The application of tribology in assessing texture perception of oral liquid medicines

Melatonin Use in School-Aged Children and Adolescents: An Exploration of Caregiver and Pharmacist Perspectives

OBJECTIVE

This study aims to explore the perspectives and experiences of Australian caregivers and community pharmacists about pediatric melatonin use.

METHODS

A convenience sample of caregivers with children (aged 11-16 years) using melatonin as a sleep aid and community pharmacists (including pharmacist interns) were recruited. Participants first completed an online survey followed by an online semi-structured interview. Interviews were guided by a schedule of questions for the respective participant groups, broadly exploring their beliefs about melatonin, experiences in using/supplying melatonin, and perceived facilitators/barriers for melatonin use. Interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach.

RESULTS

Fourteen caregivers of predominantly neurodiverse adolescents and 24 community pharmacists were interviewed. While melatonin was perceived by caregivers of both typically developing and neurodiverse dependants as safer than pharmacological sleep aids, treatment was only initiated after trialling non-pharmacological strategies first. Pharmacists expressed concerns around the ambiguities in practice and the limited scope of existing resources for guiding pediatric melatonin use. Caregivers frequently deferred to the information available online to procure products or self-adjust doses and dosing schedules. Both pharmacists and caregivers emphasized the need for more affordable and age-appropriate proprietary formulations that are readily accessible.

CONCLUSION

Melatonin is administered predominantly by caregivers of neurodiverse adolescents to address their sleep disturbances. The findings underscore the need for reliable, evidence-based information to guide safe and appropriate use of melatonin in pediatric populations. Patient education is also warranted to address maladaptive medication-administration practices. Lastly, there is a need for stronger regulatory oversight of melatonin products to ensure their quality and safety of use.

A Guide to Best Practice in Sensory Analysis of Pharmaceutical Formulations

It is well established that treatment regime compliance is linked to the acceptability of a pharmaceutical formulation, and hence also to therapeutic outcomes. To that end, acceptability must be assessed during the development of all pharmaceutical products and especially for those intended for paediatric patients. Although acceptability is a multifaceted concept, poor sensory characteristics often contribute to poor patient acceptability. In particular, poor taste is often cited as a major reason for many patients, especially children, to refuse to take their medicine. It is thus important to understand and, as far as possible, optimise the sensory characteristics and, in particular, the taste/flavour/mouthfeel of the formulation throughout the development of the product. Sensory analysis has been widely practiced, providing objective data concerning the sensory aspects of food and cosmetic products. In this paper, we present proposals concerning how the well-established principles of sensory analysis can best be applied to pharmaceutical product development, allowing objective, scientifically valid, sensory data to be obtained safely. We briefly discuss methodologies that may be helpful in reducing the number of samples that may need to be assessed by human volunteers. However, it is only possible to be sure whether or not the sensory characteristics of a pharmaceutical product are non-aversive to potential users by undertaking sensory assessments in human volunteers. Testing is also required during formulation assessment and to ensure that the sensory characteristics remain acceptable throughout the product shelf life. We provide a risk assessment procedure to aid developers to define where studies are low risk, the results of a survey of European regulators on their views concerning such studies, and detailed guidance concerning the types of sensory studies that can be undertaken at each phase of product development, along with guidance about the practicalities of performing such sensory studies. We hope that this guidance will also lead to the development of internationally agreed standards between industry and regulators concerning how these aspects should be measured and assessed throughout the development process and when writing and evaluating regulatory submissions. Finally, we hope that the guidance herein will help formulators as they seek to develop better medicines for all patients and, in particular, paediatric patients.

