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Meruva S, Singaraju AB, Vinjamuri BP, Ternik R, Stagner WC. Current State of Minitablet Product Design: A Review. J Pharm Sci 2024; 113:1123-1154. [PMID: 38369020 DOI: 10.1016/j.xphs.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
Interest in minitablets (MTs) has grown exponentially over the last 20 years and especially the last decade, as evidenced by the number of publications cited in Scopus and PubMed. MTs offer significant opportunities for personalized medicine, dose titration and flexible dosing, taste masking, and customizing drug delivery systems. Advances in specialized MT tooling, manufacturing, and characterization instrumentation have overcome many of the earlier development issues. Breakthrough MT swallowability, acceptability, and palatability research have challenged the long-standing idea that only liquids are acceptable dosage forms for infants and young children. MTs have been shown to be a highly acceptable dosage form for infants, small children, and geriatric patients who have difficulty swallowing. This review discusses the current state of MT applications, acceptability in pediatric and geriatric populations, medication adherence, manufacturing processes such as tableting and coating, running powder and tablet characterization, packaging and MT dispensing, and regulatory considerations.
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Affiliation(s)
| | | | - Bhavani Prasad Vinjamuri
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, University, MS 38677, USA
| | - Robert Ternik
- Rolara Medaka Consulting LLC, Fishers, IN 46037, USA
| | - William C Stagner
- Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC 27506, USA.
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2
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Gutierres LFDS, Montaldi MR, Nascimento WV, Dantas RO. VIDEOFLUOROSCOPIC EVALUATION OF THE IMPACT OF CAPSULE SIZE AND SUBJECT'S AGE AND GENDER ON CAPSULE SWALLOWING. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23092. [PMID: 38511792 DOI: 10.1590/s0004-2803.246102023-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/14/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND People recurrently have difficulties swallowing solid medications, which can be associated with the size of the medication and the age and gender of individuals. OBJECTIVE To evaluate the impact of capsule size and adults' age and gender on oral and pharyngeal capsule transit during capsule swallows. METHODS Videofluoroscopy was used to measure capsule oral and pharyngeal transit during swallows in 49 healthy individuals (17 men and 32 women), with a mean age of 46 years (ranging from 23 to 88 years). Smaller capsules were filled with 0.50 mL of barium sulfate, and larger capsules were filled with 0.95 mL of barium sulfate; the volume of liquid ingested with the capsules was also quantified in each ingestion. The measurements included the oral preparation time, oral transit time, swallowing reaction time, time to laryngeal vestibule closure, laryngeal vestibule closure duration, pharyngeal transit time, and upper esophageal sphincter opening duration. RESULTS The capsule size did not influence either the oral or pharyngeal transit time. Increased liquid volume was ingested with larger capsules and by people older than 40 years. The oral transit time was shorter in older adults (60-88 years), and the time to laryngeal vestibule closure was longer in women. CONCLUSION The size of large capsules did not make a difference in oral or pharyngeal transit when compared with smaller capsules. The capsule size and the participant's age influenced the volume of liquid ingested - larger capsules and older individuals required a larger volume. The capsule oral transit was faster in individuals older than 60 years. BACKGROUND •Swallowing is influenced by the characteristics of what is being swallowed. BACKGROUND •There was no difference in swallowing capsules containing 0.50 mL or 0.95 mL. BACKGROUND •Larger capsules need more liquid ingestion to make swallowing easier. BACKGROUND •Individuals older than 40 years need a greater volume of liquid to swallow capsules than younger adults.
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Affiliation(s)
| | | | | | - Roberto Oliveira Dantas
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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3
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Tablet characteristics and pharmacokinetics of orally disintegrating tablets containing coenzyme Q10 granules prepared by different methods. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:107-119. [PMID: 36692467 DOI: 10.2478/acph-2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
This study aimed to elucidate the characteristics and pharmacokinetics of orally disintegrating tablets (ODTs) containing coenzyme Q10 (CoQ10) granules prepared by spray drying, hot-melting, and wet granulation. The hardness and disintegration times of CoQ10-ODTs containing 5 % crospovidone were 61.6-81.8 N and < 30 s, respectively; these values indicate that the as-prepared ODTs were adequate for clinical use. The hardness and disintegration times of all ODTs did not change significantly after a 28-day storage period at 30 °C/10 % relative humidity (RH), but storage under high temperature and humidity affected their characteristics. The dissolution and pharmacokinetics of CoQ10-ODTs showed that ODTs prepared using the spray-drying method had the highest dissolution and absorbability among the CoQ10-ODTs tested. These results provide useful information for the preparation of ODTs using CoQ10.
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Embedding of Poorly Water-Soluble Drugs in Orodispersible Films-Comparison of Five Formulation Strategies. Pharmaceutics 2022; 15:pharmaceutics15010017. [PMID: 36678646 PMCID: PMC9864024 DOI: 10.3390/pharmaceutics15010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The poor bioavailability of many newly developed active pharmaceutical ingredients (APIs) poses a major challenge in formulation development. To overcome this issue, strategies such as the preparation of amorphous solid dispersions (ASDs), and the application of the APIs in lipid nanocarriers or the wet-milling of the substances into nanoparticles have been introduced. In addition to an efficient formulation strategy, a dosage form that is accepted by all patients is also of great importance. To enable a simple application of the oral dosage form for all patients, orodispersible films (ODFs) are a very promising delivery platform for the APIs because the films directly disintegrate in the mouth. In this study, two poorly water-soluble APIs, fenofibrate and naproxen, were formulated using five different formulation strategies and then embedded in ODFs. It was found that the deliverable amount of API with one ODF highly depends on the formulation strategy as well as the physicochemical properties of the formulated API. The most promising film formulations were ASD-ODFs as well as films with API-loaded lipid nanoemulsions. Both showed a reduction of the dissolution time of the APIs from the ODF compared to an ODF with unformulated API micro particles. In addition, short disintegration times were achieved, although the mechanical film properties were slightly worse compared to the API-free film formulation.
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Ilgaz F, Timur SS, Eylem CC, Nemutlu E, Erdem Ç, Eroğlu H, Gökmen-Özel H. Do Thickening Agents Used in Dysphagia Diet Affect Drug Bioavailability? Eur J Pharm Sci 2022; 174:106197. [PMID: 35489612 DOI: 10.1016/j.ejps.2022.106197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
Swallowing oral solid dosage forms is challenging in patients with dysphagia who are at risk of aspiration or choking. The most common method to facilitate drug administration in dysphagia patients is to mix the powdered drug with a small amount of thickened water, however little is known about the effects of this method on in vivo bioavailability of drugs. This study aimed to evaluate the impact of thickened liquids on dissolution rate and bioavailability of levetiracetam as a model drug. Powdered commercial tablets of levetiracetam, carbamazepine, atenolol and cefixime were mixed with water thickened with two commercial thickeners, modified maize starch (MS) and xanthan gam (XG), at three thickness levels: nectar, honey and pudding in test groups, and mixed with only water in the control group. At the first stage, the effects of thickened water on in vitro drug release of 4 drugs (levetiracetam, carbamazepine, atenolol and cefixime) were tested by using dialysis membrane method. Addition of both thickeners significantly reduced the release of three drugs compared to the control group, except carbamazepine. Levetiracetam which had the highest solubility was chosen as the model drug for in vivo experiments. In the second stage, New Zealand albino female rabbits (n=24) were divided into two groups as: control group (water+drug, n=6) and test group (thickened water+drug, n=18). Powdered levetiracetam tablets were mixed with water thickened with XG (n=9, 1.2 %, 2.4 %, 3.6 %) and MS (n=9, 4 %, 6%, 8 %) at three thickness levels and administered to the rabbits by intragastric gavage. Blood samples were collected at 9 time points following administration. After two-weeks of wash-out, test groups were crossed over and sample collection was repeated. Blood samples were analysed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). An in vitro-in vivo correlation (IVIVC) model was developed using in vitro drug dissolution (%) and in vivo plasma concentrations of levetiracetam for control group and test groups. The peak plasma concentration (Cmax) was lower and time to reach Cmax (tmax) was relatively higher in test groups compared to control group. The lowest Cmax was detected at the highest thickness level, however, the differences between groups were not statistically significant (p=0.117 and p=0.495 for Cmax and tmax, respectively). No significant difference in total amount of levetiracetam absorbed (AUC) was found between groups (p=0.215 and p=0.183 for AUCinfinity and AUClast, respectively). The comparisons according to the type of thickener also revealed that pharmacokinetic parameters did not significantly differ between groups, except for a significantly lower Cmax when drug was mixed with MS-thickened water at nectar consistency (1.2 %) compared to drug mixed with XG (4 %) at the same thickness level (p=0.038). A good correlation was observed between in vitro and in vivo data, which was characterized by higher r2 values as the concentration of the thickening agents was increased, but not for all thickness levels studied, indicating an inability of this in vitro model to fully predict the in vivo response. These results suggest that regardless of the thickness level, the administration of levetiracetam with two commercial thickening agents commonly used in dysphagia for safe swallowing, do not affect the pharmacokinetic efficiency and thus, the bioavailability of the drug.
