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Giri Y, Habibullah S, Dixit PK, Mahalik G, Mohanty B, Behera A. Development of microemulgel formulations with varied permeation enhancers for transungual delivery of luliconazole in onychomycosis management. Colloids Surf B Biointerfaces 2024; 234:113718. [PMID: 38176335 DOI: 10.1016/j.colsurfb.2023.113718] [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: 09/08/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024]
Abstract
Luliconazole-loaded microemulgels containing different permeation enhancers were formulated for transungual drug delivery for the management of onychomycosis, onychomycosis, which affects nails. The physicochemical properties like droplet size, zeta potential, pH, viscosity, spreadability, extrudability, oil binding capacity, drug content, and microscopic study were evaluated. The Pseudo-ternary phase diagram was constructed for the formulation of microemulsions (MEs) by keeping the Km ratio constant at 3:1 and characterized for clarity, mean droplet size, zeta potential, viscosity, pH, transmittance, refractive index, and stability. The ME mean droplet size and zeta potential were found in the range of 38.78 to 171.4 nm, and 0.00 to - 6.6 mV, respectively. Prepared MEs were converted into microemulgel by adding a 2.5% gelling agent (Carbapol 934) in the external phase, and a drug release study was conducted. Formulation E3 showed better drug release and was chosen as the control. Four different penetration enhancers were added separately within E3 and further evaluated for pH, viscosity, spreadability, extrudability, oil binding capacity, drug content, microscopic study, Compatibility study, XRD, and DSC. A favorable docking score was observed between luliconazole and Lanosterol 14-alpha-demethylase. In-vitro cumulative drug release at the end of 24 h from E3-SS, containing sodium sulfide as a penetration enhancer, was found to be 94.70% and was 2 times more than the control formulation. Ex-vivo transungual permeation studies through cutting nail clippings were found to be in the range of 28.18 - 36.52 µg/mm2. The microemulgels tagged as E3, E3-SS, and E3-SL showed a significant zone of inhibition against Candida albicans and Aspergillus fumigatus as compared to the marketed formulation.
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Affiliation(s)
- Yashwant Giri
- School of Pharmacy and Life Sciences, Centurion University of Technology and Management, Odisha, India
| | - Sk Habibullah
- Department of Pharmaceutics, Siksha 'O' Anusandhan University, Odisha, India
| | - Pradyumna Kumar Dixit
- School of Pharmacy and Life Sciences, Centurion University of Technology and Management, Odisha, India
| | - Gyanranjan Mahalik
- Department of Botany, School of Applied Sciences, Centurion University of Technology and Management, Odisha, India
| | | | - Amulyaratna Behera
- School of Pharmacy and Life Sciences, Centurion University of Technology and Management, Odisha, India.
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2
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Kumar Behera J, Kumar S, Sharma R, Jain A, Kumar Garg N, Khopade A, Sawant KK, Singh R, Nirbhavane P. Novel Discoveries and Clinical Advancements for Treating Onychomycosis: A Mechanistic Insight. Adv Drug Deliv Rev 2024; 205:115174. [PMID: 38161056 DOI: 10.1016/j.addr.2023.115174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Onychomycosis continues to be the most challenging disease condition for pharmaceutical scientists to develop an effective drug delivery system. Treatment challenges lie in incomplete cure and high relapse rate. Present compilation provides cumulative information on pathophysiology, diagnostic techniques, and conventional treatment strategies to manage onychomycosis. Novel technologies developed for successful delivery of antifungal molecules are also discussed in brief. Multidirectional information offered by this article also unlocks the panoramic view of leading patented technologies and clinical trials. The obtained clinical landscape recommends the use of advanced technology driven approaches, as a promising way-out for treatment of onychomycosis. Collectively, present review warrants the application of novel technologies for the successful management of onychomycosis. This review will assist readers to envision a better understanding about the technologies available for combating onychomycosis. We also trust that these contributions address and certainly will encourage the design and development of nanocarriers-based delivery vehicles for effective management of onychomycosis.
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Affiliation(s)
- Jitesh Kumar Behera
- Adarsh Vijendra Institute of Pharmaceutical Sciences, Shobhit University, Saharanpur, 247341, Uttar Pradesh, India
| | - Samarth Kumar
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India; Department of Pharmacy, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, Gujarat, India
| | - Rajeev Sharma
- Amity Institute of Pharmacy, Amity University Madhya Pradesh, Gwalior, 474005, M.P., India
| | - Ashay Jain
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India.
| | - Neeraj Kumar Garg
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India
| | - Ajay Khopade
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India
| | - Krutika K Sawant
- Department of Pharmacy, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, Gujarat, India
| | - Ranjit Singh
- Adarsh Vijendra Institute of Pharmaceutical Sciences, Shobhit University, Saharanpur, 247341, Uttar Pradesh, India
| | - Pradip Nirbhavane
- Amity Institute of Pharmacy, Amity University of Haryana, Gurgaon, 122413, India.
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3
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Krawczyk-Santos AP, Marreto RN, Concheiro A, Alvarez-Lorenzo C, Taveira SF. Poly(pseudo)rotaxanes formed by mixed micelles and α-cyclodextrin enhance terbinafine nail permeation to deeper layers. Int J Pharm X 2022; 4:100118. [PMID: 35602759 PMCID: PMC9117884 DOI: 10.1016/j.ijpx.2022.100118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Abstract
This work aimed to develop water-based formulations for onychomycosis topical treatment using micelles of small pegylated surfactants associated with α-cyclodextrin (αCD) to deliver terbinafine to the nail. Kolliphor® RH40 (RH40) and Gelucire® 48/16 (GEL) single and mixed micelles (RH40:GEL 1:1) were prepared. αCD was added to the surfactants dispersions to form poly(pseudo)rotaxanes (PPR). Formulations were characterized in terms of drug solubilization (3 to 34-fold increase), particle size (9–11 nm) and Z-potential (+0.3 − +1.96 mV), blood compatibility (non-hemolytic), rheological behavior (solid-like viscoelastic properties after 5–10% αCD addition), drug release and interaction with the nail plate. GEL micelles and surfactant-10% αCD PPRs notably hydrated the nail plate. The high viscosity of PPR led to a slower drug release, except for RH40:GEL +10% αCD that surprisingly released terbinafine faster. The RH40:GEL +10% αCD formulation delivered twice more amount of terbinafine to deeper regions of nail plate compared to other formulations. The results evidenced the potential of PPR formed by small pegylated surfactants as a water-based formulation for nail drug delivery. RH40, GEL and their mixed micelles increased 3-fold and 34-fold TB solubility in water and citrate buffer, respectively. Addition of αCD (5–10%) led to PPR formation and viscoelastic supramolecular gels without decrease in TB solubilization. PPR formulations with 10% αCD enhanced nail plate hydration, increasing its porosity. Compared to mixed micelles, PRP showed slower release rate but promoted TB accumulation in deeper regions of hooves.
