Introduction
Hypertension or high blood pressure as identified by World Health Organization is a multifactorial, multifaceted disease and is a leading cause of morbidity and mortality worldwide [1]. It is a “silent killer” accountable for deaths of approximately nine million people globally each year [2]. Clinically, it is defined as systolic blood pressure equal to or above 140 mmHg and/or diastolic blood pressure equal to or above 90 mmHg [2,3]. Although it remains asymptomatic in early stages but if left uncontrolled it is liable for development of further complications leading to heart attack, heart failure, stroke and kidney failure [1,2].
Blood is the vital fluid of the body; it is carried from the heart to all parts of the body. Each time the heart beats, it pumps blood into the vessels. The force by which blood is pushed against the walls of the arteries creates a pressure which is nothing but the blood pressure [4]. Viscosity of blood is known to play an important role in the development of various cardiovascular diseases [5,6]. It has been reported that alteration in blood rheology is responsible for elevation of blood pressure and thereby development of hypertension [[7], [8], [9], [10], [11]]. This increase in blood viscosity during hypertension may be due to increased red blood cell aggregability [12]. Thus the present study aims to determine morphological changes or abnormalities of the erythrocytes in hypertensive patients in comparison with normotensive and treated individuals.
Though hypertensive state converges into severe complications, preventive option imparting the use of various antihypertensives for prolong duration remains a key factor for its long term control [2]. Currently, various classes of antihypertensive agents including, diuretics, α-blockers, β-blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, and calcium channel blockers are being clinically used for the treatment of hypertension and various heart diseases [[13], [14], [15], [16]]. However, for lifelong treatment of such chronic illness, sustained release dosage form for prolong period of time is desirable. Nowadays, gastroretentive drug delivery system (GRDDS) has been evolved as a preferred option for improved sustained delivery of orally administered drugs [17]. These low density systems remain buoyant in the gastric region for prolong duration thereby providing continuous release of drug and thus enhancing the oral bioavailability [18]. Various ways have been suggested for development of GRDDS including, floating, bioadhesive, swellable, high density system and other delayed release gastric devices [18]. Amongst them, this paper reports a combination of floating and mucoadhesive system for the formulation of effervescent gastric tablets of cilnidipine to prolong its gastric residence time.
Cilnidipine, a recently developed novel dihydropyridine calcium channel blocker was selected as a model drug for the formulation of floating gastroretentive tablets. It is a fourth-generation antihypertensive agent which possesses both L- and N-type calcium channels blocking activity [19]. It is known to be safe and effective in lowering blood pressure without reflex tachycardia compared to other dihydropyridine calcium channel blockers [20] and also been confirmed to have neuroprotective, cardioprotective and renoprotective effects [19,21] in clinical and animal models. It is a highly lipophilic, Biopharmaceutics Classification System (BCS) class II drug having very low water solubility [22] which is rapidly absorbed following oral administration with maximum peak concentration attained after 2 h [23]. However, it is rapidly metabolised by CYP3A isoenzymes [24] present in the intestinal lining and liver resulting in very low oral bioavailability of approximately 13% [25] and a very short half-life of about 20.4 min [26]. Due to these characteristics, there is a need to modify cilnidipine formulation to a more effective gastroretentive dosage form. With this thought in mind the present study focused on formulation design of cilnidipine floating gastroretentive tablets using gellan gum as bioadhesive polymer.
Gellan gum is a hydrophilic, linear anionic heteropolysaccharide obtained from Pseudomonas elodea [27,28] with a tetrasaccharide repeating unit of glucuronic acid, rhamnose and glucose residues [[29], [30], [31]]. It is a food additive [32] but due to its characteristic property of undergoing ionic gelation in presence of mono- and divalent cations this novel polymer [33] is now being widely used in pharmaceuticals [34] including oral [[35], [36], [37], [38]], ophthalmic [[39], [40], [41], [42], [43], [44]], nasal [[45], [46], [47], [48]] and transdermal [[49], [50], [51]] applications as in-situ gelling agent [52], mucoadhesive agent [53,54] and as sustained or controlled release matrix polymer [[55], [56], [57]]. Considering its innumerable applications, gellan gum was employed as swellable hydrophilic mucoadhesive polymer in the present study.
Accordingly, the aim of present study was to formulate cilnidipine gastroretentive tablets using gellan gum, HPMC K4M and sodium bicarbonate as formulation variables and to systematically evaluate their impact on drug release, mucoadhesive strength and buoyancy properties along with its in-vivo pharmacokinetic and pharmacodynamic evaluation in human volunteers.