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Affiliation(s)
- Fatma Ilgaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey.
| | - Selin Seda Timur
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Cemil Can Eylem
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - ÇiğdemEroğlu Erdem
- Department of Computer Engineering, Faculty of Engineering, Marmara University, Istanbul, 34722, Turkey.
| | - Hakan Eroğlu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Hülya Gökmen-Özel
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey.
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6
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Zaid AN, Abu Zaaror Y, Kaddumi A, Ghanem M, Jaradat N, Abu Salah T, Siaj S, Omari L. Stability of extemporaneously prepared sitagliptin phosphate solution. PLoS One 2022; 17:e0262068. [PMID: 35294449 PMCID: PMC8926268 DOI: 10.1371/journal.pone.0262068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that is used orally in conjunction with diet and exercise to control sugar levels in type 2 Diabetes Mellitus patients. This study aimed to extemporaneously prepare SiP solution (1% w/v) using pure Sitagliptin phosphate (SiP) powder and assess its stability according to pharmaceutical regulatory guidelines. Four SiP solutions, coded T1, T2, T3, and T4, were extemporaneously prepared using pure SiP powder as a source of API. The most suitable one, in terms of general organoleptic properties, was selected for further investigations, including stability studies. For this last purpose, samples of the T4 solution were kept under two storage conditions, room temperature (25˚C and 60% Relative Humidity) and accelerated stability conditions (40˚C and 75% Relative Humidity). Assay, pH, organoleptic properties, related substances, and microbial contamination were evaluated for 4 consecutive weeks. A High-Performance Liquid Chromatography (HPLC) analytical method was developed and validated to be used for the analysis and quantification of SiP in selected solution formulation. The adopted formula had a pH on the average of 3 to 4. During the stability tests, all pH values remained constant. Furthermore, after 4 weeks of storage under both conditions, the SiP concentration was close to 100%. A stable SiP extemporaneous solution was successfully prepared using pure SiP powder. Patients with swallowing problems who use feeding tubes and are unable to take oral solid dosage forms may benefit from this research. Community pharmacists can prepare the solution using sitagliptin powder as the source of the active ingredient.
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Affiliation(s)
- Abdel Naser Zaid
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- * E-mail:
| | | | | | | | - Nidal Jaradat
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Tharaa Abu Salah
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sameera Siaj
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Lana Omari
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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7
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Ng DZL, Nelson AZ, Ward G, Lai D, Doyle PS, Khan SA. Control of Drug-Excipient Particle Attributes with Droplet Microfluidic-based Extractive Solidification Enables Improved Powder Rheology. Pharm Res 2022; 39:411-421. [PMID: 35119593 DOI: 10.1007/s11095-021-03155-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Industrial implementation of continuous oral solid dosage form manufacturing has been impeded by the poor powder flow properties of many active pharmaceutical ingredients (APIs). Microfluidic droplet-based particle synthesis is an emerging particle engineering technique that enables the production of neat or composite microparticles with precise control over key attributes that affect powder flowability, such as particle size distribution, particle morphology, composition, and the API's polymorphic form. However, the powder properties of these microparticles have not been well-studied due to the limited mass throughputs of available platforms. In this work, we produce spherical API and API-composite microparticles at high mass throughputs, enabling characterization and comparison of the bulk powder flow properties of these materials and greater understanding of how particle-scale attributes correlate with powder rheology. METHODS A multi-channel emulsification device and an extractive droplet-based method are harnessed to synthesize spherical API and API-excipient particles of artemether. As-received API and API crystallized in the absence of droplet confinement are used as control cases. Particle attributes are characterized for each material and correlated with a comprehensive series of powder rheology tests. RESULTS The droplet-based processed artemether particles are observed to be more flowable, less cohesive, and less compressible than conventionally synthesized artemether powder. Co-processing the API with polycaprolactone to produce composite microparticles reduces the friction of the powder on stainless steel, a common equipment material. CONCLUSIONS Droplet-based extractive solidification is an attractive particle engineering technique for improving powder processing and may aid in the implementation of continuous solid dosage form manufacturing.
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Affiliation(s)
- Denise Z L Ng
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore, 117576, Singapore.,Critical Analytics for Manufacturing Personalized-Medicine, Singapore-MIT Alliance for Research and Technology, Singapore, 138602, Singapore.,Campus for Research Excellence and Technological Enterprise, Singapore, 138602, Singapore
| | - Arif Z Nelson
- Critical Analytics for Manufacturing Personalized-Medicine, Singapore-MIT Alliance for Research and Technology, Singapore, 138602, Singapore.,Campus for Research Excellence and Technological Enterprise, Singapore, 138602, Singapore
| | - Gareth Ward
- GSK Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG12NY, UK
| | - David Lai
- GlaxoSmithKline LLC, Product and Process Engineering, 709 Swedeland Road, King of Prussia, Pennsylvania, 19406, USA.,GlaxoSmithKline LLC, Advanced Manufacturing Technologies, 830 Winter Street, Waltham, Massachusetts, 02451, USA
| | - Patrick S Doyle
- Critical Analytics for Manufacturing Personalized-Medicine, Singapore-MIT Alliance for Research and Technology, Singapore, 138602, Singapore. .,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA.
| | - Saif A Khan
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore, 117576, Singapore. .,Campus for Research Excellence and Technological Enterprise, Singapore, 138602, Singapore.
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8
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Whelchel K, Zuckerman AD, Koren DE, Derrick C, Bouchard J, Chastain CA. Crushing and Splitting Direct-Acting Antivirals for Hepatitis C Virus Treatment: A Case Series and Literature Review. Open Forum Infect Dis 2021; 8:ofab525. [PMID: 34805439 PMCID: PMC8601046 DOI: 10.1093/ofid/ofab525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 12/09/2022] Open
Abstract
Limited data exist regarding the use of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) in patients who are unable to swallow tablets. This case series describes HCV treatment in patients requiring tablet manipulation, providing evidence for safety and effectiveness of HCV DAA tablet manipulation.
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Affiliation(s)
- Kristen Whelchel
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Autumn D Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David E Koren
- Department of Pharmacy Services, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Caroline Derrick
- Department of Infectious Disease, University of South Carolina, Columbia, South Carolina, USA
| | - Jeannette Bouchard
- Department of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Cody A Chastain
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Rosenbaum C, Grimm M, Krause J, Rump A, Kessler R, Hosten N, Weitschies W. Functionality and Acceptance of the EsoCap System-A Novel Film-Based Drug Delivery Technology: Results of an In Vivo Study. Pharmaceutics 2021; 13:pharmaceutics13060828. [PMID: 34199636 PMCID: PMC8227674 DOI: 10.3390/pharmaceutics13060828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
There are no methods for specific local application of active substances to the mucosa of the esophagus to treat eosinophilic esophagitis or other esophageal diseases. This publication describes the principal in vivo functionality and acceptance of a novel modular drug delivery concept, called EsoCap system, by 12 healthy volunteers. For the first time, the EsoCap system enables targeted placement on the esophageal mucosa of a mucoadhesive polymer film. Acceptance was determined by means of a standardized questionnaire after administration and functionality of the device by MRI scans. Two different setups of the EsoCap system were tested: one setup with a density of 0.4 g/cm3 and one with a density of 1.0 g/cm3. Acceptability of the dosage form was also confirmed in addition to functionality, by measuring the applied film length. It was found that acceptance of the variant with the higher density was significantly better. This novel drug delivery technology could enable a targeted, local and long-lasting therapy of the esophagus for the first time, depending on the polymer film used.
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Affiliation(s)
- Christoph Rosenbaum
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany; (C.R.); (M.G.); (J.K.); (A.R.)
| | - Michael Grimm
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany; (C.R.); (M.G.); (J.K.); (A.R.)
| | - Julius Krause
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany; (C.R.); (M.G.); (J.K.); (A.R.)
| | - Adrian Rump
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany; (C.R.); (M.G.); (J.K.); (A.R.)
| | - Rebecca Kessler
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (R.K.); (N.H.)
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (R.K.); (N.H.)
| | - Werner Weitschies
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany; (C.R.); (M.G.); (J.K.); (A.R.)
