AVIMOX CV DS

Indications

• Dry eye conditions
• Tear deficiency
• Keratoconjunctivitis sicca

Dosage

Children: Apply as required, typically in the form of eye drops.

Adults: Apply as required, typically in the form of eye drops.

Mechanism of action

Hypromellose acts by forming a viscous gel upon contact with the ocular surface, which helps to retain moisture and protect against irritants. This gel-like property enhances the stability of the tear film and reduces evaporation, thereby alleviating symptoms associated with dry eye conditions.

Pharmacodynamics

The pharmacodynamic effects of hypromellose are primarily related to its ability to mimic natural tears, providing lubrication to the ocular surface. This lubrication reduces friction during blinking and maintains corneal hydration, which is critical for ocular comfort and health. Its high viscosity also contributes to prolonged retention time on the eye surface.

Pharmacokinetics

Hypromellose is administered topically as eye drops and is not significantly absorbed systemically. The retention time of hypromellose on the ocular surface is enhanced due to its viscosity, allowing for extended relief of dry eye symptoms. The elimination of hypromellose occurs primarily through drainage from the eye and dilution by the natural tear fluid.

Adverse effects

• Temporary visual disturbance
• Eye irritation

Precautions

• Should not be used during contact lens wear
• Use with caution in patients with known hypersensitivity to any component of the formulation

Pregnancy

Hypromellose is generally considered safe for use during pregnancy. However, it should be used only if clearly needed and after consulting a healthcare provider.

Breast-feeding

Hypromellose is unlikely to affect breastfed infants when used as directed, but consultation with a healthcare provider is advisable.

Storage

Store in a cool, dry place away from direct sunlight. Once opened, use within a specified period as indicated on the packaging.

Formulations

• {'name': 'Teardew', 'concentration': '0.3%', 'form': 'eye drops', 'volume': '10 ml'}
• {'name': 'Xailin Hydrate', 'concentration': '0.3%', 'form': 'eye drops', 'volume': '10 ml'}
• {'name': 'AacuLose', 'concentration': '0.3%', 'form': 'eye drops', 'volume': '10 ml'}
• {'name': 'Artelac', 'concentration': '0.32%', 'form': 'eye drops', 'volume': '10 ml'}
• {'name': 'Lacrilube', 'concentration': '2 mg/g', 'form': 'eye ointment', 'volume': '3.5 g'}
• {'name': 'Celluvisc', 'concentration': '1%', 'form': 'eye drops', 'volume': '0.4 ml unit dose'}

Indications

• Bacterial infections
• Urinary tract infections
• Sinusitis
• Uncomplicated community-acquired pneumonia
• Salmonellosis
• Oral infections
• Lyme disease (under expert supervision)
• Acute exacerbation of bronchiectasis
• Anthrax (treatment and post-exposure prophylaxis)

Dosage

Children: 1 month–11 years: 30 mg/kg 3 times a day for 21 days; children 1–4 years: 250 mg 3 times a day; children 5–11 years: 500 mg 3 times a day.

Adults: 500 mg 3 times a day; increased if necessary up to 1 g 3 times a day in severe infections.

Mechanism of action

Amoxicillin works by inhibiting bacterial cell wall synthesis, leading to cell lysis and death. It binds to penicillin-binding proteins (PBPs) located inside the bacterial cell wall, interfering with the transpeptidation process necessary for cell wall integrity.

Pharmacodynamics

Amoxicillin exhibits bactericidal activity against susceptible bacteria. Its action is time-dependent, meaning that its effectiveness is related to the duration of time that the drug concentration remains above the minimum inhibitory concentration (MIC) for the target pathogen.

Pharmacokinetics

Amoxicillin is well absorbed from the gastrointestinal tract, with peak plasma concentrations achieved within 1-2 hours after oral administration. It is widely distributed in body tissues and fluids, and it is excreted primarily via the kidneys. The elimination half-life is approximately 1 hour, and renal impairment may necessitate dosage adjustments.

Adverse effects

• Skin rash
• Gastrointestinal disturbances (nausea, vomiting, diarrhea)
• Allergic reactions (including anaphylaxis)
• Superinfection (due to resistant organisms)

Interactions

• Allopurinol (increases risk of skin rash)

Precautions

• History of penicillin allergy
• Renal impairment (reduce dose)
• Use with caution in patients with mononucleosis

Pregnancy

Use only if clearly needed; no adequate studies in pregnant women.

