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Pereyra RB, Gonzalez Vidal NL. Amiodarone chewable gels as a potential appproach for paediatric congenital cardiopathies treatment: Comparison between animal and vegetal gelling agents. Eur J Pharm Biopharm 2024; 201:114370. [PMID: 38880402 DOI: 10.1016/j.ejpb.2024.114370] [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: 03/21/2024] [Revised: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 06/18/2024]
Abstract
The difficulty in swallowing is a frequent problem when oral solid dosage forms (conventional tablets or capsules) are administered to paediatric population or patients with dysphagia. An interesting alternative to overcome these problems are non-conventional formulations like chewable gels, commonly known as 'gummies'. Therefore, this work addresses the design, development and characterization of gummies using gelatine and pectin, for the vehiculization of the antiarrhythmic amiodarone (AMIO). Applying a Design of Experiments (DoE) approach, four gelatine (GG1-GG4) and eight pectin formulations (PG1-PG8) were developed. Considering the obtained results for responses during DoE evaluation (i.e., volume, syneresis, hardness, and gumminess), GG3 and PG8 were selected for complete characterization. Water activity, pH, drug content, texture parameters (adhesiveness, springiness, cohesiveness, and fracturability), disintegration time, in vitro dissolution, and microbiological features were evaluated. The obtained results were within the expected values for this type of formulation. The dissolution profiles showed a 94 % - 99 % of the AMIO content released for GG3 and PG8, respectively, so they could be considered suitable as immediate release dosage forms. In conclusion, the chewable gels were successfully developed and characterised, suggesting a potential means to accomplish a final prototype for the improvement of congenital cardiopathies treatment.
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Affiliation(s)
- Romina B Pereyra
- Departamento de Biología, Bioquímica y Farmacia - Universidad Nacional del Sur (UNS), Bahía Blanca, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bahía Blanca, Buenos Aires, Argentina
| | - Noelia L Gonzalez Vidal
- Departamento de Biología, Bioquímica y Farmacia - Universidad Nacional del Sur (UNS), Bahía Blanca, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bahía Blanca, Buenos Aires, Argentina.
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2
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Paccione N, Guarnizo-Herrero V, Ramalingam M, Larrarte E, Pedraz JL. Application of 3D printing on the design and development of pharmaceutical oral dosage forms. J Control Release 2024; 373:463-480. [PMID: 39029877 DOI: 10.1016/j.jconrel.2024.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
3D printing technologies confer an unparalleled degree of control over the material distribution on the structures they produce, which has led them to become an extremely attractive research topic in pharmaceutical dosage form development, especially for the design of personalized treatments. With fine tuning in material selection and careful design, these technologies allow to tailor not only the amount of drug administered but the biopharmaceutical behaviour of the dosage forms as well. While fused deposition modelling (FDM) is still the most studied 3D printing technology in this area, others are gaining more relevance, which has led to many new and exciting dosage forms developed during 2022 and 2023. Considering that these technologies, in time, will join the current manufacturing methods and with the ever-increasing knowledge on this topic, our review aims to explore the advantages and limitations of 3D printing technologies employed in the design and development of pharmaceutical oral dosage forms, giving special focus to the most important aspects governing the resulting drug release profiles.
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Affiliation(s)
- Nicola Paccione
- TECNALIA, Basque Research and Technology Alliance (BRTA), Leonardo Da Vinci 11, 01510 Miñano, Spain; Joint Research Laboratory (JRL) on Advanced Pharma Development, A Joint Venture of TECNALIA and University of the Basque Country, Centro de investigación Lascaray ikergunea, 01006 Vitoria-Gasteiz, Spain; NanoBioCel Group, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/ EHU), 01006 Vitoria-Gasteiz, Spain
| | - Víctor Guarnizo-Herrero
- Department of Biomedical Sciences, Faculty of Pharmacy, University of Alcalá de Henares, Ctra Madrid-Barcelona Km 33, 600 28805 Madrid, Spain
| | - Murugan Ramalingam
- Joint Research Laboratory (JRL) on Advanced Pharma Development, A Joint Venture of TECNALIA and University of the Basque Country, Centro de investigación Lascaray ikergunea, 01006 Vitoria-Gasteiz, Spain; NanoBioCel Group, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/ EHU), 01006 Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Jose Atxotegi, s/n, 01009 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Health Carlos III, 28029 Madrid, Spain.; IKERBASQUE, Basque Foundation for Science, 48013 Bilbao, Spain; School of Basic Medical Sciences, Binzhou Medical University, Yantai 264003, People's Republic of China
| | - Eider Larrarte
- TECNALIA, Basque Research and Technology Alliance (BRTA), Leonardo Da Vinci 11, 01510 Miñano, Spain; Joint Research Laboratory (JRL) on Advanced Pharma Development, A Joint Venture of TECNALIA and University of the Basque Country, Centro de investigación Lascaray ikergunea, 01006 Vitoria-Gasteiz, Spain.
| | - José Luis Pedraz
- Joint Research Laboratory (JRL) on Advanced Pharma Development, A Joint Venture of TECNALIA and University of the Basque Country, Centro de investigación Lascaray ikergunea, 01006 Vitoria-Gasteiz, Spain; NanoBioCel Group, Department of Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/ EHU), 01006 Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Jose Atxotegi, s/n, 01009 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Health Carlos III, 28029 Madrid, Spain..
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Asano M, Imai S, Shimizu Y, Kizaki H, Ito Y, Tsuchiya M, Kuriyama R, Yoshida N, Shimada M, Sando T, Ishijima T, Hori S. Factor Analysis of Patients Who Find Tablets or Capsules Difficult to Swallow Due to Their Large Size: Using the Personal Health Record Infrastructure of Electronic Medication Notebooks. J Med Internet Res 2024; 26:e54645. [PMID: 38657229 PMCID: PMC11079767 DOI: 10.2196/54645] [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: 11/21/2023] [Revised: 12/22/2023] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Understanding patient preference regarding taking tablet or capsule formulations plays a pivotal role in treatment efficacy and adherence. Therefore, these preferences should be taken into account when designing formulations and prescriptions. OBJECTIVE This study investigates the factors affecting patient preference in patients who have difficulties swallowing large tablets or capsules and aims to identify appropriate sizes for tablets and capsules. METHODS A robust data set was developed based on a questionnaire survey conducted from December 1, 2022, to December 7, 2022, using the harmo smartphone app operated by harmo Co, Ltd. The data set included patient input regarding their tablet and capsule preferences, personal health records (including dispensing history), and drug formulation information (available from package inserts). Based on the medication formulation information, 6 indices were set for each of the tablets or capsules that were considered difficult to swallow owing to their large size and concomitant tablets or capsules (used as controls). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of each index. The index demonstrating the highest area under the curve of the ROC was selected as the best index to determine the tablet or capsule size that leads to swallowing difficulties. From the generated ROCs, the point with the highest discriminative performance that maximized the Youden index was identified, and the optimal threshold for each index was calculated. Multivariate logistic regression analysis was performed to identify the risk factors contributing to difficulty in swallowing oversized tablets or capsules. Additionally, decision tree analysis was performed to estimate the combined risk from several factors, using risk factors that were significant in the multivariate logistic regression analysis. RESULTS This study analyzed 147 large tablets or capsules and 624 control tablets or capsules. The "long diameter + short diameter + thickness" index (with a 21.5 mm threshold) was identified as the best indicator for causing swallowing difficulties in patients. The multivariate logistic regression analysis (including 132 patients with swallowing difficulties and 1283 patients without) results identified the following contributory risk factors: aged <50 years (odds ratio [OR] 1.59, 95% CI 1.03-2.44), female (OR 2.54, 95% CI 1.70-3.78), dysphagia (OR 3.54, 95% CI 2.22-5.65), and taking large tablets or capsules (OR 9.74, 95% CI 5.19-18.29). The decision tree analysis results suggested an elevated risk of swallowing difficulties for patients with taking large tablets or capsules. CONCLUSIONS This study identified the most appropriate index and threshold for indicating that a given tablet or capsule size will cause swallowing difficulties, as well as the contributory risk factors. Although some sampling biases (eg, only including smartphone users) may exist, our results can guide the design of patient-friendly formulations and prescriptions, promoting better medication adherence.