A Method for the Tribological Assessment of Oral Pharmaceutical Liquids

OBEJECTIVE Patient acceptance of pediatric formations is critical to compliance and consequently therapeutic outcomes; thus, having an in vitro method to evaluate sensory perception of pharmaceutical products would be beneficial. The objective of this research is to develop a sensitive and reproducible tribological method to characterize pharmaceutical suspensions at low force and sliding speeds.METHODS The discriminating potential of the method was examined using tribology profiles (coefficient of friction (COF) vs sliding speed) for commercially available products and products made for this study with widely varying sweetness, thickness and grittiness; these formulations were used to judge the sensitivity of the method. Samples were measured using 3M Transpore™ surgical tape to simulate the tongue surface, steel half ring geometry, constant gap setting, target axial force of 2 N in a 600 second exponential ramp for rotation speed.RESULTS The COF ranged from 0.1 to 0.6. For the speeds studied, the high viscosity commercial suspension Ibuprofen Drops and Acetaminophen suspension show a classic Stribeck Curve with an increasing COF at the higher rotation speeds, which indicates these formulations entered the hydrodynamic lubrication phase, while the lower viscosity suspensions only reached the mixed lubrication phase.CONCLUSIONS The contribution of particles seems to affect the COF in a dynamic pattern compared to products that are categorized as either low gritty or high viscosity. These results are important as they provide a potentially rapidly in vitro method for screening pediatric medications and help to identify the factors that affect the palatability of pediatric formulations.

Modernising Orodispersible Film Characterisation to Improve Palatability and Acceptability Using a Toolbox of Techniques

Orodispersible films (ODFs) have been widely used in paediatric, geriatric and dysphagic patients due to ease of administration and precise and flexible dose adjustments. ODF fabrication has seen significant advancements with the move towards more technologically advanced production methods. The acceptability of ODFs is dependent upon film composition and process of formation, which affects disintegration, taste, texture and mouthfeel. There is currently a lack of testing to accurately assess ODFs for these important acceptability sensory perceptions. This study produced four ODFs formed of polyvinyl alcohol and sodium carboxymethylcellulose using 3D printing. These were assessed using three in vitro methods: Petri dish and oral cavity model (OCM) methods for disintegration and bio-tribology for disintegration and oral perception. Increasing polymer molecular weight (MW) exponentially increased disintegration time in the Petri dish and OCM methods. Higher MW films adhered to the OCM upper palate. Bio-tribology analysis showed that films of higher MW disintegrated quickest and had lower coefficient of friction, perhaps demonstrating good oral perception but also stickiness, with higher viscosity. These techniques, part of a toolbox, may enable formulators to design, test and reformulate ODFs that both disintegrate rapidly and may be better perceived when consumed, improving overall treatment acceptability.

Dosage Forms Suitability in Pediatrics: Acceptability of Analgesics and Antipyretics in a German Hospital

Although medicine acceptability is likely to have a significant impact on the patient’s adherence in pediatrics and therefore on therapy success, there is still little data even for common therapeutic areas. For analgesics/antipyretics, healthcare professionals face a wide variety of products and need knowledge to select the best adapted product for each patient. We investigated acceptability of those products most used at the University Children’s Hospital Düsseldorf, Germany. Based on 180 real-life observer reports of medicine intake, we used the acceptability reference framework to score acceptability of six distinct medicines. Both ibuprofen and paracetamol tablets, mainly used in adolescents, were positively accepted. This was not the case for the solution for injection of metamizole sodium. Regarding syrups, mainly used in children under 6 years of age, ibuprofen flavored with strawberry and provided with an oral syringe was positively accepted, while paracetamol flavored with orange and provided with a measuring cup was not. Suppository appeared to be an alternative to oral liquids in infants and toddlers with palatability and administration issues. Differences appeared to be driven by dosage forms and formulations. These findings improve knowledge on acceptability drivers and might help formulating and prescribing better medicines for children.