Breast-feeding

Amoxicillin is excreted in breast milk; use with caution.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• Phenoxymethylpenicillin 250mg/5ml oral solution
• Phenoxymethylpenicillin 250 mg tablets

Indications

• Bacterial infections caused by beta-lactamase producing organisms
• Community-acquired pneumonia
• Respiratory tract infections
• Urinary tract infections
• Skin and soft tissue infections

Dosage

Children: Paediatric dosing of clavulanate should be determined based on the specific indication and the formulation used. Refer to the BNF for

Adults: The usual adult dose of clavulanate varies depending on the specific antibiotic it is combined with, generally ranging from 125 mg to 250 mg, taken every 8 hours when combined with amoxicillin.

Mechanism of action

Clavulanate works by irreversibly binding to the active site of beta-lactamase enzymes. By inhibiting these enzymes, clavulanate protects beta-lactam antibiotics from degradation, allowing them to exert their antibacterial effects effectively. This mechanism enhances the spectrum of activity of the co-administered antibiotic, thereby improving clinical outcomes in infections caused by beta-lactamase producing organisms.

Pharmacodynamics

Clavulanate exhibits a time-dependent antibacterial effect, characterized by its ability to maintain effective concentrations against beta-lactamase producing bacteria. Its pharmacodynamic properties are mainly influenced by its interaction with beta-lactam antibiotics, enhancing their efficacy in treating infections. The overall effect is a synergistic relationship that increases the potency of the antibiotic treatment.

Pharmacokinetics

Clavulanate is usually administered orally or parenterally, and it is rapidly absorbed from the gastrointestinal tract. It reaches peak plasma concentrations within 1 to 2 hours after administration. The drug is widely distributed in body tissues, with a volume of distribution indicative of good tissue penetration. Clavulanate undergoes hepatic metabolism, primarily by conjugation, and is excreted largely in the urine as metabolites. The elimination half-life is approximately 1 hour, necessitating frequent dosing for optimal therapeutic effect.

Contra-indications

• Hypersensitivity to clavulanate or any component of the formulation
• History of jaundice or hepatic impairment related to previous use of beta-lactam antibiotics

Adverse effects

• Diarrhea
• Nausea
• Vomiting
• Rash
• Hepatic dysfunction
• Allergic reactions

Interactions

• Probenecid may increase concentrations of clavulanate
• Anticoagulants may have altered effects due to changes in gut flora

Precautions

• Monitor liver function during prolonged therapy
• Use cautiously in patients with renal impairment
• Assess for history of allergy to penicillins or cephalosporins

Pregnancy

Clavulanate is classified as category B. Animal studies have not shown teratogenic effects, but adequate and well-controlled studies in pregnant women are lacking.

Breast-feeding

Clavulanate is excreted in breast milk. Caution is advised when administering to nursing mothers.

Storage

Store in a cool, dry place away from direct light. Keep out of reach of children.

Formulations

• Clavulanate potassium 125 mg/5 mL
• Clavulanate potassium 250 mg/5 mL

Indications

• Pediatric dosing adjustments
• Intravenous therapy
• Intramuscular injections
• Topical applications
• Oral medications for easier swallowing

Dosage

Children: Refer to the BNF for Children for appropriate dosing adjustments based on age and weight.

Adults: Refer to specific drug guidelines for appropriate dilution and dosage based on the active ingredient.

Mechanism of action

The mechanism of action of a diluted drug depends on the specific active ingredient within the solution. Generally, when a drug is diluted, its pharmacological effects are proportional to its concentration. The active molecules interact with specific receptors or enzymes in the body, leading to a desired therapeutic effect. For example, an analgesic diluted for oral administration will still bind to pain receptors, albeit at a lower intensity compared to its concentrated form.

Pharmacodynamics

Pharmacodynamics refers to the relationship between drug concentration and its effect on the body. In diluted solutions, the pharmacodynamic properties of the active ingredient remain intact, though the therapeutic effect may be reduced due to the lower concentration. The efficacy of the drug is influenced by factors such as receptor affinity, intrinsic activity, and the presence of other substances in the formulation.

Pharmacokinetics

Pharmacokinetics involves the absorption, distribution, metabolism, and excretion (ADME) of drugs. For diluted drugs, absorption can be affected by the dilution medium, which may enhance or delay the onset of action. Distribution is generally influenced by the volume of distribution of the active ingredient. Metabolism occurs primarily in the liver, where the drug is biotransformed, and excretion is typically via the kidneys. The pharmacokinetic profile may differ based on the dilution level and formulation.

