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Noga F, Hoti E, Ibrahimi E, Toma D, Malaj L. Perceptions and experiences of community pharmacists with off-label prescribing in the pediatric population. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024:riae031. [PMID: 38965914 DOI: 10.1093/ijpp/riae031] [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: 12/22/2023] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study aimed to investigate and provide insight into the prevalence and patterns of off-label drug use in the pediatric population from the perspective of community pharmacists, addressing the existing data gap in a developing setting. METHODS A questionnaire-based cross-sectional study was conducted on Albanian community pharmacists in June 2021. The online administered survey explored the participants' demographic details, perceptions, and experiences with off-label prescriptions in pediatric patients. The statistical analysis conducted on the survey data comprised the construction of frequency tables and the application of the chi-square test for independence. KEY FINDINGS Three hundred and thirty-six community pharmacists nationwide completed the survey, out of which 186 (55.3%) were practiced in Tirana, the capital of Albania. Over 80% of surveyed pharmacists (n = 275) had encountered off-label drug prescriptions in pediatric patients, yet only 40% of participants reported dispensing medicines for off-label use. Community pharmacists reported that general pediatricians tended to prescribe off-label medications more frequently than pediatric subspecialists or general practitioners. It was found that off-label prescriptions were more frequently observed among children aged between 2 and 11 years. Antibiotics were the most reported medicines for off-label use in this study mentioned in almost all off-label categories. CONCLUSIONS Prescribing medicines for unapproved uses for the treatment of pediatric patients is present in community settings in Albania. This indicates the need for further data collection and analysis to understand off-label practices in our country's pediatric population comprehensively.
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Affiliation(s)
- Fabiola Noga
- Department of Pharmacy, University of Medicine Tirana, Tiranë, AL 1005, Albania
| | - Ela Hoti
- Department of Pharmacy, University of Medicine Tirana, Tiranë, AL 1005, Albania
| | - Eliana Ibrahimi
- Department of Biology, University of Tirana, Tiranë, AL 1001, Albania
| | - Diana Toma
- Order of Pharmacists of Albania, Tiranë, AL 1007, Albania
| | - Ledjan Malaj
- Department of Pharmacy, University of Medicine Tirana, Tiranë, AL 1005, Albania
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2
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Briciu C, Leucuta D, Popa A, Latis A, Pop TL, Tomută I, Man SC, Lazăr C, Vostinaru S, Iurian S. Acceptability of compounded preparations - A Romanian pediatric hospital perspective. Eur J Pharm Biopharm 2024:114383. [PMID: 38936783 DOI: 10.1016/j.ejpb.2024.114383] [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: 02/06/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024]
Abstract
Compounded medicines are widely used, especially for pediatric patients. The aim of this study was to evaluate children's acceptability of compounded preparations and to provide information regarding compounding practices' characteristics in a Romanian hospital setting. An observational, cross-sectional, and retrospective study was conducted in three Clinical Pediatric Departments (Emergency Clinical Hospital for Children, Cluj-Napoca). The study population comprised patients under 18 years old taking at least one compounded medication. Study data was collected mainly through an interviewer-administered questionnaire and medicine acceptability was assessed based on the children's first reaction to the preparations using a 3-point facial hedonic scale. A total of 162 compounded medications were evaluated. A positive/negative reaction was reported for 20.83%/58.33%, 20.63%/49.21%, and 66.67%/7.41% of oral, oromucosal and cutaneous dosage forms. Although patient disapproval was recorded for various reasons, medication administration was successful in over 75% of cases. Factors such as fewer steps required for intake of a dose, capsule dosage form, no additional food/drink immediately after drug intake, medication perceived as "easy/very easy" to swallow, were correlated with a better acceptability of oral preparations. This study highlights the importance of identifying factors that can improve the acceptability of compounded preparations and, subsequently, treatment outcomes in pediatric patients.
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Affiliation(s)
- Corina Briciu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Clinical Pharmacy, Cluj-Napoca, Romania
| | - Daniel Leucuta
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania
| | - Adina Popa
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Clinical Pharmacy, Cluj-Napoca, Romania.
| | - Ana Latis
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Tudor Lucian Pop
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania; "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Medicine, Second Pediatric Discipline, Mother and Child Department, Cluj-Napoca, Romania
| | - Ioan Tomută
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Technology and Biopharmacy, Cluj-Napoca, Romania
| | - Sorin Claudiu Man
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania; "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Medicine, Third Pediatric Discipline, Mother and Child Department, Cluj-Napoca, Romania
| | - Călin Lazăr
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania; "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Medicine, First Pediatric Discipline, Mother and Child Department, Cluj-Napoca, Romania
| | | | - Sonia Iurian
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Technology and Biopharmacy, Cluj-Napoca, Romania
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3
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Gaikwad SS, Morales JO, Lande NB, Catalán-Figueroa J, Laddha UD, Kshirsagar SJ. Exploring paediatric oral suspension development: Challenges, requirements, and formulation advancements. Int J Pharm 2024; 657:124169. [PMID: 38688428 DOI: 10.1016/j.ijpharm.2024.124169] [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: 10/15/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Oral suspension is the most preferred dosage form for the paediatric population because of the difficulties related to solid medications, such as the swallowing limitations, bitter taste, and poor oral bioavailability, which can cause serious impairment to attain a successful treatment. Given the importance of successful therapies, there is a need for safe and effective commercially-available paediatric oral suspension and their characterization. For the latter, it is important to identify safe excipients and preservatives. The paediatric group is a diverse category which includes infants and teenagers, with major pharmacokinetics and pharmacodynamics differences, mainly because of physiological and behavioral variations. Therefore, finding a single formulation for paediatric population remains a challenge, as well asthe formulation of stable-in-time suspension. In addition, drug's dissolving characteristic and permeation, are the main determinants for oral absorption, which are closely related to drug release kinetics from the pharmaceutical form. In this context, drug release profile is an important and limiting step in oral bioavailability, particularly for BCS class II drugs; thus, it is possible to increase bioavailability and minimize adverse effects by changing the release rate of such drugs. This review covers all the aspects for paediatric oral suspension development, and analyses the considerations for excipients selection as a crucial task for effectively choosing a safe and effective pharmaceutical form and correctly dosing paediatric patients.
