1
|
Manning MC, Holcomb RE, Payne RW, Stillahn JM, Connolly BD, Katayama DS, Liu H, Matsuura JE, Murphy BM, Henry CS, Crommelin DJA. Stability of Protein Pharmaceuticals: Recent Advances. Pharm Res 2024; 41:1301-1367. [PMID: 38937372 DOI: 10.1007/s11095-024-03726-x] [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: 03/25/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
There have been significant advances in the formulation and stabilization of proteins in the liquid state over the past years since our previous review. Our mechanistic understanding of protein-excipient interactions has increased, allowing one to develop formulations in a more rational fashion. The field has moved towards more complex and challenging formulations, such as high concentration formulations to allow for subcutaneous administration and co-formulation. While much of the published work has focused on mAbs, the principles appear to apply to any therapeutic protein, although mAbs clearly have some distinctive features. In this review, we first discuss chemical degradation reactions. This is followed by a section on physical instability issues. Then, more specific topics are addressed: instability induced by interactions with interfaces, predictive methods for physical stability and interplay between chemical and physical instability. The final parts are devoted to discussions how all the above impacts (co-)formulation strategies, in particular for high protein concentration solutions.'
Collapse
Affiliation(s)
- Mark Cornell Manning
- Legacy BioDesign LLC, Johnstown, CO, USA.
- Department of Chemistry, Colorado State University, Fort Collins, CO, USA.
| | - Ryan E Holcomb
- Legacy BioDesign LLC, Johnstown, CO, USA
- Department of Chemistry, Colorado State University, Fort Collins, CO, USA
| | - Robert W Payne
- Legacy BioDesign LLC, Johnstown, CO, USA
- Department of Chemistry, Colorado State University, Fort Collins, CO, USA
| | - Joshua M Stillahn
- Legacy BioDesign LLC, Johnstown, CO, USA
- Department of Chemistry, Colorado State University, Fort Collins, CO, USA
| | | | | | | | | | | | - Charles S Henry
- Department of Chemistry, Colorado State University, Fort Collins, CO, USA
| | | |
Collapse
|
2
|
Designing Formulation Strategies for Enhanced Stability of Therapeutic Peptides in Aqueous Solutions: A Review. Pharmaceutics 2023; 15:pharmaceutics15030935. [PMID: 36986796 PMCID: PMC10056213 DOI: 10.3390/pharmaceutics15030935] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Over the past few decades, there has been a tremendous increase in the utilization of therapeutic peptides. Therapeutic peptides are usually administered via the parenteral route, requiring an aqueous formulation. Unfortunately, peptides are often unstable in aqueous solutions, affecting stability and bioactivity. Although a stable and dry formulation for reconstitution might be designed, from a pharmaco-economic and practical convenience point of view, a peptide formulation in an aqueous liquid form is preferred. Designing formulation strategies that optimize peptide stability may improve bioavailability and increase therapeutic efficacy. This literature review provides an overview of various degradation pathways and formulation strategies to stabilize therapeutic peptides in aqueous solutions. First, we introduce the major peptide stability issues in liquid formulations and the degradation mechanisms. Then, we present a variety of known strategies to inhibit or slow down peptide degradation. Overall, the most practical approaches to peptide stabilization are pH optimization and selecting the appropriate type of buffer. Other practical strategies to reduce peptide degradation rates in solution are the application of co-solvency, air exclusion, viscosity enhancement, PEGylation, and using polyol excipients.
Collapse
|
3
|
Cmc S, Lord H, Vargese SS, Kurian N, Cherian SA, Mathew E, Fernandez R. Effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections: a systematic review and meta-analysis. JBI Evid Synth 2023; 21:373-400. [PMID: 36758552 DOI: 10.11124/jbies-20-00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The objective of this review was to synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections. INTRODUCTION Pain associated with intramuscular injections continues to be a challenge for nurses. Various physical stimulation methods to alleviate pain and improve satisfaction for patients receiving intramuscular injections have been reported; however, the evidence surrounding the effectiveness of these methods remains inconclusive. INCLUSION CRITERIA This systematic review considered randomized and quasi-experimental studies that used any physical stimulation strategies (eg, skin tapping, manual pressure, massage, pinch, traction) for adults aged 18 years and over receiving intramuscular injections. Studies that evaluated pain using validated instruments were considered for inclusion. METHODS A three-step search strategy was conducted. MEDLINE, Embase, CINAHL, the Cochrane Library (Cochrane CENTRAL), Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar were searched from inception until 2020. We restricted the inclusion of studies to trials published in English. Two independent reviewers conducted the critical appraisal of eligible studies using the JBI checklists for randomized controlled and quasi-experimental trials. Data were extracted using the JBI data extraction tool, and meta-analysis and subgroup analysis were undertaken, where appropriate. RESULTS Twenty-five studies were included with a total sample size of 1956 patients. Pooled results demonstrated that pain was significantly less with the use of the Helfer skin tap technique compared to no intervention (two studies; RR 0.73; 95% CI 0.66, 0.81; P <0.00001) or standard intervention (three studies; SMD -2.25; 95% CI -3.65, -0.85; P =0.002). Intervention with acupressure using standard treatment as control showed significant reduction in pain intensity (MD -4.78; 95% CI -5.32, -4.24; P <0.00001). Similarly, pain was significantly lower with manual pressure (two studies; SMD -0.42; 95% CI -0.69, 0.15; P =0.002) when compared to standard treatment. Pain scores were significantly lower in patients who received pinch technique, ShotBlocker, massage, or combination intervention (skin traction, pressure, and rapid muscle release) compared with no intervention, standard treatment, or placebo control. CONCLUSIONS The evidence from this review demonstrates that physical stimulation - particularly the Helfer skin tap technique, acupressure, manual pressure, pinch technique, ShotBlocker, massage, and combination - can significantly lower intramuscular injection pain; however, this is based on low or very low certainty of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020168586.
Collapse
Affiliation(s)
- Serena Cmc
- Department of Medical Surgical Nursing, Pushpagiri College of Nursing, Thiruvalla, Kerala, India.,Pushpagiri Centre for Evidence-based Practice (PCEBP): A JBI Affiliated Group, Thiruvilla, Kerala, India.,Pushpagiri Medical College Hospital, Thiruvalla, Kerala, India
| | - Heidi Lord
- Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
| | - Saritha Susan Vargese
- Pushpagiri Centre for Evidence-based Practice (PCEBP): A JBI Affiliated Group, Thiruvilla, Kerala, India.,Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Nisha Kurian
- Pushpagiri Centre for Evidence-based Practice (PCEBP): A JBI Affiliated Group, Thiruvilla, Kerala, India.,Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Sunu Alice Cherian
- Pushpagiri Centre for Evidence-based Practice (PCEBP): A JBI Affiliated Group, Thiruvilla, Kerala, India.,Pushpagiri Medical College Hospital, Thiruvalla, Kerala, India.,Department of Oral Medicine and Radiology, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Elsheba Mathew
- Pushpagiri Centre for Evidence-based Practice (PCEBP): A JBI Affiliated Group, Thiruvilla, Kerala, India.,Pushpagiri Medical College Hospital, Thiruvalla, Kerala, India.,Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | - Ritin Fernandez
- Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia.,University of Newcastle, Gosford, NSW, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, St George Hospital, Kogarah, NSW, Australia
| |
Collapse
|
4
|
Taghizadeh B, Jaafari MR, Zarghami N. New insight into the importance of formulation variables on parenteral growth hormone preparations: potential effect on the injection-site pain. Front Endocrinol (Lausanne) 2022; 13:963336. [PMID: 36263321 PMCID: PMC9576007 DOI: 10.3389/fendo.2022.963336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Reducing injection-site pain (ISP) in patients with chronic conditions such as growth hormone deficiency is a valuable strategy to improve patient compliance and therapeutic efficiency. Thus understanding different aspects of pain induction following subcutaneous injection of biotherapeutics and identifying the responsible factors are vital. Here we have discussed the effects of formulation's viscosity, concentration, osmolality, buffering agents, pH, and temperature as well as injection volume, dosing frequency, and different excipients on ISP following subcutaneous injection of commercially available recombinant human growth hormone products. Our literature review found limited available data on the effects of different components of parenteral rhGH products on ISP. This may be due to high cost associated with conducting various clinical trials to assess each excipient in the formulation or to determine the complex interactions of different components and its impact on ISP. Recently, conducting molecular dynamics simulation studies before formulation design has been recommended as an alternative and less-expensive approach. On the other hand, the observed inconsistencies in the available data is mainly due to different pain measurement approaches used in each study. Moreover, it is difficult to translate data obtained from animal studies to human subjects. Despite all these limitations, our investigation showed that components of parenteral rhGH products can significantly contribute to ISP. We suggest further investigation is required for development of long acting, buffer-free, preservative-free formulations. Besides, various excipients are currently being investigated for reducing ISP which can be used as alternatives for common buffers, surfactants or preservatives in designing future rhGH formulations.