Pregnancy

Consult a healthcare provider, as the effects of diluted preparations can vary depending on the active ingredient.

Breast-feeding

Consult a healthcare provider, as the safety of diluted preparations during breastfeeding can depend on the active ingredient.

Storage

Store in a cool, dry place away from direct sunlight. Ensure that the specific active ingredient's storage requirements are followed.

Indications

• Monitoring respiratory function
• Assessment of metabolic status
• Management of respiratory acidosis
• Management of respiratory alkalosis

Dosage

Children: Dosing for interventions related to carbon dioxide levels in pediatric patients should be guided by clinical protocols and the BNF for Children.

Adults: Dosing for interventions related to carbon dioxide levels is typically based on clinical assessment and individual patient needs. Refer to clinical guidelines for specific scenarios.

Mechanism of action

Carbon dioxide acts primarily as a signaling molecule in the body, influencing respiratory drive and blood pH. It is produced during cellular respiration and is a critical component of the bicarbonate buffering system, which helps maintain acid-base homeostasis. Elevated levels of CO2 in the blood stimulate ventilation in the lungs, increasing the rate of gas exchange and facilitating the removal of excess CO2.

Pharmacodynamics

The pharmacodynamic effects of dioxides, particularly carbon dioxide, are closely related to its concentration in the blood. As CO2 levels increase, it leads to respiratory acidosis, which can stimulate the respiratory centers in the brain to increase ventilation. Conversely, low levels of CO2 can cause respiratory alkalosis, potentially leading to decreased respiratory drive. CO2 also plays a role in vasodilation and can affect blood flow and pressure through its influence on smooth muscle tone.

Pharmacokinetics

Carbon dioxide is produced endogenously during metabolic processes and is transported in the bloodstream primarily in three forms: dissolved in plasma, as bicarbonate ions (HCO3-), and bound to hemoglobin. The half-life of CO2 in the bloodstream is very short due to its rapid exchange with alveolar gas in the lungs. The elimination of CO2 occurs through exhalation, making it a dynamic component of respiratory physiology.

Pregnancy

Data on the effects of dioxide during pregnancy are limited. Caution is advised due to potential risks associated with exposure.

Breast-feeding

Limited data are available regarding the excretion of dioxide in human milk. Caution is recommended.

Storage

Store in a cool, dry place, away from direct sunlight and moisture.

Indications

• To enhance the palatability of oral medications
• To improve compliance in pediatric patients
• To mask unpleasant tastes of active pharmaceutical ingredients

Dosage

Children: Refer to specific formulations for guidance, as flavoring agents are typically used in very small quantities and are not dosed independently.

Adults: Refer to specific formulations for guidance, as flavoring agents are typically used in very small quantities and are not dosed independently.

Mechanism of action

Flavor compounds act primarily by stimulating taste receptors on the tongue, which can enhance the overall sensory experience of ingesting a product. Certain flavor compounds may also interact with olfactory receptors, contributing to the perception of flavor through smell. The stimulation of these receptors can lead to increased salivation and improved swallowing.

Pharmacodynamics

The use of flavoring agents in pharmaceuticals can influence compliance, particularly in children and individuals who may have difficulty swallowing pills. By enhancing the taste of a medication, these agents can reduce gag reflex and aversion, potentially improving therapeutic outcomes. However, the pharmacodynamic effects are largely dependent on the individual's taste preferences and sensitivities.

Pharmacokinetics

The pharmacokinetics of flavoring agents vary widely depending on the specific compounds used. Generally, these compounds are rapidly absorbed through the gastrointestinal tract upon ingestion, with their effects occurring within minutes. Some flavoring agents may undergo metabolism in the liver, while others may be excreted unchanged. The specific absorption, distribution, metabolism, and excretion (ADME) profiles depend on the chemical structure of each flavor compound.

Pregnancy

Generally considered safe, but specific flavoring agents may need to be evaluated individually.

Breast-feeding

Generally considered safe, but specific flavoring agents may need to be evaluated individually.

Storage

Store in a cool, dry place away from light and moisture.

Indications

• Weight management
• Diabetes management
• Caloric reduction in food products

Dosage

Children: Neotame is used in food products for children, but specific dosages are not established in the BNF for

Adults: Neotame is typically used in very small amounts due to its high potency. There is no specific dosage for adults, as it is used as an ingredient in food products rather than prescribed as a medication. Refer to specific product formulations for guidance.