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Affiliation(s)
- Sachin S Gaikwad
- Department of Pharmaceutics, Sanjivani College of Pharmaceutical Education and Research, Savitribai Phule Pune University, At Sahajanandnagar, Post-Shinganapur, Tal-Kopargaon, Ahmednagar, Maharashtra 423603, India; Department of Pharmaceutics, MET's Institute of Pharmacy, Affiliated to Savitribai Phule Pune University, Bhujbal Knowledge City, Adgaon, Nashik 422003, India.
| | - Javier O Morales
- Department of Pharmaceutical Sciences and Technology, University of Chile. Santiago 8380494, Chile; Advanced Center for Chronic Diseases (ACCDiS), Chile; Center of New Drugs for Hypertension (CENDHY), Chile
| | - Narayan B Lande
- Department of Pharmaceutics, Sanjivani College of Pharmaceutical Education and Research, Savitribai Phule Pune University, At Sahajanandnagar, Post-Shinganapur, Tal-Kopargaon, Ahmednagar, Maharashtra 423603, India
| | - Johanna Catalán-Figueroa
- Food Science Lab, Institute of Research and Postgraduate Studies, Faculty of Medicine and Health Sciences, Universidad Central de Chile, Santiago 8330546, Chile
| | - Umesh D Laddha
- Department of Pharmaceutics, MET's Institute of Pharmacy, Affiliated to Savitribai Phule Pune University, Bhujbal Knowledge City, Adgaon, Nashik 422003, India; Regeron Inc., Chuncheon-si, Gangwon-do 24232, South Korea
| | - Sanjay J Kshirsagar
- Department of Pharmaceutics, MET's Institute of Pharmacy, Affiliated to Savitribai Phule Pune University, Bhujbal Knowledge City, Adgaon, Nashik 422003, India
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4
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Mu Y, Zhao L, Shen L. Medication adherence and pharmaceutical design strategies for pediatric patients: An overview. Drug Discov Today 2023; 28:103766. [PMID: 37708932 DOI: 10.1016/j.drudis.2023.103766] [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: 08/07/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
Medication adherence in pediatric patients is a key factor in drug development and dosage form design. High medication adherence is not only important to achieve the expected treatment effects but can also effectively reduce medical costs. It is an ongoing task to accurately identify differences in medication adherence between children and adults and analyze the factors related to pediatric medication adherence. This is necessary to guide the development of pediatric drugs. This review focuses on factors that influence pediatric medication adherence as well as pharmaceutical design strategies to improve adherence. Current new dosage forms, new technologies, and new devices are comprehensively summarized in terms of their advantages and limitations.
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Affiliation(s)
- Yingying Mu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Pudong District, Shanghai 201203, PR China
| | - Lijie Zhao
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine of Ministry of Education, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Pudong District, Shanghai 201203, PR China.
| | - Lan Shen
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Pudong District, Shanghai 201203, PR China.
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5
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Lian S, Liu Y, Xu L, Wang F, Zhang M, Salunke S, Walsh J, Zhao M. Survey-based investigation into the current use of paediatric medicines and administration devices in China. Eur J Pharm Biopharm 2023; 191:290-302. [PMID: 37689320 DOI: 10.1016/j.ejpb.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023]
Abstract
The accurate, rapid and convenient administration of medicines to children is not possible without the use of appropriate administration devices. However, due to the unique nature of this patient population, inappropriate paediatric medication administration has been widely observed worldwide. According to previous surveys carried out in other countries including the UK and Japan, there has been a wide variation in the handling of paediatric devices among children. To date, little is known about the current situation in China where the variety of available paediatric administration devices is more limited than in Europe and the UK. The aim of this study was therefore to conduct a China-wide survey to gain a better understanding of the perspectives of children and their caregivers on paediatric medicines and devices. This study was conducted throughout China with 215 children as well as 749 caregivers of paediatric year groups from 1 to less than 18 years old. The majority of participants (83%) took oral dosage forms where granules, syrup and tablets were ranked as the Top 3 commonly used oral dosage forms. The most commonly used devices, i.e., measuring cups (47.3%) and household spoons (41.1%) were both well accepted by the vast majority of children. More instruction and demonstration by the healthcare professionals were provided to inhalation devices users with the nebuliser and facemask being the most commonly used. In particular, the role of pharmacists in China is expected to be better defined, which may in turn help with the education provided to paediatric users in operating medical devices. The data collected varied considerably with the age of children but not statistically significantly with the region in which the survey was conducted.
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Affiliation(s)
- Shangjie Lian
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Yixiao Liu
- China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China
| | - Luomeng Xu
- China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China
| | - Fengjing Wang
- China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China
| | - Meng Zhang
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Smita Salunke
- University College London School of Pharmacy, London, UK
| | | | - Min Zhao
- School of Pharmacy, Queen's University Belfast, Belfast, UK; China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China.
