Pharmaceutical excipients and the information on drug labels

Cariogenic and erosive potential of pediatric medicines and vitamin supplements

Abstract Introduction Pharmaceutical pediatric formulations with low in pH and high in total titratable acidicity used frequently and over long periods of time, have the potential to produce erosive lesions in teeth. On the other hand, high concentration of sucrose, the nocturnal use and the lack of hygiene after its administration, are some factors that can contribute to the cariogenic potential of these formulations. Objective To evaluate in vitro the cariogenic and erosive potential of medicines and liquid vitamins and mineral supplements for pediatric use. Material and method Medicines (n=41) and liquid vitamins and mineral supplements (n=12) childish were selected and analyzed for their physicochemical properties, pH, total titratable acidity (TTA) and total soluble solids concentration (TSS/°Brix). The package inserts and labels were analyzed to identify the composition regarding the content of sugars and acidulants, in addition to the side effects related to salivary flow. Result The pH analysis indicated that there was greater variation in the observed averages in the medication group. As for the TTA at pH 5.5, supplements and medicines groups showed significant variation between the means found (p<0.05). The TTA results at pH 7.0 showed that the highest mean found was in the class of antihistamines and the lowest in the class of drugs that contain the association of antitussives and antihistamines. The analyses TSS demonstrated that across all drug classes and supplements the amount of TSS varied significantly (p<0.05) in all classes of medicines and supplements. Conclusion Most medicines and pediatric liquid vitamin and mineral supplements demonstrated significantly different behaviors within the group itself regarding the variables analyzed that constitute risk factors for the development of dental caries and erosion.

Simple Approach to Enhance Green Tea Epigallocatechin Gallate Stability in Aqueous Solutions and Bioavailability: Experimental and Theoretical Characterizations

Because of its antioxidant, antimutagenic, and anti-infectious properties, epigallocatechin gallate (EGCG) is the most interesting compound among the green tea catechins polyphenols. However, its health effects are inconclusive due to its very low bioavailability, largely due to a particular instability that does not allow EGCG to reach the potency required for clinical developments. Over the last decade, many efforts have been made to improve the stability and bioavailability of EGCG using complex delivery systems such as nanotechnology, but these efforts have not been successful and easy to translate to industrial use. To meet the needs of a large-scale clinical trial requiring EGCG in a concentrated solution to anticipate swallowing impairments, we developed an EGCG-based aqueous solution in the simplest way while trying to circumvent EGCG instability. The solution was thoroughly characterized to sort out the unexpected stability outcome by combining experimental (HPLC-UV-mass spectrometry and infrared spectroscopy) and computational (density functional theory) studies. Against all odds, the EGCG–sucrose complex under certain conditions may have prevented EGCG from degradation in aqueous media. Indeed, in agreement with the ICH guidelines, the formulated solution was shown to be stable up to at least 24 months under 2–8 °C and at ambient temperature. Furthermore, considerable improvement in bioavailability in rats, against EGCG powder formulated in hard-gel capsules, was shown after gavage. Thus, the proposed formulation may provide an easily implementable platform to administer EGCG in the context of clinical development.

It's not all about inhaled treatment: challenges with oral therapy in paediatric respiratory medicine

Advances in therapies and management of conditions encountered by paediatric respiratory specialists have led to improved outcomes and improved survival rates dramatically in chronic diseases such as cystic fibrosis. However, this has also meant an increase in treatment burden. A variety of inhaled treatments are crucial in managing paediatric respiratory diseases, but these patients also have to take many oral medications. It is widely recognised that developing oral formulations appropriate for the paediatric population can affect how well a product is received by patients and their families. Consideration should be given to palatability and the number of medicines to be administered as these can all contribute to treatment adherence.

Polypharmacy specifically in the context of management of patients with cystic fibrosis is not a new concept, but the recently introduced cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies and their potential for interactions and adverse reactions create novel challenges. There are some strategies that families and healthcare professionals can implement to reduce treatment burden. This review will also provide some insight into the life of a teenager with cystic fibrosis and the relative complexities of her treatment and the impacts on daily life.

In children, medications given by the oral route can be challenging to administer, add to the burden of care and contribute to poor adherence. Additionally, polypharmacy increases the chances of interactions between oral medications.https://bit.ly/3fxgXQU

The Embryotoxic Effects of in Ovo Administered Sunset Yellow FCF in Chick Embryos

Sunset yellow (SY) at prescribed concentrations has been approved by regulatory authorities in several countries as an additive dye in the food, beverage, cosmetic, and pharmaceutical industries. However, there are some reports that it may cause several health problems. The aim of this study is to evaluate embryotoxic effects of SY on liver and kidney in chick embryos. Babcock white Leghorn eggs were randomly divided into four groups. Non-treated eggs served as control group. The eggs in groups SY₂₀₀, SY₁₀₀₀, and SY₂₀₀₀ were treated with a single injection of 200, 1000, and 2000 ng SY into the air sac just before incubation. The developmental stages of embryos were determined on the 10th, 13th, 16th, and 21st days of incubation. Samples of the liver and kidney were taken and routine histological procedures were performed. The highest relative embryo weight was seen in all SY treated groups on the 16th day of incubation. Necrosis of some hepatocytes and cytoplasmic degenerations were observed in all SY groups in the liver. There were degenerated or destructed renal cortex structures and necrosis in the kidney. The cell’s nuclear areas and diameters of renal cortex structures were different in all SY groups compared to the control group (p < 0.05). It was concluded that in ovo administered SY has many unfavorable effects on liver and kidney in chick embryos. The results obtained in this study suggest that it may be advisable to re-assess safety levels of SY in many industries.

