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Saha SK, Joshi A, Singh R, Dubey K. Review of industrially recognized polymers and manufacturing processes for amorphous solid dispersion based formulations. Pharm Dev Technol 2023; 28:678-696. [PMID: 37427544 DOI: 10.1080/10837450.2023.2233595] [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: 04/19/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
Evolving therapeutic landscape through combinatorial chemistry and high throughput screening have resulted in an increased number of poorly soluble drugs. Drug delivery strategies quickly adapted to convert these drugs into successful therapies. Amorphous solid dispersion (ASD) technology is widely employed as a drug delivery strategy by pharmaceutical industries to overcome the challenges associated with these poorly soluble drugs. The development of ASD formulation requires an understanding of polymers and manufacturing techniques. A review of US FDA-approved ASD-based products revealed that only a limited number of polymers and manufacturing technologies are employed by pharmaceutical industries. This review provides a comprehensive guide for the selection and overview of polymers and manufacturing technologies adopted by pharmaceutical industries for ASD formulation. The various employed polymers with their underlying mechanisms for solution-state and solid-state stability are discussed. ASD manufacturing techniques, primarily implemented by pharmaceutical industries for commercialization, are presented in Quality by Design (QbD) format. An overview of novel excipients and progress in manufacturing technologies are also discussed. This review provides insights to the researchers on the industrially accepted polymers and manufacturing technology for ASD formulation that has translated these challenging drugs into successful therapies.
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Affiliation(s)
- Sumit Kumar Saha
- Department of Pharmacology, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi, India
- Formulation Research and Development - Orals, Sun Pharmaceuticals Industries Limited, Gurugram, India
| | | | - Romi Singh
- Formulation Research and Development - Orals, Sun Pharmaceuticals Industries Limited, Gurugram, India
| | - Kiran Dubey
- Department of Pharmacology, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi, India
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2
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Melt Fusion Techniques for Solubility Enhancement: A Comparison of Hot Melt Extrusion and KinetiSol® Technologies. Sci Pharm 2022. [DOI: 10.3390/scipharm90030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A successful candidate for oral drug delivery needs to possess adequate solubility and dissolution rate to elicit its therapeutic action. Extensive research is being carried out to enhance the solubility of poorly soluble drugs through a number of techniques involving polymeric and non-polymeric approaches. Non-polymeric approaches such as micronization and nanocrystals are successful in improving the apparent solubility of drugs, but the sustenance of solubility is not always possible. Amorphous solid dispersions (ASDs) lead to solubility enhancement as well as the maintenance of solubility with the assistance of polymers, thereby improving bioavailability. Spray drying, hot melt extrusion (HME), and KinetiSol® technologies are some of the techniques capable of manufacturing ASDs. Each of these techniques has its own advantages and disadvantages in terms of processing challenges and applicability in preparing ASDs. The latter two technologies are similar in being fusion and non-solvent techniques to improve solubility. This review compares both HME and KinetiSol® techniques regarding mechanism, equipment design, formulation, and process parameters involved and scalability.
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Dharani S, Sediri K, Cook P, Arunagiri R, Khan MA, Rahman Z. Preparation and Characterization of Stable Amorphous Glassy Solution of BCS II and IV Drugs. AAPS PharmSciTech 2021; 23:35. [PMID: 34950995 DOI: 10.1208/s12249-021-02198-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
The focus of the present investigation was to develop amorphous glassy solutions (AGSs) of BCS Class II and IV drugs using sucrose acetate isobutyrate (SAIB). The drugs studied were rifaximin (RFX), dasatinib (DST), aripiprazole (APZ), dolutegravir (DLT), cyclosporine (CYS), itraconazole (ITZ), tacrolimus (TAC), sirolimus (SRL), aprepitant (APT), and carbamazepine (CBZ). AGSs were prepared by dissolving known quantity of the drug in the SAIB at 120 (TAC and APZ), 140 (CYS) or 150 oC (RFX, DST, DLT, ITZ, SRL, APT, and CBZ). They were characterized visually and by NIR, NIR hyperspectroscopy (NIR-H), and XRPD. Stability were determined by exposing open vials to 40 oC/75% RH for a week. AGSs behave like a glassy solid at room temperature and liquified above 60 oC. The solubility of APT, DLT, SRL, APZ, RFX, CBZ, TAC and CYS in SAIB was 0.4±0.0, 1.7±0.4, 1.9±0.0, 21.6±2.6, 36.4±0.9, 76.5±4.0, 115.1±2.3, and 239.0±12.6 mg/g, respectively. NIR, NIR-H, and XRPD data indicated the amorphous nature of the AGSs. Furthermore, AGSs were stable against devitrification on exposure to high temperature and humidity. In summary, SAIB can be employed to develop stable AGSs of poorly soluble drugs to increase dissolution, and oral bioavailability with the addition of hydrophilic excipients.