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Affiliation(s)
- Masaki Asano
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Shungo Imai
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Yuri Shimizu
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Hayato Kizaki
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | | | | | | | | | | | | | | | - Satoko Hori
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
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Ferreira-Neto CJB, de Lara JAA, Cominato A, Tonin FS, Wiens A. Optimization of solid oral dosage form administration to patients with swallowing difficulties: An integrative review. J Adv Nurs 2024; 80:1335-1354. [PMID: 37908152 DOI: 10.1111/jan.15910] [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: 02/20/2023] [Revised: 08/30/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
AIM To appraise and synthesize research investigating optimizing the administration of solid oral dosage forms (SODFs) to adults with swallowing difficulties. DESIGN An integrative review. METHODS An electronic search was conducted on Medical Literature Analysis and Retrieval System Online (Public Medline interface), Elsevier SciVerse Scopus and Scientific Electronic Library Online (updated February 2023). Restriction regarding the publication date was not considered for the inclusion of records. Studies addressing risks, general aspects, recommendations about patient postural adjustments, swallowing techniques, swallowing aids and aspects of concealment of SODFs were included. RESULTS Fifty-three records published between 2002 and 2021 were included. The main administration risks were aspiration, asphyxia and solid oral dosage form-induced oral/oesophageal mucosal lesions. The most frequent general aspect reported was administering one oral dosage form at a time. The sitting position was the most patient postural adjustment mentioned. The most frequently reported solid oral dosage form swallowing technique was the lean-forward method for capsules. Solid oral dosage form swallowing aids cited: tongue and throat lubricant and solid oral dosage form coating device, swallowing cup and swallowing straw. CONCLUSION The literature data on administering SODFs for adults with swallowing difficulties were appraised and synthesized. Some aspects, for example, not administering SODFs simultaneously, can make swallowing safer. Postural adjustments and solid oral dosage form swallowing aids are important to avoid administration risks. Swallowing SODFs can be easier if learned by techniques. Liquid and food are helpful as vehicles, and several of these have been listed. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE By optimizing the contributing factors of administering oral pharmacotherapy, the nurse can use appropriate practices to improve patient safety. Additionally, knowing and establishing the administration aspects are reasonable steps for standardizing care for patients with swallowing oral dosage form difficulties. IMPACT This study addressed administering SODFs to adult patients with swallowing difficulties. The administration of SODFs to adult patients with swallowing difficulties can be optimized if only one oral dosage form at a time is administrated and if patient postural adjustments, swallowing techniques and swallowing aids are used. This investigation will impact the care of patients with swallowing difficulties. REPORTING METHOD The authors declare they adhered to the relevant EQUATOR guidelines and report following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Carolina Justus Buhrer Ferreira-Neto
- Post-Graduate Program in Pharmaceutical Assistance, Federal University of Paraná, Jardim Botânico, Curitiba, PR, Brazil
- Pharmaceutical Sciences Department, State University of Ponta Grossa, Uvaranas, Ponta Grossa, PR, Brazil
| | | | - Alanis Cominato
- Pharmacy Graduation, State University of Ponta Grossa, Uvaranas, Ponta Grossa, PR, Brazil
| | - Fernanda Stumpf Tonin
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Paraná, Jardim Botânico, Curitiba, PR, Brazil
| | - Astrid Wiens
- Pharmacy Department, Federal University of Paraná, Jardim Botânico, Curitiba, PR, Brazil
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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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Logrippo S, Ganzetti R, Sestili M, Perinelli DR, Cespi M, Bonacucina G. Enteral Delivery of Pravastatin Sodium Tablets: Effect of Compounding into a Liquid Form and Co-Administration of Enteral Nutrition. PHARMACY 2024; 12:32. [PMID: 38392939 PMCID: PMC10892702 DOI: 10.3390/pharmacy12010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Compounding solid oral dosage forms into liquid preparations is a common practice for administering drug therapy to patients with swallowing difficulties. This is particularly relevant for those on enteral nutrition, where factors such as the administration procedure and co-administration of enteral nutrition play crucial roles in effective drug delivery. Due to the limited studies focused on this practice, the impact of co-administered nutrition remains unclear. METHODS Pravastatin tablets were compounded into two liquid formulations and administered through three independent tubes for ten cycles. The drug amount was quantified upstream and downstream of the tubes both with and without different (fiber content) nutritional boluses. RESULTS The compounding procedure did not lower the drug amount with respect to the original tablets. However, when the liquid formulation was pumped through the tubes, a statistically significant reduction in the pravastatin administered (between 4.6% and 11.3%) was observed. The co-administration of different nutritional boluses or the compounding procedure did not affect the general results. CONCLUSIONS Pravastatin loss appears unavoidable when administered via the enteral tube. Although, in this case, the loss was of limited clinical relevance, it is important not to underestimate this phenomenon, especially with drugs having a narrow therapeutic index.
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Affiliation(s)
- Serena Logrippo
- Hospital Pharmacy, Santa Maria della Stella Hospital, USL Umbria 2, 05018 Orvieto, Italy;
- Hospital Pharmacy, Engles Profili Hospital, AST Ancona, 60044 Fabriano, Italy
| | - Roberta Ganzetti
- Hospital Pharmacy, Carlo Urbani Hospital, AST Ancona, 60035 Jesi, Italy;
| | - Matteo Sestili
- Territorial Pharmaceutical Service, AST Ancona, 60035 Jesi, Italy;
| | - Diego Romano Perinelli
- CHIP Building, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (D.R.P.); (G.B.)
| | - Marco Cespi
- CHIP Building, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (D.R.P.); (G.B.)
| | - Giulia Bonacucina
- CHIP Building, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (D.R.P.); (G.B.)
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Woyna-Orlewicz K, Brniak W, Tatara W, Strzebońska M, Haznar-Garbacz D, Szafraniec-Szczęsny J, Antosik-Rogóż A, Wojteczko K, Strózik M, Kurek M, Jachowicz R, Mendyk A. Investigating the Impact of Co-processed Excipients on the Formulation of Bromhexine Hydrochloride Orally Disintegrating Tablets (ODTs). Pharm Res 2023; 40:2947-2962. [PMID: 37726407 PMCID: PMC10746752 DOI: 10.1007/s11095-023-03605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Orodispersible tablets (orally disintegrating tablets, ODTs) have been used in pharmacotherapy for over 20 years since they overcome the problems with swallowing solid dosage forms. The successful formula manufactured by direct compression shall ensure acceptable mechanical strength and short disintegration time. Our research aimed to develop ODTs containing bromhexine hydrochloride suitable for registration in accordance with EMA requirements. METHODS We examined the performance of five multifunctional co-processed excipients, i.e., F-Melt® C, F-Melt® M, Ludiflash®, Pharmaburst® 500 and Prosolv® ODT G2 as well as self-prepared physical blend of directly compressible excipients. We tested powder flow, true density, compaction characteristics and tableting speed sensitivity. RESULTS The manufacturability studies confirmed that all the co-processed excipients are very effective as the ODT formula constituents. We noticed superior properties of both F-Melt's®, expressed by good mechanical strength of tablets and short disintegration time. Ludiflash® showed excellent performance due to low works of plastic deformation, elastic recovery and ejection. However, the tablets released less than 30% of the drug. Also, the self-prepared blend of excipients was found sufficient for ODT application and successfully transferred to production scale. Outcome of the scale-up trial revealed that the tablets complied with compendial requirements for orodispersible tablets. CONCLUSIONS We proved that the active ingredient cannot be absorbed in oral cavity and its dissolution profiles in media representing upper part of gastrointestinal tract are similar to marketed immediate release drug product. In our opinion, the developed formula is suitable for registration within the well-established use procedure without necessity of bioequivalence testing.
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Affiliation(s)
- Krzysztof Woyna-Orlewicz
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Ul. Medyczna 9, 30-688, Krakow, Poland
- F1Pharma S.A, Ul. Bobrzynskiego 14, 30-348, Krakow, Poland
| | - Witold Brniak
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Ul. Medyczna 9, 30-688, Krakow, Poland.
| | - Wiktor Tatara
- F1Pharma S.A, Ul. Bobrzynskiego 14, 30-348, Krakow, Poland
| | - Magdalena Strzebońska
- F1Pharma S.A, Ul. Bobrzynskiego 14, 30-348, Krakow, Poland
- Department of Environmental Protection, Faculty of Geology, Geophysics and Environmental Protection, AGH University of Science and Technology, Al. Mickiewicza 30, 30-059, Kraków, Poland
| | | | - Joanna Szafraniec-Szczęsny
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Ul. Medyczna 9, 30-688, Krakow, Poland
- CHDE Polska S.A, Biesiadna 7, 35-304, Rzeszow, Poland
| | - Agata Antosik-Rogóż
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Ul. Medyczna 9, 30-688, Krakow, Poland
- F1Pharma S.A, Ul. Bobrzynskiego 14, 30-348, Krakow, Poland
| | - Kamil Wojteczko
- Department of Ceramics and Refractories, AGH University of Science and Technology, 30-059, Krakow, Poland
| | | | - Mateusz Kurek
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Ul. Medyczna 9, 30-688, Krakow, Poland
| | - Renata Jachowicz
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Ul. Medyczna 9, 30-688, Krakow, Poland
| | - Aleksander Mendyk
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Ul. Medyczna 9, 30-688, Krakow, Poland
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Alghanem S, Dziurkowska E, Ordyniec-Kwaśnica I, Sznitowska M. Intraoral medical devices for sustained drug delivery. Clin Oral Investig 2023; 27:7157-7169. [PMID: 37982874 PMCID: PMC10713785 DOI: 10.1007/s00784-023-05377-5] [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: 08/11/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES The oral cavity constitutes an attractive organ for the local and systemic application of drug substances. Oromucosal tablets, gels, or sprays are examples of the formulations applied. Due to the elution through the saliva, the residence time of the formulation at the application site is relatively short. Medical devices placed in the oral cavity, with a reservoir for an active substance, play an important role in solving this problem. MATERIALS AND METHODS In this review, we discuss the devices described in the literature that are designed to be used in the oral cavity, highlighting the advantages, disadvantages, and clinical applications of each of them. RESULTS Among the intraoral medical devices, special types are personalized 3D-printed devices, iontophoretic devices, and microneedle patches. CONCLUSION We anticipate that with the development of 3D printing and new polymers, the technology of flexible and comfortable devices for prolonged drug delivery in the oral cavity will develop intensively. CLINICAL RELEVANCE The presented review is therefore a useful summary of the current technological state, when in fact none of the existing devices has been widely accepted clinically.
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Affiliation(s)
- Suhail Alghanem
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Gdansk, Al. Gen. J. Hallera 107, 80-416, Gdansk, Poland
| | - Ewelina Dziurkowska
- Department of Analytical Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Al. Gen. J. Hallera 107, 80-416, Gdansk, Poland.
| | - Iwona Ordyniec-Kwaśnica
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdansk, Str. E. Orzeszkowej 18, 80-208, Gdansk, Poland
| | - Małgorzata Sznitowska
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Gdansk, Al. Gen. J. Hallera 107, 80-416, Gdansk, Poland
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Teder K, Karjagin J, Antoniak KM, Saar M, Volmer D. Development of an Administration Guideline of Oral Medicines to Patients with Dysphagia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1913. [PMID: 38003962 PMCID: PMC10673523 DOI: 10.3390/medicina59111913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: There is increasing evidence that patients with dysphagia often have limited access to suitable oral dosage forms, especially when administered via an enteral feeding tube (FT). In addition, there is a lack of clear and readily available information from drug manufacturers on how to administer medications to patients with dysphagia. This study aimed to develop a practical guide for healthcare professionals to increase the safe and effective administration of oral medications to patients with dysphagia. Materials and Methods: The data were collected from existing English databases and handbooks available to develop an easy-to-use tabular guideline presenting all relevant information using keywords and short expressions. The working group differentiated 514 formulation types, and the information was collected and added to the guideline separately. In addition, the instructions for the patients taking the medicines orally or via FT were described separately. Results: The guideline consisted of 24 keywords or short expressions developed by the working group and described the instructions to use them. The guideline contained 343 active pharmaceutical ingredients and 19 fixed-dose combinations. Conclusions: Knowledge about proper medication preparation and administration for patients with swallowing difficulties is limited but essential. It is crucial to encourage drug manufacturers to provide this information as a standard to ensure the safe and effective use of medications for all patient groups.
