Carbamazepine Therapy After Bariatric Surgery: Eight Sleeve Gastrectomy Cases and Review of the Literature

Bariatric surgery modifies the anatomy and physiology of the gastrointestinal tract. Carbamazepine (CBZ) is an anticonvulsant with multiple neuropsychiatric indications. Given CBZ physicochemical properties and narrow therapeutic index, bariatric surgery may potentially introduce clinically significant changes in CBZ oral absorption and bioavailability. In this communication, we describe eight patients undergoing sleeve gastrectomy (SG) and treated with CBZ, including therapeutic drug monitoring (TDM) and dosage adjustments at different timeframes before vs. after the surgery (< 3, 4-6, and 7-12 months post-SG), as well as clinical outcomes. We then provide a review of the available literature on CBZ therapy among bariatric patients, concluding with a mechanistic analysis of the results. Four of the eight patients presented with decreased post-SG CBZ levels, and two of them also experienced significant worsening of their previously well-controlled disease. Overall, altered CBZ levels are likely for at least a year after SG. Clinical recommendations include consultation with a clinical pharmacist, careful clinical monitoring, and periodic TDM after (vs. before) the bariatric surgery.

Dose-independent drug release from 3D printed oral medicines for patient-specific dosing to improve therapy safety

Fused deposition modelling (FDM) 3D printing provides the ability to address individual patients' therapeutic needs without having to change the formulation every time. This is particularly interesting for dosing and release modelling. In this study, a geometry model was developed that can represent variable dosages while keeping the surface area to volume (SA/V) ratio alike, so the drug release profiles remain similar. The model was tested on three different formulations. Two BCS I active pharmaceutical ingredients (API), pramipexole and levodopa, and one BCS II API, praziquantel, were used. Polyvinyl alcohol (PVA, water soluble) and a combination of vinylpyrrolidone-vinyl acetate copolymer (PVP-VA, water soluble) and ethylene-vinyl acetate (EVA, water insoluble) were used as the polymer matrix. The curves were compared using the similarity factor (f₂ value) and mean dissolution time (MDT). Using a hollow cylinder-based (HCb) geometry model, a dose-independent drug release could be realized. For the PVA formulations, an 8-fold dose change could be obtained and for the EVA-PVP-VA formulation a factor of 5.5 could be achieved, with f₂ > 50. Due to the layer structure of the printed objects, very fine dose variation of 0.13 mg per layer is possible within these models. This allows variable dosing in small steps with only one basis formulation.

Experimental determination of the velocity distribution in USP Apparatus 1 (basket apparatus) using Particle Image Velocimetry (PIV)

The USP Apparatus 1 (basket apparatus) is commonly used to evaluate the dissolution performance of oral solid dosage forms. The hydrodynamics generated by the basket contributes, in general, to the dissolution rate and hence the dissolution results. Here, the hydrodynamics of Apparatus 1 was quantified in a vessel filled with 900-mL de-ionized water at room temperature by determining, via Particle Image Velocimetry (PIV), the velocity profiles on a vertical central plane and on 11 horizontal planes at different elevations at three different basket agitation speeds. The flow field was dominated by the tangential velocity component and was approximately symmetrical in all cases. Despite all precautions taken, small flow asymmetries were observed in the axial and radial directions. This appears to be an unavoidable characteristic of the flow in Apparatus 1. The magnitudes of the axial and radial velocity components varied with location but were always low. A small jet was seen emanating radially near the top edge of the basket. Velocities typically scaled well with increasing agitation speed in most regions of the vessel except for a region directly below the basket. The results of this work provide a major insight into the flow field inside the USP Apparatus 1.

