1
|
Meisner M, Kuśnierz P, Duda P, Wilczyński S, Sarecka-Hujar B. Are There Differences in the Homogeneity of the Parts of Tablets Obtained after Subdivision?-A Preliminary Assessment Using an X-ray Microtomography. Pharmaceutics 2022; 14:pharmaceutics14091850. [PMID: 36145598 PMCID: PMC9506467 DOI: 10.3390/pharmaceutics14091850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Aim: The study aimed to analyze the weight and homogeneity of the parts of tablets containing carbamazepine and tablets with trazodone hydrochloride, obtained after subdivision with a kitchen knife. X-ray microtomography was used for homogeneity analysis. Methods: 30 tablets with carbamazepine and 30 tablets with trazodone hydrochloride were analyzed in terms of weight uniformity after subdivision. Then, seven tablets of each type were analyzed using an X-ray microtomography (Phoenix vǀtomeǀx, General Electric). The absorption of X-rays by an object is proportional to its density. In turn, measurement of the density of the analyzed object in a microtomographic image is the grayscale level. Based on the correlation between the grayscale value and the reference density, from the calibration phantom, we were able to determine the density of any area of the tablet’s scan. Results: During the subdivision, the weight loss exceeded 3% for two carbamazepine tablets, while for trazodone tablets, none lost more than 3%, which is the limit recommended by Food and Drug Administration (FDA). As to the density of the tablets resulting from the microtomographic analysis, two of the whole tablets containing trazodone hydrochloride had a significantly higher density than the remainder (p < 0.001). Similarly, some differences in density were observed in the analysis of the density of tablets of carbamazepine (p = 0.008). Parts of one of the analyzed tablets with trazodone obtained after subdivision differed in terms of pixel brightness, thus density. On the other hand, the uniform density was observed for parts of the split tablets containing carbamazepine. Conclusions: Parts of the trazodone hydrochloride tablets obtained after subdivision differed in terms of homogeneity and weight. Microtomographic methods may be an interesting and useful method for evaluating the uniformity of compounds in solid dosage forms.
Collapse
Affiliation(s)
- Michał Meisner
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa Str. 3, 41-200 Sosnowiec, Poland
| | - Piotr Kuśnierz
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa Str. 3, 41-200 Sosnowiec, Poland
| | - Piotr Duda
- Institute of Biomedical Engineering, Faculty o Faculty of Science and Technology, University of Silesia, 41-200 Sosnowiec, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa Str. 3, 41-200 Sosnowiec, Poland
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa Str. 3, 41-200 Sosnowiec, Poland
- Correspondence: or ; Tel.: +48-32-269-9830
| |
Collapse
|
2
|
Concerns regarding tablet splitting: a systematic review. BJGP Open 2022; 6:BJGPO.2022.0001. [PMID: 35193886 DOI: 10.3399/bjgpo.2022.0001] [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: 01/07/2022] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Tablet splitting can provide dose flexibility and cost savings; however, pharmaceutical representatives typically discourage the practice. AIM To identify and summarise all published concerns related to tablet splitting and to present the experimental evidence that investigates those concerns. DESIGN & SETTING Systematic review and qualitative synthesis of tablet-splitting concerns and evidence. METHOD Medline and EMBASE databases were searched over all years of publication for articles in English discussing the splitting of tablets. Eligible articles included original research, narrative reviews, systematic reviews, and expert opinion. RESULTS After removing duplicates, 1837 potentially relevant articles underwent dual review, whereupon 1612 articles were excluded based on title and abstract. After examination of 225 full texts, 138 articles were included (one systematic review, four narrative reviews, 101 original research articles, and 32 opinion articles). The described concerns included difficulty breaking tablets, loss of mass, weight variability, chemical instability, overly rapid dosing if sustained-release medications are split, non-compliance, and patient confusion resulting in medication errors. No substantive evidence was found to support concerns regarding loss of mass, weight variability, chemical instability, or non-compliance. Evidence does support some older adults struggling to split tablets without tablet splitters, and the inappropriateness of splitting sustained-release preparations, given the potential for alteration of the rate of drug release for some products. CONCLUSION With the exception of sustained-release tablets, which should not be split, and excepting those older people who may struggle to split tablets based on physical limitations, there is little evidence to support tablet-splitting concerns.