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Affiliation(s)
- Kersti Teder
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
- Pharmacy Department, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
| | - Juri Karjagin
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
| | - Kairi Marlen Antoniak
- Pharmacy Department, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
- Pharmacy Department, East-Tallinn Central Hospital, Ravi 18, 10138 Tallinn, Estonia
| | - Marika Saar
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
- Pharmacy Department, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
| | - Daisy Volmer
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
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10
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Du Y, Tang T, Zhang M, Mujumdar AS, Phuhongsung P, Yu D. Double-nozzle 3D-printed bean paste buns: Effect of filling ratio and microwave heating time. J Texture Stud 2023; 54:671-680. [PMID: 37218345 DOI: 10.1111/jtxs.12765] [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: 02/13/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
With the aggravation of the global aging process, more and more elderly people are facing the problem of dysphagia. The advantages of three-dimensional (3D) printing in making chewy food are increasingly prominent. In this study, the two-nozzle 3D printer was used to explore the effects of different proportions of buckwheat flour, printing filling ratio, microwave power, and time on the quality of bean-paste buns. The results showed that the bean paste filling containing 6% buckwheat flour had the best antioxidant and sensory properties. When the filling ratio was 21.6%, the microwave power was 560 W, and the time was 4 min, the obtained sample was the most satisfactory. Compared with the microwave-treated and steamed traditional samples, the chewiness of the samples was reduced by 52.43% and 15.14%, respectively, and the final product was easier to chew and swallow.
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Affiliation(s)
- Yuwei Du
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
- Jiangsu Province International Joint Laboratory on Fresh Food Smart Processing and Quality Monitoring, Jiangnan University, Wuxi, Jiangsu, China
| | - Tiantian Tang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Min Zhang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
- China General Chamber of Commerce Key Laboratory on Fresh Food Processing & Preservation, Jiangnan University, Wuxi, Jiangsu, China
| | - Arun S Mujumdar
- Department of Bioresource Engineering, Macdonald Campus, McGill University, Montreal, Quebec, Canada
| | - Pattarapon Phuhongsung
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Dongxing Yu
- Shanghao Biotech Co., Ltd., Qingdao, Shandong, China
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11
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Crampton E, Weisse CS. Antidepressant Use During Hospice Patients' Final Months on Routine Home Care. Am J Hosp Palliat Care 2023; 40:953-958. [PMID: 36242518 DOI: 10.1177/10499091221134028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Antidepressants can be used to manage symptoms at the end of life, but the dying process can impact their use. Objectives: To examine the use of antidepressants during hospice patients' final months of home care. Methods: A retrospective case records review of 227 hospice patients in their last three months of care in a residential setting. Chart reviews were conducted of medication logs, hospice staff notes, and caregiver narratives to examine antidepressant use including types of medications prescribed and factors associated with medication maintenance. Results: Thirty percent of patients were prescribed at least 1 antidepressant for symptoms including depression, anxiety, pain, disturbances in sleep, and poor appetite. The majority (96.1%) of patients were not administered their antidepressant on the day of death, and more than half (61.8%) did not receive their antidepressant during their last 3 days of life. A quarter (25.5%) of patients on antidepressants did not receive medication 4-7 days prior to death while some (12.7%) went without their antidepressant for 8 or more days. Antidepressant use was discontinued by hospice staff or caregivers due to a variety of reasons including difficulty swallowing, minimal consciousness, confusion, nausea, or patient refusal. Conclusions: Antidepressants are prescribed to manage multiple symptoms at the end of life, but use is often disrupted during patients' final days. Tapering and other prescription adjustments may be warranted to avoid risk of antidepressant discontinuation syndrome (ADS).
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Affiliation(s)
| | - Carol S Weisse
- Director of Health Professions/Professor of Psychology, Union College, Schenectady, NY, USA
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12
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Kato G, Mitome H, Miyauchi Y, Takeda S, Toyota Y, Hidaka N, Tanaka M, Akira K. A study on the chemical stability of cholesterol-lowering drugs in concomitant simple suspensions with magnesium oxide. J Pharm Health Care Sci 2023; 9:32. [PMID: 37644559 PMCID: PMC10464426 DOI: 10.1186/s40780-023-00301-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Difficulty in taking solid medicines is a common issue particularly for the elderly because of a decline in swallowing function, also known as dysphagia. For patients with such a dysfunction, a simple suspension method, in which solid medicines are disintegrated and suspended using warm water, has been developed and widely used in Japanese clinical settings. However, there is little information on drug stability in the simple co-suspension of multiple formulations especially including acidic or alkaline ones. In this study, the chemical stability of typical cholesterol-lowering drugs was investigated in a simple co-suspension with alkaline magnesium oxide (MgO) which is frequently used as a laxative or antacid in Japan. METHODS A cholesterol-lowering drug (one tablet) was soaked with or without MgO in warm water (55°C), and the vessel was left at room temperature for 10 min or 5 h. The suspensions prepared were then analyzed by high-performance liquid chromatography. Degradation products were analyzed by nuclear magnetic resonance spectroscopy and mass spectrometry for the structural elucidation. RESULTS In the simple co-suspension with MgO, no significant degradation was observed for atorvastatin or pravastatin, while a significant decrease of the recovery from the co-suspension was observed for rosuvastatin after 5 h. On the other hand, simvastatin and ezetimibe co-suspended with MgO were partially degraded to simvastatin acid and a pyran compound, respectively. CONCLUSIONS A simple co-suspension with MgO is feasible for atorvastatin, pravastatin, and rosuvastatin, although the rosuvastatin tablet should not be left soaking for a long time. Further it is inadvisable to suspend simvastatin or ezetimibe together with MgO because of their partial degradation.
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Affiliation(s)
- Ginjiro Kato
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Hidemichi Mitome
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Yusura Miyauchi
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Syu Takeda
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Yoshito Toyota
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Noriaki Hidaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mamoru Tanaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazuki Akira
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan.
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13
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Salave S, Patel P, Desai N, Rana D, Benival D, Khunt D, Thanawuth K, Prajapati BG, Sriamornsak P. Recent advances in dosage form design for the elderly: a review. Expert Opin Drug Deliv 2023; 20:1553-1571. [PMID: 37978899 DOI: 10.1080/17425247.2023.2286368] [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: 09/17/2023] [Accepted: 11/17/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION With the increase in the elderly population and the prevalence of multiple medical conditions, medication adherence, and efficacy have become crucial for the effective management of their health. The aging population faces unique challenges that need to be addressed through advancements in drug delivery systems and formulation technologies. AREAS COVERED The current review highlights the recent advances in dosage form design for older individuals, with consideration of their specific physiological and cognitive changes. Various dosage forms, such as modified-release tablets/capsules, chewable tablets, and transdermal patches, can be tailored to meet the specific needs of elderly patients. Advancements in drug delivery systems, such as nanotherapeutics, additive manufacturing (three-dimensional printing), and drug-food combinations, improve drug delivery and efficacy and overcome challenges, such as dysphagia and medication adherence. EXPERT OPINION Regulatory guidelines and considerations are crucial in ensuring the safe utilization of medications among older adults. Important factors to consider include geriatric-specific guidelines, safety considerations, labeling requirements, clinical trial considerations, and adherence and accessibility considerations.
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Affiliation(s)
- Sagar Salave
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Pranav Patel
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Nimeet Desai
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, India
| | - Dhwani Rana
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Derajram Benival
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Dignesh Khunt
- Graduate School of Pharmacy, Gujarat Technological University, Gandhinagar, Gujarat, India
| | | | - Bhupendra G Prajapati
- Shree S. K. Patel College of Pharmaceutical Education and Research, Ganpat University, Mehsana, India
| | - Pornsak Sriamornsak
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
- Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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14
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Hummler H, Sarwinska D, Weitschies W, Gollasch M, Page S. Parameters to Consider for Successful Medication Use in Older Adults - an AGePOP Review. Eur J Pharm Sci 2023:106453. [PMID: 37149104 DOI: 10.1016/j.ejps.2023.106453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Older adults are the main users of medicine and due to their multimorbidity are often faced/confronted with a complex medication management. This review article provides a brief overview on aspects of medication management such as maintaining a stock of the required medicine, understanding and following the instructions for use, coping with the primary and secondary packaging as well as preparation prior to use. The main focus however is on the drug intake itself and provides an overview about the current understanding of real life dosing conditions of older adults and geriatric patients. Furthermore, it elaborates the acceptability of dosage forms, in particular solid oral dosage forms as they represent the majority of dosage forms taken by these patient populations. An improved understanding of the needs of older adults and geriatric patients, their acceptability of various dosage forms and the circumstances under which they manage their medications, will make the design of more patient-centric drug products possible.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070, Basel, Switzerland
| | - Dorota Sarwinska
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489, Greifswald, Germany
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489, Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070, Basel, Switzerland.