Fasted and fed state human duodenal fluids: Characterization, drug solubility, and comparison to simulated fluids and with human bioavailability

Accurate in vivo predictions of intestinal absorption of low solubility drugs require knowing their solubility in physiologically relevant dissolution media. Aspirated human intestinal fluids (HIF) are the gold standard, followed by simulated intestinal HIF in the fasted and fed state (FaSSIF/FeSSIF). However, current HIF characterization data vary, and there is also some controversy regarding the accuracy of FaSSIF and FeSSIF for predicting drug solubility in HIF. This study aimed at characterizing fasted and fed state duodenal HIF from 16 human volunteers with respect to pH, buffer capacity, osmolarity, surface tension, as well as protein, phospholipid, and bile salt content. The fasted and fed state HIF samples were further used to investigate the equilibrium solubility of 17 representative low-solubility small-molecule drugs, six of which were confidential industry compounds and 11 were known and characterized regarding chemical diversity. These solubility values were then compared to reported solubility values in fasted and fed state HIF, FaSSIF and FeSSIF, as well as with their human bioavailability for both states. The HIF compositions corresponded well to previously reported values and current FaSSIF and FeSSIF compositions. The drug solubility values in HIF (both fasted and fed states) were also well in line with reported solubility data for HIF, as well as simulated FaSSIF and FeSSIF. This indicates that the in vivo conditions in the proximal small intestine are well represented by simulated intestinal fluids in both composition and drug equilibrium solubility. However, increased drug solubility in the fed vs. fasted states in HIF did not correlate with the human bioavailability changes of the same drugs following oral administration in either state.

A moving-boundary model of dissolution from binary drug-excipient granules incorporating microstructure

Accurate mechanistic in vitro dissolution models can deliver insight into drug release behaviour and guide formulation development. Drug release profiles from drug-excipient granules can be impacted by variation of porosity and drug load within granules, which may arise from inherent variability in granulation processes. Here, we analyse and validate a recent model of drug release from a single spherical granule with a matrix of insoluble excipient, incorporating radial variation of porosity and drug load. The model is presented and specialised to the case where the initial drug load is large compared to the capacity of the granule's pores at solubility. In this limit, the model reduces to a single ordinary differential equation describing depletion of a shrinking, drug-saturated core. Model validation is performed using drug release data from the literature for a granule system consisting of acetaminophen and microcrystalline cellulose. A new extended model to describe dissolution from a polydisperse collection of granules is derived. The performance is compared to single particle models using equivalent spherical diameters. The developed model provides a new tool to explore the dissolution parameter space for these systems and for considering the impact of radial variation of granule porosity and drug load arising from manufacturing processes.

Fabrication and characterisation of melt-extruded chitosan/keratin/PCL/PEG drug-eluting sutures designed for wound healing

Diclofenac potassium loaded sutures based upon PEG/PCL/chitosan-keratin blends were fabricated using the hot-melt extrusion technique. Polymer sutures were evaluated based on their physical, thermal and mechanical properties, while the drug-eluting sutures were evaluated for drug release properties. Lastly, the performance of the drug-loaded sutures in the contact with the human keratinocyte cell line HaCat were assessed. Results showed that the sutures extruded homogeneously at a temperature of 63 ± 1 °C providing a uniform thickness of fibres. Analysis by Differential Scanning Calorimetry (DSC) and Thermogravimetric Analysis (TGA) showed that completely amorphous and miscible solid dispersions were created. Fourier transform infrared (FTIR) spectroscopy indicated that the presence of hydrogen bonds between the polymers improved material miscibility. Tensile properties of the sutures were clearly affected by the PEG, chitosan and keratin additions. The optimal formulation of tensile strength was obtained when PCL/PEG/chitosan-keratin were combined at a ratio of 80/19/1 w/w. Rapid and sustained drug release rates were achieved with the PEG/PCL/chitosan/keratin blends at various combinations. The composite of PCL/PEG/chitosan-keratin with 30 wt% of diclofenac potassium also exhibited high cell viability and wound healing rates in vitro cytotoxicity testing. The anti-inflammatory properties imparted by the PCL/PEG/chitosan/keratin/drug sutures may further the use of composite sutures for wound healing in clinical settings.

