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Mota S, Torres A, Quintas C, Peres AM, Ferreiro N, Cruz R, Ferreira H, Almeida IF, Casal S. Characterization of Liquid Dosage Forms of Atenolol and Enalapril Maleate for Oral and Enteral Feeding Administration. Pharmaceuticals (Basel) 2024; 17:1052. [PMID: 39204157 PMCID: PMC11359931 DOI: 10.3390/ph17081052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/26/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
The limited availability of pharmaceutical formulations tailored for cardiovascular diseases in both pediatric and geriatric populations generates the need for compounded dosage forms to guarantee precise dosing and medication adherence. This study aimed to analyze the physicochemical properties and stability of formulations of atenolol and enalapril maleate prepared with a proprietary oral vehicle, SuspendIt®. To this end, palatability, injectability, pH, rheological behavior, and physical, microbiological, and chemical stability over a 180-day storage period at 25 °C and 5 °C were evaluated. Injectability tests confirmed the suitable use of both formulations for administration through enteral feeding tubes. By using a potentiometric electronic tongue, it was confirmed that the SuspendIt® vehicle effectively served as a bitter-blocking strategy for atenolol and enalapril maleate. Adequate stability throughout the storage period was confirmed in terms of the mechanical properties, pH, and effectiveness of the preservative system. The atenolol concentration remained above 90% of the initial amount, while the concentration of enalapril maleate decreased to 88% after 90 days of storage at 25 °C. In summary, the atenolol formulation maintained suitable chemical, physical, and microbiological stability after 180 days at both storage temperatures, while the enalapril maleate formulation remained stable up to 60 days at 25 °C and for 180 days at 5 °C.
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Affiliation(s)
- Sandra Mota
- Associate Laboratory i4HB, Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (S.M.); (A.T.); (C.Q.)
- UCIBIO—Applied Molecular Biosciences Unit, Laboratory of Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Ana Torres
- Associate Laboratory i4HB, Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (S.M.); (A.T.); (C.Q.)
- UCIBIO—Applied Molecular Biosciences Unit, Laboratory of Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Clara Quintas
- Associate Laboratory i4HB, Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (S.M.); (A.T.); (C.Q.)
- UCIBIO—Applied Molecular Biosciences Unit, Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - António M. Peres
- CIMO, LA SusTEC, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; (A.M.P.); (N.F.)
| | - Nuno Ferreiro
- CIMO, LA SusTEC, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal; (A.M.P.); (N.F.)
| | - Rebeca Cruz
- Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), Laboratory of Bromatology and Hydrology, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (R.C.); (S.C.)
| | - Helena Ferreira
- Associate Laboratory i4HB, Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (S.M.); (A.T.); (C.Q.)
- UCIBIO–Applied Molecular Biosciences, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Isabel F. Almeida
- Associate Laboratory i4HB, Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (S.M.); (A.T.); (C.Q.)
- UCIBIO—Applied Molecular Biosciences Unit, Laboratory of Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Susana Casal
- Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), Laboratory of Bromatology and Hydrology, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; (R.C.); (S.C.)
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Wang J, Sun H, Yang H, Yang R, Zhu X, Guo S, Huang Y, Xu Y, Li C, Tu J, Sun C. Dessecting the toxicological profile of polysorbate 80 (PS80): comparative analysis of constituent variability and biological impact using a zebrafish model. Eur J Pharm Sci 2024; 198:106796. [PMID: 38735400 DOI: 10.1016/j.ejps.2024.106796] [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: 01/11/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
Polysorbate 80, commonly abbreviated as PS80, is a widely used pharmaceutical excipient renowned for its role as a solubilizer and stabilizer in drug formulations. Although PS80 is essential for various pharmaceutical applications, particularly in the formulation of injectable drugs, it has been implicated in a range of adverse reactions. However, due to the complexity of the composition of PS80, the differences in the types and contents of the constituents of PS80 from different manufacturers increase the probability or likelihood of their uneven quality. Addressing the complete spectrum of PS80's components is challenging; thus, most studies to date have examined PS80 as a singular entity. This approach, however, carries a degree of uncertainty, as it overlooks the unique composition and concentration of components within the PS80 used in experiments, which may not reflect the actual diversity in commercially available PS80 products. Recognizing the critical need to understand how PS80's composition influences biological effects and toxicity, our study aims to bridge this knowledge gap. By doing so, we can clarify how different PS80 compositions from various manufacturers might affect the quality of pharmaceutical formulations, and also guide excipient manufacturers toward producing higher-quality PS80. Such insights could further facilitate a more targeted application