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15
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Schramm L, Byrne MK, Sweetnam T. Antibiotic Misuse Behaviours of Older People: Confirmation of the Factor Structure of the Antibiotic Use Questionnaire. Antibiotics (Basel) 2023; 12:antibiotics12040718. [PMID: 37107080 PMCID: PMC10135189 DOI: 10.3390/antibiotics12040718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Antibacterial resistance (AR) is responsible for steadily rising numbers of untreatable bacterial infections, most prevalently found in the older adult (OA) population due to age-related physical and cognitive deterioration, more frequent and long-lasting hospital visits, and reduced immunity. There are currently no established measures of antibiotic use behaviours for older adults, and theory-informed approaches to identifying the drivers of antibiotic use in older adults are lacking in the literature. The objective of this study was to identify predictors of antibiotic use and misuse in older adults using the Antibiotic Use Questionnaire (AUQ), a measure informed by the factors of the Theory of Planned Behaviour (TPB): attitudes and beliefs, social norms, perceived behavioural control, behaviour, and a covariate-knowledge. A measure of social desirability was included, and participants scoring highly were excluded to control for social desirability bias. Confirmatory Factor Analyses and regression analyses were conducted to test the hypotheses in a cross-sectional, anonymous survey. A total of 211 participants completed the survey, 47 of which were excluded due to incompletion and high social desirability scores (≥5). Results of the factor analysis confirmed that some (but not all) factors from previous research in the general population were confirmed in the OA sample. No factors were found to be significant predictors of antibiotic use behaviour. Several suggestions for the variance in results from that of the first study are suggested, including challenges with meeting requirement for statistical power. The paper concludes that further research is required to determine the validity of the AUQ in an older adult population.
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Affiliation(s)
- Loni Schramm
- Faculty of Health, Charles Darwin University, Darwin, NT 0909, Australia
| | - Mitchell K Byrne
- Faculty of Health, Charles Darwin University, Darwin, NT 0909, Australia
| | - Taylor Sweetnam
- Faculty of Health, Charles Darwin University, Darwin, NT 0909, Australia
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16
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Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat Rev Drug Discov 2023; 22:387-409. [PMID: 36973491 PMCID: PMC10041531 DOI: 10.1038/s41573-023-00670-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
Poor medication adherence is a pervasive issue with considerable health and socioeconomic consequences. Although the underlying reasons are generally understood, traditional intervention strategies rooted in patient-centric education and empowerment have proved to be prohibitively complex and/or ineffective. Formulating a pharmaceutical in a drug delivery system (DDS) is a promising alternative that can directly mitigate many common impediments to adherence, including frequent dosing, adverse effects and a delayed onset of action. Existing DDSs have already positively influenced patient acceptability and improved rates of adherence across various disease and intervention types. The next generation of systems have the potential to instate an even more radical paradigm shift by, for example, permitting oral delivery of biomacromolecules, allowing for autonomous dose regulation and enabling several doses to be mimicked with a single administration. Their success, however, is contingent on their ability to address the problems that have made DDSs unsuccessful in the past.
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Affiliation(s)
| | | | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kevin J McHugh
- Department of Bioengineering, Rice University, Houston, TX, USA.
- Department of Chemistry, Rice University, Houston, TX, USA.
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17
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Ji S, Sun R, Wang W, Xia Q. Preparation, characterization, and evaluation of tamarind seed polysaccharide-carboxymethylcellulose buccal films loaded with soybean peptides-chitosan nanoparticles. Food Hydrocoll 2023. [DOI: 10.1016/j.foodhyd.2023.108684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
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18
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Tan PL, Loh TJ, Chan SY. A Pilot Study on Pharmacists' Knowledge, Attitudes and Practices towards Medication Dysphagia via Asynchronous Online Focus Group Discussion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2858. [PMID: 36833554 PMCID: PMC9956395 DOI: 10.3390/ijerph20042858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Medication dysphagia (MD) refers to difficulty swallowing oral medications. To cope, patients may inappropriately modify or skip medications, leading to poorer outcomes. Little is known about healthcare professionals' (HCPs') perspectives in managing MD. This study investigated pharmacists' knowledge, attitudes, and practices (KAP) in caring for patients with MD. An asynchronous online focus group was pilot tested in seven pharmacists, with up to two questions posted daily on an online platform over 15 days. Thematic analysis of the transcripts revealed five interrelated themes: (1) knowledge about MD; (2) management of MD; (3) expectations of patient proactivity; (4) desire for objectivity; (5) professional roles. The findings provided insight into pharmacists' KAP and may be incorporated into a full-scale study involving various HCPs.
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Affiliation(s)
| | | | - Sui Yung Chan
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117559, Singapore
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19
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Lee SV, Aplin T, Sefidani Forough A, Steadman KJ. Perceived Usability of Tablet Crushers: Comparison of Devices by People with and without Limited Hand Functions. Pharmaceutics 2023; 15:pharmaceutics15020517. [PMID: 36839840 PMCID: PMC9961238 DOI: 10.3390/pharmaceutics15020517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Tablet crushing is a common practice used by patients and their carers, mainly to facilitate swallowing. Various tablet-crushing devices with different designs are currently available on the market. This study aimed to compare the usability of different tablet-crushing devices in people with and without limited hand functions. The hand function of 100 adults recruited from the general community (40 of whom self-reported a limited hand function) was assessed using the hand and finger function subscale of the Arthritis Impact Measurement Scale version 2. The hand strength was measured using a dynamometer. Participants crushed tablets using 11 crushing devices and completed a Rapid Assessment of Product Usability and Universal Design questionnaire for each device. Hand-held twist-action crushers with an ergonomic grip received the highest usability scores among both groups, irrespective of the cost (p < 0.05). Crushers with bags were scored lower by those with limited hand functions, although the score improved if the device was automatic. Preferences regarding electronic crushers significantly changed once the cost was revealed. Economical twist-action crushers with ergonomic grips and without bags or cups were the most favoured crushers.
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Affiliation(s)
- Su Vin Lee
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Tammy Aplin
- School of Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Aida Sefidani Forough
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Kathryn J. Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4072, Australia
- Correspondence:
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20
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Orodispersible Films-Current State of the Art, Limitations, Advances and Future Perspectives. Pharmaceutics 2023; 15:pharmaceutics15020361. [PMID: 36839683 PMCID: PMC9965071 DOI: 10.3390/pharmaceutics15020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Orodispersible Films (ODFs) are drug delivery systems manufactured with a wide range of methods on a big scale or for customized medicines and small-scale pharmacy. Both ODFs and their fabrication methods have certain limitations. Many pharmaceutical companies and academic research centers across the world cooperate in order to cope with these issues and also to find new formulations for a wide array of APIs what could make their work profitable for them and beneficial for patients as well. The number of pending patent applications and granted patents with their innovative approaches makes the progress in the manufacturing of ODFs unquestionable. The number of commercially available ODFs is still growing. However, some of them were discontinued and are no longer available on the markets. This review aims to summarize currently marketed ODFs and those withdrawn from sale and also provides an insight into recently published studies concerning orodispersible films, emphasizing of utilized APIs. The work also highlights the attempts of scientific communities to overcome ODF's manufacturing methods limitations.
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21
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McCloskey AP, Penson PE, Tse Y, Abdelhafiz MA, Ahmed SN, Lim EJ. Identifying and addressing pill aversion in adults without physiological-related dysphagia: A narrative review. Br J Clin Pharmacol 2022; 88:5128-5148. [PMID: 35849849 PMCID: PMC9805106 DOI: 10.1111/bcp.15463] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 01/09/2023] Open
Abstract
Solid oral dosage forms (SODFs) (often called pills by patients) are the default formulation to treat medical ailments. Beneficial therapeutic outcomes rely on patients taking them as directed. Up to 40% of the population experience difficulties swallowing SODFs, resulting in reduced adherence and impaired therapeutic efficacy. Often associated with children, this also presents in adults with dysphagia, and without any organic dysphagia (non-physiological-related or functional dysphagia). This review aims to identify and appraise current interventions used to screen for and overcome pill aversion in adults with functional dysphagia. A comprehensive search of the literature was conducted. Articles reporting pill aversion in adults aged ≥18 years with no underlying cause, history of, or existing dysphagia were included. Study quality was determined using the STROBE tool for observational studies. A narrative synthesis of the findings was prepared. We identified 18 relevant cohort studies, which demonstrate that pill aversion is a global problem. Perceived ease of and/or SODF swallowability appears to be influenced by female gender, younger age, co-morbidities (e.g., depression), and physical SODF properties. Patients often modify their medicines rather than raise this issue with their healthcare team. Screening for pill aversion is haphazard but controlled postural adjustments, coating SODFs and behavioural interventions appear to be successful solutions. SODF swallowing difficulties are a barrier to effective medication use. Healthcare professionals must recognise that pill aversion is a problem requiring identification through effective screening and resolution by training interventions, appropriate formulation selection or specialist referral.
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Affiliation(s)
- Alice P. McCloskey
- School of Pharmacy and Biomolecular SciencesLiverpool John Moores UniversityLiverpoolUK
| | - Peter E. Penson
- School of Pharmacy and Biomolecular SciencesLiverpool John Moores UniversityLiverpoolUK
| | - Yincent Tse
- Great North Children's HospitalNewcastle‐upon‐TyneUK,Newcastle University Medical SchoolNewcastle upon TyneUK
| | - Majadah A. Abdelhafiz
- School of Pharmacy and Biomolecular SciencesLiverpool John Moores UniversityLiverpoolUK
| | - Shah N. Ahmed
- School of Pharmacy and Biomolecular SciencesLiverpool John Moores UniversityLiverpoolUK
| | - Emma J. Lim
- Great North Children's HospitalNewcastle‐upon‐TyneUK,Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
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22
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Lim CX, Livesay K, Stevens J, Nooney V, Baverstock K, Orwin N, Stupans I. Dosage Form Modification, a Simulation Activity between Nursing and Pharmacy Students. PHARMACY 2022; 10:pharmacy10060141. [PMID: 36412817 PMCID: PMC9680216 DOI: 10.3390/pharmacy10060141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The aim of this exploratory pilot study was to evaluate student perceptions of a simulation activity involving undergraduate nursing and pharmacy students. The key question was "how do nursing and pharmacy students respond in an immersive collaborative simulation activity which involves medication dosage form modification?" Methods: One hundred nursing students participated in a simulated exercise where patients required medications for which there were barriers to administration. Fourteen pharmacy students were also present in the simulated health environment, observing the work of the nursing students and being available to provide advice regarding medication administration to the nursing students. A mixed methods approach was employed for this exploratory pilot study, where both nursing and pharmacy students were invited to complete a survey regarding the experience at the end of the simulation exercise and pharmacy students completed a reflection. Both surveys and reflections were analyzed. Results: Survey results indicated very high satisfaction regarding the exercise for both pharmacy and nursing students. Analysis of pharmacy student reflections also indicated apprehension regarding their preparedness to contribute to the exercise, enjoyment in participation, their understanding of the value of collaboration between the two groups of students, and also recognition of their need to be more prepared for such situations. Conclusion: This study assessed student perceptions and did not formally evaluate learning outcomes. The interprofessional immersive simulated learning opportunity was viewed as valuable by both nursing and pharmacy students. The immersive simulation provided teaching staff with the opportunity to develop a new approach for the teaching of dosage form modification to both nursing and pharmacy students in an interprofessional setting.
