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Salunke S, Agrawal A, Walsh J, Nunn A, Hughes K, Kuehl P, Caivano G, Clapham D, Thompson K, Rumondor A, Enright B, Sherratt P. Selecting appropriate excipients for paediatric dosage form - Paediatric excipients risk assessment (PERA) framework - Part 1. Eur J Pharm Biopharm 2024; 203:114458. [PMID: 39159869 DOI: 10.1016/j.ejpb.2024.114458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
Excipients are often the major component of the formulation that critically affect the dosage form, manufacturing process, product performance, stability and safety. They exert different roles and functions in a dosage form. Selecting excipients with appropriate safety and tolerability is a major hurdle in paediatric formulation development. The suitability of a particular excipient will be dependent on the context of its use with regard to the paediatric age range, acute versus chronic use, and clinical risk-benefit of the disease, active and excipient. Scientists are encouraged to apply the principle of risk-benefit to assess the suitability of excipients to the specific paediatric population. Indicative list of parameters that should be taken into consideration and hierarchy of information sources when assessing the excipients risks is provided by regulatory agencies. However, the approach to be taken and details of how the risk evaluation should be undertaken are lacking. There is a need for a systematic approach to selection of excipients and assessment of the risk of excipient exposure. The Paediatric Excipients Risk Assessment (PERA) framework developed and proposed in this paper provides a structured, systematic decision-making framework via customizable tools and processes that can help to improve the transparency and communications on the selection and justification of use of excipients in a paediatric formulation.
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Affiliation(s)
- Smita Salunke
- European Paediatric Formulation Initiative (EUPFI), University College London School of Pharmacy, London WC1N 1AX, UK.
| | - Anjali Agrawal
- Novo Nordisk Inc., 300 North Beacon Street, Suite 501, Watertown, MA 02472, USA.
| | | | - Anthony Nunn
- University of Liverpool, Department of Women's and Children's Health, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS, UK.
| | - Kevin Hughes
- IPEC (International Pharmaceutical Excipients Council) and Colorcon Ltd, Dartford, UK.
| | - Peter Kuehl
- F. Hoffmann La Roche AG, Grenzacher Str. 124, CH-4070 Basel, Switzerland
| | - Grazia Caivano
- Chiesi Farmaceutici S.p.A., Largo Francesco Belloli 11/A, 43122 Parma, Italy.
| | - David Clapham
- Independent Pharmaceutical Consultant, Bishops Stortford, UK.
| | - Karen Thompson
- Merck & Co., Inc., 126 E Lincoln Ave, Rahway, NJ 07065, USA.
| | - Alfred Rumondor
- Bristol Myers Squibb, One Squibb Drive, New Brunswick, NJ 08901, USA.
| | - Brian Enright
- Abbvie Inc., 1 N Waukegan Road, North Chicago, IL 60064, USA.
| | - Philip Sherratt
- Bristol Myers Squibb, 556 Morris Avenue, Summit, NJ 07901, USA.
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Buchanan AM, Bekker A, Chandasana H, DeMasi R, Lulic Z, Ernest T, Brothers C, Min S, Ruel T, Tan LK. Advancing research and development of anti-infectives for children with a focus on antiretroviral therapy: A clinical development perspective. Int J Antimicrob Agents 2024; 64:107306. [PMID: 39146996 DOI: 10.1016/j.ijantimicag.2024.107306] [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: 12/01/2023] [Revised: 06/17/2024] [Accepted: 08/06/2024] [Indexed: 08/17/2024]
Abstract
The HIV treatment landscape for adults has progressed dramatically in recent decades; however, paediatric populations continue to experience delayed and limited access to effective and safe antiretroviral therapy options. Despite current incentive programmes, formulation research and development and approved drug dosing for children have been limited, particularly for neonates (aged <4 wk). Regulatory approval of drug formulations and dosing in children may lag behind adult approvals by years. Formulation and trial design adjustments complicate paediatric drug development, all of which are vital to accommodate for physiological differences, organ maturation, and rapid weight gain, which are most significant in the youngest children. To facilitate more rapid anti-infective drug development for paediatric populations, regulatory agencies provide guidelines that include extrapolating efficacy and safety data from relevant populations; using pharmacokinetic (PK) bridging and modelling to reduce sample sizes and limit the number of PK studies needed before efficacy analyses; and enrolling age- or weight-based cohorts in parallel rather than sequentially for clinical trials. Ensuring access to approved drugs poses an additional challenge, as uncertainty in demand leads to manufacturing and supply complexity with potentially higher costs that can be a barrier to uptake. Here we summarise challenges in drug development for children living with HIV, which are not unique to antiretrovirals. We aim to propose strategies for how model-based approaches and global partnerships can overcome some of these barriers to accelerate paediatric drug development, with particular reference to HIV, and how lessons learnt from HIV could be extended to other anti-infectives.
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Affiliation(s)
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | | | - Theodore Ruel
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, CA, USA
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Song L, Zhang N, Jiang TT, Jia Y, Liu Y. Paediatric Drug Development in China: Current Status and Future Prospects. Paediatr Drugs 2024; 26:555-563. [PMID: 38837008 DOI: 10.1007/s40272-024-00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/06/2024]
Abstract
For more than two decades, regulatory agencies throughout the world released guidelines, rules and laws to stimulate and assist in paediatric drug development. In 2014, the National Health and Family Planning Commission (now known as the National Health Commission, NHC) and five other departments in China jointly issued 'Several Opinions on Safeguarding Medication for Children', after which several policies and regulations were issued to implement the priority review and approval of paediatric medicinal products and support the development of new drugs, including new dosage forms and strengths, for children. A total of 172 special medicinal products for children were approved from 2018 to 2022. Since 2016, the NHC, together with relevant administrative departments, has formulated and issued four paediatric drug lists containing 129 medicinal products to encourage research and development. At present, approximately 25 of these drugs (at exactly the same dosage forms and strengths as on the lists) have been approved for marketing, including antitumour drugs and immunomodulators, nervous system drugs, drugs for mental disorders and drugs for rare diseases. In this review, we analysed the regulations issued for promoting paediatric drug development in China, including the priority review and approval system, technical guidelines, data protection and financial support policies and general profiles of paediatric drug approval, clinical trials and the addition of information for children in the labels of marketed medicinal products. Finally, we discussed the challenges and possible strategies in the research and development of paediatric drugs in China.
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Affiliation(s)
- Lin Song
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Ni Zhang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Ting-Ting Jiang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yuntao Jia
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Baumgartner A, Planinšek O. Development of Orodispersible Tablets with Solid Dispersions of Fenofibrate and Co-Processed Mesoporous Silica for Improved Dissolution. Pharmaceutics 2024; 16:1060. [PMID: 39204405 PMCID: PMC11359594 DOI: 10.3390/pharmaceutics16081060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/05/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024] Open
Abstract
Poor water solubility is an important challenge in the development of oral patient-friendly solid dosage forms. This study aimed to prepare orodispersible tablets with solid dispersions of a poorly water-soluble drug fenofibrate and a co-processed excipient consisting of mesoporous silica and isomalt. This co-processed excipient, developed in a previous study, exhibited improved flow and compression properties compared to pure silica while maintaining a high specific surface area for drug adsorption. Rotary evaporation was used to formulate solid dispersions with different amounts of fenofibrate, which were evaluated for solid state properties and drug release. The solid dispersion with 30% fenofibrate showed no signs of crystallinity and had a significantly improved dissolution rate, making it the optimal sample for formulation or orodispersible tablets. The aim was to produce tablets with minimal amounts of additional excipients while achieving a drug release profile similar to the uncompressed solid dispersion. The compressed formulations met the requirements for orodispersible tablets in terms of disintegration time, and the drug release from best formulation approximated the profile of uncompressed solid dispersion. Future research should focus on reducing the disintegration time and tablet size to enhance patient acceptability further.
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Affiliation(s)
- Ana Baumgartner
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia
| | - Odon Planinšek
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia
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Kemal LK, Abebe RB, Sendekie AK, Zeleke TK, Mehari EA, Mekonnen GA, Sema FD. Rational prescribing and dispensing of oral dosage forms of medicines to children: an observational study. BMJ Paediatr Open 2024; 8:e002431. [PMID: 39097329 PMCID: PMC11298748 DOI: 10.1136/bmjpo-2023-002431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/27/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Irrational prescribing and dispensing of oral dosage forms of medicines to paediatric patients are major public health issues, especially in low-income and middle-income countries. Many challenges affect the rational use of oral dosage forms of medicines in children; these include a lack of dosage forms appropriate for the age and a lack of dose flexibility in dosage forms. OBJECTIVES To assess the rational prescribing and dispensing practices of oral dosage forms to children at dispensaries of the University of Gondar Comprehensive and Specialised Hospital (UoGCSH). METHOD A retrospective design for prescribing indicators and a cross-sectional study design to assess rational dispensing were used at the outpatient dispensary units of UoGCSH. A total of 931 oral dosage forms to assess prescribing indicators and 400 for dispensing indicators were used. The data were analysed using the Statistical Package for Social Sciences (SPSS V.26.0, IBM Corporation). Descriptive statistics were used to analyse indicators, and the χ2 test was used to compare indicators between dispensaries. RESULT Out of a total of 931 oral dosage forms for 700 prescriptions, 56.3% were solid oral dosage forms. An average number of oral dosage forms per child was 1.33±0.62. Only 150 (16.13%) (95% CI: 14% to 18.4%) were adequate for the weight of the child. The percentage of oral dosage forms not suitable for the age was 7.1% (66), (95% CI: 5.6% to 8.8%), and about 0.8% (95% CI: 0% to 1.8%) were adequately labelled. Drugs that needed manipulation before administering a single unit were 81 (39.7%), 95% CI: 33.7% to 47.1%. CONCLUSION The proportion of the prescribed medications that were adequate for the weight of the child was low, although the majority of prescriptions' weights were not recorded. Oral dosage forms not suitable for children were prescribed. The proportion of medications that needed manipulation before being administered as a single unit was high.
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Affiliation(s)
- Leila Kenzu Kemal
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rahel Belete Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tirsit Ketsela Zeleke
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Eden Abetu Mehari
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizework Alemnew Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Faisel Dula Sema
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bartlett J, Culver N, Zhang X, Waybrant B, Sullivan H, Howell L. Commercialization of the Xalkori Pediatric Multiparticulate Product Using Quality-by-Design Principles. Pharmaceutics 2024; 16:1027. [PMID: 39204372 PMCID: PMC11360164 DOI: 10.3390/pharmaceutics16081027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/23/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
A pediatric dosage form for crizotinib (Xalkori) was commercialized using quality-by-design principles in a material-sparing fashion. The dosage form consists of spherical multiparticulates (microspheres or pellets) that are coated and encapsulated in capsules for opening. The crizotinib (Xalkori)-coated pellet product is approved in the US for pediatric patients 1 year of age and older and young adults with relapsed or refractory, systemic anaplastic large cell lymphoma (ALCL) and unresectable, recurrent, or refractory inflammatory myofibroblastic tumor (IMT) that is ALK-positive. The product is also approved in the US for adult patients with non-small cell lung cancer (NSCLC) who are unable to swallow intact capsules. The lipid multiparticulate is composed of a lipid matrix, a dissolution enhancer, and an active pharmaceutical ingredient (API). The API, which remains crystalline, is embedded within the microsphere at a 60% drug loading in the uncoated lipid multiparticulate to enable dose flexibility. The melt spray congealing technique using a rotary atomizer is used to manufacture the lipid multiparticulate. Following melt spray congealing, a barrier coating is applied via fluid bed coating. Due to their particle size and content uniformity, this dosage form provides the dosing flexibility and swallowability needed for the pediatric population. The required pediatric dose is achieved by opening the capsules and combining doses of different encapsulated dose strengths, followed by administration of the multiparticulates directly to the mouth. The encapsulation process was optimized through equipment modifications and by using a design of experiments approach to understand the operating space. A limited number of development batches produced using commercial-scale equipment were leveraged to design, understand, and verify the manufacturing process space. The quality by design and material-sparing approach taken to design the melt spray congeal and encapsulation manufacturing processes resulted in a pediatric product with exceptional content uniformity (a 95% confidence and 99% probability of passing USP <905> content uniformity testing for future batches).