of PS80 in drug development. Building on our previous work, we isolated and prepared two key components of PS80-polyoxyethylene sorbitan monooleate (PSM) and polyoxyethylene isosorbide monooleate (PIM)-and conducted a systematic comparison. We evaluated the acute, hemolytic, and target organ toxicity of two different PS80 samples, as well as PSM and PIM, using a zebrafish model. Our research also delved into the potential mechanisms behind the observed toxicological effects, providing an in-depth understanding of PS80's impact on biological systems.The results show that PS80, PSM, and PIM resulted in developmental anomalies in larval zebrafish. The primary organs of acute toxicity in zebrafish exposed to PS80 and its typical components PSM and PIM include the cardiovascular system, kidneys, intestines, skin, and liver. Notably, PIM further induced severe pericardial edema and erythrocyte hemolysis, thereby affecting blood flow. The samples also instigated oxidative damage by disrupting the redox equilibrium in the larvae. Compared to PS80, both PSM and PIM induced greater oxidative damage, with PIM notably causing significantly higher lipid oxidation, suggesting that oxidative stress may play a crucial role in polysorbate80-induced toxicity. Furthermore, our study found that PS80 could induce alterations in DNA conformation. The findings underscore the necessity for excipient regulators to establish comprehensive quality standards for Polysorbate 80 (PS80). By implementing such standards, it is possible to minimize the clinical risks associated with the variability in PS80 composition, ensuring safer pharmaceutical products for patients.
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Affiliation(s)
- Jue Wang
- State Key Laboratory of Natural Medicines, NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China; NMPA Key Laboratory for Quality Control of Pharmaceutical Excipients, National Institutes for Food and Drug Control, 2 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Huimin Sun
- NMPA Key Laboratory for Quality Control of Pharmaceutical Excipients, National Institutes for Food and Drug Control, 2 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Huiying Yang
- NMPA Key Laboratory for Quality Control of Pharmaceutical Excipients, National Institutes for Food and Drug Control, 2 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Rui Yang
- NMPA Key Laboratory for Quality Control of Pharmaceutical Excipients, National Institutes for Food and Drug Control, 2 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Xiaoyu Zhu
- Hunter Biotechnology Inc, F1A, building 5, No. 88 Jiangling Road, Binjiang Zone, Hangzhou City, Zhejiang Province 310051, China
| | - Shengya Guo
- Hunter Biotechnology Inc, F1A, building 5, No. 88 Jiangling Road, Binjiang Zone, Hangzhou City, Zhejiang Province 310051, China
| | - Yanfeng Huang
- Hunter Biotechnology Inc, F1A, building 5, No. 88 Jiangling Road, Binjiang Zone, Hangzhou City, Zhejiang Province 310051, China
| | - Yiqiao Xu
- Hunter Biotechnology Inc, F1A, building 5, No. 88 Jiangling Road, Binjiang Zone, Hangzhou City, Zhejiang Province 310051, China
| | - Chunqi Li
- Hunter Biotechnology Inc, F1A, building 5, No. 88 Jiangling Road, Binjiang Zone, Hangzhou City, Zhejiang Province 310051, China
| | - Jiasheng Tu
- State Key Laboratory of Natural Medicines, NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China.
| | - Chunmeng Sun
- State Key Laboratory of Natural Medicines, NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients, and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China.
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Wong SW, Chew SP, Abdul Aziz SA, Mohamed Shah N. Exposure to potentially harmful excipients in medications among neonates at a state hospital in Malaysia. Drug Dev Ind Pharm 2024:1-9. [PMID: 38459761 DOI: 10.1080/03639045.2024.2327462] [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: 04/12/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES This study aimed to determine the incidence, types and predictors of Potentially Harmful Excipients (PHE) exposure among hospitalized neonates. METHODS A prospective observational study was conducted from March to April 2022 in neonatal wards at a state hospital in Malaysia. The PHEs of interest were aspartame, benzalkonium chloride, benzyl alcohol, benzoic acid or benzoates, ethanol, parabens, polysorbate 80, propylene glycol, saccharin sodium, sorbitol and sulfites. Product information leaflets (PILs) and summaries of product characteristics (SPCs) were referred to obtain information on active pharmaceutical ingredient, strength, trade name as well as type and amount of the excipients. RESULTS A total of 108 neonates were recruited and 97.2% of them were exposed to at least one PHE. Parabens (47.2%) and sulfites (27.5%) were the two most commonly administered PHEs. Benzyl alcohol is contraindicated in neonates but was administered to 8% of neonates in this study. The median daily dose of ethanol (24.11 mg/kg/day, IQR 19.73, 28.49) exceeded the acceptable daily intake (ADI) by four times. However, the dose was not available for all PHEs as this information is not always available in the PIL or SPC. Administration of cardiovascular drugs was associated with a higher risk of exposure to any PHE (OR 6.38, CI 2.75, 14.79, p-value < 0.001). CONCLUSION The exposure of PHE among neonates in this study is high with certain PHEs exceeding the ADI. It highlights the need for certain strategies to be implemented to reduce such exposure in neonates.
