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Liu GW, Pickett MJ, Kuosmanen JLP, Ishida K, Madani WAM, White GN, Jenkins J, Park S, Feig VR, Jimenez M, Karavasili C, Lal NB, Murphy M, Lopes A, Morimoto J, Fitzgerald N, Cheah JH, Soule CK, Fabian N, Hayward A, Langer R, Traverso G. Drinkable in situ-forming tough hydrogels for gastrointestinal therapeutics. NATURE MATERIALS 2024; 23:1292-1299. [PMID: 38413810 PMCID: PMC11364503 DOI: 10.1038/s41563-024-01811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
Pills are a cornerstone of medicine but can be challenging to swallow. While liquid formulations are easier to ingest, they lack the capacity to localize therapeutics with excipients nor act as controlled release devices. Here we describe drug formulations based on liquid in situ-forming tough (LIFT) hydrogels that bridge the advantages of solid and liquid dosage forms. LIFT hydrogels form directly in the stomach through sequential ingestion of a crosslinker solution of calcium and dithiol crosslinkers, followed by a drug-containing polymer solution of alginate and four-arm poly(ethylene glycol)-maleimide. We show that LIFT hydrogels robustly form in the stomachs of live rats and pigs, and are mechanically tough, biocompatible and safely cleared after 24 h. LIFT hydrogels deliver a total drug dose comparable to unencapsulated drug in a controlled manner, and protect encapsulated therapeutic enzymes and bacteria from gastric acid-mediated deactivation. Overall, LIFT hydrogels may expand access to advanced therapeutics for patients with difficulty swallowing.
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Affiliation(s)
- Gary W Liu
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matthew J Pickett
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemistry, Yale University, New Haven, CT, USA
| | - Johannes L P Kuosmanen
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Keiko Ishida
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Fractyl Health, Inc., Lexington, MA, USA
| | - Wiam A M Madani
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Weill Cornell Medical College, New York City, NY, USA
| | - Georgia N White
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joshua Jenkins
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts and Nevis
| | - Sanghyun Park
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vivian R Feig
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Stanford University, Stanford, CA, USA
| | - Miguel Jimenez
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Boston University, Boston, MA, USA
| | - Christina Karavasili
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikhil B Lal
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- MIT Media Lab, Cambridge, MA, USA
| | - Matt Murphy
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Lopes
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua Morimoto
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Nina Fitzgerald
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Tufts University, Medford, MA, USA
| | - Jaime H Cheah
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Christian K Soule
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Niora Fabian
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Alison Hayward
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giovanni Traverso
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Kim JJ, Pritts JD, Ngo M, Estoll CR, Rao VA. Trends in Light and Temperature Sensitivity Recommendations among Licensed Biotechnology Drug Products. Pharm Res 2023; 40:1491-1505. [PMID: 37022633 PMCID: PMC10338390 DOI: 10.1007/s11095-023-03494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Inherent structural and functional properties of biotechnology-derived therapeutic biologics make them susceptible to light- and temperature-induced degradation and consequently can influence their quality. Photosensitivity of therapeutic proteins continues to be examined, but the commonalities and trends of storage conditions and information about light and temperature sensitivity among currently licensed therapeutic proteins has not been previously surveyed. METHODS Using a comprehensive and relational database approach, we conducted a scientific survey of all licensed biotechnology-derived drug products with the goal of providing evidence-based information about recommended storage conditions of formulations sorted by light- and temperature-related attributes as described for each product at licensure. RESULTS We report the prevalence of indications for light and temperature sensitivity in formulations categorized by their presentation type, number of doses, container type, dosage form and active molecule type. We also report the storage temperature range across formulations and diluents for reconstitution and dilution. Formulations with excipients that potentially facilitate light-induced and thermal degradation were also noted. CONCLUSIONS The result of our analysis indicates that light and temperature sensitivity are prevalent across therapeutic protein formulations. However, when a formulation is reconstituted or diluted, both light and temperature sensitivity are less clear. In addition, light and temperature sensitivity are more well defined in liquid formulations than lyophilized powder formulations, and more well defined in products manufactured in autoinjectors, prefilled-syringes, and pens than products in vials. Overall, our report provides a data-driven summary of storage conditions among therapeutic protein formulations to support the development of future biologic drug products.
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Affiliation(s)
- Jennifer J Kim
- Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Jordan D Pritts
- Laboratory of Applied Biochemistry, Division of Biotechnology Review and Research III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave / Bldg. 52/72 Rm 2212, Silver Spring, MD, 20993, USA
| | - Mai Ngo
- Laboratory of Applied Biochemistry, Division of Biotechnology Review and Research III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave / Bldg. 52/72 Rm 2212, Silver Spring, MD, 20993, USA
- Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Corey R Estoll
- Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - V Ashutosh Rao
- Laboratory of Applied Biochemistry, Division of Biotechnology Review and Research III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave / Bldg. 52/72 Rm 2212, Silver Spring, MD, 20993, USA.
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3
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Wale A, Young Z, Zhang W, Hiom S, Ahmed H, Yemm R, Mantzourani E. Factors affecting the patient journey and patient care when receiving an unlicensed medicine: A systematic review. Res Social Adm Pharm 2023; 19:1025-1041. [PMID: 37121796 DOI: 10.1016/j.sapharm.2023.04.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents have reported facing challenges with unlicensed medicines at the points of transfer of care between settings, a key time when medication errors may occur. There is little known about the patient journey as a whole, or the factors affecting patient care when receiving an unlicensed medicine. OBJECTIVE A systematic review of UK literature to better understand factors that affect the entire patient journey from the decision to initiate treatment with an unlicensed medicine to the point at which treatment is supplied through a community pharmacy or ends. METHODS Scopus, OVID EMCARE, EMBASE, OVID Medline ALL, CINAHL, Web of Science and Joanna Briggs Institute were searched from 1968 (introduction of the Medicines Act) until November 2020, using the PRISMA guidelines. Narrative synthesis of UK studies was employed to analyse descriptive and qualitative data on any reported findings that would impact the patient journey or care related to the use of unlicensed medicines, and any described barriers or enablers. RESULTS Forty-five studies met criteria for final inclusion, with high levels of heterogeneity in terms of designs and methods. Specific challenges that were seen to impact the continuity of care across care settings, patient safety and provision of patient-centred care included diversity of clinical needs and impact of patient population age; healthcare professional awareness and acceptability of the use of unlicensed medicines; the hierarchical structure of the NHS; inconsistent doses and formulations with varying bioequivalence; patient/parent/carer/public awareness of unlicensed medicines use and perceived acceptability. CONCLUSIONS This review identified a clear need for consistent information to be provided to healthcare professional and patients alike to support the safe and effective use of unlicensed medicines across care settings.
