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Ma AP, Robertson SG, Glass BD. Telmisartan Tablets Repackaged into Dose Administration Aids: Physicochemical Stability under Tropical Conditions. Pharmaceutics 2022; 14:pharmaceutics14081667. [PMID: 36015293 PMCID: PMC9414511 DOI: 10.3390/pharmaceutics14081667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Dose administration aids (DAAs) are commonly used to assist patients with chronic disease to manage multiple medications and thus improve adherence. Several brands of telmisartan, commonly prescribed for hypertension, are available in Australia. Manufacturer’s storage advice is to leave tablets in the blister strip until administered to patients. This study aimed to investigate the stability of telmisartan tablets when repackaged and stored in DAAs, to identify a brand, which is sufficiently stable to be repackaged. All available brands of telmisartan tablets in Australia, which contain different excipients, were repackaged into DAAs and stored at 30 °C, 75% RH for 28 days before screening, using visual inspection and physical testing. A candidate brand was then selected for physicochemical and photostability testing using pharmacopoeial methods. Repackaged Mizart® tablets were shown to be sufficiently stable, when repackaged and stored under tropical conditions (30 °C, 75% RH) for 28 days. Several of the other brands were deemed inappropriate for repackaging, due to physical instability, highlighting the importance of considering not only the drug, but also excipients to ensure the stability of repackaged medicines. Although the repackaging of telmisartan tablets is not advised, this study provides evidence to support the Mizart® brand as an option for pharmacists to recommend for repackaging.
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Lim CX, Aliakbari M, Gokulanathan VR, Noah S, Taskin R, Stupans I, Allahham A. Stability implications of repackaged medications in dose administration aids: a systematic review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:93-107. [PMID: 35435960 DOI: 10.1093/ijpp/riac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/09/2022] [Indexed: 09/08/2023]
Abstract
BACKGROUND Dose administration aids (DAAs) or multi-compartment compliance aids are commonly used to organise doses of medications in accordance with a patient's dosing schedule. Despite their widespread use, there is a paucity of information on the stability of repackaged medications in DAAs. OBJECTIVES The objectives of this work were to evaluate stability studies conducted on repackaged medicine in DAAs and to provide a summary of the latest stability data available. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on studies associated with repackaged medications in DAAs and drug stability. PubMed, CINAHL, EMBASE and SCOPUS were searched from January 1998 to June 2021. KEY FINDINGS A total of 342 articles were retrieved and 29 articles met the inclusion criteria. Data regarding medications from the reviewed papers were reported according to stability testing and physicochemical properties. The extracted data were then compared with stability information on DAA provision available on the database in the UK. This review identified several discrepancies between this dataset and reported stability and reveals a significant shortage in the stability data of medications repackaged in DAAs. CONCLUSION This review highlights the need for further studies to be conducted to better understand the impact of DAA repackaging on the stability, safety and efficacy of medications. It is recommended that a database of stability information of repackaged medications via systematic stability testing studies could be established, serving as a valuable resource for pharmacists when preparing DAAs without compromising patient safety.
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Affiliation(s)
- Chiao Xin Lim
- Discipline of Pharmacy, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Mozghan Aliakbari
- Discipline of Pharmacy, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Vithiya R Gokulanathan
- Discipline of Pharmacy, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Sadeem Noah
- Discipline of Pharmacy, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Rabia Taskin
- Discipline of Pharmacy, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Ieva Stupans
- Discipline of Pharmacy, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
| | - Ayman Allahham
- Discipline of Pharmacy, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, VIC, Australia
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Dose Administration Aid Service in Community Pharmacies: Characterization and Impact Assessment. PHARMACY 2021; 9:pharmacy9040190. [PMID: 34842810 PMCID: PMC8628955 DOI: 10.3390/pharmacy9040190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022] Open
Abstract
Adherence to therapies is a primary determinant of treatment success. Lack of medication adherence is often associated with medical and psychosocial issues due to complications from underlying conditions and is an enormous waste of medical resources. Dose Administration Aid Service (DAAS) can be seen as part of the solution, allowing individual medicine doses to be organized according to the dosing schedule determined by the patient’s prescriber. The most recent systematic reviews admit the possibility of a positive impact of this service. In line with this background, the study reported in this paper aimed to characterize DAAS implementation in Portugal and understand the perceptions of pharmacists and owners of community pharmacies regarding the impact of DAAS, preferred methodology types, and State contribution. The study was guided by qualitative description methodology and reported using the consolidated criteria for reporting qualitative research (COREQ) checklist. Data were collected through semi-structured interviews with 18 pharmacists and/or owners of community pharmacies. Using qualitative content analysis, we identified categories that revealed that automated weekly methodology is the preferred methodology, because of its easiness of use and lower cost of preparation. However, the investment cost was felt to be too high by the participants considering the number of potential users for implementation in practice. Participants were also unanimous in recognizing that DAAS has a very positive impact in terms of safety and medication adherence, and the majority agreed that it also helped reduce medication waste. Implications of these findings for medication adherence are discussed.