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Affiliation(s)
| | | | - Xiang Zhang
- Pfizer, Eastern Point Road, Groton, CT 06340, USA
| | | | | | - Logan Howell
- Lonza, 63045 NE Corporate Place, Bend, OR 97701, USA
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Pereyra RB, Gonzalez Vidal NL. Amiodarone chewable gels as a potential appproach for paediatric congenital cardiopathies treatment: Comparison between animal and vegetal gelling agents. Eur J Pharm Biopharm 2024; 201:114370. [PMID: 38880402 DOI: 10.1016/j.ejpb.2024.114370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 06/18/2024]
Abstract
The difficulty in swallowing is a frequent problem when oral solid dosage forms (conventional tablets or capsules) are administered to paediatric population or patients with dysphagia. An interesting alternative to overcome these problems are non-conventional formulations like chewable gels, commonly known as 'gummies'. Therefore, this work addresses the design, development and characterization of gummies using gelatine and pectin, for the vehiculization of the antiarrhythmic amiodarone (AMIO). Applying a Design of Experiments (DoE) approach, four gelatine (GG1-GG4) and eight pectin formulations (PG1-PG8) were developed. Considering the obtained results for responses during DoE evaluation (i.e., volume, syneresis, hardness, and gumminess), GG3 and PG8 were selected for complete characterization. Water activity, pH, drug content, texture parameters (adhesiveness, springiness, cohesiveness, and fracturability), disintegration time, in vitro dissolution, and microbiological features were evaluated. The obtained results were within the expected values for this type of formulation. The dissolution profiles showed a 94 % - 99 % of the AMIO content released for GG3 and PG8, respectively, so they could be considered suitable as immediate release dosage forms. In conclusion, the chewable gels were successfully developed and characterised, suggesting a potential means to accomplish a final prototype for the improvement of congenital cardiopathies treatment.
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Affiliation(s)
- Romina B Pereyra
- Departamento de Biología, Bioquímica y Farmacia - Universidad Nacional del Sur (UNS), Bahía Blanca, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bahía Blanca, Buenos Aires, Argentina
| | - Noelia L Gonzalez Vidal
- Departamento de Biología, Bioquímica y Farmacia - Universidad Nacional del Sur (UNS), Bahía Blanca, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bahía Blanca, Buenos Aires, Argentina.
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Suksawat T, Brniak W, Łyszczarz E, Wesoły M, Ciosek-Skibińska P, Mendyk A. Orodispersible Dosage Forms with Rhinacanthin-Rich Extract as a Convenient Formulation Dedicated to Pediatric Patients. Pharmaceuticals (Basel) 2024; 17:994. [PMID: 39204099 PMCID: PMC11356918 DOI: 10.3390/ph17080994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/03/2024] Open
Abstract
Rhinacanthins, derived from Rhinacanthus nasutus, widely used in traditional medicine, exhibit antifungal, anticancer, antiviral, antibacterial, and antiplatelet aggregation effects. Recently, their anti-diabetic activity was confirmed, which makes them an interesting natural alternative in the therapy of the early stage of diabetes mellitus. The aim of this study was to demonstrate the possibility of formulating orodispersible tablets (ODTs) and orodispersible films (ODFs) containing rhinacanthin-rich extract (RRE). Tablets with 50 mg or 100 mg of RRE were produced by direct compression. ODFs were manufactured by casting of Lycoat RS 720 or polyvinyl alcohol solution with RRE and additional excipients. The mechanical properties and disintegration times of the prepared formulations were studied. The effectiveness of taste masking was analyzed with an electronic tongue system. Six months simplified stability studies were performed in conditions complying to ICH guidelines. Appropriate friability of ODTs was achieved, despite low tensile strength (0.45-0.62 MPa). All prepared ODFs successfully met the acceptance criteria regarding Young's modulus, tensile strength, and elongation at break. The observed variations in their mechanical properties were dependent on the type and quantity of polymers and plasticizers used. Disintegration time of ODTs ranged from 38.7 s to 54.2 s, while for ODFs from 24.2 to 40 s in the pharmacopoeial apparatus. Analyses made with the electronic tongue showed the significant taste-masking effect in both formulations. The addition of sucralose as a sweetener and menthol with mint flavor as a taste-masking agent was sufficient to mask an RRE's taste in the case of ODTs and ODFs. Stability studies of ODTs packed in the PVC/Alu blisters showed a decrease in the RRE content below 90% after 6 months. However, ODFs with PVA were physicochemically stable for 6 months while being stored in Alu/Alu sachets. Our study proved for the first time the possibility of the formulation of orodispersible dosage forms with RRE, characterized by good mechanical properties, disintegration time, and appropriate taste masking.
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Affiliation(s)
| | - Witold Brniak
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Ewelina Łyszczarz
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Małgorzata Wesoły
- Chair of Medical Biotechnology, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland
| | - Patrycja Ciosek-Skibińska
- Chair of Medical Biotechnology, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland
| | - Aleksander Mendyk
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
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Racaniello GF, Silvestri T, Pistone M, D'Amico V, Arduino I, Denora N, Lopedota AA. Innovative Pharmaceutical Techniques for Paediatric Dosage Forms: A Systematic Review on 3D Printing, Prilling/Vibration and Microfluidic Platform. J Pharm Sci 2024; 113:1726-1748. [PMID: 38582283 DOI: 10.1016/j.xphs.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
The production of paediatric pharmaceutical forms represents a unique challenge within the pharmaceutical industry. The primary goal of these formulations is to ensure therapeutic efficacy, safety, and tolerability in paediatric patients, who have specific physiological needs and characteristics. In recent years, there has been a significant increase in attention towards this area, driven by the need to improve drug administration to children and ensure optimal and specific treatments. Technological innovation has played a crucial role in meeting these requirements, opening new frontiers in the design and production of paediatric pharmaceutical forms. In particular, three emerging technologies have garnered considerable interest and attention within the scientific and industrial community: 3D printing, prilling/vibration, and microfluidics. These technologies offer advanced approaches for the design, production, and customization of paediatric pharmaceutical forms, allowing for more precise dosage modulation, improved solubility, and greater drug acceptability. In this review, we delve into these cutting-edge technologies and their impact on the production of paediatric pharmaceutical forms. We analyse their potential, associated challenges, and recent developments, providing a comprehensive overview of the opportunities that these innovative methodologies offer to the pharmaceutical sector. We examine different pharmaceutical forms generated using these techniques, evaluating their advantages and disadvantages.
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Affiliation(s)
| | - Teresa Silvestri
- Department of Pharmacy, University of Naples Federico II, D. Montesano St. 49, 80131 Naples, Italy
| | - Monica Pistone
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari, Via E. Orabona, 4, 70125, Bari, Italy
| | - Vita D'Amico
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari, Via E. Orabona, 4, 70125, Bari, Italy
| | - Ilaria Arduino
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari, Via E. Orabona, 4, 70125, Bari, Italy
| | - Nunzio Denora
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari, Via E. Orabona, 4, 70125, Bari, Italy.
| | - Angela Assunta Lopedota
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari, Via E. Orabona, 4, 70125, Bari, Italy
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Wang L, Ding Z, Wang Z, Zhao Y, Wu H, Wei Q, Gao L, Han J. The Development of an Oral Solution Containing Nirmatrelvir and Ritonavir and Assessment of Its Pharmacokinetics and Stability. Pharmaceutics 2024; 16:109. [PMID: 38258119 PMCID: PMC10818454 DOI: 10.3390/pharmaceutics16010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Paxlovid®, a co-packaged medication comprised of separate tablets containing two active ingredients, nirmatrelvir (NRV) and ritonavir (RTV), exhibits good effectiveness against coronavirus disease 2019 (COVID-19). However, the size of the NRV/RTV tablets makes them difficult for some patients to swallow, especially the elderly and those with dysphagia. Therefore, an oral liquid formulation that can overcome this shortcoming and improve patient compliance is required. In this study, we developed a liquid formulation containing NRV and RTV by adopting strategies that used co-solvents and surfactants to enhance the solubility and inhibit possible recrystallization. The in vitro release results showed that NRV and RTV could be maintained at high concentrations in solution for a certain period in the investigated media. In vivo studies in rats showed that the oral bioavailability of NRV/RTV solution was significantly enhanced. Compared to Paxlovid® tablets, the AUC(0-t) of NRV and RTV increased by 6.1 and 3.8 times, respectively, while the Cmax increased by 5.5 times for both. Furthermore, the promoting effect of the absorption of RTV on the bioavailability of NRV was confirmed. Experiments with a beagle showed a similar trend. Stability studies were also conducted at 4 °C, 25 °C, and 40 °C for 90 days, indicating that the oral liquid formulation was physically and chemically stable. This study can be used as a valuable resource for developing and applying oral liquid NRV/RTV formulations in a clinical context.
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Affiliation(s)
- Lili Wang
- School of Chemistry and Chemical Engineering, University of Jinan, Jinan 250022, China
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng 252000, China
| | - Zhuang Ding
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng 252000, China
| | - Zhengping Wang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng 252000, China
| | - Yanna Zhao
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng 252000, China
| | - Hengqian Wu
- School of Chemistry and Chemical Engineering, University of Jinan, Jinan 250022, China
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng 252000, China
| | - Qipeng Wei
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng 252000, China
| | - Lingfeng Gao
- School of Chemistry and Chemical Engineering, University of Jinan, Jinan 250022, China
| | - Jun Han
- School of Chemistry and Chemical Engineering, University of Jinan, Jinan 250022, China
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng 252000, China
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11
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Li KY, Lin BT, Hsu ST, Chien CF, Chang YP, Yang YH. Quetiapine Oral Solution in Alzheimer's Disease: Efficacy and Dosage Insights from a Real-World Retrospective Study. J Alzheimers Dis 2024; 97:805-811. [PMID: 38143365 DOI: 10.3233/jad-231007] [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] [Indexed: 12/26/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are distressing for patients with dementia, often accelerating functional decline and nursing home placement. Medications such as quetiapine are used to alleviate NPS, but their side effects require cautious use. Liquid formulations such as quetiapine oral suspension suit specific populations; however, real-world data on their use in patients with dementia are limited. OBJECTIVE The purpose of this retrospective, naturalistic study was to provide preliminary data on the effects of treatment with quetiapine oral suspension on behavioral and psychiatric disturbances in Alzheimer's disease (AD) outpatients in Taiwan. METHODS Between January 2022 and June 2023, data were collected from outpatients with a diagnosis of probable AD who received treatment with Qting® (quetiapine oral solution 25 mg/ml). Primary outcome measures were changes in Neuropsychiatric Inventory (NPI) total score and its sub-items from baseline to the endpoint. RESULTS We recruited 66 AD patients with a mean age of 72.1±7.6 years, most of whom were female (69.7%). Twenty-three patients had data on neuropsychological test and NPI scores before and after quetiapine treatment. There was no significant change in global cognitive function from baseline to the endpoint. A significant reduction in NPI total score after quetiapine treatment was noted, while the effect on NPI sub-items was limited. The average maintenance dose was 1.5±0.6 ml. CONCLUSIONS We demonstrated our clinical experience of the use of quetiapine oral solution in AD patients with NPS. Our results showed that quetiapine oral solution treatment significantly improved these symptoms at a relatively low dose.
