Journal of Chromatography A, 1119 (2006) 277–284
Study on the conversion of three natural statins from lactone
forms to their corresponding hydroxy acid forms and their
a Department of Health Diet and Restaurant Management, Chung Shan Medical University, 110, Chien-Kuo N. Rd. Sec. 1,Taichung 402, Taiwan
b Institute of Food Science and Technology, National Taiwan University, 1, Roosevelt Rd., Sec. 4, Taipei 106, TaiwanAbstract
Conversions of statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, from lactone forms to their corresponding
hydroxy acid form in 0.1N NaOH or 0.05N KOH (prepared with 25, 50, 75, 90% acetonitrile or methanol in water or 100% water) were evaluated. Results showed that lactone form statins could be transformed almost completely only in alkaline solutions prepared with 25 or 50% acetonitrile. In all methanolic alkaline solutions, lactone form statins could also be converted entirely, nevertheless, they would be further transformed to themethyl ester of the hydroxy acid form and the transformation increased as methanol rises. When lactone and hydroxy acid forms of statins werein methanol, ethyl acetate, 70% acetonitrile in water (with 0.5% acetic acid or no) for 0–48 h at room temperature or in 100 ◦C water for 0–2 h,lactone form statins were converted to their corresponding hydroxy acids, which were raised as time extends and the highest conversions of themwere about 35% in 100 ◦C water and 70% acetonitrile, slightly transformed for lactone form statins in 70% acetonitrile (with 0.5% acetic acid) after8 h, and the other treatments for all statins showed no significant changes. Interferences would be reduced efficiently when statins were extractedfrom Pu-Erh tea with methanol, ethyl acetate or 100 ◦C water followed by purifying through a C18 solid-phase extraction cartridge. Lovastatin wasthe only statin found in Pu-Erh tea and the highest content of it was found under ethyl acetate extraction. In ethyl acetate and methanol extracts,lovastatin existed merely as lactone form. The lowest content of lovastatin was found in the 100 ◦C water extract of Pu-Erh tea, however, both oflactone and hydroxy acid forms were found to exist in the extract. 2005 Elsevier B.V. All rights reserved. Keywords: HMG-CoA reductase inhibitor; HPLC; Pu-Erh tea; Statin; Lovastatin; Simvastatin; Pravastatin
1. Introduction
Statins exist in two forms, lactone and hydroxy acid in gen-
eral. In vivo, the hydroxy acid forms are the active drugs to
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)
lower plasma cholesterol while the lactone forms are inac-
reductase is the key enzyme that catalyzes the conversion of
tive (prodrug). Lactone form of statins can be absorbed from
HMG-CoA to mevalonate, which is an early rate-limiting step
the gastrointestinal tract and transformed to the active drugs
in the cholesterol biosynthetic pathway such as lovas-
in liver and non-hepatic tissues Some authors
tatin, simvastatin, or pravastatin are potent inhibitors of HMG-
also reported that lactone form of statins would be con-
CoA reductase, which possess high effectiveness in reducing
verted to their corresponding hydroxy acids easily in water
total cholesterol and the low-density lipoprotein cholesterol lev-
and plasma, moreover, the conversion would be enhanced
els in the body. So they are usually used to remedy several forms
when they are in alkaline solutions (0.1N NaOH and 0.05N
of hypercholesterolemic patients and could reduce morbidity
and mortality associated with coronary heart disease (CHD) sig-
It is important to determine the contents of statins in plasma
and their distribution in tissues for pharmaceutical and clini-cal investigations. The major extraction methods of them areliquid–liquid extraction solid-phase extractionThese extraction methods, however, were suitable
∗ Corresponding author. Tel.: +886 2 23629984; fax: +886 2 33664113.
for only one statin at a time and each statin was extracted under
E-mail address: [email protected] (L.S. Hwang).