- Correspondence: ; Tel.: +49-3834-420-4811/+49-3834-420-4813
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10
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Radhakrishnan C, Sefidani Forough A, Cichero JAY, Smyth HE, Raidhan A, Nissen LM, Steadman KJ. A Difficult Pill to Swallow: An Investigation of the Factors Associated with Medication Swallowing Difficulties. Patient Prefer Adherence 2021; 15:29-40. [PMID: 33469272 PMCID: PMC7810703 DOI: 10.2147/ppa.s277238] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many medications are available as solid oral dosage forms such as tablets and capsules; however, some people find these medications difficult to swallow. AIM To identify whether certain psychological, oral sensory, and oral motor characteristics contribute to medication swallowing difficulties. METHODS A sample of healthy adults from two academic institutions in Brisbane were assessed for their experiences with swallowing solid oral dosage forms, food preferences, and food neophobia. The gag reflex, oral cavity size, fungiform papillae count, and chewing efficacy were also evaluated followed by a capsule-swallowing task. Primary outcome was the incidence of medication swallowing difficulties. Secondary outcomes were the association of medication swallowing difficulties with psychological, oral sensory, and oral motor factors. RESULTS Of 152 subjects, 32% reported difficulty swallowing tablets or capsules whole. This group was significantly more likely to have had a memory of choking on medications compared to those without medication swallowing difficulties (OR = 7.25, p < 0.05). Current medication swallowing difficulties were significantly associated with a smaller mouth cavity size (OR = 2.98, p < 0.05), a higher density of taste receptors on the tongue (OR = 3.27, p < 0.05), and were higher among those who chewed a jelly candy to non-homogenous particle size (OR = 4.1, p < 0.05). Current medication swallowing difficulties were associated with lower confidence in swallowing large capsules (000 size: OR = 0.47, 00 size: OR = 0.39, p < 0.05). No associations were found between medication swallowing difficulties and the gag reflex or food neophobia. CONCLUSION A combination of heightened oral perception characterized by a small oral cavity and high taste sensitivity compounded by a past choking episode on medications may be precipitating factors for medication swallowing difficulties. These factors may be helpful in identifying individuals who are more likely to experience difficulty swallowing medications.
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Affiliation(s)
| | - Aida Sefidani Forough
- School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Heather E Smyth
- Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, Centre for Nutrition and Food Sciences, Brisbane, Queensland, Australia
| | - Aisha Raidhan
- Department of Pharmacy, King’s College London, London, UK
| | - Lisa M Nissen
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Correspondence: Kathryn J Steadman Tel +61 7 334 61886Fax +61 7 3346 1999 Email
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11
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A formulation for suppressing bitter taste in the human oral cavity. Physiol Behav 2020; 226:113129. [DOI: 10.1016/j.physbeh.2020.113129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
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12
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Bracken L, McDonough E, Ashleigh S, Wilson F, Shakeshaft J, Ohia U, Mistry P, Jones H, Kanji N, Liu F, Peak M. Can children swallow tablets? Outcome data from a feasibility study to assess the acceptability of different-sized placebo tablets in children (creating acceptable tablets (CAT)). BMJ Open 2020; 10:e036508. [PMID: 33039988 PMCID: PMC7549447 DOI: 10.1136/bmjopen-2019-036508] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Feasibility study to investigate the acceptability of different-sized placebo tablets in children aged 4-12 years. DESIGN AND SETTING Clinical Research Facilities, inpatient wards and outpatient clinics within a Regional Paediatric Hospital and/or District General Hospital. Healthy children and National Health Service (NHS) patients were asked to swallow three placebo tablets: 6 mm, 8 mm and 10 mm, smallest to largest. The researcher observed children's facial expressions and behaviours on swallowing and measured the volume of water consumed. Participants completed a questionnaire about the overall acceptability; including swallowability, taste and volume of water consumed. For analysis, participants were stratified by age: 4-8 years and 9-12 years. RESULTS The feasibility study led to an estimated recruitment rate of 0.8% for NHS inpatients and 211 healthy children over a 1-year period. In total, 55 participants were recruited, 30 to the younger group, of which 77% had never taken a tablet before. 84% of the 25 older children had previously taken a tablet. All participants attempted to swallow the smallest sized tablet. The children aged 4-8 years found the larger tablets easier to swallow, however the older children found little difference between the tablet sizes. The younger children required more water to swallow each tablet size compared with the older children where an increasing volume of water was consumed as tablet size increased. Taste was rated highly for both age groups. The 8 mm tablets were deemed the most acceptable tablet size by all participants. CONCLUSION Tablets are potentially an acceptable formulation for children aged 4-12 years. Most children aged 4-8 years who attempted to swallow tablets successfully did so. Recruitment of NHS inpatients to medicine acceptability studies is challenging, however, recruitment of children of staff proved an effective strategy. Valuable lessons have been learnt from this feasibility study which will inform the design of a larger definitive trial.
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Affiliation(s)
- Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emma McDonough
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Samantha Ashleigh
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Fiona Wilson
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Joanne Shakeshaft
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Udeme Ohia
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Punam Mistry
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Huw Jones
- Pediatric Services, Quotient Sciences, Nottingham, UK
| | - Nazim Kanji
- Pediatric Services, Quotient Sciences, Nottingham, UK
| | - Fang Liu
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, UK
| | - Matthew Peak
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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13
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Turner-Bowker DM, An Haack K, Krohe M, Yaworsky A, Vivas N, Kelly M, Chatterjee G, Chaston E, Mann E, Reaney M. Development and content validation of the Pediatric Oral Medicines Acceptability Questionnaires (P-OMAQ): patient-reported and caregiver-reported outcome measures. J Patient Rep Outcomes 2020; 4:80. [PMID: 33000327 PMCID: PMC7527387 DOI: 10.1186/s41687-020-00246-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evolving regulatory guidelines recommend routine assessment of the acceptability of pediatric oral medicines throughout clinical development processes. However, such assessment is problematic owing to a lack of standard methods or criteria that define acceptability for children and their caregivers. This research aimed to identify the attributes of acceptability for targeted oral formulation types that are important to children, and to develop content-valid patient- and caregiver-reported outcome acceptability measures for use in the context of clinical drug development. METHODS A concept-focused literature review and two advisory panel meetings involving researchers, clinicians, and measurement scientists were conducted to identify acceptability attributes that may be relevant to children taking targeted oral medicine formulations. The Pediatric Oral Medicines Acceptability Questionnaires (P-OMAQs), including patient (P-OMAQ-P) and caregiver (P-OMAQ-C) versions, were drafted to assess these attributes. Qualitative concept elicitation (CE) and cognitive debriefing (CD) patient and caregiver interviews were conducted to confirm key acceptability attribute concepts for measurement and to evaluate patient and caregiver ability to understand and respond to the questions. RESULTS A full-text review of 40 articles identified 24 acceptability attributes that were categorized into 10 overarching domains and organized into a preliminary conceptual model. Feedback from the advisory panel refined the preliminary model. In total, 14 attributes were reported during the CE phase of the interviews (n = 23 pediatric patients, n = 13 caregivers); six attributes were included in the final model. The draft P-OMAQ was refined over four waves of CD interviews (n = 31 pediatric patients, n = 48 caregivers). The final version of the P-OMAQ-P is a 12-item questionnaire designed for young people aged 8-17 years. The P-OMAQ-C is a 19-item questionnaire designed for adult caregivers of young people aged 6 months to 17 years. There are two versions of each questionnaire: one with a 24-h recall period and one with a 7-day recall period. All items are answered on a 5-point numerical rating scale. CONCLUSIONS This research supports the content validity of the patient and caregiver versions of the P-OMAQ. Both questionnaires appropriately assess the acceptability of oral medicine formulations from the perspective of pediatric patients and their caregivers.
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Affiliation(s)
| | | | - Meaghan Krohe
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Andrew Yaworsky
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Norma Vivas
- Sanofi Argentina S.A., Tucumán 1, 4th Floor, C1049AAA, CABA, Argentina
| | - Masami Kelly
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Godhuli Chatterjee
- Sanofi-Synthelabo (India) Private Limited, CTS No.117-B, L&T Business Park, Saki Vihar Road, Powai, Mumbai, Maharashtra, 400072, India
| | - Emily Chaston
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Erin Mann
- Massachusetts Department of Public Health, Jamaica Plain, MA, USA
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14
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Gosdin L, Sharma AJ, Tripp K, Amoaful EF, Mahama AB, Selenje L, Jefferds ME, Ramakrishnan U, Martorell R, Addo OY. Barriers to and Facilitators of Iron and Folic Acid Supplementation within a School-Based Integrated Nutrition and Health Promotion Program among Ghanaian Adolescent Girls. Curr Dev Nutr 2020; 4:nzaa135. [PMID: 32914043 PMCID: PMC7467268 DOI: 10.1093/cdn/nzaa135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Anemia is a moderate public health problem among adolescent girls in Ghana. OBJECTIVES We aimed to evaluate the barriers to and facilitators of program fidelity to a school-based anemia reduction program with weekly iron and folic acid (IFA) supplementation. METHODS Authors analyzed directly observed weekly IFA consumption data collected longitudinally and cross-sectional data from a representative survey of 60 secondary schools and 1387 adolescent girls in the Northern and Volta regions of Ghana after 1 school year (2017-2018) of the intervention (30-36 wk). A bottleneck analysis was used to characterize the levels of IFA coverage and used adjusted generalized linear mixed-effects models to quantify the school and student drivers of IFA intake adherence. RESULTS Of girls, 90% had ever consumed the tablet, whereas 56% had consumed ≥15 weekly tablets (mean: 16.4, range: 0-36), indicating average intake adherence was about half of the available tablets. Among ever consumers, 88% of girls liked the tablet, and 27% reported undesirable changes (primarily heavy menstrual flow). School-level factors represented 75% of the variance in IFA consumption over the school year. Total IFA tablets consumed was associated with the ability to make up missed IFA distributions (+1.4 tablets; 95% CI: +0.8, +2.0 tablets), junior compared with senior secondary school (+5.8; 95% CI: +0.1, +11.5), educators' participating in a program-related training (+7.6; 95% CI: +2.9, 12.2), and educator perceptions that implementation was difficult (-6.9; 95% CI: -12.1, -1.7) and was an excessive time burden (-4.4; 95% CI: -8.4, -0.4). CONCLUSIONS Although the program reached Ghanaian schoolgirls, school-level factors were barriers to adherence. Modifications such as expanded training, formalized make-up IFA distributions, sensitization (awareness promotion), and additional support to senior high schools may improve adherence. Spreading the responsibility for IFA distribution to other teachers and streamlining monitoring may reduce the burden at the school level. Strengthening the health education component and improving knowledge of IFA among students may also be beneficial.