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Affiliation(s)
- Alesha Wale
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Zoe Young
- University Library Services, Cardiff University, Cardiff, Wales, UK
| | - Wenjuan Zhang
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Sarah Hiom
- Research and Development, St Mary's Pharmaceutical Unit, Cardiff, Wales, UK
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
| | - Rowan Yemm
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
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Münch J, Kloft C, Farhan M, Fishman V, Leng S, Bosse HM, Klingmann V. Acceptability, Swallowability, Palatability, and Safety of Multiple Film-Coated Mini-Tablets in Children Aged ≥2-<7 Years: Results of an Open-Label Randomised Study. Pharmaceutics 2023; 15:pharmaceutics15020701. [PMID: 36840023 PMCID: PMC9964507 DOI: 10.3390/pharmaceutics15020701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
This single-centre, open-label, randomised, parallel-group study assessed the acceptability, swallowability, palatability, and safety of film-coated, 3 mm diameter mini-tablets in children aged ≥2-<7 years. In total, 300 participants were randomised (2:2:1:1) to receive a single oral administration of 16 (group A) or 32 (group B) mini-tablets with soft food or 16 (group C) or 32 (group D) mini-tablets with water. Children in each group were stratified by age group (2-<3 years; 3-<4 years; 4-<5 years; 5-<6 years; and 6-<7 years). Groups C and D were pooled for statistical analyses. The rates of acceptability (swallowed ≥80% of the mini-tablets with or without chewing), swallowability (swallowed all mini-tablets without chewing or any leftover), and palatability (positive/neutral responses) were ≥80.0%, ≥42.0%, and ≥82.0%, respectively, across the study groups. No marked differences were observed between groups or across age groups. No adverse events or issues of clinical relevance with deglutition were reported. Mini-tablets taken with soft food or water provide a suitable method for administering medicines to children aged ≥2-<7 years. This study was registered in the German Clinical Trial Register (No. DRKS00024617).
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Affiliation(s)
- Juliane Münch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Carolin Kloft
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Madhi Farhan
- Actelion Pharmaceuticals Ltd., a Janssen Pharmaceutical Company of Johnson & Johnson, 4123 Allschwil, Switzerland
| | | | - Sining Leng
- Actelion Pharmaceuticals Ltd., a Janssen Pharmaceutical Company of Johnson & Johnson, 4123 Allschwil, Switzerland
| | - Hans Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstraße 5, 40225 Düsseldorf, Germany
- Correspondence: ; Tel.: +49-211-81-07906
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Andersson ÅC, Eksborg S, Förberg U, Nydert P, Lindemalm S. Manipulated Oral and Rectal Drugs in a Paediatric Swedish University Hospital, a Registry-Based Study Comparing Two Study-Years, Ten Years Apart. Pharmaceuticals (Basel) 2022; 16:8. [PMID: 36678505 PMCID: PMC9866613 DOI: 10.3390/ph16010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
This is a registry-based study with the aim of describing and comparing the frequency of manipulations of solid oral and rectal medicines in 2009 and 2019 at inpatient units and an emergency department in a paediatric hospital within a Swedish university hospital. All patients aged 1 month−18 years with oral or rectal administrations were included. In total, 140,791 oral and rectal administrations were included in 2009, and 167,945 oral and rectal administrations were included in 2019. The frequency of patients receiving at least one manipulated oral medicine decreased between the study years, both in inpatient units and in the emergency department (from 19% to 17%, p = 0.0029 and from 11% to 5%, p < 0.0001, respectively). The frequency of patients receiving a manipulated rectal medicine also decreased between the study years, both in inpatient units and in the emergency department (from 22% to 10%, p < 0.0001 and from 35% to 7% 2019, p < 0.0001, respectively). The results show a decrease in the manipulation of both oral and rectal medicines to paediatric patients in 2019 compared to 2009. Even though this implies a safer practice, there is still a pronounced lack of child-friendly dosage forms and suitable strengths enabling the safe administration of medicines to sick children.
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Affiliation(s)
- Åsa C. Andersson
- Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Staffan Eksborg
- Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Ulrika Förberg
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
- School of Health and Welfare, Dalarna University, 79131 Falun, Sweden
| | - Per Nydert
- Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14152 Stockholm, Sweden
| | - Synnöve Lindemalm
- Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14152 Stockholm, Sweden
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Arab R, Kassai B, Kilo R, Cornu C, Gomes E, Dagonneau T. Replacing liquid with solid dosage forms in pediatric practice: Feasibility and economic impact from a hospital-based study. Therapie 2022; 77:445-452. [DOI: 10.1016/j.therap.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/04/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
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Aanisah N, Wardhana YW, Chaerunisaa AY, Budiman A. Review on Modification of Glucomannan as an Excipient in Solid Dosage Forms. Polymers (Basel) 2022; 14:2550. [PMID: 35808596 PMCID: PMC9269564 DOI: 10.3390/polym14132550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 01/09/2023] Open
Abstract
Glucomannan (GM)-a polysaccharide generally extracted from the tuber of Amorphophallus konjac-has great potential as a filler-binder in direct compression, disintegrant in tablets, or gelling agent due to its strong hydrophilicity and extremely high viscosity. However, it has poor water resistance and low mechanical strength when used as an excipient in solid form. Several physical and chemical modifications have been carried out to improve these drawbacks. Chemical modification affects the characteristics of GM based on the DS. Carboxymethylation improves GM functionality by modifying its solubility and viscosity, which in turn allows it to bind water more efficiently and thus improve its elongation and gel homogeneity. Meanwhile, physical modification enhances functionality through combination with other excipients to improve mechanical properties and modify swelling ability and drug release from the matrix. This review discusses extraction of GM and its modification to enhance its applicability as an excipient in solid form. Modified GM is a novel excipient applicable in the pharmaceutical industry for direct compression, as a tablet disintegrant, a film-forming agent, and for encapsulation of macromolecular compounds or drug carriers for controlled release.
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Affiliation(s)
- Nuur Aanisah
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia; (N.A.); (A.Y.C.); (A.B.)
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Tadulako University, Palu 94118, Indonesia
| | - Yoga W. Wardhana
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia; (N.A.); (A.Y.C.); (A.B.)
- Study Center Development of Pharmaceutical Preparations, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
| | - Anis Y. Chaerunisaa
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia; (N.A.); (A.Y.C.); (A.B.)
- Study Center Development of Pharmaceutical Preparations, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
| | - Arif Budiman
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia; (N.A.); (A.Y.C.); (A.B.)