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Affiliation(s)
- Kuan-Ying Li
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bin-Tse Lin
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Ting Hsu
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Fang Chien
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Evgenii T, Valerie L, Michelle Å, Nicole DG, Maria S, Thomas K, Julian Q, Jonas L. Impact of polymer chemistry on critical quality attributes of selective laser sintering 3D printed solid oral dosage forms. Int J Pharm X 2023; 6:100203. [PMID: 37564113 PMCID: PMC10410523 DOI: 10.1016/j.ijpx.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
The aim of this study is to investigate the influence of polymer chemistry on the properties of oral dosage forms produced using selective laser sintering (SLS). The dosage forms were printed using different grades of polyvinyl alcohol or copovidone in combination with indomethacin as the active pharmaceutical ingredient. The properties of the printed structures were assessed according to European Pharmacopoeia guidelines at different printing temperatures and laser scanning speeds in order to determine the suitable printing parameters. The results of the study indicate that the chemical properties of the polymers, such as dynamic viscosity, degree of hydrolyzation, and molecular weight, have significant impact on drug release and kinetics. Drug release rate and supersaturation can be modulated by selecting the appropriate polymer type. Furthermore, the physical properties of the dosage forms printed under the same settings are influenced by the selected polymer type, which determines the ideal manufacturing settings. This study demonstrates how the chemical properties of the polymer can determine the appropriate choice of manufacturing settings and the final properties of oral dosage forms produced using SLS.
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Affiliation(s)
- Tikhomirov Evgenii
- Division of Nanotechnology and Functional Materials, Department of Materials Science and Engineering, Ångström Laboratory, Uppsala University, Uppsala SE-751 03, Box 35, Sweden
| | - Levine Valerie
- Division of Nanotechnology and Functional Materials, Department of Materials Science and Engineering, Ångström Laboratory, Uppsala University, Uppsala SE-751 03, Box 35, Sweden
| | - Åhlén Michelle
- Division of Nanotechnology and Functional Materials, Department of Materials Science and Engineering, Ångström Laboratory, Uppsala University, Uppsala SE-751 03, Box 35, Sweden
| | - Di Gallo Nicole
- Merck KGaA, Frankfurter Str. 250, Postcode: D033/001, Darmstadt DE-642 93, Germany
| | - Strømme Maria
- Division of Nanotechnology and Functional Materials, Department of Materials Science and Engineering, Ångström Laboratory, Uppsala University, Uppsala SE-751 03, Box 35, Sweden
| | - Kipping Thomas
- Merck KGaA, Frankfurter Str. 250, Postcode: D033/001, Darmstadt DE-642 93, Germany
| | - Quodbach Julian
- Division of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, the Netherlands
| | - Lindh Jonas
- Division of Nanotechnology and Functional Materials, Department of Materials Science and Engineering, Ångström Laboratory, Uppsala University, Uppsala SE-751 03, Box 35, Sweden
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13
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Mu Y, Zhao L, Shen L. Medication adherence and pharmaceutical design strategies for pediatric patients: An overview. Drug Discov Today 2023; 28:103766. [PMID: 37708932 DOI: 10.1016/j.drudis.2023.103766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
Medication adherence in pediatric patients is a key factor in drug development and dosage form design. High medication adherence is not only important to achieve the expected treatment effects but can also effectively reduce medical costs. It is an ongoing task to accurately identify differences in medication adherence between children and adults and analyze the factors related to pediatric medication adherence. This is necessary to guide the development of pediatric drugs. This review focuses on factors that influence pediatric medication adherence as well as pharmaceutical design strategies to improve adherence. Current new dosage forms, new technologies, and new devices are comprehensively summarized in terms of their advantages and limitations.
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Affiliation(s)
- Yingying Mu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Pudong District, Shanghai 201203, PR China
| | - Lijie Zhao
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine of Ministry of Education, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Pudong District, Shanghai 201203, PR China.
| | - Lan Shen
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Pudong District, Shanghai 201203, PR China.
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14
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Mansourian M, Dijkers E, Silva CCV, Polonini HC. Compatibility of Commonly Used Active Pharmaceutical Ingredients in a Ready-to-Use Oral Suspending Vehicle. Pharmaceutics 2023; 15:2388. [PMID: 37896148 PMCID: PMC10609746 DOI: 10.3390/pharmaceutics15102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
The present study aimed to evaluate the stability of active pharmaceutical ingredients (APIs) from different pharmacological classes in a compounded oral suspending vehicle. Oral suspensions of amoxicillin trihydrate (50 mg/mL), clozapine (25 mg/mL), indomethacin (5.0 mg/mL), levodopa/carbidopa (10.0/2.5 mg/mL), levothyroxine sodium (T4, 25 µg/mL), lomustine (4.0 and 10.0 mg/mL), methyldopa (25 mg/mL) and procarbazine (10.0 mg/mL) were formulated in SyrSpend® SF PH4 and the stability was monitored for up to 90 days, except for amoxicillin trihydrate, which was evaluated for 30 days only. The APIs' stability was determined by measuring percent recovery using stability-indicating high-performance liquid chromatography (HPLC or UHPLC) or titration (amoxicillin trihydrate only). The stability of amoxicillin trihydrate, clozapine, indomethacin and levodopa/carbidopa were studied at both refrigerated (2-8 °C) and room temperature (20-25 °C). Lomustine, procarbazine, and methyldopa were studied at refrigerated temperature only. Our data demonstrated promising stability for the compounded suspensions containing various APIs, investigated in SyrSpend® SF PH4, as all APIs exhibited stability throughout the study duration and met content uniformity criteria. These findings lead to the conclusion that the tested compounded oral suspensions present a viable approach for creating personalized, age-appropriate formulations. The capacity to ensure dose consistency and stability using APIs from diverse pharmacological classes renders them suitable choices for both pediatric and geriatric patients.
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Affiliation(s)
| | | | | | - Hudson C. Polonini
- Fagron BV, 3065 WB Rotterdam, The Netherlands; (M.M.); (E.D.); (C.C.V.S.)
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15
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Alessandrini E, Walsh J, Hermans E, Salunke S. Putting children first: Understanding caregivers' and children's perspectives on the usability of oral and respiratory administration devices for paediatric medication. Eur J Pharm Biopharm 2023; 190:35-46. [PMID: 37463632 DOI: 10.1016/j.ejpb.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 07/15/2023] [Indexed: 07/20/2023]
Abstract
A multi-national online survey was developed to obtain feedback on users' experiences of administration devices for oral and inhaled paediatric medicines. The questionnaire was divided into two identical parts: 1) for caregivers looking after children aged 0-18 years, and 2) for children aged 10 years and above, with parental consent. Each part of the questionnaire consisted of a section regarding oral devices and the other about respiratory devices. All data were anonymous and handled and stored in compliance with GDPR. Ethics approval (REC4612-016) was obtained. The study involved eight countries: Albania, Italy, Israel, the Netherlands, Romania, Spain, UK, and USA. A total of 206 adults and 43 children agreed to take part in the survey. Oral dosage forms were more used than inhaled medicines. For oral liquid medicines, oral syringe was the device mostly used by European and Israeli participants. Measuring spoon was the second most common device used, and was also often used in the USA. For respiratory devices, manually actuated and breath actuated metered dose inhalers were the most common everywhere. All devices were deemed easy to use by most of respondents and instructions clear. However, a recurrent suggestion was to simplify device instructions by adding explanatory images and to summarise or highlight key points. Moreover, respondents proposed other improvements related to device appearance and design that would make the device more acceptable for them to use. Understanding paediatric patients and caregivers' experiences about oral and respiratory devices is key to provide industry with information that can help improve the use and acceptability of administration devices. Aspects that device suppliers and healthcare professionals would need to prioritise are the provision of simpler instructions in the form of images and key summaries, and to provide adequate training on device use. These improvements are essential to ensure that children and caregivers are able to use the device appropriately.
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Affiliation(s)
| | - Jennifer Walsh
- Jenny Walsh Consulting Ltd., East Midlands Chamber, 8 Experian Way, ng2 Business Park, Nottingham NG1 1EP, UK
| | | | - Smita Salunke
- University College London School of Pharmacy, London, UK
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16
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Münch J, Sessler I, Bosse HM, Wargenau M, Dreesen JD, Loforese G, Webb NJA, Sivasubramanian R, Reidemeister S, Lustenberger P, Klingmann V. Evaluating the Acceptability, Swallowability, and Palatability of Film-Coated Mini-Tablet Formulation in Young Children: Results from an Open-Label, Single-Dose, Cross-Over Study. Pharmaceutics 2023; 15:1729. [PMID: 37376177 DOI: 10.3390/pharmaceutics15061729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Mini-tablets are advantageous over liquid formulations in overcoming challenges related to stability, taste, and dosage. This open-label, single-dose, cross-over study investigated the acceptability and safety of drug-free, film-coated mini-tablets in children aged 1 month-6 years (stratified: 4-6 years, 2-<4 years, 1-<2 years, 6-<12 months, and 1-<6 months), and their preference for swallowing either a high quantity of 2.0 mm or a low quantity of 2.5 mm diameter mini-tablets. The primary endpoint was acceptability derived from swallowability. The secondary endpoints were investigator-observed palatability, acceptability as a composite endpoint derived from both swallowability and palatability, and safety. Of 320 children randomized, 319 completed the study. Across all tablet sizes, quantities and age groups, acceptability rates based on swallowability were high (at least 87%). Palatability was rated as "pleasant/neutral" in 96.6% of children. The acceptability rates as per the composite endpoint were at least 77% and 86% for the 2.0 mm and 2.5 mm film-coated mini-tablets, respectively. No adverse events or deaths were reported. Recruitment in the 1-<6-months group was stopped early due to coughing-evaluated as "choked on" in three children. Both 2.0 mm and 2.5 mm film-coated mini-tablets are suitable formulations for young children.
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Affiliation(s)
- Juliane Münch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Isabelle Sessler
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Hans Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Manfred Wargenau
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, 40211 Düsseldorf, Germany
| | - Janine D Dreesen
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, 40211 Düsseldorf, Germany
| | - Giulio Loforese
- Global Drug Development, Novartis Pharma AG, 4002 Basel, Switzerland
| | - Nicholas J A Webb
- Global Drug Development, Novartis Pharma AG, 4002 Basel, Switzerland
| | | | | | | | - Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
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17
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Hummler H, Sarwinska D, Weitschies W, Gollasch M, Page S. Parameters to Consider for Successful Medication Use in Older Adults - an AGePOP Review. Eur J Pharm Sci 2023:106453. [PMID: 37149104 DOI: 10.1016/j.ejps.2023.106453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Older adults are the main users of medicine and due to their multimorbidity are often faced/confronted with a complex medication management. This review article provides a brief overview on aspects of medication management such as maintaining a stock of the required medicine, understanding and following the instructions for use, coping with the primary and secondary packaging as well as preparation prior to use. The main focus however is on the drug intake itself and provides an overview about the current understanding of real life dosing conditions of older adults and geriatric patients. Furthermore, it elaborates the acceptability of dosage forms, in particular solid oral dosage forms as they represent the majority of dosage forms taken by these patient populations. An improved understanding of the needs of older adults and geriatric patients, their acceptability of various dosage forms and the circumstances under which they manage their medications, will make the design of more patient-centric drug products possible.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070, Basel, Switzerland
| | - Dorota Sarwinska
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489, Greifswald, Germany
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489, Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070, Basel, Switzerland.