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Affiliation(s)
- Lucas Gosdin
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, CDC, Atlanta, GA, USA
| | - Andrea J Sharma
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, CDC, Atlanta, GA, USA
- US Public Health Service Commissioned Corps, Atlanta, GA, USA
| | | | - Esi F Amoaful
- Nutrition Department, Ghana Health Service of Ministry of Health, Accra, Ghana
| | | | | | - Maria E Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, CDC, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reynaldo Martorell
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - O Yaw Addo
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, CDC, Atlanta, GA, USA
- Emory Global Health Institute, Atlanta, GA, USA
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15
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Niazi M, Wissmar J, Berggren AR, Karlsson C, Johanson P. Development Strategy and Relative Bioavailability of a Pediatric Tablet Formulation of Ticagrelor. Clin Drug Investig 2019; 39:765-773. [PMID: 31140114 DOI: 10.1007/s40261-019-00800-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Ticagrelor is a P2Y12 receptor inhibitor approved as an antiplatelet drug for patients with acute coronary syndrome or a history of myocardial infarction. Ticagrelor is also being investigated for the reduction of vaso-occlusive crises in pediatric patients with sickle cell disease. A pediatric formulation suitable for this age range was developed; the development strategy is described. Primary objectives were determining the relative bioavailability of ticagrelor pediatric tablets and granules for oral suspension to the adult immediate-release tablet, and the pediatric tablets taken whole and dispersed/suspended in water to the granules for oral suspension. Bioequivalence between the pediatric tablet taken whole or suspended in water was also assessed. Secondary objectives were comparing the formulations' safety and tolerability. METHODS We conducted a randomized, four-period, cross-over, single-dose study. Pharmacokinetic parameters were assessed for ticagrelor and its active metabolite AR-C124910XX. Bioequivalence was concluded if the 90% confidence intervals of the maximum plasma concentration and area under the plasma concentration-time curve ratios were contained completely within the 80.00-125.00% limits for ticagrelor/AR-C124910XX. RESULTS Forty-four healthy adults (95% white; 57% male) were included. Similar bioavailability of ticagrelor (and AR-C124910XX) was demonstrated for all comparisons tested. Ticagrelor pediatric tablets taken whole were bioequivalent to pediatric tablets suspended in water. The plasma concentration-time profiles for ticagrelor and AR-C124910XX were similar, showing rapid ticagrelor absorption and AR-C124910XX formation. All formulations were well tolerated. CONCLUSION Similar bioavailability of a new pediatric dispersible tablet formulation of ticagrelor for use across a wide age range of pediatric patients was demonstrated compared with other oral ticagrelor formulations. CLINICALTRIALS. GOV IDENTIFIER NCT03126695. EUDRACT 2017-000371-93.
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Affiliation(s)
- Mohammad Niazi
- Quantitative Clinical Pharmacology, Early Clinical Development, AstraZeneca Gothenburg, Mölndal, Sweden.
| | - Jenny Wissmar
- Global Medicines Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Anders R Berggren
- Global Medicines Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Christer Karlsson
- Pharmaceutical Technology and Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Per Johanson
- Global Medicines Development, AstraZeneca Gothenburg, Mölndal, Sweden
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16
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Marshall AC, Damstra M, Tuley M, Schifando EL. Assessment of Taste and Grittiness of Riomet ® ER Strawberry, Riomet ® ER Grape, Riomet ® Cherry, and Metformin Immediate-Release Tablets in Healthy Subjects. Drugs R D 2019; 19:57-66. [PMID: 30649711 PMCID: PMC6380966 DOI: 10.1007/s40268-018-0260-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective This study was conducted to evaluate the taste and grittiness of two formulations of Riomet® ER (metformin hydrochloride for extended release [ER] oral suspension 100 mg/mL) differing only in their flavoring agents (strawberry and grape) in comparison with two commercially available immediate-release (IR) formulations of metformin, Riomet® Cherry (metformin hydrochloride oral solution 500 mg/5 mL) and metformin IR tablets (metformin hydrochloride IR tablets 500 mg), in healthy human subjects aged 10–70 years. Methods Five comparison sets (i.e., Riomet® Cherry vs. Riomet® ER Strawberry; Riomet® Cherry vs. Riomet® ER Grape; metformin IR vs. Riomet® ER Strawberry; metformin IR vs. Riomet® ER Grape; and Riomet® Cherry vs. metformin IR) were evaluated. Riomet® ER was reconstituted as instructed on the label. Metformin IR tablets were crushed one at a time into a fine powder using a pharmaceutical pill crusher and mixed with 5 mL of water. A 2.5-mL dose of each product was administered to each subject. Subjects were instructed not to swallow any of the products. Each product in the comparison set was rated by the subjects for taste and grittiness according to a 7-point hedonic facial scale and a 5-point level of agreement scale. A comparison questionnaire was also completed by the subjects after evaluating each set. In all, 56 subjects were enrolled and 55 subjects completed the study. The taste preference was statistically evaluated. Results and Conclusions All Riomet® formulations were significantly preferred overall to metformin IR crushed tablets. Both the strawberry and the grape flavors of Riomet® ER tended to be preferred to Riomet® Cherry. Electronic supplementary material The online version of this article (10.1007/s40268-018-0260-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allyson C Marshall
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA.
| | - Maureen Damstra
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA
| | - Michael Tuley
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA
| | - Elena L Schifando
- Sun Pharmaceuticals Industries, Inc., 2 Independence Way, Princeton, NJ, 08540, USA
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17
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Takano H, Uchida S, Kashiwagura Y, Tanaka S, Hakamata A, Odagiri K, Inui N, Watanabe H, Namiki N. Preparation of Cocoa Powder-Containing Orally Disintegrating Tablets of Rebamipide (Rebamipide Chocolet) and Evaluation of Their Clinical Palatability. Chem Pharm Bull (Tokyo) 2019; 67:112-119. [DOI: 10.1248/cpb.c18-00629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hidehito Takano
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences University of Shizuoka
- Department of Pharmacy, Kameda Medical Center Hospital
| | - Shinya Uchida
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences University of Shizuoka
| | - Yasuharu Kashiwagura
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences University of Shizuoka
| | - Shimako Tanaka
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences University of Shizuoka
| | - Akio Hakamata
- Department of Clinical Pharmacology & Therapeutics, Hamamatsu University School of Medicine
| | - Keiichi Odagiri
- Department of Clinical Pharmacology & Therapeutics, Hamamatsu University School of Medicine
- Center for Clinical Research, Hamamatsu University Hospital
| | - Naoki Inui
- Department of Clinical Pharmacology & Therapeutics, Hamamatsu University School of Medicine
| | - Hiroshi Watanabe
- Department of Clinical Pharmacology & Therapeutics, Hamamatsu University School of Medicine
| | - Noriyuki Namiki
- Department of Pharmacy Practice and Science, School of Pharmaceutical Sciences University of Shizuoka
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18
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Souza LF, Nascimento WV, Alves LMT, Silva ACV, Cassiani RA, Alves DC, Dantas RO. Medication swallowing difficulties in people without dysphagia. REVISTA CEFAC 2019. [DOI: 10.1590/1982-0216/20192140119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to assess the difficulty in swallowing medications and correlate it with age and gender in healthy adults and elderly. Methods: a total of 439 asymptomatic healthy volunteers (270 females and 169 males), who were not taking any medication on a regular basis, aged from 20 to 84 years, were questioned as for dysphagia, by using the Eating Assessment Tool (EAT-10). Question number five of the EAT-10, specifically, approached the difficulty in swallowing drugs, considering zero as “no swallowing problem” and 1 to 4 as “some degree of difficulty” (4 as great difficulty).The chi-square test (x2) was used for the statistical analysis. Results: a total of 365 (83%) volunteers reported having no difficulty in swallowing medications (89% of men and 80% of women), whereas 74 (17%) reported some degree of difficulty (11% of men and 20% of women)(p = 0.01). These represented 20% of those aged between 20 and 49, and 9% of those aged 50 and over (p = 0.02). Conclusion: in this study, it was observed that both age and gender influence on medication swallowing, a difficulty more frequent among women and young adults. Some degree of difficulty was reported by 17% of the volunteers.