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Affiliation(s)
- Shien Woan Wong
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Pharmacy Department, Hospital Melaka, Melaka, Kementerian Kesihatan Malaysia, Malaysia
| | - Soo Piing Chew
- Pharmacy Department, Hospital Melaka, Melaka, Kementerian Kesihatan Malaysia, Malaysia
| | - Siti Azdiah Abdul Aziz
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Saito J, Nakamura H, Akabane M, Yamatani A. Quantitative Investigation on Exposure to Potentially Harmful Excipients by Injection Drug Administration in Children Under 2 Years of Age and Analysis of Association with Adverse Events: A Single-Center, Retrospective Observational Study. Ther Innov Regul Sci 2024; 58:316-335. [PMID: 38055156 DOI: 10.1007/s43441-023-00596-0] [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: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Potentially harmful excipients (PHEs) for children have been reported and the need for information collection has been advocated. However, studies on the actual occurrence of adverse events are limited. This study investigated the quantitative exposure of PHEs via injection and their association with adverse events in children under 2 years of age. MATERIALS AND METHODS As a single-center observational study, children aged 0-23 months received injectable drugs from April 1, 2018, to March 31, 2023 were included. Information on PHE exposure and adverse events after administration were extracted from medical records. Sodium benzoate, benzyl alcohol, ethanol, glycerol, lactose, polyethylene glycol paraben, polysorbate, propylene glycol, sorbitol, sucrose, sulfite, and thimerosal were selected as PHEs. RESULTS AND DISCUSSION 6265 cases, 333,694 prescriptions, and 368 drugs (264 ingredients) were analyzed. The median age was 0.63 years (interquartile range [IQR] 0.1-1.1). 72,133 prescriptions, 132 drugs and 99 ingredients contained PHE; 2,961 cases exposed to PHE and 1825 cases exceeding permitted daily exposure. The drug with the highest number of exposure cases was hydroxyzine, and the highest number of prescriptions was heparin (both drugs contain benzyl alcohol). In association between adverse events and PHE exposure, higher doses in cases of adverse event occurrence were found in benzyl alcohol, glycerol, polyethylene glycol, and polysorbate exposed cases. Among thimerosal-exposed cases, "developmental delay" was more frequent in exposed cases, but the causal relationship was unknown. Further investigation is needed to clarify the relationship between adverse events and PHE exposure. Additionally, more precise information on PDE for pediatrics including neonates is necessary.
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Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, 2-10-1, Okura, Setagayaku, Tokyo, 157-8535, Japan.
| | - Hidefumi Nakamura
- Department of Research and Development Supervision, National Center for Child Health and Development, 2-10-1, Okura, Setagayaku, Tokyo, 157-8535, Japan
| | - Miki Akabane
- Department of Pharmacy, National Center for Child Health and Development, 2-10-1, Okura, Setagayaku, Tokyo, 157-8535, Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, 2-10-1, Okura, Setagayaku, Tokyo, 157-8535, Japan
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Yeung CHT, Verstegen RHJ, Greenberg R, Lewis TR. Pharmacokinetic and pharmacodynamic principles: unique considerations for optimal design of neonatal clinical trials. Front Pediatr 2024; 11:1345969. [PMID: 38283405 PMCID: PMC10811156 DOI: 10.3389/fped.2023.1345969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Core clinical pharmacology principles must be considered when designing and executing neonatal clinical trials. In this review, the authors discuss important aspects of drug dose selection, pharmacokinetics, pharmacogenetics and pharmacodynamics that stakeholders may consider when undertaking a neonatal or infant clinical trial.