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Affiliation(s)
- Anna Paula Krawczyk-Santos
- Laboratory of Nanosystems and Drug Delivery Devices (NanoSYS), School of Pharmacy, Universidade Federal de Goiás (UFG), Rua 240, Setor Leste Universitário, 74, 605-170 Goiânia, GO, Brazil
| | - Ricardo Neves Marreto
- Laboratory of Nanosystems and Drug Delivery Devices (NanoSYS), School of Pharmacy, Universidade Federal de Goiás (UFG), Rua 240, Setor Leste Universitário, 74, 605-170 Goiânia, GO, Brazil
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+DFarma Group (GI-1645), Facultad de Farmacia, iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+DFarma Group (GI-1645), Facultad de Farmacia, iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Corresponding authors.
| | - Stephânia Fleury Taveira
- Laboratory of Nanosystems and Drug Delivery Devices (NanoSYS), School of Pharmacy, Universidade Federal de Goiás (UFG), Rua 240, Setor Leste Universitário, 74, 605-170 Goiânia, GO, Brazil
- Corresponding authors.
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4
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Bellmann T, Luber R, Kischio L, Karl B, Pötzinger Y, Beekmann U, Kralisch D, Wiegand C, Fischer D. Bacterial nanocellulose patches as a carrier for hydrating formulations to improve the topical treatment of nail diseases. Int J Pharm 2022; 628:122267. [DOI: 10.1016/j.ijpharm.2022.122267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 10/31/2022]
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New Strategies for Improving Budesonide Skin Retention. Pharmaceutics 2021; 14:pharmaceutics14010030. [PMID: 35056927 PMCID: PMC8781796 DOI: 10.3390/pharmaceutics14010030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this work was to evaluate the ex vivo effect of the combination of two strategies, complexation with cyclodextrin, and poloxamer hydrogels, for improving water solubility in the dermal absorption of budesonide. Two hydrogels containing 20% poloxamer 407, alone or in combination with poloxamer 403, were prepared. Each formulation was loaded with 0.05% budesonide, using either pure budesonide or its inclusion complex with hydroxypropyl-β-cyclodextrin, and applied in finite dose conditions on porcine skin. The obtained results showed that for all formulations, budesonide accumulated preferentially in the epidermis compared to the dermis. The quantity of budesonide recovered in the receptor compartment was, in all cases, lower than the LOQ of the analytical method, suggesting the absence of possible systemic absorption. The use of a binary poloxamer mixture reduced skin retention, in line with the lower release from the vehicle. When the hydrogels were formulated with the inclusion complex, an increase in budesonide skin retention was observed with both hydrogels. Poloxamer hydrogel proved to be a suitable vehicle for cutaneous administration of budesonide.
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Smart antifungal thermosensitive chitosan/carboxymethylcellulose/scleroglucan/montmorillonite nanocomposite hydrogels for onychomycosis treatment. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2020.125600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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8
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Aggarwal R, Targhotra M, Sahoo P, Chauhan MK. Efinaconazole nail lacquer for the transungual drug delivery: Formulation, optimization, characterization and in vitro evaluation. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Transungual Delivery, Anti-Inflammatory Activity, and In Vivo Assessment of a Cyclodextrin Polypseudorotaxanes Nail Lacquer. Pharmaceutics 2020; 12:pharmaceutics12080730. [PMID: 32759698 PMCID: PMC7465521 DOI: 10.3390/pharmaceutics12080730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
A new cyclodextrin polypseudorotaxanes nail lacquer (Regenail®) containing biotin, methyl sulphonyl methane (MSM), and dimethylsilanediol salicylate was developed and evaluated in vitro and in vivo. The product was developed to improve nail status and diminish signs of pathological nail alterations. A reference product (Betalfatrus®) was used for comparative purposes. An in vitro permeation experiment in hooves showed high MSM and biotin absorption. The content of sulfur and silicon in hooves was also found to be higher compared with the reference product. MSM was tested in human keratinocytes, exhibiting a good cytotoxicity profile and anti-inflammatory activity by the reduction in IL-8 and TNF-α under LPS stimuli. A clinical study was performed to check product safety and efficacy against nail brittleness and alterations such as Beau's lines and onychorrhexis. A reduction in both alterations and in surface roughness without alteration of nail structure was observed, with a good level of patient acceptance and satisfaction.
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10
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Aggarwal R, Targhotra M, Sahoo P, Chauhan MK. Onychomycosis: Novel strategies for treatment. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Aggarwal R, Targhotra M, Kumar B, Sahoo PK, Chauhan MK. Treatment and management strategies of onychomycosis. J Mycol Med 2020; 30:100949. [PMID: 32234349 DOI: 10.1016/j.mycmed.2020.100949] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-β-cyclodextrin (HP-β-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.
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Affiliation(s)
- R Aggarwal
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India.
| | - M Targhotra
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - B Kumar
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - P K Sahoo
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - M K Chauhan
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
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12
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Cutrín-Gómez E, Conde-Penedo A, Anguiano-Igea S, Gómez-Amoza JL, Otero-Espinar FJ. Optimization of Drug Permeation from 8% Ciclopirox Cyclodextrin/Poloxamer-Soluble Polypseudorotaxane-Based Nail Lacquers. Pharmaceutics 2020; 12:pharmaceutics12030231. [PMID: 32151015 PMCID: PMC7150861 DOI: 10.3390/pharmaceutics12030231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022] Open
Abstract
Cyclodextrin/poloxamer-soluble polypseudorotaxane-based nail lacquers have demonstrated significant capacity for promoting the permeation of drugs into the nail plate. Furthermore, previous studies have shown that the use of hydroalcoholic blends as vehicles promotes drug permeation. The work described herein studies the effect of the type of alcohol used in the lacquer preparation, and the composition of the vehicle is optimized to obtain soluble doses of 8% and to promote the diffusion of ciclopirox base and olamine across the nail. Permeation studies on different types of alcohols show that optimum results are achieved with short-chain alcohols, and that results become less satisfactory the higher the number of alcohol carbons. In addition, solubility and penetration studies on the bovine hoof have enabled the composition of the lacquer to be optimized for both forms of ciclopirox. The results suggest that optimized lacquers have better ciclopirox diffusion and penetration properties than the commercial reference lacquer. Lastly, in vivo studies in which optimized ciclopirox olamine lacquer was applied for 45 days to the nails of healthy volunteers showed that it caused no negative effects or changes to the nail surface. These results demonstrate the significant potential of cyclodextrin/poloxamer-soluble polypseudorotaxane-based nail lacquers for the ungual administration of drugs.