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18
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Hummler H, Page S, Stillhart C, Meilicke L, Grimm M, Mannaa M, Gollasch M, Weitschies W. Influence of Solid Oral Dosage Form Characteristics on Swallowability, Visual Perception, and Handling in Older Adults. Pharmaceutics 2023; 15:pharmaceutics15041315. [PMID: 37111799 PMCID: PMC10142368 DOI: 10.3390/pharmaceutics15041315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Swallowability, visual perception, and any handling to be conducted prior to use are all influence factors on the acceptability of an oral dosage form by the patient. Knowing the dosage form preferences of older adults, as the major group of medication end users, is needed for patient-centric drug development. This study aimed at evaluating the ability of older adults to handle tablets as well as to assess the anticipated swallowability of tablets, capsules, and mini tablets based on visual perception. The randomized intervention study included 52 older adults (65 to 94 years) and 52 younger adults (19 to 36 years). Within the tested tablets, ranging from 125 mg up to 1000 mg in weight and being of different shapes, handling was not seen as the limiting factor for the decision on appropriate tablet size. However, the smallest sized tablets were rated worst. According to visual perception, the limit of acceptable tablet size was reached at around 250 mg for older adults. For younger adults, this limit was shifted to higher weights and was dependent on the tablet shape. Differences in anticipated swallowability with respect to tablet shapes were most pronounced for tablets of 500 mg and 750 mg in weight, independent of the age category. Capsules performed worse compared to tablets, while mini tablets appeared as a possible alternative dosage form to tablets of higher weight. Within the deglutition part of this study, swallowability capabilities of the same populations were assessed and have been reported previously. Comparing the present results with the swallowing capabilities of the same populations with respect to tablets, it shows adults' clear self-underestimation of their ability to swallow tablets independent of their age.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070 Basel, Switzerland
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070 Basel, Switzerland
| | - Cordula Stillhart
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070 Basel, Switzerland
| | - Lisa Meilicke
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Michael Grimm
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Marwan Mannaa
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17489 Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17489 Greifswald, Germany
| | - Werner Weitschies
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17489 Greifswald, Germany
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19
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Hummler H, Stillhart C, Meilicke L, Grimm M, Krause E, Mannaa M, Gollasch M, Weitschies W, Page S. Impact of Tablet Size and Shape on the Swallowability in Older Adults. Pharmaceutics 2023; 15:pharmaceutics15041042. [PMID: 37111528 PMCID: PMC10145850 DOI: 10.3390/pharmaceutics15041042] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Older adults represent the major target population for oral medications, due to the high prevalence of multimorbidity. To allow for successful pharmacological treatments, patients need to adhere to their medication and, thus, patient-centric drug products with a high level of acceptability by the end users are needed. However, knowledge on the appropriate size and shape of solid oral dosage forms, as the most commonly used dosage forms in older adults, is still scarce. A randomized intervention study was performed including 52 older adults (65 to 94 years) and 52 young adults (19 to 36 years). Each participant swallowed four coated placebo tablets differing in weight (250 to 1000 mg) and shape (oval, round, oblong) in a blinded manner on three study days. The choice of tablet dimensions allowed for a systematic comparison between different tablet sizes of the same shape, as well as between different tablet shapes. Swallowability was assessed using a questionnaire-based method. All tested tablets were swallowed by ≥80% of adults, independent of age. However, only the 250 mg oval tablet was classified as well swallowable by ≥80% of old participants. The same was true for young participants; however, they also considered the 250 mg round and the 500 mg oval tablet as well swallowable. Furthermore, swallowability was seen to influence the willingness to take a tablet on a daily basis, especially for an intake over longer time periods.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Cordula Stillhart
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
| | - Lisa Meilicke
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Michael Grimm
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Elischa Krause
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstr. 1/2, 17489 Greifswald, Germany
| | - Marwan Mannaa
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17489 Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17489 Greifswald, Germany
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
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20
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Querin B, Schweitzer-Chaput A, Cisternino S, Auvity S, Fauqueur AS, Negbane A, Hadchouel A, Schlatter J, Cotteret C. Pharmaceutical Oral Formulation of Methionine as a Pediatric Treatment in Inherited Metabolic Disease. Pharmaceutics 2023; 15:pharmaceutics15030957. [PMID: 36986818 PMCID: PMC10056843 DOI: 10.3390/pharmaceutics15030957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
L-Methionine (Met) is an essential alpha-amino acid playing a key role in several metabolic pathways. Rare inherited metabolic diseases such as mutations affecting the MARS1 gene encoding methionine tRNA synthetase (MetRS) can cause severe lung and liver disease before the age of two years. Oral Met therapy has been shown to restore MetRS activity and improve clinical health in children. As a sulfur-containing compound, Met has a strongly unpleasant odor and taste. The objective of this study was to develop an optimized pediatric pharmaceutical formulation of Met powder, to be reconstituted with water, to obtain a stable oral suspension. Organoleptic characteristics and physicochemical stability of the powdered Met formulation and suspension were evaluated at three storage temperatures. Met quantification was assessed by a stability-indicating chromatographic method as well as microbial stability. The use of a specific fruit flavor (e.g., strawberry) with sweeteners (e.g., sucralose) was considered acceptable. No drug loss, pH changes, microbiological growth, or visual changes were observed at 23 ± 2 °C and 4 ± 2 °C with the powder formulation for 92 days, and the reconstituted suspension for at least 45 days. The developed formulation facilitates the preparation, administration, the dose adjustment and palatability of Met treatment in children.
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Affiliation(s)
- Benjamin Querin
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Arnaud Schweitzer-Chaput
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Salvatore Cisternino
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
- Université Paris Cité, Inserm UMRS 1144, Faculté de Pharmacie, 4, Avenue de l’Observatoire, F-75006 Paris, France
- Correspondence: ; Tel.: +33-1-44-495-191
| | - Sylvain Auvity
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
- Université Paris Cité, Inserm UMRS 1144, Faculté de Pharmacie, 4, Avenue de l’Observatoire, F-75006 Paris, France
| | - Anne-Sophie Fauqueur
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Abdel Negbane
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Alice Hadchouel
- Service de Pneumologie Pédiatrique, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP-HP, 149 rue de Sèvres, F-75015 Paris, France
- Institut Necker Enfants Malades (INEM), INSERM U1151, Faculté de Médecine, Université Paris Cité, 156 rue de Vaugirard, F-75015 Paris, France
| | - Joël Schlatter
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
- Service Pharmacie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris, AP-HP, 1 rue de l’hôpital, F-60140 Labruyère, France
| | - Camille Cotteret
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
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21
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McCloskey AP, Lunn A, Traynor MJ, Lim EJ, Tse Y, McCabe PG, Mistry RD, Vasey N, Pickering A, Rathbone AP. KidzMed e-learning to upskill student pharmacists to teach pill swallowing to children. PLoS One 2023; 18:e0282070. [PMID: 36928840 PMCID: PMC10019696 DOI: 10.1371/journal.pone.0282070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Appropriate medication use is essential in ensuring optimal pharmacotherapeutic outcomes. It is mistakenly assumed that adults can swallow solid oral dosage forms (SODFs, e.g. tablets/capsules colloquially referred to as 'pills'), without difficulty and that children cannot. KidzMed is a 'pill swallowing' training programme designed to teach effective SODF use in patients of all ages. It may be utilised by healthcare professionals to assist patients taking SODFs. E-learning was essential for training during COVID pandemic to reduce viral transmission. The aim of this study was to explore UK student pharmacists views of e-learning to support swallowing solid oral dosage forms. METHODS This study used pre- and post-intervention online surveys on Microsoft Forms to evaluate self-directed eLearning about pill swallowing on MPharm programmes at three UK Universities using a 13-item survey. A combination of five-point Likert Scales and free-text items were used. The eLearning was available via the virtual learning environment at the University and embedded within existing curriculum. Descriptive statistical analysis was used to explore responses. RESULTS In total, 113 of 340 (33%) students completed the survey. Seventy-eight percent (n = 65) reported the eLearning would enable them to teach adults and children to swallow SODFs successfully. Learners either agreed or strongly agreed that they felt comfortable to teach patients (95%, n = 62/113) and parents or carers (94%, n = 60) to swallow medications having completed the e-learning. Student pharmacists generally found eLearning as an acceptable way to reflect on their own experiences of 'pill' swallowing and how to support patients to swallow SODFs. CONCLUSION The KidzMed eLearning was well received by student pharmacists. Further work is needed to explore whether skills translates into real life application in the clinical settings.
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Affiliation(s)
- Alice P. McCloskey
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
| | - Andrew Lunn
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, United Kingdom
| | - Michael J. Traynor
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Emma J. Lim
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
- Institute of Health and Society Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Yincent Tse
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
- Newcastle University Medical School, Newcastle-upon-Tyne, United Kingdom
| | - Philippa G. McCabe
- School of Computer Science and Mathematics Liverpool John Moores University, Liverpool, United Kingdom
| | - Ravi D. Mistry
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Nicola Vasey
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Ailsa Pickering
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Adam P. Rathbone
- Newcastle University School of Pharmacy, Newcastle-upon-Tyne, United Kingdom
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22
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Wademan DT, Palmer M, Purchase S, van der Zalm MM, Osman M, Garcia-Prats AJ, Seddon JA, Schaaf HS, Hesseling AC, Reis R, Reynolds LJ, Hoddinott G. Toward a conceptual framework of the acceptability of tuberculosis treatment in children using a theory generative approach. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001267. [PMID: 36962908 PMCID: PMC10021666 DOI: 10.1371/journal.pgph.0001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
To describe an early-stage holistic framework towards evaluating factors that impact the overall acceptability of TB treatment along the TB care cascade in children. We developed a conceptual framework utilising a theory generative approach. Domains were developed through review of existing definitions and analysis of existing qualitative data undertaken in acceptability studies of TB treatment in children. Clarity of domain definitions was achieved through iterative refinement among the research team. Three domains, each comprising several dimensions, were identified to holistically evaluate treatment acceptability: (1) usability, which involves the alignment between the requirements of treatment use and caregivers' and children's ability to integrate TB treatment into their everyday routines, (2) receptivity, which describes the end-user's perception and expectations of treatment and its actual use, and (3) integration, which describes the relationship between available health services and caregivers/children's capacity to make use of those services. Our framework addresses the gaps in current research which do not account for the influence of caregivers' and children's contexts on TB treatment uptake and overall acceptability. This approach may support the development of more standard, holistic measures to improve TB treatment delivery and experiences and future research in children.
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Affiliation(s)
- Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Purchase
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Anthony J. Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Paediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - H. Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ria Reis
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey J. Reynolds
- Department of Sociology and Social Anthropology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
- Pivot Collective, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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23
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Moretti F, Ruiz F, Bonifazi F, Pizzo E, Kindblom JM. Health technology assessment of paediatric medicines: European landscape, challenges and opportunities inside the conect4children project. Br J Clin Pharmacol 2022; 88:5052-5059. [PMID: 34931373 PMCID: PMC9786554 DOI: 10.1111/bcp.15190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/30/2022] Open
Abstract
The medicine development process is complex and requires time and effort to ensure safety, efficacy and quality. In paediatrics, this process is even more challenging, as it involves a subgroup of the population that already faces a considerable gap in the clinical evaluation of medicines and devices compared to the adult population. Moreover, access to therapies is heavily influenced by national health technology assessment (HTA) recommendations, which often form the basis for pricing and reimbursement decisions that affect the availability of effective treatments within the national health systems. Yet performing an HTA to assess the relative effectiveness and cost-effectiveness of a new children's treatment has several non-trivial implications, creating a critical issue for the paediatric population. In addition, the advent of innovative health technologies for children emphasises the need to empower the role of HTAs in paediatrics. This article aims at describing the most relevant elements of the drug development process in the paediatric field by focusing on the HTA. Particular attention will be paid to the factors that influence market access for new paediatric medicines and patients' access to treatment. The article will also highlight some central methodological challenges in conducting HTA in the paediatric field. Finally, the article will provide insight into how initiatives, such as conect4children, may subsequently reinforce HTA awareness in the paediatric community and strengthen collaborations through network mechanisms.
