Thursday, 17 May 2012

Avanafil (StendraTM) Better than sildenafil (Viagra ®) Approved 2012

On April 27th, the FDA approved Avanafil (tradename: Stendra; Research Code: TA-1790), a phosphodiesterase 5 (PDE5) inhibitor for the treatment of erectile dysfunction (ED). ED is a sexual dysfunction characterized by the inability to produce an erection of the penis. The physiologic mechanism of penile erection involves the release of nitric oxide in the corpus cavernosum during sexual stimulation, which in turn activates the enzyme guanylate cyclase, resulting in increased levels of cyclic guanosine monophosphate (cGMP). cGMP produces relaxation of smooth muscle tissues, which in the corpus cavernosum results in vasodilation and increased blood flow. Avanafil (PubChem: CID9869929, ChemSpider: 8045620) enhances the relaxant effects of cGMP by selectively inhibiting PDE5 (ChEMBL: CHEMBL1827; Uniprot: O76074), an enzyme responsible for the degradation of cGMP.

Other PDE5 inhibitors are already available on the market and these include Sildenafil (approved in 1998; tradename: Viagra, Revatio; ChEMBL: CHEMBL192), Tadalafil (approved in 2003; tradename: Cialis; ChEMBL: CHEMBL779) and Vardenafil (approved in 2003; tradename: Levitra; ChEMBL: CHEMBL1520). These other PDE5 inhibitors are also approved for the treatment of pulmonary arterial hypertension (PAH).
PDE5 is an 875 amino acid-long enzyme (EC=3.1.4.35), belonging to the cyclic nucleotide phosphodiesterase family (PFAM: PF00233).
 
Several crystal structures of PDE5 are now available. The catalytic domain of human PDE5 complexed with sildenafil is shown below (PDBe:1tbf)



 

Preclinical studies have shown that Avanafil strongly inhibits PDE5 (half maximal inhibitory concentration = 5.2 nM) in a competitive manner and is 100-fold more potent for PDE5 than PDE6, which is found in the retina and is responsible for phototransduction. Also, Avanafil has shown higher selectivity (120-fold) against PDE6 than Sildenafil (16-fold) and Vardenafil (21-fold), and high selectivity (>10 000-fold) against PDE1 compared with Sildenafil (380-fold) and Vardenafil (1000-fold). 

Avanafil has also been reported to be a faster-acting drug than Sildenafil, with an onset of action as little as 15 minutes as opposed to 30 minutes for the other drugs.

 
Avanafil is a synthetic small molecule, with one chiral center. Avanafil has a molecular weight of 345.21 Da, an ALogP of 2.16, 3 hydrogen bond donors and 9 hydrogen bond acceptors and thus fully rule-of-five compliant. (IUPAC: 4-[(3-chloro-4-methoxyphenyl)methylamino]-2-[(2S)-2-(hydroxymethyl)-pyrrolidin-1-yl]-N-(pyrimidin-2-ylmethyl)pyrimidine-5-carboxamide; Canonical Smiles: COC1=C(C=C(C=C1)CNC2=NC(=NC=C2C(=O)NCC3=NC=CC=N3)N4CCC[C@H]4CO)Cl; InChI: InChI=1S/C23H26ClN7O3/c1-34-19-6-5-15(10-18(19)24)11-27-21-17(22(33)28-
13-20-25-7-3-8-26-20)12-29-23(30-21)31-9-2-4-16(31)14-32/h3,5-8,10,12,
16,32H,2,4,9,11,13-14H2,1H3,(H,28,33)(H,27,29,30)/t16-/m0/s1)
The recommended starting dose of Avanafil is 100 mg and should be taken orally as needed approximately 30 minutes before sexual activity. Depending on individual efficacy and tolerability, the dose can be varied to a maximum dose of 200 mg or decreased to 50 mg. The lowest dose that  provides efficacy should be used. The maximum recommended dosing frequency is once per day.

Avanafil is rapidly absorbed after oral administration, with a median Tmax of 30 to 45 minutes in the fasted state and 1.12 to 1.25 hours when taken with a high fat meal. Avanafil is approximately 99% bound to plasma proteins and has been found to not accumulate in plasma. It is predominantely cleared by hepatic metabolism, mainly by CYP3A4 enzyme and to a minor extent by CYP2c isoform. The plasma concentrations of the major metabolites, M4 and M16, are approximately 23% and 29% of that of the parent compound, respectively. The M4 metabolite accounts for approximately 4% of the pharmacologic activity of Avanafil, with an in vitro inhibitory potency for PDE5 of 18% of that of Avanafil. The M16 metabolite has been found inactive against PDE5. After oral administration, Avanafil is excreted as metabolites mainly in the feces (approximately 62% of administrated dose) and to a lesser extent in the urine (approximately 21% of the administrated dose). Avanafil has a terminal elimination  half-life (t1/2) of approximately 5 hours, which is comparable to that of Sildenafil (3-4h) and Vardenafil (4-5h), but very short relative to the very long half-life of Tadalafil (17.5h).

The full prescribing information of Avanafil can be found here.

The license holder is Vivus, Inc.
 
Wikipedia: Avanafil
 
 
 

Friday, 11 May 2012

Acne Cures: Is there a Natural Acne Cure that Works?