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6
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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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7
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Development of a Hospital Compounded, Taste-Masked, Temozolomide Oral Suspension and 5-Year Real-Life Experience in Treating Paediatric Patients. Pharmaceuticals (Basel) 2022; 15:ph15050555. [PMID: 35631381 PMCID: PMC9146721 DOI: 10.3390/ph15050555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/14/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
The development of oral pediatric forms by pharmaceutical companies is still insufficient. In fact, many drugs used in paediatric oncology, such as temozolomide, are not labeled and adapted for paediatric use. Temozolomide (TMZ) is an alkylating agent used as the standard of care for many adult and pediatric brain tumours, such as neuroblastoma, glioblastoma and medulloblastoma. The present study was carried out to propose a suitable and palatable formulation of the oral liquid preparation of TMZ. The suspension is composed of TMZ suspended in SyrSpend SF pH 4, as well as TMZ crystallization stabilizing agents and sweetening agents. To reach this formulation, several taste-masking agents were evaluated. Here, we describe the method of preparation of the formation as well as the monocentric population treated with the formulation over a 5–year period. A 20 mg/mL TMZ suspension was developed. TMZ suspension is stable for 6 weeks, stored between 2 and 8 degrees, protected from light, and compatible with nasogastric tubes. Thirty-eight patients participated in the palatability study and choose cola flavour, and 104 patients were treated in Gustave Roussy with the developed suspension; no unexpected event was reported. To conclude, we propose here a new TMZ liquid formulation which is stable for at least 6 weeks and well-tolerated with extensive feedback.
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8
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Cumulative Risks of Excipients in Pediatric Phytomucolytic Syrups: The Implications for Pharmacy Practice. Sci Pharm 2021. [DOI: 10.3390/scipharm89030032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Expectorant phytomucolytic syrups are widely used pediatric OTC-medicines. Physicians, pediatricians, and pharmacists are traditionally concerned with the efficacy of the active ingredients in cough syrups, and rarely consider the safety aspects of excipients that however are not absolutely “inactive” and are proved to initiate some negative reactions and interactions with other drugs. This paper presents a review, categorization, and comparative analysis of the safety profile of excipients contained in the 22 best-selling OTC pediatric phytomucolytic syrups available in pharmaceutical markets in Ukraine and Germany and proposes an approach to the consideration of the excipients’ safety risks for a pharmacist in the process of pharmaceutical care. The study has revealed that only one of the twenty-two analyzed syrups does not contain any potentially harmful excipients. The results of this analysis were used for developing a specific decision tool for pharmacists that can be used for minimizing excipient-initiated reactions when delivering OTC phytomucolytic syrups for children.
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9
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European Paediatric Formulation Initiative (EuPFI) successfully navigating the road to formulating better medicines for children. Eur J Pharm Biopharm 2021; 167:114-115. [PMID: 34175374 DOI: 10.1016/j.ejpb.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Excipients in the Paediatric Population: A Review. Pharmaceutics 2021; 13:pharmaceutics13030387. [PMID: 33805830 PMCID: PMC8000418 DOI: 10.3390/pharmaceutics13030387] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
This theoretical study seeks to critically review the use of excipients in the paediatric population. This study is based on the rules and recommendations of European and American drug regulatory agencies. On the one hand, this review describes the most frequent excipients used in paediatric medicine formulations, identifying the compounds that scientific literature has marked as potentially harmful regarding the side effects generated after exposure. On the other hand, this review also highlights the importance of carrying out safety -checks on the excipients, which, in most cases, are linked to toxicity studies. An excipient in the compilation of paediatric population databases is expected to target safety and toxicity, as in the STEP database. Finally, a promising pharmaceutical form for child population, ODT (Orally Disintegrating Tablets), will be studied.
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11
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Belayneh A, Tadese E, Molla F. Safety and Biopharmaceutical Challenges of Excipients in Off-Label Pediatric Formulations. Int J Gen Med 2020; 13:1051-1066. [PMID: 33204140 PMCID: PMC7667588 DOI: 10.2147/ijgm.s280330] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background One of the major challenges in pediatric treatment is the lack of suitable drug preparations specifically designed and marketed for children. Most of the FDA approved drug formulations for adults have not been approved for use in pediatric patients. Shortage of suitable pediatric dosage information often leads health professionals to use adult formulations in an off-label manner. The aim of this work was to review the safety and biopharmaceutical challenges of commonly found excipients in off-label pediatric formulations as well as to show the current progress to alleviate pediatric toxicity related to excipients. Methods Research findings and medical case reports were searched from credible sources including Scopus, PubMed, OVID, Google Scholar, Embase, Cochrane Library, and Web of Science. Results As several studies and clinical case reports have revealed, off-label adult formulations usage causes pediatric patients to become exposed to potentially harmful excipients, which are essential components of drug products. In addition to their toxicities, some of the excipients affect the biopharmaceutical property of different drugs. Immature organ and body composition, large body surface area and slower metabolism and elimination capabilities of pediatrics are the main causes of toxicities associated with different excipients. Recent studies have also shown that good progress is being made to develop safe and suitable excipients for pediatric use. Conclusion A risk and benefit assessment should be done before using off-label formulation as excipients cause mild to severe toxicities and biopharmaceutical problems to pediatric patients.