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Affiliation(s)
- Francesco Moretti
- Arsenàl.IT—Centro Veneto Ricerca e Innovazione per la Sanità digitalePadovaItaly
| | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi OnlusBariItaly
| | - Elena Pizzo
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | - Jenny M. Kindblom
- Pediatric Clinical Research Center at the Queen Silvia Children's Hospital at Sahlgrenska University HospitalGöteborgSweden
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24
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A novel soft robotic pediatric in vitro swallowing device to gain insights into the swallowability of mini-tablets. Int J Pharm 2022; 629:122369. [DOI: 10.1016/j.ijpharm.2022.122369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022]
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25
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Kaneria NS, Tuleu C, Ernest T. Opportunities for enteral drug delivery for neonates, infants and toddlers: a critical exploration. Expert Opin Drug Deliv 2022; 19:475-519. [PMID: 35404191 DOI: 10.1080/17425247.2022.2064449] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The field of neonatal, infant and toddler pharmaceutical development is constantly improving, however a lag still remains in comparison to older children and adults. Their rapid anatomical, physiological and behavioural developmental rates pose extra challenges in diagnosing, treating, or preventing their disease. In turn, this brings complexity in formulating truly age-appropriate medicinal products that suit this heterogeneous paediatric subset. Progress in the availability of such products has ensued following the introduction of the 2007 European Union Paediatric Regulation, and in recent years, oral multiparticulate and dispersible solid formulations have gained interest alongside liquid formulations. However, the need is still great for dosage forms that do not compromise on pharmaceutical efficacy, safety and global accessibility in those aged under 2. AREAS COVERED This article highlights some of the formulation challenges correlated with this age group and critically explores recent solid age-appropriate formulations and their administration devices for enteral drug delivery. EXPERT OPINION There are many formulation requirements to consider when formulating drug products for children aged under 2. Efforts are required into understanding acceptability in this age group and of their carers, and whether innovation or optimisation is required, to help guide formulators towards optimal approaches without impacting access.
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Affiliation(s)
- Nicole Sheena Kaneria
- University College London, School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX UK
| | - Catherine Tuleu
- University College London, School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX UK
| | - Terry Ernest
- GlaxoSmithKline, New Frontiers Science Park, Third Avenue Essex, Harlow, CM19 5AW UK.,GlaxoSmithKline, Hertfordshire, Park Road, Ware, UK, SG12 0DP
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26
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Preference, Perception, and Acceptability of Fluid Gels as a Potential Age-Appropriate Dosage Form for Elderly Patients with Dysphagia. Gels 2022; 8:gels8040218. [PMID: 35448119 PMCID: PMC9028045 DOI: 10.3390/gels8040218] [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: 03/04/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 12/14/2022] Open
Abstract
The development of pharmaceutical dosage forms that are tailored to specific populations according to their preferences and acceptability could improve medication adherence, which could lead to effective pharmacotherapy. This study evaluated the preference for and perceptions of fluid gels as a potential age-appropriate dosage form for older adults with dysphagia. The palatability and swallowability of the developed fluid gels were also assessed to determine the consumer acceptability of this formulation. A cross-sectional survey was conducted through the electronic distribution of a self-administered questionnaire among adults in Malaysia between April and December 2021. A randomized and double-blinded clinical study was conducted to evaluate the palatability and swallowability of the fluid gels in 30 healthy participants. A cross-sectional study involving 673 respondents revealed that the fluid gels were perceived positively by consumers (64.4%), were easily swallowed (50.8%), were safe to be consumed (45.3%), and were suitable as a new pharmaceutical formulation (43.8%). The clinical study shows that moderately thickened fluid gels masked the bitterness of the medication and were easily swallowed. The newly developed fluid gels were also positively perceived by the participants. Taken together, fluid gels have shown great potential as an innovative oral formulation that is suitable for consumption by elderly patients with dysphagia.
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27
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Saito J, Agrawal A, Patravale V, Pandya A, Orubu S, Zhao M, Andrews GP, Petit-Turcotte C, Landry H, Croker A, Nakamura H, Yamatani A, Salunke S. The Current States, Challenges, Ongoing Efforts, and Future Perspectives of Pharmaceutical Excipients in Pediatric Patients in Each Country and Region. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040453. [PMID: 35455497 PMCID: PMC9026161 DOI: 10.3390/children9040453] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/23/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
Abstract
A major hurdle in pediatric formulation development is the lack of safety and toxicity data on some of the commonly used excipients. While the maximum oral safe dose for several kinds of excipients is known in the adult population, the doses in pediatric patients, including preterm neonates, are not established yet due to the lack of evidence-based data. This paper consists of four parts: (1) country-specific perspectives in different parts of the world (current state, challenges in excipients, and ongoing efforts) for ensuring the use of safe excipients, (2) comparing and contrasting the country-specific perspectives, (3) past and ongoing collaborative efforts, and (4) future perspectives on excipients for pediatric formulation. The regulatory process for pharmaceutical excipients has been developed. However, there are gaps between each region where a lack of information and an insufficient regulation process was found. Ongoing efforts include raising issues on excipient exposure, building a region-specific database, and improving excipient regulation; however, there is a lack of evidence-based information on safety for the pediatric population. More progress on clear safety limits, quantitative information on excipients of concern in the pediatric population, and international harmonization of excipients’ regulatory processes for the pediatric population are required.
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Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo 157-8535, Japan;
- Correspondence: ; Tel.: +81-3-3416-0181
| | - Anjali Agrawal
- Drug Product Development, Bristol Myers Squibb, 181 Passaic Avenue, Summit, NJ 07901, USA;
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, India; (V.P.); (A.P.)
| | - Anjali Pandya
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, India; (V.P.); (A.P.)
| | - Samuel Orubu
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215, USA;
- Department of Pharmaceutics and Pharmaceutical Technology, Niger Delta University, Amassama 560103, Nigeria
| | - Min Zhao
- Medical Biology Centre, School of Pharmacy, China Medical University-Queen’s University Belfast Joint College (CQC), Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.Z.); (G.P.A.)
| | - Gavin P. Andrews
- Medical Biology Centre, School of Pharmacy, China Medical University-Queen’s University Belfast Joint College (CQC), Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.Z.); (G.P.A.)
| | - Caroline Petit-Turcotte
- Therapeutic Products Directorate, Health Canada, Government of Canada, Ottawa, ON K1A 0K9, Canada;
| | - Hannah Landry
- Office of Pediatrics and Patient Involvement, Health Canada, Government of Canada, Ottawa, ON K1A 0K9, Canada; (H.L.); (A.C.)
| | - Alysha Croker
- Office of Pediatrics and Patient Involvement, Health Canada, Government of Canada, Ottawa, ON K1A 0K9, Canada; (H.L.); (A.C.)
| | - Hidefumi Nakamura
- Department of Research and Development Supervision, National Center for Child Health and Development, Tokyo 157-8535, Japan;
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo 157-8535, Japan;
| | - Smita Salunke
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK;
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28
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Saito J, Nakamura H, Yamatani A. Issues on Powder Forms for Oral Solution and Suspension for Pediatric Patients in Japan: A Questionnaire-Based Observational Survey to Pediatric Pharmacists. Ther Innov Regul Sci 2022; 56:301-312. [PMID: 35088393 DOI: 10.1007/s43441-021-00361-1] [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: 07/14/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Powders for oral solutions and suspensions (POS) are commonly used as pediatric oral medicines worldwide, except for Japan. Although global pediatric formulation development accelerates POS importation to Japan without any formulation change, oral solid multiparticulates remain to be the preferred pediatric forms in the country. This study aimed to evaluate the acceptance situation of four typical POS form products (mycophenolate mofetil, sildenafil citrate, valganciclovir hydrochloride, and voriconazole) that were recently approved in Japan. METHODS A questionnaire on four products was completed by pharmacists in 29 children's hospitals with more than 100 beds each, between November and December of 2019. The questionnaire has six items on (#1) type of institution, (#2) formulary status, (#3) dispensing practice, (#4) reasons why POS form(s) were not selected as hospital formulary, (#5) advantages and disadvantages of POS form, and (#6) opinions for POS form. RESULTS Of the 29 institutions, 7 (24%), 9 (31%), 4 (13%), and 10 (34%) institutions used POS of mycophenolate mofetil, sildenafil citrate, valganciclovir hydrochloride, and voriconazole, respectively. Reasons for not using these products were dispensed drug loss, formulation issues, and management issues in the pharmaceutical department and pediatric ward. Pharmacists preferred drug compounding such as tablet crushing and capsule opening to POS form use. CONCLUSIONS POS forms might be an unsuitable formulation for the current hospital settings in Japan. Thus, appropriate dosage forms that reflect the current clinical settings are necessary.
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Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
- Department of Research and Development Supervision, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Hidefumi Nakamura
- Department of Research and Development Supervision, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Research and Development Supervision, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
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29
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Page S, Khan T, Kühl P, Schwach G, Storch K, Chokshi H. Patient Centricity Driving Formulation Innovation: Improvements in Patient Care Facilitated by Novel Therapeutics and Drug Delivery Technologies. Annu Rev Pharmacol Toxicol 2022; 62:341-363. [PMID: 34990203 DOI: 10.1146/annurev-pharmtox-052120-093517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Innovative formulation technologies can play a crucial role in transforming a novel molecule to a medicine that significantly enhances patients' lives. Improved mechanistic understanding of diseases has inspired researchers to expand the druggable space using new therapeutic modalities such as interfering RNA, protein degraders, and novel formats of monoclonal antibodies. Sophisticated formulation strategies are needed to deliver the drugs to their sites of action and to achieve patient centricity, exemplified by messenger RNA vaccines and oral peptides. Moreover, access to medical information via digital platforms has resulted in better-informed patient groups that are requesting consideration of their needs during drug development. This request is consistent with health authority efforts to upgrade their regulations to advance age-appropriate product development for patients. This review describes formulation innovations contributingto improvements in patient care: convenience of administration, preferred route of administration, reducing dosing burden, and achieving targeted delivery of new modalities.
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Affiliation(s)
- Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland;
| | - Tarik Khan
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland;
| | - Peter Kühl
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland;
| | - Gregoire Schwach
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland;
| | - Kirsten Storch
- Pharma Technical Development, Roche Diagnostics GmbH, 68305 Mannheim, Germany
| | - Hitesh Chokshi
- Pharma Technical Development, Roche TCRC Inc., Little Falls, New Jersey 07424, USA
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30
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Duncan JC, Bracken LE, Nunn AJ, Peak M, Turner MA. Development and evaluation of an assessment of the age-appropriateness/inappropriateness of formulations used in children. Int J Clin Pharm 2022; 44:1394-1405. [PMID: 36208398 PMCID: PMC9718882 DOI: 10.1007/s11096-022-01478-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medicines designed for adults may be inappropriate for use in children in terms of strength, dosage form and/or excipient content. There is currently no standardised method of assessing the age-appropriateness of a medicine for paediatric use. AIM To develop and test a tool to assess whether a dosage form (formulation) is appropriate for children and estimate the proportion of formulations considered 'inappropriate' in a cohort of hospitalised paediatric patients with a chronic illness. METHOD A multi-phase study: patient data collection, tool development, case assessments and tool validation. Inpatients aged 0-17 years at two UK paediatric/neonatal hospitals during data collection periods between January 2015 and March 2016. Written informed consent/assent was obtained. Medicines assessed were new or regularly prescribed to inpatients as part of their routine clinical care. All medicine administration episodes recorded were assessed using the Age-appropriate Formulation tool. The tool was developed by a consensus approach, as a one-page flowchart. Independent case assessments were evaluated in 2019. RESULTS In 427 eligible children; 2,199 medicine administration episodes were recorded. Two assessors reviewed 220 episodes in parallel: percentage exact agreement was found to be 91.7% (99/108) and 93.1% (95/102). In total, 259/2,199 (11.8%) medicine administration episodes involved a dosage form categorised as 'age-inappropriate'. CONCLUSION A novel tool has been developed and internally validated. The tool can identify which medicines would benefit from development of an improved paediatric formulation. It has shown high inter-rater reliability between users. External validation is needed to further assess the tool's utility in different settings.