0021-9673/$ – see front matter 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.chroma.2005.12.031
D.-J. Yang, L.S. Hwang / J. Chromatogr. A 1119 (2006) 277–284
Gas chromatography–mass spectrometry (GC–MS) is one
neutralization with 0.1N HCl (prepared with acetonitrile), and
of the analytical methods to determine statins Though
then kept at −20 ◦C after removal of solvent under nitrogen
GC–MS provides rapid identification and quantification, it needs
and weighed. The purities of these standards were about 95%
a time-consuming derivation step for sample preparation. There-
as determined by HPLC coupled with photodiode-array detec-
fore, high-performance liquid chromatography–mass spectrom-
tor (model 996, Waters Associate, Milford, MA, USA). Their
chemical structures are shown in Solvents used for the
array detector (PDA) adopted extensively for
extraction and analysis of statin compounds including methanol,
statins analyses, because they could permit rapid identifica-
ethyl acetate, acetic acid and hydrochloric acid were obtained
tion and quantification and the samples do not need to be
from Tedia Co. (Fairfield, OH, USA). HPLC-grade acetoni-
derivatized. Ochiai et al. ve derivatized simvastatin with
trile was purchased from Lab-Scan (Dublin, Ireland). Deionized
1-bromoacetylpyrene and then determined it by HPLC with flu-
water was prepared with Milli-Q water purification system (Mil-
orescence detector. Raja et al. ve determined lovastatin
lipore Co., Bedford, MA, USA) it was degassed under vacuum
and its oxidation products with capillary electrophoresis (CE).
and filtered through a 0.2 m membrane filter (nylon) prior to
Endo and Monacolin the first investigators who iso-
use in the HPLC analysis. Sodium hydroxide (NaOH) and potas-
lated lovastatin (also called mevinolin) from Monascus ruber.
sium hydroxide (KOH) were purchased from Sigma (St. Louis,
Albert et al. ve isolated lovastatin from Aspergillus ter-reus. Since then, there are many kinds of statins isolated orsynthesized. Endo et al. Alberts indicated
2.2. The conversions of statins from lactone forms to their
that many strains of Monascus as well as a variety of other fila-
corresponding hydroxy acid forms under different alkaline
mentous fungi including some species of Doratomyces, Eupeni-cillium, Gymnoascus, Hypomyces, Penicillium, Phoma and Tri-choderma could produce lovastatin.
The method was based on that reported by Brown et al.
Pu-Erh tea is a post-fermented tea, produced in Yunnan area,
and Shen et al. ov-L or Sim-L (0.5 mg) was added to 0.1N
which is in the southwestern part of China. Recently, Pu-Erh tea
NaOH or 0.05N KOH (prepared with 25, 50, 75 and 90% ace-
has gained popularity in Taiwan because of its anti-atherogenic
tonitrile or methanol in water or 100% water) and kept at 45 ◦C
effect The manufacture of Pu-Erh tea includes both nat-
for 1 h, followed by neutralization with 0.5 mL of 0.05N or
ural fermentation and prolonged storage under high moisture
0.1N HCl (prepared with acetonitrile or methanol) before HPLC
condition at ambient temperature, which is prone to microbial
growth, such as Aspergillus. It is therefore expected that Pu-Erhtea contains bioactive metabolites derived from microorganisms. 2.3. Stability of statins in various solutions
Hwang et al. that lovastatin was found in Pu-Erhtea, the content of lovastatin was not determined, however.
Each statin standard (0.5 mg) was added to 0.5 mL of
There were neither detailed reports on the conversion of
methanol, ethyl acetate, or 70% acetonitrile in water (with or
statins from lactone forms to their corresponding hydroxy acid
without 0.5% acetic acid) for 0, 1, 2, 3, 8, 16, 24 and 48 h at
forms, nor the stabilities of statins in various solution. In the
room temperature or added to 100 ◦C water for 0, 0.5, 1or 2 h,
present study, we investigated three natural statins (lovastatin,
simvastatin and pravastatin) and compared their conversion ratesfrom lactone forms to their corresponding hydroxy acids forms
2.4. Solid-phase extraction of statins
under different alkaline solutions conditions, and determinedthe stabilities of these three statins in various solutions. We also
The method employed was modified from Miao and Met-
developed a C18 solid-phase extraction method for the determi-
calfe solid-phase extraction cartridges (500 mg)
(Supelco Co., St. Louis, MO, USA) were conditioned by passingthrough 6 mL of methanol followed by 6 mL of water. Mixture
2. Experimental
of the five statin standards (each weighed 0.5 mg) was dissolvedin 1 mL of methanol and loaded onto an outlet blocked DSC-
C18 cartridge. After evaporation of solvent with nitrogen gas,the outlet of the cartridge was opened and then eluted with 6 mL
Pu-Erh tea was purchased from Yunnan, China. It was ground
aliquots of water, 5–95% methanol in water (in the increment of
into powder of 40 mesh with a RT08 grinder (Rong-Tsong Co.,
5% each time) and 100% methanol. Each eluate was collected
Taipei, Taiwan) prior to use. Standard compounds of statin,
and analyzed by HPLC in order to find the best eluting solvent
lovastatin (lactone form) (Lov-L), simvastatin (lactone form,
Sim-L) and pravastatin (hydroxy acid form, Pra-H) were pur-chased from Sigma (St. Louis, MO). Lovastatin (hydroxy acid
2.5. Recoveries of statin standards after solid-phase
form, Lov-H) and simvastatin (hydroxy acid form, Sim-H) were
prepared in our laboratory from Lov-L and Sim-L, respectively. Lov-L and Sim-L were reacted with 0.1N NaOH (prepared in
Mixtures of the five statin standards (each statin weighed
50% aqueous acetonitrile solution) at 45 ◦C for 1 h followed by
20, 100, 500 and 1000 ng), dissolved in methanol, were loaded
D.-J. Yang, L.S. Hwang / J. Chromatogr. A 1119 (2006) 277–284
Fig. 1. Chemical structures of statins.