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19
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Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135:75-84. [PMID: 29660383 DOI: 10.1016/j.addr.2018.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
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Affiliation(s)
- Esther T L Lau
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Lisa M Nissen
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
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20
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Cherian S, Lee BS, Tucker RM, Lee K, Smutzer G. Toward Improving Medication Adherence: The Suppression of Bitter Taste in Edible Taste Films. Adv Pharmacol Sci 2018; 2018:8043837. [PMID: 30046304 PMCID: PMC6036852 DOI: 10.1155/2018/8043837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/06/2018] [Accepted: 04/16/2018] [Indexed: 01/23/2023] Open
Abstract
Bitter taste is aversive to humans, and many oral medications exhibit a bitter taste. Bitter taste can be suppressed by the use of inhibitors or by masking agents such as sucralose. Another approach is to encapsulate bitter tasting compounds in order to delay their release. This delayed release can permit the prior release of bitter masking agents. Suppression of bitter taste was accomplished by encapsulating a bitter taste stimulus in erodible stearic acid microspheres, and embedding these 5 µmeter diameter microspheres in pullulan films that contain sucralose and peppermint oil as masking agents, along with an encapsulated masking agent (sucralose). Psychophysical tests demonstrated that films which encapsulated both quinine and sucralose produced a significant and continuous sweet percept when compared to films without sucralose microspheres. Films with both quinine and sucralose microspheres also produced positive hedonic scores that did not differ from control films that contained only sucralose microspheres or only empty (blank) microspheres. The encapsulation of bitter taste stimuli in lipid microspheres, and embedding these microspheres in rapidly dissolving edible taste films that contain masking agents in both the film base and in microspheres, is a promising approach for diminishing the bitter taste of drugs and related compounds.
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Affiliation(s)
- Silvy Cherian
- Department of Biology, Temple University, 1900 N. 12th Street, Philadelphia, PA 19122, USA
| | - Brian Sang Lee
- Department of Biology, Temple University, 1900 N. 12th Street, Philadelphia, PA 19122, USA
| | - Robin M. Tucker
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - Kevin Lee
- Department of Biology, Temple University, 1900 N. 12th Street, Philadelphia, PA 19122, USA
| | - Gregory Smutzer
- Department of Biology, Temple University, 1900 N. 12th Street, Philadelphia, PA 19122, USA
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21
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Ranmal SR, O’Brien F, Lopez F, Ruiz F, Orlu M, Tuleu C, Walsh J, Liu F. Methodologies for assessing the acceptability of oral formulations among children and older adults: a systematic review. Drug Discov Today 2018; 23:830-847. [DOI: 10.1016/j.drudis.2018.01.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/07/2017] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
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22
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Jones DF, McRea AR, Jairath MK, Jones MS, Bradford KK, Jhaveri R. Prospective Assessment of Pill-Swallowing Ability in Pediatric Patients. Clin Pediatr (Phila) 2018; 57:300-306. [PMID: 28770624 DOI: 10.1177/0009922817724399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Difficulty with pill-swallowing ability (PSA) is common in children, yet formal evaluation is rare. The objective of this study was to prospectively evaluate and compare PSA of inpatient and outpatient children using the Pediatric Oral Medications Screener. We identified children aged 3 to 17 years admitted to a general or subspecialty pediatric service at a university hospital or outpatient clinic. Using the Pediatric Oral Medications Screener, patients were observed swallowing 3 different-sized placebo pills (5 mm tablet, 10 mm tablet, and 22 mm capsule), and subjective measures were assessed from parents and children. We analyzed 47 inpatients and 62 outpatients. Sixteen percent of patients could not swallow any pill, 11% only swallowed the small pill, 14% swallowed up to the medium pill, and 60% swallowed all formulations. After controlling for multiple factors, inpatients had superior PSA compared with outpatients ( P = .004). These results suggest targeted inpatient screening and widespread outpatient screening would likely identify children with reduced PSA.
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Affiliation(s)
- Denise F Jones
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA.,2 University of North Carolina at Chapel Hill, NC, USA
| | | | | | | | - Kathleen K Bradford
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA.,2 University of North Carolina at Chapel Hill, NC, USA
| | - Ravi Jhaveri
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA.,2 University of North Carolina at Chapel Hill, NC, USA
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23
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Walsh J, Ranmal SR, Ernest TB, Liu F. Patient acceptability, safety and access: A balancing act for selecting age-appropriate oral dosage forms for paediatric and geriatric populations. Int J Pharm 2018; 536:547-562. [DOI: 10.1016/j.ijpharm.2017.07.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022]
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24
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Forough AS, Lau ET, Steadman KJ, Cichero JA, Kyle GJ, Serrano Santos JM, Nissen LM. A spoonful of sugar helps the medicine go down? A review of strategies for making pills easier to swallow. Patient Prefer Adherence 2018; 12:1337-1346. [PMID: 30100710 PMCID: PMC6065591 DOI: 10.2147/ppa.s164406] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Solid oral dosage forms such as tablets and capsules are generally the preferred method of drug delivery due to their convenience, cost, and acceptability. However, for many people, it can be a challenge to swallow solid oral medications, even those with healthy swallowing function. This review describes current strategies available to facilitate medication administration to otherwise healthy people with pill-swallowing difficulties. In general, restoring and maintaining the ability to swallow pills whole should ideally be the first choice in managing people with pill-swallowing difficulties. A number of strategies can potentially make it easier to swallow pills whole. These include postural adjustments, using pill-swallowing aids, and teaching pill-swallowing techniques. Where these are not successful or appropriate, then other approaches have to be considered using alternative formulations/routes of administration or deprescribing. If there is no other option, and it is not directly contraindicated for each specific medication dosage form, pills may be modified and mixed in foods and drinks to aid swallowing. In conclusion, people with pill-swallowing difficulties can benefit from a number of strategies designed to facilitate swallowing medications. However, these strategies should be further evaluated with regard to the evidence relating to both their efficacy and safety.
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Affiliation(s)
- Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia,
| | - Esther Tl Lau
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia,
| | - Kathryn J Steadman
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia,
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Julie Ay Cichero
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia,
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Greg J Kyle
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia,
| | - Jose Manuel Serrano Santos
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia,
| | - Lisa M Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia,
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25
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Caballero J, Darsey EH, Walters F, Belden HW. Methylphenidate extended-release oral suspension for the treatment of attention-deficit/hyperactivity disorder: a practical guide for pharmacists. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:163-171. [PMID: 29354563 PMCID: PMC5774317 DOI: 10.2147/iprp.s142576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects children, adolescents, and adults worldwide. The purpose of this review was to inform pharmacists of the numerous options to treat ADHD, with a focus on one of the more recently approved formulations, methylphenidate extended-release oral suspension (MEROS). Symptoms of ADHD can negatively impact an individual’s health and quality of life and impair function in multiple settings. Psychostimulants such as methylphenidate- and amphetamine-based agents are first-line pharmacologic treatments for ADHD. However, there are multiple formulations, including immediate release (administered two to three times/day), solid extended release (ER), or transdermal patch. MEROS is a once daily, long-acting liquid preparation that has demonstrated favorable safety and efficacy in patients with ADHD. MEROS may improve treatment adherence in patients who cannot tolerate or have difficulties administering pill or transdermal patch formulations.
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Affiliation(s)
- Joshua Caballero
- Department of Clinical and Administrative Sciences, College of Pharmacy, Larkin Health Sciences Institute, Miami, FL
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26
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Zaid AN, Assali M, Zalmout S, Basheer A. Compounding and stability evaluation of atorvastatin extemporaneous oral suspension using tablets or pure powder. Eur J Hosp Pharm 2017; 24:157-161. [PMID: 31156928 DOI: 10.1136/ejhpharm-2016-000913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/10/2016] [Accepted: 05/19/2016] [Indexed: 11/03/2022] Open
Abstract
Background Statins are the first-line therapy for lowering high lipid levels. Atorvastatin calcium (AtC) is the most commonly prescribed statin. It inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase which converts HMG-CoA into mevalonic acid, a cholesterol precursor. Objective To compound and evaluate the stability of AtC suspension (0.4% w/v) using commercial tablets or pure AtC powder as the source of the active pharmaceutical ingredient. Method Several AtC suspension formulations were produced using commercial AtC tablets or AtC pure powder as the source of the active ingredient. The most suitable one in terms of general organoleptic properties and dissolution was selected for stability studies. For this purpose, samples of final suspensions were stored at room temperature and in the refrigerator. Assay, pH, organoleptic properties and microbial contamination were evaluated according to the USP specifications. High performance liquid chromatography was used for the analysis and quantification of AtC in the studied samples. Results The obtained suspension (S4) had good organoleptic properties. It showed complete dissolution of AtC within 30 min. However, the suspension prepared from crushed tablet (St4) showed a better dissolution profile than that prepared from pure powder (Sp4). The prepared formula had unchanged pH, which remained around 9.9. St and Sp formulas were both free from microbial contamination. Both products showed good stability within at least the period of use of the 100 mL AtC bottles. Conclusions AtC extemporaneous suspension was successfully prepared using tablets as a source of AtC or pure AtC powder. However, St4 had a better dissolution profile than Sp4. This study provides a solution for patients with swallowing difficulties or feeding tubes who are unable to take medicines in solid oral dosage forms. Community pharmacists can prepare the suspension using AtC tablets as the source of the active ingredient.