- Study Center Development of Pharmaceutical Preparations, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor 45363, Indonesia
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Orubu ESF, Duncan J, Tuleu C, Turner MA, Nunn A. WHO essential medicines for children 2011-2019: age-appropriateness of enteral formulations. Arch Dis Child 2022; 107:317-322. [PMID: 34479858 DOI: 10.1136/archdischild-2021-321831] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/11/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The WHO Essential Medicine List for children (EMLc) is used for promoting access to medicines. The age-appropriateness of enteral (oral and rectal) formulations for children depend on their adaptability/flexibility to allow age-related or weight-related doses to be administered/prescribed and the child's ability to swallow, as appropriate. There is scant information on the age-appropriateness of essential enteral medicines for children. OBJECTIVE To evaluate the age-appropriateness of enteral essential medicines. MATERIALS AND METHODS Age-appropriateness of all enteral formulations indicated and recommended in the EMLc 3rd to 7th (2011-2019) editions were determined by assessing swallowability and/or dose adaptability for children under 12 years, stratified into five age groups. RESULTS Enteral formulations in the EMLc were more age-appropriate for older children aged 6-11 years than for younger children. In the 3rd edition, for older children, 77%, n=342, of formulations were age-appropriate. For younger children, age-appropriateness decreased with age group: 34% in those aged 3-5 years, 30% in those aged 1-2 years, 22% among those aged 28 days to 11 months and 15% in those aged 0-27 days. Overall, similar proportions were found for the 7th edition. In contrast, the majority of medicines in the 7th list were age-appropriate in targeted diseases like HIV and tuberculosis. CONCLUSION Most recommended enteral essential medicines in EMLc 2011 and 2019 were not age-appropriate for children <6 years. Medicines which are not age-appropriate must be manipulated before administration, leading to potential issues of safety and efficacy. Evaluation of the age-appropriateness of formulations for medicines to be included in EMLc could improve access to better medicines for children in the future.
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Affiliation(s)
| | - Jennifer Duncan
- Paediatric Medicines Research Unit (PMRU), Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Mark A Turner
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Liverpool Health Partners, Liverpool, UK.,Paediatric Medicines Research Unit (PRMU), Clinical Research Division, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anthony Nunn
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,Paediatric Medicines Research Unit (PMRU), Clinical Research Division, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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9
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Saito J, Nakamura H, Yamatani A. Issues on Powder Forms for Oral Solution and Suspension for Pediatric Patients in Japan: A Questionnaire-Based Observational Survey to Pediatric Pharmacists. Ther Innov Regul Sci 2022; 56:301-312. [PMID: 35088393 DOI: 10.1007/s43441-021-00361-1] [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: 07/14/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Powders for oral solutions and suspensions (POS) are commonly used as pediatric oral medicines worldwide, except for Japan. Although global pediatric formulation development accelerates POS importation to Japan without any formulation change, oral solid multiparticulates remain to be the preferred pediatric forms in the country. This study aimed to evaluate the acceptance situation of four typical POS form products (mycophenolate mofetil, sildenafil citrate, valganciclovir hydrochloride, and voriconazole) that were recently approved in Japan. METHODS A questionnaire on four products was completed by pharmacists in 29 children's hospitals with more than 100 beds each, between November and December of 2019. The questionnaire has six items on (#1) type of institution, (#2) formulary status, (#3) dispensing practice, (#4) reasons why POS form(s) were not selected as hospital formulary, (#5) advantages and disadvantages of POS form, and (#6) opinions for POS form. RESULTS Of the 29 institutions, 7 (24%), 9 (31%), 4 (13%), and 10 (34%) institutions used POS of mycophenolate mofetil, sildenafil citrate, valganciclovir hydrochloride, and voriconazole, respectively. Reasons for not using these products were dispensed drug loss, formulation issues, and management issues in the pharmaceutical department and pediatric ward. Pharmacists preferred drug compounding such as tablet crushing and capsule opening to POS form use. CONCLUSIONS POS forms might be an unsuitable formulation for the current hospital settings in Japan. Thus, appropriate dosage forms that reflect the current clinical settings are necessary.
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Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
- Department of Research and Development Supervision, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Hidefumi Nakamura
- Department of Research and Development Supervision, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Research and Development Supervision, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
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10
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Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics 2021; 148:183379. [PMID: 34851406 DOI: 10.1542/peds.2021-054666] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
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Affiliation(s)
- H Shonna Yin
- Departments of Pediatrics and Population Health, Grossman School of Medicine, New York University, New York, New York
| | | | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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11
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Rashed AN, Terry D, Fox A, Christiansen N, Tomlin S. Feasibility of developing children's Pill School within a UK hospital. Arch Dis Child 2021; 106:705-708. [PMID: 33229414 DOI: 10.1136/archdischild-2020-319154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We assessed the feasibility of introducing an intervention (children's Pill School-PS) within a UK hospital to provide swallowing training for children, identified the proportion of children who can be switched from oral liquid medicines to pills and assessed children/parents' opinions about the PS training. METHODS 30 inpatient children (aged 3-18 years; taking oral liquid medicines; their liquid medications assessed suitable for switching to pills; can (and their parents) speak/understand English were included. Training sessions were delivered using hard sweets of different sizes. RESULTS 87% (26) of children successfully learnt how to swallow pills after one training session (mean duration 14.5 min), and 92% (24) were discharged on pills. 75 prescribed oral liquid medications were deemed suitable for switching to pills. Of these, 89% (67) were switched successfully. CONCLUSION Children as young as 3 years were successful in swallowing pills after training. Providing children PS training session within hospital is feasible and acceptable to children and their parents.
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Affiliation(s)
- Asia N Rashed
- Institute of Pharmaceutical Science, King's College London, London, London, UK .,Evelina Pharmacy, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, London, UK
| | - David Terry
- Academic Practice Unit, Life & Health Sciences, Aston University, Birmingham, Birmingham, UK
| | - Andy Fox
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Nanna Christiansen
- Evelina Pharmacy, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, London, UK
| | - Stephen Tomlin
- Pharmacy, Great Ormond Street Hospital for Children, London, UK
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12
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Alessandrini E, Brako F, Scarpa M, Lupo M, Bonifazi D, Pignataro V, Cavallo M, Cullufe O, Enache C, Nafria B, Claverol J, De Taeye L, Vermeulen E, Preston J, Tuleu C. Children's Preferences for Oral Dosage Forms and Their Involvement in Formulation Research via EPTRI (European Paediatric Translational Research Infrastructure). Pharmaceutics 2021; 13:pharmaceutics13050730. [PMID: 34063499 PMCID: PMC8156390 DOI: 10.3390/pharmaceutics13050730] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
The paucity of evidence-based data on formulation characteristics preferred by the children is known to limit the design of tailored paediatric dosage forms. The European Paediatric Translational Research Infrastructure (EPTRI) commissioned a study to evaluate children's dosage forms perceived preferences in some European countries and explore the feasibility of using the young persons advisory groups (YPAGs) to involve children in formulation research. An online, age-adapted survey was developed and translated into six languages. The survey link was disseminated across seven European countries: Albania, Italy, the Netherlands, and Dutch-speaking part of Belgium, Romania, Spain, and the United Kingdom. Respondents' (n = 1172) perceived preferences for oral dosage forms primarily differed based on age, health status, and experience. Conventional dosage forms, i.e., liquid (35%), tablets (19%), and capsules (14%), were the most selected. Liquid was widely selected by children less than 12 years and by those healthy and taking medicines rarely. Monolithic solid forms were mostly chosen by adolescents and by children with a chronic disease taking medicines frequently. There was a clear lack of familiarity with more novel dosage forms (e.g., orodispersible films and granules). Noteworthy, granules were not appreciated, particularly by adolescents (52.8%). To rationalise the creation of paediatric formulations, it is important to involve children as active stakeholders and to apply tools assessing children's perspectives on medicines to inform acceptable dosage form development from the start.