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Affiliation(s)
- Anteneh Belayneh
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ebisa Tadese
- Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fantahun Molla
- Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Moreira M, Sarraguça M. How can oral paediatric formulations be improved? A challenge for the XXI century. Int J Pharm 2020; 590:119905. [DOI: 10.1016/j.ijpharm.2020.119905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023]
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13
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Bracken L, McDonough E, Ashleigh S, Wilson F, Shakeshaft J, Ohia U, Mistry P, Jones H, Kanji N, Liu F, Peak M. Can children swallow tablets? Outcome data from a feasibility study to assess the acceptability of different-sized placebo tablets in children (creating acceptable tablets (CAT)). BMJ Open 2020; 10:e036508. [PMID: 33039988 PMCID: PMC7549447 DOI: 10.1136/bmjopen-2019-036508] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Feasibility study to investigate the acceptability of different-sized placebo tablets in children aged 4-12 years. DESIGN AND SETTING Clinical Research Facilities, inpatient wards and outpatient clinics within a Regional Paediatric Hospital and/or District General Hospital. Healthy children and National Health Service (NHS) patients were asked to swallow three placebo tablets: 6 mm, 8 mm and 10 mm, smallest to largest. The researcher observed children's facial expressions and behaviours on swallowing and measured the volume of water consumed. Participants completed a questionnaire about the overall acceptability; including swallowability, taste and volume of water consumed. For analysis, participants were stratified by age: 4-8 years and 9-12 years. RESULTS The feasibility study led to an estimated recruitment rate of 0.8% for NHS inpatients and 211 healthy children over a 1-year period. In total, 55 participants were recruited, 30 to the younger group, of which 77% had never taken a tablet before. 84% of the 25 older children had previously taken a tablet. All participants attempted to swallow the smallest sized tablet. The children aged 4-8 years found the larger tablets easier to swallow, however the older children found little difference between the tablet sizes. The younger children required more water to swallow each tablet size compared with the older children where an increasing volume of water was consumed as tablet size increased. Taste was rated highly for both age groups. The 8 mm tablets were deemed the most acceptable tablet size by all participants. CONCLUSION Tablets are potentially an acceptable formulation for children aged 4-12 years. Most children aged 4-8 years who attempted to swallow tablets successfully did so. Recruitment of NHS inpatients to medicine acceptability studies is challenging, however, recruitment of children of staff proved an effective strategy. Valuable lessons have been learnt from this feasibility study which will inform the design of a larger definitive trial.
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Affiliation(s)
- Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emma McDonough
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Samantha Ashleigh
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Fiona Wilson
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Joanne Shakeshaft
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Udeme Ohia
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Punam Mistry
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Huw Jones
- Pediatric Services, Quotient Sciences, Nottingham, UK
| | - Nazim Kanji
- Pediatric Services, Quotient Sciences, Nottingham, UK
| | - Fang Liu
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, UK
| | - Matthew Peak
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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14
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Miyazaki Y, Tsuboi A, Maruyama S, Aoshima H, Uchino T, Kagawa Y. Evaluation of Dantrolene Granules Extemporaneously Reformulated from Capsules in a Pharmacy. Chem Pharm Bull (Tokyo) 2020; 68:989-995. [PMID: 32999151 DOI: 10.1248/cpb.c20-00521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dantrolene capsule, an effective therapeutic agent for the treatment of spasticity, is administered to children who cannot swallow the capsule after reformulation into a powder. The powdered drug can alter the specified dosage and it is also difficult to dispense the powdered formulation because of its bulky and sticky nature. To resolve these problems, we reformulated dantrolene capsules into granules using a centrifugal planetary mixer in the pharmacy. The granules containing lactose-cornstarch, D-mannitol, or microcrystalline cellulose as a diluent were examined to determine particle size distribution, flowability, drug content uniformity, and disintegration time. The granules with microcrystalline cellulose were superior to the other forms, owing to their smaller size, good drug content uniformity, and rapid disintegration. We further investigated the usability of the granules in the dispensing procedure (dividing and packing) and in the dosing process (retrieval from package) using the powders as controls. The deviation of the divided amount and loss on dosing were reduced relative to the powders. In addition, drug dissolution properties and storage stability for 12 months were the same as those of the powders. Therefore, we concluded that dantrolene granules are excellent alternatives as an extemporaneous preparation in pharmacies.
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Affiliation(s)
- Yasunori Miyazaki
- Department of Clinical Pharmaceutics, School of Pharmaceutical Sciences, University of Shizuoka
| | - Ayaka Tsuboi
- Department of Pharmacy, Shizuoka Children Hospital
| | | | | | - Tomonobu Uchino
- Department of Clinical Pharmaceutics, School of Pharmaceutical Sciences, University of Shizuoka
| | - Yoshiyuki Kagawa
- Department of Clinical Pharmaceutics, School of Pharmaceutical Sciences, University of Shizuoka
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15
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Bhatt-Mehta V, Hammoud H, Amidon GL. A proposed pediatric biopharmaceutical classification system for medications for chronic diseases in children. Eur J Pharm Sci 2020; 152:105437. [PMID: 32598914 DOI: 10.1016/j.ejps.2020.105437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 01/04/2023]
Abstract
Age-appropriate pediatric formulations for oral administration can be challenging to formulate. Development of such formulations is often time consuming, labor-intensive and costly. The Biopharmaceutical Classification System (BCS), developed more than two decades ago, is used to develop suitable oral drug formulations for adult use. In theory, some of the same principles could be applied to formulate pediatric oral liquid dosage forms. However, the present BCS system was developed using adult gastrointestinal physiologic factors. Direct extrapolation of this method to develop pediatric oral dosage forms is inappropriate due to differences in adult and pediatric gastrointestinal physiologic differences during development. To date age-appropriate BCS to guide pediatric oral liquid formulation development has not been developed for various pediatric subpopulations. The objective of this study was to provisionally classify oral liquid formulations of extemporaneously prepared drugs at our institution into an age-appropriate BCS class after elimination of any duplicate listing when matched with the most current World Health Organization's Essential Medicines List for Children available at the time of this study and other published studies that may have reported BCS classification of drugs used as extemporaneous oral liquid formulations in children to treat chronic or rare diseases. A total of 96 orally administered extemporaneously compounded liquid formulations were included in this classification. Dose numbers were calculated using age-appropriate initial gastric volume for neonates, 6-month-old infants, and children up to 6 years of age. Using age-appropriate initial gastric volumes and pediatric and neonatal Lexicomp® age-specific maximal dosing recommendations for calculation of dose numbers, the solubility classes shifted for 62.5% of the drugs studied. A significant number of currently used extemporaneously compounded oral liquid formulations for age groups of children included in this study may not provide formulations with predictable safety and efficacy. Factors used in development of adult BCS cannot be applied directly to pediatric subpopulations.