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Affiliation(s)
- Chiao Xin Lim
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
- Correspondence:
| | - Karen Livesay
- Nursing, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
| | - Julie Stevens
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Vivek Nooney
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
| | - Katherine Baverstock
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
| | - Nichole Orwin
- Nursing, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3000, Australia
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23
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Ullah F, Ali Khan MF, Khan NH, Rehman MF, Shah SS, Mustaqeem M, Ullah S, Zhang Q, Shi H. Simvastatin-Loaded Lipid Emulsion Nanoparticles: Characterizations and Applications. ACS OMEGA 2022; 7:23643-23652. [PMID: 35847279 PMCID: PMC9280776 DOI: 10.1021/acsomega.2c02242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Simvastatin (SIM) is a diet drug to treat high lipid levels in the blood. It has the drawback of being metabolized in humans' gastrointestinal tract (GIT) when taken in an oral dosage form. To enhance the role of SIM in treating hyperlipidemias and bypassing its metabolism in GIT, a biodegradable nanocarrier as a SIM-loaded lipid emulsion nanoparticle via the solvent injection method was designed. Cholesterol acts as a lipid core, and Tween 80 was utilized to stabilize the core. The optimized nanoformulation was characterized for its particle diameter, zeta potential, surface morphology, entrapment efficiency, crystallinity, and molecular interaction. Furthermore, the transdermal hydrogel was characterized by physical appearance, rheology, pH, and spreadability. In vitro assays were executed to gauge the potential of LENPs and olive oil for transdermal delivery. The mean particle size and zeta potential of the optimized nanoparticles were 174 nm and -22.5 mV 0.127, respectively. Crystallinity studies and Fourier transform infrared analyses revealed no molecular interactions. Hydrogels showed a sustained release compared to SIM-loaded LENPs that can be proposed as a better delivery system for SIM. We encourage further investigations to explore the effect of reported formulations for transdermal delivery by in vivo experiments.
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Affiliation(s)
- Faiz Ullah
- Department
of Chemistry, Quaid-i-Azam University, Islamabad 15320, Pakistan
| | | | - Nazeer Hussain Khan
- Henan
International Joint Laboratory for Nuclear Protein Regulation, School
of Basic Medical Sciences, Henan University, Kaifeng, Henan 475004, China
- School
of Life Sciences, Henan University, Kaifeng, Henan 475004, China
| | | | - Syed Sakhawat Shah
- Department
of Chemistry, Quaid-i-Azam University, Islamabad 15320, Pakistan
| | - Muhammad Mustaqeem
- Department
of Chemistry, Thal University, Bhakkar Campus, Bhakkar 30000, Pakistan
| | - Sami Ullah
- Department
of Zoology, Government College University, Faisalabad 54000, Pakistan
| | - Qidi Zhang
- Department
of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong, University School of Medicine, Shanghai 200025, China
| | - Hongchao Shi
- Department
of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong, University School of Medicine, Shanghai 200025, China
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Zhang W, Xiao C, Xiao Y, Tian B, Gao D, Fan W, Li G, He S, Zhai G. An overview of in vitro dissolution testing for film dosage forms. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Krueger L, Miles JA, Steadman KJ, Kumeria T, Freeman CR, Popat A. 3D printing: potential clinical applications for personalised solid dose medications. Med J Aust 2022; 216:64-67. [PMID: 34984697 DOI: 10.5694/mja2.51381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Tushar Kumeria
- Australian Centre for Nanomedicine, University of New South Wales, Sydney, NSW
| | - Christopher R Freeman
- University of Queensland, Brisbane, QLD.,Metro North Hospital and Health Service, Brisbane, QLD
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In Vitro Stability and Recovery Studies of Pimavanserin in Water and in Different Vehicles Orally Administered. Drugs R D 2022; 22:95-104. [PMID: 35107816 PMCID: PMC8885838 DOI: 10.1007/s40268-022-00381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background and objective Swallowing difficulties (i.e., dysphagia) occur in up to 40% of the adult general population, particularly among the elderly prescribed solid oral dosage forms. Pimavanserin is approved for the treatment of hallucinations and delusions in patients with Parkinson’s disease psychosis (PDP) as a 34-mg capsule formulation. Patients with PDP may be at-risk for dysphagia that could affect administration of intact pimavanserin capsules. The stability of oral pimavanserin was evaluated in different liquid/soft food vehicles. Methods The stability of pimavanserin intended for oral administration was assessed by sprinkling the contents of 1 pimavanserin 34-mg capsule into water (40 mL), applesauce (40 g), vanilla Ensure (60 mL), or non-pulp orange juice (60 mL). Results The stability study demonstrated >95% recovery within 24 hours after contents of a 34-mg pimavanserin capsule were dispersed in applesauce, vanilla Ensure®, orange juice, or water. Assay values at 24 h for individual capsules were within 5% of time zero, and no significant change in the impurity profile was observed in any vehicle. Pimavanserin degradation products recovered from various food vehicles for individual and total degradation products were < 0.5% at all time points. In addition, the impurity profile of compatibility samples matched that obtained for a control sample. Conclusion These results support the ability of pimavanserin to be given orally by emptying the capsule contents into soft foods or liquids in accordance with the product label.
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Woerdenbag HJ, Visser JC, Leferink op Reinink MPAM, van Orsoy RR, Eissens AC, Hagedoorn P, Dijkstra H, Allersma DP, Ng SW, Smeets OSNM, Frijlink HW. Performance of Tablet Splitters, Crushers, and Grinders in Relation to Personalised Medication with Tablets. Pharmaceutics 2022; 14:pharmaceutics14020320. [PMID: 35214052 PMCID: PMC8878961 DOI: 10.3390/pharmaceutics14020320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Swallowing problems and the required dose adaptations needed to obtain optimal pharmacotherapy may be a hurdle in the use of tablets in daily clinical practice. Tablet splitting, crushing, or grinding is often applied to personalise medication, especially for the elderly and children. In this study, the performance of different types of (commercially available) devices was studied. Included were splitters, screwcap crushers, manual grinders, and electric grinders. Unscored tablets without active ingredient were prepared, with a diameter of 9 and 13 mm and a hardness of 100–220 N. Tablets were split into two parts and the difference in weight was measured. The time needed to pulverise the tablets (crush time) was recorded. The residue remaining in the device (loss) was measured. The powder was sieved to obtain a particle fraction >600 µm and <600 µm. The median particle size and particle size distribution of the later fraction were determined using laser diffraction analysis. Splitting tablets into two equal parts appeared to be difficult with the devices tested. Most screwcap grinders yielded a coarse powder containing larger chunks. Manual and especially electric grinders produced a finer powder, making it suitable for administration via an enteral feeding tube as well as for use in individualised preparations such as capsules. In conclusion, for domestic and incidental use, a screwcap crusher may provide sufficient size reduction, while for the more demanding regular use in hospitals and nursing residences, a manual or electric grinder is preferred.
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Affiliation(s)
- Herman J. Woerdenbag
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (J.C.V.); (M.P.A.M.L.o.R.); (R.R.v.O.); (A.C.E.); (P.H.); (H.W.F.)
- Correspondence: ; Tel.: +31-50-363-3351
| | - J. Carolina Visser
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (J.C.V.); (M.P.A.M.L.o.R.); (R.R.v.O.); (A.C.E.); (P.H.); (H.W.F.)
| | - Marlyn P. A. M. Leferink op Reinink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (J.C.V.); (M.P.A.M.L.o.R.); (R.R.v.O.); (A.C.E.); (P.H.); (H.W.F.)
| | - Roël R. van Orsoy
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (J.C.V.); (M.P.A.M.L.o.R.); (R.R.v.O.); (A.C.E.); (P.H.); (H.W.F.)
| | - Anko C. Eissens
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (J.C.V.); (M.P.A.M.L.o.R.); (R.R.v.O.); (A.C.E.); (P.H.); (H.W.F.)
| | - Paul Hagedoorn
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (J.C.V.); (M.P.A.M.L.o.R.); (R.R.v.O.); (A.C.E.); (P.H.); (H.W.F.)
| | - Hilda Dijkstra
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (H.D.); (D.P.A.)
| | - Derk P. Allersma
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (H.D.); (D.P.A.)
| | - Shi W. Ng
- Royal Dutch Pharmacists Association (KNMP), Alexanderstraat 11, 2514 JL The Hague, The Netherlands; (S.W.N.); (O.S.N.M.S.)
| | - Oscar S. N. M. Smeets
- Royal Dutch Pharmacists Association (KNMP), Alexanderstraat 11, 2514 JL The Hague, The Netherlands; (S.W.N.); (O.S.N.M.S.)
| | - Henderik W. Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (J.C.V.); (M.P.A.M.L.o.R.); (R.R.v.O.); (A.C.E.); (P.H.); (H.W.F.)