Tribology provides an in vitro tool that correlated to in vivo sensory data on the mouthfeel of coated tablets

Tribology is an emerging technique in the pharmaceutical field for texture and mouthfeel studies. Due to its relevance to oral sensory perception, tribology supports the development of novel products in the food industry. This study explores tribology as a tool to optimise the mouthfeel and ease of swallowing of pharmaceutical coatings and coated tablets. We measured the lubricating properties of eight pharmaceutical coatings using two methods: surface tribology and thin film tribology. As food science is more advanced in texture and mouthfeel studies, methods were developed from this field with the intention to mimic tablet ingestion. Further, the link between tribological measurements and the sensory evaluation of the coated tablets obtained by a human panel was explored. We have demonstrated that discrimination of tablets with different coatings using tribology is feasible. The viscosity, solubility and composition of the coating formulations played an important factor in lubrication. For the first time, tribology was used to analyse the lubricating properties of conventional tablet coatings and a linear relationship between tribology and the oral sensory perception, i.e. slipperiness and stickiness, was demonstrated. Tribology has the potential to become a valuable formulation tool to characterise the lubricating behaviour of coated tablets in the context of oral sensory perception.

3D Biomimetic Tongue-Emulating Surfaces for Tribological Applications

Oral friction on the tongue surface plays a pivotal role in mechanics of food transport, speech, sensing, and hedonic responses. The highly specialized biophysical features of the human tongue such as micropapillae-dense topology, optimum wettability, and deformability present architectural challenges in designing artificial tongue surfaces, and the absence of such a biomimetic surface impedes the fundamental understanding of tongue-food/fluid interaction. Herein, we fabricate for the first time, a 3D soft biomimetic surface that replicates the topography and wettability of a real human tongue. The 3D-printed fabrication contains a Poisson point process-based (random) papillae distribution and is employed to micromold soft silicone surfaces with wettability modifications. We demonstrate the unprecedented capability of these surfaces to replicate the theoretically defined and simulated collision probability of papillae and to closely resemble the tribological performances of human tongue masks. These de novo biomimetic surfaces pave the way for accurate quantification of mechanical interactions in the soft oral mucosa.

Characterization of Orodispersible Films: An Overview of Methods and Introduction to a New Disintegration Test Apparatus Using LDR - LED Sensors

Orodispersible Film (ODF) is a promising and progressive dosage form that offers exceptional drug delivery benefits to patients. Indeed, they are the most transformational alternatives to traditional/conventional dosage forms such as tablets and capsules. ODFs are portable and highly comfortable for self-administration by patients with swallowing problems. The key to gain end-user acceptance is to have an ODF with outstanding quality. Poor quality may lead to choking or spitting, accordingly leading to a lack of compliance. It is vital to employ suitable experimental methodologies that facilitate characterization or determination of the quality of ODF. Nonetheless, there are no standard techniques prescribed in official compendia of any country. But, there is a consensus in the thin-film research community about the characterization techniques that one relies on deciding the quality of an ODF. We review various experimental techniques and highlight its importance in determining the performance and quality of an ODF. We provide a relatively novel and inventive disintegration test apparatus, which works using 'Light Dependent Resistor (LDR) and Light Emitting Diode (LED) sensors' for clear and accurate determination of start and end disintegration time of an ODF.

Orodispersible films containing ball milled aripiprazole-poloxamer®407 solid dispersions

This research aimed at developing ODFs containing an antipsychotic drug - aripiprazole (ARP). ARP, as a BCS II class molecule, requires enhancing its water solubility prior to formulating. Therefore, a solid dispersion of ARP - Poloxamer® 407 was prepared by ball milling, then incorporated into the films. It was found that co-processing led to an over 100-fold increase in drug solubility in comparison with pure drug. Moreover, ODFs with solid dispersion showed faster drug release (>95% below 15 min) and disintegration (<30 s), compared with raw ARP films. These results are believed to be due to the solubilization effect of poloxamer and enhanced wettability of the film. Films containing solid dispersions were found to possess smoother film surfaces and favorable mechanical properties - flexibility and strength. The ODF formulations, prepared by a casting method, were based on three different polymers (Kollicoat® IR, Kollicoat® Protect or PVA). It was found that not only the form of the incorporated drug, but also the type of film-forming polymer had an impact on the analyzed parameters. The use of PVA was beneficial in the film formulation with aripiprazole in comparison to other tested film-forming polymers.