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Affiliation(s)
- Jennifer C Duncan
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Louise E Bracken
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anthony J Nunn
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Matthew Peak
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Mark A Turner
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, UK
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
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31
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Atkins B, Bhattacharya D, Smith C, Scott S. Barriers and enablers to switching from a solid to a liquid formulation of Parkinson's medication: a theory-based mixed methods investigation. Int J Clin Pharm 2022; 44:1046-1056. [PMID: 35842516 PMCID: PMC9393141 DOI: 10.1007/s11096-022-01446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Swallowing tablets/capsules can become difficult and dangerous for People with Parkinson's (PwP) who develop oropharyngeal dysphagia. Switching to a liquid delays the need for progressing to last line patches/injections. However, liquids are rarely used therefore a change in prescribing practice is warranted but, as with any change in behaviour, may be met with resistance. AIM To characterise PwPs and carers' barriers and enablers (determinants) of switching from solid to liquid Parkinson's medication formulations. METHOD Underpinned by the Theoretical Domains Framework, focus groups with PwPs and carers were convened to identify determinants of switching, which were then used to develop a questionnaire distributed across the UK. Determinants were prioritised if ≥ 50% of respondents agreed/strongly agreed that they were important to their decision to switch to a liquid formulation. Percentage precisions were reported as 95% confidence intervals. RESULTS From three focus groups and 131 questionnaires responses, PwPs and carers prioritised nine determinants. Three enablers had almost unanimous agreement: liquids' flexibility for incremental dosing (72% ± 8); decline in Parkinson's control (72% ± 8); prescriber's endorsement to switch (70% ± 8). The barriers: perception that tablets/capsules are easier to dose than liquids (72% ± 8); and prescriber's opposition to switching (70% ± 8), attracted similarly high agreement. CONCLUSION There is a desire to switch to liquids when Parkinson's progresses and for their use beyond this to offer flexibility in dosing, a previously unrecognised indication for switching. The only notable resistance to switching may be addressed by innovations from the pharmaceutical industry to make liquids easier to measure.
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Affiliation(s)
- Bethany Atkins
- School of Allied Health Professions, University of Leicester, Leicestershire, LE1 7RH UK
| | - Debi Bhattacharya
- School of Allied Health Professions, University of Leicester, Leicestershire, LE1 7RH UK
| | - Caroline Smith
- School of Allied Health Professions, University of Leicester, Leicestershire, LE1 7RH UK
| | - Sion Scott
- School of Allied Health Professions, University of Leicester, Leicestershire, LE1 7RH, UK.
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Pérez-González GL, Cornejo-Bravo JM, Vera-Graciano R, Adan-López ES, Villarreal-Gómez LJ. Development, characterization, and in vitro evaluation of adhesive fibrous mat for mucosal propranolol delivery. E-POLYMERS 2021. [DOI: 10.1515/epoly-2022-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
This research focuses on the synthesis and adhesive properties of mucoadhesive mats, prepared with poly(vinylic alcohol) as a base polymer for the oromucosal release of propranolol (PRO) by the electrospinning technique. The nanofibers mats were evaluated by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy, thermogravimetric analysis, and differential scanning calorimetry; in vitro drug entrapment efficiency, degradation time, and adhesion studies were performed. SEM images of the electrospun mats show the correct formation of fibers with a variable diameter and porosity. Thermal studies indicate excellent thermal stability of the scaffolds, The fibrous mats loaded with 10% of the drug exhibit the best thermal stability with decomposition after 450°C. In vitro studies indicate a drug content of 88% loaded in the mats. In the cytotoxicity test, loaded mat presents cell proliferations of 97% and 88% for drug concentrations of 10% an 15%, respectively. To conclude, the formed electrospun adhesive mats exhibited excellent thermal stability, adhesive properties, and drug entrapment efficiency, promising features for a successful drug topical release system on mucosal tissue in the oral cavity.
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Affiliation(s)
- Graciela Lizeth Pérez-González
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Blvd. Universitario 1000, Unidad Valle de las Palmas , 22260 , Tijuana , Baja California , México
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Calzada Universidad 14418 Parque Industrial Internacional , Tijuana , Baja California 22390 , México
| | - José Manuel Cornejo-Bravo
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Calzada Universidad 14418 Parque Industrial Internacional , Tijuana , Baja California 22390 , México
| | - Ricardo Vera-Graciano
- Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior S/N Circuito de la Investigación Científica, Ciudad Universitaria , 04510 , Ciudad de México , México
| | - Eduardo Sinaí Adan-López
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Blvd. Universitario 1000, Unidad Valle de las Palmas , 22260 , Tijuana , Baja California , México
| | - Luis Jesús Villarreal-Gómez
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Blvd. Universitario 1000, Unidad Valle de las Palmas , 22260 , Tijuana , Baja California , México
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Calzada Universidad 14418 Parque Industrial Internacional , Tijuana , Baja California 22390 , México
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Optimising Medication Use along Dementia Progression: Recommendations from a Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9080982. [PMID: 34442119 PMCID: PMC8391125 DOI: 10.3390/healthcare9080982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022] Open
Abstract
Medicines management is known to be an integral part of the role of family caregivers; it also contributes to the burden and stress of caregivers’ experience. As dementia progresses, new challenges arise as a consequence, which negatively affects the ability of people living with dementia (PLWD) regarding practical decision making and may lead to a change of setting. The aim of this study is to identify and explore changes in medicines management and associated caregiver burden as dementia progresses. To examine medicines management and related issues across severities, a qualitative approach utilising face-to-face and telephone interviews with PLWD and their family caregivers in both the community and care-home setting in London was used. Follow-up interviews with family caregivers were also conducted to gain additional insight into change over time. Eleven family caregivers, ten PLWD, and eight care-home staff were interviewed in 2016. Findings identified how key changes along dementia progression affect medication use. These include changes to caregiver burden, respecting the PLWD’s autonomy and decline in capacity, scheduling and administration, choice of formulation, interactions with and between providers, and information needs. The findings assist in informing recommendations to optimise medication use and alleviate caregiver burden.
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Walsh J, Schaufelberger D, Iurian S, Klein S, Batchelor H, Turner R, Gizurarson S, Boltri L, Alessandrini E, Tuleu C. Path towards efficient paediatric formulation development based on partnering with clinical pharmacologists and clinicians, a conect4children expert group white paper. Br J Clin Pharmacol 2021; 88:5034-5051. [PMID: 34265091 DOI: 10.1111/bcp.14989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/10/2021] [Accepted: 07/07/2021] [Indexed: 12/18/2022] Open
Abstract
Improved global access to novel age-appropriate formulations for paediatric subsets, either of new chemical entities or existing drugs, is a priority to ensure that medicines meet the needs of these patients. However, despite regulatory incentives, the introduction to the market of paediatric formulations still lags behind adult products. This is mainly caused by additional complexities associated with the development of acceptable age-appropriate paediatric medicines. This position paper recommends the use of a paediatric Quality Target Product Profile as an efficient tool to facilitate early planning and decision making across all teams involved in paediatric formulation development during the children-centric formulation design for new chemical entities, or to repurpose/reformulate off-patent drugs. Essential key attributes of a paediatric formulation are suggested and described. Moreover, greater collaboration between formulation experts and clinical colleagues, including healthcare professionals, is advocated to lead to safe and effective, age-appropriate medicinal products. Acceptability testing should be a secondary endpoint in paediatric clinical trials to ensure postmarketing adherence is not compromised by a lack of acceptability. Not knowing the indications and the related age groups and potential dosing regimens early enough is still a major hurdle for efficient paediatric formulation development; however, the proposed paediatric Quality Target Product Profile could be a valuable collaborative tool for planning and decision making to expedite paediatric product development, particularly for those with limited experience in developing a paediatric product.
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Affiliation(s)
- Jennifer Walsh
- BioCity Nottingham, Jenny Walsh Consulting Ltd, Nottingham, UK
| | - Daniel Schaufelberger
- School of Medicine, All Children's Hospital, Schaufelberger Consulting LLC and Johns Hopkins University, St. Petersburg, FL, USA
| | - Sonia Iurian
- Department of Pharmaceutical Technology and Biopharmacy, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sandra Klein
- Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Greifswald, Germany
| | - Hannah Batchelor
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Roy Turner
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Sveinbjörn Gizurarson
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland; and Pharmacy Department, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luigi Boltri
- Pharmaceutical Development, Adare Pharmaceuticals, Milan, Italy
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Accuracy of Dose Administered to Children Using Off-Labelled or Unlicensed Oral Dosage Forms. Pharmaceutics 2021; 13:pharmaceutics13071014. [PMID: 34371705 PMCID: PMC8308974 DOI: 10.3390/pharmaceutics13071014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
The pediatric population suffers from a lack of age-appropriate medicines leading to unsafe situations when off-labelled or unlicensed drugs are used. Assessing the best option to administrate medicines when manipulations are required is essential in order to improve child care. This study aimed to compare the accuracy of the administered dose provided by three dosage forms and their techniques of administration. Different techniques of administration were assessed, covering three oral dosage forms (commercially available tablets, capsules, oral suspensions) using two APIs not available in a children-adapted dosage form. Techniques of administration were simulated and administered doses were determined using HPLC-UV. Means were compared to the target dose while distributions of doses were compared between each technique. For both APIs, mean administered doses obtained with capsules and tablets were significantly different from the target dose, whereas there was no statistical difference with oral suspensions. Distributions of doses showed significant difference between the three dosage forms. This study demonstrates that manipulations of solid oral dosage forms provide dramatic underdosing leading to unsafe situations. Compounded oral suspension is the best option to avoid underdosing and dose variation. This solution should be prioritized when age-appropriate commercial medicines are not available.
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Simšič T, Nolimal B, Minova J, Baumgartner A, Planinšek O. A straw for paediatrics: How to administer highly dosed, bitter tasting paracetamol granules. Int J Pharm 2021; 602:120615. [PMID: 33887392 DOI: 10.1016/j.ijpharm.2021.120615] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Abstract
Paediatric practice requires various dosing forms that are acceptable for children of different ages and abilities. A straw prefilled with a drug formulation might serve as a dosing form, especially for children and patients with swallowing difficulties. Using a two-step procedure, we developed granulated coated particles of bitter tasting paracetamol that are appropriate for use in a newly developed straw with two valves to assure liquid flow towards the oral cavity. The paracetamol crystals were coated with five different polymers (water-soluble, entero-soluble) to assure the duration of the taste-masking properties for several minutes during sipping of the drug. As none of these polymer coats assured small enough liquid volumes needed to empty the straw (20 mL) or low enough vacuum for easy drug consumption (130 mbar), the coated crystals were granulated with trehalose-erythritol powder mixture. Acceptable results were obtained with these granulated coated paracetamol particles when polyvinyl alcohol/polyethylene glycol graft copolymer (Kollicoat IR) or a mixture of this polymer with polyvinyl alcohol (Kollicoat Protect) were used. Dissolution tests in water and acidic media confirmed the taste-masking functionality of these particles during drinking simulation and immediate release of paracetamol in the stomach (85% in <30 min at pH 1.2, 4.5).
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Affiliation(s)
- Tilen Simšič
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia; Alterno Labs d.o.o., Brnčičeva 29, 1231 Ljubljana-Črnuče, Slovenia.
| | - Boris Nolimal
- Alterno Labs d.o.o., Brnčičeva 29, 1231 Ljubljana-Črnuče, Slovenia.
| | - Jasmina Minova
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia; Alterno Labs d.o.o., Brnčičeva 29, 1231 Ljubljana-Črnuče, Slovenia.
| | - Ana Baumgartner
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia.
| | - Odon Planinšek
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000 Ljubljana, Slovenia.
