[OP.4C.10] CLINICALLY IMPORTANT DIFFERENCES IN SYSTOLIC AMBULATORY BLOOD PRESSURE IN PATIENTS SWITCHED BETWEEN ALTERNATE NIFEDIPINE OSMOTIC DELIVERY FORMULATIONS
Bibliographic record
Abstract
Objective: Anecdotal evidence suggested clinically important systolic blood pressure (SBP) differences occurred in our patients whose nifedipine was being switched by pharmacies between AdN (Adalat XL – a formulation providing zero order release from the GastroIntestinal Therapeutic System - GITS) and MyN (Mylan-nifedipine ER - a formulation providing a delayed first-order release from the Osmotic Release Oral System - OROS). In vitro dissolution studies showed greater lag time to initial release from MyN and declining release at end of dosing interval. The objective of this study was to use Ambulatory Blood Pressure Monitoring (ABPM) to examine whether differences in overall effectiveness and duration of action exist between these two nifedipine formulations. Design and method: A randomized cross-over trial studied 20 patients receiving daily morning AdN vs. MyN 60 mg. After each 2-week period, 24-h ABPM was done. SBP data for 24 h and last 8 h (22:00 - 06:00 h) were examined using a Generalized Additive Mixed Model (GAMM). The software (R) used 2560 data points to model SBP population curves and compare them statistically. Results: GAMM of SBP over time showed MyN mean ± SE SBP was 2.59 ± 1.09 mmHg higher for 24 h (p = 0.0173) and 4.18 ± 1.6 mmHg higher for last 8 h (p = 0.0098). Mean 24-h SBP was > = 2 mmHg higher, while taking MyN in 50% of patients while SBP for last 8 h ranged as high as 18 mmHg higher while taking MyN.Conclusions: Clinically meaningful differences in SBP were seen in a cohort of patients when taking MyN compared to when they were taking AdN. This was likely based on differences in release profiles. For nifedipine, a potent vasodilator with a steep dose-response relationship and a 2-hour half-life, differences in timing and/or extent of delivery over as little as 6 h could allow clinically important changes in SBP. These data support the conclusion that formulations using differing release technologies are not suitable for bioequivalence testing. Undisclosed switching of nifedipine formulations by pharmacies can lead to an undesirable increase in variability in BP control.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.128 | 0.014 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".