Collapse
Affiliation(s)
- Bita Taghizadeh
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reza Jaafari
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- *Correspondence: Nosratollah Zarghami,
| |
Collapse
|
5
|
Jakaria SM, Budil DE, Murtagh J. Glycopeptide antibiotic drug stability in aqueous solution. AAPS OPEN 2022; 8:20. [PMCID: PMC9742044 DOI: 10.1186/s41120-022-00067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
Glycopeptide antimicrobials are a class of naturally occurring or semi-synthetic glycosylated products that have shown antibacterial activity against gram-positive organisms by inhibiting cell-wall synthesis. In most cases, these drugs are prepared in dry powder (lyophilized) form due to chemical and physical instability in aqueous solution; however, from an economic and practical point of view, liquid formulations are preferred. Researchers have recently found ways to formulate some glycopeptide antibiotic therapeutic drugs in aqueous solution at refrigerated or room temperature. Chemical degradation can be significantly slowed by formulating them at a defined pH with specific buffers, avoiding oxygen reactive species, and minimizing solvent exposure. Sugars, amino acids, polyols, and surfactants can reduce physical degradation by restricting glycopeptide mobility and reducing solvent interaction. This review focuses on recent studies on glycopeptide antibiotic drug stability in aqueous solution. It is organized into three sections: (i) glycopeptide antibiotic instability due to chemical and physical degradation, (ii) strategies to improve glycopeptide antibiotic stability in aqueous solution, and (iii) a survey of glycopeptide antibiotic drugs currently available in the market and their stability based on published literature and patents. Antimicrobial resistance deaths are expected to increase by 2050, making heat-stable glycopeptides in aqueous solution an important treatment option for multidrug-resistant and extensively drug-resistant pathogens. In conclusion, it should be possible to formulate heat stable glycopeptide drugs in aqueous solution by understanding the degradation mechanisms of this class of therapeutic drugs in greater detail, making them easily accessible to developing countries with a lack of cold chains.
Collapse
Affiliation(s)
- Sardar M. Jakaria
- Hikma Pharmaceuticals, Bedford, OH 44146 USA ,grid.261112.70000 0001 2173 3359Department of Chemistry and Chemical Biology, Northeastern University, MA 02115 Boston, USA
| | - David E. Budil
- grid.261112.70000 0001 2173 3359Department of Chemistry and Chemical Biology, Northeastern University, MA 02115 Boston, USA
| | | |
Collapse
|
6
|
Ayinde O, Hayward RS, Ross JDC. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis. PLoS One 2021; 16:e0250883. [PMID: 33939726 PMCID: PMC8092782 DOI: 10.1371/journal.pone.0250883] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
AIM To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults. METHODS The review protocol was registered on PROSPERO (CRD42019136097). MEDLINE, EMBASE, British Nursing Index and CINAHL were searched up to June 2020. Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Standardised mean difference (SMD) with a 95% confidence interval in reported injection pain (intervention cf. control) was reported. RESULTS 29 studies were included in the systematic review and 20 studies in the meta-analysis. 13 IMI techniques were identified. 10 studies applied local pressure to the injection site. Of these, applying manual pressure (4 studies, SMD = -0.85[-1.36,-0.33]) and Helfer (rhythmic) tapping (3 studies, SMD = -2.95[-5.51,-0.39]) to the injection site reduced injection pain, whereas the use of a plastic device to apply local pressure to the skin (ShotBlocker) did not significantly reduce pain (2 studies, SMD = -0.51[-1.58,0.56]). Acupressure techniques which mostly involved applying sustained pressure followed by intermittent pressure (tapping) to acupressure points local to the injection site reduced pain (4 studies: SMD = -1.62[-2.80,-0.44]), as did injections to the ventrogluteal site compared to the dorsogluteal site (2 studies, SMD = -0.43[-0.81,-0.06]). There was insufficient evidence on the benefits of the 'Z track technique' (2 studies, SMD = -0.20[-0.41,0.01]) and the cold needle technique (2 studies, SMD = -0.73[-1.83,0.37]) on injection pain. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants. CONCLUSIONS Manual pressure or rhythmic tapping over the injection site and applying local pressure around the injection site reduced IMI pain. However, there was very high unexplained heterogeneity between studies and risk of significant bias within small studies.
Collapse
Affiliation(s)
- Oluseyi Ayinde
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Rachel S. Hayward
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Jonathan D. C. Ross
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| |
Collapse
|
7
|
Shi GH, Pisupati K, Parker JG, Corvari VJ, Payne CD, Xu W, Collins DS, De Felippis MR. Subcutaneous Injection Site Pain of Formulation Matrices. Pharm Res 2021; 38:779-793. [PMID: 33942212 DOI: 10.1007/s11095-021-03047-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The objective of this work was to systematically evaluate the effects of formulation composition on subcutaneous injection site pain (ISP) using matrices comprising of common pharmaceutical excipients. METHODS Two randomized, blinded, crossover studies in healthy subjects were conducted at a single site, where subjects received 1 mL SC injections of the buffer matrices. ISP intensity was measured using a 100 mm visual analogue scale (VAS), which was then analyzed via heatmap, categorical grouping, subgroup analysis, and paired delta analysis. RESULTS Buffer type, buffer concentration and tonicity agent showed a substantial impact on ISP. Citrate buffer demonstrated a higher ISP than acetate buffer or saline). The 20 mM citrate buffer was more painful than 10 or 5 mM citrate buffers. NaCl and propylene glycol were significantly more painful than sugar alcohols (mannitol, sucrose, trehalose or glycerol). Histidine buffers exhibited ISP in the descending order of 150 mM > 75 mM > 25 mM > 0 mM NaCl, while histidine buffers containing Arginine-HCl at 0, 50, or 150 mM all showed very low ISP. Histidine buffer at pH 6.5 showed a lower ISP than pH 5.7. CONCLUSIONS This systematic study via orthogonal analyses demonstrated that subcutaneous ISP is significantly influenced by solution composition.
Collapse
Affiliation(s)
- Galen H Shi
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Karthik Pisupati
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Jonathan G Parker
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Vincent J Corvari
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA.
| | - Christopher D Payne
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Wen Xu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - David S Collins
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | | |
Collapse
|
8
|
Adcock SJJ, Tucker CB. The effect of early burn injury on sensitivity to future painful stimuli in dairy heifers. PLoS One 2020; 15:e0233711. [PMID: 32492026 PMCID: PMC7269268 DOI: 10.1371/journal.pone.0233711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
Animals that experience painful procedures as neonates are more sensitive to pain later in life. We evaluated whether disbudding with a heated iron at 3 (n = 12), 35 (n = 9), or 56 (n = 20) d of age affected heifers’ pain responses to vaccine injections at 11 mo of age. Heifers responded to the injection procedure with struggling and changes in eye temperature and heart rate variability compared to a sham procedure the day before, and still had a heightened response 6 d later, regardless of disbudding age. However, some heart rate variability indices suggested increased sympathetic dominance in heifers disbudded at 35 d, compared to the other 2 age groups, independent of the injection procedure. We also found that heifers disbudded at 3 or 35 d had a higher mean heart rate after the injection procedure compared to those disbudded at 56 d. We conclude that: (1) heifers find injections aversive; and (2) there is some evidence that disbudding age influences autonomic nervous system activity later in life.
Collapse
Affiliation(s)
- Sarah J J Adcock
- Center for Animal Welfare, Department of Animal Science, University of California, Davis, California, United States of America
- Animal Behavior Graduate Group, University of California, Davis, California, United States of America
| | - Cassandra B Tucker
- Center for Animal Welfare, Department of Animal Science, University of California, Davis, California, United States of America
| |
Collapse
|
9
|
Santos-Jimenez Z, Guillen-Gargallo S, Encinas T, Berlinguer F, Veliz-Deras FG, Martinez-Ros P, Gonzalez-Bulnes A. Use of Propylene-Glycol as a Cosolvent for GnRH in Synchronization of Estrus and Ovulation in Sheep. Animals (Basel) 2020; 10:ani10050897. [PMID: 32455785 PMCID: PMC7278457 DOI: 10.3390/ani10050897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
Simple Summary The foreseeable shortage of equine chorionic gonadotrophin (eCG) for estrus synchronization in sheep will have a huge impact on breeders using out-of-season breeding, artificial insemination, or embryo transfer because there is no other product with similar activity. Hence, there is a strong need for alternative protocols. The aim of the present work was to evaluate the reproductive response of sheep in breeding season to the administration of gonadotrophin-releasing hormone (GnRH) using propylene-glycol as a cosolvent, as well as the most adequate timing for such administration. From the results obtained, protocols based on a short-term treatment with a Controlled Internal Drug Release (CIDR) device and a single dose of GnRH in propylene-glycol at 36 h after CIDR removal may constitute an alternative to traditional protocols based on the administration of a single dose of eCG at CIDR removal. Abstract The foreseen shortage of eCG for estrus synchronization in sheep makes necessary the development of alternative protocols. The aim of the present work was to evaluate the reproductive response of sheep in breeding season to the administration of GnRH using propylene-glycol as a cosolvent and the subcutaneous route for slowing and extending the release of GnRH, as well as the most adequate timing for such administration. In the present study, protocols based on a short-term CIDR treatment and a single subcutaneous dose of GnRH in propylene-glycol at 36 h after CIDR removal induced a similar ovarian response to protocols based on administration of eCG at CIDR removal or intramuscular GnRH in distilled water at 56 h after. In such protocol, 80% of the animals developed estrus in a narrow timing (75% between 36 and 48 h after CIDR removal), and all of them also ovulated in a narrow window (87.5% between 72 and 76 h after CIDR removal, with 62.5% between 72 and 76 h) and showed a similar ovulation rate and plasma progesterone concentrations at the induced estrous cycle. Hence, administration of GnRH in propylene-glycol may constitute an alternative to traditional protocols based on the administration of eCG.