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Affiliation(s)
- Elisa Alessandrini
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
- Correspondence:
| | - Francis Brako
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
- Medway School of Pharmacy, Universities at Medway, Anson Building, Chatham ME4 4TB, UK
| | - Mariagiovanna Scarpa
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
| | - Mariangela Lupo
- TEDDY European Network of Excellence for Paediatric Research, via Luigi Porta 14, 27100 Pavia, Italy;
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, CVBF, via N. Putignani 178, 70122 Bari, Italy; (D.B.); (V.P.); (M.C.)
| | - Valeria Pignataro
- Consorzio per Valutazioni Biologiche e Farmacologiche, CVBF, via N. Putignani 178, 70122 Bari, Italy; (D.B.); (V.P.); (M.C.)
| | - Maria Cavallo
- Consorzio per Valutazioni Biologiche e Farmacologiche, CVBF, via N. Putignani 178, 70122 Bari, Italy; (D.B.); (V.P.); (M.C.)
| | - Ornela Cullufe
- Consorzio per Valutazioni Biologiche e Farmacologiche, Dege e Shoqerise se Huaj, CVBF Albania, Rr.Prokop Myzeqari, 1000 Tirana, Albania;
| | - Cristina Enache
- The Romanian Angel Appeal Foundation, Strada Rodiei, 030956 București, Romania;
| | - Begonya Nafria
- Sant Joan de Déu Research Institute, Esplugues de Llobregat, 08950 Barcelona, Spain; (B.N.); (J.C.)
| | - Joana Claverol
- Sant Joan de Déu Research Institute, Esplugues de Llobregat, 08950 Barcelona, Spain; (B.N.); (J.C.)
| | - Leen De Taeye
- Department of Internal Medicine and Paediatrics, Ghent University, 9000 Ghent, Belgium;
| | - Eric Vermeulen
- Dutch Patient Alliance for Rare and Genetic Diseases, VSOP, Koninginnelaan 23, 3762 DA Soest, The Netherlands;
| | - Jennifer Preston
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UK;
| | - Catherine Tuleu
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (F.B.); (M.S.); (C.T.)
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13
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Kufiyah AK, Bagasi AMH, Nawlalili SM, Bazaid DS, Marghalani AA, Fathi A. Effect of Zamzam Water on Microhardness of Primary Tooth Enamel After Erosion Induced by Claritin Syrup: An In-vitro Study. J Int Soc Prev Community Dent 2021; 11:173-178. [PMID: 34036079 PMCID: PMC8118050 DOI: 10.4103/jispcd.jispcd_420_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Dental erosion is an irreversible damage to hard tissues in the mouth due to acid dissolution not induced by microorganisms. Oral medications contributed to the etiology of dental erosion. Among these medications, antihistamine-containing syrups were reported to have a considerable erosive effect on hard dental tissues. Objective: The objective was to evaluate the effect of Zamzam water on the microhardness of primary tooth enamel after erosion induced by Claritin™ syrup. Materials and Methods: The present in-vitro study was conducted on 25 primary central incisor teeth. The labial surfaces of the specimens were prepared for microhardness testing. Baseline microhardness was measured first, then the samples were submerged in the erosive agent Claritin™ syrup, for 30 min every 12 h for 12 days. Thereafter, all the teeth were placed in Zamzam water for 30 min every 12 h for 12 days. The microhardness was measured by the Vickers hardness tester and expressed as Vickers microhardness value (VH). The measurements were completed three times for the same sample: baseline, after erosion, and after Zamzam treatment. Data were analyzed statistically using one-way repeated analysis of variance (ANOVA) followed by Tukey’s post hoc test. Results: The primary teeth included in this study showed a significant increase in their surface microhardness after Zamzam water treatment; the mean value of VH was increased from 33.12 ± 1.62 to 89.32 ± 8.52 (P-value <0.0001). Conclusion: Zamzam water could be introduced as a part of the management of dental erosion in the primary dentition.
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Affiliation(s)
| | | | | | | | | | - Adel Fathi
- Preventive Dentistry Department, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Pedodontics and Oral Health, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
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14
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Roy V, Singhal S, Tayal H, Dubey AP. Availability of Pediatric Formulations in Public Health Care System in India: A Case Study. Indian J Pediatr 2021; 88:227-234. [PMID: 32086758 DOI: 10.1007/s12098-020-03220-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the availability of pediatric formulations in Essential Medicines Lists and public health care facility in India. METHODS Availability of pediatric formulations in the public health sector was evaluated by assessing inclusion of pediatric formulations in the National List of Essential Medicines (NLEM), Delhi Essential Medicine List (DEML), Indian Academy of Pediatrics (IAP) Essential Medicines Lists (EML) and comparing it with the World Health Organization's list of essential medicines for children (WHO, EMLc). In addition, availability of 30 essential medicines in a public, tertiary care hospital was assessed over a period of 1 y. RESULTS Many medicines present in WHO EMLc were not there in NLEM and DEML. The number of pediatric medicines formulations not available in pediatric doses as compared to WHO EMLc was 98,97 and 97 in NLEM, DEML and IAP respectively. Palliative care was the most neglected area in all the lists. In the public health care facility, only 53% of the tracer pediatric medicines were available. CONCLUSIONS There is less availability of pediatric formulations in the Indian NEML and state DEML. Availability of key tracer pediatric medicine formulations in public health facility is poor. A separate pediatric EML is required in the country to improve focus on availability of child-specific formulations.
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Affiliation(s)
- Vandana Roy
- Department of Pharmacology, Maulana Azad Medical College & Associated Hospitals, New Delhi, India.
| | - Shubha Singhal
- Department of Pharmacology, Maulana Azad Medical College & Associated Hospitals, New Delhi, India
| | - Himanshu Tayal
- Department of Pharmacology, Maulana Azad Medical College & Associated Hospitals, New Delhi, India
| | - A P Dubey
- Department of Pediatrics, Lok Nayak Hospital, New Delhi, India
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15
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Tse Y, Vasey N, Dua D, Oliver S, Emmet V, Pickering A, Lim E. The KidzMed project: teaching children to swallow tablet medication. Arch Dis Child 2020; 105:1105-1107. [PMID: 31594776 DOI: 10.1136/archdischild-2019-317512] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 11/04/2022]
Abstract
Tablets are safer, more convenient and cheaper than liquid medications. Children and young people (CYP) often remain on liquids due to habit, reluctance to change or staff and parents' lack of knowledge about switching to tablets. We describe a quality improvement project to train staff and embed a system of converting eligible children to tablet medication. A series of tests of change were made including training, making kit available, publicity and developing team protocols. In 3 months, 21 out of 25 eligible CYP were successfully converted with added benefit of saving £46 588 per year. Switching children to tablets is simple but requires whole team engagement, culture change of expectations and available resources.