Mechanism of action

Neotame interacts with the sweet taste receptor, which is a heterodimer of two G protein-coupled receptors, T1R2 and T1R3. It binds to specific sites within these receptors, influencing their activity and leading to the sensation of sweetness. The binding interactions involve key residues in the amino terminal domain of T1R2, allowing neotame to activate the sweet taste pathway effectively.

Pharmacodynamics

As a sweetener, neotame activates the sweet taste receptor, leading to the perception of sweetness. Its potency allows for minimal quantities to achieve a desired level of sweetness, which can help reduce overall caloric intake. Neotame does not have caloric value as it is not metabolized into carbohydrates or fats. It is not associated with the same metabolic effects as sugar, making it suitable for individuals with specific dietary requirements.

Pharmacokinetics

Neotame is rapidly absorbed and metabolized in the body. It is broken down into its constituent amino acids, which are then utilized by the body like those from protein sources. The half-life of neotame is not specifically documented, but it is known to be cleared from the system quickly. Due to its structure, neotame does not accumulate in the body and is considered safe for consumption.

Pregnancy

Safety during pregnancy has not been established. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether neotame is excreted in human milk. Caution should be exercised when administered to nursing women.

Storage

Store in a cool, dry place, away from light. Keep out of reach of children.

Formulations

• Powder for oral use
• Tablets

Dosage

Children: Refer to BNF for Children for specific recommendations regarding the consumption of orange juice in children.

Adults: There is no standard dosage for orange juice as it is typically consumed as a beverage. Moderation is advised, especially for individuals on certain medications.

Mechanism of action

The exact mechanism of action of orange juice is not fully understood, but it is known to contain compounds that can influence the metabolism of certain drugs. For instance, it may affect the activity of cytochrome P450 enzymes, particularly CYP3A4, which can alter the pharmacokinetics of medications.

Pharmacodynamics

Orange juice is known to enhance the bioavailability of certain nutrients and may influence the pharmacological effects of some drugs. Its high vitamin C content contributes to various physiological functions, including antioxidant activity, which may indirectly support overall health.

Pharmacokinetics

The pharmacokinetics of orange juice itself are not extensively studied, but it is generally absorbed well through the gastrointestinal tract. The compounds in orange juice can affect the absorption and metabolism of medications, leading to varied clinical effects depending on the drug in question.

Interactions

• orange juice + celiprolol: Unknown (decreases exposure)

Formulations

• juice
• whole fruit

Indications

• Potential role in bone health
• Support for connective tissue formation
• May aid in mineral metabolism

Dosage

Children: There is no established clinical dosage for silicon in paediatric populations, as it is not classified as an essential nutrient.

Adults: There is no established clinical dosage for silicon in adults, as it is not classified as an essential nutrient.

Mechanism of action

Silicon is believed to enhance the synthesis of glycosaminoglycans and collagen, which are important for the structural integrity of connective tissues. It may also influence the activity of certain enzymes involved in bone mineralization, thus playing a role in maintaining bone density and health.

Pharmacodynamics

The pharmacodynamics of silicon is not fully elucidated; however, it is thought to involve the modulation of bone metabolism and the promotion of connective tissue health. Silicon may have a synergistic effect with other minerals, such as calcium and magnesium, aiding in their utilization and metabolism in the body.

Pharmacokinetics

The pharmacokinetics of silicon is complex, as it is not absorbed through typical gastrointestinal pathways. Instead, silicon is thought to be taken up in the form of silicates and then distributed throughout the body, particularly in connective tissues. The elimination of silicon occurs primarily through renal excretion, with some variations depending on dietary intake and individual metabolism.

Pregnancy

Silicon is generally considered safe during pregnancy, as it is a naturally occurring element in the human body. However, specific recommendations regarding supplementation should be followed based on the advice of a healthcare provider.

Breast-feeding

Silicon is present in breast milk in small amounts. Its safety during breastfeeding is generally regarded as acceptable, although supplementation should be approached with caution and under medical advice.

Storage

Silicon should be stored in a cool, dry place, protected from light and moisture. Follow specific storage recommendations provided by the manufacturer if available.

Indications

• Energy metabolism disorders
• Neuroprotection
• Potential adjunct therapy in mitochondrial dysfunction
• Investigational uses in ischemic conditions

Dosage

Children: Refer to specific guidelines and clinical recommendations for paediatric dosing as it may vary based on the therapeutic context.

Adults: Refer to specific guidelines and clinical recommendations for adult dosing as it may vary based on the therapeutic context.