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Affiliation(s)
- Varsha Bhatt-Mehta
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Hannah Hammoud
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Gordon L Amidon
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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16
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Walsh J, van Riet-Nales D, Hermans E, de Vries R, Hilton G, Blowers P, Salunke S. European Paediatric Formulation Initiative workshop report: Improving the administration of oral liquid medicines in paediatrics using dosing syringes and enteral accessories. Eur J Pharm Biopharm 2020; 151:91-97. [PMID: 32289491 DOI: 10.1016/j.ejpb.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022]
Abstract
Accurate dosing of the right medicine to the right patient is a key element of safe and efficacious pharmacotherapy, yet prone to technical challenges and human error when dosing involves the administration of small volumes of liquid medicines. For this reason, the topic has gained increased attention over the last decade from multiple stakeholder parties e.g. academia, hospital pharmacy, the medical device and pharmaceutical industry, and regulatory agencies. It is now well acknowledged that spoons and cups are not suitable for the measurement of small volumes of oral liquid medicines and that syringes are a better alternative, but syringes for parenteral use should not be used for oral dosing in order to avoid accidental parenteral delivery of oral products. However, dosing accuracy of very small volumes of liquid medicines to young children, and especially pre-term neonates, is still not sufficiently ensured. A workshop was organised in 2018 by the European Paediatric Formulation Initiative to reflect on current status and challenges (first part) and possible strategies to improve the present situation (second part). A voting system (n = 24) was used to consider the most favourable solutions. The harmonisation and/or standardisation of the technical design of oral syringes (including e.g. female/male connection) was considered a key priority.
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Affiliation(s)
| | | | - Esmerald Hermans
- Janssen Pharmaceutica NV (Pharmaceutical Companies of Johnson & Johnson), Beerse, Belgium.
| | | | | | | | - Smita Salunke
- European Paediatric Formulation Initiative (EuPFI), University College London School of Pharmacy, London, UK.
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Nakama KA, Dos Santos RB, Serpa P, Maciel TR, Haas SE. Organoleptic excipients used in pediatric antibiotics. Arch Pediatr 2019; 26:431-436. [PMID: 31611144 DOI: 10.1016/j.arcped.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/18/2019] [Accepted: 09/22/2019] [Indexed: 12/15/2022]
Abstract
Taste is a crucial factor that determines the palatability of the oral dosage form and patient compliance. OBJECTIVE The aim of this work was to evaluate the organoleptic excipients in oral antibiotics for pediatric use marketed in Brazil. METHODS The information was obtained from the GuidetoPharmacy, a reference for the pharmaceutical trade. The analysis included dosage forms for oral administration and drugs and their combination with antibacterial action. After this survey, we identified the constitution of the flavoring, sweetening, and coloring agents of each medicine. The results are presented in a descriptive form. RESULTS Twelve drugs or associations are distributed in 70medicines. Oral suspension was the most common pharmaceutical dosage form. Sweeteners were sucrose, sodium saccharin, and sodium cyclamate. All the coloring agents observed are synthetic and the most frequent ones were yellow twilight no. 6, yellow tartrazine no. 5, and red ponceau 4R. The presence of two or more types of flavorings per medicine was observed. CONCLUSION Antibacterials use coloring agents, flavorings, and sweeteners to facilitate the administration of medicines for children, using up to six different substances per formulation. No natural coloring agent was observed, demonstrating an issue to be explored in the future. It is important to note that, although necessary, these excipients are responsible for a high incidence of allergic reactions in children.
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Affiliation(s)
- K A Nakama
- Curso de farmácia, Universidade Federal do Pampa, UNIPAMPA, BR 472, Km 592, CEP 97501-970, Uruguaiana, RS, Brazil
| | - R B Dos Santos
- Curso de farmácia, Universidade Federal do Pampa, UNIPAMPA, BR 472, Km 592, CEP 97501-970, Uruguaiana, RS, Brazil
| | - P Serpa
- Curso de farmácia, Universidade Federal do Pampa, UNIPAMPA, BR 472, Km 592, CEP 97501-970, Uruguaiana, RS, Brazil
| | - T R Maciel
- Curso de farmácia, Universidade Federal do Pampa, UNIPAMPA, BR 472, Km 592, CEP 97501-970, Uruguaiana, RS, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Pampa, UNIPAMPA, Uruguaiana, Brazil
| | - S E Haas
- Curso de farmácia, Universidade Federal do Pampa, UNIPAMPA, BR 472, Km 592, CEP 97501-970, Uruguaiana, RS, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Pampa, UNIPAMPA, Uruguaiana, Brazil.