Collapse
Affiliation(s)
- Zurisaday Santos-Jimenez
- Departamento de Farmacologia y Toxicologia Facultad de Veterinaria, UCM, Ciudad Universitaria s/n, 28040 Madrid, Spain; (Z.S.-J.); (T.E.); (A.G.-B.)
- Universidad Autónoma Agraria Antonio Narro, Torreón, Coahuila 25315, Mexico;
| | - Sara Guillen-Gargallo
- Departamento de Produccion y Sanidad Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, C/ Tirant lo Blanc, 7, Alfara del Patriarca, 46115 Valencia, Spain;
| | - Teresa Encinas
- Departamento de Farmacologia y Toxicologia Facultad de Veterinaria, UCM, Ciudad Universitaria s/n, 28040 Madrid, Spain; (Z.S.-J.); (T.E.); (A.G.-B.)
| | - Fiammetta Berlinguer
- Dipartamento di Medicina Veterinaria, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy;
| | | | - Paula Martinez-Ros
- Departamento de Produccion y Sanidad Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, C/ Tirant lo Blanc, 7, Alfara del Patriarca, 46115 Valencia, Spain;
- Correspondence: ; Tel.: +34961369000
| | - Antonio Gonzalez-Bulnes
- Departamento de Farmacologia y Toxicologia Facultad de Veterinaria, UCM, Ciudad Universitaria s/n, 28040 Madrid, Spain; (Z.S.-J.); (T.E.); (A.G.-B.)
- Departamento de Reproduccion Animal, INIA, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain
| |
Collapse
|
10
|
Liu HL, Zhou RH, Luo LL, Yuan X, Ye L, Luo HG. Ultrasound-Guided Transversus Abdominis Plane Block for Cesarean Delivery: Injection Site Pain as a New Complication and Dexamethasone Reduced Incidence. J Pain Res 2020; 13:565-573. [PMID: 32256104 PMCID: PMC7090204 DOI: 10.2147/jpr.s222767] [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: 07/11/2019] [Accepted: 03/07/2020] [Indexed: 02/05/2023] Open
Abstract
Background Although ultrasound-guided transversus abdominis plane block (TAPB) is widely used in multimodal analgesia after cesarean delivery (CD), the complications of TAPB during analgesia after CD have rarely been reported. Methods A total of 84 cases of CD were randomly assigned to either a ropivacaine group (R group) or ropivacaine + dexamethasone group (RD group) in this double-blind trial. The pain site and pain degree at rest and during activity at 2 h, 6 h, 10 h, 12 h, 14 h, 16 h, 20 h, and 24 h after maternal surgery were recorded. The consumption of opioids at 24h, postoperative nausea, vomiting, exhaustion, and other adverse reactions were recorded. Results A total of 80 patients were included in the analysis of results. A total of 19 patients developed ISP, 14 in the R group and 5 in the RD group. The incidence of ISP in the R and RD groups was 35% and 12.5%, respectively. The results described above showed that combining dexamethasone with ropivacaine reduced the incidence of ISP, and the difference was statistically significant (P<0.05). Two groups of women with positive ISP had higher values of opioid consumption than women with negative ISP, but the difference was not significant. Conclusion Dexamethasone as an adjuvant for ropivacaine can effectively relieve the ISP of ultrasound-guided TAPB after CD, and can enhance the analgesic effect of ropivacaine.
Collapse
Affiliation(s)
- Hai-Lin Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Rui-Hao Zhou
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Li-Li Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Xue Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - He-Guo Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| |
Collapse
|
11
|
Sahu A, Sahu P, Agrawal R. Synthesis, Pharmacological and Toxicological Screening of Penicillin-Triazole Conjugates (PNTCs). ACS OMEGA 2019; 4:17230-17235. [PMID: 31656896 PMCID: PMC6812114 DOI: 10.1021/acsomega.9b01724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
A series of hybrid antimicrobial compounds were prepared by carboxylic acid protection of 6-aminopenicillanic acid using benzyl alcohol and thionyl chloride succeeded by azide displacement using trifluoromethanesulfonyl azide in dichloromethane. The azide thus formed was reacted with substituted alkynes to furnish benzyl-protected penicillin-triazole conjugates. Benzyl deprotection of the conjugates resulted in furnishing PNTCs under water methanol mixture using Pd/C as a catalyst. The PNTCs (7a-j) formed were screened for in vitro antibacterial potency against pathogenic strains of Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes and antifungal potency against Candida albicans, Aspergillus niger, and Aspergillus clavatus. Further antimicrobial evaluation revealed compounds 7c, 7d, 7e, 7g, and 7i to be the most compounds of the series with minimum inhibitory concentration value for antibacterial in the range 0.5-50 μg/mL and for antifungal in the range 9-300 μg/mL. Toxicological analysis documented for compounds 7c, 7d, 7e, 7g, and 7i revealed compound 7i to be the most promising member of the series with 1000 and 500 mg/kg LD50, and no-observed-adverse-effect level to facilitate future clinical studies of the same.
Collapse
Affiliation(s)
- Adarsh Sahu
- Department
of Pharmaceutical Sciences, Dr. Harisingh
Gour Vishwavidyalaya, Sagar, Madhya Pradesh 470003, India
| | - Preeti Sahu
- Department
of Chemistry, Central University of Kerala, Periye, Kerala 671320, India
| | - Ramkishore Agrawal
- Department
of Pharmaceutical Sciences, Dr. Harisingh
Gour Vishwavidyalaya, Sagar, Madhya Pradesh 470003, India
| |
Collapse
|
12
|
Jain D, Mahammad SS, Singh PP, Kodipyaka R. A review on parenteral delivery of peptides and proteins. Drug Dev Ind Pharm 2019; 45:1403-1420. [DOI: 10.1080/03639045.2019.1628770] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Divisha Jain
- Custom Pharma Services (CPS), Dr. Reddy’s Laboratories Ltd, Hyderabad, India
| | - S. Shahe Mahammad
- Custom Pharma Services (CPS), Dr. Reddy’s Laboratories Ltd, Hyderabad, India
| | - Pirthi Pal Singh
- Custom Pharma Services (CPS), Dr. Reddy’s Laboratories Ltd, Hyderabad, India
| | - Ravinder Kodipyaka
- Custom Pharma Services (CPS), Dr. Reddy’s Laboratories Ltd, Hyderabad, India
| |
Collapse
|
13
|
Abstract
We assessed aversion to injections using an avoidance-learning paradigm. Holstein calves (n = 24) were randomly assigned to one of four routes of administration for 0.5 ml of saline: intramuscular (IM), intranasal (IN), subcutaneous (SC) and a null control. Calves were first trained to approach a milk reward of 1 L. Once the latency to approach the reward was consistent, calves received their assigned treatment when approaching the bottle. For the first 3 treatment sessions calves received a 1 L milk reward. This reward was then reduced to 500 mL, and then to 250 mL, and finally to 0 mL, each for 3 sessions. Compared to control calves, calves receiving the intramuscular injections showed a longer latency to approach the milk reward, but only when the milk reward was 0.25 L (P = 0.05) and 0 L (P < 0.01). Calves receiving the intranasal injections showed longer latencies relative to the controls only for the 0 L reward (P = 0.01). Calves receiving the subcutaneous injections did not differ from controls for any of the milk rewards (P > 0.2). We conclude that IM injections are aversive and that SC and IN routes are a refinement to be considered when feasible.