Emulsion Microgel Particles as High-Performance Bio-Lubricants

Starch-based emulsion microgel particles with different starch (15 and 20 wt %) and oil contents (0-15 wt %) were synthesized, and their lubrication performance under physiological conditions was investigated. Emulsion microgels were subjected to skin mimicking or oral cavity mimicking conditions, i.e., smooth hydrophobic polydimethylsiloxane ball-on-disc tribological tests, in the absence or presence of salivary enzyme (α-amylase). In the absence of enzyme, emulsion microgel particles (30-60 vol % particle content) conserved the lubricating properties of emulsion droplets, providing considerably lower friction coefficients (μ ≤ 0.1) in the mixed lubrication regime compared to plain microgel particles (0 wt % oil). Upon addition of enzyme, the lubrication performance of emulsion microgel particles became strongly dependent on the particles' oil content. Microgel particles encapsulating 5-10 wt % oil showed a double plateau mixed lubrication regime having a lowest friction coefficient μ ∼ 0.03 and highest μ ∼ 0.1, the latter higher than with plain microgel particles. An oil content of 15 wt % was necessary for the microgel particles to lubricate similarly to the emulsion droplets, where both systems showed a normal mixed lubrication regime with μ ≤ 0.03. The observed trends in tribology, theoretical considerations, and the combined results of rheology, light scattering, and confocal fluorescence microscopy suggested that the mechanism behind the low friction coefficients was a synergistic enzyme- and shear-triggered release of the emulsion droplets, improving lubrication. The present work thus demonstrates experimentally and theoretically a novel biolubricant additive with stimuli-responsive properties capable of providing efficient boundary lubrication between soft polymeric surfaces. At the same time, the additive should provide an effective delivery vehicle for oil soluble ingredients in aqueous media. These findings demonstrate that emulsion microgel particles can be developed into multifunctional biolubricant additives for future use in numerous soft matter applications where both lubrication and controlled release of bioactives are essential.

Validation and Feasibility of the Medication Acceptability Questionnaire to Investigate Tablet and Liquid Alendronic Acid with Older Hospital Patients

The effects of formulation characteristics on acceptability are poorly understood. This study evaluated the validity and feasibility of using the Medication Acceptability Questionnaire (MAQ) to investigate factors influencing acceptability of tablet compared with liquid alendronic acid. Written consent was obtained from eligible patients on Older People’s Medicine wards. MAQ face and content validity were evaluated through cognitive interviews while internal consistency and criterion validity were investigated by calculating Cronbach’s alpha and correlation of MAQ items with visual analogue scale (VAS) responses. MAQ data were obtained from 33 and 25 participants for tablet and liquid formulations respectively. Cognitive interviews indicated MAQ face and content validity. The domains of appearance, efficacy, and tolerability demonstrated adequate internal consistency and suitable refinements were identified for the domains of convenience and taste with Cronbach’s alpha <0.7. Significant positive correlations were identified between all MAQ domains and VAS. The liquid trended towards performing better for taste, appearance and tolerability and the tablet for convenience and efficacy. It is feasible to capture patient acceptability of a medication by questionnaire. Interpatient variation in acceptability for two formulations indicates that medication characteristics should be considered during prescribing and medication reviews to match patient preference with the appropriate formulation.