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Thakkar R, Jara MO, Swinnea S, Pillai AR, Maniruzzaman M. Impact of Laser Speed and Drug Particle Size on Selective Laser Sintering 3D Printing of Amorphous Solid Dispersions. Pharmaceutics 2021; 13:1149. [PMID: 34452109 PMCID: PMC8400191 DOI: 10.3390/pharmaceutics13081149] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
This research demonstrates the influence of laser speed and the drug particle size on the manufacturing of amorphous solid dispersions (ASD) and dosage forms thereof using selective laser sintering 3-dimensional (3D) printing. One-step manufacturing of ASD is possible using selective laser sintering 3D printing processes, however, the mechanism of ASD formation by this process is not completely understood and it requires further investigation. We hypothesize that the mechanism of ASD formation is the diffusion and dissolution of the drug in the polymeric carrier during the selective laser sintering (SLS) process and the drug particle size plays a critical role in the formation of said ASDs as there is no mixing involved in the sintering process. Herein, indomethacin was used as a model drug and introduced into the feedstock (Kollidon® VA64 and Candurin® blend) as either unprocessed drug crystals (particle size > 50 µm) or processed hot-melt extruded granules (DosePlus) with reduced drug particle size (<5 µm). These feedstocks were processed at 50, 75, and 100 mm/s scan speed using SLS 3D printing process. Characterization and performance testing were conducted on these tablets which revealed the amorphous conversion of the drug. Both MANOVA and ANOVA analyses depicted that the laser speed and drug particle size significantly impact the drug's apparent solubility and drug release. This significant difference in performance between formulations is attributed to the difference in the extent of dissolution of the drug in the polymeric matrix, leading to residual crystallinity, which is detrimental to ASD's performance. These results demonstrate the influence of drug particle size on solid-state and performance of 3D printed solid dispersions, and, hence, provide a better understanding of the mechanism and limitations of SLS 3D printing of ASDs and its dosage forms.
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Affiliation(s)
- Rishi Thakkar
- Pharmaceutical Engineering and 3D Printing (PharmE3D) Lab, Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; (R.T.); (A.R.P.)
| | - Miguel O. Jara
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Steve Swinnea
- Department of Chemical Engineering, Texas Materials Institute, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Amit R. Pillai
- Pharmaceutical Engineering and 3D Printing (PharmE3D) Lab, Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; (R.T.); (A.R.P.)
| | - Mohammed Maniruzzaman
- Pharmaceutical Engineering and 3D Printing (PharmE3D) Lab, Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; (R.T.); (A.R.P.)
