Douglas E. Moore

Drug-Induced Cutaneous Photosensitivity

The interaction of sunlight with drug medication leads to photosensitivity responses in susceptible patients, and has the potential to increase the incidence of skin cancer. Adverse photosensitivity responses to drugs occur predominantly as a phototoxic reaction which is more immediate than photoallergy, and can be reversed by withdrawal or substitution of the drug. The bias and inaccuracy of the reporting procedure for these adverse reactions is a consequence of the difficulty in distinguishing between sunburn and a mild drug photosensitivity reaction, together with the patient being able to control the incidence by taking protective action. The drug classes that currently are eliciting a high level of adverse photosensitivity are the diuretic, antibacterial and nonsteroidal anti-inflammatory drugs (NSAIDs). Photosensitising chemicals usually have a low molecular weight (200 to 500 Daltons) and are planar, tricyclic, or polycyclic configurations, often with heteroatoms in their structures enabling resonance stabilisation. All absorb ultraviolet (UV) and/or visible radiation, a characteristic that is essential for the chemical to be regarded as a photosensitiser. The photochemical and photobiological mechanisms underlying the adverse reactions caused by the more photoactive drugs are mainly free radical in nature, but reactive oxygen species are also involved. Drugs that contain chlorine substituents in their chemical structure, such as hydrochlorthiazide, furosemide and chlorpromazine, exhibit photochemical activity that is traced to the UV-induced dissociation of the chlorine substituent leading to free radical reactions with lipids, proteins and DNA. The photochemical mechanisms for the NSAIDs that contain the 2-aryl propionic acid group involve decarboxylation as the primary step, with subsequent free radical activity. In aerated systems, the reactive excited singlet form of oxygen is produced with high efficiency. This form of oxygen is highly reactive towards lipids and proteins. NSAIDs without the 2-arylpropionic acid group are also photoactive, but with differing mechanisms leading to a less severe biological outcome. In the antibacterial drug class, the tetracyclines, fluoroquinolones and sulfonamides are the most photoactive. Photocontact dermatitis due to topically applied agents interacting with sunlight has been reported for some sunscreen and cosmetic ingredients, as well as local anaesthetic and antiacne agents. Prevention of photosensitivity involves adequate protection from the sun with clothing and sunscreens. In concert with the preponderance of free radical mechanisms involving the photosensitising drugs, some recent studies suggest that diet supplementation with antioxidants may be beneficial in increasing the minimum erythemal UV radiation dose.

A COMPARATIVE STUDY OF THE PHOTOCHEMISTRY OF THE NON‐STEROIDAL ANTI‐INFLAMMATORY DRUGS, NAPROXEN, BENOXAPROFEN AND INDOMETHACIN

Abstract— The photochemical reactivity of the non‐steroidal anti‐inflammatory drugs, naproxen and indomethacin, has been studied and compared with benoxaprofen, a similar compound of known cutaneous phototoxicity. Although indomethacin shows some phosphorescence at 77 K, flash photolysis at room temperature revealed only a weak photoionization process, and no photochemical reactivity was detected in steady state photolysis. Naproxen has strong fluorescence and phosphorescence, and in laser flash photolysis showed photoionization and a triplet state species in approximately equal yield. Naproxen and benoxaprofen produced singlet oxygen with similar quantum yield, as deduced from the sensitized rates of photooxidation of 2,5‐dimethylfuran. Naproxen underwent photodecarboxylation as detected by ESR‐spin trap experiments with 2‐methyl‐2‐nitrosopropane. The decarboxy‐naproxen radical combined readily with oxygen in aerated solution, and l‐(6‐methoxy‐2‐napthyl)ethanol and 2‐acetyl‐6‐methoxynaphthalene were formed as the oxidation products. In deaer‐ated solution, the major product was 2‐ethyI‐6‐methoxynaphthalene, with the alcohol also formed. In comparison, benoxaprofen also underwent decarboxylation, with much higher quantum yield, but the decarboxy‐benoxaprofen radical did not add oxygen. This difference in photoreactivity between naproxen and benoxaprofen, together with the much lower molar absorptivity of naproxen are the significant factors in relating to the differences in reported levels of clinical photosensitivity responses.

Photochemical Studies On the Antiinflammatory Drug Diclofenac

Abstract— Irradiation with UVA light of the anti‐inflammatory drug diclofenac [2‐(2,6‐dichloroanilino) phenylacetic acid] in aqueous buffer or methanol solution leads to sequential loss of both chlorine substituents and ring closure to carbazole‐1‐acetic acid as the major product. Minor products result from substitution by the solvent. The photosensitizing properties of diclofenac and its major photoproduct were tested with singlet oxygen substrates and in the free radical polymerization of acrylamide. Although the major carbazole product is a weakly phototoxic agent, able to generate singlet oxygen more efficiently than diclofenac, the free radical photodechlorination process is postulated as the probable initiation step of in vivo photosensitivity responses.

Photochemical decomposition of sulfamethoxazole

Sulfamethoxazole (4-amino-N-(5-methyl-3-isoxazolyl)benzenesulfonamide) is extremely photolabile in acidic aqueous solution, giving rise to at least five primary photoproducts. The major product has been identified as 4-aminoN-(5-methyl-2-oxazolyl)benzenesulfonamide resulting from photoisomerization of the isoxazole ring. This product was found to exist predominantly in its imido tautomeric form. Other products include sulfanilic acid, aniline, 3-amino-5-methylisoxazole and a hydrated product. The pathways leading to the formation of the products are postulated.

