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Briciu C, Leucuța D, Popa A, Latiș A, Pop TL, Tomuță I, Man SC, Lazăr C, Voștinaru S, Iurian S. Acceptability of compounded preparations - A Romanian pediatric hospital perspective. Eur J Pharm Biopharm 2024; 202:114383. [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] [MESH Headings] [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 Hațieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Clinical Pharmacy, Cluj-Napoca, Romania
| | - Daniel Leucuța
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania
| | - Adina Popa
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Clinical Pharmacy, Cluj-Napoca, Romania.
| | - Ana Latiș
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Tudor Lucian Pop
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania; "Iuliu Hațieganu" University of Medicine and Pharmacy, Faculty of Medicine, Second Pediatric Discipline, Mother and Child Department, Cluj-Napoca, Romania
| | - Ioan Tomuță
- "Iuliu Hațieganu" 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 Hațieganu" 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 Hațieganu" University of Medicine and Pharmacy, Faculty of Medicine, First Pediatric Discipline, Mother and Child Department, Cluj-Napoca, Romania
| | | | - Sonia Iurian
- "Iuliu Hațieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Technology and Biopharmacy, Cluj-Napoca, Romania
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Dahlmann-Noor A, Bloom J, Lee SK, Chowdhury S, Nischal K, Bremond-Gignac D. Commercial Versus Compounded Preparations in Pediatric Ophthalmology. Paediatr Drugs 2024; 26:475-477. [PMID: 38937427 DOI: 10.1007/s40272-024-00642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
Many conditions managed by pediatric ophthalmologists are rare diseases, and even if pharmacological treatments are available, these have often not been evaluated in children. Off-label prescribing is a common practice in pediatric ophthalmology. In addition, there is often no commercial case for the production of a medicine that may only be used for a small number of patients worldwide. Compounded preparations prepared locally are therefore still in frequent use, although it is known that production may not meet stringent quality assurance standards. For several indications, commercial preparations, evaluated in rigorous clinical trials with children, are now available. Myopia management is joining the list of these indications, with low-concentration atropine formulations derived from recent clinical trials in Australia, USA, and Europe now entering the market. This short article gives an overview of the background and recent developments of compounded and commercial preparations for use in pediatric ophthalmology.
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Affiliation(s)
- Annegret Dahlmann-Noor
- University College London, Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
- National Institute for Health Research Moorfields Biomedical Research Centre, 162 City Road, London, EC1V 2PD, UK.
| | - Jill Bloom
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Saw Keng Lee
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Samiya Chowdhury
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Kanwal Nischal
- The Eye Centre, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA
| | - Dominique Bremond-Gignac
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, Paris, France
- INSERM, UMRS1138, Team 17, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France
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Knol CWJ, Stob PH, Woerdenbag HJ. Development and Implementation of an Ultraviolet-Dye-Based Qualification Procedure for Hand Washing and Disinfection to Improve Quality Assurance of Pharmacy Preparations and Compounding, Especially in Cleanrooms: A Pilot Study. PHARMACY 2024; 12:73. [PMID: 38804465 PMCID: PMC11130823 DOI: 10.3390/pharmacy12030073] [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: 02/29/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Even though, nowadays, most medicines are manufactured industrially, patients may have medical needs that can only be met by a tailor-made approach. This requires the availability of pharmacy preparations made under Good Manufacturing Practice (GMP) conditions. An efficient hand hygiene practice is essential herewith, especially if sterile products that are prepared in a cleanroom are concerned. The effectiveness of hand washing and hand disinfection procedures greatly relies on adequate training. We carried out an observational cross-sectional pilot study aimed at optimizing hand hygiene training with objective and measurable quality assessments using an ultraviolet (UV) dye. Practical acceptance criteria for qualifying personnel through this method were set and evaluated. In total, 25 GMP-qualified cleanroom operators washed and disinfected their hands with UV dye hand wash lotion and UV dye hand alcohol, respectively. To obtain a proof-of-concept, the results were judged based on adherence to the WHO six-step protocol and associated acceptance criteria. Commonly missed areas were brought to light, and the influence of procedure duration was investigated. UV-dye-based assessments appeared to be more valuable in hand disinfection than in hand washing. In both procedures, the back of the hands and the thumbs were frequently missed. This underpins the need for enhanced and repeated education on hand washing and disinfection. Additionally, a dry skin gave rise to extra cleaning challenges. From this pharmacy practice pilot study with a focus on pharmaceutical product care, it may be concluded that the application of UV-dye-based assessments offers valuable insights for pharmacists to optimize hand hygiene, thereby increasing the safety of tailor-made medicines and on-site preparations.