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Thompson SA, Williams RO. Specific mechanical energy - An essential parameter in the processing of amorphous solid dispersions. Adv Drug Deliv Rev 2021; 173:374-393. [PMID: 33781785 DOI: 10.1016/j.addr.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
Specific mechanical energy (SME) is a frequently overlooked but essential parameter of hot-melt extrusion (HME). It can determine whether an amorphous solid dispersion (ASD) can be successfully processed. A minimum combination of thermal input and SME is required to convert a crystalline active pharmaceutical product (API) into its amorphous form. A maximum combination is allowed before it or the carrier polymer chemically degrades. This has important implications on design space. SME input during HME provides information on the totality of the effect of various independent processing parameters such as screw speed, feed rate, and complex viscosity. If only these independent processing parameters are considered separately instead of SME, then important information would be lost regarding the interaction of these parameters and their ability to affect ASD formulation. A complete understanding of the HME process requires an analysis of SME. This paper provides a review of SME use in the pharmaceutical processing of ASDs, the importance of SME in terms of a variety of formulation qualities, and novel future uses of SME. Theoretical background is discussed, along with the relative importance of thermal and mechanical input on various nonsolvent ASD processing methods.
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Thakore SD, Akhtar J, Jain R, Paudel A, Bansal AK. Analytical and Computational Methods for the Determination of Drug-Polymer Solubility and Miscibility. Mol Pharm 2021; 18:2835-2866. [PMID: 34041914 DOI: 10.1021/acs.molpharmaceut.1c00141] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the pharmaceutical industry, poorly water-soluble drugs require enabling technologies to increase apparent solubility in the biological environment. Amorphous solid dispersion (ASD) has emerged as an attractive strategy that has been used to market more than 20 oral pharmaceutical products. The amorphous form is inherently unstable and exhibits phase separation and crystallization during shelf life storage. Polymers stabilize the amorphous drug by antiplasticization, reducing molecular mobility, reducing chemical potential of drug, and increasing glass transition temperature in ASD. Here, drug-polymer miscibility is an important contributor to the physical stability of ASDs. The current Review discusses the basics of drug-polymer interactions with the major focus on the methods for the evaluation of solubility and miscibility of the drug in the polymer. Methods for the evaluation of drug-polymer solubility and miscibility have been classified as thermal, spectroscopic, microscopic, solid-liquid equilibrium-based, rheological, and computational methods. Thermal methods have been commonly used to determine the solubility of the drug in the polymer, while other methods provide qualitative information about drug-polymer miscibility. Despite advancements, the majority of these methods are still inadequate to provide the value of drug-polymer miscibility at room temperature. There is still a need for methods that can accurately determine drug-polymer miscibility at pharmaceutically relevant temperatures.
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Affiliation(s)
- Samarth D Thakore
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Sector 67, S.A.S. Nagar, Mohali, Punjab 160062, India
| | - Junia Akhtar
- Department of Pharmaceutical Technology (Formulations), National Institute of Pharmaceutical Education and Research, Sector 67, S.A.S. Nagar, Mohali, Punjab 160062, India
| | - Ranjna Jain
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Sector 67, S.A.S. Nagar, Mohali, Punjab 160062, India
| | - Amrit Paudel
- Research Center Pharmaceutical Engineering (RCPE) GmbH, Inffeldgasse 13, 8010 Graz, Austria.,Institute for Process and Particle Engineering, Graz University of Technology, Inffeldgasse 13, 8010 Graz, Austria
| | - Arvind K Bansal
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Sector 67, S.A.S. Nagar, Mohali, Punjab 160062, India
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Davis DA, Thakkar R, Su Y, Williams RO, Maniruzzaman M. Selective Laser Sintering 3-Dimensional Printing as a Single Step Process to Prepare Amorphous Solid Dispersion Dosage Forms for Improved Solubility and Dissolution Rate. J Pharm Sci 2020; 110:1432-1443. [PMID: 33227241 DOI: 10.1016/j.xphs.2020.11.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
This study reports the development of ritonavir-copovidone amorphous solid dispersions (ASDs) and dosage forms thereof using selective laser sintering (SLS) 3-dimensional (3-D) printing in a single step, circumventing the post-processing steps required in common techniques employed to make ASDs. For this study, different drug loads of ritonavir with copovidone were processed at varying processing conditions to understand the impact, range, and correlation of these parameters for successful ASD formation. Further, ASDs characterized using conventional and advanced solid-state techniques including wide-angle X-ray scattering (WAXS), solid-state nuclear magnetic resonance (ssNMR), revealed the full conversion of the crystalline drug to its amorphous form as a function of laser-assisted selective fusion in a layer-by-layer manner. It was observed that an optimum combination of the powder flow properties, surface temperature, chamber temperature, laser speed, and hatch spacing was crucial for successful ASD formation, any deviations resulted in print failures or only partial amorphous conversion. Moreover, a 21-fold increase in solubility was demonstrated by the SLS 3-D printed tablets. The results confirmed that SLS 3-D printing can be used as a single-step platform for creating ASD-based pharmaceutical dosage forms with a solubility advantage.