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Trofimiuk M, Wasilewska K, Winnicka K. How to Modify Drug Release in Paediatric Dosage Forms? Novel Technologies and Modern Approaches with Regard to Children's Population. Int J Mol Sci 2019; 20:E3200. [PMID: 31261877 PMCID: PMC6650933 DOI: 10.3390/ijms20133200] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/23/2022] Open
Abstract
In the pharmaceutical technology, paediatric population still presents the greatest challenge in terms of developing flexible and appropriate drug dosage forms. As for many medicines, there is a lack of paediatric dosage forms adequate for a child's age; it is a prevailing practice to use off label formulations. Children need balanced and personalized treatment, patient-friendly preparations, as well as therapy that facilitates dosing and thus eliminates frequent drug administration, which can be ensured by modified release (MR) forms. MR formulations are commonly used in adult therapy, while rarely available for children. The aim of this article is to elucidate how to modify drug release in paediatric oral dosage forms, discuss the already accessible technologies and to introduce novel approaches of manufacturing with regard to paediatric population.
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Affiliation(s)
- Monika Trofimiuk
- Department of Pharmaceutical Technology, Medical University of Bialystok, Mickiewicza 2c, 15-222 Bialystok, Poland
- Department of Clinical Pharmacy, Medical University of Bialystok, Mickiewicza 2a, 15-222 Bialystok, Poland
| | - Katarzyna Wasilewska
- Department of Pharmaceutical Technology, Medical University of Bialystok, Mickiewicza 2c, 15-222 Bialystok, Poland
| | - Katarzyna Winnicka
- Department of Pharmaceutical Technology, Medical University of Bialystok, Mickiewicza 2c, 15-222 Bialystok, Poland.
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19
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Islam MS, Reineke J, Kaushik R, Woyengo T, Baride A, Alqahtani MS, Perumal O. Bioadhesive Food Protein Nanoparticles as Pediatric Oral Drug Delivery System. ACS APPLIED MATERIALS & INTERFACES 2019; 11:18062-18073. [PMID: 31033278 DOI: 10.1021/acsami.9b00152] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The goal of this study was to develop bioadhesive food protein nanoparticles using zein (Z), a hydrophobic corn protein, as the core and whey protein (WP) as the shell for oral pediatric drug delivery applications. Lopinavir (LPV), an antiretroviral drug, and fenretinide, an investigational anticancer agent, were used as model drugs in the study. The particle size of ZWP nanoparticles was in the range of 200-250 nm, and the drug encapsulation efficiency was >70%. The nanoparticles showed sustained drug release in simulated gastrointestinal fluids. ZWP nanoparticles enhanced the permeability of LPV and fenretinide across Caco-2 cell monolayers. In both ex vivo and in vivo studies, ZWP nanoparticles were found to be strongly bioadhesive. ZWP nanoparticles enhanced the oral bioavailability of LPV and fenretinide by 4 and 7-fold, respectively. ZWP nanoparticles also significantly increased the half-life of both drugs. The nanoparticles did not show any immunogenicity in mice. Overall, the study demonstrates the feasibility of developing safe and effective food protein-based nanoparticles for pediatric oral drug delivery.
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Affiliation(s)
| | | | | | | | - Aravind Baride
- Department of Chemistry , University of South Dakota , Vermillion , South Dakota 57069 , United States
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20
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Reker D, Blum SM, Steiger C, Anger KE, Sommer JM, Fanikos J, Traverso G. "Inactive" ingredients in oral medications. Sci Transl Med 2019; 11:eaau6753. [PMID: 30867323 PMCID: PMC7122736 DOI: 10.1126/scitranslmed.aau6753] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
Oral forms of medications contain "inactive" ingredients to enhance their physical properties. Using data analytics, we characterized the abundance and complexity of inactive ingredients in approved medications. A majority of medications contain ingredients that could cause adverse reactions, underscoring the need to maximize the tolerability and safety of medications and their inactive ingredients.
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Affiliation(s)
- Daniel Reker
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Steven M Blum
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kevin E Anger
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jamie M Sommer
- Investigational Drug Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - John Fanikos
- Investigational Drug Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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21
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Daniel E, Whitaker MJ, Keevil B, Wales J, Ross RJ. Accuracy of hydrocortisone dose administration via nasogastric tube. Clin Endocrinol (Oxf) 2019; 90:66-73. [PMID: 30311954 PMCID: PMC6334520 DOI: 10.1111/cen.13876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Hydrocortisone via nasogastric (NG) tube is used in sick children with adrenal insufficiency; however, there is no licensed formulation for NG administration. METHODS We investigated hydrocortisone recovery after passage through NG tubes in vitro for three formulations: liquid suspension, crushed tablets mixed with water, and hydrocortisone granules designed for oral administration to children. Cortisol was measured by LC-MS/MS. RESULTS Hydrocortisone content was variable and recovery low after preparation in syringe and prior to passage through NG tubes. For doses, 0.5 and 2.0 mg mean percentage recovery was as follows: liquid suspension 57% and 58%; crushed tablets 46% and 30%; and hydrocortisone granules 78% and 71%. Flushing the administering syringe increased recovery. Hydrocortisone recovery after passage with flushing through 6-12Fr gauge NG tubes was variable: liquid suspension 61%-92%, crushed tablets 40%-174%, hydrocortisone granules 61%-92%. Administration of hydrocortisone granules occluded 6 and 8Fr NG tubes; however, administration using a sampling needle to prevent granules being administered gave a recovery of 74%-98%. CONCLUSIONS The administration of hydrocortisone through NG tubes is possible; however, current methods deliver a variable dose of hydrocortisone, generally less than that prescribed. Attention should be placed on the technique used to optimize drug delivery such as flushing of the administering syringe. Hydrocortisone granules block small NG tubes but behaved as well as the commonly used liquid suspension when prepared with a filtering needle that filters out granules.