Collapse
|
14
|
Griffin P, Elliott S, Krauer K, Davies C, Rachel Skinner S, Anderson CD, Forster A. Safety, acceptability and tolerability of uncoated and excipient-coated high density silicon micro-projection array patches in human subjects. Vaccine 2017; 35:6676-6684. [DOI: 10.1016/j.vaccine.2017.10.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 11/16/2022]
|
15
|
A novel injectable formulation of 6-fluoro-l-DOPA imaging agent for diagnosis of neuroendocrine tumors and Parkinson's disease. Int J Pharm 2017; 519:304-313. [PMID: 28119123 DOI: 10.1016/j.ijpharm.2017.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
Two [19F]F-l-DOPA (F-DOPA) new β-cyclodextrin (CD)-based dosage forms (FA and FB, respectively) have been studied and their physico-chemical and pharmacological features determined to overcome the administration site reactions showed by the currently used [18F]F-l-DOPA formulation (IASOdopa®) to perform PET-CT diagnosis in oncology (neuroendocrine tumors) and neurological (Parkinson's disease) field. Chemical stability of FA and FB was found to be longer than IASOdopa® by adding the thiol-antioxidant agent, L-Cysteine. 1H and 19F NMR investigations suggest the formation of an inclusion complex of F-DOPA with β-CD. In vitro experiments on the effects of FA and FB on mouse skeletal muscle fibers and on the human neuroblastoma SH-SY5Y and embryonal kidney tsA201 cell lines viability showed that FA was the most performant formulation compared to F-DOPA solutions. In vivo tolerability tests of FA on adult male rat showed no significant effects on body weight and no change in their dried organs weight. In addition, their metabolic and physiological parameters were not affected. In conclusion, [18F]F-l-DOPA, formulated as FA, constitutes a promising dosage form for PET-CT diagnosis of both neuroendocrine tumors and Parkinson's disease.
Collapse
|
16
|
Zbacnik TJ, Holcomb RE, Katayama DS, Murphy BM, Payne RW, Coccaro RC, Evans GJ, Matsuura JE, Henry CS, Manning MC. Role of Buffers in Protein Formulations. J Pharm Sci 2016; 106:713-733. [PMID: 27894967 DOI: 10.1016/j.xphs.2016.11.014] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/25/2016] [Accepted: 11/17/2016] [Indexed: 12/19/2022]
Abstract
Buffers comprise an integral component of protein formulations. Not only do they function to regulate shifts in pH, they also can stabilize proteins by a variety of mechanisms. The ability of buffers to stabilize therapeutic proteins whether in liquid formulations, frozen solutions, or the solid state is highlighted in this review. Addition of buffers can result in increased conformational stability of proteins, whether by ligand binding or by an excluded solute mechanism. In addition, they can alter the colloidal stability of proteins and modulate interfacial damage. Buffers can also lead to destabilization of proteins, and the stability of buffers themselves is presented. Furthermore, the potential safety and toxicity issues of buffers are discussed, with a special emphasis on the influence of buffers on the perceived pain upon injection. Finally, the interaction of buffers with other excipients is examined.
Collapse
Affiliation(s)
| | - Ryan E Holcomb
- LegacyBioDesign LLC, Johnstown, Colorado 80534; Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
| | - Derrick S Katayama
- LegacyBioDesign LLC, Johnstown, Colorado 80534; Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
| | - Brian M Murphy
- LegacyBioDesign LLC, Johnstown, Colorado 80534; Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
| | - Robert W Payne
- LegacyBioDesign LLC, Johnstown, Colorado 80534; Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
| | | | | | | | - Charles S Henry
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
| | - Mark Cornell Manning
- LegacyBioDesign LLC, Johnstown, Colorado 80534; Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523.
| |
Collapse
|
17
|
Roethlisberger D, Mahler HC, Altenburger U, Pappenberger A. If Euhydric and Isotonic Do Not Work, What Are Acceptable pH and Osmolality for Parenteral Drug Dosage Forms? J Pharm Sci 2016; 106:446-456. [PMID: 27889072 DOI: 10.1016/j.xphs.2016.09.034] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Abstract
Parenteral products should aim toward being isotonic and euhydric (physiological pH). Yet, due to other considerations, this goal is often not reasonable or doable. There are no clear allowable ranges related to pH and osmolality, and thus, the objective of this review was to provide a better understanding of acceptable formulation pH, buffer strength, and osmolality taking into account the administration route (i.e., intramuscular, intravenous, subcutaneous) and administration technique (i.e., bolus, push, infusion). This evaluation was based on 3 different approaches: conventional, experimental, and parametric. The conventional way of defining formulation limits was based on standard pH and osmolality ranges. Experimental determination of titratable acidity or in vitro hemolysis testing provided additional drug product information. Finally, the parametric approach was based on the calculation of theoretical values such as (1) the maximal volume of injection which cannot shift the blood's pH or its molarity out of the physiological range and (b) a dilution ratio at the injection site and by verifying that threshold values are not exceeded. The combination of all 3 approaches can support the definition of acceptable pH, buffer strength, and osmolality of formulations and thus may reduce the risk of failure during preclinical and clinical development.
Collapse
Affiliation(s)
- Dieter Roethlisberger
- F. Hoffmann-La Roche Ltd., Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, Basel, Switzerland.
| | - Hanns-Christian Mahler
- F. Hoffmann-La Roche Ltd., Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, Basel, Switzerland
| | - Ulrike Altenburger
- F. Hoffmann-La Roche Ltd., Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, Basel, Switzerland
| | - Astrid Pappenberger
- F. Hoffmann-La Roche Ltd., Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, Basel, Switzerland
| |
Collapse
|
18
|
Bouma M, Nuijen B, Challa EE, Sava G, Flaibani A, Bult A, Beijnen JH. Stability and compatibility of the investigational antimetastatic ruthenium complex NAMI-A in infusion systems and its hemolytic potential. J Oncol Pharm Pract 2016. [DOI: 10.1191/1078155204jp118oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
NAMI-A (imidazolium trans-imidazole dimethylsulfoxide tetrachlororuthenate (III)) is a novel antimetastatic ruthenium complex currently undergoing Phase I clinical trials. It is pharmaceutically formulated as a lyophilized product to be reconstituted and diluted before infusion. The aim of this study was to determine the reconstitution and dilution fluid of choice, and to investigate the stability and compatibility of NAMI-A in solution under different storage conditions and with several container materials. Furthermore, the hemolytic potential and buffer capacity of NAMI-A infusion solution were investigated in vitro. Normal saline or Water for Injections (WfI) can be used for reconstitution of NAMI-A, and the reconstituted solution should be diluted with normal saline to infusion concentration immediately after dissolution if stored at room temperature (1 20 - 258C), but can be stored for up to 48 hours at refrigerated conditions (1 2 - 88C). Infusion solutions can be stored for a maximum of four hours at room temperature or 24 hours at refrigerated conditions before administration to the patient. The infusion solutions can be prepared in either glass or PVC containers, although for practical reasons PVC containers are recommended. The infusion solutions are compatible with a PVC infusion system consisting of a PVC container, PVC infusion line, and needle. Furthermore, NAMI-A infusion solutions have a low buffer capacity and do not cause hemolysis in vitro. Therefore, no pain or hemolysis upon infusion of NAMI-A in the clinical setting is expected.
Collapse
Affiliation(s)
- Marjan Bouma
- Slotervaart Hospital/The Netherlands Cancer Institute, Department of Pharmacy and Pharmacology, 1066 EC Amsterdam, The Netherlands
| | - Bastiaan Nuijen
- Slotervaart Hospital/The Netherlands Cancer Institute, Department of Pharmacy and Pharmacology, 1066 EC Amsterdam, The Netherlands
| | - Eric E Challa
- Slotervaart Hospital/The Netherlands Cancer Institute, Department of Pharmacy and Pharmacology, 1066 EC Amsterdam, The Netherlands
| | | | | | - Auke Bult
- Faculty of Pharmaceutical Sciences, Utrecht University, 3584 CA Utrecht, The Netherlands
| | - Jos H Beijnen
- Slotervaart Hospital/The Netherlands Cancer Institute, Department of Pharmacy and Pharmacology, 1066 EC Amsterdam, The Netherlands, Faculty of Pharmaceutical Sciences, Utrecht University, 3584 CA Utrecht, The Netherlands
| |
Collapse
|
19
|
den Brok MWJ, Nuijen B, Harms R, Buluran JN, Harvey MD, Grieshaber CK, Beijnen JH. Compatibility and stability of the novel anti-cancer agent C1311 in infusion devices and its in vitro biocompatibility. J Oncol Pharm Pract 2016; 11:13-9. [PMID: 16460599 DOI: 10.1191/1078155205jp142oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
C1311 is the lead compound from the imidazoacridinones, a novel group of rationally designed anti-cancer agents. The compound is pharmaceutically formulated as a lyophilized product containing 100 mg C1311 (anhydrous free base) per dosage unit and requires reconstitution before intravenous administration. The aim of this study was to determine the stability of C1311 in the reconstituted solution and infusion solution and its compatibility with infusion devices. Moreover, the buffer capacity and haemolytic potential of C1311 infusion solutions, which exhibit a relatively low pH of 2-3, were evaluated in vitro. C1311 was shown to be stable in the reconstituted solution for at least 48 h and for at least 96 h after subsequent dilution in 0.9% sodium chloride and 5% dextrose. In vitro infusion simulation studies showed C1311 infusion solutions to be compatible with a low-density polyethylene administration set. Furthermore, the buffer capacity and haemolysis studies showed no indications for haemolysis or potential for vascular irritation upon continuous infusion of C1311. In conclusion, C1311 lyophilized product is adequately stable and compatible after reconstitution and in infusion fluids to be used in the clinic and is not expected to cause formulation-associated side effects in the intended administration schedule in the forthcoming Phase I clinical study.