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Rodrigues DA, Miguel SP, Loureiro J, Ribeiro M, Roque F, Coutinho P. Oromucosal Alginate Films with Zein Nanoparticles as a Novel Delivery System for Digoxin. Pharmaceutics 2021; 13:pharmaceutics13122030. [PMID: 34959312 PMCID: PMC8706652 DOI: 10.3390/pharmaceutics13122030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 12/30/2022] Open
Abstract
Digoxin is a hydrophobic drug used for the treatment of heart failure that possesses a narrow therapeutic index, which raises safety concerns for toxicity. This is of utmost relevance in specific populations, such as the elderly. This study aimed to demonstrate the potential of the sodium alginate films as buccal drug delivery system containing zein nanoparticles incorporated with digoxin to reduce the number of doses, facilitating the administration with a quick onset of action. The film was prepared using the solvent casting method, whereas nanoparticles by the nanoprecipitation method. The nanoparticles incorporated with digoxin (0.25 mg/mL) exhibited a mean size of 87.20 ± 0.88 nm, a polydispersity index of 0.23 ± 0.00, and a zeta potential of 21.23 ± 0.07 mV. Digoxin was successfully encapsulated into zein nanoparticles with an encapsulation efficiency of 91% (±0.00). Films with/without glycerol and with different concentrations of ethanol were produced. The sodium alginate (SA) films with 10% ethanol demonstrated good performance for swelling (maximum of 1474%) and mechanical properties, with a mean tensile strength of 0.40 ± 0.04 MPa and an elongation at break of 27.85% (±0.58), compatible with drug delivery application into the buccal mucosa. The current study suggests that SA films with digoxin-loaded zein nanoparticles can be an effective alternative to the dosage forms available on the market for digoxin administration.
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Affiliation(s)
- Daniela A. Rodrigues
- Center of Potential and Innovation in Natural Resources, Research Unit for Inland Development, Polytechnic Institute of Guarda (CPIRN-UDI/IPG), Avenida Dr. Francisco de Sá Carneiro, No. 50, 6300-559 Guarda, Portugal; (D.A.R.); (S.P.M.); (J.L.); (M.R.); (F.R.)
| | - Sónia P. Miguel
- Center of Potential and Innovation in Natural Resources, Research Unit for Inland Development, Polytechnic Institute of Guarda (CPIRN-UDI/IPG), Avenida Dr. Francisco de Sá Carneiro, No. 50, 6300-559 Guarda, Portugal; (D.A.R.); (S.P.M.); (J.L.); (M.R.); (F.R.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Jorge Loureiro
- Center of Potential and Innovation in Natural Resources, Research Unit for Inland Development, Polytechnic Institute of Guarda (CPIRN-UDI/IPG), Avenida Dr. Francisco de Sá Carneiro, No. 50, 6300-559 Guarda, Portugal; (D.A.R.); (S.P.M.); (J.L.); (M.R.); (F.R.)
| | - Maximiano Ribeiro
- Center of Potential and Innovation in Natural Resources, Research Unit for Inland Development, Polytechnic Institute of Guarda (CPIRN-UDI/IPG), Avenida Dr. Francisco de Sá Carneiro, No. 50, 6300-559 Guarda, Portugal; (D.A.R.); (S.P.M.); (J.L.); (M.R.); (F.R.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Fátima Roque
- Center of Potential and Innovation in Natural Resources, Research Unit for Inland Development, Polytechnic Institute of Guarda (CPIRN-UDI/IPG), Avenida Dr. Francisco de Sá Carneiro, No. 50, 6300-559 Guarda, Portugal; (D.A.R.); (S.P.M.); (J.L.); (M.R.); (F.R.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Paula Coutinho
- Center of Potential and Innovation in Natural Resources, Research Unit for Inland Development, Polytechnic Institute of Guarda (CPIRN-UDI/IPG), Avenida Dr. Francisco de Sá Carneiro, No. 50, 6300-559 Guarda, Portugal; (D.A.R.); (S.P.M.); (J.L.); (M.R.); (F.R.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal
- Correspondence: ; Tel.: +351-965544187
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Solid Oral Dosage Forms Use in Adults with Neurological Disorders and Swallowing Difficulties: A Scoping Review. Dysphagia 2021; 37:909-922. [PMID: 34652512 DOI: 10.1007/s00455-021-10352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Swallowing difficulties affects the deglutition of solid oral dosage forms (SODFs) and it is a common problem among neurological disorders. Interventions may improve the use of SODFs in healthcare settings. The aim of this study was to map the available research about the interventions aiming the effective and safe use of SODFs in adults with neurological disorders and swallowing difficulties and to identify potential literature gaps in this scientific field. A scoping review was carried out based on Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, in PubMed, Scopus, and SciELO databases (March 2021). Peer-reviewed observational studies assessed the effectiveness and safety of SODFs in adults with neurological disorders and swallowing difficulties in the healthcare organizations setting were included. 11 studies were included (three case reports, two mixed-methods intervention studies, and six analytic studies). The frequency of women ranged from 49 to 67%, and the age from 57 to 91 years. Most studies (n = 7) included elderly patients, Parkinson (n = 6) and dementia (n = 3). Medication review was the most frequently reported intervention, 35% (9/26). In most studies, interventions were targeted to patients during hospitalization (n = 7) and performed by physicians (n = 8). At least 20 different outcomes were evaluated in the studies. Implementing specific protocols for using SODFs aimed at the swallowing difficulties of this population is not a common practice. Additional studies on interventions aimed at optimizing SODFs are needed to support the safety and efficacy of oral therapy in this patient group.
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Chang WC, Chen HW, Hsieh TY, Lin JC. Successful treatment of chronic hepatitis C virus infection with crushed elbasvir/grazoprevir administered through a nasogastric tube in a patient with hypoxic encephalopathy. Kaohsiung J Med Sci 2021; 38:77-78. [PMID: 34558811 DOI: 10.1002/kjm2.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Wen-Cheng Chang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Wei Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Combining Liquid Oral Drugs with Thickener: Compatibility and Changes in Viscosity. Dysphagia 2021; 37:889-899. [PMID: 34373976 DOI: 10.1007/s00455-021-10348-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Older adults with oropharyngeal dysphagia (OD) are unable to swallow pills safely, so some of them use liquid-formulated drugs mixed with thickeners to ensure safety. The aim of this study was to analyze the physical compatibility of a group of drugs with a thickener formulated with modified starch (Thick & Easy®). A secondary goal was to evaluate the amount of thickener needed to obtain the thickness levels 2, 3, and 4 defined by IDDSI framework for each drug. For this purpose, the rheological properties of the mixtures obtained were determined. Samples of each drug were prepared and 7, 10, and 12 g of thickener were added. Physical compatibility of the mixtures was observed; the apparent viscosity of the samples was measured using a rotational viscometer, and the results obtained were compared with the reference drug-free sample. We analyzed 45 medicinal products (38 active substances). Three drugs (almagate, ibuprofen, and macrogol) were found to be physically incompatible with the thickener and should not be mixed. Viscosity measurements indicated that clarithromycin and plantago ovata increased the viscosity of the mixture and required lower amount to achieve the target textures (110 cP, 590 cP, and 2620 cP for 7 g, 10 g, and 12 g in drug-free samples, respectively), whereas another subset reduced viscosity and required more thickener. This proved very relevant for acetylcysteine, amoxicillin, calcifediol, ferrous gluconate, fosfomycin, lactitol, lactulose, mepifiline, paracetamol, rivastigmine, sertraline, and tramadol. Measurements were below 1750 cP. Awareness of how each drug behaves when combined with thickeners is essential to avoid potential complications in OD.
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Sangnim T, Sriamornsak P, Singh I, Huanbutta K. Swallowing Gel for Patients with Dysphagia: A Novel Application of Chitosan. Gels 2021; 7:108. [PMID: 34449603 PMCID: PMC8395724 DOI: 10.3390/gels7030108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Dysphagia refers to difficulty swallowing certain foods, liquids, or pills. It is common among the elderly with chronic diseases who need to take drugs for long periods. Therefore, dysphagia might reduce compliance with oral drug administration in the aging population. Many pharmaceutical companies search for new products to serve as swallowing aids. Existing products are expensive and do not suit all geriatric patients. Therefore, this study aimed to develop and investigate pill swallowing aid gels prepared from carboxymethyl cellulose and chitosan. We formulated gels by dissolving different concentrations of carboxymethyl cellulose and low or high molecular weight chitosan in solvents to find appropriate gel rheology properties. We then added several portions of glycerin as the glidant of the formulation. We found that the optimized gel formulation was 6.25% (w/w) chitosan with a molecular weight of 80-120 kDa dissolved in 1.2% acetic acid and 4% (w/w) glycerin. The developed pill swallowing gel's rheology was pseudoplastic with a viscosity of 73.74 ± 3.20 Pa⸱s. The developed chitosan gel had enhanced flow ability; it allowed the pill to cross a 300 mm tube within 6 s, while the reference product took 3 s. Even though the reference product could carry the pill in the tube faster, the chitosan gel better covered the pill, making it more convenient to use. Finally, using a theophylline tablet as a model tablet dosage form, we assessed the gel's effect on drug disintegration and dissolution. The chitosan gel delayed the tablet disintegration time by about 3-7 min and slightly affected the theophylline dissolution rate. Lastly, all gels were physically stable after a month of storage in the stress condition. These results show the feasibility of manufacturing a chitosan gel usable as a pill swallowing gel for patients with dysphagia.