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Vikas A, Rashmin P, Mrunali P, Chavan RB, Kaushik T. Mechanistic Insights of Formulation Approaches for the Treatment of Nail Infection: Conventional and Novel Drug Delivery Approaches. AAPS PharmSciTech 2020; 21:67. [PMID: 31938980 DOI: 10.1208/s12249-019-1591-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023] Open
Abstract
Onychomycosis is a chronic disorder that is difficult to manage and hard to eradicate with perilous trends to relapse. Due to increased prevalence of HIV, use of immunosuppressant drugs and lifestyle-related factors, population affected with fungal infection of nail (Onychomycosis) happens to increase extensively in last two decades. Modalities available for the treatment of onychomycosis include systemically administered antifungals, mechanical procedures, and topical drug therapy. But the efficacy of the most of approaches to deliver drug at targeted site, i.e., deep-seated infected nail bed is limited due to compact and highly keratinized nail structure. A series of advanced formulation approaches, such as transfersomes, liposomes, nano/micro emulsion, nail lacquers etc., have been attempted to improve the drug penetration into nail plate more efficiently. The manuscript reviews these formulation approaches with their possible mechanisms by which they improve the drug penetration.Comparative analysis of available treatment modalities for onychomycosis has been provided with pros and cons of each alternatives. Additionally, ongoing research about the application of biological materials such as modified cationic antimicrobial peptides (AMPs), plant-derived proteins, and synthetic antimicrobial peptidomimetics have also been explored.
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Dhamoon RK, Goyal RK, Popli H, Gupta M. Luliconazole-Loaded Thermosensitive Hydrogel as Aqueous based Nail Lacquer for the Treatment of Onychomycosis. ACTA ACUST UNITED AC 2019. [DOI: 10.2174/2210303109666190520081552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Onychomycosis is a nail fungal infection which accounts for 50% of the nail
diseases and is characterized by disfigurement and discoloration of nails. The current therapy includes
oral and topical formulations both of which come with their own drawbacks. This has left a room for
developing patient- compliant novel strategies which can facilitate drug delivery deeper into the nails
effectively.
Objective:
The main objective of the present work was to develop and evaluate in situ gelling thermosensitive
hydrogel as an aqueous nail lacquer for the treatment of onychomycosis. The idea was to
enhance permeation of Luliconazole into the nail while simultaneously solubilizing it in a hydrophilic
formulation.
Methods:
The sample of Luliconazole was authenticated using modern analytical techniques. The hydrogel-
nail lacquer was prepared using poloxamer Pluronic F127. The formulation was evaluated in
terms of drying time, viscosity, non- volatile content, pH, transition temperature, etc. In vitro study was
done to check the drug release while determining release kinetics. In vitro transungual permeation study
was done to check drug permeation through porcine hoof membrane. Stability studies were conducted
to ensure formulation stability.
Results:
The results confirmed a stable formulation with enhanced permeation through porcine hoof
membrane.
Conclusion:
The results support the potential use of in situ gelling thermo-sensitive hydrogels as a
novel transungual formulation in the treatment of onychomycosis with a slight improvement in water
resistance.
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Affiliation(s)
- Rupinder K. Dhamoon
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Ramesh K. Goyal
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Harvinder Popli
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Madhu Gupta
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
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Hassan N, Singh M, Sulaiman S, Jain P, Sharma K, Nandy S, Dudeja M, Ali A, Iqbal Z. Molecular Docking-Guided Ungual Drug-Delivery Design for Amelioration of Onychomycosis. ACS OMEGA 2019; 4:9583-9592. [PMID: 31460049 PMCID: PMC6648890 DOI: 10.1021/acsomega.9b00436] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/13/2019] [Indexed: 05/09/2023]
Abstract
The present work envisaged an adherent luliconazole-loaded bilayer nail lacquer (BNL) with significant transungual activity. The locally applied sustained-release BNL formulation was designed for an improved retention, payload, and final dermatokinetic disposition. A primary step in the fabrication of a BNL included overcoming of physical barriers like α-keratin (also α-keratin), a protein present in human nails, and then allowing the drug molecule to permeate at the site of action. Although luliconazole is an established antifungal agent, has limited clinical exploitation for its use in treating onychomycosis. An in silico study elucidating its interaction with lanosterol-14-α demethylase, an enzyme which is the key region of drug action mechanism, was highly supportive of its imminent clinical potential. Optimization of prepared BNL formulations via response surface modeling (Box-Behnken Design-Expert 10.0.6) logically ascertained the effect of selected independent variables and showcased its effect via dependent responses. Surface morphology of the prepared BNL films was well corroborated for the presence of two distinct polymeric layers through scanning electron microscopy imaging. Nail permeation studies revealed a cumulative drug release of 71.25 ± 0.11% through bovine hooves up to 24 h. Luliconazole while exposing antifungal activity against clinical isolates of Trichophyton rubrum in agar cup-plate method disclosed a 38 mm diameter zone of inhibition. Further, the optimized BNL exhibited a bioadhesive force of 1.9 ± 0.11 N, which assured its retention on the nail surface for prolonged duration of time. In Conclusion, it is deduced that the conventional treatment modalities for onychomycosis require circumvention of certain pharmacotechnical caveats. Therefore, in the present study, a multipronged BNL system was proposed, which negates the need of frequent drug application, improvises cosmetic appearance, yields fruitful therapeutic outcomes, and has a clinical supremacy over the available therapeutics.