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Affiliation(s)
- Daniel A Davis
- Department of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Rishi Thakkar
- Department of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Yongchao Su
- Pharmaceutical Sciences, Merck & Co, Inc, Rahway, NJ 07065, USA
| | - Robert O Williams
- Department of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Mohammed Maniruzzaman
- Department of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
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Davis DA, Miller DA, Su Y, Williams RO. Thermally Conductive Excipient Expands KinetiSol® Processing Capabilities. AAPS PharmSciTech 2020; 21:319. [PMID: 33179174 DOI: 10.1208/s12249-020-01817-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/08/2020] [Indexed: 01/28/2023] Open
Abstract
We report for the first time that incorporation of a thermally conductive excipient (TCE) modifies the thermal conductivity of the ternary drug-polymer-TCE compositions such that high-energy mixing can occur for prolonged periods at a selected steady-state temperature during the KinetiSol process. In this study, candurin, a TCE, is incorporated within a composition that is processed by high-energy mixing from the KinetiSol process to increase the thermal conductivity of the ternary composition. The improved thermal conductivity promotes heat transfer and enables the high-energy mixing applied during the KinetiSol process to be continued for prolonged time intervals at a selected steady-state temperature, instead of undergoing a continued increase in temperature when the TCE is not present in the composition. The addition of candurin does not impact the molecular structure and mixing of the drug and polymer in ASDs from solid-state NMR characterizations. Compositions with candurin achieved a steady-state processing temperature with + 5°C of the target temperature, and these compositions demonstrated the ability to mix for prolonged time periods while maintaining within this steady-state temperature range, thus enabling the formation of an ASD at a temperature that the drug does not chemically degrade. This study demonstrated that inclusion of the TCE modified the composition's thermal conductivity to efficiently dissipate heat to achieve a selected steady-state temperature during the KinetiSol process, thus providing prolonged mixing times at a lower temperature for dissolving the drug into the polymer to achieve an ASD without sacrificing product performance.
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Tan DK, Davis DA, Miller DA, Williams RO, Nokhodchi A. Innovations in Thermal Processing: Hot-Melt Extrusion and KinetiSol® Dispersing. AAPS PharmSciTech 2020; 21:312. [PMID: 33161479 PMCID: PMC7649167 DOI: 10.1208/s12249-020-01854-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022] Open
Abstract
Thermal processing has gained much interest in the pharmaceutical industry, particularly for the enhancement of solubility, bioavailability, and dissolution of active pharmaceutical ingredients (APIs) with poor aqueous solubility. Formulation scientists have developed various techniques which may include physical and chemical modifications to achieve solubility enhancement. One of the most commonly used methods for solubility enhancement is through the use of amorphous solid dispersions (ASDs). Examples of commercialized ASDs include Kaletra®, Kalydeco®, and Onmel®. Various technologies produce ASDs; some of the approaches, such as spray-drying, solvent evaporation, and lyophilization, involve the use of solvents, whereas thermal approaches often do not require solvents. Processes that do not require solvents are usually preferred, as some solvents may induce toxicity due to residual solvents and are often considered to be damaging to the environment. The purpose of this review is to provide an update on recent innovations reported for using hot-melt extrusion and KinetiSol® Dispersing technologies to formulate poorly water-soluble APIs in amorphous solid dispersions. We will address development challenges for poorly water-soluble APIs and how these two processes meet these challenges.