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Affiliation(s)
- Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK .,Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Nicola Vasey
- Department of Paediatric Pharmacy, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Damneek Dua
- Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Susan Oliver
- Department of Paediatric Pharmacy, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Victoria Emmet
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Ailsa Pickering
- Department of Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Emma Lim
- Department of Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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16
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de Torre MP, Vizmanos JL, Cavero RY, Calvo MI. Improvement of antioxidant activity of oregano (Origanum vulgare L.) with an oral pharmaceutical form. Biomed Pharmacother 2020; 129:110424. [PMID: 32563980 DOI: 10.1016/j.biopha.2020.110424] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/26/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023] Open
Abstract
Aging-related diseases can be triggered by multiple factors such as oxidative stress. Oxidative stress is an imbalance between free radicals and antioxidants, so today, compounds capable of reducing or neutralizing free radicals are being studied for a therapeutic use. Origanum vulgare L. is a traditional medicinal plant used for a wide number of health problems due to its antimicrobial, carminative and antioxidant activities. However, when administered orally, gastrointestinal digestion can modify some of therapeutical properties. To avoid this, two different solid oral formulations have been designed for an O. vulgare extract evaluating their antioxidant behaviours in vitro and in vivo after a simulation of gastrointestinal digestion. The results showed that the divided powder has a lower antioxidant activity both in vitro and in vivo than the encapsulated extract. The quantitative difference of polyphenols found on HPLC-DAD (especially luteolin, apigenin and caffeic acid) may explain the differences in pharmacological activity. Thus, we propose that the best form to administrate O. vulgare extracts to maintain the antioxidant properties is the encapsulated form, that is, two capsules of 250 mg of a hydroalcoholic extract of O. vulgare with a minimum of 33 % of rosmarinic acid as a daily dose.
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Affiliation(s)
- María Pilar de Torre
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain.
| | - Jose Luis Vizmanos
- IDISNA-Instituto de Investigación Biosanitaria de Navarra, 31008 Pamplona, Spain; Department of Biochemistry & Genetics, School of Sciences, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain.
| | - Rita Yolanda Cavero
- IDISNA-Instituto de Investigación Biosanitaria de Navarra, 31008 Pamplona, Spain; Department of Environmental Biology, School of Sciences, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain.
| | - María Isabel Calvo
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain; IDISNA-Instituto de Investigación Biosanitaria de Navarra, 31008 Pamplona, Spain.
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17
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Bannigan P, Flynn J, Hudson SP. The impact of endogenous gastrointestinal molecules on the dissolution and precipitation of orally delivered hydrophobic APIs. Expert Opin Drug Deliv 2020; 17:677-688. [DOI: 10.1080/17425247.2020.1743677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pauric Bannigan
- Department of Chemical Sciences, SSPC the SFI Pharmaceutical Centre, Bernal Institute, University of Limerick, Limerick, Ireland
| | - James Flynn
- Department of Chemical Sciences, SSPC the SFI Pharmaceutical Centre, Bernal Institute, University of Limerick, Limerick, Ireland
| | - Sarah P. Hudson
- Department of Chemical Sciences, SSPC the SFI Pharmaceutical Centre, Bernal Institute, University of Limerick, Limerick, Ireland
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18
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Tay JYS, Kok BWT, Liew CV, Heng PWS. Effects of Particle Surface Roughness on In-Die Flow and Tableting Behavior of Lactose. J Pharm Sci 2019; 108:3011-3019. [PMID: 31054886 DOI: 10.1016/j.xphs.2019.04.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
Particle rearrangement takes place during the initial phase of tablet compaction. In this study, rough lactose particles were prepared by roller compaction, and their surface roughness modified by partial surface dissolution using a fluidized bed processor. Flow characteristics of the particles were determined using various flow methods, and their compaction characteristics studied using a compaction simulator with punches of different geometry and compaction pressure. Rougher particles demonstrated poorer compressibility and powder flow due to the higher interparticulate frictional forces required for particle movement. Rearrangement energy during tablet compaction was found to be correlated with compressibility (R2 = 0.92) and increased with surface roughness of the particles. Particle rearrangement was found to be dependent on interparticulate frictional forces, which could be measured using FT4 powder rheometer variable flow rate test and compressibility test. Plastic energy decreased as a result of the increased rearrangement energy requirements. Decrease in tensile strength as a result of decrease in plastic energy was not significantly different. Roller-compacted lactose particles produced tablets of higher tensile strength than crystalline lactose because of prefragmentation of the crystalline structure during roller compaction.
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Affiliation(s)
- Justin Yong Soon Tay
- GEA-NUS Pharmaceutical Processing Research Laboratory, Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
| | - Berlinda Wen Ting Kok
- GEA-NUS Pharmaceutical Processing Research Laboratory, Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
| | - Celine Valeria Liew
- GEA-NUS Pharmaceutical Processing Research Laboratory, Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
| | - Paul Wan Sia Heng
- GEA-NUS Pharmaceutical Processing Research Laboratory, Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore.
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19
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In vitro and sensory tests to design easy-to-swallow multi-particulate formulations. Eur J Pharm Sci 2019; 132:157-162. [DOI: 10.1016/j.ejps.2019.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 12/15/2022]
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20
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Bergene EH, Nordeng H, Rø TB, Steinsbekk A. Register-based study showed that the age when children were prescribed antibiotic tablets and capsules instead of liquids increased from 2004 to 2016. Acta Paediatr 2019; 108:699-706. [PMID: 30136300 DOI: 10.1111/apa.14550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/27/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
AIM We investigated the age when the prescriptions of oral antibiotic formulations for children from birth to 12 years of age changed from being mostly liquid to mostly solid and the associations between solid formulations and child, prescriber and medication characteristics. METHODS This register-based study comprised data from the Norwegian Prescription Database on oral antibiotics dispensed between 2004 and 2016 when both solid and liquid dosage forms were available in appropriate doses. RESULTS Just over 1.2 million prescriptions were studied, and the age when children were prescribed oral solid antibiotics gradually increased. The mean age of conversion from liquids to solid formulations was 6.9 years and ranged from 5.7 years in 2004/2005 to 7.9 years in 2015/2016. Patient factors associated with solid dosage forms were the children's increasing age and male gender. Practitioner factors were the prescribers' increasing age, male gender, being a general practitioner and issuing fewer than 23 paediatric antibiotic prescriptions per year. Medication factors were bad-tasting liquids and the size and shape of solid dosage forms. CONCLUSION The age when children were prescribed antibiotic tablets and capsules increased from 2004 to 2016. The medicine characteristics were quite consistent, so this was probably caused by a shift in formulation preferences.