Collapse
Affiliation(s)
- Monique W J den Brok
- Department of Pharmacy & Pharmacology, Slotervaart Hospital/The Netherlands Cancer Institute, Louwesweg 6, 1066 EC Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
20
|
Doughty DV, Clawson CZ, Lambert W, Subramony JA. Understanding Subcutaneous Tissue Pressure for Engineering Injection Devices for Large-Volume Protein Delivery. J Pharm Sci 2016; 105:2105-13. [PMID: 27287520 DOI: 10.1016/j.xphs.2016.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/29/2022]
Abstract
Subcutaneous injection allows for self-administration of monoclonal antibodies using prefilled syringes, autoinjectors, and on-body injector devices. However, subcutaneous injections are typically limited to 1 mL due to concerns of injection pain from volume, viscosity, and formulation characteristics. Back pressure can serve as an indicator for changes in subcutaneous mechanical properties leading to pain during injection. The purpose of this study was to investigate subcutaneous pressures and injection site reactions as a function of injection volume and flow rate. A pressure sensor in the fluid path recorded subcutaneous pressures in the abdomen of Yorkshire swine. The subcutaneous tissue accommodates large-volume injections and with little back pressure as long as low flow rates are used. A 1 mL injection in 10 seconds (360 mL/h flow rate) generated a pressure of 24.0 ± 3.4 kPa, whereas 10 mL delivered in 10 minutes (60 mL/h flow rate) generated a pressure of 7.4 ± 7.8 kPa. After the injection, the pressure decays to 0 over several seconds. The subcutaneous pressures and mechanical strain increased with increasing flow rate but not increasing dose volume. These data are useful for the design of injection devices to mitigate back pressure and pain during subcutaneous large-volume injection.
Collapse
Affiliation(s)
- Diane V Doughty
- Drug Delivery and Device Development, Biopharmaceutical Development, MedImmune LLC., Gaithersburg, Maryland 20878.
| | - Corbin Z Clawson
- Drug Delivery and Device Development, Biopharmaceutical Development, MedImmune LLC., Gaithersburg, Maryland 20878
| | - William Lambert
- Drug Delivery and Device Development, Biopharmaceutical Development, MedImmune LLC., Gaithersburg, Maryland 20878
| | - J Anand Subramony
- Drug Delivery and Device Development, Biopharmaceutical Development, MedImmune LLC., Gaithersburg, Maryland 20878
| |
Collapse
|
21
|
Formulation Studies During Preclinical Development of Influenza Hemagglutinin and Virus-Like Particle Vaccine Candidates. Methods Mol Biol 2016. [PMID: 27076313 DOI: 10.1007/978-1-4939-3389-1_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
A critical element of vaccine formulation studies is the identification of chemical and physical degradation pathways that compromise structural integrity, and which may in turn affect the clinical safety and efficacy, of macromolecular antigens. Formulation development helps optimize and maintain the long-term storage stability and viability of vaccine antigens in pharmaceutically relevant dosage forms. The protocols presented in this manuscript highlight the use of accelerated stability studies for the formulation of influenza vaccine candidates including virus-like particles (VLP) and particle forming hemagglutinin (HA) antigens. Three case studies, each targeting a different facet of preclinical vaccine formulation development, are reviewed: (1) excipient screening experiments to mitigate VLP physical degradation, (2) methods for monitoring a specific chemical perturbation of the recombinant HA antigen and elucidating its effect on in vitro potency, and (3) maintaining HA conformational stability in the presence of freeze-thaw and freeze-drying stresses.
Collapse
|
22
|
Berteau C, Filipe-Santos O, Wang T, Rojas HE, Granger C, Schwarzenbach F. Evaluation of the impact of viscosity, injection volume, and injection flow rate on subcutaneous injection tolerance. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:473-84. [PMID: 26635489 PMCID: PMC4646585 DOI: 10.2147/mder.s91019] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The primary objective of this study was to evaluate the impact of fluid injection viscosity in combination with different injection volumes and flow rates on subcutaneous (SC) injection pain tolerance. Methods The study was a single-center, comparative, randomized, crossover, Phase I study in 24 healthy adults. Each participant received six injections in the abdomen area of either a 2 or 3 mL placebo solution, with three different fluid viscosities (1, 8–10, and 15–20 cP) combined with two different injection flow rates (0.02 and 0.3 mL/s). All injections were performed with 50 mL syringes and 27G, 6 mm needles. Perceived injection pain was assessed using a 100 mm visual analog scale (VAS) (0 mm/no pain, 100 mm/extreme pain). The location and depth of the injected fluid was assessed through 2D ultrasound echography images. Results Viscosity levels had significant impact on perceived injection pain (P=0.0003). Specifically, less pain was associated with high viscosity (VAS =12.6 mm) than medium (VAS =16.6 mm) or low (VAS =22.1 mm) viscosities, with a significant difference between high and low viscosities (P=0.0002). Target injection volume of 2 or 3 mL was demonstrated to have no significant impact on perceived injection pain (P=0.89). Slow (0.02 mL/s) or fast (0.30 mL/s) injection rates also showed no significant impact on perceived pain during SC injection (P=0.79). In 92% of injections, the injected fluid was located exclusively in SC tissue whereas the remaining injected fluids were found located in SC and/or intradermal layers. Conclusion The results of this study suggest that solutions of up to 3 mL and up to 15–20 cP injected into the abdomen within 10 seconds are well tolerated without pain. High viscosity injections were shown to be the most tolerated, whereas injection volume and flow rates did not impact perceived pain.
Collapse
Affiliation(s)
- Cecile Berteau
- Becton-Dickinson Medical Pharmaceutical Systems, Le Pont de Claix, France
| | | | - Tao Wang
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Corinne Granger
- Becton-Dickinson Medical Pharmaceutical Systems, Le Pont de Claix, France
| | | |
Collapse
|
23
|
The Use of ShotBlocker for Reducing the Pain and Anxiety Associated With Intramuscular Injection. Holist Nurs Pract 2015; 29:261-71. [DOI: 10.1097/hnp.0000000000000105] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Tolerability of hypertonic injectables. Int J Pharm 2015; 490:308-15. [DOI: 10.1016/j.ijpharm.2015.05.069] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/21/2022]
|
25
|
Bak A, Leung D, Barrett SE, Forster S, Minnihan EC, Leithead AW, Cunningham J, Toussaint N, Crocker LS. Physicochemical and formulation developability assessment for therapeutic peptide delivery--a primer. AAPS JOURNAL 2014; 17:144-55. [PMID: 25398427 DOI: 10.1208/s12248-014-9688-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/09/2014] [Indexed: 12/12/2022]
Abstract
Peptides are an important class of endogenous ligands that regulate key biological cascades. As such, peptides represent a promising therapeutic class with the potential to alleviate many severe disease states. Despite their therapeutic potential, peptides frequently pose drug delivery challenges to scientists. This review introduces the physicochemical, biophysical, biopharmaceutical, and formulation developability aspects of peptides pertinent to the drug discovery-to-development interface. It introduces the relevance of these properties with respect to the delivery modalities available for peptide pharmaceuticals, with the parenteral route being the most prevalent route of administration. This review also presents characterization strategies for oral delivery of peptides with the aim of illuminating developability issues with the drug candidate. A brief overview of other routes of administration, including inhaled, transdermal, and intranasal routes, is provided as these routes are generally preferred by patients over injectables. Finally, this review presents formulation techniques to mitigate some of the developability obstacles associated with peptide delivery. The authors emphasize opportunities for the thoughtful application of pharmaceutical science to the development of peptide drugs and to the general advancement of this promising class of pharmaceuticals.
Collapse
Affiliation(s)
- Annette Bak
- Discovery Pharmaceutical Sciences, Merck & Co, Kenilworth, New Jersey, USA,
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Scheller KJ, Williams SJ, Lawrence AJ, Jarrott B, Djouma E. An improved method to prepare an injectable microemulsion of the galanin-receptor 3 selective antagonist, SNAP 37889, using Kolliphor(®) HS 15. MethodsX 2014; 1:212-6. [PMID: 26150955 PMCID: PMC4472996 DOI: 10.1016/j.mex.2014.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022] Open
Abstract
Research into the galanin-3 (GAL3) receptor has many challenges, including the lack of commercially available selective ligands. While the identification of non-peptidergic GAL3 receptor-selective antagonists, 1-phenyl-3-[3-(trifluoromethyl)phenyl]iminoindol-2-one (SNAP 37889) and 1-[3-(2-pyrrolidin-1-ylethoxy)phenyl]-3-[3-(trifluoromethyl)phenyl]iminoindol-2-one (SNAP 398299) have implicated a role for GAL3 receptors in anxiety, depression and drug-seeking behaviour, a major limitation of their use is poor aqueous solubility. Previously we have used 5% dimethylsulfoxide (DMSO) with 1% hydroxypropylmethyl cellulose in saline to dissolve SNAP 37889 for intraperitoneal (i.p.) injections of rats; however this produced a micro-suspension that was not ideal. The injectable formulation of SNAP 37889 was improved as follows:•30% (w/v) Kolliphor(®) HS 15 (Solutol HS(®) 15) and sodium phosphate buffer (0.01 M, pH 7.4) were used as vehicles.•A smooth glass mortar and pestle was used to triturate the Kolliphor(®) HS 15 and SNAP 37889 into a paste before addition to the sodium phosphate buffer at room temperature (RT).•The resulting mixture was vortexed until the paste was fully dissolved and the microemulsion was allowed to sit for 20 min to allow air bubbles to coalesce.