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Chaudhri K, Kearney M, Day RO, Rodgers A, Atkins E. Effect of dose administration aids on adherence to self-administered medications: a systematic review protocol. BMJ Open 2019; 9:e030536. [PMID: 31585972 PMCID: PMC6797326 DOI: 10.1136/bmjopen-2019-030536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/23/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Forgetting to take a medication is the most common reason for non-adherence to self-administered medication. Dose administration aids (DAAs) are a simple and common solution to improve unintentional non-adherence for oral tablets. DAAs can be in the form of compartmentalised pill boxes, automated medication dispensing devices, blister packs and sachets packets. This protocol aims to outline the methods that will be used in a systematic review of the current literature to assess the impact of DAAs on adherence to medications and health outcomes. METHODS AND ANALYSIS Randomised controlled trials will be identified through electronic searches in databases including EMBASE, MEDLINE, CINAHL and the Cochrane Library, from the beginning of each database until January 2020. Two reviewers will independently screen studies and extract data using the standardised forms. Data extracted will include general study information, characteristics of the study, participant characteristics, intervention characteristics and outcomes. Primary outcome is to assess the effects of DAAs on medication adherence. Secondary outcome is to evaluate the changes in health outcomes. The risk of bias will be ascertained by two reviewers in parallel using The Cochrane Risk of Bias Tool. A meta-analysis will be performed if data are homogenous. ETHICS AND DISSEMINATION Ethics approval will not be required for this study. The results of the review described within this protocol will be disseminated through publication in a peer-reviewed journal and relevant conference presentations. PROSPERO REGISTRATION NUMBER CRD42018096087.
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Affiliation(s)
- Kanika Chaudhri
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincents Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Madeleine Kearney
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Richard O Day
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincents Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Anthony Rodgers
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Emily Atkins
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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García ER, Thalhauser S, Loscertales HR, Modamio P, Lastra CF, Mariño EL. Current evidence in the stability of medicines in dose administration aids: implications for patient safety. Expert Opin Drug Deliv 2018; 15:577-587. [PMID: 29792364 DOI: 10.1080/17425247.2018.1480610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION As the elderly population and polypharmacy are increasing, it is predicted that interventions to enhance medication adherence, as dose administration aids (DAA), will grow. One of the limitations of repackaging medicines into DAA is to assure the stability of medicines, and, therefore, their quality, efficacy and safety. AREAS COVERED This article collects and summarises data of all the stability studies of repackaged medicines into DAAs. Computerized search in databases: PubMed, Google Scholar, SciELO, and reference texts related to the field (keywords: drug stability, DAAs, compliance aids, and repackaging), open access databases and guidelines. Also, it provides recommendations on the suitability of repackaging and compares them with those established. EXPERT OPINION Since medicines are removed from primary package, their stability can be compromised due to psychochemical characteristics of the drug substance and product, the dosage form, the type of DAA selected, the co-storage and splitting, the repackaging conditions, and the conditions of storage. This review reflects the need of more standardized stability studies to guarantee the quality of repackaged medicines. In addition, the importance of them to support the pharmacist to make the best decisions in order to maximize outcomes and minimize risks related to patients' medication when repackaging it.
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Affiliation(s)
- Estela R García
- a Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences , University of Barcelona , Barcelona , Spain
| | - Stefanie Thalhauser
- a Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences , University of Barcelona , Barcelona , Spain
| | - Hèctor R Loscertales
- a Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences , University of Barcelona , Barcelona , Spain
| | - Pilar Modamio
- a Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences , University of Barcelona , Barcelona , Spain
| | - Cecilia F Lastra
- a Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences , University of Barcelona , Barcelona , Spain
| | - Eduardo L Mariño
- a Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences , University of Barcelona , Barcelona , Spain
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Bjerknes K, Helmizadeh Z, Brustugun J, Smistad G. Physical stability of moisture-sensitive tablets stored in a canister or as a unit-dose. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kathrin Bjerknes
- Hospital Pharmacies Enterprise; South Eastern Norway Lørenskog Norway
| | | | - Jørgen Brustugun
- Hospital Pharmacies Enterprise; South Eastern Norway Lørenskog Norway
| | - Gro Smistad
- School of Pharmacy; University of Oslo; Oslo Norway
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