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Affiliation(s)
- Tanikan Sangnim
- Faculty of Pharmaceutical Sciences, Burapha University, 169 Longhaad Bangsaen Road, Saensuk, Mueang, Chon Buri 20131, Thailand;
| | - Pornsak Sriamornsak
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand;
- Academy of Science, The Royal Society of Thailand, Bangkok 10300, Thailand
| | - Inderbir Singh
- Chitkara College of Pharmacy, Chitkara University, Patiala 140401, Punjab, India;
| | - Kampanart Huanbutta
- Faculty of Pharmaceutical Sciences, Burapha University, 169 Longhaad Bangsaen Road, Saensuk, Mueang, Chon Buri 20131, Thailand;
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El-Saifi NNF, Moyle W, Jones CJ, Tuffaha HWA. The perceptions of informal carers of older people with dementia about the role of their pharmacists. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:465-470. [PMID: 34331443 DOI: 10.1093/ijpp/riab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 07/01/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES As medication experts, pharmacists can play a significant role in helping people living with dementia and their informal carers make the best use of medications. However, little is known about this population's needs and expectations of their pharmacists. The objective of this study was to report informal carers' perceptions about the role of their pharmacists. METHODS In a previous study, informal carers were interviewed to explore factors influencing medication adherence in older people living with dementia. The interview transcripts from the previous study were analysed thematically using an inductive approach to explore carers' perceptions about the role of community pharmacists in helping carers and people living with dementia use medications as prescribed. KEY FINDINGS The interviews of 20 informal carers were analysed. Carers were primarily females (85%), married (60%), completed university (60%) and unemployed (70%). The majority of care recipients had comorbidities (75%), and the number of medications ranged from 1 to 20. Three significant roles emerged: (1) provision of medication information, (2) advising on medication organisation and (3) conducting medication reviews. CONCLUSIONS Informal carers face several challenges in administering the medications to older people living with dementia. Pharmacists are expected to play a more active role in helping people living with dementia, and their carers make safe and effective use of medications.
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Affiliation(s)
- Najwan N F El-Saifi
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Brisbane, QLD, Australia
| | - Cindy J Jones
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD, Australia
| | - Haitham W A Tuffaha
- The Centre for the Business and Economics of Health, University of Queensland, St Lucia, Brisbane, QLD, Australia
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Barry HE, Hughes CM. An Update on Medication Use in Older Adults: a Narrative Review. CURR EPIDEMIOL REP 2021; 8:108-115. [PMID: 34306966 PMCID: PMC8294219 DOI: 10.1007/s40471-021-00274-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. RECENT FINDINGS A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. SUMMARY Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.
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Affiliation(s)
- Heather E. Barry
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Carmel M. Hughes
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
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Pijnenburg DWM, van Seyen M, Abbink EJ, Colbers A, Drenth JPH, Burger DM. Pharmacokinetic similarity demonstrated after crushing of the elbasvir/grazoprevir fixed-dose combination tablet for HCV infection. J Antimicrob Chemother 2021; 75:2661-2665. [PMID: 32544221 PMCID: PMC7443725 DOI: 10.1093/jac/dkaa230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/23/2020] [Accepted: 05/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Finding a suitable treatment for HCV patients with swallowing disorders is still a major challenge. In practice, direct-acting antivirals are crushed without knowledge of adequate absorption. Crushing can alter drug exposure, possibly leading to treatment failure, development of resistance or toxicity. Currently, there is no information about crushing of the fixed-dose combination tablet of elbasvir/grazoprevir; therefore, crushing of this tablet is not recommended. OBJECTIVES To investigate the influence of crushing on the pharmacokinetics of the elbasvir/grazoprevir fixed-dose combination tablet. METHODS We conducted an open-label, two-period, randomized, cross-over, Phase I, single-dose trial in 11 healthy adult volunteers. Subjects randomly received whole-tablet elbasvir/grazoprevir or crushed and suspended elbasvir/grazoprevir in a fasted state. Pharmacokinetic similarity criteria (90% CIs lie within 70%-143% acceptance range) were used for AUC0-∞ and AUC0-72. RESULTS Mean plasma concentration-time curves of elbasvir and grazoprevir showed similar pharmacokinetic profiles. The primary pharmacokinetic parameters AUC0-∞ and AUC0-72 of elbasvir and grazoprevir after intake of a crushed tablet were on average 12%-16% higher compared with the whole tablet, but 90% CIs were all within the predefined boundaries of pharmacokinetic similarity. Crushing leads to a higher Cmax of grazoprevir (42%); no significant difference was found between treatments with regard to the Cmax of elbasvir. No serious adverse events were reported during the trial. CONCLUSIONS Pharmacokinetic similarity could be demonstrated for a crushed and suspended tablet compared with a whole tablet, without impacting drug safety or efficacy. Crushed and suspended administration of elbasvir/grazoprevir can be used in patients with swallowing disorders.
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Affiliation(s)
- Daniëlle W M Pijnenburg
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Minou van Seyen
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evertine J Abbink
- Radboudumc Technology Center Clinical Studies, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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He M, Zhu L, Yang N, Li H, Yang Q. Recent advances of oral film as platform for drug delivery. Int J Pharm 2021; 604:120759. [PMID: 34098053 DOI: 10.1016/j.ijpharm.2021.120759] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022]
Abstract
Orally drug delivery film has received extensive interest duo to a distinct set of its advantageous properties compared to the traditional orally administered dosages, including faster rate of drug absorption, higher bioavailability and better patient compliance for children and elders with swallowing deficiencies. In particular, its potential capacity of delivering proteins and peptides has further attracted great attention. Lately, tremendous advances have been made in designing and developing both novel mucoadhesive films and orodispersible films to fulfill specific accomplishments of drug delivery. This review aims to summarize those newly developed oral films, discussing their formulation strategies, manufacturing methods as well as advantages and limitations thereof. Conclusions and future perspectives are also provided in brief.
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Affiliation(s)
- Mengning He
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, China
| | - Lingmeng Zhu
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, China
| | - Ni Yang
- School of Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Huijie Li
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, China
| | - Qingliang Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, China; Ningbo Wesdon Powder Pharma Coatings Co. Ltd., Ningbo 315042, China.
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Establishing an Electronic Referral System from Speech and Language Therapy to Pharmacy to Improve Medication Administration in Patients with Dysphagia in an Acute Hospital Setting. Dysphagia 2021; 37:125-136. [PMID: 33587172 DOI: 10.1007/s00455-021-10256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Dysphagia affects swallowing not only of food and drink, but also of orally administered medications. Altering solid or liquid dose formulations renders administration unlicensed and may have adverse effects. Medication administration in patients with dysphagia necessitates a multidisciplinary approach with no one profession holding all necessary expertise. This project aimed to improve the process of medication administration for patients with dysphagia in an acute hospital. Following a baseline audit of practice, an electronic referral system from Speech & Language Therapy (SLT) to Pharmacy was established. Repeat post-implementation audits documenting medication administration to patients with dysphagia and SLT compliance in completing electronic referral were conducted. Of the 43 patients included in the post-implementation audits, 14 (32.6%) were referred from SLT to Pharmacy using the electronic referral system. Those patients referred electronically were reviewed by Pharmacy quicker than those patients who were not referred and had a higher percentage of optimally administered medications. All SLTs eligible (n = 10) were surveyed to explore use of the system and barriers to its use; reasons given for not completing an electronic referral included not prioritizing the referral if under time pressure and lack of IT access to make the referral. Overall compliance with use of the electronic referral system was lower than expected; further work is needed to establish consistency of practice in using the electronic referral system in the interest of optimizing medication administration to patients.
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de Paiva MRB, Arribada RG, da Silva CN, Ribeiro MCS, Jorge R, Fialho SL, Silva-Cunha A. Assessment of the safety of intravitreal injection of metoprolol tartrate in rabbits. Doc Ophthalmol 2021; 142:75-85. [PMID: 32623534 DOI: 10.1007/s10633-020-09781-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To verify the safety of different doses of intravitreal metoprolol tartrate (MT) after intravitreal injection in rabbit eyes. METHODS Animals were randomly assigned into 2 groups: group I received 50 µg of MT and group II 100 µg of MT. A volume of 0.05 mL of the drug solution was administered through an intravitreal injection, while the control eyes received an equal volume of saline solution. Safety was assessed by clinical observation, electroretinography (ERG) and histological evaluation. RESULTS No evidence of clinical toxicity was observed. ERG waveforms from the MT treated eyes were similar to those recorded from the control eyes in dark-adapted state, amplitude and the implicit time are similar between the groups in light-adapted state, and their retinas had no signs of toxicity by histological evaluation 7 days after intravitreal injection. CONCLUSIONS The intravitreal use of metoprolol at 50 and 100 µg dosages does not cause short-term retinal toxicity in rabbits.
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Affiliation(s)
- Mayara Rodrigues Brandão de Paiva
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Pharmaceutical Research and Development, Ezequiel Dias Foundation, CEP 30510-010, Belo Horizonte, Brazil
| | | | | | | | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Silvia Ligório Fialho
- Pharmaceutical Research and Development, Ezequiel Dias Foundation, CEP 30510-010, Belo Horizonte, Brazil
| | - Armando Silva-Cunha
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Sabere AM, Suhaimi NNM, Ahmed Q, Mahat M, Roslan N, Azizi J. Soft-chewable paracetamol tablets by melt granulation method: Formulation and characterization. J Pharm Bioallied Sci 2021; 13:312-316. [PMID: 35017887 PMCID: PMC8698080 DOI: 10.4103/jpbs.jpbs_783_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 07/20/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Oral drug delivery is the most preferred route for drug administration in the world, with tablets being one of the most common dosage forms. However, some people, particularly children and the elderly, have difficulty swallowing the tablets. Chewable tablets are the dosage form that can address the issue while also providing a valuable masking effect on drug taste, allowing patients to swallow the drugs more easily. Materials and Methods: In this study, the chewable tablets were manufactured using the melt granulation method, which resulted in tablets with a chewy texture. The tablets contained paracetamol as well as Arabic gum, starch, agar, and mannitol. Results: The drug release profiles for the fragmented form showed that 50% of the drug was released within 4 min and 100% was released within 30 min of the dissolution process. The intact form released nearly 90% of the drug within 2 h. Conclusion: Formulation 2 was determined as the best formulation. This tablets' formulation had passed all characterization tests and displayed a moderate hardness and chewy texture.