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Affiliation(s)
- Abdel Naser Zaid
- Department of Pharmacy, An Najah National University, Nablus, Palestine
| | - Mohyeddin Assali
- Department of Pharmacy, An Najah National University, Nablus, Palestine
| | - Samah Zalmout
- Department of Pharmacy, An Najah National University, Nablus, Palestine.,Sama Pharmaceuticals Co. Ltd., Nablus, Palestine
| | - Aseel Basheer
- Department of Pharmacy, An Najah National University, Nablus, Palestine
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Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children's Acceptability of Oral Formulations (CALF) Study. Int J Pharm 2017; 514:296-307. [PMID: 27863675 DOI: 10.1016/j.ijpharm.2016.07.054] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/20/2016] [Accepted: 07/23/2016] [Indexed: 11/23/2022]
Abstract
A lack of evidence to guide the design of age-appropriate and acceptable dosage forms has been a longstanding knowledge gap in paediatric formulation development. The Children's Acceptability of Oral Formulations (CALF) study captured end-user perceptions and practices with a focus on solid oral dosage forms, namely tablets, capsules, chewables, orodispersibles, multiparticulates (administered with food) and mini-tablets (administered directly into the mouth). A rigorous development and testing phase produced age-adapted questionnaires as measurement tools with strong evidence of validity and reliability. Overall, 590 school children and adolescents, and 428 adult caregivers were surveyed across hospitals and various community settings. Attitudes towards dosage forms primarily differed based on age and prior use. Positive attitudes to tablets and capsules increased with age until around 14 years. Preference was seen for chewable and orodispersible preparations across ages, while multiparticulates were seemingly less favourable. Overall, 59.6% of school children reported willingness to take 10mm diameter tablets, although only 32.1% of caregivers perceived this size to be suitable. While not to be taken as prescriptive guidance, the results of this study provide some evidence towards rational dosage form design, as well as methodological approaches to help design tools for further evaluation of acceptability within paediatric studies.
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28
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Preparation and evaluation of oral dissolving film containing local anesthetic agent, lidocaine. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2016. [DOI: 10.1007/s40005-016-0298-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duggan JM, Akpanudo B, Shukla V, Gutterson G, Eitniear L, Sahloff EG. Alternative antiretroviral therapy formulations for patients unable to swallow solid oral dosage forms. Am J Health Syst Pharm 2016; 72:1555-65. [PMID: 26346211 DOI: 10.2146/ajhp140575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Evidence-based guidance is presented to assist clinicians in selecting alternative formulations of antiretroviral (ARV) agents for patients with human immunodeficiency virus (HIV) infection who are unable to swallow tablets or capsules. SUMMARY The inability to take medications in standard oral dosage forms can be associated with nonadherence or the use of alternative administration strategies such as capsule or tablet breaking, crushing, or chewing. Patients with HIV infection require long-term ARV therapy to maintain viral suppression; ARV agents are predominately available as tablets and capsules that may pose swallowing difficulties for some patients. Using a variety of sources (the primary literature, pharmaceutical package inserts, and requests for unpublished data from drug manufacturers), available evidence on the bioavailability of ARV medications after disruption of the capsule or tablet matrix was reviewed; information on alternative formulations of ARV agents was also assessed. With several ARV agents, disruption of the solid oral dosage form by crushing, chewing, or breaking tablets or opening capsules prior to ingestion has been shown to result in altered bioavailability or pharmacokinetics and thus the potential for incomplete virological suppression, increased adverse effects, and suboptimal health outcomes. CONCLUSION Of the 33 single-agent ARV medications and combination ARV products in five classes available at the time of review, approximately half exist as powders, liquids, injectables, or chewable or dissolvable tablets. If alternative ARV formulations or administration methods are used, close monitoring for achievement of virological and immunologic success and potential toxicities is recommended.
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Affiliation(s)
- Joan M Duggan
- Joan M. Duggan, M.D., FACP, FIDSA, AAHIVS, is Infectious Diseases Specialist; and Barbara Akpanudo, M.S.N., M.P.H., CNP, is Family Nurse Practitioner, Division of Infectious Diseases, Department of Medicine, University of Toledo Medical Center (UTMC), Toledo, OH. Vipul Shukla, B.S., is a medical student; and Glen Gutterson, B.S., is a medical student, College of Medicine, University of Toledo. Lindsey Eitniear, Pharm.D., is Clinical Pharmacist, UTMC. Eric G. Sahloff, Pharm.D., AAHIVP, is Associate Professor of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, University of Toledo
| | - Barbara Akpanudo
- Joan M. Duggan, M.D., FACP, FIDSA, AAHIVS, is Infectious Diseases Specialist; and Barbara Akpanudo, M.S.N., M.P.H., CNP, is Family Nurse Practitioner, Division of Infectious Diseases, Department of Medicine, University of Toledo Medical Center (UTMC), Toledo, OH. Vipul Shukla, B.S., is a medical student; and Glen Gutterson, B.S., is a medical student, College of Medicine, University of Toledo. Lindsey Eitniear, Pharm.D., is Clinical Pharmacist, UTMC. Eric G. Sahloff, Pharm.D., AAHIVP, is Associate Professor of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, University of Toledo
| | - Vipul Shukla
- Joan M. Duggan, M.D., FACP, FIDSA, AAHIVS, is Infectious Diseases Specialist; and Barbara Akpanudo, M.S.N., M.P.H., CNP, is Family Nurse Practitioner, Division of Infectious Diseases, Department of Medicine, University of Toledo Medical Center (UTMC), Toledo, OH. Vipul Shukla, B.S., is a medical student; and Glen Gutterson, B.S., is a medical student, College of Medicine, University of Toledo. Lindsey Eitniear, Pharm.D., is Clinical Pharmacist, UTMC. Eric G. Sahloff, Pharm.D., AAHIVP, is Associate Professor of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, University of Toledo
| | - Glen Gutterson
- Joan M. Duggan, M.D., FACP, FIDSA, AAHIVS, is Infectious Diseases Specialist; and Barbara Akpanudo, M.S.N., M.P.H., CNP, is Family Nurse Practitioner, Division of Infectious Diseases, Department of Medicine, University of Toledo Medical Center (UTMC), Toledo, OH. Vipul Shukla, B.S., is a medical student; and Glen Gutterson, B.S., is a medical student, College of Medicine, University of Toledo. Lindsey Eitniear, Pharm.D., is Clinical Pharmacist, UTMC. Eric G. Sahloff, Pharm.D., AAHIVP, is Associate Professor of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, University of Toledo
| | - Lindsey Eitniear
- Joan M. Duggan, M.D., FACP, FIDSA, AAHIVS, is Infectious Diseases Specialist; and Barbara Akpanudo, M.S.N., M.P.H., CNP, is Family Nurse Practitioner, Division of Infectious Diseases, Department of Medicine, University of Toledo Medical Center (UTMC), Toledo, OH. Vipul Shukla, B.S., is a medical student; and Glen Gutterson, B.S., is a medical student, College of Medicine, University of Toledo. Lindsey Eitniear, Pharm.D., is Clinical Pharmacist, UTMC. Eric G. Sahloff, Pharm.D., AAHIVP, is Associate Professor of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, University of Toledo
| | - Eric G Sahloff
- Joan M. Duggan, M.D., FACP, FIDSA, AAHIVS, is Infectious Diseases Specialist; and Barbara Akpanudo, M.S.N., M.P.H., CNP, is Family Nurse Practitioner, Division of Infectious Diseases, Department of Medicine, University of Toledo Medical Center (UTMC), Toledo, OH. Vipul Shukla, B.S., is a medical student; and Glen Gutterson, B.S., is a medical student, College of Medicine, University of Toledo. Lindsey Eitniear, Pharm.D., is Clinical Pharmacist, UTMC. Eric G. Sahloff, Pharm.D., AAHIVP, is Associate Professor of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, University of Toledo.