A Soluplus/Poloxamer 407-based self-nanoemulsifying drug delivery system for the weakly basic drug carvedilol to improve its bioavailability

Carvedilol (CAR), a β-adrenoceptor and α1-receptor blocker, has pH-dependent solubility, which greatly limits its oral bioavailability. In this work, a precipitation inhibitor-based self-nanoemulsifying drug delivery system (PI-SNEDDS) was developed by employing Soluplus and Poloxamer 407 to improve drug dissolution and to inhibit drug precipitation in the gastrointestinal tract. In vitro phase distribution and in vivo dissolution studies indicated that PI-SNEDDS significantly increased drug content in the oil phase of the nanoemulsions in the stomach and greatly inhibited the subsequent precipitation of CAR in the intestine compared with the carvedilol self-nanoemulsifying drug delivery system (CAR SNEDDS) and the carvedilol tablets. Moreover, a 1.56-fold increase in the relative bioavailability of CAR was observed for the CAR PI-SNEDDS (397.41%) compared to a CAR SNEDDS (254.09%) with commercial capsules as a reference. Therefore, our developed PI-SNEDDS is a promising vehicle for improving the dissolution and bioavailability of poorly soluble drugs with pH-dependent solubility.

Self-assembled PEGylated albumin nanoparticles (SPAN) as a platform for cancer chemotherapy and imaging

Paclitaxel (PTX) is used as a major antitumor agent for the treatment of recurrent and metastatic breast cancer. For the clinical application of PTX, it needs to be dissolved in an oil/detergent-based solvent due to its poor solubility in an aqueous medium. However, the formulation often causes undesirable complications including hypersensitivity reactions and limited tumor distribution, resulting in a lower dose-dependent antitumor effect. Herein, we introduce a facile and oil-free method to prepare albumin-based PTX nanoparticles for efficient systemic cancer therapy using a conjugate of human serum albumin (HSA) and poly(ethyleneglycol) (PEG). PTX were efficiently incorporated in the self-assembled HSA-PEG nanoparticles (HSA-PEG/PTX) using a simple film casting and re-hydration procedure without additional processes such as application of high pressure/shear or chemical crosslinking. The spherical HSA-PEG nanoparticle with a hydrodynamic diameter of ca. 280 nm mediates efficient cellular delivery, leading to comparable or even higher cytotoxicity in various breast cancer cells than that of the commercially available Abraxane^®. When systemically administered in a mouse xenograft model for human breast cancer, the HSA-PEG-based nanoparticle formulation exhibited an extended systemic circulation for more than 96 h and enhanced intratumoral accumulation, resulting in a remarkable anticancer effect and prolonged survival of the animals.

Polyethylene glycol functionalized carbon nanotubes/gelatin-chitosan nanocomposite: An approach for significant drug release

This research work blooms the new idea of developing a safe and controlled drug releasing matrix using multi-walled carbon nanotubes (MWCNTs). In aqueous solution, uniform and highly stable dispersion of MWCNTs was obtained after secondary functionalization with polyethylene glycol (PEG) which was studied by Fourier transmission infrared spectroscopy (FTIR) and thermogravimetric analysis (TGA). Solution casting method was used to prepare MWCNTs/gelatin-chitosan nanocomposite films and the effect of MWCNTs on physico-mechanical, thermal and water uptake properties of the nanocomposites were evaluated. Incorporation of MWCNTs into the porous gelatin-chitosan matrix showed interesting stiffness and dampness along with developed microfibrillar structures within the pore walls intended at being used in tissue engineering of bone or cartilage. A common antibiotic drug, ciprofloxacin was incorporated into nanocomposite matrix. The evaluation of the effect of MWCNTs on drug release rate by dissolution test and antimicrobial susceptibility test was performed. Sharp release of the drug was found at early stages (∼1 h), but the rate was reduced afterwards, showing a sustained release. It was observed that for all microorganisms, the antibacterial activities of drug loaded MWCNTs/gelatin-chitosan nanocomposites were higher than that of drug loaded gelatin-chitosan composite films containing no MWCNTs. Comparative statistical studies by ANOVA techniques also showed remarkable difference between the antibacterial activities, exhibited by MWCNTs-incorporated and non-incorporated composite films.