Are there natural acne cures that work or is it a new age myth? Is there a permanent cure for acne or are all acne sufferers sentenced to the Sisyphean battle of tackling the ‘on the surface’ symptoms? Is there an honest, natural and safer alternative to the endless use of over the counters and to the nasty side effects inflicted by conventional drugs, creams and topical acne treatments?

Most dermatologists and other western medicine followers have already answered that controversial question by claiming that acne, among other diseases simply cannot be cured.

There are 2 reasons for that:

1. Most dermatologists don't even know what the real cause of acne is. It's amazing but true. They are highly familiar with the symptoms of acne and they specialize in tackling the 'on the surface' symptoms, but unfortunately they cannot tell you what the internal conditions are that cause your acne to form in the first place. If you don't believe me just ask your dermatologist.

2. Most doctors work in conjunction with the pharmaceutical and drug companies and the latter is not motivated, so to speak, at discovering a cure for Acne or Aids or Cancer - simply because hundreds of millions of dollars have been spent on finding treatments for the symptoms of diseases. Why? simply because their global aim is to make more profit by creating consumer dependency. By applying medications and creams that deal merely with the symptoms while ignoring the source or the internal cause of the disease, acne will never be cured. The average acne sufferer will become more and more reliant on drugs that temporarily calm the symptoms and that means steady income for the drug and pharmaceutical companies.

There's a lovely metaphor describing acne among other chronic diseases and the way modern medicine deals with these afflictions: If you manage to kill all the mosquitoes around a stale pond using chemicals, for a little while there will be no mosquitoes.

But since the source of the problem (what causes the mosquitoes to appear) is still there – the stale, disgusting pond where mosquitoes can find food and fertile ground for laying their eggs – mosquitoes will always come back!

The same thing happens with your acne!

Without eliminating the source of your acne condition, you will never get rid of your acne. Without fixing the internal problem that is causing your acne, you may find temporary relief, but your acne will always come back until you do something fundamental to eradicate the cause from within...until you make the pond (your body or internal system) a place where ‘mosquitoes’ cannot exist.

Ultimately, every disease results from a breakdown within your body. All major diseases and chronic conditions are warning signs of something very fundamentally wrong inside. Deepak Chopra refers to this as "The violation of simple laws of nature that make our body function."

The very surprising truth is that you are lucky for having acne. Let me explain...Acne, like constant headaches, irritable bowel syndrome or dandruffs is only a small message from your body that something is wrong internally and should be addressed and corrected.

Now, there are two choices you can make - you can:

1.Ignore that message - big mistake! The internal imbalance that caused your acne will, in most cases, turn into a chronic condition. Now instead of just having acne you'll start having other hormonal imbalance or toxic overload related symptoms in addition to acne. Because the internal problem is not fixed, the disease symptoms get more and more intense.

2.Listen to your body and start fixing the internal problem that causes your acne to appear in the first place; you will not only get rid of your acne you will also achieve beautiful, healthy, even toned clear skin complexion, re-balance your body and prevent future hormonal or toxic overload related conditions.

The simple truth is...you are out of balance. We now live a 'far-from-natural' lifestyle. There are over 300 synthetic industrial chemicals present in our bodies that did not exist 50 years ago. We are filled with toxins from the food, and medication we ingest and use.

By fixing the internal condition that causes your acne in addition to adopting a healthy lifestyle (healthy diet & mindset, cleanse & detoxify, hormonal balancing etc.) you will put your body back into balance – holistically - your acne will cease to exist and you feel as healthy and attractive as ever!

It doesn't matter what type of acne you have. Whether you suffer from: acne vulgaris, acne Conglobata, acne Rosacea, Acne Fulminans, Blackheads, Whiteheads, Papules, Pustules, Nodules or Cysts: The principles required to cure your acne are basically the same. The "holistic" ways of treating people have been around for thousands of years, and they absolutely work whether you have teen or adult acne; whether you suffer from acne on your back, shoulders or chest or if you suffer from female related acne such as menopause acne or acne due to monthly cycles.

Whatever your acne condition is, when you finally decide to stop making the same acne treatment mistakes that have been holding you back and begin applying the holistic approach to curing acne, you can literally choose to become clear and stay clear. You will have the power to make it happen. 

Mike Walden is a certified nutritionist, independent medical researcher, natural health consultant and author of the #1 best-selling e-book, "Acne No More- Open The Door To An Acne Free Life." Mike has written dozens of holistic health articles and has been featured in ezines and print magazines, as well as on hundreds of websites worldwide. For information on Mike's Holistic Clear Skin program, visit: http://mcaf.ee/6kes2

Books that may also be useful 


Acne and its therapy Acne causes and treatment
Ance no more Acne





Wednesday, 25 April 2012

Nausea : Causes and Treatment


Nausea is unpleasant and something everyone has experienced. Yet while nausea and vomiting are common symptoms, they are not conditions in their own right – and the best way to stop them is to work out the cause and provide the right OTC or prescription treatment.

Common causes of nausea and vomiting include infection, emotional or physical stress, alcohol, food poisoning, overeating or a reaction to certain smells. While nausea and vomiting are common, patients who experience symptoms for more than two days should be referred to the pharmacist, as should children under two years as they are at risk of dehydration.

Monday, 9 April 2012

Welcome

Welcome To Daily OTC


Hello and welcome to Daily OTC


Simply this blog will provide you with some medical and pharmaceutical information that going to help you as a Physican , pharmacist also patient 

 
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