Collapse
|
3
|
Godaert L, Cofais C, Proye E, Allard Saint Albin L, Dramé M. Medication modification in a population of community-dwelling individuals aged 65 years or older. Age Ageing 2022; 51:6527372. [PMID: 35150582 DOI: 10.1093/ageing/afab240] [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: 06/07/2021] [Revised: 09/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND medication safety is a major public health challenge, particularly among older populations. Changing the medication's form may be inappropriate and may incur a risk of adverse effects. OBJECTIVES the objectives were to estimate the prevalence of medication modification and to identify factors associated with the practice of medication modification in community-dwelling older individuals. DESIGN observational, cross-sectional, single-centre and epidemiological study. SETTINGS community. SUBJECTS outpatients and/or their accompanying persons, aged 65 years or over. METHODS sociodemographic and clinical variables were recorded. It was also noted how the medication was taken, who administered the medications, the number of oral medications ingested per day, and whether or not the form of the medication was modified to facilitate administration. Descriptive analyses and logistic regression were performed. RESULTS a total of 252 individuals were included in the study, with a mean age of 83 ± 7 years. Of these, 44 (17.5%) reported modifying their medication, either routinely (n = 36) or occasionally (n = 8). The factors independently associated with medication modification were the existence of psycho-behavioural disorders [odds ratio (OR) = 3.78; 95% confidence interval (CI) = 1.84-7.76; P < 0.0001], mobility difficulties (OR = 2.16; 95% CI = 1.01-4.62; P = 0.04), and the presence of dysphagia (OR = 3.23; 95% CI = 1.49-6.99; P < 0.0001). CONCLUSIONS this study indicates that main caregivers are more likely to engage in medication modification than nurses or the patients themselves. Factors associated with medication modification include swallowing difficulties and psycho-behavioural disorders. These findings provide new avenues that could help to mitigate this practice.
Collapse
Affiliation(s)
- Lidvine Godaert
- Department of Geriatrics, General Hospital of Valenciennes, Valenciennes F-59300, France
| | - Cécilia Cofais
- Department of Geriatrics, University Hospitals of Rennes, Rennes F-35000, France
| | - Emeline Proye
- Department of Geriatrics, General Hospital of Valenciennes, Valenciennes F-59300, France
| | - Laury Allard Saint Albin
- Department of Geriatrics, University Hospitals of Martinique, Fort-de-France F-97261, Martinique
| | - Moustapha Dramé
- Faculty of Medicine, University of the French West Indies, Fort-de-France F-97200, Martinique
- Department of Clinical Research and Innovation, University Hospitals of Martinique, Fort-de-France F-97261, Martinique
| |
Collapse
|
4
|
Ganzetti R, Logrippo S, Sestili M, Caraffa A, Cespi M, Pelliccioni G, Blasi P, Bonacucina G. Tablet Splitting in Elderly Patients with Dementia: The Case of Quetiapine. Pharmaceutics 2021; 13:pharmaceutics13091523. [PMID: 34575599 PMCID: PMC8469994 DOI: 10.3390/pharmaceutics13091523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Quetiapine is an atypical antipsychotic approved for treating schizophrenia, bipolar depression, and mania but is frequently used in an off-label manner to control the behavioral and psychological symptoms of dementia in elderly patients with dementia. Due to the need to personalize doses for elderly patients with dementia, quetiapine tablet manipulation is widespread in hospital settings, long-term care facilities, and patient homes. The aim of this study was to assess the impact of the different splitting techniques on quetiapine fumarate tablets by analysing the obtained sub-divided tablets and to discuss compliance with the European Pharmacopoeia limits on whole and split tablets. Quetiapine fumarate tablets of two dose strengths were taken at random (in a number able to assure a power of 0.8 during statistical comparison) and were split with a kitchen knife or tablet cutter. The weight and the drug content were determined for each half tablet. The obtained data were compared to the European Pharmacopoeia limits. The differences between the different splitting techniques were statistically tested. Data showed that split tablets, independently of the dose strength and the technique employed, were not compliant with the European Pharmacopoeia specifications for both entire and subdivided tablets in terms of weight and content uniformity. Thus, such a common practice could have potential effects on treatment efficacy and toxicity, especially when also considering the fragility of the elderly target population in which polypharmacotherapy is very common. These results indicate a compelling need for flexible quetiapine formulations that can assure more accurate dose personalization.