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Affiliation(s)
- Cindy Hoi Ting Yeung
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ruud H. J. Verstegen
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rachel Greenberg
- Duke Clinical Research Institute, Durham, NC, United States
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Tamorah Rae Lewis
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Petkova V, Georgieva D, Dimitrov M, Nikolova I. Off-Label Prescribing in Pediatric Population-Literature Review for 2012-2022. Pharmaceutics 2023; 15:2652. [PMID: 38139994 PMCID: PMC10747118 DOI: 10.3390/pharmaceutics15122652] [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: 10/05/2023] [Revised: 11/05/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
Off-label prescribing is widespread among pediatricians, and it is unlikely that this trend will soon be bound by a uniform legal framework. This is necessitated by the fact that there are four variables: the patient's health condition, the physician's experience and knowledge, the legislative measures (laws, directives, guidelines, and recommendations), and finally, the pharmaceutical industry. There is considerable concern worldwide about the use of off-label medicines in children. We may call it an enormous global problem that is much talked about and written about; however, we should not forget that the goal around which everyone should unite is the patient's life. For healthcare providers, the most important thing will always be the health and preservation of the patient's life, particularly when it comes to children with life-threatening conditions in neonatal and pediatric intensive care units (NICU and PICU). The study aimed to examine the prevalence of off-label drug use in pediatrics. Literature research was conducted, and we included studies from 2012 to 2022 that evaluated off-label drug prevalence in various pediatric patient populations.
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Affiliation(s)
- Valentina Petkova
- Department of Social Pharmacy, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria
| | - Dilyana Georgieva
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (D.G.); (M.D.)
| | - Milen Dimitrov
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (D.G.); (M.D.)
| | - Irina Nikolova
- Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria;
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Iacobelli S, Commins M, Lorrain S, Gouyon B, Ramful D, Richard M, Grondin A, Gouyon JB, Bonsante F. Paraben exposure through drugs in the neonatal intensive care unit: a regional cohort study. Front Pharmacol 2023; 14:1200521. [PMID: 37361223 PMCID: PMC10285404 DOI: 10.3389/fphar.2023.1200521] [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: 04/05/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objectives: Environmental factors influence the development of very preterm infants (VPIs, born at less than 32 weeks of gestation). It is important to identify all potential sources of paraben exposure in these vulnerable infants. We aimed to quantify paraben exposure via drug administration in a cohort of VPI cared for in neonatal intensive care units (NICUs). Methods: A prospective, observational study was carried out over a five-year period in a regional setting (two NICUs using the same computerized order-entry system). The main outcome was exposure to paraben-containing drugs. The secondary outcomes were: time of the first exposure, daily intake, number of infants exceeding paraben acceptable daily intake (ADI: 0-10 mg/kg/d), duration of exposure, and cumulative dose. Results: The cohort consisted of 1,315 VPIs [BW 1129.9 (±360.4) g]. Among them, 85.5% were exposed to paraben-containing drugs. In 40.4% of infants, the first exposure occurred during the second week of life. Mean paraben intake and duration of exposure were, respectively, 2.2 (±1.4) mg/kg/d and 33.1 (±22.3) days. The cumulative paraben intake was 80.3 (±84.6) mg/kg. The ADI was exceeded in 3.5% of exposed infants. Lower GA was associated with higher intake and longer exposure (p < 0.0001). The main molecules involved in paraben exposure were: sodium iron feredetate, paracetamol, furosemide, and sodium bicarbonate + sodium alginate. Conclusion: Commonly used drugs are potential source of parabens, and ADI can be easily exceeded in VPIs cared for in NICUs. Efforts are needed to identify paraben-free alternative formulations for these vulnerable infants.