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Older adults with difficulty swallowing oral medicines: a systematic review of the literature. Eur J Clin Pharmacol 2015; 72:141-51. [DOI: 10.1007/s00228-015-1979-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
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Patient-centred pharmaceutical design to improve acceptability of medicines: similarities and differences in paediatric and geriatric populations. Drugs 2015; 74:1871-1889. [PMID: 25274536 PMCID: PMC4210646 DOI: 10.1007/s40265-014-0297-2] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient acceptability of a medicinal product is a key aspect in the development and prescribing of medicines. Children and older adults differ in many aspects from the other age subsets of population and require particular considerations in medication acceptability. This review highlights the similarities and differences in these two age groups in relation to factors affecting acceptability of medicines. New and conventional formulations of medicines are considered regarding their appropriateness for use in children and older people. Aspects of a formulation that impact acceptability in these patient groups are discussed, including, for example, taste/smell/viscosity of a liquid and size/shape of a tablet. A better understanding of the acceptability of existing formulations highlights opportunities for the development of new and more acceptable medicines and facilitates safe and effective prescribing for the young and older populations.
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Nsabagasani X, Hansen E, Mbonye A, Ssengooba F, Muyinda H, Mugisha J, Ogwal-Okeng J. Explaining the slow transition of child-appropriate dosage formulations from the global to national level in the context of Uganda: a qualitative study. J Pharm Policy Pract 2015. [PMID: 26203358 PMCID: PMC4511518 DOI: 10.1186/s40545-015-0039-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2007, the Sixtieth World Health Assembly (WHA) passed a resolution entitled "Better medicines for children" and subsequently the World Health Organization (WHO) recommended the inclusion of child-appropriate dosage formulations in the essential medicines lists of member countries. However, child-appropriate dosage formulations are not highlighted in the Essential Medicines and Health Supplies List of Uganda (EMHSLU) 2012 and they are still limited in availability in public health facilities. Several stakeholders influenced the status of child-appropriate dosage formulations in the EMHSLU 2012. OBJECTIVE To explore stakeholders' views about the relevance of the globally recommended child-appropriate dosage formulations in the context of Uganda. METHODS The findings derive from thirty three in-depth interviews with stakeholder representatives and the results of a follow up validation meeting where preliminary findings were shared with stakeholders. Policy analysis and policy transfer theories were used to guide a deductive analysis for manifest and latent content. RESULTS According to stakeholders, the transition to the globally recommended child-appropriate dosage formulations has been slow in Uganda due to a number of factors. These factors include resource constraints at the global and national levels, lack of Ministry of Health (MOH) formal commitment to the adoption of the child-appropriate dosage formulations policy and a lack of consensus between those who advocated for the availability of liquid oral dosage formulations for easy administration and effectiveness and those who were more convinced by economic arguments and preferred the procurement of solid oral dosage formulations intended for adults. CONCLUSIONS The global policy for child-appropriate dosage formulations still remains to be implemented in Uganda and other low income countries. This has been due to lack of resources that hindered formal transfer of the policy from the global to the local level. To achieve this transfer there is a need for resource mobilisation at both the international and local levels, together with the revitalisation of UMTAC to enable it to take on a leadership role of the coalitions supporting child-appropriate dosage formulations.
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Affiliation(s)
- Xavier Nsabagasani
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Ebba Hansen
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | - Anthony Mbonye
- Ministry of Health Uganda and Department of Health, Uganda Christian University, Kampala, Uganda
| | - Freddie Ssengooba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Herbert Muyinda
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - James Mugisha
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Jasper Ogwal-Okeng
- Departments of Pharmacology and Therapeutics, Gulu University, Gulu, Uganda
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Patel A, Jacobsen L, Jhaveri R, Bradford KK. Effectiveness of pediatric pill swallowing interventions: a systematic review. Pediatrics 2015; 135:883-9. [PMID: 25896843 DOI: 10.1542/peds.2014-2114] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatric patients commonly have difficulty swallowing pills. Targeted interventions have shown to improve medication administration and treatment compliance. The objective was to evaluate studies performed on pill swallowing interventions in the pediatric population since 1987. METHODS We performed a comprehensive PubMed search and a bibliography review to identify articles for our review. We selected articles published in English between December 1986 and December 2013 that included >10 participants aged 0 to 21 years with pill swallowing difficulties without a comorbid condition affecting their swallowing. Reviewers extracted the relevant information and rated the quality of each study as "poor," "fair," or "good" based on the sample size and study design. RESULTS We identified 4 cohort studies and 1 case series that met our criteria. All 5 studies found their intervention to be successful in teaching children how to swallow pills. Interventions included behavioral therapies, flavored throat spray, verbal instructions, specialized pill cup, and head posture training. Quality ratings differed between the articles, with 3 articles rated as "fair," 1 article as "good," and 1 article as "poor." CONCLUSIONS Pill swallowing difficulties are a barrier that can be overcome with a variety of successful interventions. Addressing this problem and researching more effective ways of implementing these interventions can help improve medication administration and compliance in the pediatric population.
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Affiliation(s)
- Amee Patel
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; University of North Carolina School of Public Health, Chapel Hill, North Carolina; and
| | - Laura Jacobsen
- Divisions of General Pediatrics and Adolescent Medicine and
| | - Ravi Jhaveri
- Infectious Diseases, North Carolina Children's Hospital, Chapel Hill, North Carolina
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Nissen LM, Haywood A, Steadman KJ. Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2009.tb00436.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Lisa M Nissen
- School of Pharmacy; The University of Queensland; Brisbane
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35
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Lau ETL, Steadman KJ, Mak M, Cichero JAY, Nissen LM. Prevalence of swallowing difficulties and medication modification in customers of community pharmacists. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esther T. L. Lau
- School of Clinical Sciences; Queensland University of Technology; Brisbane Australia
- School of Pharmacy; The University of Queensland; Brisbane Australia
| | | | - Marilyn Mak
- School of Pharmacy; The University of Queensland; Brisbane Australia
| | | | - Lisa M. Nissen
- School of Clinical Sciences; Queensland University of Technology; Brisbane Australia
- School of Pharmacy; The University of Queensland; Brisbane Australia
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36
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Boztepe H, Özdemir H, Karababa Ç, Yıldız Ö. Difficulties experienced during preparation and administration of oral drugs. Turk Arch Pediatr 2014; 49:231-7. [PMID: 26078668 DOI: 10.5152/tpa.2014.1795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/19/2014] [Indexed: 11/22/2022]
Abstract
AIM It was aimed to determine the difficulties experienced by pediatric nurses working in the wards of a university hospital during preparation and administration of drugs and to determine solution recommendations. MATERIAL AND METHODS One hundred and eight nurses who accepted to participate in the study constituted the sample of the study. Open-ended questions were asked in order to obtain detailed information about the attitudes and views of the participants and face to face interview was used. The problems experienced during preparation and administration of drugs were collected using the data collection form prepared by the investigators. Institution approval, ethics committee approval (HEK12/193) and written informed consent from the nurses who wished to participate in the study were obtained to conduct the study. The data obtained were expressed as figures and percentages. RESULTS The most commonly reported problems in preparation of drugs included incomplete dissolution of tablets or non-homogeneous distribution in fluids (54.6%) and difficulty in breaking tablets in appropriate doses (45.3%). The most commonly reported problem experienced during administration of drugs was rejection of drugs which tasted bad by babies/children or spitting out the drug (75.9%). In our study, the nurses also mentioned the problems related with drug administration equipment. These problems included fear of injectors (25.9%), escape of the drugs into the respiratory way (15.7%) and lack of appropriate equipment for administering the drugs (7.4%). CONCLUSIONS In our study, it was found that all nurses experienced difficulty in preparing and administering drugs. The problems experienced by the nurses and solution recommendations for these problems were reported to the hospital administration.
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Affiliation(s)
- Handan Boztepe
- Department of Pediatric Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Handan Özdemir
- Hacettepe University İhsan Doğramacı Children's Hospital, Shift Responsible Nurse, Ankara, Turkey
| | - Çiğdem Karababa
- Hacettepe University İhsan Doğramacı Children's Hospital, Nurse Assistant Manager, Ankara, Turkey
| | - Özlem Yıldız
- Hacettepe University İhsan Doğramacı Children's Hospital, Nurse Assistant Manager, Ankara, Turkey
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Childress A, Sallee FR. The use of methylphenidate hydrochloride extended-release oral suspension for the treatment of ADHD. Expert Rev Neurother 2014; 13:979-88. [PMID: 24053342 DOI: 10.1586/14737175.2013.833002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
More than 50 years ago, methylphenidate immediate-release (MPH-IR) was found to be effective in relieving symptoms of attention-deficit/hyperactivity disorder. Although the exact mechanism of the action is unknown, the efficacy of MPH is thought to be mediated by blocking the reuptake of norepinephrine and dopamine into the presynaptic neuron and increasing the release of these neurotransmitters into the extraneuronal space. Because of its short duration of effect, MPH-IR had to be dosed multiple times daily. In recent years, several methyphenidate extended-release (MPH-ER) formulations have been developed. Methylphenidate hydrochloride for extended-release oral suspension (MEROS or Quillivant(TM) XR) is the first long-acting MPH-ER oral suspension developed to treat attention-deficit/hyperactivity disorder. It offers advantages when compared with other MPH-ER preparations for patients who cannot or prefer not to swallow or manipulate capsules or wear a transdermal patch, while maintaining comparable efficacy and duration of effect. The pharmacokinetic, efficacy and safety profiles of this controlled substance are reviewed.