Collapse
Affiliation(s)
- Roberta Ganzetti
- Hospital Pharmacy, IRCCS INRCA, Via della Montagnola 81, 60127 Ancona, Italy;
| | - Serena Logrippo
- School of Specialization in Hospital Pharmacy, University of Camerino, 62032 Camerino, Italy;
| | - Matteo Sestili
- Hospital Pharmacy, ASUR Marche, Area Vasta 2, 60127 Ancona, Italy;
| | - Alessandro Caraffa
- Hospital Pharmacy, Hospital S. Maria Della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Marco Cespi
- School of Pharmacy, University of Camerino, Via Gentile III da Varano, 62032 Camerino, Italy; (M.C.); (G.B.)
| | - Giuseppe Pelliccioni
- Department of Neurology, IRCCS INRCA, Via della Montagnola 81, 60127 Ancona, Italy;
| | - Paolo Blasi
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, 40127 Bologna, Italy
- Correspondence: ; Tel.: +39-051-209-5639
| | - Giulia Bonacucina
- School of Pharmacy, University of Camerino, Via Gentile III da Varano, 62032 Camerino, Italy; (M.C.); (G.B.)
| |
Collapse
|
5
|
Cui M, Pan H, Fang D, Sun H, Qiao S, Pan W. Exploration and evaluation of dynamic dose-control platform for pediatric medicine based on Drop-on-Powder 3D printing technology. Int J Pharm 2021; 596:120201. [PMID: 33539997 DOI: 10.1016/j.ijpharm.2021.120201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
Patient responses to doses vary widely, and affording limited doses to such a diverse population will inevitably yield unsatisfactory therapeutic effects and even adverse effects. In Particular, there is an urgent demand for a dynamic dose-control platform for pediatric patients, many of whom require diverse doses and flexible dose adjustments. The aim of this study was to explore the possibility of using a drop-on-powder (DoP) technology-based desktop 3D printer to build a dynamic dose-control platform for theophylline (TP) and metoprolol tartrate (MT). In addition, the impact of drug loading patterns on the accuracy of dose regulation was also assessed. All of the printed tablets exhibited good mechanical properties and satisfactory structural integrity. On printing tablets with target drug doses, the accuracy was in the range of 91.2~108% with a small variation coefficient in the range of 0.5~3.2%. Compared with traditional divided-dose methods, drop-on-powder 3D printing technology exhibited higher accuracy in dose regulation, but had less impact on the in vitro drug release behavior. The results in this work clearly indicate the possibility and ability of DoP technology as a promising method for constructing a dynamic dose-control platform for the fabrication of personalized medicines for pediatric patients.