Co-Processed Excipients for Dispersible Tablets-Part 2: Patient Acceptability

Palatability and patient acceptability are critical attributes of dispersible tablet formulation. Co-processed excipients could provide improved organoleptic profile due to rational choice of excipients and manufacturing techniques. The aim of this study was to identify the most suitable co-processed excipient to use within directly compressible dispersible tablet formulations. Nine excipients, selected based on successful manufacturability, were investigated in a randomised, preference and acceptability testing in 24 healthy adult volunteers. Excipients were classified in order of preference as follows (from most preferred): SmartEx QD100 > F-Melt Type C > F-Melt Type M > MicroceLac > Ludiflash > CombiLac > Pharmaburst 500 > Avicel HFE-102 > Avicel PH-102. Broad differences were identified in terms of acceptability, with SmartEx QD100 being 'very acceptable', F-Melt Type C, F-Melt Type M and MicroceLac being 'acceptable', Ludiflash, CombiLac and Pharmaburst 500 being 'neutral' and Avicel products being 'very unacceptable' based on ratings using five-point hedonic scales. Organoleptic differences were ascribed to different composition and physical properties of excipients, resulting in dissimilar taste and mouth-feel. Excipients with particle size in water larger than 200-250 μm were considered poorly acceptable, which supports the use of this value as a threshold for maximum particle size of dispersible formulation. The most promising co-processed excipients for directly compressible dispersible tablets were successfully identified.

A review of diet standardization and bolus rheology in the management of dysphagia

PURPOSE OF REVIEW

Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This article aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances.

RECENT FINDINGS

Instrumental assessment of texture modification in vivo is challenging, and studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardization of foods and drinks. However in 2015 a not-for-profit organization, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the - limited - available clinical evidence.

SUMMARY

Rheology exists in the lab; however, normal practice is often subjective or lacking control and standardization. In the near future, cohesion of practice and the availability of practical standardization tools may increase awareness and use of rheology.

An in vitro experiment to simulate how easy tablets are to swallow

The compliance of patients to solid oral dosage forms is strongly conditioned by the perceived ease of swallowing, especially in geriatric and pediatric populations. This study proposes a method, based on an in vitro model of the human oropharyngeal cavity, to study quantitatively the oral phase of human swallowing in presence of single or multiple tablets. The dynamics of swallowing was investigated varying the size and shape of model tablets and adjusting the force applied to the mechanical setup to simulate tongue pressure variations among individuals. The evolution of the velocity of the bolus, the oral transit time, and the relative position of the solid oral dosage form within the liquid bolus were measured quantitatively from high speed camera recordings. Whenever the solid dosage forms were big enough to interact with the walls of the in vitro oral cavity, a strong effect of the volume of the medication in respect of its swallowing velocity was observed, with elongated tablets flowing faster than spherical tablets. Conversely, the geometrical properties of the solid oral dosage forms did not significantly affect the bolus dynamics when the cross section of the tablet was lower than 40% of that of the bolus. The oral phase of swallowing multiple tablets was also considered in the study by comparing different sizes while maintaining a constant total mass. The predictive power of different theories was also evaluated against the experimental results, providing a mechanistic interpretation of the dynamics of the in vitro oral phase of swallowing. These findings and this approach could pave the way for a better design of solid oral medications to address the special needs of children or patients with swallowing disorders and could help designing more successful sensory evaluations and clinical studies.

Pediatric Dispersible Tablets: a Modular Approach for Rapid Prototyping

PURPOSE

The design of pediatric formulations is challenging. Solid dosage forms for children have to meet the needs of different ages, e.g. high number of dosing increments and strengths. A modular formulation strategy offering the possibility of rapid prototyping was applied. Different tablet compositions and the resulting tablet characteristics were investigated for dispersible tablets using customized analytical methods.

METHODS

Fluid bed granules were blended with extragranular components, and compressed to tablets. Disintegration behavior was studied with a Texture Analyzer and a Tensiometer.

RESULTS

Methods for determination of disintegration time and water uptake of tablets were developed with a Texture Analyzer, and a Tensiometer, respectively. Twenty-two different tablet formulations were prepared and analyzed with respect to disintegration time, hardness, friability, and viscosity. Multivariate data analysis revealed a high impact of type and amount of viscosity enhancer on the disintegration behavior of tablets. An optimized formulation was selected with a disintegration time of 24 s.

CONCLUSION

Methods providing additional information on the disintegration behavior of dispersible tablets compared to standard pharmacopoeia methods were established. Selecting the right type and level of viscosity enhancer and superdisintegrant was critical for developing pediatric tablets with a disintegration time of less than 30 s but still pleasant mouth feel.