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Affiliation(s)
- Nazia Hassan
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Manvi Singh
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Sufiyanu Sulaiman
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Pooja Jain
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Kalicharan Sharma
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Shyamasree Nandy
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Mridu Dudeja
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Asgar Ali
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
| | - Zeenat Iqbal
- Department
of Pharmaceutics, Department of Pharmaceutical Chemistry, School
of Pharmaceutical Education and Research, and Department of Microbiology, Hamdard
Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi 110062, India
- E-mail: , . Tel: +91-9811733016
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16
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Zhao D, Song H, Zhou X, Chen Y, Liu Q, Gao X, Zhu X, Chen D. Novel facile thermosensitive hydrogel as sustained and controllable gene release vehicle for breast cancer treatment. Eur J Pharm Sci 2019; 134:145-152. [PMID: 30926401 DOI: 10.1016/j.ejps.2019.03.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
The current research process in gene therapy for cancer treatment has brought much attention due to its great potential for both inherited and acquired diseases. Precise accumulation in target site and on-demand release of drug is critical factors for the efficient gene therapy. Since the delivery of suitable gene largely depends on the delivery carrier, the design of suitable gene delivery vehicle for the sustained gene release in target site are attracting increasingly interest among the researchers. In this report, an effective and relatively convenient gene delivery platform is developed by the electrostatic interaction between negative charged survivin antisense oligonucleotide (Sur-ASON) and positive charged PHB-b-PDMAEMA (PHB-P) co-polymer and then the induction of thermosensitive PF127 hydrogel. The prepared hydrogel could achieve a sustained gene release property in the tumor region after injection, thus to enhance the effect of Survivin antisense oligonucleotide and inhibit P-gp impaired drug uptake simultaneously. In vivo anti-tumor efficacy and H&E staining indicated that Sur-ASON/PHB-P/PF127 hydrogel was greatly effective in enhancing the treatment effects of Sur-ASON while reducing the degradation and the possible adverse side effects, and this novel hydrogel could achieve the controlled gene release up to maximum 16 days. The aforementioned properties indicated that the novel hydrogel could be applied as a promising and convenient anti-cancer agent for anticancer therapy with minimum injection frequency to possibly increase patient compliance.
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Affiliation(s)
- Dan Zhao
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Hua Song
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Xinyi Zhou
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Yilin Chen
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Qiuhong Liu
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Xuemin Gao
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Xuan Zhu
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China.
| | - Dengyue Chen
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian 361005, China.
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Terbinafine hydrochloride nail lacquer for the management of onychomycosis: formulation, characterization and in vitro evaluation. Ther Deliv 2019; 9:99-119. [PMID: 29325509 DOI: 10.4155/tde-2017-0069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM The present investigation's intention was to develop an optimized nail lacquer (NL) for the management of onychomycosis. MATERIALS & METHODS The NL was optimized statistically adopting 32 full factorial design having different polymer ratios and solvent ratios. The formulations were assessed for drug permeation drying time and peak adhesive strength of the film. Characterization was done using techniques including attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR), scanning electron microscopy (SEM), differential scanning calorimetry (DSC), x-ray diffraction (XRD), etc. RESULTS & CONCLUSION The formulation that had 1:1 polymer ratio and 80:20 solvent ratio was chosen as the optimized formulation. In vitro permeation studies showed better penetration (∼3.25-fold) as well as retention (∼11-fold) of the optimized NL formulation in the animal hoof as compared with the commercial formulation. The findings of in vitro and ex vivo studies elucidated the potential of the optimized formulation. [Formula: see text].
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18
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Dhamoon RK, Popli H, Gupta M. Novel Drug Delivery Strategies for the Treatment of Onychomycosis. Pharm Nanotechnol 2019; 7:24-38. [PMID: 31092174 PMCID: PMC6691844 DOI: 10.2174/2211738507666190228104031] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. It was primarily considered a cosmetic problem but has been garnering attention lately due to its persistent nature and difficult treatment with relapses. With prolonged treatment duration and high cost involved in treating onychomycosis, several attempts have been made in overcoming the rigid nail barrier. The conventional treatment of onychomycosis involves oral and topical therapy. The oral antifungal agents though quite effective, are hepato-toxic and cause drug-drug interactions. Topical therapy is more patient compliant being devoid of such adverse effects but it suffers from another setback of improper nail penetration. Amorolfine and ciclopirox nail lacquers are popular market products. Since decades, efforts have been made to enhance topical delivery for efficiently treating onychomycosis. Mechanical, physical and chemical methods have been employed. Despite all the attempts made, the nail delivery issues are far from being solved. Recently, the focus has shifted to novel drug delivery systems like nanoparticles, microemulsions, polymeric films and nail lacquers for enhanced drug permeation and localized therapy. The research around the world is exploring their potential as effective treatment options. This review intends to further explore the novel delivery strategies to treat a persistent fungal infection like onychomycosis.
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Affiliation(s)
- Rupinder K. Dhamoon
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Harvinder Popli
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Madhu Gupta
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3, M.B Road, New Delhi -110017, India
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Cutrín-Gómez E, Anguiano-Igea S, Delgado-Charro MB, Gómez-Amoza JL, Otero-Espinar FJ. Effect of Penetration Enhancers on Drug Nail Permeability from Cyclodextrin/Poloxamer-Soluble Polypseudorotaxane-Based Nail Lacquers. Pharmaceutics 2018; 10:pharmaceutics10040273. [PMID: 30551601 PMCID: PMC6321522 DOI: 10.3390/pharmaceutics10040273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/06/2018] [Accepted: 12/11/2018] [Indexed: 12/26/2022] Open
Abstract
Nail delivery has interest for local treatment of nail diseases. Nevertheless, the low permeability of drugs in the nail plaque precludes the efficacy of local treatments. The use of penetration enhancers can increase drug permeability and improve the efficacy of the treatment of nail pathologies. In this work, different chemical substances have been evaluated as potential penetration enhancers. With this aim, the effect of different substances such as sodium lauryl sulfate (SLS), polyethylene glycol 300 (PEG 300), carbocysteine, N-acetylcysteine, lactic acid, potassium phosphate, Labrasol® and Labrafil® in the microstructure, nail surface and drug permeability has been evaluated. The models obtained by mercury intrusion porosimetry and PoreXpert™ software show a more porous structure in nails treated with different enhancers. Permeation studies with bovine hooves and nails revealed that all the hydroalcoholic lacquers developed, and particularly those prepared with SLS, provide better nail penetration of the drugs ciclopirox olamine and clobetasol propionate. Results have shown that the increase of the drug penetration in the nail is caused by the formation of a porous random microstructure and by the decrease of the contact angle between lacquers and the surface or the nail plaque. The presence of SLS produces an improvement in the spreading of the solution on the nail surface and promotes the penetration of the solution into the nail pores. The hydroalcoholic lacquer, elaborated with cyclodextrin/poloxamer soluble polypseudorotaxane and sodium lauryl sulfate as an enhancer, allowed the rate of diffusion and penetration of the active ingredient within the nail to be significantly higher than obtained with the reference lacquers when using either ciclopirox olamine or clobetasol propionate as the active ingredient.