Mechanism of action

Succinic acid acts primarily as a substrate in the citric acid cycle, where it is converted to fumarate by the enzyme succinate dehydrogenase. This reaction is part of the electron transport chain, which is vital for ATP production. Additionally, succinic acid can influence cellular signaling pathways, contributing to the regulation of mitochondrial function and energy homeostasis. It also has effects on GABA receptors, which may modulate neuronal excitability and contribute to its neuroprotective properties.

Pharmacodynamics

The pharmacological effects of succinic acid are related to its role in metabolism and energy production. By participating in the citric acid cycle, it helps maintain the balance of energy substrates in cells. Succinic acid may also have antioxidant properties, reducing oxidative stress and mitigating cellular damage. In the context of neuroprotection, it may enhance neuronal survival in conditions of hypoxia or ischemia.

Pharmacokinetics

Succinic acid is rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It is metabolized in the liver and can be converted to various metabolites that enter the citric acid cycle. The elimination of succinic acid occurs primarily through renal excretion. The half-life and specific pharmacokinetic parameters may vary based on the formulation and method of administration.

Pregnancy

There is limited information on the safety of succinic acid during pregnancy. Consult healthcare professionals before use.

Breast-feeding

It is not known whether succinic acid is excreted in human milk. Caution is advised.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

Indications

• Flavoring agent in food and beverages
• Aromatherapy for stress relief
• Potential antioxidant supplementation

Dosage

Children: Refer to specific product guidelines for appropriate dosing, as pediatric doses can differ significantly based on age and formulation.

Adults: Refer to specific product guidelines for appropriate dosing as it may vary based on the form (e.g., extract, powder) and intended use.

Mechanism of action

The primary active component of vanilla, vanillin, acts as an antioxidant by scavenging free radicals, which helps to mitigate oxidative stress. It may also engage in various metabolic pathways including the degradation of vanillin and vanillate, contributing to its bioavailability and therapeutic effects.

Pharmacodynamics

Vanilla exhibits several pharmacodynamic properties, including its ability to enhance flavor perception and stimulate appetite. The antioxidant properties of vanillin can reduce cellular damage and support overall health. Additionally, it may influence mood and cognition through its aromatic compounds, which have been associated with improved psychological well-being.

Pharmacokinetics

Vanilla is typically consumed orally and is absorbed in the gastrointestinal tract. The bioavailability of vanillin can vary based on the formulation and method of consumption. Once absorbed, vanillin is metabolized in the liver and excreted primarily through urine. The half-life and exact pharmacokinetic parameters of vanilla compounds can differ based on individual metabolism and the presence of other substances.

Pregnancy

Vanilla is generally considered safe during pregnancy when used in food amounts. However, high concentrations or extracts should be used cautiously.

Breast-feeding

Vanilla is likely safe during breastfeeding when used in food amounts, but should be used cautiously in higher concentrations.

Storage

Store in a cool, dry place away from direct sunlight. Keep tightly closed to maintain flavor and prevent contamination.

Formulations

• Vanilla extract
• Vanilla powder
• Vanilla bean

Indications

• Used as a thickening agent in food products
• Utilized in pharmaceutical formulations as a stabilizer
• Employed in cosmetics for texture improvement
• Applied in industrial products for its viscosity properties

Dosage

Children: Refer to specific product guidelines for appropriate use. Xanthan is used in formulations as a thickener or stabilizer, and dosage should be evaluated based on the specific product and formulation.

Adults: Refer to specific product guidelines for appropriate use. Xanthan is typically used in small quantities as a thickener or stabilizer in food and pharmaceutical products.

Mechanism of action

Xanthan functions primarily as a thickener and stabilizer. It acts by interacting with water molecules to form a gel-like consistency, which enhances the texture and stability of products. Its unique rheological properties allow it to maintain viscosity under varying conditions, which is beneficial in food and pharmaceutical applications.

Pharmacodynamics

Xanthan's action is primarily physical rather than pharmacological. It does not exert a direct therapeutic effect but influences the delivery and stability of active ingredients in formulations. The gel formation and viscosity changes help ensure the uniform distribution of substances in liquid formulations, which can improve the effectiveness of the drug delivery.

Pharmacokinetics

As xanthan is a polysaccharide, it is not absorbed in the gastrointestinal tract when ingested. It passes through the digestive system largely unchanged. In terms of metabolism, xanthan is broken down by colonic bacteria, resulting in short-chain fatty acids. Its pharmacokinetic profile indicates that it has a low bioavailability due to its large molecular size and structure.

Pregnancy

There is insufficient data on the use of xanthan during pregnancy. Consult a healthcare professional before use.