Collapse
Affiliation(s)
- Karlene J. Scheller
- Department of Human Biosciences, La Trobe University, Bundoora, Victoria, Australia
| | - Spencer J. Williams
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J. Lawrence
- Florey Institute of Neuroscience & Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Bevyn Jarrott
- Florey Institute of Neuroscience & Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Elvan Djouma
- Department of Human Biosciences, La Trobe University, Bundoora, Victoria, Australia
- Corresponding author at: Department of Human Biosciences, La Trobe University, Bundoora, Victoria 3086, Australia. Tel.: +61 3 9479 5005.
| |
Collapse
|
27
|
Tuğrul E, Khorshıd L. Effect on pain intensity of injection sites and speed of injection associated with intramuscular penicillin. Int J Nurs Pract 2013; 20:468-74. [DOI: 10.1111/ijn.12161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Emel Tuğrul
- Department of Nursing; School of Health; Adnan Menderes University; Aydın Turkey
| | | |
Collapse
|
28
|
Pourghaznein T, Azimi AV, Jafarabadi MA. The effect of injection duration and injection site on pain and bruising of subcutaneous injection of heparin. J Clin Nurs 2013; 23:1105-13. [DOI: 10.1111/jocn.12291] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Tayebe Pourghaznein
- Department of Medical-Surgical; School of Nursing and Midwifery; Mashhad University of Medical Sciences; Mashhad Iran
| | | | - Mohammad Asghari Jafarabadi
- Tabriz Health Services Management Research Center; Department of Statistics and Epidemiology; Faculty of Health; Tabriz University of Medical Sciences; Tabriz Iran
| |
Collapse
|
29
|
Kang DW, Oh DA, Fu GY, Anderson JM, Zepeda ML. Porcine model to evaluate local tissue tolerability associated with subcutaneous delivery of protein. J Pharmacol Toxicol Methods 2013; 67:140-7. [PMID: 23376811 DOI: 10.1016/j.vascn.2013.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 12/20/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The conversion from intravenous (IV) to subcutaneous (SC) delivery of biotherapeutics has increased in recent years. Some of the reasons for this shift in route of delivery are due to patient convenience, reduced adverse systemic effects, lack of a need for vascular access, and reduced cost of patient care, which ultimately lead to improved patient quality of life. One caveat to SC delivery is the limited volumes that can be administered at a single site and the associated local tolerability. To characterize factors that affect subcutaneous delivery of large volumes of therapeutic proteins, a porcine model was developed. Model endpoints included measurement of interstitial pressure, assessment of local skin visco-elasticity, and the qualitative assessment of local infusion sites. METHODS Immunoglobulin G (IgG) was subcutaneously infused into the abdominal region of Yucatan miniature swine. Changes in interstitial pressure were measured, using an in-line pressure transducer, during and after infusions. Additionally, pre- and post-infusion changes in local skin visco-elasticity were measured using a Cutometer®. Lastly, infusion sites were assessed for post-infusion local skin reactions such as erythema and swelling. Similar assessments were made following SC IgG delivery with the permeation enhancer recombinant human hyaluronidase PH20 (rHuPH20). RESULTS Subcutaneous infusions of IgG, in the presence of rHuPH20, significantly reduced average interstitial pressures by 55% during the infusion period and by 67% during the post-infusion period, compared to the control. Infusions in the presence of rHuPH20 also maintained better local skin elasticity as seen by a 42% increase in local skin pliability compared to the control. Finally, infusions with rHuPH20 resulted in an 80% reduction in swelling area compared to the control. DISCUSSION A large animal model was developed that incorporates both quantitative and qualitative assessment methods to aid in understanding SC delivery of proteins.
Collapse
Affiliation(s)
- D W Kang
- Halozyme Therapeutics Inc., San Diego, CA 92121, United States.
| | | | | | | | | |
Collapse
|
30
|
Hassett KJ, Nandi P, Randolph TW. Formulation Approaches and Strategies for Vaccines and Adjuvants. STERILE PRODUCT DEVELOPMENT 2013. [DOI: 10.1007/978-1-4614-7978-9_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
31
|
Ward WK, Castle JR, Branigan DL, Massoud RG, El Youssef J. Discomfort from an alkaline formulation delivered subcutaneously in humans: albumin at pH 7 versus pH 10. Clin Drug Investig 2012; 32:433-8. [PMID: 22568666 DOI: 10.2165/11632840-000000000-00000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE There is a paucity of data regarding tolerability of alkaline drugs administered subcutaneously. The aim of this study was to assess the tolerability of alkaline preparations of human albumin delivered subcutaneously to healthy humans. METHODS We compared the tolerability of neutral versus alkaline (pH 10) formulations of human albumin in ten volunteers. With an intent to minimize the time required to reach physiological pH after injection, the alkaline formulation was buffered with a low concentration of glycine (20 mmol/L). Each formulation was given at two rates: over 5 seconds and over 60 seconds. A six-point scale was used to assess discomfort. RESULTS For slow injections, there was a significant difference between pH 7.4 and pH 10 injections (0.4 ± 0.2 vs 1.1 ± 0.2, mean ± SEM; p = 0.025), though the degree of discomfort at pH 10 injections was only 'mild or slight'. For fast injections, the difference between neutral and alkaline formulations was of borderline significance. Inflammation and oedema, as judged by a physician, were very minimal for all injections, irrespective of pH. CONCLUSION For subcutaneous drug administration (especially when delivered slowly), there was more discomfort associated with alkaline versus neutral formulations of albumin, though the discomfort was mild. This study suggests that there is little discomfort and inflammation resulting from subcutaneous administration of protein drugs formulated with weak buffers at alkaline pH.
Collapse
Affiliation(s)
- W Kenneth Ward
- Legacy Health and Legacy Research Institute, Portland, OR, USA.
| | | | | | | | | |
Collapse
|
32
|
Thackaberry EA. Non-clinical toxicological considerations for pharmaceutical salt selection. Expert Opin Drug Metab Toxicol 2012; 8:1419-33. [DOI: 10.1517/17425255.2012.717614] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
33
|
Nakashima T, Ogawa Y, Kimura A, Kido M, Okikawa Y, Ito T, Hosokawa A, Kozawa K, Niimi H, Kiba T. Coadministration of 5% glucose solution has a decrease in bendamustine-related vascular pain grade. J Oncol Pharm Pract 2012; 18:445-7. [PMID: 22449716 DOI: 10.1177/1078155212442560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
34
|
Babiuch K, Gottschaldt M, Werz O, Schubert US. Particulate transepithelial drug carriers: barriers and functional polymers. RSC Adv 2012. [DOI: 10.1039/c2ra20726e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
35
|
Equal volumes of undiluted nalbuphine and lidocaine and normal diluted saline prevents nalbuphine-induced injection pain. ACTA ACUST UNITED AC 2011; 49:125-9. [DOI: 10.1016/j.aat.2011.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/30/2011] [Accepted: 09/02/2011] [Indexed: 11/23/2022]
|
36
|
Luciani P, Fevre M, Leroux JC. Development and physico-chemical characterization of a liposomal formulation of istaroxime. Eur J Pharm Biopharm 2011; 79:285-93. [PMID: 21550400 DOI: 10.1016/j.ejpb.2011.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 04/12/2011] [Accepted: 04/21/2011] [Indexed: 11/17/2022]
Abstract
Istaroxime, an investigational new drug that targets defective Ca(2+) cycling without compromising cardiac efficiency, may represent a promising and safe treatment of both acute and chronic heart failure. Even though the compound demonstrated good tolerability in a phase I/II safety study, symptoms related to the gastro-intestinal tract and pain at the injection site were reported as the most frequent side effects. The aim of this study was to encapsulate istaroxime in a drug delivery system (DDS) that could minimize the pain perceived upon administration. The DDS was designed to be quickly destabilized in plasma, in order to minimize alteration of the pharmacokinetic profile of istaroxime. To meet those requirements, a balance between the encapsulation efficiency and the release rate was sought. Transmembrane pH-gradient liposomes formulated with different phosphatidylcholines were investigated as vehicles for an efficient active drug loading. Poly(ethylene glycol)-660-hydroxystearate (PEG-HS) was chosen as excipient to modulate the bilayer fluidity and the release properties of the liposomes. A fast and efficient encapsulation was obtained by modulating the drug-to-lipid ratio, the amount of PEG-HS, and the incubation temperature. High encapsulation efficiency was achieved by incubating the drug with liposomal dispersions at room temperature for 10 min. Almost complete release was obtained in physiological conditions in less than 10 min, suggesting a model formulation potentially useful for drugs presenting similar features and side effects.