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Affiliation(s)
- Silvia Iacobelli
- Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion, Site Sud, Saint Pierre, France
- Centre d’Études Périnatales de l’Océan Indien, Université de la Réunion, Saint-Pierre, France
| | - Marie Commins
- Centre d’Études Périnatales de l’Océan Indien, Université de la Réunion, Saint-Pierre, France
| | - Simon Lorrain
- Centre d’Études Périnatales de l’Océan Indien, Université de la Réunion, Saint-Pierre, France
| | - Beatrice Gouyon
- Centre d’Études Périnatales de l’Océan Indien, Université de la Réunion, Saint-Pierre, France
| | - Duksha Ramful
- Service de Réanimation Néonatale, CHU La Réunion, Saint-Denis, France
| | - Magali Richard
- Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion, Site Sud, Saint Pierre, France
| | - Anthony Grondin
- Service de Réanimation Néonatale, CHU La Réunion, Saint-Denis, France
| | - Jean-Bernard Gouyon
- Centre d’Études Périnatales de l’Océan Indien, Université de la Réunion, Saint-Pierre, France
| | - Francesco Bonsante
- Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion, Site Sud, Saint Pierre, France
- Centre d’Études Périnatales de l’Océan Indien, Université de la Réunion, Saint-Pierre, France
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Querin B, Schweitzer-Chaput A, Cisternino S, Auvity S, Fauqueur AS, Negbane A, Hadchouel A, Schlatter J, Cotteret C. Pharmaceutical Oral Formulation of Methionine as a Pediatric Treatment in Inherited Metabolic Disease. Pharmaceutics 2023; 15:pharmaceutics15030957. [PMID: 36986818 PMCID: PMC10056843 DOI: 10.3390/pharmaceutics15030957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
L-Methionine (Met) is an essential alpha-amino acid playing a key role in several metabolic pathways. Rare inherited metabolic diseases such as mutations affecting the MARS1 gene encoding methionine tRNA synthetase (MetRS) can cause severe lung and liver disease before the age of two years. Oral Met therapy has been shown to restore MetRS activity and improve clinical health in children. As a sulfur-containing compound, Met has a strongly unpleasant odor and taste. The objective of this study was to develop an optimized pediatric pharmaceutical formulation of Met powder, to be reconstituted with water, to obtain a stable oral suspension. Organoleptic characteristics and physicochemical stability of the powdered Met formulation and suspension were evaluated at three storage temperatures. Met quantification was assessed by a stability-indicating chromatographic method as well as microbial stability. The use of a specific fruit flavor (e.g., strawberry) with sweeteners (e.g., sucralose) was considered acceptable. No drug loss, pH changes, microbiological growth, or visual changes were observed at 23 ± 2 °C and 4 ± 2 °C with the powder formulation for 92 days, and the reconstituted suspension for at least 45 days. The developed formulation facilitates the preparation, administration, the dose adjustment and palatability of Met treatment in children.
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Affiliation(s)
- Benjamin Querin
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Arnaud Schweitzer-Chaput
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Salvatore Cisternino
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
- Université Paris Cité, Inserm UMRS 1144, Faculté de Pharmacie, 4, Avenue de l’Observatoire, F-75006 Paris, France
- Correspondence: ; Tel.: +33-1-44-495-191
| | - Sylvain Auvity
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
- Université Paris Cité, Inserm UMRS 1144, Faculté de Pharmacie, 4, Avenue de l’Observatoire, F-75006 Paris, France
| | - Anne-Sophie Fauqueur
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Abdel Negbane
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
| | - Alice Hadchouel
- Service de Pneumologie Pédiatrique, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris, AP-HP, 149 rue de Sèvres, F-75015 Paris, France
- Institut Necker Enfants Malades (INEM), INSERM U1151, Faculté de Médecine, Université Paris Cité, 156 rue de Vaugirard, F-75015 Paris, France
| | - Joël Schlatter
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
- Service Pharmacie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris, AP-HP, 1 rue de l’hôpital, F-60140 Labruyère, France
| | - Camille Cotteret
- Service Pharmacie, Hôpital Universitaire Necker—Enfants Malades, Assistance Publique des Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, F-75015 Paris, France
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Prevalence, Risk, and Challenges of Extemporaneous Preparation for Pediatric Patients in Developing Nations: A Review. Pharmaceutics 2023; 15:pharmaceutics15030840. [PMID: 36986701 PMCID: PMC10058853 DOI: 10.3390/pharmaceutics15030840] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Extemporaneous preparations are still widely prescribed for pediatric patients with special treatments of certain doses and/or combinations of drugs. Several problems related to extemporaneous preparations have been linked to the incidence of adverse events or a lack of therapeutic effectiveness. Developing nations are facing the challenges of compounding practices. The prevalence of compounded medication in developing nations must be explored to determine the urgency of compounding practices. Furthermore, the risks and challenges are described and explained through investigation and collection of numerous scientific articles from reputable databases, including Web of Science, Scopus, and PubMed. Pediatric patients need compounded medication related to the appropriate dosage form and dosage adjustment. Notably, it is important to observe extemporaneous preparations in order to provide patient-oriented medication.