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Affiliation(s)
- E H Bergene
- Department of Public Health and Nursing; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Central Norway Hospital Pharmacy Trust; Trondheim Norway
| | - H Nordeng
- PharmacoEpidemiology and Drug Safety Research Group; School of Pharmacy; University of Oslo; Oslo Norway
- Department of Child Health and Development; Norwegian Institute of Public Health; Oslo Norway
| | - T B Rø
- Department of Clinical and Molecular Medicine; NTNU; Trondheim Norway
- Department of Pediatrics; St Olav's Hospital; Trondheim Norway
| | - A Steinsbekk
- Department of Public Health and Nursing; Norwegian University of Science and Technology (NTNU); Trondheim Norway
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21
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Hori KS, Siu AM, Yamamoto LG. Replacing Liquid Antibiotics With Cheaper Pill Equivalents: An Opportunity for Substantial Savings. Clin Pediatr (Phila) 2018; 57:1294-1299. [PMID: 29732920 DOI: 10.1177/0009922818774340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Liquid antibiotics are often substantially more expensive than their pill counterparts, representing an opportunity for substantial cost reductions. Children can be taught to swallow pills at about age 6 years. The objective of this study was to calculate the potential cost saved by replacing liquid antibiotics with cheaper pill equivalents for pediatric patients for the antibiotic prescriptions written by a health care system. A retrospective smart cost analysis was performed of pediatric patients within a health care system, age 6 to less than 18 years of age receiving a liquid antibiotic prescription. The estimated cost savings over the span of 2 years for 15 161 prescriptions was $1 million. In order to achieve these substantial savings, pediatricians could encourage parents to teach their children to swallow pills at a young age and prescribe cheaper pill equivalents over liquid medications at an earlier age.
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Affiliation(s)
- Kristen S Hori
- 1 Kapi'olani Medical Center for Women & Children, Hawai'i Pacific Health, Honolulu, HI, USA
| | - Andrea M Siu
- 1 Kapi'olani Medical Center for Women & Children, Hawai'i Pacific Health, Honolulu, HI, USA
| | - Loren G Yamamoto
- 1 Kapi'olani Medical Center for Women & Children, Hawai'i Pacific Health, Honolulu, HI, USA.,2 University of Hawai'i, Honolulu, HI, USA
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22
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Saito J, Akabane M, Komura M, Nakamura H, Ishikawa Y. Age-Appropriate Pediatric Dosage Forms in Japan: Insights into End-User Perceptions From an Observational Cross-Sectional Survey Assessing the Acceptability of Oral Formulation. Ther Innov Regul Sci 2018; 53:455-471. [PMID: 30157669 DOI: 10.1177/2168479018791133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The lack of appropriate pediatric formulations is a global issue and information on acceptability is urgently needed to develop standard pediatric formulations. This study aimed to assess perceptions of acceptability of several oral dosage forms among pediatric patients at a community and a pediatric hospital in Japan and collected information about age-appropriate pediatric formulations, aiming to contribute to drug development promotion worldwide. METHODS A cross-sectional observational study was performed. A convenience sample of caregivers was recruited from available chain-owned retail pharmacies and inpatient pediatric units. The questionnaire was composed of 3 parts: (1) acceptability of the 5 dosage forms (tablets, capsules, powders, liquids, and orally disintegrating tablet) by age; (2) acceptability of dosage size, amount, and volume by age; and (3) the actual method of administration. Face-to-face interviews were conducted at 3 independent community pharmacies (324 parents) and tertiary care pediatric hospital wards (112 nursing staff). Acceptability scores and acceptable dosages were then determined. The survey was conducted from October 1 to December 1, 2017, for the hospital setting and November 1 to 30, 2017, for the outpatient setting. RESULTS The acceptability of oral dosage forms was roughly similar to the matrix drafted by the European Medical Agency. Differences in perception of the powder forms between communities and hospitals were also observed, with the nursing staff perceiving powder as being acceptable from the neonatal period. CONCLUSIONS The difference in caregivers' perception of the acceptability of oral formulations between Japan and Europe was small. The powder form was found to be more acceptable in Japan. Further intervention studies are needed to assess the preferred pediatric formulation worldwide.
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Affiliation(s)
- Jumpei Saito
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.,2 Department of Clinical Research, Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Miki Akabane
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.,2 Department of Clinical Research, Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Makoto Komura
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Hidefumi Nakamura
- 3 Department of Development Strategy, Division for Clinical Trials, Center for Social and Clinical Research, National Research Institute for Child Health and Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Yoichi Ishikawa
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.,2 Department of Clinical Research, Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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23
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Facteurs influençant l’acceptabilité des formulations galéniques en pédiatrie – revue de la littérature. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:163-171. [DOI: 10.1016/j.pharma.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/04/2018] [Indexed: 11/15/2022]
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24
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Alyami H, Koner J, Huynh C, Terry D, Mohammed AR. Current opinions and recommendations of paediatric healthcare professionals - The importance of tablets: Emerging orally disintegrating versus traditional tablets. PLoS One 2018; 13:e0193292. [PMID: 29489871 PMCID: PMC5830997 DOI: 10.1371/journal.pone.0193292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/30/2018] [Indexed: 12/02/2022] Open
Abstract
The appropriate prescribing of paediatric dosage forms is paramount in providing the desired therapeutic effect alongside successful medication adherence with the paediatric population. Often it is the opinion of the healthcare practitioner that dictates which type of dosage form would be most appropriate for the paediatric patient, with liquids being both the most commonly available and most commonly used. Orally disintegrating tablets (ODTs) are an emerging dosage form which provide many benefits over traditional dosage forms for paediatric patients, such as rapid disintegration within the oral cavity, and the reduction in the risk of choking. However the opinion and professional use of healthcare practitioners regarding ODT's is not known. This study was designed to assess the opinions of several types of healthcare professionals (n = 41) regarding ODTs, using a survey across two hospital sites. Results reaffirmed the popularity of liquids for prescribing in paediatrics, with 58.0% of participants preferring this dosage form. ODTs emerged as the second most popular dosage form (30.0%), with healthcare practitioners indicating an increasing popularity amongst patients in the hospital setting, belief with 63.0% of practitioners agreeing that many liquid formulations could be substituted with a suitable ODT. The desired properties of an ideal ODT were also identified by healthcare practitioners preferring a small, fast disintegrating tablet (90.2% and 95.1% respectively), with the taste, disintegration time and flavour being the three most important attributes identified (29.5%, 28.7% and 21.7% respectively). This study provided a pragmatic approach in assessing healthcare professional's opinions on ODTs, highlighting the ideas and thoughts of practitioners who are on the frontline of paediatric prescribing and treatment and gave an indication to their preference for ODT properties.