Collapse
Affiliation(s)
- Mengsuo Cui
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, China
| | - Hao Pan
- School of Pharmacy, Liaoning University, 66 Chongshan Middle Road, Shenyang 110036, China
| | - Dongyang Fang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, China
| | - Haowei Sun
- Department of Traditional Chinese Medicine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China
| | - Sen Qiao
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, China
| | - Weisan Pan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, China.
| |
Collapse
|
6
|
Melo VV, Pereira GR, Soares AQ, Silva IC, Taveira SF, Cunha-Filho M, Marreto RN. Prevalence of tablet splitting in a Brazilian tertiary care hospital. Pharm Pract (Granada) 2020; 18:1910. [PMID: 32566050 PMCID: PMC7290181 DOI: 10.18549/pharmpract.2020.2.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/31/2020] [Indexed: 11/14/2022] Open
Abstract
Background: Although a highly common practice in hospital care, tablet splitting can cause dose variation and reduce drug stability, both of which impair drug therapy. Objective: To determine the overall prevalence of tablet splitting in hospital care as evidence supporting the rational prescription of split tablets in hospitals. Methods: Data collected from inpatients’ prescriptions were analyzed using descriptive statistics and used to calculate the overall prevalence of tablet splitting and the percentage of split tablets that had at least one lower-strength tablet available on the market. The associations between the overall prevalence and gender, age, and hospital unit of patients were also assessed. The results of laboratory tests, performed with a commercial splitter, allowed the calculation of the mass loss, mass variation, and friability of the split tablets. Results: The overall prevalence of tablet splitting was 4.5%, and 78.5% of tablets prescribed to be split had at least one lower-strength tablet on the market. The prevalence of tablet splitting was significantly associated with the patient’s age and hospital unit. Laboratory tests revealed mean values of mass loss and variation of 8.7% (SD 1.8) and 11.7% (SD 2.3), respectively, both of which were significantly affected by the presence of coating and scoreline. Data from laboratory tests indicated that the quality of 12 of the 14 tablets deviated in at least one parameter examined. Conclusions: The high percentage of unnecessary tablet splitting suggests that more regular, rational updates of the hospital’s list of standard medicines are needed. Also, inappropriate splitting behavior suggests the need to develop tablets with functional scores.
Collapse
Affiliation(s)
- Vivianne V Melo
- MSc. Laboratory of Nanosystems and Drug Delivery Devices (NanoSYS), School of Pharmacy, Federal University of Goiás. Goiânia, GO (Brazil).
| | - Gessyka R Pereira
- MSc. Laboratory of Nanosystems and Drug Delivery Devices (NanoSYS), School of Pharmacy, Federal University of Goiás. Goiânia, GO (Brazil).
| | - Amanda Q Soares
- PhD, MSc. Pharmacy Service, University Hospital of the Federal University of Goiás. Goiânia, GO (Brazil).
| | - Izabel C Silva
- PhD, Msc. Laboratory of Food, Drug, and Cosmetics (LTMAC), School of Health Sciences, University of Brasília, Brasilia, DF (Brazil).
| | - Stephania F Taveira
- PhD, MSc. Laboratory of Nanosystems and Drug Delivery Devices (NanoSYS), School of Pharmacy, Federal University of Goiás. Goiânia, GO (Brazil).
| | - Marcilio Cunha-Filho
- PhD, MSc. Laboratory of Food, Drug, and Cosmetics (LTMAC), School of Health Sciences, University of Brasília, Brasilia, DF (Brazil).
| | - Ricardo N Marreto
- PhD. Laboratory of Nanosystems and Drug Delivery Devices (NanoSYS), School of Pharmacy, Federal University of Goiás. Goiânia, GO (Brazil).
