumatoid arthritis.

Indoprofen was given intravenously (bolus followed by infusion) and orally to 7 patients suffering from active rheumatoid arthritis with knee joint effusion. Indoprofen readily penetrated into synovial fluid in amounts which were directly correlated with areas under curves of plasma drug levels. Synovial fluid acted as a compartment distinct from the central (plasma) compartment. Indoprofen caused a substantial decrease in E2 and F2 alpha prostaglandin concentration in synovial fluid.

Adult↗

A comparison of indoprofen and indomethacin in the treatment of ankylosing spondylitis.

A double-blind, crossover trial was carried out to compare the effectiveness and tolerance of indoprofen with indomethacin in the treatment of ankylosing spondylitis. Nineteen patients entered the study and 1 was withdrawn for reasons unrelated to therapy. Patients received 4-weeks' treatment in random order, with 200 mg indoprofen 4-times daily and 25 mg indomethacin 4-times daily. Most subjective and objective clinical measurements of disease activity showed a comparable degree of improvement with either drug although few statistically significant changes were observed. There was no statistically significant difference between treatments and, although gastro-intestinal side-effects occurred more commonly with indoprofen, patients known to be intolerant of indomethacin had been excluded from this trial.

Adult↗

Indoprofen in the treatment of osteoarthritis. Results of a phase IV multiclinic study in 1629 patients.

This paper contains a detailed account of the results obtained in 1629 patients with osteoarthritis treated with indoprofen, a recently introduced non-steroidal anti-inflammatory drug. Several traditional objective variables were selected for evaluation of efficacy, and they were shown to be highly correlated. After four weeks' treatment with doses of indoprofen ranging in the great majority of cases from two to four 200 mg tablets daily, highly significant improvement of pain was observed along with amelioration of joint motion as measured with a new arthrogoniometer specially developed for the trial. On a 5 point semiquantitative scale, pain severity decreased on the average ofrom 2.31 (0.03 S.E.M.) to 0.66 (0.02); knee flexion increased on the average from 71.8 (2 . 00) degrees to 93.0 (1.74) (p less than 0.001). These results have confirmed on a much larger scale the conclusions of phase 2 studies. The multiclinic trial disclosed more adverse reactions than those found in phase 3 studies, thus confirming that phase 4 studies are more suitable for supplying information on the acceptance of drugs by practising physicians. The risk/benefit ratio turned out to be very favourable on account of the acceptable frequency of adverse reactions which were mainly confined to the gastrointestinal tract and forced withdrawal in only 6.0% of patients. Untoward clinical events were validated with a new algorithm: their relationship with the drug was in 51.5% probable and 35.6% definite. The results of this study have confirmed the usefulness of indoprofen in the treatment of osteoarthritis.

Anti-Inflammatory Agents, Non-Steroidal↗

Effect of food on absorption of indoprofen administered orally to man in two dosage forms.

The influence of food on the bioavailability of two oral dosage forms (100-mg capsules and 200-mg tablets) of indoprofen, a new propionic acid derivative with marked anti-inflammatory and analgesic properties, has been investigated. Plasma levels and urinary excretion of indoprofen were determined both in the fasting state and after a standard meal in healthy volunteers after administration of two 100-mg capsules (4 subjects) and of one 200-mg tablet (6 subjects). Indoprofen in biological fluids was determined by gas-liquid chromatography. The extent of absorption from tablets was not affected by food as indicated from the values of the total area under plasma level curves and urinary excretion of the drug. The rate of absorption was faster after meal than in the fasting state. The opposite was found for capsules, which showed a slightly delayed absorption after food. The results suggest that food may differently influence the absorption pattern of different pharmaceutical forms of the same drug.

Administration, Oral↗

Pharmacokinetic studies of indoprofen in healthy volunteers and in patients.

The pharmacokinetics of indoprofen in healthy subjects after single oral and i.v. administrations is reviewed. During repeated administration of indoprofen to 6 normal subjects (200-mg tablet every 8 hours for 6 days) no variations in the disposition of the drug were found in comparison with single dose administration. In 6 inpatients, with rheumatoid arthritis, the pharmacokinetics of indoprofen was studied after single oral (tablet) and i.m. administration. As for oral doses, no difference in main kinetic parameters was detected between the patients and normal subjects except for a higher volume of distribution in the former population. The bioavailability of the drug given by i.m. injection was not significantly different from that observed after oral administration.

Administration, Oral↗

Inhibition of prostaglandin synthesis by indoprofen.

Many non-steroidal anti-inflammatory, analgesic drugs appear to produce their effects by inhibiting prostaglandin synthesis. These investigations were undertaken to determine whether a new anti-inflammatory compound, indoprofen, inhibited prostaglandin synthesis in vitro when present in incubation medium or following systemic administration. The results indicated that indoprofen effectively inhibited prostaglandin synthesis in kidney and uterus. Indoprofen was equally effective as indomethacin and aspirin in inhibiting prostaglandin synthesis. The relative potency of the drug was intermediate between indomethacin and aspirin.

Animals↗

Some novel observations of a drug (indoprofen)--albumin interaction.

Indoprofen, a new-steroidal anti-inflammatory agent, binds to human serum albumin in an endothermic reaction at low degrees of saturation and with an exothermic reaction at higher drug to protein ratios. Although indoprofen appears to bind to the same primary site as diazepam, dialysis studies show an increased binding of both drugs in the presence of the other. This novel observation is probably due to the effect of the drugs on the N leads to B conformational change of human serum albumin.

Diazepam↗