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Affiliation(s)
- Hamad Alyami
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - Jasdip Koner
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - Chi Huynh
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - David Terry
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
- Academic Practice Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
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Lajoinie A, Janiaud P, Henin E, Gleize JC, Berlion C, Nguyen KA, Nony P, Gueyffier F, Maucort-Boulch D, Kassaï Koupaï B. Assessing the effects of solid versus liquid dosage forms of oral medications on adherence and acceptability in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Audrey Lajoinie
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
| | - Perrine Janiaud
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research; University Hospital Basel, University of Basel; Basel Switzerland
| | - Emilie Henin
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Jean-Cédric Gleize
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Clémentine Berlion
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Kim An Nguyen
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
| | | | - Francois Gueyffier
- UMR5558, CNRS et Université Claude Bernard - Service de Pharmacologie & Toxicologie; Hopital Cardio-Vasculaire et Pneumologique Louis Pradel; Lyon France
| | - Delphine Maucort-Boulch
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Behrouz Kassaï Koupaï
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
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Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children's Acceptability of Oral Formulations (CALF) Study. Int J Pharm 2017; 514:296-307. [PMID: 27863675 DOI: 10.1016/j.ijpharm.2016.07.054] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/20/2016] [Accepted: 07/23/2016] [Indexed: 11/23/2022]
Abstract
A lack of evidence to guide the design of age-appropriate and acceptable dosage forms has been a longstanding knowledge gap in paediatric formulation development. The Children's Acceptability of Oral Formulations (CALF) study captured end-user perceptions and practices with a focus on solid oral dosage forms, namely tablets, capsules, chewables, orodispersibles, multiparticulates (administered with food) and mini-tablets (administered directly into the mouth). A rigorous development and testing phase produced age-adapted questionnaires as measurement tools with strong evidence of validity and reliability. Overall, 590 school children and adolescents, and 428 adult caregivers were surveyed across hospitals and various community settings. Attitudes towards dosage forms primarily differed based on age and prior use. Positive attitudes to tablets and capsules increased with age until around 14 years. Preference was seen for chewable and orodispersible preparations across ages, while multiparticulates were seemingly less favourable. Overall, 59.6% of school children reported willingness to take 10mm diameter tablets, although only 32.1% of caregivers perceived this size to be suitable. While not to be taken as prescriptive guidance, the results of this study provide some evidence towards rational dosage form design, as well as methodological approaches to help design tools for further evaluation of acceptability within paediatric studies.
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Van Riet-Nales DA, Kozarewicz P, Aylward B, de Vries R, Egberts TCG, Rademaker CMA, Schobben AFAM. Paediatric Drug Development and Formulation Design-a European Perspective. AAPS PharmSciTech 2017; 18:241-249. [PMID: 27270905 DOI: 10.1208/s12249-016-0558-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/19/2016] [Indexed: 12/17/2022] Open
Abstract
The availability of licensed paediatric drugs is lagging behind those for adults, and there is a lack of safe formulations in suitable doses that children are able and willing to take. As a consequence, children are commonly treated with off-label or unlicensed drugs. As off-label and unlicensed drug use are associated with a greater risk for harm than on-label drug use, a range of global initiatives have been developed to realize "better" medicines for children. This review describes the challenges and achievements of the European Union to realize this goal, with a focus on paediatric drug development and formulation design. In 2007, a European Paediatric Regulation was installed enforcing companies to consider children in the early development of drugs with a new drug substance, for a new indication or with a new route of administration. The Regulation, e.g. requires companies to develop a paediatric investigation plan discussing the proposed clinical trials in children of different ages and the formulations for future marketing. Since 2013, the pharmaceutical design of any newly marketed paediatric drug should comply with the "Guideline on the Pharmaceutical Development of Medicines for Paediatric Use." Companies should, e.g. justify the route of administration, dosage form, formulation characteristics, safety of excipients, dosing frequency, container closure system, administration device, patient acceptability and user information. In this review, the guideline's key aspects are discussed with a focus on novel formulations such as mini-tablets and orodispersible films, excipients with a potential risk for harm such as azo dyes and adequate user instructions.
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Jagani M, Legay H, Ranmal SR, Bertrand J, Ooi K, Tuleu C. Can a Flavored Spray (Pill Glide) Help Children Swallow Their Medicines? A Pilot Study. Pediatrics 2016; 138:peds.2016-0680. [PMID: 27940673 DOI: 10.1542/peds.2016-0680] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/24/2022] Open
Abstract
Pediatric pharmacists are constantly faced with the challenges of supporting children and caregivers for whom the difficulties of swallowing medicines can be a daily struggle. Most medicines are only available as tablets and capsules, and where liquid alternatives exist, these products often have issues with palatability and high costs. The objective of this study was to evaluate whether the swallowing spray, Pill Glide, could help children in taking their solid and liquid medicines. This open label pilot study compared the spray with a behavioral approach alone, the current standard of care at the pediatric hospital. Patients were children on long-term drug therapies, either transitioning from liquid preparations to tablets and capsules, or known to be experiencing swallowing difficulties. Using age-adapted diaries, patients self-reported the difficulty of taking medicines on a 6-point hedonic scale for 2 weeks before the intervention, and then for 1 week while using Pill Glide. Data were analyzed from 10 children aged 6 to 16 years, with an average burden of 3.5 tablets per day. Pill Glide (strawberry was the most popular flavor) was shown to significantly decrease the overall medicine taking difficulty score by 0.93 (range, 0.33-1.53), almost 1 hedonic face point on the scale used (P = .002). There was insufficient data for liquid medicines. Pill Glide could help children with pill swallowing, thus improving patient acceptability of medicines and potentially adherence. It could also be implemented as a useful cost-saving intervention because solid dosage forms are cheaper.
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Affiliation(s)
- Mamta Jagani
- Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Hélène Legay
- Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom.,School of Pharmacy, and.,Camden and Islington National Health Service Foundation Trust, London, United Kingdom; and
| | | | - Julie Bertrand
- UCL Genetics Institute, University College London, London, United Kingdom.,Unité Mixte de Recherche 1137, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot, Paris, France
| | - Kuan Ooi
- Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
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Zhu N, Li JC, Zhu JX, Wang X, Zhang J. Characterization and Bioavailability of Wogonin by Different Administration Routes in Beagles. Med Sci Monit 2016; 22:3737-3745. [PMID: 27744456 PMCID: PMC5070617 DOI: 10.12659/msm.897621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background With the gradually accumulating research on pharmacological activity of wogonin, the in vitro analysis research on wogonin has become more and more popular, but there are very few reports about in vivo detection, and there are no solid dispersions (SDs) of Wogonin. The aim of this study was to explore the formation of solid dispersions (SDs) of wogonin. The reasons for the low bioavailability were studied through different routes of administration. Material/Methods SDs was formulated using the solvent evaporation method via polyvinylpyrrolidone K30 (PVP). The characterization of the drug and its carrier was detected by X-ray diffraction (XRD) and differential scanning calorimetry (DSC). The serum concentrations of Wogonin were detected using the LC-MS/MS method. Six beagles were fed 3 different formulations of wogonin in 3 cycles. Results The SDs of wogonin had a higher solubility than the physical mixtures. Based on XRD and DSC, wogonin was transformed from a crystalline morphology to an amorphous structure. The main pharmacokinetic parameters of i.g. administration (crude material and SD) and i.v. route were as follows: Cmax (2.5±1.1), (7.9±3.3), and (6838.7±1322.1) μg/L, tmax (0.7±0.3) and (0.3±0.2) h for the former, AUC0-t (7.1±2.0), (21.0±3.2) and (629.7±111.8) μg·h/L. The absolute bioavailability of native wogonin and wogonin arginine solution were (0.59±0.35)% and (3.65±2.60)%. Further research showed that the low bioavailability of wogonin might be associated with low solubility and rapid combination with glucuronic acid in vivo. Conclusions The significantly increased solubility of SDs and the further preparation of arginine solution could significantly increase the bioavailability of wogonin.