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37
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Alessandrini E, Brako F, Scarpa M, Lupo M, Bonifazi D, Pignataro V, Cavallo M, Cullufe O, Enache C, Nafria B, Claverol J, De Taeye L, Vermeulen E, Preston J, Tuleu C. Children's Preferences for Oral Dosage Forms and Their Involvement in Formulation Research via EPTRI (European Paediatric Translational Research Infrastructure). Pharmaceutics 2021; 13:pharmaceutics13050730. [PMID: 34063499 PMCID: PMC8156390 DOI: 10.3390/pharmaceutics13050730] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
The paucity of evidence-based data on formulation characteristics preferred by the children is known to limit the design of tailored paediatric dosage forms. The European Paediatric Translational Research Infrastructure (EPTRI) commissioned a study to evaluate children's dosage forms perceived preferences in some European countries and explore the feasibility of using the young persons advisory groups (YPAGs) to involve children in formulation research. An online, age-adapted survey was developed and translated into six languages. The survey link was disseminated across seven European countries: Albania, Italy, the Netherlands, and Dutch-speaking part of Belgium, Romania, Spain, and the United Kingdom. Respondents' (n = 1172) perceived preferences for oral dosage forms primarily differed based on age, health status, and experience. Conventional dosage forms, i.e., liquid (35%), tablets (19%), and capsules (14%), were the most selected. Liquid was widely selected by children less than 12 years and by those healthy and taking medicines rarely. Monolithic solid forms were mostly chosen by adolescents and by children with a chronic disease taking medicines frequently. There was a clear lack of familiarity with more novel dosage forms (e.g., orodispersible films and granules). Noteworthy, granules were not appreciated, particularly by adolescents (52.8%). To rationalise the creation of paediatric formulations, it is important to involve children as active stakeholders and to apply tools assessing children's perspectives on medicines to inform acceptable dosage form development from the start.
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Affiliation(s)
- Elisa Alessandrini
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
- Correspondence:
| | - Francis Brako
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
- Medway School of Pharmacy, Universities at Medway, Anson Building, Chatham ME4 4TB, UK
| | - Mariagiovanna Scarpa
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
| | - Mariangela Lupo
- TEDDY European Network of Excellence for Paediatric Research, via Luigi Porta 14, 27100 Pavia, Italy;
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, CVBF, via N. Putignani 178, 70122 Bari, Italy; (D.B.); (V.P.); (M.C.)
| | - Valeria Pignataro
- Consorzio per Valutazioni Biologiche e Farmacologiche, CVBF, via N. Putignani 178, 70122 Bari, Italy; (D.B.); (V.P.); (M.C.)
| | - Maria Cavallo
- Consorzio per Valutazioni Biologiche e Farmacologiche, CVBF, via N. Putignani 178, 70122 Bari, Italy; (D.B.); (V.P.); (M.C.)
| | - Ornela Cullufe
- Consorzio per Valutazioni Biologiche e Farmacologiche, Dege e Shoqerise se Huaj, CVBF Albania, Rr.Prokop Myzeqari, 1000 Tirana, Albania;
| | - Cristina Enache
- The Romanian Angel Appeal Foundation, Strada Rodiei, 030956 București, Romania;
| | - Begonya Nafria
- Sant Joan de Déu Research Institute, Esplugues de Llobregat, 08950 Barcelona, Spain; (B.N.); (J.C.)
| | - Joana Claverol
- Sant Joan de Déu Research Institute, Esplugues de Llobregat, 08950 Barcelona, Spain; (B.N.); (J.C.)
| | - Leen De Taeye
- Department of Internal Medicine and Paediatrics, Ghent University, 9000 Ghent, Belgium;
| | - Eric Vermeulen
- Dutch Patient Alliance for Rare and Genetic Diseases, VSOP, Koninginnelaan 23, 3762 DA Soest, The Netherlands;
| | - Jennifer Preston
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UK;
| | - Catherine Tuleu
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
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Development and optimisation of simulated salivary fluid for biorelevant oral cavity dissolution. Eur J Pharm Biopharm 2021; 160:125-133. [PMID: 33524535 DOI: 10.1016/j.ejpb.2021.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
Drug release within the oral cavity can be of paramount importance for formulations that are designed for specific purposes such as taste-masking, faster onset of therapeutic action, localization of treatment or avoidance of first-pass metabolism. Preclinical methods for assessment of dissolution in the oral cavity are necessary for design and development of these formulation but currently there is no consensus on what variables should be defined to achieve biorelevance in these tests. In this study, biorelevant simulated salivary fluids (SSFs) that can be uniformly applied for oral cavity dissolution testing were developed. Unstimulated saliva (US) SSF and stimulated saliva (SS) SSF were separately developed since the two states significantly differ. Physicochemical properties including pH, buffer capacity, surface tension and viscosity were assessed during development and optimised to mimic human saliva (HS). In order to account for the salivary proteins in HS, use of bovine submaxillary mucin (BSM) and porcine gastric mucin (PGM) in SSFs was evaluated. Following optimisation of the SSFs, biorelevance of the developed SSFs to HS was assessed by their comparative physicochemical properties as well as dissolution profiles of three diverse model compounds (sildenafil citrate, efavirenz, and caffeine) which showed comparable profiles between the SSFs and HS. This work addresses the lack of uniformed biorelevant dissolution media for oral cavity dissolution studies and provides a basis for standardised dissolution tests that provide consistency and harmonisation in future oral cavity dissolution studies. We envisage that this will have a positive impact on the development of new medicines that require functionality in the oral cavity.
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Freerks L, Sommerfeldt J, Löper PC, Klein S. Safe, swallowable and palatable paediatric mini-tablet formulations for a WHO model list of essential medicines for children compound – A promising starting point for future PUMA applications. Eur J Pharm Biopharm 2020; 156:11-19. [DOI: 10.1016/j.ejpb.2020.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/21/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022]
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Abruzzo A, Crispini A, Prata C, Adduci R, Nicoletta FP, Dalena F, Cerchiara T, Luppi B, Bigucci F. Freeze-Dried Matrices for Buccal Administration of Propranolol in Children: Physico-Chemical and Functional Characterization. J Pharm Sci 2020; 110:1676-1686. [PMID: 33164786 DOI: 10.1016/j.xphs.2020.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
Buccal matrices represent a widely accepted dosage form permitting a convenient, easy, reliable drug administration and reducing administration errors. The aim of this study was the development of mucoadhesive buccal matrices for propranolol administration in children. Matrices were obtained by freeze-drying of drug loaded polymeric solutions based on gum tragacanth (GT), pectin (PEC), hydroxypropylmethylcellulose (HPMC), sodium hyaluronate (HA), gelatin (GEL), chitosan (CH) or a mixture of CH and HPMC (CH/HPMC). Matrices were characterized for drug solid state, morphology, water-uptake, mucoadhesion ability, in vitro drug release and permeation through porcine epithelium. The most promising formulations were tested for in vitro biocompatibility in human dental pulp fibroblasts. The preparative method and the polymeric composition influenced the drug solid state, as a complete amorphization as well as different polymorphic forms were observed. GEL and PEC guaranteed a fast and complete drug release due to their rapid dissolution, while for the other matrices the release was influenced by drug diffusion through the viscous gelled matrix. Moreover, matrices based on CH and CH/HPMC showed the best mucoadhesive properties, favoured the drug permeation, in virtue of CH ability to interfere with the lipid organization of biological membrane, and were characterized by a good biocompatibility profile.
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Affiliation(s)
- Angela Abruzzo
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, 40127 Bologna, Italy.
| | - Alessandra Crispini
- Department of Chemistry and Chemical Technologies, University of Calabria, Via P. Bucci Edificio Polifunzionale, 87036 Arcavacata di Rende, Cosenza, Italy
| | - Cecilia Prata
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126 Bologna, Italy
| | - Rosanna Adduci
- Department of Chemistry and Chemical Technologies, University of Calabria, Via P. Bucci Edificio Polifunzionale, 87036 Arcavacata di Rende, Cosenza, Italy
| | - Fiore Pasquale Nicoletta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via P. Bucci Edificio Polifunzionale, 87036 Arcavacata di Rende, Cosenza, Italy
| | - Francesco Dalena
- Department of Chemistry and Chemical Technologies, University of Calabria, Via P. Bucci Edificio Polifunzionale, 87036 Arcavacata di Rende, Cosenza, Italy
| | - Teresa Cerchiara
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, 40127 Bologna, Italy
| | - Barbara Luppi
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, 40127 Bologna, Italy
| | - Federica Bigucci
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, 40127 Bologna, Italy
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Gupta MS, Kumar TP, Gowda DV. Orodispersible Thin Film: A new patient-centered innovation. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101843] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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42
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Devine A, Hegarty C, Casimero C, Molyneaux RL, Smith RB, Cardosi MF, Davis J. Electrochemically initiated release: exploring new modalities for controlled drug release. J Electroanal Chem (Lausanne) 2020. [DOI: 10.1016/j.jelechem.2020.113926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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43
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Use of amlodipine oral solution for the treatment of hypertension in children. Int J Clin Pharm 2020; 42:848-852. [PMID: 32378123 DOI: 10.1007/s11096-020-01000-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Background Amlodipine is a widely used antihypertensive agent for the treatment of paediatric hypertension, but the commercially available tablets are not suitable to treat young patients, who need lower, flexible dosages and a liquid formulation. Objective To determine the pharmacokinetic properties of amlodipine and the acceptability of a standardised, extemporaneous oral solution. Method A newly developed liquid formulation of amlodipine was administered to hypertensive children between the age of 6 months and 11 years. Using a limited sampling strategy, population PK analysis was performed using nonlinear mixed effects modelling. Results Nine children, with a median age of 2.9 years (IQR 1.8-8.4), receiving stable amlodipine therapy in a median dose of 0.15 mg kg-1 day-1 (IQR 0.11-0.18), were switched to study medication. The population pharmacokinetic model was able to accurately predict the clearance of amlodipine in the study population. Based on the final model, clearance was reduced by 31.2% (RSE: 10%) in females. Patient reported outcomes on taste from a five-point hedonic scale were available for five patients, who scored the taste from positive to slightly negative. Conclusion The results from the PK study and the acceptability assessment show that the amlodipine oral solution presented in this study offers an appropriate treatment option for young children.
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Barnett S, Bhatt A. A chewable pediatric preparation of ibuprofen is palatable and acceptable to children. PAEDIATRIC AND NEONATAL PAIN 2020; 2:2-6. [PMID: 35547858 PMCID: PMC8975196 DOI: 10.1002/pne2.12013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/15/2019] [Accepted: 01/12/2020] [Indexed: 11/11/2022]
Abstract
The development of palatable and acceptable analgesics for children is a major challenge. Given the majority of medications are administered orally, and children are more sensitive to and less tolerant of bitterness, novel “child‐friendly” preparations need to be developed and tested specifically in this patient population. This study investigated the palatability and acceptability of a therapeutic dose of ibuprofen in the form of soft chewable capsules in 100 healthy children aged 7‐12 years of age and the acceptability of this novel preparation to their caregivers. About 97% of children adhered to a full therapeutic age‐related dose, with 72% of these participants rating the preparation as acceptable on a hedonic facial scale. Despite 22% of children noting a “hot, spicy, or burning” sensation, consistent with known chemesthetic effects of ibuprofen, 83% of children confirmed they would take the medication in future, which rose to 87% in the context of future illness. In addition, after observing their children ingesting the medication, 92% of parents/guardians confirmed that they would be happy to administer this preparation of ibuprofen to their child if they were unwell. In conclusion, ibuprofen administered in the form of soft chewable capsules was palatable and acceptable to the majority of children and their parents/guardians and may provide a convenient and easy to dose preparation to reduce fever and relieve pain in children.
