Paracetamol 500mg / Domperidone 10mg tablets

Migraine burden is over twice as high among females than males. Although sex differences are recognized in migraine, robust sex-specific guidance for management remains limited. To systematically review and synthesize current evidence on sex-related clinical differences in migraine, including treatment outcomes and reproductive management, and to provide evidence-based or expert consensus recommendations where high-quality data are lacking. A systematic literature review using the PICO framework addressed 24 sex-specific questions across three domains: (1) biological sex differences across the lifespan, (2) sex-specific variations in treatment outcomes, and (3) fertility and reproduction-related management. To address anticipated evidence gaps, a structured Delphi consensus process complemented the review. The protocol was registered in PROSPERO (CRD420251058438). Thirty-seven studies informed 10 evidence summaries. Acute and preventive anti-CGRP therapies seem to show similar efficacy between sexes. For menstrual-related migraine attacks (MM), triptans and lasmiditan are effective, with frovatriptan being recommended for short-term prevention; long-term prevention include topiramate and anti-CGRP mAbs. In pregnancy triptans, greater occipital nerve (GON) blocks, and onabotulinumtoxinA are safe, with GON blocks showing potential efficacy. During breastfeeding, triptans appear to be safe. Anti-CGRP mAbs are equally effective in pre and postmenopausal women. Expert consensus emphasizes the influence of hormonal transitions on migraine expression across sexes and supports the use of acetaminophen, antiemetics, magnesium, NSAIDs, steroids, beta-blockers, amitriptyline, and calcium channel blockers as generally safe in WOCBP and during pregnancy, although some agents have trimester-specific limitations. Efficacy was noted for acetaminophen, sumatriptan, antiemetics, magnesium, propranolol, amitriptyline, and onabotulinumtoxinA. During breastfeeding, acetaminophen, NSAIDs, domperidone, prochlorperazine, magnesium, caffeine, beta-blockers, tricyclics, onabotulinumtoxinA, and GON blocks were considered safe. Evidence is limited, but sex (likely mediated by sex hormones) influence the clinical course of migraine, and likely treatment response. Limitations include absence of sex-specific analyses in older trials, underrepresentation of men, and scarce reproductive safety data. Integrating sex-based analyses and broadening trial inclusion and more reproductive safety evidence are essential for personalized, equitable migraine care.

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BACKGROUND OBJECTIVES: Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians. METHODS: It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as 'prescriptions having deviations'. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an 'unacceptable deviation'. RESULTS: Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108). INTERPRETATION CONCLUSIONS: The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.

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Two key properties of excipients for inclusion in direct compression tablets are flowability and compactibility. Glutinous rice starch (GRS) has poor flowability, which limits its use in direct compression tablets. This study aimed to create a multifunctional direct compression excipient (filler binder disintegrant) with improved flowability from GRS by the co-precipitation method. The physicochemical and pharmaceutical properties of the co-precipitated GRS (cpGRS) were investigated. The optimum conditions for producing cpGRS (0.43 M sodium hydroxide solution, 7.09% PVP K30, 14.02% calcium carbonate, 95 min of mixing time and pH of 6.97) resulted in 68.80% yield, fair to good flowability, acceptable tablet strength, and fast disintegration. The FT-IR spectra of cpGRS showed no significant shifts in the key peaks, which indicates that there was an absence of chemical interactions within cpGRS. X-ray diffractograms also showed no significant changes, indicating that the GRS granules, calcium carbonate, and PVP K30 components remained unaltered during co-precipitation. cpGRS also demonstrated a dilution capacity of 50% when paracetamol was used as model drug. When cpGRS was combined with domperidone or propranolol hydrochloride it showed a better deformation capability than the physical mixtures. Although cpGRS was sensitive to lubricant, the hardness and tensile strength were higher than common strength for general purpose use in tablets. When compared to the physical mixture, pregelatinized starch and directly compressible calcium carbonate, the results showed that cpGRS tablets of both model drugs passed the friability test, demonstrated the best disintegration property, provided the fastest and highest drug release profile for propranolol, and improved the drug release profile for domperidone. For propranolol-cpGRS tablets, dissolution medium at different pH did not affect the dissolution profile. For domperidone-cpGRS tablets, the pH of dissolution medium did affect the dissolution profile of the tablets. This was according to the API solubility. These results reveal that cpGRS is an excellent multifunctional i.e., filler, binder, and disintegrant excipient suitable for direct compression tablets. The main component is natural. The preparation method is simple, quick, and efficient. This method does not produce harmful waste and requires only basic equipment, and affordable reactants and devices.