separately onto DSC-C18 solid-phase extraction cartridges as
described above. The cartridges were then washed with 6 mLof water followed by 6 mL of 10% methanol in water for the
The method employed was similar to that reported by Shen
removal of possible impurities, the statins were eluted using
et al. The analyses were carried out with a Hitachi L-
6 mL of 90% methanol in water. Each eluate was concentrated
7100 HPLC pump (Hitachi Instruments Inc., Tokyo, Japan)
to dryness in a rotary evaporator at 35 ◦C (B¨uchi Co., Flawil,
using a isocratic solvent system consisting of acetonitrile,
Switzerland) and re-dissolved in 1 mL of the mobile phase
deionized water and acetic acid (70/30/0.5, v/v) as the mobile
before HPLC analysis. The recovery of each statin was calcu-
phase at a flow rate of 1 mL/min. The stationary phase was
lated from the analytical result and the original amount of statin
Luna C18 column (4.6 mm i.d. × 250 mm, 5 m) (Phenomenex,
Torrance, CA, USA) and the sample injection volume was20 L. A Hitachi L-7420 UV–vis detector (set at 237 nm)
2.6. The extraction efficiency of statins from Pu-Erh tea
(Hitachi Instruments Inc., Tokyo, Japan) was used to detect
The statins in Pu-Erh tea samples were identified by: (1)
Adding a mixture of the five statin standards (each weighed
addition of statin standards to sample for co-chromatography
20, 100 or 500 ng) to the 10 g of Pu-Erh tea, and then extracted
and (2) comparison of retention time, molecular absorption
with 100 mL of methanol or ethyl acetate at room temperature
spectra, and mass spectra of the unknown peaks with statin
for 24 h or refluxed in water (100 mL) at 100 ◦C for 1 h, respec-
standards. Absorption spectra were obtained on a photodi-
tively. The extracts were filtered and concentrated to dryness in
ode array detector (Model 996, Waters Associate, Milford,
a rotary evaporator at 35 ◦C. Each extract was dissolved in 1 mL
MA, USA) and mass spectra were resolved on a VG plat-
of methanol and then pre-treated with DSC-C18 solid-phase
form II LC–MS (Micromass Co., Cheshire, UK) (conditions
extraction as described above. The eluate was then subjected
of LC–MS: electrospray ionization-positive ion, APCI+ mode,
to HPLC analysis of statins contents, and the recoveries were
cone voltage = 30 eV, source temperature = 120 ◦C, probe tem-
perature = 400 ◦C, discharge needle = 3.3 eV). D.-J. Yang, L.S. Hwang / J. Chromatogr. A 1119 (2006) 277–284
100% water. Hence, we modified to prepare the alkaline solu-tions with 25, 50, 75 and 90% acetonitrile in water.
