Imipramine Pamoate

Intraoperative floppy iris syndrome (IFIS) is associated with an increased rate of severe intraoperative complications and greater visual morbidity during cataract surgery, particularly in females. To date, no postmarketing pharmacovigilance study has comprehensively examined all FDA-approved drugs for their association with IFIS development or explored potential sex differences. Understanding the risk factors for IFIS allows cataract surgeons to better stratify surgical risks and implement appropriate preoperative and intraoperative measures to ensure adequate management in high-risk patients.

Retrospective pharmacovigilance clinical cohort study.

This population-based, observational study analyzed IFIS cases reported to the Food and Drug Administration Adverse Event Reporting System from October 2003 to March 2024 using OpenVigil 2.1. Disproportionality metrics, including reporting odds ratios (RORs), proportional reporting ratios (PRRs), and relative risk reductions, were used to assess signals for positive adverse reactions (n > 2, χ² > 4, PRR > 2), compared to all other drugs. Subgroup analyses were also conducted by sex.

Of 12,345,128 adverse event reports, 649 (0.0053%) involved IFIS. The majority of cases were reported by healthcare professionals (75.75%, n = 203), followed by consumers (12.69%, n = 34) and unknown sources (11.57%, n = 31). Drugs with the highest disproportionality for IFIS included imipramine (ROR = 251.66, 95% confidence interval [CI] = 157.53-402.02), tamsulosin (ROR = 171.44, 95% CI = 143.12-205.36), and chlorpromazine (ROR = 91.30, 95% CI = 49.91-167.03) (all P < .0001, IC₀₂₅ > 0). Over-reported drug classes included α1-blockers, tricyclic antidepressants, atypical antipsychotics, carbonic anhydrase inhibitors, corticosteroids, 5α-reductase inhibitors, β-blockers, prostaglandin analogs, and β2-agonists. Among females, brinzolamide (ROR = 409.63, 95% CI = 196.78-852.73) and salbutamol (ROR = 67.12, 95% CI = 28.37-158.80) were disproportionately associated with IFIS (both P < .0001, IC₀₂₅ > 0), whereas these associations were not observed in males.

This analysis of over 20,000 drugs and 12 million reports highlights that, in addition to α1-blockers and atypical antipsychotics, tricyclic antidepressants are among the key agents most disproportionately associated with IFIS, with notable sex differences. These findings are crucial for informing perioperative counseling and surgical planning for cataract surgery.

Amyloid peptide non-fibrillar oligomers cause neurotoxicity and may contribute to Alzheimer's disease (AD) pathogenesis. Mounting evidence indicates that Aβ_1-42 oligomers disrupt and remodel neuronal membrane, causing neuronal cell death. The involvement of individual neuronal membrane constituents in real-time Aβ_1-42 aggregate assembly is unclear due to complexity of neuronal cell membrane. We used non-Faradaic electrochemical impedance spectroscopy (EIS) to track monomeric Aβ_1-42 peptide binding and aggregation pathways in real-time in asymmetric micropore suspended lipid bilayer membranes with anionic phospholipids and glycosphingolipids. Anionic DOPC:PIP2 pore suspended membrane showed pore-formation within 2 h of incubation, but peptide insertion occurred over 6 h, with an onset time of ∼6-8 h for peptide aggregation at the membrane surface. Among different gangliosides, peptide binding to GM1- and GM3-containing membranes did not result pore development, but receptor mediated peptide aggregation formation caused membrane admittance to decrease within 2 h. In contrast, partial peptide insertion in the membrane surface increases membrane admittance at GD1a and mixed GSL membranes, arresting aggregation. Time-lapsed AFM imaging at asymmetric solid supported lipid bilayers (aSLBs) corroborated EIS findings, capturing pore-formation and receptor mediated peptide assembly routes. Fluorescence lifetime imaging (FLIM) imaging and spatial resolved single-point fluorescence correlation spectroscopy (FCS) at aSLBs revealed membrane-peptide interaction, assembly, and peptide induced membrane reorganization. Treatment with antidepressants fluoxetine and imipramine therapeutics, in synergy, which are cost-effective and capable of crossing the central nervous system (CNS+), resulted in the disassembly of membrane mediated Aβ_1-42 aggregates, but not fibrils. Overall, the data suggests that membrane-mediated aggregate disassembly at the correct timing of AD progression may halt or reverse amyloid assembly through the use of repurposed drugs.