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Affiliation(s)
- Elena Cutrín-Gómez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain.
| | - Soledad Anguiano-Igea
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain.
| | | | - José Luis Gómez-Amoza
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain.
| | - Francisco J Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain.
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20
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Valdes BSG, Serro AP, Marto J, Santos RGD, Gómez EC, Otero-Espinar FJ, Bordado JM, Ribeiro HM. Polyurethanes as New Excipients in Nail Therapeutics. Pharmaceutics 2018; 10:E276. [PMID: 30551686 PMCID: PMC6321266 DOI: 10.3390/pharmaceutics10040276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022] Open
Abstract
Onychomycosis affects about 15% of the population. This disease causes physical and psychosocial discomfort to infected patients. Topical treatment (creams, solutions, gels, colloidal carriers, and nail lacquers) is usually the most commonly required due to the high toxicity of oral drugs. Currently, the most common topical formulations (creams and lotions) present a low drug delivery to the nail infection. Nail lacquers appear to increase drug delivery and simultaneously improve the effectiveness of treatment with increased patient compliance. These formulations leave a polymer film on the nail plate after solvent evaporation. The duration of the film residence in the nail constitutes an important property of nail lacquer formulation. In this study, a polyurethane polymer was used to delivery antifungals drugs, such as terbinafine hydrochloride (TH) and ciclopirox olamine (CPX) and the influence of its concentration on the properties of nail lacquer formulations was assessed. The nail lacquer containing the lowest polymer concentration (10%) was the most effective regarding the in vitro release, permeation, and antifungal activity. It has also been demonstrated that the application of PU-based nail lacquer improves the nail plate, making it smooth and uniform and reduces the porosity contributing to the greater effectiveness of these vehicles. To conclude, the use of polyurethane in nail formulations is promising for nail therapeutics.
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Affiliation(s)
- Barbara S Gregorí Valdes
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisboa, Portugal.
- Centre for Natural Resources and the Environment (Cerena), Instituto Superior Técnico, Universidade de Lisboa, 1049-001Lisboa, Portugal.
| | - Ana Paula Serro
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, 2829-511 Caparica, Portugal.
- Centro de Química Estrutural (CQE), Instituto Superior Técnico, Universidade de Lisboa, 1049-001Lisboa, Portugal.
| | - Joana Marto
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisboa, Portugal.
| | - Rui Galhano Dos Santos
- Centre for Natural Resources and the Environment (Cerena), Instituto Superior Técnico, Universidade de Lisboa, 1049-001Lisboa, Portugal.
| | - Elena Cutrín Gómez
- Department of Pharmacy and Pharmaceutical Technology Santiago de Compostela, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Francisco J Otero-Espinar
- Department of Pharmacy and Pharmaceutical Technology Santiago de Compostela, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - João Moura Bordado
- Centre for Natural Resources and the Environment (Cerena), Instituto Superior Técnico, Universidade de Lisboa, 1049-001Lisboa, Portugal.
| | - Helena Margarida Ribeiro
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisboa, Portugal.
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21
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22
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Cutrín-Gómez E, Anguiano-Igea S, Delgado-Charro MB, Gómez-Amoza JL, Otero-Espinar FJ. Effect on Nail Structure and Transungual Permeability of the Ethanol and Poloxamer Ratio from Cyclodextrin-Soluble Polypseudorotaxanes Based Nail Lacquer. Pharmaceutics 2018; 10:pharmaceutics10030156. [PMID: 30208659 PMCID: PMC6160925 DOI: 10.3390/pharmaceutics10030156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/11/2022] Open
Abstract
Aqueous-based nail lacquers have shown potential in promoting the diffusion of drugs into the nail. In our laboratory, we have recently developed a transungual delivery system based on an aqueous dispersion of cyclodextrin-poloxamer soluble polypseudorotaxanes, supramolecular host−guest assemblies that improves the drug permeation into the nail. However, the high-water content and the rheological and adhesive properties of this lacquer negatively affect properties that play a fundamental role in the patients’ acceptance such as stickiness, nail film formation or drying rate, properties. In this work, we have optimized the composition of these lacquers to improve these properties whilst maintaining good drug permeation profiles. Incorporating ethanol into the vehicle and reducing the proportion of Poloxamer 407 (PL), provided a good strategy. The use of hydro-ethanolic mixtures (>50% ethanol) and the reduction of the poloxamer concentration significantly improved the lacquer drying speed by reducing the stickiness and promoting film formation on the nail surface. Additionally, in a surprising way, the use of hydro-ethanolic vehicles further enhanced the permeation of ciclopirox olamine and clobetasol propionate, used for the treatment of onychomycosis and nail psoriasis respectively, into the nail and hooves.
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Affiliation(s)
- Elena Cutrín-Gómez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | - Soledad Anguiano-Igea
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | | | - José Luis Gómez-Amoza
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | - Francisco J Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
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23
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Sayed S, Elsayed I, Ismail MM. Optimization of β-cyclodextrin consolidated micellar dispersion for promoting the transcorneal permeation of a practically insoluble drug. Int J Pharm 2018; 549:249-260. [PMID: 30077759 DOI: 10.1016/j.ijpharm.2018.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 11/25/2022]
Abstract
Development of efficient ocular drug delivery system for antifungal drugs becomes a must nowadays to face and eradicate the widely spread ophthalmic fungal infections. Itraconazole, a triazole antifungal, is struggling to penetrate the cornea and subsequently, its efficacy is limited. The aim of this study was to enhance itraconazole corneal penetration through utilizing the minimum surfactant amount in presence of β-cyclodextrin which acted as a dissolution and permeation enhancer. β-Cyclodextrin consolidated micellar dispersions (CCMD) were prepared after an initial screening to select the composition of surfactant(s). The preparation was done according to a modified melt dispersion technique. The prepared CCMD were characterized through the analysis of their particle size, zeta potential and solubilization efficiency. The optimum formula was chosen based on a factorial response surface analysis and it was composed of 17:1 w/w surfactant/drug, 30:1 w/w cyclodextrin/drug ratios and 0.02% polyethylene oxide. This formula was subjected to in vitro characterization including release, imaging by transmission electron microscope, mucoadhesion, stability, in addition to the determination of the minimum inhibitory concentration. Moreover, the ex vivo/in vivo permeation, safety and efficacy profiles were determined. The optimized CCMD formula was found to be significantly safe, stable, mucoadhesive and efficient to permeate the drug through rabbits' corneas. Consequently, the optimized CCMD formulation can be a promising, safe and efficient platform for the transcorneal delivery of lipophilic drugs including most antifungals.