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Affiliation(s)
- Catharina W. J. Knol
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Fagron Sterile Services Nederland, Dieselstraat 3, 7903 AR Hoogeveen, The Netherlands;
| | - Paul H. Stob
- Fagron Sterile Services Nederland, Dieselstraat 3, 7903 AR Hoogeveen, The Netherlands;
| | - Herman J. Woerdenbag
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
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Rahić O, Behrem S, Tucak-Smajić A, Hadžiabdić J, Imamović B, Hindija L, Šahinović M, Vranić E. Sweeteners in Orodispersible Films: How Much is too Much? Drug Res (Stuttg) 2024; 74:180-186. [PMID: 38508227 DOI: 10.1055/a-2266-2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Four natural sweeteners (sucrose, xylitol, fructose, and isomalt) were selected to examine the influence of their qualities and amounts on the characteristics of orodispersible films. Sodium carboxymethylcellulose (2% w/w) was utilized as the film-forming polymer and 1% w/w glycerol as a plasticizer. Films were produced through the solvent casting method, rendering them suitable for convenient application in community or hospital pharmacy settings. The physicochemical and optical properties of the films were analyzed, and Fourier-transform infrared analysis was carried out. All films exhibited acceptable disintegration time, uniformity of mass, thickness, and optical characteristics, with significant dependence (p<0.05) on both sweetener type and quantity. Disintegration time varied based on the employed method, as well as the characteristics and amount of sweetener. Additionally, all films maintained pH values within the oral cavity range, suggesting no potential irritancy upon administration. Fourier-transform infrared analysis confirmed the formation of the film and demonstrated compatibility between its components.
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Affiliation(s)
- Ognjenka Rahić
- University of Sarajevo - Faculty of Pharmacy, Department of Pharmaceutical Technology, Sarajevo, Bosnia and Herzegovina
| | - Sabina Behrem
- University of Sarajevo - Faculty of Pharmacy, Department of Pharmaceutical Technology, Sarajevo, Bosnia and Herzegovina
| | - Amina Tucak-Smajić
- University of Sarajevo - Faculty of Pharmacy, Department of Pharmaceutical Technology, Sarajevo, Bosnia and Herzegovina
| | - Jasmina Hadžiabdić
- University of Sarajevo - Faculty of Pharmacy, Department of Pharmaceutical Technology, Sarajevo, Bosnia and Herzegovina
| | - Belma Imamović
- University of Sarajevo - Faculty of Pharmacy, Department of Drug Analysis, Sarajevo, Bosnia and Herzegovina
| | - Lamija Hindija
- University of Sarajevo - Faculty of Pharmacy, Department of Pharmaceutical Technology, Sarajevo, Bosnia and Herzegovina
| | - Merima Šahinović
- University of Sarajevo - Faculty of Pharmacy, Department of Pharmaceutical Technology, Sarajevo, Bosnia and Herzegovina
| | - Edina Vranić
- University of Sarajevo - Faculty of Pharmacy, Department of Pharmaceutical Technology, Sarajevo, Bosnia and Herzegovina
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Ramtoola Z, Catibusic A, Ameen H, Cullen S, Barlow JW. Evaluation of the type and frequency of extemporaneous formulations dispensed in hospital and community pharmacies. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100380. [PMID: 38146320 PMCID: PMC10749281 DOI: 10.1016/j.rcsop.2023.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023] Open
Abstract
Background Extemporaneous compounding is practiced globally by pharmacists to allow for dispensing of personalised doses of medicinal products not commercially available. Extemporaneous compounding must result in a product which is safe and effective. However, data on formulation and expiry of extemporaneous products may not be readily available. Pharmacists access various resources including compounding databases to obtain information on composition, preparation, and expiry of extemporaneous preparations. Objectives The aim of this study was to evaluate the type and frequency of extemporaneous compounding in hospital and community pharmacies in the Republic of Ireland (ROI) and to obtain contemporary information on compounding practices and resources used. Methods All community and hospital pharmacists registered with the Pharmaceutical Society of Ireland, were invited to participate in an on-line survey. The study was approved by the Royal College of Surgeons in Ireland (RCSI) research ethics committee. Results A total of 202 pharmacists responded to the survey, of which 145 were community-based, 52 hospital-based, and 5 practicing in both. On average, hospital and community pharmacists (n = 138) dispensed <2-10 prescriptions for extemporaneous products per month. Pharmacists reported compounding 13 different types of extemporaneous preparations. Of these, dermatological preparations and oral liquid formulations (OLFs) were most commonly compounded. Extemp.ie, an Irish compounding database, was the most frequently used resource for compounding guidance and product expiry. Conclusions The results of this study show that extemporaneous compounding is still practiced in hospital and community pharmacies in the ROI. The limited response of 4.6% obtained may reflect that extemporaneous compounding is concentrated in a relatively small number of pharmacies. There remains a clinical need for extemporaneous products in the ROI and extemporaneous compounding continues to be an invaluable skillset for pharmacists.