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Drumond N, Stegemann S. Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience. Pharmaceutics 2020; 13:pharmaceutics13010032. [PMID: 33379258 PMCID: PMC7824227 DOI: 10.3390/pharmaceutics13010032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.
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Affiliation(s)
- Nélio Drumond
- Correspondence: (N.D.); (S.S.); Tel.: +49-178-2144689 (N.D.); +49-172-6054869 (S.S.)
| | - Sven Stegemann
- Correspondence: (N.D.); (S.S.); Tel.: +49-178-2144689 (N.D.); +49-172-6054869 (S.S.)
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Wu Q, Feng D, Huang Z, Chen M, Yang D, Pan X, Lu C, Quan G, Wu C. Supersaturable organic-inorganic hybrid matrix based on well-ordered mesoporous silica to improve the bioavailability of water insoluble drugs. Drug Deliv 2020; 27:1292-1300. [PMID: 32885715 PMCID: PMC7580725 DOI: 10.1080/10717544.2020.1815898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022] Open
Abstract
Mesoporous silica with uniform 2-D hexagonal pores has been newly employed as facile reservoir to impove the dissolution rate of water insoluble drugs. However, rapid drug release from mesoporous silica is usually accompanied by the generation of supersaturated solution, which leads to the drug precipitation and compromised absorption. To address this issue, a supersaturated ternary hybrid system was constructed in this study by utilizing inorganic mesoporous silica and organic precipitation inhibitor. Vinylprrolidone-vinylacetate copolymer (PVP VA64) with similar solubility parameter to model drug fenofibrate (FNB) was expected to well inhibit the precipitation. Mesoporous silica Santa Barbara amorphous-15 (SBA-15) was synthesized in acidic media and hybrid matrix was produced by hot melt extrusion technique. The results of in vitro supersaturation dissolution test obviously revealed that the presence of PVP VA64 could effectively sustain a higher apparent concentration. PVP VA64 was suggested to simultaneously reduce the rate of nucleation and crystal growth and subsequently maintain a metastable supersaturated state. The absorption of FNB delivered by the organic-inorganic hybrid matrix was remarkably enhanced in beagle dogs, and its AUC value was 1.92-fold higher than that of FNB loaded mesoporous silica without PVP VA 64. In conclusion, the supersaturated organic-inorganic hybrid matrix can serve as a modular strategy to enhance the oral availability of water insoluble drugs.
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Affiliation(s)
- Qiaoli Wu
- College of Pharmacy, Jinan University, Guangzhou, China
- Department of Pharmacy, Zengcheng District People’s Hospital, Guangzhou, China
| | - Disang Feng
- College of Pharmacy, Jinan University, Guangzhou, China
| | | | - Minglong Chen
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Dan Yang
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Xin Pan
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Chao Lu
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Guilan Quan
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Chuanbin Wu
- College of Pharmacy, Jinan University, Guangzhou, China
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
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Takahashi N, Fujita Y, Takahashi N, Nakamura A, Harada T. Effect of xanthan gum-based food thickeners on the dissolution profile of fluoroquinolones oral formulations. J Pharm Health Care Sci 2020; 6:25. [PMID: 33292643 PMCID: PMC7708189 DOI: 10.1186/s40780-020-00181-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background Xanthan gum-based food thickeners (XG-FTs) are often ingested by patients with dysphagia to prevent aspiration during drug treatment. Reportedly, XG-FTs affect tablet disintegration, drug dissolution rates, and reduce the efficacy of postprandial antihyperglycemic agents. The absorption rate and quantity of fluoroquinolone antimicrobial agents correlate with drug efficacy, raising concern about the impact of XG-FTs. Previously, we reported that film-coated tablets were less susceptible to the effects of XG-FT than conventional and orally disintegrating tablets. Here, we compare the effect of XG-FTs on dissolution profiles of three oral fluoroquinolone-based film-coated tablets by evaluating the dissolution of crushed products, fine granules, and film-coated fine granules. Methods We examined formulations of tosufloxacin tosylate monohydrate (TFLX), levofloxacin hemihydrate (LVFX), and ciprofloxacin hydrochloride hydrate (CPFX). The formulations were immersed in 20 mL of 1.5% (w/v) XG-FT aqueous solution for 2.5 min followed by a dissolution test using the paddle method according to the Japanese Pharmacopoeia (dissolution test solution pH 1.2; volume 900 mL; temperature 37 ± 0.5 °C). The dissolution profile was evaluated according to the dissolution quantity indicated in product specifications and guidelines for bioequivalence testing of generic drugs. The 15-min mean dissolution rate was determined for a formulation immersed in 1.5% (w/v) XG-FT aqueous solution and compared with that for a non-immersed formulation (control). Fluoroquinolone film-coated tablets were mixed with starch-based FTs, guar gum-based FTs, or XG-FTs to observe their appearances. Results The dissolution profile of LVFX film-coated tablets was not affected by XG-FTs, but the dissolution of TFLX and CPFX was delayed. For crushed film-coated tablets, the 15-min mean dissolution rate was significantly delayed for all three fluoroquinolones when compared with that of uncrushed products. The dissolution profile of TFLX film-coated fine granules was unchanged by XG-FTs. CPFX film-coated tablets and crushed products produced a gel-like precipitate when mixed with XG-FTs and failed to meet product-dissolution specifications. A gel-like precipitate was also observed with guar gum-based FTs. Conclusion The effect of XG-FTs on the dissolution profile of film-coated fluoroquinolone formulations varied depending on the formulation. The CPFX formulation formed a gel-like precipitate when immersed in XG-FTs resulting in a significantly delayed dissolution.
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Affiliation(s)
- Nobuyuki Takahashi
- Division of Pharmaceutics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Yoshiaki Fujita
- Division of Pharmaceutics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Nanako Takahashi
- Division of Pharmaceutics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Akihiro Nakamura
- Division of Pharmaceutics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Tsutomu Harada
- Division of Pharmaceutics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
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Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Pharmaceutics 2020; 12:pharmaceutics12100924. [PMID: 32998301 PMCID: PMC7601516 DOI: 10.3390/pharmaceutics12100924] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/03/2022] Open
Abstract
Medication lubricants are thick liquids or gels that are designed to aid swallowing of solid oral dosage forms. Tablets and capsules are placed within a spoonful of the product for swallowing. The aim of this study was to describe and compare commercially available medication lubricants in terms of textural suitability for patients with dysphagia. Twelve medication lubricants were characterised according to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. Apparent viscosity, yield stress, thickness consistency, and various texture features were compared. Gloup Forte was the only medication lubricant classified as IDDSI level 4 (pureed/extremely thick) at room (24 °C) temperature. Four other Gloup products were IDDSI level 3 (liquidised/moderately thick) at room temperature but testing at 4 °C or pouring from the container instead of using the pump dispenser resulted in classification as IDDSI level 4. The IDDSI Flow test would have classified MediSpend and Slo Tablets as IDDSI level 3, but their very low yield stress led to these fluids flowing too quickly through the prongs of a fork and so these were classified as <3. Severo was IDDSI level 2. Heyaxon and the two versions of Magic Jelly tested contained lumps, and Swallow Aid had exceptionally high viscosity, hardness, adhesiveness, and gumminess, classifying them as IDDSI Level 7 (“regular textures”) and therefore as unsuitable for people with dysphagia according to IDDSI. This study provides valuable information to help with the selection of a safe medication lubricant with appropriate thickness level suited to each individual with dysphagia.
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Appropriateness of oral dosage form modification for aged care residents: a video-recorded observational study. Int J Clin Pharm 2020; 42:938-947. [DOI: 10.1007/s11096-020-01036-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/11/2020] [Indexed: 12/17/2022]
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Hoekman J, Ray S, Aurora SK, Shrewsbury SB. The Upper Nasal Space—A Novel Delivery Route Ideal for Central Nervous System Drugs. ACTA ACUST UNITED AC 2020. [DOI: 10.17925/usn.2020.16.1.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Preparation and evaluation of orally disintegrating film containing donepezil for Alzheimer disease. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.101321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Tablet Scoring: Current Practice, Fundamentals, and Knowledge Gaps. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9153066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral solid dosage formulations and/or tablets have remained the preferred route of administration by both patients and health care practitioners. Oral tablets are easy to administer, they are non-invasive and cause less risk adversity. Because of the lack of commercially available tablet dose options, tablets are being split or partitioned by users. Tablet scoring refers to the breakage of a tablet to attain a desired efficacy dose and is an emerging concept in the pharmaceutical industry. The primary reason for the tablet scoring practice is to adjust the dose: dose tapering or dose titrating. Other reasons for tablet partitioning are to facilitate dose administration, particularly among the pediatric and the geriatric patient population, and to mitigating the high cost of prescription drugs. The scope of this review is to: (1) evaluate the advantages and inconveniences associated with tablet scoring/portioning, and (2) identify factors in the formulation and the manufacturing of tablets that influence tablet splitting. Whereas tablet partitioning has been a common practice, there is a lack of understanding regarding the fundamentals underpinning the performance of tablets with respect to splitting. Several factors can influence tablet partitioning: tablet size, shape, and thickness. A requirement has recently been set by the European Pharmacopoeia and the U.S. Food and Drug Administration for the uniformity of mass of subdivided tablets. For breaking ease, an in-vivo reference test and a routinely applicable in-vitro test need to be established.
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Pill swallowing in Parkinson's disease: A prospective study based on flexible endoscopic evaluation of swallowing. Parkinsonism Relat Disord 2019; 62:51-56. [DOI: 10.1016/j.parkreldis.2019.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 11/21/2022]
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Thiazolidinedione as an alternative to facilitate oral administration in geriatric patients with Alzheimer's disease. Eur J Pharm Sci 2019; 129:173-180. [DOI: 10.1016/j.ejps.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/04/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
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