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Affiliation(s)
- Sinar Sayed
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Ibrahim Elsayed
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt; Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, United Arab Emirates.
| | - Maha M Ismail
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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24
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Evaluation of the promoting effect of soluble cyclodextrins in drug nail penetration. Eur J Pharm Sci 2018; 117:270-278. [DOI: 10.1016/j.ejps.2018.02.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 12/17/2022]
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25
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Cutrín Gómez E, Anguiano Igea S, Delgado-Charro MB, Gómez Amoza JL, Otero Espinar FJ. Microstructural alterations in the onychomycotic and psoriatic nail: Relevance in drug delivery. Eur J Pharm Biopharm 2018; 128:48-56. [PMID: 29673870 DOI: 10.1016/j.ejpb.2018.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/03/2018] [Accepted: 04/15/2018] [Indexed: 11/17/2022]
Abstract
Despite the important nail alterations caused by onychomycosis and psoriasis few studies have characterized the microstructure of the diseased nail plate and the diffusion and penetration of drugs through this altered structure. This work aimed to characterize the microstructure of the healthy, onychomycotic and psoriatic human nail using Raman spectroscopy, scanning electron microscopy, optical microscope profilometry and mercury intrusion porosimetry followed by analysis of the structure with PoreCor® software. The results showed that onychomycotic nails have higher porosity and lower amounts of disulphide bonds compared to healthy nails. This suggests that the presence and action of fungi on the nail plate makes this structure more permeable to water and drugs. Psoriatic nails had increased porosity compared to healthy nails but lower than fungal infected specimens. In vitro permeation studies showed that diseased nails were more permeable to ciclopirox (onychomycosis) and clobetasol (psoriasis) although drug permeation was highly variable and likely to be influenced by the degree of alteration of the nail structure. On the whole, this work provides new and valuable information about the microstructure and porosity of diseased nails and a plausible explanation of the increased drug permeability observed in this work and elsewhere.
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Affiliation(s)
- Elena Cutrín Gómez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
| | - Soledad Anguiano Igea
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
| | | | - José Luis Gómez Amoza
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
| | - Francisco J Otero Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela, Spain; Industrial Pharmacy Institute, University of Santiago de Compostela, Spain
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26
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Voriconazole-loaded nanostructured lipid carriers (NLC) for drug delivery in deeper regions of the nail plate. Int J Pharm 2017; 531:292-298. [PMID: 28859937 DOI: 10.1016/j.ijpharm.2017.08.115] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 12/31/2022]
Abstract
Voriconazole-loaded nanostructured lipid carriers (VOR-NLC) were developed and drug penetration evaluated in porcine hooves in vitro. Synergistic effect of urea (Ur), selected among other known chemical enhancers according to hoof hydration potential, was also evaluated. VOR-NLC presented a high encapsulation efficiency (74.52±2.13%), approximate mean diameter of 230nm and were positively charged (+27.32±2.74mV). Stability studies indicated they were stable under refrigeration (4±2°C) for up to 150days. SEM images revealed hooves treated with VOR-NLC and VOR-NLC-Ur suffered a disturbance on the surface depicting high roughness and porosity. Permeation data showed a substantial VOR amount retained in superficial hooves sections independent of the formulation used (2.42±0.26; 2.52±0.36 and 2.41±0.60μg/cm2 for unloaded VOR, VOR-NLC and VOR-NLC-Ur, respectively, p>0.05). Still, successive extractions, revealed the amount of VOR retained in deeper regions was significantly higher when VOR-NLC or VOR-NLC-Ur was used (0.17±0.04, 0.47±0.14 and 0.36±0.07μg/cm2 for unloaded VOR, VOR-NLC and VOR-NLC-Ur, respectively, p<0.05). Such results indicate NLC are promising formulations for the management of onychomycosis. Further studies in diseased nail plates are necessary.
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27
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Thapa RK, Choi JY, Go TG, Kang MH, Han SD, Jun JH, Son MW, Yong CS, Kim JO. Development of ciclopirox nail lacquer with enhanced permeation and retention. Arch Pharm Res 2016; 39:953-9. [PMID: 27306785 DOI: 10.1007/s12272-016-0774-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Abstract
Onychomycosis is a prevailing disease caused by fungal infection of nails that mostly affects athletes and the elderly. Ciclopirox is approved by the US Food and Drug Administration for the topical treatment of onychomycosis. However, the desired penetration of ciclopirox into the nail bed has not been achieved via topical application for efficient treatment. Therefore, the main aim of this study was to enhance ciclopirox permeation and retention in nail by the development of a new nail lacquer formulation. We screened the effects of different solvents, alkalizing agents, and permeation enhancers on the permeation of bovine hooves by ciclopirox and its retention in human nail clippings. The results suggest that isopropyl alcohol, potassium hydroxide, and urea as the solvent, alkalizing agent, and permeation enhancer, respectively, improved the permeation of the ciclopirox nail lacquer formulation the most with high flux rates. Comparison of the final formulation and marketed product revealed enhanced retention of ciclopirox from our developed formulation in human nail clippings. Therefore, our newly developed nail lacquer may be a potentially effective formulation for the treatment of onychomycosis in humans.
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Affiliation(s)
- Raj Kumar Thapa
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Ju Yeon Choi
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Toe Gyung Go
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Min Hyung Kang
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Sang Duk Han
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Joon-Ho Jun
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Mi Won Son
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Chul Soon Yong
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Jong Oh Kim
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea.