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Affiliation(s)
| | | | - Brian Keevil
- Manchester Academic Health Science Centre (MAHSC), The University of ManchesterManchesterUK
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22
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Castro JCDSXE, Botelho SF, Machado TRL, Martins MAP, Vieira LB, Reis AMM. Suitability of new drugs registered in Brazil from 2003 to 2013 for pediatric age groups. EINSTEIN-SAO PAULO 2018; 16:eAO4354. [PMID: 30427486 PMCID: PMC6223947 DOI: 10.31744/einstein_journal/2018ao4354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/10/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To analyze suitability of new drugs registered in Brazil from 2003 to 2013 for pediatric age groups. Methods A descriptive study of drugs with pediatric indication included in a retrospective cohort of new drugs registered in Brazil. The evaluation of drug suitability for the pediatric age group was performed using the following criteria: suitability of dosage form and capacity to deliver the recommended dose. The drugs were considered adequate for the pediatric age groups when they met both criteria. The statistical analysis included calculation of frequencies and proportions. Results Suitability due to the drug capacity to deliver the recommended dose was greater than 80% across all age groups. Regarding suitability of the dosage form, we identified that the older the age group, the greater suitability for pediatric use. Concerning the drugs presented in solid dosage form, we showed that half were classified as inadequate for one or more pediatric age groups to whom they were indicated. The adequacy of drugs to the pediatric age group was 64.3% for preschool children, 66.7% for full-term newborns, 66.7% for premature newborns, and over 70% for other age groups. Conclusion Drugs for children aged under 6 years were less often adequate, considering the dosage form and capacity to provide the recommended dose. The availability and proportional suitability of medicines for pediatric use are greater for older age groups, according to age groups the drug is registered for.
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Affiliation(s)
| | | | | | | | - Liliana Batista Vieira
- Faculdade de Ciências Farmacêuticas, Universidade Federal de Alfenas, Alfenas, MG, Brazil
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23
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Del Moral Sanchez JM, Gonzalez-Alvarez I, Cerda-Revert A, Gonzalez-Alvarez M, Navarro-Ruiz A, Amidon GL, Bermejo M. Biopharmaceutical optimization in neglected diseases for paediatric patients by applying the provisional paediatric biopharmaceutical classification system. Br J Clin Pharmacol 2018; 84:2231-2241. [PMID: 29846973 DOI: 10.1111/bcp.13650] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/09/2018] [Accepted: 05/20/2018] [Indexed: 01/13/2023] Open
Abstract
AIMS Unavailability and lack of appropriate, effective and safe formulations are common problems in paediatric therapeutics. Key factors such as swallowing abilities, organoleptic preferences and dosage requirements determine the need for optimization of formulations. The provisional Biopharmaceutics Classification System (BCS) can be used in paediatric formulation design as a risk analysis and optimization tool. The objective of this study was to classify six neglected tropical disease drugs following a provisional paediatric BCS (pBCS) classification adapted to three paediatric subpopulations (neonates, infants and children). METHODS Albendazole, benznidazole, ivermectin, nifurtimox, praziquantel and proguanil were selected from the 5th edition of the Model List of Essential Medicines for Children from the World Health Organization. Paediatric drug solubility classification was based on dose number calculation. Provisional permeability classification was based on log P comparison versus metoprolol log P value, assuming passive diffusion absorption mechanisms and no changes in passive membrane permeability between paediatric patients and adults. pBCS classes were estimated for each drug, according to different doses and volumes adapted for each age stage and were compared to the adult classification. RESULTS All six drugs were classified into provisional pBCS in the three paediatric subpopulations. Three drugs maintained the same classification as for adults, ivermectin and benznidazole changed solubility class from low to high in neonates and proguanil changed from low to high solubility in all age stages. CONCLUSION Provisional pBCS classification of these six drugs shows potential changes in the limiting factors in oral absorption in paediatrics, depending on age stage, compared to the adult population. This valuable information will aid the optimization of paediatric dosing and formulations and can identify bioinequivalence risks when comparing different formulations and paediatric populations.