Effects of Sunset Yellow FCF on Immune System Organs During Different Chicken Embryonic Periods

Introduction

Sunset Yellow FCF (SY), used frequently in ready-made foods, cosmetics, and the pharmaceutical industry, may cause many health problems. This study is intended to evaluate the morphological and cellular effects of SY on the embryonic chicken immune system throughout incubation.

Material and Methods

Babcock white leghorn eggs were randomly divided into four groups. Besides a control group, there were three treatment groups which received a single injection of 200, 1,000, or 2,000 ng of SY into the air sac just before incubation. The eggs were opened on the 10^th, 13^th, 16^th, and 21^st days of incubation. Samples of the bursa of Fabricius, thymus, and spleen were taken from embryos. Serial sections of 5 μm thickness were stained with histological methods and routine histological procedures were performed.

Results

An increase in the spleen volume was determined as the hatching time of the chicks approached. The highest eosinophil ratio was found in the SY_1,000 and SY_2,000 groups (P < 0.05), where the most significant change was developmental retardation in the thymus. In the bursa of Fabricius, there was less lymphocyte accumulation and eosinophilic cell infiltration with increasing doses.

Conclusion

It was concluded that in ovo administered SY has undesired effects on embryonic development of the bursa of Fabricius, spleen, and thymus, and on spleen volume.

Safety and Biopharmaceutical Challenges of Excipients in Off-Label Pediatric Formulations

BACKGROUND

One of the major challenges in pediatric treatment is the lack of suitable drug preparations specifically designed and marketed for children. Most of the FDA approved drug formulations for adults have not been approved for use in pediatric patients. Shortage of suitable pediatric dosage information often leads health professionals to use adult formulations in an off-label manner. The aim of this work was to review the safety and biopharmaceutical challenges of commonly found excipients in off-label pediatric formulations as well as to show the current progress to alleviate pediatric toxicity related to excipients.

METHODS

Research findings and medical case reports were searched from credible sources including Scopus, PubMed, OVID, Google Scholar, Embase, Cochrane Library, and Web of Science.

RESULTS

As several studies and clinical case reports have revealed, off-label adult formulations usage causes pediatric patients to become exposed to potentially harmful excipients, which are essential components of drug products. In addition to their toxicities, some of the excipients affect the biopharmaceutical property of different drugs. Immature organ and body composition, large body surface area and slower metabolism and elimination capabilities of pediatrics are the main causes of toxicities associated with different excipients. Recent studies have also shown that good progress is being made to develop safe and suitable excipients for pediatric use.

CONCLUSION

A risk and benefit assessment should be done before using off-label formulation as excipients cause mild to severe toxicities and biopharmaceutical problems to pediatric patients.

Prevalence of ethanol and other potentially harmful excipients in pediatric oral medicines: survey of community pharmacies in a Nigerian City

OBJECTIVE

Excipients are needed in the formulation of oral liquid medicines intended for children; they have however been reported to trigger safety issues. This study evaluated the concentrations and prevalence of ethanol and other potentially harmful excipients in pediatric formulations marketed in South Eastern Nigeria in line with international labeling guidelines and allowable daily limits (ADL). The study sampled oral pediatric formulations offered for sale in registered pharmacies. Those with accessible information leaflets were assessed for the presence and quantity of previously flagged excipients with potential to harm the pediatric population.

RESULT

Of the 380 oral pediatric medicines, 140 provided access to list/quantity of ingredients. 47.9% (67) of the formulations contain at least one of the flagged excipients while the remaining only listed the active ingredients. Ethanol had the highest occurrence (62.7%) and was more in cough/cold medicines. A homeopathic cough and cold remedy had concentration of 90% v/v. Ethanol and sucrose in some formulations exhibited concentrations with a potential of crossing their approved daily intake (ADI) (1-90% v/v and 1.7 g-3.7 g/5 ml respectively). Ethanol use in studied pediatric formulations was quite high, with ethanol-containing formulations being prescribed for children 0-6 years and older. Only 26 (38.8%) completely satisfied the labelling requirements for ethanol containing formulations.

Methylparaben concentration in commercial Brazilian local anesthetics solutions

Objective

To detect the presence and concentration of methylparaben in cartridges of commercial Brazilian local anesthetics.

Material and methods

Twelve commercial brands (4 in glass and 8 in plastic cartridges) of local anesthetic solutions for use in dentistry were purchased from the Brazilian market and analyzed. Different lots of the commercial brands were obtained in different Brazilian cities (Piracicaba, Campinas and São Paulo). Separation was performed using high performance liquid chromatography (HPLC) with UV-Vis detector. The mobile phase used was acetonitrile:water (75:25 - v/v), pH 4.5, adjusted with acetic acid at a flow rate of 1.0 ml.min^-1.

Results

When detected in the solutions, the methylparaben concentration ranged from 0.01% (m/v) to 0.16% (m/v). One glass and all plastic cartridges presented methylparaben.

Conclusion

1. Methylparaben concentration varied among solutions from different manufacturers, and it was not indicated in the drug package inserts; 2. Since the presence of methylparaben in dental anesthetics is not regulated by the Brazilian National Health Surveillance Agency (ANVISA) and this substance could cause allergic reactions, it is important to alert dentists about its possible presence.