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28
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Kataria P, Sharma G, Thakur K, Bansal V, Dogra S, Katare OP. Emergence of nail lacquers as potential transungual delivery system in the management of onchomycosis. Expert Opin Drug Deliv 2016; 13:937-52. [DOI: 10.1080/17425247.2016.1174691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Gajanand Sharma
- Division of Pharmaceutics, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
| | - Kanika Thakur
- Division of Pharmaceutics, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
| | - Vikas Bansal
- Chandigarh College of Pharmacy, Mohali, Punjab, India
| | - Sunil Dogra
- Department of Dermatology Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Katare
- Division of Pharmaceutics, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
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Physicochemical characterization and in vivo evaluation of triamcinolone acetonide-loaded hydroxyapatite nanocomposites for treatment of rheumatoid arthritis. Colloids Surf B Biointerfaces 2016; 140:223-232. [DOI: 10.1016/j.colsurfb.2015.12.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/05/2015] [Accepted: 12/27/2015] [Indexed: 01/17/2023]
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30
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Maged A, Mahmoud AA, Ghorab MM. Nano Spray Drying Technique as a Novel Approach To Formulate Stable Econazole Nitrate Nanosuspension Formulations for Ocular Use. Mol Pharm 2016; 13:2951-65. [PMID: 27010795 DOI: 10.1021/acs.molpharmaceut.6b00167] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effect of using methyl-β-cyclodextrin and hydroxypropyl-β-cyclodextrin as carriers for econazole nitrate nanoparticles prepared by nano spray dryer was explored in this work. Stabilizers, namely, poly(ethylene oxide), polyvinylpyrrolidone k30, poloxamer 407, Tween 80, and Cremophor EL, were used. The nano spray dried formulations revealed almost spherical particles with an average particle size values ranging from 121 to 1565 nm and zeta potential values ranging from -0.8 to -2.5 mV. The yield values for the obtained formulations reached 80%. The presence of the drug in the amorphous state within the nanosuspension matrix system significantly improved drug release compared to that for pure drug. Combination of hydroxypropyl-β-cyclodextrin with Tween 80 achieved an important role for preserving the econazole nanosuspension from aggregation during storage for one year at room temperature as well as improving drug release from the nanosuspension. This selected formulation was suspended in chitosan HCl to increase drug release and bioavailability. The in vivo evaluation on albino rabbit's eyes demonstrated distinctly superior bioavailability of the selected formulation suspended in chitosan compared to its counterpart formulation suspended in buffer and crude drug suspension due to its mucoadhesive properties and nanosize. The nano spray dryer could serve as a one step technique toward formulating stable and effective nanosuspensions.
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Affiliation(s)
- Amr Maged
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt , Cairo, Egypt
| | - Azza A Mahmoud
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt , Cairo, Egypt.,Department of Pharmaceutical Technology, National Research Center , Dokki, Cairo, Egypt
| | - Mahmoud M Ghorab
- Department of Pharmaceutics, Faculty of Pharmacy, Cairo University , Cairo, Egypt
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Bseiso EA, Nasr M, Sammour OA, Abd El Gawad NA. Novel nail penetration enhancer containing vesicles "nPEVs" for treatment of onychomycosis. Drug Deliv 2015; 23:2813-2819. [PMID: 26447337 DOI: 10.3109/10717544.2015.1099059] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CONTEXT The systemic treatment of onychomycosis has been hampered by the reported side effects of antifungals in addition to the limited blood circulation to the affected nails. Topical ungual treatment would circumvent the limitations of systemic onychomycosis treatment. OBJECTIVE Preparation and characterization of nail penetration enhancer containing nanovesicles (nPEVs) loaded with sertaconazole for topical treatment of onychomycosis. MATERIALS AND METHODS nPEVs were prepared using different nail penetration enhancers (N-acetyl-L-cysteine, thioglycolic acid, thiourea and ethanol) by the thin film hydration method, and characterized for their particle size, zeta potential, entrapment efficiency (EE%), elasticity, viscosity, physical stability and morphology. The selected nPEVs formula and the marketed Dermofix® cream were compared in terms of nail hydration, transungual drug uptake and antifungal activity against Trichophyton rubrum. RESULTS N-acetyl-l-cysteine was the optimum nail penetration enhancer for incorporation within vesicles. nPEVs showed high EE% of sertaconazole ranging from 77 to 95%, a size ranging from 38-538 nm and a zeta potential ranging from +48 to +72 mV. The selected nPEVs formula displayed spherical morphology and good storage stability. Compared to the conventional marketed cream, the selected nPEVs formula showed 1.4-folds higher hydration and drug uptake enhancement into nail clippings. Furthermore, it showed significantly higher zone of inhibition for Trichophyton rubrum (20.9 ± 0.25 mm) than the marketed cream (11.6 ± 0.44 mm). CONCLUSION Nail penetration enhancer containing nanovesicles (nPEVs) present a very promising option, worthy of clinical experimentation on onychomycotic patients.
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Affiliation(s)
- Eman A Bseiso
- a Department of Pharmaceutics , Faculty of Pharmacy, October 6 University , Cairo , Egypt
| | - Maha Nasr
- b Department of Pharmaceutics and Industrial Pharmacy , Faculty of Pharmacy, Ain Shams University , Cairo , Egypt , and
| | - Omaima A Sammour
- b Department of Pharmaceutics and Industrial Pharmacy , Faculty of Pharmacy, Ain Shams University , Cairo , Egypt , and
| | - Nabaweya A Abd El Gawad
- a Department of Pharmaceutics , Faculty of Pharmacy, October 6 University , Cairo , Egypt.,c Department of Pharmaceutics and Industrial Pharmacy , Faculty of Pharmacy, Cairo University , Cairo , Egypt
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Abstract
Nail disorders are beyond cosmetic concern; besides discomfort in the performance of daily chores, they disturb patients psychologically and affect their quality of life. Fungal nail infection (onychomycosis) is the most prevalent nail-related disorder affecting a major population worldwide. Overcoming the impenetrable nail barrier is the toughest challenge for the development of efficacious topical ungual formulation. Sophisticated techniques such as iontophoresis and photodynamic therapy have been proven to improve transungual permeation. This article provides an updated and concise discussion regarding the conventional approach and upcoming novel approaches focused to alter the nail barrier. A comprehensive description regarding preformulation screening techniques for the identification of potential ungual enhancers is also described in this review while highlighting the current pitfalls for the development of ungual delivery.
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Täuber A, Müller-Goymann CC. In vitro permeation and penetration of ciclopirox olamine from poloxamer 407-based formulations – comparison of isolated human stratum corneum, bovine hoof plates and keratin films. Int J Pharm 2015; 489:73-82. [DOI: 10.1016/j.ijpharm.2015.04.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
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Thatai P, Tiwary AK, Sapra B. Progressive development in experimental models of transungual drug delivery of anti-fungal agents. Int J Cosmet Sci 2015; 38:1-12. [PMID: 25919363 DOI: 10.1111/ics.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/15/2015] [Indexed: 12/31/2022]
Abstract
Pre-clinical development comprises of different procedures that relate drug discovery in the laboratory for commencement of human clinical trials. Pre-clinical studies can be designed to recognize a lead candidate from a list to develop the procedure for scale-up, to choose the unsurpassed formulation, to determine the frequency, and duration of exposure; and eventually make the foundation of the anticipated clinical trial design. The foremost aim in the pharmaceutical research and industry is the claim of drug product quality throughout a drug's life cycle. The particulars of the pre-clinical development process for different candidates may vary; however, all have some common features. Typically in vitro, in vivo or ex vivo studies are elements of pre-clinical studies. Human pharmacokinetic in vivo studies are often supposed to serve as the 'gold standard' to assess product performance. On the other hand, when this general assumption is revisited, it appears that in vitro studies are occasionally better than in vivo studies in assessing dosage forms. The present review is compendious of different such models or approaches that can be used for designing and evaluation of formulations for nail delivery with special reference to anti-fungal agents.