The standard calibration equations of statins, recoveries and
indicates that the conversions of Lov-L and Sim-L are similar
quantitative analyses were conducted in triplicate and the mean
in either 0.1N NaOH or 0.05N KOH, they can be transformed
values were determined. Statistical analyses of the data were
almost completely only in alkaline solutions prepared with 25
conducted by the analysis of variance and Duncan’s multiple
or 50% acetonitrile in water. In the alkaline solutions prepared
with 90% acetonitrile, however, Lov-L and Sim-L had only about29–37% and 35–38% conversions, respectively. Higher amounts
3. Results and discussion
of Lov-H and Sim-H were formed (about 86–87% conversionsfor Lov-H and 87–91% conversions for Sim-H) when the alka-
3.1. The conversions of statins from lactone forms to their
line solutions were in 75% acetonitrile in 0.1N NaOH. It appears
corresponding hydroxy acid forms under different alkaline
that alkaline solutions containing lower concentrations of ace-
tonitrile in water will facilitate the conversion. Apparently, bothenough water and appropriate solubility are important for the
Brown et al. Shen et al. ve prepared hydroxy
complete transformation of lactone form statins to their corre-
acids of statins from their lactone forms by adding 0.1N NaOH
water solution and 0.05N KOH in aqueous methanol, individu-
In this investigation, we found that the conversions would
ally. In order to confirm the best alkaline condition, we measured
be better if lactone form statins were placed in 0.1N NaOH
the preparation of hydroxy acids of statins with 0.1N NaOH or
or 0.05N KOH solutions prepared with 25 or 50% acetoni-
0.05N KOH (prepared with 25, 50, 75 and 90% methanol in
trile in water. Therefore, we recommend that Lov-H and Sim-H
water or 100% water) further. The results showed that Lov-L
standards to be prepared from Lov-L and Sim-L standards by
and Sim-L could be converted to Lov-H and Sim-H entirely in
transformation in 0.1N NaOH or 0.05N KOH (prepared with 25
0.1N NaOH and 0.05N KOH (prepared with 25–90% methanol
or 50% acetonitrile in water), around 98% conversion can be
in water), nevertheless, they would be further transformed to
the methyl ester of the hydroxy acid form and the transfor-mation increased as methanol raised There was only
3.2. Stabilities of statins (lactone and hydroxy acid forms)
about 5% methyl ester form of lovastatin (Lov-M) generated
when Lov-L was in 0.1N NaOH or 0.05N KOH (preparedwith 25% methanol). When the alkaline was prepared in 90%
Because the stabilities of statins during extraction or HPLC
methanol, 15% Lov-M was formed. Sim-L also showed the sim-
analysis would affect the results of quantification, we studied
ilar results. Shen et al. Maio and Metcalfe
the stabilities of them in various solutions in advance. Each
that methanolysis of lactone form statins and esterification of
hydroxy acid or lactone form of statin standard (0.5 mg) was dis-
hydroxy acid form statins would take place if they were in
solved in methanol, ethyl acetate, or 70% acetonitrile in water
methanol. In 100% water, however, the conversions of Lov-L
(with or without 0.5% acetic acid), respectively for 0–48 h at
and Sim-L to Lov-H and Sim-H were only 90–93%. It is spec-
room temperature or added to 100 ◦C water for 0–2 h. Lactone
ulated that this is due to the insolubility of Lov-L and Sim-L in
form statins showed no significant changes in pure methanol and
Fig. 2. HPLC chromatograms of lovastatin treated with 0.05N KOH (prepared in solutions containing different ratios of methanol in water) at 45 ◦C for 1 h: (A)90% methanol; (B) 75% methanol; (C) 50% methanol; and (D) 25% methanol. HPLC conditions: column, Luna C-18 (4.6 mm i.d. × 250 mm, 5 m); mobile phase,acetonitrile/H2O/acetic acid = 70/30/0.5 (v/v/v); flow rate, 1 mL/min; detection, 237 nm. D.-J. Yang, L.S. Hwang / J. Chromatogr. A 1119 (2006) 277–284
Table 1Comparison of the conversion of statins under different alkaline conditions
The original content of each statin (lactone form) was 500 g.
a All values are mean ± SD obtained by triplicate analyses, numbers in parentheses are the % conversion.
b Values bearing different letters in the same column are significantly different (p < 0.05).
ethyl acetate at room temperature even after 48 h. The lactone
27.7%, respectively, while Sim-L to Sim-H were 11.1, 27.9 and
form statins would be converted to their corresponding hydroxy
29.4%, respectively In 70% acetonitrile at room tem-
acids in 70% acetonitrile and 100 ◦C water, and the conversion
perature for 1, 24 and 48 h, the conversions were 5.4, 33.5 and
increased with time (In 100 ◦C water for 0.5, 1
34.2% for Lov-L to Lov-H and 4.9, 35.9 and 35.3% for Sim-L to
and 2 h, the conversions of Lov-L to Lov-H were 8.9, 25.7 and
Sim-H, respectively (Hydroxy acid form statins were
Table 2The conversions of statins in water at 100 ◦C
The original amount of each statin (lactone form) was 500 g.
a All values are mean ± SD obtained by triplicate analyses, numbers in parentheses are the % conversion.
b Values bearing different letters in the same column are significantly different (p < 0.05).