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Kaguelidou F, Ouèdraogo M, Treluyer JM, Le Jeunne C, Annereau M, Blanc P, Bureau S, Ducassou S, Fiquet B, Flamein F, Gaillard S, Hankard R, Laugel V, Laurent C, Levy C, Marquet T, Polak M, Portefaix A, Vassal G. Paediatric drug development and evaluation: Existing challenges and recommendations. Therapie 2023; 78:105-114. [PMID: 36528416 DOI: 10.1016/j.therap.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 12/11/2022]
Abstract
Despite various international regulatory initiatives over the last 20 years, many challenges remain in the field of paediatric drug development and evaluation. Indeed, drug research and development is still focused essentially on adult indications, thereby excluding many paediatric patients, limiting the feasibility of trials and favouring competing developments. Off-label prescribing persists and the development of age-appropriate dosage forms for children remains limited. Against this background, the members of this panel (TR) recommend the launch of multi-partner exchange forums on specific topics in order to focus new drug research and development on the real, unmet medical needs of children and adolescents, and in keeping with the underlying mechanisms of action. Scientific information sharing and cooperation between stakeholders are also essential for defining reference evaluation methods in each medical field. These forums can be organised through existing paediatric facilities and research networks at the French and European level. The latter are specifically dedicated to paediatric research and can facilitate clinical trial implementation and patient enrolment. Moreover, specific grants and public/private partnerships are still needed to support studies on the repositioning of drugs in paediatric indications, and pharmacokinetic studies aimed at defining appropriate dosages. The development of new pharmaceutical forms, better suited for paediatric use, and the promotion of resulting innovations will stimulate future investments. Initiatives to gather observational safety and efficacy data following off-label and/or derogatory early access should also be encouraged to compensate for the lack of information available in these situations. Finally, the creation of Ethics Committees (EC) with a specific "mother-child" advisory expertise should be promoted to ensure that the current regulation (Jardé law in France) is implemented whilst also taking into account the paediatric specificities in medical trials.
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Affiliation(s)
- Florentia Kaguelidou
- Center of Clinical Investigations and Pediatric Pharmacology, Inserm CIC1426, Robert-Debré hospital, AP-HP.Nord, 75000 Paris, France; Paris Cité University, EA7323 « Therapeutic assessment, and perinatal and pediatric pharmacology », 75000 Paris, France.
| | - Maria Ouèdraogo
- Lead « partenaires parcours de soins référents médicaux », laboratoire Roche, 92100 Boulogne, France
| | - Jean-Marc Treluyer
- Paris Cité University, EA7323 « Therapeutic assessment, and perinatal and pediatric pharmacology », 75000 Paris, France; Département de pharmacologie, CRPV, hôpital Cochin, AP-HP.Centre, 75014 Paris, France
| | - Claire Le Jeunne
- Paris Cité University, EA7323 « Therapeutic assessment, and perinatal and pediatric pharmacology », 75000 Paris, France; Service de médecine interne, hôpital Cochin, AP-HP Centre, 75014 Paris, France
| | - Maxime Annereau
- Département de pharmacie clinique, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Patricia Blanc
- Association de patients («) Imagine for Margo - Enfants sans Cancer », 78100 Saint-Germain-en-Laye, France
| | - Serge Bureau
- Direction de la recherche clinique, de l'innovation, des relations avec les universités et organismes de recherche (DRCI), Assistance publique-Hôpitaux de Paris, 75000 Paris, France
| | - Stéphane Ducassou
- Unité hématologie oncologie pédiatrique, CHU Bordeaux, 33000 Bordeaux, France
| | - Béatrice Fiquet
- Département médical, Amgen, 92100 Boulogne-Billancourt, France
| | - Florence Flamein
- University Lille, Inserm, CHU Lille, CIC-1403 Inserm-CHU, 59000 Lille, France; French Clinical Research Infrastructure Network (F-CRIN) - PEDSTART, 94000 Créteil, France
| | - Ségolène Gaillard
- Hospices civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, 69677 Bron, France; Université Lyon 1, CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, 69622 Villeurbanne, France
| | | | - Vincent Laugel
- Pôle médico-chirurgical de pédiatrie, centre d'investigation clinique, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | | | - Corinne Levy
- Clinical Research Center (CRC), centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - Thierry Marquet
- Accès des patients à l'innovation, Takeda, 75116 Paris, France
| | - Michel Polak
- Unité d'endocrinologie, gynécologie, diabétologie pédiatriques, Inserm U1016, Institut Imagine, centre de référence des maladies endocriniennes rares de la croissance et du développement, hôpital universitaire Necker-Enfants-Malades, AP-HP Centre, université Paris-Descartes, 75743 Paris, France
| | - Aurélie Portefaix
- Hospices civils de Lyon, Pediatric Clinic Investigation Center, Inserm P-1407, 69500 Bron, France
| | - Gilles Vassal
- Département de cancérologie de l'enfant et de l'adolescent, Gustave Roussy Comprehensive Cancer Center et université Paris-Saclay, 94805 Villejuif, France
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Kaguelidou F, Ouèdraogo M, Treluyer JM, Le Jeunne C, Annereau M, Blanc P, Bureau S, Ducassou S, Fiquet B, Flamein F, Gaillard S, Hankard R, Laugel V, Laurent C, Levy C, Marquet T, Polak M, Portefaix A, Vassal G. Développement des médicaments en pédiatrie : défis existants et recommandations. Therapie 2023; 78:95-104. [PMID: 36543724 DOI: 10.1016/j.therap.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Florentia Kaguelidou
- Center of Clinical Investigations and Pediatric Pharmacology, Inserm CIC1426, Robert-Debré Hospital, AP-HP Nord, 75000 Paris, France; Paris Cité University, EA7323 « Therapeutic assessment, and perinatal and pediatric pharmacology », 75000 Paris, France.