Collapse
Affiliation(s)
- Paola Luciani
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland
| | | | | |
Collapse
|
37
|
Wu Z, Tucker IG, Razzak M, Yang L, McSporran K, Medlicott NJ. Absorption and tissue tolerance of ricobendazole in the presence of hydroxypropyl-β-cyclodextrin following subcutaneous injection in sheep. Int J Pharm 2010; 397:96-102. [DOI: 10.1016/j.ijpharm.2010.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/30/2010] [Accepted: 07/03/2010] [Indexed: 10/19/2022]
|
38
|
Wu Z, Tucker IG, Razzak M, McSporran K, Medlicott NJ. Tissue compatibility and pharmacokinetics of three potential subcutaneous injectables for low-pH drug solutions. J Pharm Pharmacol 2010. [DOI: 10.1211/jpp.62.07.0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
39
|
Kang HJ, Kwon MY, Choi BM, Koo MS, Jang YJ, Lee MA. Clinical factors affecting the pain on injection of propofol. Korean J Anesthesiol 2010; 58:239-43. [PMID: 20498771 PMCID: PMC2872839 DOI: 10.4097/kjae.2010.58.3.239] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 01/05/2010] [Accepted: 01/29/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain on propofol injection is a well-known adverse effect. We evaluated the clinical factors that affect the pain on injection of propofol to develop a strategy to prevent or reduce pain. METHODS We conducted a prospective, observational study of 207 adult patients (ASA I-II), and the patients were classified according to gender, age, the body mass index (BMI), the IV site and the side of the IV site. During the 10 seconds after propofol injection, pain intensity was measured on an 11-point numerical rating scale (0 = no pain and 10 = worst possible pain). Pain in excess of 3 on the numerical scale was regarded as moderate to severe pain. RESULTS THE SUBGROUPS OF GENDER (FEMALE: 55.6% vs. male: 25.0%; P < 0.01) and the IV site (dorsum of hand: 61.2% vs. wrist: 40.0% vs. antecubital fossa: 22.5%; P < 0.01) had significantly different frequencies for the incidence of pain on injection on the univariate and multivariate analyses. For the subgroup of females, the incidence of pain was statistically different according to the age group (20-40 yr: 71.0% vs. 41-60: 54.8% vs. 61-80: 38.5%; P = 0.014). CONCLUSIONS Our results showed that the younger age patients, the patients with a peripheral IV site and female patients are more sensitive to pain on the injection of propofol.
Collapse
Affiliation(s)
- Hye-Joo Kang
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
40
|
Kovács K, Antal I, Stampf G, Klebovich I, Ludányi K. Composition optimization and stability testing of a parenteral antifungal solution based on a ternary solvent system. AAPS PharmSciTech 2010; 11:285-93. [PMID: 20182828 DOI: 10.1208/s12249-009-9368-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 12/16/2009] [Indexed: 11/30/2022] Open
Abstract
An intravenous solution is a dosage forms intended for administration into the bloodstream. This route is the most rapid and the most bioavailable method of getting drugs into systemic circulation, and therefore it is also the most liable to cause adverse effects. In order to reduce the possibility of side effects and to ensure adequate clinical dosage of the formulation, the primarily formulated composition should be optimized. It is also important that the composition should retain its therapeutic effectiveness and safety throughout the shelf-life of the product. This paper focuses on the optimization and stability testing of a parenteral solution containing miconazole and ketoconazole solubilized with a ternary solvent system as model drugs. Optimization of the solvent system was performed based on assessing the risk/benefit ratio of the composition and its properties upon dilution. Stability tests were conducted based on the EMEA (European Medicines Agency) "guideline on stability testing: stability testing of existing active substances and related finished products". Experiments show that both the amount of co-solvent and surface active agent of the solvent system could substantially be reduced, while still maintaining adequate solubilizing power. It is also shown that the choice of various containers affects the stability of the compositions. It was concluded that by assessing the risk/benefit ratio of solubilizing power versus toxicity, the concentration of excipients could be considerably decreased while still showing a powerful solubilizing effect. It was also shown that a pharmaceutically acceptable shelf-life could be assigned to the composition, indicating good long-term stability.
Collapse
|
41
|
Mao C, Wan J, Chen H, Xu H, Yang X. The composition of oil phase modulates venous irritation of lipid emulsion-loaded diallyl trisulfide. Drug Dev Ind Pharm 2010; 36:698-704. [PMID: 20050725 DOI: 10.3109/03639040903449746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In this study, a nanoemulsion system (LE) was investigated for intravenous delivery of diallyl trisulfide (DT), which was a lipophilic and venous irritant drug for systemic therapy of bacterial and fungal infection. METHODS Egg phospholipid was chosen as the only emulsifier, soybean oil, medium chain triglyceride (MCT), and olive oil were used as the oil phases, forming stable DT LEs (o/w) with small particle sizes. The venous irritation of DT LEs was evaluated by in vitro human umbilical cord endothelial cells (HUV-EC CRL 1730) tolerance model with the intracellular ATP and GTP concentrations as the indices. RESULTS The intracellular ATP and GTP reduction changed with the incorporation of a variety of oils, which were strongly related with the free DT concentration of DT LEs. DISCUSSION It was deduced that the free DT concentrations of LEs made of various oils depended on the particle sizes of the DT LEs. In conclusion, the oil phases modulated the free DT concentrations by forming DT LEs with different particle sizes, and optimization of the oil phase was an effective method to alleviate the venous irritation of DT LEs.
Collapse
Affiliation(s)
- Chengwen Mao
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, PR China
| | | | | | | | | |
Collapse
|
42
|
Mao C, Wan J, Chen H, Xu H, Yang X. Emulsifiers' composition modulates venous irritation of the nanoemulsions as a lipophilic and venous irritant drug delivery system. AAPS PharmSciTech 2009; 10:1058-64. [PMID: 19669895 DOI: 10.1208/s12249-009-9295-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 07/27/2009] [Indexed: 11/30/2022] Open
Abstract
In this study, a nanoemulsion (NE) system was investigated for intravenous delivery of lipophilic and venous irritant drugs. NEs were prepared to deliver diallyl trisulfide (DT) for systemic therapy of bacterial and fungal infection, egg phospholipid was chosen as the main emulsifier, and two co-emulsifiers were also incorporated, including Poloxamer 188 (P188) and Solutol HS 15 (S15). Soybean oil was used as the dispersed phases, forming stable DT NEs with small particle sizes. The venous irritation of DT NEs was evaluated by in vitro human umbilical cord endothelial cells (CRL 1730) compatibility model with the intracellular adenosine triphosphate (ATP) and guanosine triphosphate (GTP) concentrations as the indices. The intracellular ATP and GTP reduction changed with the incorporation of a variety of co-emulsifiers, which varied in a free DT concentration-dependent manner. It was deduced that the free DT concentrations of NEs containing co-emulsifiers were determined by the partition coefficient of DT between oil and surfactant buffer solution. In conclusion, NE was an appropriate delivery system for lipophilic and venous irritant drug, and optimization of the composition of emulsifiers was an effective method to alleviate the venous irritation of DT NEs.
Collapse
|
43
|
Sim JY, Lee SH, Park DY, Jung JA, Ki KH, Lee DH, Noh GJ. Pain on injection with microemulsion propofol. Br J Clin Pharmacol 2008; 67:316-25. [PMID: 19220277 DOI: 10.1111/j.1365-2125.2008.03358.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS To evaluate the incidence and severity of injection pain caused by microemulsion propofol and lipid emulsion propofol in relation to plasma bradykinin generation and aqueous free propofol concentrations. METHODS Injection pain was evaluated in 147 patients. Aqueous free propofol concentrations in each formulation, and in formulation mixtures containing agents that reduce propofol-induced pain, were measured by high-performance liquid chromatography. Plasma bradykinin concentrations in both formulations and in their components mixed with blood sampled from six volunteers were measured by radioimmunoassays. Injection pain caused by 8% polyethylene glycol 660 hydroxystearate (PEG660 HS) was evaluated in another 10 volunteers. RESULTS The incidence of injection pain [visual analogue scale (VAS) >30 mm] caused by microemulsion and lipid emulsion propofol was 69.7 and 42.3% (P < 0.001), respectively. The median VAS scores for microemulsion and lipid emulsion propofol were 59 and 24 mm, respectively (95% confidence interval for the difference 12.5, 40.0). The aqueous free propofol concentration of microemulsion propofol was seven times higher than that of lipid emulsion propofol. Agents that reduce injection pain did not affect aqueous free propofol concentrations. Microemulsion propofol and 8% PEG660 HS enhanced plasma bradykinin generation, whereas lipid emulsion propofol and lipid solvent did not. PEG660 HS did not cause injection pain. CONCLUSIONS Higher aqueous free propofol concentrations of microemulsion propofol produce more frequent and severe pain. The plasma kallikrein-kinin system may not be involved, and the agents that reduce injection pain may not act by decreasing aqueous free propofol concentrations.