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Affiliation(s)
- Jose Manuel Del Moral Sanchez
- Institute of Molecular and Cellular Biology of Miguel Hernandez University, Avda de la Universidad s/n, 03202, Elche (Alicante), Spain.,Department of Pharmacokinetics and Pharmaceutical Technology, Miguel Hernandez University, San Juan de Alicante, 03550, Alicante, Spain
| | - Isabel Gonzalez-Alvarez
- Department of Pharmacokinetics and Pharmaceutical Technology, Miguel Hernandez University, San Juan de Alicante, 03550, Alicante, Spain
| | - Aaron Cerda-Revert
- Department of Pharmacokinetics and Pharmaceutical Technology, Miguel Hernandez University, San Juan de Alicante, 03550, Alicante, Spain
| | - Marta Gonzalez-Alvarez
- Department of Pharmacokinetics and Pharmaceutical Technology, Miguel Hernandez University, San Juan de Alicante, 03550, Alicante, Spain
| | - Andres Navarro-Ruiz
- Pharmacy Service, General University Hospital of Elche, 03202, Elche (Alicante), Spain
| | - Gordon L Amidon
- University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI, 48109-1065, USA
| | - Marival Bermejo
- Department of Pharmacokinetics and Pharmaceutical Technology, Miguel Hernandez University, San Juan de Alicante, 03550, Alicante, Spain
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Guimarães M, Statelova M, Holm R, Reppas C, Symilllides M, Vertzoni M, Fotaki N. Biopharmaceutical considerations in paediatrics with a view to the evaluation of orally administered drug products - a PEARRL review. ACTA ACUST UNITED AC 2018; 71:603-642. [PMID: 29971768 DOI: 10.1111/jphp.12955] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/28/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In this review, the current biopharmaceutical approaches for evaluation of oral formulation performance in paediatrics are discussed. KEY FINDINGS The paediatric gastrointestinal (GI) tract undergoes numerous morphological and physiological changes throughout its development and growth. Some physiological parameters are yet to be investigated, limiting the use of the existing in vitro biopharmaceutical tools to predict the in vivo performance of paediatric formulations. Meals and frequencies of their administration evolve during childhood and affect oral drug absorption. Furthermore, the establishment of a paediatric Biopharmaceutics Classification System (pBCS), based on the adult Biopharmaceutics Classification System (BCS), requires criteria adjustments. The usefulness of computational simulation and modeling for extrapolation of adult data to paediatrics has been confirmed as a tool for predicting drug formulation performance. Despite the great number of successful physiologically based pharmacokinetic models to simulate drug disposition, the simulation of drug absorption from the GI tract is a complicating issue in paediatric populations. SUMMARY The biopharmaceutics tools for investigation of oral drug absorption in paediatrics need further development, refinement and validation. A combination of in vitro and in silico methods could compensate for the uncertainties accompanying each method on its own.
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Affiliation(s)
- Mariana Guimarães
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Marina Statelova
- Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - René Holm
- Drug Product Development, Janssen Research and Development, Johnson & Johnson, Beerse, Belgium
| | - Christos Reppas
- Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Moira Symilllides
- Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Vertzoni
- Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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Thabet Y, Slavkova M, Breitkreutz J. 10 years EU regulation of pediatric medicines – impact on cardiovascular drug formulations. Expert Opin Drug Deliv 2017; 15:261-270. [DOI: 10.1080/17425247.2018.1420054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yasmin Thabet
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich-Heine-University, Duesseldorf, Germany
| | - Marta Slavkova
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich-Heine-University, Duesseldorf, Germany
- Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Jörg Breitkreutz
- Institute of Pharmaceutics and Biopharmaceutics, Heinrich-Heine-University, Duesseldorf, Germany
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26
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Size and Taste Matters: Recent Progress in the Development of Age-Appropriate Medicines for Children. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0218-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Mennella JA, Mathew PS, Lowenthal ED. Use of Adult Sensory Panel to Study Individual Differences in the Palatability of a Pediatric HIV Treatment Drug. Clin Ther 2017; 39:2038-2048. [PMID: 28923290 PMCID: PMC5654675 DOI: 10.1016/j.clinthera.2017.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/26/2017] [Accepted: 08/23/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE The recommended first-line treatment for young children infected with HIV includes the liquid formulation of the co-formulated protease inhibitors lopinavir/ritonavir (Kaletra® [Abbott Laboratories, Chicago, Illinois]). Clinical reports indicate that some children readily accept the taste of Kaletra, whereas others strongly reject it, which can deter therapeutic adherence and outcomes. METHODS As a proof-of-concept approach, a sensory panel of genotyped adults was used to document the range of individual differences in the taste and palatability (hedonics) of the liquid formulation of Kaletra and other taste stimuli, including common excipients. Panelists rated taste sensations using generalized labeled magnitude scales to determine genotype-phenotype relationships. Several months later, the panelists were retested to assess response reliability. FINDINGS Not all panelists had the same sensory experience when tasting Kaletra. Palatability ratings varied widely, from moderate like to strongest imaginable dislike, and were reliable over time. The more irritating and bitter Kaletra tasted, the more disliked by the panelist. The more they disliked the taste of Kaletra, the more they disliked the taste of its excipient ethanol and the bitter stimulus denatonium. Those who experienced less bitter and sweeter taste sensations had a different genetic signature than the other panelists. Bitterness and irritation ratings of Kaletra varied by the orphaned bitter receptor gene (TAS2R60), whereas sweetness ratings of Kaletra varied according to the cold receptor gene (TRPM8), which is activated by menthol, an excipient of Kaletra. Neither genotype related to ratings for ethanol or denatonium, however. IMPLICATIONS The use of a sensory panel holds promise as a first step in determining the nature of individual differences in the palatability of existing pediatric drug formulations and sources of variation. In this era of personalized medicine, the need is great to develop psychophysical tools to determine which drugs will show variation in acceptance by children and whether patterns of individual variation in taste as assessed by adults mirror those of young patients. ClinicalTrials.gov identifier: NCT01841710.
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Affiliation(s)
| | | | - Elizabeth D Lowenthal
- University of Pennsylvania Perelman School of Medicine, Departments of Pediatrics and Epidemiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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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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Preis M, Breitkreutz J. Pediatric Drug Development and Dosage Form Design. AAPS PharmSciTech 2017; 18:239-240. [PMID: 28116597 DOI: 10.1208/s12249-016-0705-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/25/2016] [Indexed: 11/30/2022] Open
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