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Affiliation(s)
| | - Aomesh Bhatt
- Reckitt Benckiser Research & Development Berkshire UK
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Menditto E, Orlando V, De Rosa G, Minghetti P, Musazzi UM, Cahir C, Kurczewska-Michalak M, Kardas P, Costa E, Sousa Lobo JM, Almeida IF. Patient Centric Pharmaceutical Drug Product Design-The Impact on Medication Adherence. Pharmaceutics 2020; 12:E44. [PMID: 31947888 PMCID: PMC7023035 DOI: 10.3390/pharmaceutics12010044] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
Medication adherence is a growing concern for public health and poor adherence to therapy has been associated with poor health outcomes and higher costs for patients. Interventions for improving adherence need to consider the characteristics of the individual therapeutic regimens according to the needs of the patients. In particular, geriatric and paediatric populations as well as dermatological patients have special needs/preferences that should be considered when designing drug products. Patient Centric Drug Product Pharmaceutical Design (PCDPD) offers the opportunity to meet the needs and preferences of patients. Packaging, orodispersible formulations, fixed dose combinations products, multiparticulate formulations, topical formulations and 3D printing are of particular relevance in a PCDPD process. These will be addressed in this review as well as their impact on medication adherence.
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Affiliation(s)
- Enrica Menditto
- CIRFF, Centre of Pharmacoeconomics, Department of Pharmacy, University of Naples Federico II, Corso Umberto I, 40, 80138 Napoli NA, Italy; (E.M.); (V.O.)
| | - Valentina Orlando
- CIRFF, Centre of Pharmacoeconomics, Department of Pharmacy, University of Naples Federico II, Corso Umberto I, 40, 80138 Napoli NA, Italy; (E.M.); (V.O.)
| | - Giuseppe De Rosa
- Department of Pharmacy, University of Naples Federico II Corso Umberto I, 40, 80138 Napoli NA, Italy;
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via G. Colombo 71, 20133 Milan, Italy; (P.M.); (U.M.M.)
| | - Umberto Maria Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via G. Colombo 71, 20133 Milan, Italy; (P.M.); (U.M.M.)
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons, Beaux Lane House, Mercer Street, Dublin 2, Ireland;
| | - Marta Kurczewska-Michalak
- Department of Family Medicine, Medical University of Lodz, 60, Narutowicza St., 90-136 Lodz, Poland; (M.K.-M.); (P.K.)
| | - Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, 60, Narutowicza St., 90-136 Lodz, Poland; (M.K.-M.); (P.K.)
| | - Elísio Costa
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal;
| | - José Manuel Sousa Lobo
- UCIBIO/REQUIMTE, MedTech-Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal;
| | - Isabel F Almeida
- UCIBIO/REQUIMTE, MedTech-Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal;
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Łyszczarz E, Hofmanová J, Szafraniec-Szczęsny J, Jachowicz R. Orodispersible films containing ball milled aripiprazole-poloxamer®407 solid dispersions. Int J Pharm 2019; 575:118955. [PMID: 31843552 DOI: 10.1016/j.ijpharm.2019.118955] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/25/2019] [Accepted: 12/11/2019] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Ewelina Łyszczarz
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland.
| | - Justyna Hofmanová
- School of Pharmacy, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Joanna Szafraniec-Szczęsny
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland; Department of Physical Chemistry and Electrochemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Renata Jachowicz
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
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Lopalco A, Denora N, Laquintana V, Cutrignelli A, Franco M, Robota M, Hauschildt N, Mondelli F, Arduino I, Lopedota A. Taste masking of propranolol hydrochloride by microbeads of EUDRAGIT® E PO obtained with prilling technique for paediatric oral administration. Int J Pharm 2019; 574:118922. [PMID: 31836482 DOI: 10.1016/j.ijpharm.2019.118922] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to develop a new solid paediatric formulation for propranolol hydrochloride (PR). This drug is used to treat various paediatric diseases, and recently received clearance to treat haemangioma. However, PR has a bitter salty taste that does not facilitate high rates of compliance among children, especially in liquid formulations. In addition, the solid formulations are designed for adults and often their dosage is not suitable for children that require a flexible dose based on their weight. Therefore, matrix microbeads of EUDRAGIT® E PO containing PR were manufactured to overcome these limitations. Nine different samples were prepared using the prilling-congealing technique with high yield. Using 2 nozzles, 300 and 450 μm (code n), the diameters obtained of microbeads (from 333 to 699 μm) were homogenous and appropriate to be swallowed by children. In this study, the ratio drug:matrix for the microbeads was also examined in detail: 1:25 (F1), 1:15 (F2) and 1:10 (F3) in aqueous and tert-butyl alcohol/aqueous (code t) media. Most of the examined microbeads were characterized by high percentage of encapsulation efficiency (22-100%) and drug loading (22-77 mg of drug per g of matrix) effective for the administration of low and high doses of PR. SEM analysis revealed a matrix with a radial or a spongy structure, with numerous pores that generated soft floating microbeads in aqueous solution. Release studies confirmed a low release and dissolution of the drug in artificial saliva, mainly F1n > F1 > F2nt, and a prompt dissolution in simulated gastric media. Finally, electronic tongue measurements revealed the ability of these formulations to mask the bitter drug taste, especially for the sample with a ratio 1:25 (F1n and F1). These samples were chemically and physically stable for six months. In conclusion, the projected microbeads F1, and F1n reached the goal of the study, and could be proposed as new solid oral formulations dedicated to use by children.
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Affiliation(s)
- Antonio Lopalco
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Nunzio Denora
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Valentino Laquintana
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Annalisa Cutrignelli
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Massimo Franco
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Miriam Robota
- Formulation and Application Services, Evonik Nutrition & Care GmbH, Darmstadt, Germany
| | - Nina Hauschildt
- Formulation and Application Services, Evonik Nutrition & Care GmbH, Darmstadt, Germany
| | - Francesco Mondelli
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Ilaria Arduino
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Angela Lopedota
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari "Aldo Moro", Bari, Italy.
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Belissa E, Vallet T, Laribe-Caget S, Chevallier A, Chedhomme FX, Abdallah F, Bachalat N, Belbachir SA, Boulaich I, Bloch V, Delahaye A, Depoisson M, Wojcicki AD, Gibaud S, Grancher AS, Guinot C, Lachuer C, Lechowski L, Leglise P, Mahiou A, Meaume S, Michel C, Michelon H, Orven Y, Perquy I, Piccoli M, Rabus M, Ribemont AC, Rwabihama JP, Trouvin JH, Ruiz F, Boudy V. Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues. BMC Geriatr 2019; 19:344. [PMID: 31810442 PMCID: PMC6898963 DOI: 10.1186/s12877-019-1337-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population. Methods An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively. Results Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men. Conclusion This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.
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Affiliation(s)
- Emilie Belissa
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Thibault Vallet
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Sandra Laribe-Caget
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Alain Chevallier
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - François-Xavier Chedhomme
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Fattima Abdallah
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Nathalie Bachalat
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Sid-Ahmed Belbachir
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Imad Boulaich
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Vanessa Bloch
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Anne Delahaye
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Mathieu Depoisson
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Amélie Dufaÿ Wojcicki
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Stéphane Gibaud
- Centre Hospitalier de l'Ouest Vosgien, 1280 avenue division Leclerc, 88300, Neufchâteau, France
| | - Anne-Sophie Grancher
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Caroline Guinot
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Celia Lachuer
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Laurent Lechowski
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Patrick Leglise
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Abdel Mahiou
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Sylvie Meaume
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Corinne Michel
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Hugues Michelon
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Yann Orven
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Ines Perquy
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Matthieu Piccoli
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Maïté Rabus
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Annie-Claude Ribemont
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Paul Rwabihama
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Hugues Trouvin
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Fabrice Ruiz
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Vincent Boudy
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France.
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Ali J, Chiang M, Lee JB, Voronin GO, Bennett J, Cram A, Kagan L, Garnett MC, Roberts CJ, Gershkovich P. Is rat a good model for assessment of particulate-based taste-masked formulations? Eur J Pharm Biopharm 2019; 146:1-9. [PMID: 31726218 DOI: 10.1016/j.ejpb.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/06/2019] [Indexed: 02/06/2023]
Abstract
Recently there has been an increased interest to develop specialised dosage forms that are better suited to specific patient populations, such as paediatrics and geriatrics. In these patient populations the acceptability of the oral dosage form can be paramount to the products success. However, many Active Pharmaceutical Ingredients (APIs) are known to cause an aversive taste response. One way to increase the acceptability and to enhance the palatability of the formulation is to design coated taste-masked particulate-based dosage forms. The masking of poorly tasting drugs with physical barriers such as polymer coatings can be utilised to prevent the release of drug within the oral cavity, thus preventing a taste response. However, currently, there are few assessment tools and models available to test the efficiency of these particulate-based taste-masked formulations. The rat brief access taste aversion model has been shown to be useful in assessment of taste for liquid dosage forms. However, the applicability of the rat model for particulate-based taste masked formulations is yet to be assessed. It is not understood whether dissolution, solubility and thus exposure of the drug to taste receptors would be the same in rat and human. Therefore, rat saliva must be compared to human saliva to determine the likelihood that drug release would be similar within the oral cavity for both species. In this study rat saliva was characterised for parameters known to be important for drug dissolution, such as pH, buffer capacity, surface tension, and viscosity. Subsequently dissolution of model bitter tasting compounds, sildenafil citrate and efavirenz, in rat saliva was compared to dissolution in human saliva. For all parameters characterised and for the dissolution of both drugs in rat saliva, a substantial difference was observed when compared to human saliva. This discrepancy in saliva parameters and dissolution of model drugs suggests that preclinical taste evaluation of particulate-based taste-masked formulations suggests rat is not a good model for predicting taste of solid dosage forms or undissolved drug where dissolution is required. Alternative preclinical in vivo models in other species, or improved biorelevant in vitro models should be considered instead.
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Affiliation(s)
- Joseph Ali
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Manting Chiang
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Jong Bong Lee
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Gregory O Voronin
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Joanne Bennett
- Pfizer Ltd., Discovery Park, Ramsgate Road, Sandwich CT13 9ND, UK
| | - Anne Cram
- Pfizer Ltd., Discovery Park, Ramsgate Road, Sandwich CT13 9ND, UK
| | - Leonid Kagan
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Martin C Garnett
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Clive J Roberts
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Pavel Gershkovich
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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van der Vossen A, Buljaç S, Akçay K, Brugma JD, Vulto A, Hanff L. Availability of age-appropriate paediatric formulations in the Netherlands: the need in daily clinical practice remains. Eur J Hosp Pharm 2019; 28:306-312. [PMID: 34697046 PMCID: PMC8552141 DOI: 10.1136/ejhpharm-2019-001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives To quantify the availability of authorised, age-appropriate paediatric medicines in clinical practice in the Netherlands and to identify gaps by assessing dispensing practice in a paediatric hospital. Methods The availability of age-appropriate formulations was assessed by conducting a survey on the use of pharmacy compounded medicines among the paediatric hospitals in the Netherlands, and by analysing dispensing data of oral medication from the inpatient pharmacy of the largest paediatric hospital in the Netherlands. The age-appropriateness of the dispensed formulations was assessed on two aspects: dose-capability and acceptability. Liquid drug products that are unsuitable due to the presence of potentially harmful excipients, were identified based on the dosage in clinical practice. Results For 129 out of 139 drug substances included in the survey (93%), at least one of the eight respondents stated to use a pharmacy compounded product to meet the needs of their paediatric patients. The age-appropriateness of medicines dispensed from the inpatient pharmacy increased with age, and was higher for non-intensive care unit (ICU) patients than for ICU patients. We identified 15 drug products causing excipient exposure above the European Medicines Agency-recommended values. Conclusions This study confirms there is still a large need for age-appropriate formulations in daily clinical practice. Pharmacy compounding for paediatric patients remains essential for many indications. The need for potentially harmful excipients in compounded products should be critically assessed.
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Affiliation(s)
- Anna van der Vossen
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sandra Buljaç
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Kadir Akçay
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Dietert Brugma
- Department of Outpatient Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arnold Vulto
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lidwien Hanff
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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