Collapse
Affiliation(s)
- Ji-Yeon Sim
- Department of Anesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
44
|
GOKBULUT C, KARADEMIR U, BOYACIOGLU M, McKELLAR QA. The effect of sesame and sunflower oils on the plasma disposition of ivermectin in goats. J Vet Pharmacol Ther 2008; 31:472-8. [DOI: 10.1111/j.1365-2885.2008.00980.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
Contreras-Solis I, Gomez-Brunet A, Encinas T, Gonzalez-Bulnes A, Santiago-Moreno J, Lopez-Sebastian A. Influence of vehicle on kinetics of exogenous progesterone administered either by subcutaneous and intramuscular routes to sheep. Res Vet Sci 2008; 85:162-5. [DOI: 10.1016/j.rvsc.2007.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Revised: 07/17/2007] [Accepted: 09/14/2007] [Indexed: 11/16/2022]
|
46
|
Müller R, Schwartzkopf-Genswein KS, Shah MA, von Keyserlingk MAG. Effect of neck injection and handler visibility on behavioral reactivity of beef steers. J Anim Sci 2008; 86:1215-22. [PMID: 18272853 DOI: 10.2527/jas.2007-0452] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of the neck region as an injection site in cattle is becoming routine. Use of a blind may reduce aversive behavior caused by the presence of the person administering the injection. To evaluate whether cattle react to the proximity of the stockperson or to the actual injection, one hundred twenty 10-mo-old Angus steers (298 +/- 28 kg of BW; mean +/- SD) were assigned to 1 of 4 treatment groups using a partial crossover design (neck/sham injection x blind/no blind) replicated over 2 d (3 d apart). Steers were restrained for a total of 60 s in a squeeze chute, with treatment being administered 20 s after entry. Animal reactivity was rated using 2 scoring methods, including a visual and an electronic score, for three 20-s intervals (pre-treatment, treatment, and posttreatment intervals). Flight speed (m/s) was used as a measure of aversion to the treatments and was taken upon release from the chute. No interactions (P > 0.10) were observed between the blind and injection treatments for any of the measurements taken. No treatment or day effect on flight speed (2.7 vs. 2.6 m/s; P > 0.03) was observed; however, the correlation between days (r = 0.74; P < 0.001) was significant. Visual scores indicated that injected steers were more agitated during the treatment interval than were the sham injected steers (1.9 vs. 1.6, respectively; P = 0.01). However, no differences (P > 0.10) were found between injection and sham injection treatments for any of the electronic scores. Steers exposed to the blind had lower electronic reactivity scores (P < 0.05) than those not exposed to the blind, which was in contrast to the results obtained for the visual scores (P < 0.05). Discrepancies between reactivity scores may be due to the difficulty of accurately assessing minor animal responses using the visual method. The presence of a handler during an injection procedure could be a contributor to the aversion response observed in cattle undergoing routine neck injections, and use of a blind helped to reduce the reactivity of the steers.
Collapse
Affiliation(s)
- R Müller
- Animal Welfare Program, Faculty of Land and Food Systems, University of British Columbia, Canada
| | | | | | | |
Collapse
|
47
|
Piedmonte DM, Treuheit MJ. Formulation of Neulasta (pegfilgrastim). Adv Drug Deliv Rev 2008; 60:50-8. [PMID: 17822802 DOI: 10.1016/j.addr.2007.04.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 04/04/2007] [Indexed: 11/20/2022]
Abstract
Neulasta (pegfilgrastim) is a PEGylated version of its parent molecule NEUPOGEN (Filgrastim). This work describes the formulation development for Neulasta (pegfilgrastim), and the analytical techniques used to monitor degradation during these studies. Stability was assessed as a function of pH, protein concentration, buffer type, tonicity modifiers and surfactant concentration under both accelerated conditions and quiescent long-term storage. The stability of Neulasta (pegfilgrastim) to agitation and successive freeze-thaw cycles was also assessed. Neulasta (pegfilgrastim), at a protein concentration of 10 mg/mL formulated in 10 mM acetate, pH 4.0 with 5% sorbitol and 0.004% polysorbate 20, is stable for two years stored at 2-8 degrees C.
Collapse
Affiliation(s)
- Deirdre Murphy Piedmonte
- Department of Pharmaceutics, Amgen Incorporated, One Amgen Center Drive, Thousand Oaks, CA 91320 USA
| | | |
Collapse
|
48
|
Shah VS, Taddio A, Hancock R, Shah P, Ohlsson A. Topical amethocaine gel 4% for intramuscular injection in term neonates: A double-blind, placebo-controlled, randomized trial. Clin Ther 2008; 30:166-74. [DOI: 10.1016/j.clinthera.2008.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2007] [Indexed: 11/16/2022]
|
49
|
Pannier A, Jordan P, Dougherty FC, Bour F, Reigner B. Subcutaneous injection pain with C.E.R.A., a continuous erythropoietin receptor activator, compared with darbepoetin alfa. Curr Med Res Opin 2007; 23:3025-32. [PMID: 17961301 DOI: 10.1185/030079907x242700] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study assessed injection site pain following subcutaneous (SC) administration with a continuous erythropoietin receptor activator (C.E.R.A.), compared with darbepoetin alfa in healthy adults. METHODS In a randomized, placebo-controlled, single-centre, single-blind, three-way crossover study, subjects received one of six treatment sequences (ABC/ACB/BAC/BCA/CBA/CAB) involving SC injection of (A) C.E.R.A. 50 microg, (B) darbepoetin alfa 50 microg, or (C) placebo on days 1, 29, and 57. An initial pilot phase (n = 12) was used to determine the sample size for the confirmatory phase (n = 72), and data were combined for the final analysis (n = 84). MAIN OUTCOME MEASURES The primary endpoint was pain on the 100 mm visual analog scale (VAS) immediately after dosing. Secondary endpoints included VAS at 1 hour after dosing and pain on the six-point verbal rating scale (VRS) immediately and at 1 hour after dosing. RESULTS C.E.R.A. was associated with significantly less pain immediately after SC injection compared with darbepoetin alfa: least squares mean VAS 21.5 (95% confidence interval [CI]: 17.5, 25.5) versus 33.4 (95% CI: 28.4, 38.4) (p < 0.0001). Incidence of pain on the VRS was lower with C.E.R.A. compared with darbepoetin alfa immediately after dosing (p < 0.0001). One hour after administration, most subjects had no VRS pain. A study limitation is the small sample size and the findings need to be confirmed in a large trial of chronic kidney disease patients. CONCLUSIONS SC injection with C.E.R.A. is significantly less painful than SC darbepoetin alfa in healthy adults. Treatment of anemia in chronic kidney disease with SC injection of C.E.R.A. may provide a lower pain burden compared with darbepoetin alfa.
Collapse
|
50
|
Leist TP, Vermersch P. The potential role for cladribine in the treatment of multiple sclerosis: clinical experience and development of an oral tablet formulation. Curr Med Res Opin 2007; 23:2667-76. [PMID: 17880754 DOI: 10.1185/030079907x233142] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Disease-modifying drugs available for multiple sclerosis (MS) require chronic, regular, parenteral administration. Effective oral MS therapies may improve long-term adherence. A number of oral therapies are in development, including cladribine--a preferential lymphocyte-depleting therapy with a well-established safety profile across other indications. OBJECTIVE To review information available on the safety and efficacy of cladribine in the treatment of MS, in the context of the ongoing development of an oral tablet formulation. METHODS An electronic search was performed to identify publications in which 'cladribine' was listed as a major index term. Results of the literature search were supplemented by other relevant secondary references and publications. FINDINGS The majority of published data on cladribine describe its use in diseases other than MS. However, three major, industry-sponsored, double-blind, placebo-controlled trials of parenteral cladribine were identified, involving 262 patients with relapsing or progressive forms of MS. Patients received cumulative doses of 0.7-2.8 mg/kg of cladribine over 4-6 months and were followed-up for at least 6-12 months thereafter. Individual results of these studies of parenteral cladribine indicate that it can reduce: (i) the number and volume of T1 gadolinium-enhancing lesions; (ii) the accumulation of T2 lesion volume; (iii) relapse rate; and (iv) disability progression. A dose-dependent increase in adverse events was observed, leading to selection of low doses for use in an ongoing clinical development program of an oral tablet formulation. Efficacy and safety data from four independent studies/case reports have also supported the potential benefits of cladribine in MS. While parenteral cladribine (at doses of 0.7-2.1 mg/kg) is associated with a good short-term safety and tolerability profile, additional long-term data are required--and the safety profile of the oral tablet formulation is yet to be established. To this end, the efficacy and safety of oral cladribine tablets are now being assessed as monotherapy and add-on therapy to interferon-beta-1a in two, 96-week, double-blind clinical trials of relapsing forms of MS. These ongoing studies will utilize newer diagnostic criteria and more sensitive evaluation techniques than were available at the time of the parenteral studies of cladribine. CONCLUSION Preliminary data indicate that cladribine is effective for the treatment of MS and has a promising safety and tolerability profile. The sustained immunologic effects of cladribine make it suitable for intermittent oral dosing, which is expected to offer benefits for patient satisfaction and therapeutic adherence.
Collapse
|