Table 3The conversions of statins in acetonitrile/water (70/30, v/v) at room temperature
The original amount of each statin (lactone form) was 500 g.
a All values are mean ± SD obtained by triplicate analyses, numbers in parentheses are the % conversion.
b Values bearing different letters in the same column are significantly different (p < 0.05). D.-J. Yang, L.S. Hwang / J. Chromatogr. A 1119 (2006) 277–284
Table 4The conversions of statins in acetonitrile/water/acetic acid (70/30/0.5, v/v) at room temperature
The original amount of each statin (lactone form) was 500 g.
a All values are mean ± SD obtained by triplicate analyses, numbers in parentheses are the % conversion.
b Values bearing different letters in the same column are significantly different (p < 0.05).
more stable than the lactone forms; they showed no significant
3.3. Evaluation of solid-phase extraction of statins
The results were different from those reported by Shen et
Due to Pu-Erh tea crude extracts were more adhesive and
al. they indicated that methanolysis would take place if
contained a lot of impurities, which would interfere with the
the lactone form statins were stored in neat methanol at 25 ◦C
HPLC analysis of statins. We modified the method of Miao and
for 2 days and the methyl ester of statins would be formed.
Metcalfe evaluated the C18 solid-phase extraction for
In our study, however, there were no methyl esters of statins
the five statin standards. The results showed that the first eluate,
occurred in neat methanol at 25 ◦C for 0–48 h regardless of lac-
Pra-H was eluted until the C18 cartridge with 15% methanol,
tone or hydroxy acid forms of statins. The transformations of
Lov-H, Sim-H, Lov-L and Sim-L were then eluted in turn. All
statins from lactone forms to their corresponding hydroxy acids
of these statins were completely from the cartridge with 90%
were found to be retarded when acetic acid (0.5%) was add to
methanol. Therefore, the condition of solid-phase extraction of
70% acetonitrile. In this solution, Lov-L and Sim-L could be
statins was that samples (extracts) were dissolved in methanol
converted to Lov-H and Sim-H until 8 h storing at room tem-
and poured them into an outlet blocked C18 cartridge; after dry-
perature The percentage conversion was much lower
ing the cartridge with nitrogen, the outlet opened cartridge was
than in 70% acetonitrile from 16 to 48 h. Shen et al.
washed with 6 mL of water and 6 mL of 10% methanol in turn
that lactone and hydroxy acid forms of statins could maintain
to remove the polar impurities followed by statins elution with
their original structures better without affecting lactonization
and hydrolysis when they were in 70% acetonitrile with acetic
The recoveries of these statins from the above solid-phase
acid (0.5%) at 25 ◦C. Our results confirmed their findings. Ace-
extraction were about 95–99% when the amounts of statins pass-
tonitrile/water/acetic acid (70/30/0.5, v/v) would therefore be
ing through the cartridge were from 20 to 1000 ng We,
suitable as the mobile phase for HPLC separation of statins.
therefore, felt confident to employ this solid-phase extraction
the HPLC chromatogram of the five statin standards. Ye
method for the pretreatment of statins containing samples.
et al. ve investigated the conversions of Lov-L to Lov-H inplasma at 37 ◦C, room temperature, −20 ◦C and −70 ◦C. Their
3.4. Statins contents in Pu-Erh tea
results showed that the complete transformation (from Lov-Lto Lov-H) would be for 21.5 and 121.5 h at 37 ◦C and room
In order to find the best extracting solvent for statins from
temperature, respectively, moreover, Lov-L was not altered sig-
Pu-Erh tea, 10 g of Pu-Erh tea was spiked with the five statin
nificantly at −20 and −70 ◦C for 4 months.
standards (each weighed 20, 100 and 500 ng) and extracted with
Fig. 3. HPLC chromatogram of statin standards. HPLC conditions: same as in
D.-J. Yang, L.S. Hwang / J. Chromatogr. A 1119 (2006) 277–284
Table 5The recoveries of statins after passing through the C18 solid-phase extraction cartridge
a All data are the means of triplicate analyses.
b Values in parentheses are the coefficient of variation (%).
c Values bearing different letters in the same column are significantly different (p < 0.05).
