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Yoo O, Tang E, Hossain ML, von Ungern-Sternberg BS, Sommerfield D, Heath C, Hauser N, Khan RN, Locher C, Nguyen M, Lim LY. The Development of a Chocolate-Based Chewable Tablet of Prednisolone-Enhancing the Palatability of Steroids for Pediatric Use. Pharmaceutics 2024; 16:1099. [PMID: 39204444 PMCID: PMC11359696 DOI: 10.3390/pharmaceutics16081099] [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: 07/30/2024] [Revised: 08/14/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Oral liquid prednisolone medications have poor acceptance among paediatric patients due to ineffective masking of the bitterness taste of prednisolone. This study aimed to develop a child-friendly prednisolone tablet using a patented chewable chocolate-based delivery system (CDS) previously applied successfully to mask the bitterness tastes of midazolam and tramadol. Prednisolone sodium phosphate (PSP) and prednisolone base (PB) CDS tablets were prepared, and the manufacturing process was optimised using a design of experiments (DoE) approach. Stability was assessed by quantifying residual drug content via a validated HPLC assay. A pilot randomised crossover taste study involving 25 young adult volunteers evaluated taste-masking effectiveness against Redipred™, a commercial oral PSP liquid medicine. The results showed that the PSP CDS tablet was chemically stable following storage for three months at ambient temperature, while the PB CDS tablet was unstable. The optimised PSP CDS tablet, manufactured at 50 °C with a stirring time of 26 h, was found to release over 80% of its drug load within 20 min in 0.1 M HCl and had a significantly better mean taste score compared to Redipred™ (7.08 ± 2.40 vs. 5.60 ± 2.33, p = 0.03). Fifty six percent of the participants preferred the PSP CDS tablet. In conclusion, compared to Redipred™, the CDS technology provided a more effective taste masking of PSP, potentially offering a child-friendly prednisolone formulation with improved compliance, dosing accuracy, and storage stability.
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Affiliation(s)
- Okhee Yoo
- Discipline of Pharmacy, School of Allied Health, The University of Western Australia, Perth, WA 6009, Australia; (O.Y.); (E.T.); (M.L.H.); (C.L.); (M.N.)
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA 6009, Australia
| | - Edith Tang
- Discipline of Pharmacy, School of Allied Health, The University of Western Australia, Perth, WA 6009, Australia; (O.Y.); (E.T.); (M.L.H.); (C.L.); (M.N.)
| | - Md Lokman Hossain
- Discipline of Pharmacy, School of Allied Health, The University of Western Australia, Perth, WA 6009, Australia; (O.Y.); (E.T.); (M.L.H.); (C.L.); (M.N.)
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
| | - Britta S. von Ungern-Sternberg
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA 6009, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA 6009, Australia
- Department of Anaesthesia and Pain Medicine, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - David Sommerfield
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA 6009, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA 6009, Australia
- Department of Anaesthesia and Pain Medicine, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - Chloe Heath
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA 6009, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA 6009, Australia
- Department of Anaesthesia and Pain Medicine, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - Neil Hauser
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA 6009, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA 6009, Australia
- Department of Anaesthesia and Pain Medicine, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - R. Nazim Khan
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA 6009, Australia
- Department of Mathematics and Statistics, The University of Western Australia, Perth, WA 6009, Australia
| | - Cornelia Locher
- Discipline of Pharmacy, School of Allied Health, The University of Western Australia, Perth, WA 6009, Australia; (O.Y.); (E.T.); (M.L.H.); (C.L.); (M.N.)
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
| | - Minh Nguyen
- Discipline of Pharmacy, School of Allied Health, The University of Western Australia, Perth, WA 6009, Australia; (O.Y.); (E.T.); (M.L.H.); (C.L.); (M.N.)
| | - Lee Yong Lim
- Discipline of Pharmacy, School of Allied Health, The University of Western Australia, Perth, WA 6009, Australia; (O.Y.); (E.T.); (M.L.H.); (C.L.); (M.N.)
- Institute for Pediatric Perioperative Excellence, The University of Western Australia, Perth, WA 6009, Australia; (B.S.v.U.-S.); (D.S.); (N.H.); (R.N.K.)