| | - Maria Ouèdraogo
- Lead « partenaires parcours de soins référents médicaux », laboratoire Roche, 92100 Boulogne, France
| | - Jean-Marc Treluyer
- Paris Cité University, EA7323 « Therapeutic assessment, and perinatal and pediatric pharmacology », 75000 Paris, France; Département de pharmacologie, CRPV, hôpital Cochin, AP-HP Centre, 75014 Paris, France
| | - Claire Le Jeunne
- Paris Cité University, EA7323 « Therapeutic assessment, and perinatal and pediatric pharmacology », 75000 Paris, France; Service de médecine interne, hôpital Cochin, AP-HP Centre, 75014 Paris, France
| | - Maxime Annereau
- Département de pharmacie clinique, Gustave-Roussy Cancer Campus, 94800 Villejuif, France
| | - Patricia Blanc
- Association de patients « Imagine for Margo - Enfants sans Cancer », 78100 Saint-Germain-en-Laye, France
| | - Serge Bureau
- Direction de la recherche clinique, de l'innovation, des relations avec les universités et organismes de recherche (DRCI), Assistance publique-Hôpitaux de Paris, 75000 Paris, France
| | - Stéphane Ducassou
- Unité hématologie oncologie pédiatrique, CHU Bordeaux, 33000 Bordeaux, France
| | - Béatrice Fiquet
- Département médical, Amgen, 92100 Boulogne-Billancourt, France
| | - Florence Flamein
- Université Lille, Inserm, CHU Lille, CIC-1403 Inserm-CHU, 59000 Lille, France; French Clinical Research Infrastructure Network (F-CRIN) - PEDSTART, 94000 Créteil, France
| | - Ségolène Gaillard
- Hospices civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, CHU-Lyon, 69677 Bron, France; Université Lyon 1, CNRS UMR 5558, laboratoire de biométrie et biologie évolutive, 69622 Villeurbanne, France
| | | | - Vincent Laugel
- Pôle médicochirurgical de pédiatrie, centre d'investigation clinique, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | | | - Corinne Levy
- Clinical Research Center (CRC), centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - Thierry Marquet
- Directeur de l'accès des patients à l'innovation, Takeda, 75116 Paris, France
| | - Michel Polak
- Unité d'endocrinologie, gynécologie, diabétologie pédiatriques, Inserm U1016, Institut Imagine, centre de référence des maladies endocriniennes rares de la croissance et du développement, hôpital universitaire Necker-Enfants-Malades, AP-HP Centre, université Paris Descartes, 75743 Paris, France
| | - Aurélie Portefaix
- Hospices civils de Lyon, Pediatric Clinic Investigation Center, Inserm P-1407, 69500 Bron, France
| | - Gilles Vassal
- Département de cancérologie de l'enfant et de l'adolescent, Gustave-Roussy Comprehensive Cancer Center, université Paris-Saclay, 94805 Villejuif, France
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Saito J, Agrawal A, Patravale V, Pandya A, Orubu S, Zhao M, Andrews GP, Petit-Turcotte C, Landry H, Croker A, Nakamura H, Yamatani A, Salunke S. The Current States, Challenges, Ongoing Efforts, and Future Perspectives of Pharmaceutical Excipients in Pediatric Patients in Each Country and Region. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040453. [PMID: 35455497 PMCID: PMC9026161 DOI: 10.3390/children9040453] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/23/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
Abstract
A major hurdle in pediatric formulation development is the lack of safety and toxicity data on some of the commonly used excipients. While the maximum oral safe dose for several kinds of excipients is known in the adult population, the doses in pediatric patients, including preterm neonates, are not established yet due to the lack of evidence-based data. This paper consists of four parts: (1) country-specific perspectives in different parts of the world (current state, challenges in excipients, and ongoing efforts) for ensuring the use of safe excipients, (2) comparing and contrasting the country-specific perspectives, (3) past and ongoing collaborative efforts, and (4) future perspectives on excipients for pediatric formulation. The regulatory process for pharmaceutical excipients has been developed. However, there are gaps between each region where a lack of information and an insufficient regulation process was found. Ongoing efforts include raising issues on excipient exposure, building a region-specific database, and improving excipient regulation; however, there is a lack of evidence-based information on safety for the pediatric population. More progress on clear safety limits, quantitative information on excipients of concern in the pediatric population, and international harmonization of excipients’ regulatory processes for the pediatric population are required.