Table 6The recoveries of added statins in Pu-Erh tea after different solvent extraction
a All data are the means of triplicate analyses.
b Values in parentheses are the coefficient of variation (%).
c Extraction condition: room temperature, 24 h.
d Extraction condition: 100 ◦C, 1 h.
f Values bearing different letters in the same column are significantly different (p < 0.05).
100 mL of methanol, or ethyl acetate at room temperature for 1
findings. We extracted the statins, which were added to Pu-Erh
day or refluxed in 100 mL water at 100 ◦C for 1 hr. The extracts
tea by refluxing in water at 100 ◦C for 1 h. This extraction condi-
were filtered and dried in a rotary evaporator. Each dry extract
tion might cause more vigorous conversion of Lov-L and Sim-L
was dissolved in methanol and then poured onto a C18 cartridge
for statins solid-phase extraction under the same condition as
Pra-H, the high polar compound was not retained well in the
column under the HPLC system, and was interfered by polar
With methanol or ethyl acetate as extraction solvent, the
impurities of Pu-Erh tea extract easily as UV detection. How-
recoveries of statins from Pu-Erh tea were about 90–95%
ever, it was decided that Pra-H did not existed in Pu-Erh tea after
(They were slightly lower than statins alone
LC–MS assistant detection; simvastatin (lactone and hydroxy
This slight loss of statins in Pu-Erh tea samples might arise from
acid forms) also did not be identified. ws that Pu-
the statins remained on the tube wall during extraction from Pu-
Erh tea contains lovastatin. The highest content of Lov-L was
Erh tea, which contained viscous materials. Therefore, lowerrecovery occurred while adding lower amounts of statins to Pu-
Erh tea. It is also noticed that the recoveries of lactone form
Statins contents in Pu-Erh tea using different solvent extraction
statins using methanol and ethyl acetate as extracting solvent
were much higher than extracting by refluxing in water. Lac-tone form statins would be transformed to their corresponding
hydroxy acids during 100 ◦C water extraction, therefore Lov-L
and Sim-L had much lower recoveries, 55–73% and 52–71%,
respectively. In the mean time, Lov-H and Sim-H showed the
opposite situation, their recoveries were higher (125–137% and
a All values are mean ± SD obtained by triplicate analyses.
123–137%, individually) (Miao and Metcalfe ve
Extraction condition: room temperature, 24 h.
used the C18 cartridge to extract statins in surface water, and
Extraction condition: 100 ◦C, 1 h.
d Values bearing different letters in the same column are significantly different
found the recoveries of Lov-L, Sim-L and Pra-H were 90, 82 and
90%, respectively. These results are different from the present
D.-J. Yang, L.S. Hwang / J. Chromatogr. A 1119 (2006) 277–284
found under ethyl acetate extraction (139.26 ng/g dw), followed
Acknowledgment
by methanol extraction (135.54 ng/g dw), which was not sig-nificantly different from ethyl acetate extraction. The lowest
This research was supported by the National Science Council,
content of lovastatin (61.54 ng/g dw) was found under 100 ◦C
Taiwan, the Republic of China (project no. NSC 92-2811-B-002-
water extraction, however, both of Lov-L (21.12 ng/g dw) and
Lov-H (40.42 ng/g dw) were found in the extract. Apparently,some of the Lov-L in Pu-Erh tea was transformed into Lov-H
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forms to 123–137%. Lovastatin was the only statin found in Pu-
[21] A.W. Alberts, Am. J. Cardiol. 62 (1988) 10J.
Erh tea, and the content was 139.26 ng/g dw under ethyl acetate
[22] L.S. Hwang, L.C. Lin, N.T. Chen, H.C. Liuchang, M.S. Shiao, ACS
Co-Promotion von Takeda und Pfizer: gemeinsamer Vertrieb von actos® in China Takeda Pharmaceutical Company Limited (Takeda) hat Pfizer Inc. (Pfizer) als Co-Promotionpartner für den Vertrieb von actos® (Pioglitazon HCI) in China gewonnen. Diese exklusive Vereinbarung berücksichtigt das Umsatzpotenzial von actos® und erhöht entsprechend den medizinischen Außendienst zur Unterst
neonatale, il basso peso alla nascita, lagonadotropine. I livelli di pulsatilità diQuesti riflessi negativi sull’ipotalamouna gravidanza indesiderata. All’inizioeffetti diretti degli oppioidi sul feto el’ipertensione può determinare rotturaematici di sostanze d’abuso. Inoltre losostanze; l’esame fisico, l’esame delleurine, i segni e i sintomi d’astinenza. MTD - It J Addic