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Affiliation(s)
- Zebunnissa Ramtoola
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 111 St. Stephen's Green, Dublin 2, Ireland
| | - Ayumi Catibusic
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 111 St. Stephen's Green, Dublin 2, Ireland
| | - Hitam Ameen
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 111 St. Stephen's Green, Dublin 2, Ireland
| | - Sarah Cullen
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 111 St. Stephen's Green, Dublin 2, Ireland
| | - James W. Barlow
- Department of Chemistry, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
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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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Banov D, Liu Y, Ip K, Shan A, Vu C, Zdoryk O, Bassani AS, Carvalho M. Analysis of the Physical Characteristics of an Anhydrous Vehicle for Compounded Pediatric Oral Liquids. Pharmaceutics 2023; 15:2642. [PMID: 38004620 PMCID: PMC10674891 DOI: 10.3390/pharmaceutics15112642] [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: 09/04/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
The paucity of suitable drug formulations for pediatric patients generates a need for customized, compounded medications. This research study was set out to comprehensively analyze the physical properties of the new, proprietary anhydrous oral vehicle SuspendIt® Anhydrous, which was designed for compounding pediatric oral liquids. A wide range of tests was used, including sedimentation volume, viscosity, droplet size after dispersion in simulated gastric fluid, microscopic examination and content uniformity measurements to evaluate the properties of the anhydrous vehicle. The results showed that the vehicle exhibited consistent physical properties under varying conditions and maintained stability over time. This can be attributed to the unique blend of excipients in its formulation, which not only maintain its viscosity but also confer thixotropic behavior. The unique combination of viscous, thixotropic and self-emulsifying properties allows for rapid redispersibility, sedimentation stability, accurate dosing, potential drug solubility, dispersion and promotion of enhanced gastrointestinal distribution and absorption. Furthermore, the vehicle demonstrated long-term sedimentation stability and content uniformity for a list of 13 anhydrous suspensions. These results suggest that the anhydrous oral vehicle could serve as a versatile base for pediatric formulation, potentially filling an important gap in pediatric drug delivery. Future studies can further investigate its compatibility, stability and performance with other drugs and in different clinical scenarios.
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Affiliation(s)
- Daniel Banov
- Professional Compounding Centers of America (PCCA), Houston 77099, TX, USA
| | - Yi Liu
- Professional Compounding Centers of America (PCCA), Houston 77099, TX, USA
| | - Kendice Ip
- Professional Compounding Centers of America (PCCA), Houston 77099, TX, USA
| | - Ashley Shan
- Professional Compounding Centers of America (PCCA), Houston 77099, TX, USA
| | - Christine Vu
- Professional Compounding Centers of America (PCCA), Houston 77099, TX, USA
| | - Oleksandr Zdoryk
- Institute for Pharma Technology, School of Life Sciences, University of Applied Sciences und Arts Northwestern Switzerland, 4132 Muttenz, Switzerland
- Department of Pharmaceutical Technologies and Medicines Quality Assurance, Institute of the Professional Skills Improvement in the Field of Pharmacy, National University of Pharmacy, 61002 Kharkiv, Ukraine
| | - August S. Bassani
- Professional Compounding Centers of America (PCCA), Houston 77099, TX, USA
| | - Maria Carvalho
- Professional Compounding Centers of America (PCCA), Houston 77099, TX, USA
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Patel A, Nguyen CM, Willins K, Wang EY, Magedman G, Yang S. Improving Pharmacist-Led Pediatric Patient Education on Oral Chemotherapy at Home. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1656. [PMID: 37892319 PMCID: PMC10605141 DOI: 10.3390/children10101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023]
Abstract
Oral chemotherapy (OC) has been increasingly used in pediatric patients diagnosed with cancer, which is primarily managed in the outpatient setting. Different from adults, pediatric patients face unique challenges in administering these hazardous medications at home. Because of the complexity of pediatric pharmaceutical care and the hazardous nature of chemotherapy agents, comprehensive patient education is imperative to mitigate the potential safety risks associated with OC administration at home. Pharmacists play a vital role in patient education and medication consultations. However, the lack of practice guidelines and limited resources supporting OC counseling are noted. Additional barriers include insufficient knowledge and training on OC, which can be improved by continuing education. In a regional children's hospital, a comprehensive OC education checklist was developed for pediatric patients and their caregivers to standardize consultations led by pharmacists. An infographic OC handout was also formulated to improve patient knowledge and awareness. Moreover, innovative approaches such as using telepharmacy, smartphone applications, and artificial intelligence have been increasingly integrated into patient care, which can help optimize OC consultations for children and adolescents. Further studies are warranted to enhance oral chemotherapy education specifically tailored for pediatric patients in outpatient settings.