Breast-feeding

There is insufficient data on the excretion of xanthan in human milk. Consult a healthcare professional before use.

Storage

Store in a cool, dry place, away from direct sunlight.

Formulations

• Xanthan gum powder

Mechanism of action

Amoxicillin competitively inhibits penicillin-binding protein 1 and other high molecular weight penicillin binding proteins. Penicillin bind proteins are responsible for glycosyltransferase and transpeptidase reactions that lead to cross-linking of D-alanine and D-aspartic acid in bacterial cell walls. Without the action of penicillin binding proteins, bacteria upregulate autolytic enzymes and are unable to build and repair the cell wall, leading to bacteriocidal action. The penicillins and their metabolites are potent immunogens because of their ability to combine with proteins and act as haptens for acute antibody-mediated reactions. The most frequent (about 95 percent) or "major" determinant of penicillin allergy is the penicilloyl determinant produced by opening the beta-lactam ring of the penicillin. This allows linkage of the penicillin to protein at the amide group. "Minor" determinants (less frequent) are the other metabolites formed, including native penicillin and penicilloic acids. /Penicillins/ Amoxicillin is similar to penicillin in its bactericidal action against susceptible bacteria during the stage of active multiplication. It acts through the inhibition of cell wall biosynthesis that leads to the death of the bacteria.

Pharmacodynamics

Amoxicillin competitively inhibit penicillin binding proteins, leading to upregulation of autolytic enzymes and inhibition of cell wall synthesis. Amoxicillin has a long duration of action as it is usually given twice daily. Amoxicillin has a wide therapeutic range as mild overdoses are not associated with significant toxicity. Patients should be counselled regarding the risk of anaphylaxis, _Clostridium difficile_ infections, and bacterial resistance.

Mechanism of action

The sweet taste receptor is a heterodimer of two G protein coupled receptors, T1R2 and T1R3. Previous experimental studies using sweet receptor chimeras and mutants show that there are at least three potential binding sites in this heterodimeric receptor. Receptor activity toward the artificial sweeteners aspartame and neotame depends on residues in the amino terminal domain of human T1R2. In contrast, receptor activity toward the sweetener cyclamate and the sweet taste inhibitor lactisole depends on residues within the transmembrane domain of human T1R3. Furthermore, receptor activity toward the sweet protein brazzein depends on the cysteine rich domain of human T1R3. The sweet protein brazzein [recombinant protein with sequence identical with the native protein lacking the N-terminal pyroglutamate (the numbering system used has Asp2 as the N-terminal residue)] activates the human sweet receptor, a heterodimeric G-protein-coupled receptor composed of subunits Taste type 1 Receptor 2 (T1R2) and Taste type 1 Receptor 3 (T1R3). In order to elucidate the key amino acid(s) responsible for this interaction, we mutated residues in brazzein and each of the two subunits of the receptor. The effects of brazzein mutations were assayed by a human taste panel and by an in vitro assay involving receptor subunits expressed recombinantly in human embryonic kidney cells; the effects of the receptor mutations were assayed by in vitro assay. We mutated surface residues of brazzein at three putative interaction sites: site 1 (Loop43), site 2 (N- and C-termini and adjacent Glu36, Loop33), and site 3 (Loop9-19). Basic residues in site 1 and acidic residues in site 2 were essential for positive responses from each assay. Mutation of Y39A (site 1) greatly reduced positive responses. A bulky side chain at position 54 (site 2), rather than a side chain with hydrogen-bonding potential, was required for positive responses, as was the presence of the native disulfide bond in Loop9-19 (site 3). Results from mutagenesis and chimeras of the receptor indicated that brazzein interacts with both T1R2 and T1R3 and that the Venus flytrap module of T1R2 is important for brazzein agonism. With one exception, all mutations of receptor residues at putative interaction sites predicted by wedge models failed to yield the expected decrease in brazzein response. The exception, hT1R2 (human T1R2 subunit of the sweet receptor):R217A/hT1R3 (human T1R3 subunit of the sweet receptor), which contained a substitution in lobe 2 at the interface between the two subunits, exhibited a small selective decrease in brazzein activity. However, because the mutation was found to increase the positive cooperativity of binding by multiple ligands proposed to bind both T1R subunits (brazzein, monellin, and sucralose) but not those that bind to a single subunit (neotame and cyclamate), we suggest that this site is involved in subunit-subunit interaction rather than in direct brazzein binding. Results from this study support a multi-point interaction between brazzein and the sweet receptor by some mechanism other than the proposed wedge models.