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AIM: This study aims to examine changes in the osmolality of pasteurized donor human milk (PDHM) following the addition of probiotics and commonly used neonatal additives. METHODS: The osmolality of PDHM was measured at 10 minutes using a calibrated osmometer by a technician blinded to the probiotics and additives used in the study. The osmolality of 5 mL of PDHM was measured after the addition of four different probiotics and commonly used additives, including caffeine, cephalexin, domperidone, esomeprazole, fluconazole, furosemide, ibuprofen, lansoprazole, levetiracetam, paracetamol, phenobarbitone, sildenafil, and ursodeoxycholic acid, administered separately in therapeutic doses. The osmolality of the oral iodinated non-ionic contrast agent (Omnipaque) was measured after 1:2 and 1:4 dilution with sterile water. The volume of PDHM required to be added to each additive to keep the osmolality below 450 mOsm/kg, as recommended by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), was calculated. RESULTS: The mean osmolality of PDHM was 256 mOsm/kg, which, on reconstitution with most additives, exceeded 450 mOsm/kg. The osmolality of pure additives ranged from 161 to >2000 mOsm/kg. There was a significant increase in the osmolality of PDHM beyond the recommended 450 mOsm/kg with most additives, except caffeine, cephalexin, esomeprazole, fluconazole, furosemide, lansoprazole, and sildenafil. A maximum increase in osmolality to 1723 mOsm/kg (range 260-1723 mOsm/kg) was observed with probiotics. Domperidone, ibuprofen, levetiracetam, paracetamol, phenobarbitone, and ursodeoxycholic acid increased the osmolality beyond 450 mOsm/kg. The osmolality of the iodinated non-ionic contrast agent (Omnipaque), when diluted with sterile water in a 1:4 ratio, was 461 mOsm/kg. CONCLUSION: The addition of probiotics to PDHM increases osmolality and requires appropriate dilution to maintain levels below the recommended 450 mOsm/kg. Therapeutic additives such as domperidone, ibuprofen, levetiracetam, paracetamol, phenobarbitone, and ursodeoxycholic acid also increase the osmolality of PDHM and require appropriate dilution. Future research should focus on developing probiotics and additives with lower osmolality to improve safety in neonates.

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BACKGROUND AND OBJECTIVES: Migraine is a highly prevalent, disabling disease of the brain. Despite the availability of migraine-specific medications, it is undertreated across the world. This study reports the real-world scenario regarding the treatment patterns of migraine in India. MATERIALS AND METHODS: We conducted a cross-sectional study of 400 persons with migraines, fulfilling the ICHD-3 criteria. The demographic details, history of headache, disability, and treatment details, including pathways to care, were collected. RESULTS: The majority (77.3%) of those with migraine were females, unemployed (64%), and reported a mean age of 37.2 ± 11.5 years. The median duration of migraine was 24 months. The most common diagnosis was episodic migraine (57.3%), and the remaining cases were chronic migraine. Only 11 (<3%) among the 400 patients disclosed visiting a Complementary and Alternative Medicine (CAM) practitioner. The majority of the patients (72.5%) routinely used balms and oils for acute pain relief. The most common abortive medications were naproxen, frequently in combination with domperidone, and/or paracetamol. Among the patients with a high frequency of episodic migraines, only 25% were on adequate prophylaxis. CONCLUSION: This study describes the pattern of acute and preventive treatment of migraine in a large sample of patients with migraine attending a tertiary care center. After identifying the gaps and comparison them with international literature, we suggest that awareness programs targeting pharmacists, as well as the education and empowerment of healthcare professionals at the grassroots level, may be required to tackle the challenges posed in the management of migraine.

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Abstract This work demonstrates simple and reliable spectrophotometric methods for the simultaneous determination of paracetamol (PAR) and meloxicam (MEL) in mixture I as well as PAR and domperidone (DOM) in mixture II in bulk form and laboratory-made tablets. Successful determination of mixture I was accomplished using direct zero-order spectrophotometry at 361 nm for MEL and first-order derivative ( 1 D) spectrophotometry by measuring the peak at 342 nm and the trough at 262 nm for MEL and PAR respectively. On the other hand, a ratio difference method was suggested for the analysis of mixture II. The difference between the ratio spectra amplitudes at 256 and 288 nm were recorded for PAR determination, and 216 and 288 nm for DOM quantitation using 50 µg/mL DOM and PAR respectively as divisors. The efficacy of the proposed procedures was assessed using ICH criteria for linearity, ranges, precision, accuracy, detection, and quantitation limits. With regard to mixture I, the calibration curves showed linearity in the ranges of 3–30 µg/mL for MEL (zero-order method) and 2.5–30 and 3–15 µg/mL for MEL and PAR, respectively (first-order method), with correlation values of at least 0.9991.Whereas for mixture II, with correlation coefficients of 0.9999, the calibration curves for PAR and DOM were linear in the ranges of 3–70 and 2.5–15 µg/mL, respectively.The established procedures were used to analyze the combinations in the lab-prepared pills, and assay results were compared with reported methods. Greenness of the devised spectrophotometric procedures was assessed using the Analytical Eco-Scale and the Analytical Greenness metric (AGREE).