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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;
- Correspondence: ; Tel.: +81-3-3416-0181
| | - Anjali Agrawal
- Drug Product Development, Bristol Myers Squibb, 181 Passaic Avenue, Summit, NJ 07901, USA;
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, India; (V.P.); (A.P.)
| | - Anjali Pandya
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, India; (V.P.); (A.P.)
| | - Samuel Orubu
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215, USA;
- Department of Pharmaceutics and Pharmaceutical Technology, Niger Delta University, Amassama 560103, Nigeria
| | - Min Zhao
- Medical Biology Centre, School of Pharmacy, China Medical University-Queen’s University Belfast Joint College (CQC), Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.Z.); (G.P.A.)
| | - Gavin P. Andrews
- Medical Biology Centre, School of Pharmacy, China Medical University-Queen’s University Belfast Joint College (CQC), Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (M.Z.); (G.P.A.)
| | - Caroline Petit-Turcotte
- Therapeutic Products Directorate, Health Canada, Government of Canada, Ottawa, ON K1A 0K9, Canada;
| | - Hannah Landry
- Office of Pediatrics and Patient Involvement, Health Canada, Government of Canada, Ottawa, ON K1A 0K9, Canada; (H.L.); (A.C.)
| | - Alysha Croker
- Office of Pediatrics and Patient Involvement, Health Canada, Government of Canada, Ottawa, ON K1A 0K9, Canada; (H.L.); (A.C.)
| | - Hidefumi Nakamura
- Department of Research and Development Supervision, National Center for Child Health and Development, 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;
| | - Smita Salunke
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK;
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Bacteriostatic preserved saline for pain-free periocular injections: review. Eye (Lond) 2022; 36:1546-1552. [PMID: 35017698 PMCID: PMC8749351 DOI: 10.1038/s41433-021-01925-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/20/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
We review evidence regarding the use of 0.9% benzyl alcohol in 0.9% sodium chloride solution for periocular injections (‘preserved saline’) including botulinum toxin A injections and local anaesthesia. A literature search was undertaken using search terms ‘bacteriostatic saline’, ‘benzyl-alcohol saline’, ‘benzyl alcohol sodium chloride’ and ‘preserved saline’. Bibliographies identified further sources. There have been 62 studies published on the subject of preserved-saline since 1928. Significantly lower injection-associated pain levels for periocular/facial botulinum toxin injections reconstituted with preserved-saline rather than preservative-free saline are reported by 5 studies. Significantly lower injection-associated pain with preserved-saline diluted lidocaine and epinephrine solution for eyelid anaesthesia compared with unmodified or buffered lidocaine with epinephrine, and adequate anaesthesia, was reported by one study. Thirty-one studies have explored preserved-saline for anaesthetic and seven for bacteriostatic properties, with very low infection rates after periocular botulinum toxin injections, and reduced rates of infection in indwelling catheters when preserved saline is used to flush. A meta-analysis concluded that lidocaine-containing solutions are more effective at reducing pain from insertion of intravenous catheters. Patient-perceived pain related to periorbital injections of local anaesthesia is reduced when the anaesthetic is diluted with benzyl alcohol-preserved saline compared with other dilution or buffering options. Pain is similarly reduced for periocular botulinum toxin injections reconstituted with preserved saline compared with unpreserved saline. Benzyl-alcohol preserved-saline is inexpensive but costlier than unpreserved-saline, with minimal reported complications, particularly with periocular administration, and offers the opportunity to improve the patient experience.
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