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Yoo O, Tang EKY, Salman S, Nguyen MN, Sommerfield D, Sommerfield A, Khan N, von Ungern Sternberg BS, Lim LY. A randomised controlled trial of a novel tramadol chewable tablet: pharmacokinetics and tolerability in children. Anaesthesia 2022; 77:438-448. [PMID: 35083739 DOI: 10.1111/anae.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
Tramadol is a bitter atypical opioid analgesic drug and is prescribed to treat postoperative pain in children. However, in many countries there is no licensed paediatric tramadol formulation available. We have formulated a novel chewable chocolate-based drug delivery system for the administration of tramadol to children. This pilot, single-centre, open-label, randomised clinical study assessed the taste tolerability and comparative population pharmacokinetics of the novel tramadol chewable tablet against a compounded tramadol hydrochloride oral liquid, at a dose of 1 mg.kg-1 . A 5-point facial hedonic scale was used by the children, parents and nurses to assess tolerability. One hundred and forty-one children aged 3-16 years were given tramadol 30 min before general anaesthesia. Blood samples were taken following the induction of anaesthesia and for up to 5 h following tramadol administration. Tramadol and its active metabolite O-desmethyltramadol were analysed using reversed-phase high-performance liquid chromatography. A population pharmacokinetic model was built using non-linear mixed effects modelling. The relative bioavailability for the tablet was 1.25 times higher (95%CI 1.16-1.35) than for tramadol hydrochloride oral liquid, while the absorption rate constant for the tablet was significantly lower (1.97 h-1 vs. 3.34 h-1 , p < 0.001). Larger inter-individual variability in absorption rates were observed with the liquid tramadol. The tramadol chewable tablet was more acceptable in taste to children when assessed by the children, parents and nurses (all p < 0.001). We conclude that the novel tramadol chewable tablet has favourable acceptability and more reliable relative bioavailability in children compared with tramadol hydrochloride oral liquid.
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Affiliation(s)
- O Yoo
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - E K Y Tang
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - S Salman
- Clinical Pharmacology and Toxicology Unit, PathWest, Perth, WA, Australia.,Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - M N Nguyen
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - D Sommerfield
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia.,Peri-operative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - N Khan
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - B S von Ungern Sternberg
- Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - L Y Lim
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, WA, Australia
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Jeon A, Han E, Lee K, Sommerfield A, Lim LY, Sommerfield D, von Ungern-Sternberg BS. Parents' perspectives towards paediatric confectionary masked medications: a qualitative study. Int J Clin Pharm 2021; 44:374-380. [PMID: 34813028 DOI: 10.1007/s11096-021-01349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
Background The availability of age-appropriate, taste-masked oral solid medications for the paediatric population is currently inadequate. We have developed a novel chocolate-based drug delivery platform to taste-mask bitter drugs commonly utilised in the hospital setting, but there is limited evidence regarding parent's perspectives on these medications. Aim To identify key themes regarding parents' perspectives on taste-masked medications that look like confectionary. Additionally, to explore and identify the various barriers and facilitators to using oral medication among the paediatric population.Methods Qualitative descriptive study (July to August 2020) at a single tertiary paediatric hospital (Perth Children's Hospital-PCH). Parents with at least one child (2-18 years) that underwent any elective operation at PCH were included in the study, in total 17 were interviewed. Results The two primary themes that underpinned parent's perspectives on taste-masked medications that look like confectionary were medication safety and taste. Majority of parents supported the use of the proposed medication on the basis that the favourable taste profile will facilitate oral consumption, as opposed to their previous experiences with conventional paediatric medications that do not taste mask the bitter flavour. However, medication safety, in the forms of patient education and appropriate packaging, must be considered to minimise harmful misuse of the proposed medication. Conclusion Participants unanimously support the short-term use of taste-masked medications that look like confectionary, particularly in the hospital setting. However, patient education is highly sought after by parents regarding the role of these medications, to ensure medication safety with their children.
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Affiliation(s)
- Andy Jeon
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia.,School of Public Health, The University of Sydney, Sydney, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Ellen Han
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Lee Yong Lim
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - David Sommerfield
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Britta S von Ungern-Sternberg
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia. .,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia. .,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia.
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