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Background and objective Previous studies have demonstrated that local analgesic and antiemetic prescribing practices were inconsistent with best practices. In light of this, we aimed to assess the current prescribing practices against best practices, as defined by national guidelines. Methods This study involved a point-prevalence audit in the inpatient gastroenterology wards at a University Teaching Hospital in Glasgow. Patients were identified by case notes; a clinical diagnosis of cirrhosis documented by a consultant hepatologist was required for inclusion. Data including Child-Pugh score and prescribed medications were collected. Prescribing practice was reaudited after each intervention. Interventions included educational seminars, posters, and the formulation of new local guidelines. Results A total of 249 inpatients were included; 70 were identified as having a clinical diagnosis of cirrhosis. The number of patients who were prescribed weak opioids decreased from 23% in cycle 1 to 11% in cycle 3. Prescription of 3 g/day paracetamol decreased from 36% to 24%. The number of patients who were prescribed an inappropriate antiemetic decreased from 45% to 17%. Laxatives, topical analgesics, and adjuvant analgesics were variably prescribed in all three cycles. Conclusions The development of concise local guidelines and targeted educational interventions for junior medical staff can improve prescribing practices for inpatients with decompensated cirrhosis. Currently, significant variability exists in the routine prescription of laxatives, adjuvants, and topical analgesics.

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BACKGROUND: Recently, many scientific studies have examined the handling and disposal practices of unused medicines in adults, but research focusing on parental management of pediatric pharmaceuticals remains limited. Therefore, this study aims to determine the practices and perspectives of parents about unused pediatric pharmaceuticals, to measure the amount of unused pediatric pharmaceuticals and to classify medicines in Burdur-Türkiye. METHODS: This study was designed as a cross-sectional study and conducted in Burdur-Türkiye. Data were collected between January 1, 2024, and January 31, 2025, using convenience sampling, with each participant visited in their household. Pharmaceuticals were classified according to both mechanism of action and ATC. Data were analyzed with SPSS v27. RESULTS: The study included 227 participants and 558 unused pediatric pharmaceuticals were obtained from them. It was found that NSAIDs (21.3%), analgesics and antipyretics (14.5%) and antibiotics (12%) were the most commonly kept at home as unused medicines. It was found that the reason for keeping leftover medicines was early recovery (51.2%), that expired medicines were thrown in the household garbage (85.5%), and that the mother was the one who most often gave the medicine to the child (84.1%). In the participants' opinion, when only the "yes" option was considered, the prevalence of self-medication was 45.8%. When the "yes and sometimes" options were combined, it was 82.4%, and the frequency was high for antipyretics, analgesics, and cold medicine, but low for antibiotics (1.3%). In participant practice, the prevalence was 58.4%, and 40.3% for antibiotics. A statistical difference was found between participants' opinions and practices (p < 0.001), and Cohen's k was -0.036 (95% CI: -0.215-0.137). For antibiotics, it was -0.212 (95% CI: -0.556-0.222) and p < 0.001. The volume of unused medication Median(25-75;IQR) was 56(27-80;53) ml and its percentage was 51.7% for all medications, and 43(22-69;47) ml and 47% for antibiotics (respectively). According to ATC, drugs coded R05X-Other Cold Preparations (n = 85 and 15.2%), N02BE01-Paracetamol (n = 77 and 13.8%) and M01AE01-Ibuprofen (n = 73 and 13.1%) were the most commonly unused pediatric drugs. CONCLUSION: There are significant amounts of unused medicines at homes and the amounts of used and unused medicines are close to each other. Self-medication is a common behavior in opinion and practice among parents, and the findings regarding antibiotics are remarkable. Reported behaviors and viewpoints concerning unused medications among adults show parallels with the findings of this study regarding pediatric pharmaceuticals, which is a concerning situation. Since medication storage areas are largely accessible to children, precautions should be taken against potential risks. Information on unused pediatric pharmaceuticals should be added to trainings on drug use. Individuals, expectant mothers, pregnant women and mothers should be informed about pediatric pharmaceuticals. An economical and efficient drug take-back system should be established.

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