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Affiliation(s)
- Anika Patel
- School of Pharmacy, Chapman University, Irvine, CA 92618, USA
| | | | - Kristin Willins
- School of Pharmacy, Chapman University, Irvine, CA 92618, USA
| | - Elsabella Y. Wang
- Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA 92093, USA
| | | | - Sun Yang
- School of Pharmacy, Chapman University, Irvine, CA 92618, USA
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Chachlioutaki K, Gioumouxouzis C, Karavasili C, Fatouros DG. Small patients, big challenges: navigating pediatric drug manipulations to prevent medication errors - a comprehensive review. Expert Opin Drug Deliv 2023; 20:1489-1509. [PMID: 37857515 DOI: 10.1080/17425247.2023.2273838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Medication errors during drug manipulations in pediatric care pose significant challenges to patient safety and optimal medication management. Epidemiological studies have revealed a high prevalenceof medication errors throughout the medication process. Due to the lack of age-appropriate dosage forms, medication manipulation is common in pediatric drug administration. The consequences of these manipulations on drug efficacy and safety could be devastating, highlighting the need for evidence-based guidelines and standardized compounding practices. AREAS COVERED This review focuses on examining medication errors in pediatric care and delving into the manipulation of medicinal products. EXPERT OPINION The observed prevalence of medication errors and manipulations underscores the importance of addressing these issues to enhance patient safety and improve medication outcomes in pediatric care. Overall, the development of age-appropriate formulations and the dissemination of comprehensive clinical guidelines are essential steps toward improving medication safety and minimizing manipulations in pediatric healthcare settings.
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Affiliation(s)
- Konstantina Chachlioutaki
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
| | - Christos Gioumouxouzis
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Karavasili
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Fatouros
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
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Fukumori C, Branco PC, Barreto T, Ishida K, Lopes LB. Development and cytotoxicity evaluation of multiple nanoemulsions for oral co-delivery of 5-fluorouracil and short chain triglycerides for colorectal cancer. Eur J Pharm Sci 2023; 187:106465. [PMID: 37178734 DOI: 10.1016/j.ejps.2023.106465] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer in the world, but current chemotherapy options are limited due to adverse effects and low oral bioavailability of drugs. In this study, we investigated the obtainment parameters and composition of new multiple nanoemulsions (MN) based on microemulsions for oral co-delivery of 5-fluorouracil (5FU) and short-chain triglycerides (SCT, either tributyrin or tripropionin). The area of microemulsion formation was increased from 14% to 38% when monocaprylin was mixed with tricaprylin as oil phase. Addition of SCT reduced this value to 24-26%. Using sodium alginate aqueous dispersion as internal aqueous phase (to avoid phase inversion) did not further affected the area but increased microemulsion viscosity by 1.5-fold. To obtain the MN, selected microemulsions were diluted in an external aqueous phase; droplet size was 500 nm and stability improved using polyoxyethylene (den Besten et al., 2013) oleyl ether at 1-2.5% as surfactant in the external phase and a dilution ratio of 1:1 (v/v). 5FU in vitro release could be better described by the Korsmeyer-Peppas model. No pronounced changes in droplet size were observed when selected MNs were incubated in buffers mimicking gastrointestinal fluids. The 5FU cytotoxicity in monolayer cell lines presenting various mutations was influenced by its incorporation in the nanocarrier, presence of SCT and cell mutation status. The MNs selected reduced the viability of tumor spheroids (employed as 3D tumor models) by 2.2-fold compared to 5FU solution and did not affect the survival of the G. mellonella, suggesting effectiveness and safety.
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Affiliation(s)
- Claudio Fukumori
- Department of Pharmacology, Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | - Paola Cristina Branco
- Department of Pharmacology, Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | - Thayná Barreto
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Kelly Ishida
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Luciana B Lopes
- Department of Pharmacology, Institute of Biomedical Sciences, University of Sao Paulo, Brazil.
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