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Affiliation(s)
- Na Zhu
- Faculty of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Jian-Chun Li
- Faculty of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Jin-Xiu Zhu
- Department of Pharmacy, The 1st Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Xiu Wang
- Faculty of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Jin Zhang
- Faculty of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China (mainland)
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Oral dosage form administration practice in children under 6 years of age: A survey study of paediatric nurses. Int J Pharm 2016; 511:855-63. [PMID: 27492017 DOI: 10.1016/j.ijpharm.2016.07.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to interview paediatric nurses on administration issues using extemporaneous capsules and marketed capsules and tablets in children younger than 6 years old, based on most frequently administered drugs in six participating wards. The 59 responding nurses estimated respectively at 7.7±1.7 and 7.3±1.8years the age from which children would properly swallow extemporaneous capsules and marketed solids, with 33% and 37% of nurses considering that children under 6 would not get their prescribed treatment using these dosage forms. Refusal of the child to take the solid was the first reason to explain administration failure (85% of nurses for extemporaneous capsules, 89% for marketed solids). Although type of formulation and requirement of chewing were factors influencing the age at which children would take solid from nurses' experience, size of conventional tablets was not among these factors. All respondents use to crush tablets in children unable to swallow whole solids; 37% of nurses systematically split the tablets to ease the swallowing in children able to swallow. Only 11 nurses had an information tool at their disposal to guide manipulation of solids, with 7 of them using it in their daily practice. Providing specific-ward questionnaires, this study gives factual information on administration practices, perceptions and issues faced by paediatric nurses.
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Lajoinie A, Henin E, Nguyen KA, Malik S, Mimouni Y, Sapori JM, Bréant V, Cochat P, Kassai B. Oral drug dosage forms administered to hospitalized children: Analysis of 117,665 oral administrations in a French paediatric hospital over a 1-year period. Int J Pharm 2016; 500:336-44. [PMID: 26804927 DOI: 10.1016/j.ijpharm.2016.01.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 11/16/2022]
Abstract
Selecting the most appropriate dosage form, that ensures safe administration and adherence of medications, is a major issue for children. Marketed drugs, however, have rarely been tested for their use in children. There is a need for more data on drug formulations administered to children to identify unmet needs, and drive future paediatric research. We observed, over a 12-month follow-up, 117,665 oral drug administrations to 1998 hospitalized children. Nine-tenths belonged to five Anatomical Therapeutic Chemical classes: Alimentary tract & metabolism, Nervous system, Cardiovascular system, Anti-infectives for systemic use and Blood & blood forming organs, one third of drug doses administered to school-age children and adolescents were liquids, and extemporaneous capsules were commonly used in younger children. Our study shows that despite the advantages of solid dosage forms and recent evidence from randomized controlled trials showing their acceptability in infants, they are seldom used in paediatric practice.
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Affiliation(s)
- A Lajoinie
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon, France; UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, University of Lyon 1, France.
| | - E Henin
- UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, University of Lyon 1, France
| | - K A Nguyen
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon, France
| | - S Malik
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon, France
| | - Y Mimouni
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon, France
| | - J M Sapori
- Toxicovigilance and Poison Control Center, Hospices Civils de Lyon, France
| | - V Bréant
- Department of Pharmacy, Hospices Civils de Lyon, France
| | - P Cochat
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon, France; Department of Pediatric Nephrology, Hopital Femme Mere Enfant, Hospices Civils de Lyon, France
| | - B Kassai
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon, France; UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, University of Lyon 1, France
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Lajoinie A, Henin E, Kassai B. Choisir la forme pharmaceutique orale la plus adaptée à l’enfant. Arch Pediatr 2015; 22:877-85. [DOI: 10.1016/j.arcped.2015.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/23/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
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Baldauf KJ, Royal JM, Hamorsky KT, Matoba N. Cholera toxin B: one subunit with many pharmaceutical applications. Toxins (Basel) 2015; 7:974-96. [PMID: 25802972 PMCID: PMC4379537 DOI: 10.3390/toxins7030974] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/16/2015] [Indexed: 12/22/2022] Open
Abstract
Cholera, a waterborne acute diarrheal disease caused by Vibrio cholerae, remains prevalent in underdeveloped countries and is a serious health threat to those living in unsanitary conditions. The major virulence factor is cholera toxin (CT), which consists of two subunits: the A subunit (CTA) and the B subunit (CTB). CTB is a 55 kD homopentameric, non-toxic protein binding to the GM1 ganglioside on mammalian cells with high affinity. Currently, recombinantly produced CTB is used as a component of an internationally licensed oral cholera vaccine, as the protein induces potent humoral immunity that can neutralize CT in the gut. Additionally, recent studies have revealed that CTB administration leads to the induction of anti-inflammatory mechanisms in vivo. This review will cover the potential of CTB as an immunomodulatory and anti-inflammatory agent. We will also summarize various recombinant expression systems available for recombinant CTB bioproduction.
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Affiliation(s)
- Keegan J Baldauf
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
| | - Joshua M Royal
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
| | - Krystal Teasley Hamorsky
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA.
| | - Nobuyuki Matoba
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
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Hsu CC, Chou CY, Chou CL, Ho CC, Chen TJ, Chiang SC, Wu MS, Wang SW, Lee CY, Chou YC. Impact of a warning CPOE system on the inappropriate pill splitting of prescribed medications in outpatients. PLoS One 2014; 9:e114359. [PMID: 25479360 PMCID: PMC4257670 DOI: 10.1371/journal.pone.0114359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 11/06/2014] [Indexed: 11/20/2022] Open
Abstract
Background Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE) system for special oral formulation drugs in outpatient settings. We examined the impact of the warning system on inappropriate prescribing of pill splitting and assess prescribers' responses to the warnings. Methods Drugs with extended-release or enteric-coated formulations that were not originally intended to be split were recognized as “special oral formulations”. A hard-stop system which could examine non-integer doses of drugs with special oral formulations, provide warnings to interrupt inappropriate prescriptions was integrated in CPOE in a medical center since June 2010. We designed an intervention study to compare the inappropriate splitting before and after the implementation of the warning system (baseline period 2010 January to May vs. intervention period 2010 June to 2011 August). During the intervention period, prescription changes in response to a warning were logged and analyzed. Results A total of 470,611 prescribed drug items with 34 different drugs with special oral formulations were prescribed in the study period. During the 15-month intervention period, 909 warnings for 26 different drugs were triggered among 354,523 prescribed drug items with special oral formulations. The warning rate of inappropriate splitting in the late intervention period was lower than those in baseline period (0.16% vs. 0.61%, incidence rate ratio 0.27, 95% CI 0.23–0.31, P<0.001). In respond to warnings, physicians had to make adjustments, of which the majority was changing to an unsplit pill (72.9%). Conclusions The interruptive warning system could avoid the prescriptions with inappropriate pill splitting. Accordingly, physicians changed their behavior of prescribing special oral formulations regarding inappropriate pill splitting. We suggest the establishment of such system to target special oral formulations with warnings to prevent inappropriate pill splitting.
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Affiliation(s)
- Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Yu Chou
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Chia-Lin Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chin Ho
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chiung Chiang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Min-Shan Wu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sen-Wen Wang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Yuan Lee
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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