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Affiliation(s)
- P Thatai
- Pharmaceutics Division, Department of Pharmaceutical Sciences & Drug Research, Punjabi University, Patiala, India
| | - A K Tiwary
- Pharmaceutics Division, Department of Pharmaceutical Sciences & Drug Research, Punjabi University, Patiala, India
| | - B Sapra
- Pharmaceutics Division, Department of Pharmaceutical Sciences & Drug Research, Punjabi University, Patiala, India
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Murdan S, Kerai L, Hossin B. To what extent do in vitro tests correctly predict the in vivo residence of nail lacquers on the nail plate? J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Elsayed MMA. Development of topical therapeutics for management of onychomycosis and other nail disorders: a pharmaceutical perspective. J Control Release 2014; 199:132-44. [PMID: 25481439 DOI: 10.1016/j.jconrel.2014.11.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
The human nail plate is a formidable barrier to drug permeation. Development of therapeutics for management of nail diseases thus remains a challenge. This article reviews the current knowledge and recent advances in the field of transungual drug delivery and provides guidance on development of topical/ungual therapeutics for management of nail diseases, with special emphasis on management of onychomycosis, the most common nail disease. Selection of drug candidates, drug delivery approaches, and evaluation of formulations are among the topics discussed. A comprehensive mathematical description for transungual permeation is also introduced.
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Affiliation(s)
- Mustafa M A Elsayed
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, El-Khartoum Square, El-Azarita, Alexandria 21521, Egypt.
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Thatai P, Sapra B. Transungual delivery: deliberations and creeds. Int J Cosmet Sci 2014; 36:398-411. [PMID: 24888698 DOI: 10.1111/ics.12142] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/21/2014] [Indexed: 12/13/2022]
Abstract
Although considered as trifling illness, nail diseases have a reasonably high occurrence and a noteworthy impact on the patients' quality of life. Furthermore, there is a need to improve the topical treatment for nail diseases to avoid drug interactions and to reduce side effects associated with oral therapy. Topical drug delivery to the nails has established amplified consideration lately. Strategies (such as chemical enhancers, formulation strategies, physical and mechanical methods) are being investigated in order to improve drug permeability across the nail plate. The rationale of this review is to present contemporary information on the structure of human nail along with its comparison with animal hooves. Precincts of nail permeability have been briefly discussed with respect to factors like permeant's molecular size, hydrophilicity, charge and the nature of the vehicle. These factors affect drug uptake and permeation through the nail. Formulations like nail lacquers which mimic cosmetic varnish and colloidal carriers along with nail substitutes that can be utilized for transungual delivery have also been discussed.
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Affiliation(s)
- P Thatai
- Pharmaceutics Division, Department of Pharmaceutical Sciences, Punjabi University, Patiala, India
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Abstract
Topical therapy is at the forefront in treating nail ailments (especially onychomycosis and nail psoriasis) due to its local effects, which circumvents systemic adverse events, improves patient compliance and reduces treatment cost. However, the success of topical therapy has been hindered due to poor penetration of topical therapeutics across densely keratinized nail plate barrier. For effective topical therapy across nail plate, ungual drug permeation must be enhanced. Present review is designed to provide an insight into prime aspects of transungual drug delivery viz. nail structure and physiology, various onychopathies, techniques of nail permeation enhancement and in vitro models for trans-nail drug permeation studies. Updated list of drug molecules studied across the nail plate and key commercial products have been furnished with sufficient depth. Patents pertinent to, and current clinical status of transungual drug delivery have also been comprehensively reviewed. This is the first systematic critique encompassing the detailed aspects of transungual drug delivery. In our opinion, transungual drug delivery is a promising avenue for researchers to develop novel formulations, augmenting pharmaceutical industries to commercialize the products for nail disorders.
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Affiliation(s)
- Manish V Saner
- Department of Pharmaceutics, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, North Maharshtra University , Maharashtra , India
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Shubhra QTH, Tóth J, Gyenis J, Feczkó T. Poloxamers for Surface Modification of Hydrophobic Drug Carriers and Their Effects on Drug Delivery. POLYM REV 2014. [DOI: 10.1080/15583724.2013.862544] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Täuber A, Müller-Goymann CC. Comparison of the Antifungal Efficacy of Terbinafine Hydrochloride and Ciclopirox Olamine Containing Formulations against the Dermatophyte Trichophyton rubrum in an Infected Nail Plate Model. Mol Pharm 2014; 11:1991-6. [DOI: 10.1021/mp400711q] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anja Täuber
- Institut für Pharmazeutische
Technologie, Technische Universität Braunschweig, Mendelssohnstraße
1, 38106 Braunschweig, Germany
| | - Christel C. Müller-Goymann
- Institut für Pharmazeutische
Technologie, Technische Universität Braunschweig, Mendelssohnstraße
1, 38106 Braunschweig, Germany
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Influence of penetration enhancers and molecular weight in antifungals permeation through bovine hoof membranes and prediction of efficacy in human nails. Eur J Pharm Sci 2013; 51:20-5. [PMID: 23999034 DOI: 10.1016/j.ejps.2013.08.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/02/2013] [Accepted: 08/20/2013] [Indexed: 12/20/2022]
Abstract
This work aimed to evaluate the effect of different substances on the permeation of geraniol through bovine hoof membranes. Different penetration enhancers were able to increase the permeability up to 25 times compared to control. It was demonstrated that acetilcysteine in association with ascorbic acid increased the permeation, even in acid formulations. In addition, some antifungal drugs were incorporated into a gel formulation of HPMC containing acetylcysteine 5% and ascorbic acid 0.2% and then the permeation coefficient through bovine hoof membranes was evaluated. The relationship between permeability and molecular weight was established for fluconazole, miconazole, terbinafine, butenafine, geraniol and nerol. Geraniol and nerol, the antifungals with lower molecular weight, had the better permeability results. Permeability coefficients for nail plates were estimated and geraniol demonstrated similar or even better efficacy index values against T. rubrum, T. menthagrophytes and M. canis compared with terbinafine and miconazole.
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