Evaluation of amperometric detection for the liquid-chromatographic determination of tetracycline antibiotics and their common contaminants in pharmaceutical formulations

A sensitive high-performance liquid chromatographic technique with amperometric detection has been developed for the determination of seven commercially used tetracyclines in bulk powders and pharmaceutical preparations. The technique is based on the oxidation of these compounds and their contaminants at the glassy carbon electrode. The extraction procedures are simple and the HPLC conditions separate the tetracyclines from their major degradation products. The chromatography was performed using a commercially available octadecylsilane column, with a mobile phase: KH2 PO4 (pH = 2.5; 0.05 M) - acetonitrile (84:16, v/v) and detection at 1.2 V. The technique permits the simultaneous determination of trace amounts of chlortetracycline, demeclocycline, doxycycline, methacycline, minocycline, oxytetracycline and tetracycline as well as the separation of their common impurities (epi, anhydro and epianhydro contaminants) with detection limits of 0.1-1.0 ng microl(-1) and recoveries of 99.1-100.4%. No interference was observed from the commonly present excipients in pharmaceutical formulations.

PHOTOSENSITIZATION BY ANTIMALARIAL DRUGS

Abstract The antimalarial drugs, chloroquine, hydroxychloroquine, quinine, quinacrine, amodiaquine and primaquine and the local anaesthetic, dibucaine, were tested for in vitro photosensitizing capability by irradiation with 365 nm UV light in aqueous solutions. The ability of these compounds to photosensitize the oxidation of 2,5‐dimethylfuran, histidine, tryptophan or xanthine, and to initiate the free radical polymerization of acrylamide was examined in the pH range 2‐12. Chloroquine and hydroxychloroquine show maximal photooxidative behaviour when in the monocation form at pH 9, in contrast to quinine which is extremely efficient as the dication below pH 4. This pattern appears to relate to the fluorescence yield as a function of pH. Chloroquine in the monocation or neutral form was found to undergo dechlorination upon irradiation, and this correlates directly with its ability to initiate photo‐polymerization of acrylamide. Quinine also gives rise to small polymerization rates, attributed to photo‐ionization in the quinoline ring, yielding a cation radical. Amodiaquine, primaquine and quinacrine do not have significant photochemical activity in aqueous solution. Dibucaine exhibits a strong photosensitizing capability at low pH, similar to quinine.

PHOTOSENSITIZATION BY DRUGS: NALIDIXIC AND OXOLINIC ACIDS

Abstract— The antibacterial drugs, nalidixic acid and oxolinic acid, have been tested as photosensitizers in aqueous solution using 365 nm UV light. Absorption and fluorescence spectra indicate that intramolecular hydrogen bonding stabilizes the unionized form of these compounds in the pH region2–4. The ability of the unionized species to sensitize photooxidation by the type II (singlet oxygen) mechanism was found to be lower than when these drugs were ionized. Comparison withquinoline–3‐carboxylic acid and the methyl esters of nalidixic and oxolinic acids emphasised the significance of the hydrogen bonding in relation to the excited state properties. Unionized nalidixic acid undergoes photolysis more readily than the ionized form, apparently by a free radical mechanism, while oxolinic acid is more stable.

Photosensitizing activity of the anti-bacterial drugs sulfamethoxazole and trimethoprim

The photochemical reactions in vitro of sulfamethoxazole alone and in combination with trimethoprim were studied to obtain information on the photosensitization mechanism. Sulfamethoxazole in aqueous solution, on exposure to UVB radiation, generates free radicals and singlet oxygen, with the neutral molecule being at least twice as active as the sulfamethoxazole anion. Photoexcited sulfamethoxazole can participate in electron transfer to cytochrome-c and nitro blue tetrazolium, and sensitizes the peroxidation of linoleic acid and the hemolysis of human erythrocytes, predominantly by a free radical mechanism. Trimethoprim is relatively inactive in the same photochemical systems.

Photosensitization by drugs: photolysis of some chlorine‐containing drugs

Irradiation with ultraviolet light of chlorpromazine, prochlorperazine, frusemide or hydrochlorothiazide in either aqueous or methanol solution yielded free chloride ion. Potentiometric methods were used to detect one mol of chloride ion produced per mol of drug irradiated in deoxygenated solution, with a concomitant equimolar appearance of hydrogen ion. Saturation of the solutions with oxygen strongly inhibited the photolysis reaction in methanol but only partially inhibited the production of Cl− and H+ in aqueous solution. The oxidation of 2,5‐dimethylfuran is photosensitized by these drugs more effectively in methanol compared with aqueous solution. The photochemical behaviour is consistent with a photo‐ dissociative process occurring predominantly in methanol while photoionization predominates in aqueous media. No chloride ion was detected after extended irradiation of Chlortetracycline, demeclocycline, chlordiazepoxide and hexachlorophane. The photolability of the chlorine in the compounds tested correlated with their ability to photosensitize oxidation by the Type I (free radical) mechanism.

PHOTOCHEMICAL SENSITIZATION BY AZATHIOPRINE AND ITS METABOLITES—I. 6-MERCAPTOPURINE

Abstract— Azathioprine is used as an immunosuppressant for renal transplant recipients, but is frequently associated with severe skin cancer as a side effect. 6‐Mercaptopurine, the primary metabolite of azathioprine. absorbs strongly in the UVA region and displays substantial photochemical reactivity. The primary photochemical processes in aqueous solution are triplet state formation and photoionization, as shown by flash photolysis. In oxygenated solution, singlet oxygen and superoxide are produced, and ground state 6MP appears to react with these species. Glutathione inhibits this reaction and is itself oxidized. In deoxygenated solution, reactions implicating the thiyl radical and hydrogen atom and electron transfer occur as shown by reaction with histidine and p‐nitrosodimethylaniline. Nitro Blue Tetrazolium or acrylamide.