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Affiliation(s)
- Deck Khong Tan
- Pharmaceutics Research Laboratory, Arundel Building, School of Life Sciences, University of Sussex, Brighton, BN1 9QJ, UK
| | - Daniel A Davis
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, 78712, USA
| | - Dave A Miller
- DisperSol Technologies, LLC, 111 W. Cooperative Way, Building 3, Suite 300, Georgetown, Texas, 78626, USA
| | - Robert O Williams
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, 78712, USA.
| | - Ali Nokhodchi
- Pharmaceutics Research Laboratory, Arundel Building, School of Life Sciences, University of Sussex, Brighton, BN1 9QJ, UK.
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Jermain SV, Lowinger MB, Ellenberger DJ, Miller DA, Su Y, Williams RO. In Vitro and In Vivo Behaviors of KinetiSol and Spray-Dried Amorphous Solid Dispersions of a Weakly Basic Drug and Ionic Polymer. Mol Pharm 2020; 17:2789-2808. [DOI: 10.1021/acs.molpharmaceut.0c00108] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Scott V. Jermain
- College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, A1920, Austin, Texas 78712, United States
| | - Michael B. Lowinger
- Merck Research Laboratories (MRL), Merck & Co., Inc., 126 East Lincoln Avenue, Rahway, New Jersey 07065, United States
| | - Daniel J. Ellenberger
- DisperSol Technologies, LLC, 111 West Cooperative Way, Building 2, Suite 200, Georgetown, Texas 78626, United States
| | - Dave A. Miller
- DisperSol Technologies, LLC, 111 West Cooperative Way, Building 2, Suite 200, Georgetown, Texas 78626, United States
| | - Yongchao Su
- College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, A1920, Austin, Texas 78712, United States
- Merck Research Laboratories (MRL), Merck & Co., Inc., 126 East Lincoln Avenue, Rahway, New Jersey 07065, United States
| | - Robert O. Williams
- College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, A1920, Austin, Texas 78712, United States
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Mendonsa N, Almutairy B, Kallakunta VR, Sarabu S, Thipsay P, Bandari S, Repka MA. Manufacturing strategies to develop amorphous solid dispersions: An overview. J Drug Deliv Sci Technol 2019; 55. [PMID: 32863891 DOI: 10.1016/j.jddst.2019.101459] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the past several decades, poor water solubility of existing and new drugs in the pipeline have remained a challenging issue for the pharmaceutical industry. Literature describes several approaches to improve the overall solubility, dissolution rate, and bioavailability of drugs with poor water solubility. Moreover, the development of amorphous solid dispersion (SD) using suitable polymers and methods have gained considerable importance in the recent past. In the present review, we attempt to discuss the important and industrially scalable thermal strategies for the development of amorphous SD. These include both solvent (spray drying and fluid bed processing) and fusion (hot melt extrusion and KinetiSol®) based techniques. The current review also provides insights into the thermodynamic properties of drugs, their polymer miscibility and solubility, and their molecular dynamics to develop stable and more efficient amorphous SD.
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Affiliation(s)
- Nicole Mendonsa
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, Oxford, MS, 38677, United States
| | - Bjad Almutairy
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, Oxford, MS, 38677, United States
| | - Venkata Raman Kallakunta
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, Oxford, MS, 38677, United States
| | - Sandeep Sarabu
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, Oxford, MS, 38677, United States
| | - Priyanka Thipsay
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, Oxford, MS, 38677, United States
| | - Suresh Bandari
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, Oxford, MS, 38677, United States
| | - Michael A Repka
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, Oxford, MS, 38677, United States.,Pii Center for Pharmaceutical Innovation & Instruction, The University of Mississippi, Oxford, MS, 38677, United States
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Moon C, Sahakijpijarn S, Koleng JJ, Williams RO. Processing design space is critical for voriconazole nanoaggregates for dry powder inhalation produced by thin film freezing. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.101295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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