| |
Collapse
|
7
|
Ashrafpour R, Ayati N, Sadeghi R, Zare Namdar S, Ayati N, Ghahremani S, Zakavi SR. Comparison of Treatment Response Achieved by Tablet Splitting Versus Whole Tablet Administration of Levothyroxine in Patients with Thyroid Cancer. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2018; 6:108-112. [PMID: 29998143 PMCID: PMC6038971 DOI: 10.22038/aojnmb.2018.26793.1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives TSH suppression by Levothyroxine consumption is a mainstay of thyroid cancer treatment. Tablet-splitting is a worldwide approach in dose adjustment in patients. However, it is highly recommended to evaluate the validity of tablet splitting for each distinctive drug by clinical trials before routinely using tablet halves in clinical practice. In this study we compared the effect of 150 µg dose of Levothyroxine by use of a100 and a 50 µg tablets or one and half 100 µg tablets in Differentiated thyroid cancer (DTC) patients. Methods One hundred DTC patients treated with one and half 100 µg Levothyroxine tablets were randomly divided into two groups. The first group continued taking medication as before and the second group received the same daily dose by taking one 100 and one 50 microgram Levothyroxine tablets. The mean changes in TSH and T3 levels and patients weight were compared between the groups. Results 91 patients completed the study. Levothyroxine consumption pattern, age, gender distribution, weight and TSH levels were comparable between groups at the beginning of the study. The mean change of body weights, serum levels of T3 and TSH showed no significant difference between groups in different time points during the study (P>0.05). Conclusion This study showed similar efficacy of tablet splitting and two tablets administration for Levothyroxine; however, patients preferred two tablets at the end of the study. It can be concluded that tablet splitting can be used as an alternative way when the 50 µg tablet is not available.
Collapse
Affiliation(s)
- Ramin Ashrafpour
- School of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narjess Ayati
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zare Namdar
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nayyereh Ayati
- Department of harmacoeconomics and harmaceutical dministration, aculty of harmacy, Tehran University of medical sciences, Tehran, Iran
| | - Somayyeh Ghahremani
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
8
|
Drumond N, van Riet-Nales DA, Karapinar-Çarkit F, Stegemann S. Patients' appropriateness, acceptability, usability and preferences for pharmaceutical preparations: Results from a literature review on clinical evidence. Int J Pharm 2017; 521:294-305. [PMID: 28229945 DOI: 10.1016/j.ijpharm.2017.02.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/26/2017] [Accepted: 02/10/2017] [Indexed: 11/18/2022]
Abstract
Patients play an important role in achieving the desired therapeutic outcomes, as they are frequently responsible for their own medication management. To facilitate drug administration and overcome medication issues, the patients' needs and preferences should be considered in the pharmaceutical drug product design. With the aim to evaluate the current state of evidence for patient appropriateness, acceptability, usability and preference for aspects of this design, a literature search was performed. Comparative clinical studies that assessed such endpoints for different patient populations were included and summarized descriptively. The search identified 45 publications that met the inclusion criteria. A detailed analysis of the studies identified two main areas investigating either packaging design (n=10) or dosage form design (n=35). Studies on packaging design showed preferences for wing top and screw cap openings, push-through blisters and suppositories with slide system. Additionally, child-resistant containers should be avoided concerning specific patient populations. Regarding dosage form design, sprinkles and minitablets were the most preferred in studies involving young patients, while preferences varied considerably depending on route of administration and geographical region in studies with adult patients. Review of the methodology used in the studies revealed that ten studies had used well-defined protocols and observational endpoints to investigate patient appropriateness. Studies focusing on methodology for testing the appropriateness and usability of drug products by patients were not found. In conclusion, more interdisciplinary scientific efforts are required to develop and increase research in understanding patient needs and preferences.
Collapse
Affiliation(s)
- Nélio Drumond
- Graz University of Technology, Inffeldgasse 13, 8010 Graz, Austria
| | | | | | - Sven Stegemann
- Graz University of Technology, Inffeldgasse 13, 8010 Graz, Austria; Capsugel, Rijksweg 11, 2880 Bornem, Belgium.
| |
Collapse
|
9
|
Mc Gillicuddy A, Kelly M, Sweeney C, Carmichael A, Crean AM, Sahm LJ. Modification of oral dosage forms for the older adult: An Irish prevalence study. Int J Pharm 2016; 510:386-93. [DOI: 10.1016/j.ijpharm.2016.06.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/22/2016] [Indexed: 12/11/2022]
|