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Affiliation(s)
- Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc., 7351 Prairie Falcon Road, Suite 160, Las Vegas, NV 89128, USA
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Asnis GM, Henderson MA. EMSAM (deprenyl patch): how a promising antidepressant was underutilized. Neuropsychiatr Dis Treat 2014; 10:1911-23. [PMID: 25336957 PMCID: PMC4200016 DOI: 10.2147/ndt.s59107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The EMSAM patch is a unique monoamine oxidase inhibitor (MAOI) being the only antidepressant utilizing a transdermal delivery system. This was welcomed by clinicians who hoped that EMSAM would be better tolerated than oral MAOIs and non-MAOI antidepressants, as well as being effective for treatment in a wide spectrum of depressed patients including atypical depression, bipolar depression, and refractory depression. Unfortunately, the clinical use of EMSAM has been underutilized and its potential usefulness overlooked. This article suggests that fear of possible side effects, particularly the "cheese reaction" and serotonin syndrome, are some of the main contributors to underutilization by clinicians. These risks have been significantly exaggerated with the 6 mg/day dose not even requiring a special diet. Other contributing factors leading to underutilization are reviewed such as: the lack of studies addressing many important clinical questions; inadequate data analyses; not evaluating the effect of EMSAM on comorbid psychiatric conditions, particularly anxiety disorders; lack of antidepressant comparators versus EMSAM; no dose-response relationship examined; various depressive subtypes and conditions are unexplored, eg, bipolar depression and refractory depression; poor insurance coverage for an expensive medication; as well as minimal marketing efforts and postmarketing studies. On the other hand, many potential advantages of EMSAM are not highlighted enough in the literature and by pharmaceutical companies which might have increased clinical interest and utilization of the antidepressant. For example, the advantages of EMSAM include: avoidance of swallowing issues, as can be seen with oral antidepressants; minimal side effects, probably due to a favorable pharmacokinetic profile; minimal evidence of suicidal behavior, probably relating to the transdermal route of administration; low rates of inducing hypomanic/manic episodes; as well as significant efficacy in "anxious depression" and atypical depression. Recent efforts in conducting some post hoc analyses and presentations on EMSAM may yet stimulate further clinical interest and use of this antidepressant.
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Affiliation(s)
- Gregory M Asnis
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA ; Anxiety and Depression Clinic, Montefiore Medical Center, New York, NY, USA
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Developmental Changes in the Processes Governing Oral Drug Absorption. PEDIATRIC FORMULATIONS 2014. [DOI: 10.1007/978-1-4899-8011-3_3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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40
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Mafiana RN, Taqi A, Al-Zakwani I. Evaluation of nurses' knowledge of oral solid dosage forms that should not be crushed at a university hospital in Oman. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Aqeela Taqi
- Department of Pharmacy; Sultan Qaboos University Hospital; Muscat Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy; College of Medicine; Sultan Qaboos University; Muscat Oman
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Sharaideh R, Wazaify M, Albsoul-Younes A. Knowledge and attitude of school children in Amman/Jordan toward the appropriate use of medicines: A cross-sectional study. Saudi Pharm J 2013; 21:25-33. [PMID: 23960817 PMCID: PMC3745049 DOI: 10.1016/j.jsps.2012.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES The aim of this study is to examine the knowledge, practice, and attitude toward medications of different primary school children at age group (7-9) years. METHODS This cross sectional study adopted the form of structured interviewing technique using a validated and pre-piloted questionnaire. The questionnaire consisted of a mixture of multiple choice and open-ended questions, 15 USP pictograms and six dosage form demos. A randomized stratified target sample of 200 students (n = 100 of each gender), of the first, second and third grades from the four Amman Education Directorates was recruited. School children were interviewed regarding their knowledge, attitude and the way they think medicines should be used. RESULTS The mean score value achieved by children in all the knowledge questions was 23.26 ± 0.25 out of 32, which was considered as satisfactory knowledge by the research team. The most significant factors affecting children's knowledge (including: multiple choice questions, pictograms and dosage forms) were: age, school/area of residency, and the presence of a first-degree relative working in a medical job. The majority of participants (79%) stated that the taste of the medication was the main factor to prevent them from taking their medication. CONCLUSION In general, school children in our sample have satisfactory knowledge and a generally positive attitude toward medicines. However, school curricula in Jordan should include more education regarding the effective and safe use of medicines.
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Affiliation(s)
| | - M. Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Jordan
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Schiele JT, Quinzler R, Klimm HD, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol 2012; 69:937-48. [DOI: 10.1007/s00228-012-1417-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
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Discussion of prevalence and management of discomfort when swallowing pills: orodispersible tablets expand treatment options in patients with depression. Ther Deliv 2012; 2:611-22. [PMID: 22833978 DOI: 10.4155/tde.11.32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many patients experience discomfort when trying to swallow tablets and capsules, but this issue is rarely discussed between patients and physicians. Discomfort when swallowing pills is common and arises due to the morphology of the oropharynx and esophagus, which are not well suited to swallowing rigid objects of small volume. Compliance with medication is poor in patients with chronic diseases such as depression. An inability or unwillingness to swallow medication can further reduce acceptance of and compliance with medication, which has an impact on effectiveness. Recognition that patient acceptance of prescribed medication is an important component of compliance has led to the development of pill-swallowing training programs and alternative formulations. Orodispersible tablets do not need to be taken with water and can be packaged discreetly in single doses. Orodispersible tablets have been shown to be effective in a number of therapy areas including depression.
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Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm 2012; 430:197-206. [DOI: 10.1016/j.ijpharm.2012.04.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 01/03/2023]
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Abstract
Barriers to swallowing tablets and capsules can impact adherence to medication regimens. Few tools are currently available to assist adolescent children who have difficulty swallowing tablets and capsules. A convenience sample of adolescent children, identified through selfreport as having difficulty in swallowing tablets or capsules in the past, were provided Pill Glide, a flavored spray promoted to aid swallowing. To emulate medication administration, a tic tac (candy) was placed in the middle of the tongue, and with a drink of water, the participant was instructed to swallow the tic tac. Success or failure to swallow the tic tac was recorded. A total of 11 adolescent children ranging in age from 9 to 17 years reported past difficulty with swallowing medication. Seven of the 11 participants were successful in swallowing the tic-tac with the use of Pill Glide. This initial assessment of Pill Glide spray demonstrates positive findings for improving the ease of swallowing tablets and capsules for adolescents.
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Hansen DL, Hansen EH, Holstein BE. Young women's use of medicines: autonomy and positioning in relation to family and peer norms. Health (London) 2009; 13:467-85. [PMID: 19491237 DOI: 10.1177/1363459309103918] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medicine use among youths is widespread and on the increase. This is especially true for young females, whose utilization of a variety of medications grows considerably during the teenage years. This user perspective study aims to obtain a greater understanding of what young women perceive as the norms for medicine use at home and among peers, and how these perceptions are reflected in their own use of medicine. In-depth interviews were conducted with 20 young Danish women between the ages of 16 and 20. During the interviews, participants described their perceptions regarding usual medicine taking practices and ideas about appropriate medicine use within their family and peer group. Young women possessed a keen awareness of medicine-related norms, although medicine use was a topic only rarely discussed with others. At the interface of these themes pertaining to family and peer norms, a unifying concept involving growing autonomy in medicine use emerged. This concept consisted of three parts: the great influence of family norms when autonomy was limited, growing autonomy under changing influences and assertion of autonomy and positioning of own behaviour relative to the norm. This study's findings indicate that despite increases in autonomy in medicine use, normative perceptions continued to serve as important reference points for informants' own medicine taking behaviour. Practitioners involved in the health care and promotion of youth may benefit from an increased awareness of the influential role that perceived norms in peer and family contexts can play in young women's use of medicine.
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Affiliation(s)
- Dana Lee Hansen
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, University of Copenhagen, Denmark.
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Hansen DL, Holstein BE, Hansen EH. "I'd rather not take it, but . . .": young women's perceptions of medicines. QUALITATIVE HEALTH RESEARCH 2009; 19:829-839. [PMID: 19366860 DOI: 10.1177/1049732309335447] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Little is known about healthy young women's everyday experiences with medicine use and their general perceptions of medicines. In this article, we describe a user-perspective study involving in-depth qualitative interviews with 20 young women between the ages of 16 and 20 in Copenhagen, Denmark. Inspired by Schutz's phenomenology, informants' medicine-taking experiences were considered within the context of their life-worlds. Analysis revealed that the young women possessed predominantly negative perceptions of medicines, which were linked to a preference for complete avoidance of medicines and a desire to maintain a natural body ideal. The essence of participants' experiences was characterized by conflict, as most used medicines at least occasionally, despite the negative perceptions they held. Participants strove to make sense of their medicine-taking practices and provided rationales for their use of medicine, often based on perceptions of need and reduced personal risk.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:292-5. [DOI: 10.1097/moo.0b013e3283041256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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