Hydrochlorothiazide doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production.

Two cyclodextrin micellar liquid chromatographic methods were developed and applied to the simultaneous determination of bisoprolol/hydrochlorothiazide and atenolol/chlorthalidone combinations in urine matrices without sample pretreatment. These combined β-blockers and diuretics chemotherapies are commonly used in the treatment of hypertension and cardiovascular diseases. Hybrid isocratic mobile phases containing hydroxypropyl-β-cyclodextrin, sodium dodecyl sulfate, phosphate buffer and methanol on a Luna C18 column with 0.5 mL min(-1) flow rate and 25.0°C column temperature were used. The methods were sensitive enough for the determination of analytes at the therapeutic urine levels with limits of detections down to 1.0 µg mL(-1); relative standard deviations and recoveries were ranged between 1.5-4.4% and 98.00-109.52%, respectively. Urinary excretion studies showed that the detection of drugs is possible up to 24 h after their ingestion. The selective proposed separations with less consumption of organic solvents over the hitherto ones could be attributed to the four point competitive interactions among analysts, pseudostationary phases and a real stationary phase.

The association of an on-line circulation system with a chemometrics-assisted UV detection strategy is described as a useful system to continuously monitor the dissolution of a pharmaceutical preparation containing two active ingredients, and as a tool for the simultaneous determination of the dissolution curves and dissolution profiles of the latter. Multivariate curve resolution with alternating least squares (MCR-ALS) was used as the chemometric tool to quantitate the analytes, while the hydrochlorothiazide-bisoprolol fumarate (HCT-BIS) association was employed as a model for method development. The experiments were carried out with a dissolution tester configured as apparatus II (paddles), under USP 32 official conditions. The suitability of the calibration procedure for quantitating the dissolved drugs was assessed according to ICH guidelines, with regards to linearity in the working range, specificity, accuracy and precision. Figures of merit, including limits of detection and quantitation were also determined, as well as the method's robustness with regards to detection wavelength range. The system was able to consistently provide very reproducible dissolution curves of commercial tablets, which were statistically similar to those furnished by a manual sampling technique, followed by HPLC analysis. To demonstrate the usefulness of the proposed system, the dissolution profiles of different lots of HCT-BIS tablets were acquired and three of them were conveniently compared at a 31 data point level, employing the f(1) and f(2) ("difference" and "similarity") indexes. Use of multiple data points for comparison ensured reliability of the results.

This methods paper is third in a series addressing client outcomes in HIV/AIDS case management. After introducing earlier work the authors outline their effort to consolidate numerous discrete outcome measures and to establish each outcome indicator along a continuum scale that can be self-abstracted by HIV/AIDS service providers. The paper includes in-depth discussion of challenges and benefits derived from this type of outcome measurement process. Key lessons learned from a pilot study are offered for those considering development of similar client outcomes assessment programmes. The paper concludes with several opportunities for future research for those desiring to work in this relatively uncharted domain.

Only approximately 40% to 50% of hypertensive patients will achieve goal blood pressures of <140/ 90 mm Hg with monotherapy, regardless of the medication used. Fixed-dose combination therapy with two different classes of antihypertensive agents will achieve goal pressures in more than 70%. The sixth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure has suggested that the use of combination therapy is appropriate as initial treatment. The advantages of combinations include: 1) greater blood pressure decrease and response rates than monotherapy; 2) fewer side effects with small doses of two drugs than with large doses of one agent; 3) improved adherence to treatment; and 4) possibly lower cost of therapy. Many different combinations of diuretics and beta-blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists, as well as ACE inhibitors and calcium antagonists are available. Two of these, Ziac and Capozide, have been approved as initial therapy. It is possible that the number of hypertensive individuals controlled at goal blood pressure levels will be increased if combination therapy is used as initial treatment.