A compact, portable, re-configurable, and automated system for on-demand pharmaceutical tablet manufacturing

Due to the complex nature of the pharmaceutical supply chain, the industry faces several major challenges when it comes to ensuring an adequate supply of quality drug products. These challenges are not only the causes of supply chain disruptions and financial loss, but can also prevent underserved and remote areas from receiving life-saving drugs. As a preliminary demonstration to mitigate all these challenges, at MIT we have developed active pharmaceutical ingredients manufacturing in a miniature platform. However, manufacturing of final oral solid dosage as tablets from drug substances had not been demonstrated. In this study, a compact, portable, re-configurable, and automated tablet manufacturing system, roughly the size of a North American household oven, [72.4 cm (length) × 53.3 cm (width) × 134.6 cm (height)] was designed, built and demonstrated. This miniature system is able to manufacture on-demand tablets from drug crystals on a scale of hundreds to thousands per day. Ibuprofen and Diazepam, each having different drug loading, were manufactured using this miniature system and meet U.S. Pharmacopeia standards. We foresee this flexible, miniature, plug-and-play pharmaceutical solids dosage manufacturing system advancing on-demand ready-to-use pharmaceuticals enabling future treatment of human diseases at the point-of-care.

In-vitro study of Ketoprofen Release from Synthesized Silica Aerogels (as Drug Carriers) and Evaluation of Mathematical Kinetic Release Models

Silica aerogels are porous and extremely lightweight nano-materials that show interesting properties. These materials, because of biocompatibility, non-harmful to the body, and special physical characteristics such as large surface area and low density have great potential for use in a drug delivery system (DDS). The focus of this study is the evaluation of the effects of silica aerogels on improving the release rate of Ketoprofen as a relevant model drug of poorly soluble drugs in water. The in-vitro release rate of a conventional crystalline form of pure drug and three samples of drug loaded silica aerogels with different densities, 0.033, 0.080, and 0.24 g/cm³ were measured and investigated. The results show that all three samples of silica aerogels considerably increased (p < 0.05) the rate of drug release compared to its crystalline form. The silica aerogel sample with the lowest density (0.033 gr/cm³) has demonstrated the highest release rate of the drug (approximately five times faster than pure drug). Thus, silica aerogels could be acceptable carriers for poorly soluble drugs that require treatment with the fast release. Moreover, three release kinetic models were fitted with in-vitro drug release data and evaluated. The results indicate that the First-Order model is the best fit with the in-vitro Ketoprofen release data. Finally, in this article, a new kinetic release equation was obtained based on the first order model and release data, with applying the density of silica aerogel as an effective index parameter. This equation was proposed to describe Ketoprofen release rate in silica aerogels.

[Potential of allogeneic bone grafts as antibiotic carriers : Effect of different preparation processes on efficacy]

BACKGROUND

The rising number of primary joint replacements worldwide is causing an increase of endoprosthetic revision surgery due bacterial infection. Revision surgery using non-cemented implants seems beneficial for the long-term outcome, and the use of antibiotic-impregnated bone grafts might control the infection and provide a good support for the implant. In this study, we evaluated the release of antibiotics from fresh-frozen and lyophilized allogeneic bone grafts.

METHODS

Heat-treated, lyophilized and fresh frozen cryopreserved bone chips were impregnated with gentamicin sulphate, gentamicin palmitate and vancomycin, and calcium carbonate/calcium sulphate treated with antibiotics. The efficacy of each preparation was measured by drug release tests and bacterial susceptibility using B. subtilis, S. aureus and methicillin-resistant Staphylococcus aureus.

RESULTS

The release of gentamicin from lyophilized bone was similar to the release rate from fresh frozen bone during the entire experiment. This might be related to the similar porosity and microstructure of the bone chips. The release of gentamicin from lyophilized and fresh frozen bone was high on the first and second days, then decreased and stayed at a low rate until the end of the second week.

CONCLUSION

Depending on the surgical strategy, either polymethylmethacrylate or allogeneic bone are able to deliver sufficient concentrations of gentamicin to achieve bacterial inhibition within 2 weeks after surgery. In the case of uncemented revision of joint replacements, allogeneic bone can deliver therapeutic doses of gentamicin and peak levels immediately and a fortnight after implantation.

Effect of hydrophobic inclusions on polymer swelling kinetics studied by magnetic resonance imaging

The rate of drug release from polymer matrix-based sustained release formulations is often controlled by the thickness of a gel layer that forms upon contact with dissolution medium. The effect of formulation parameters on the kinetics of elementary rate processes that contribute to gel layer formation, such as water ingress, polymer swelling and erosion, is therefore of interest. In the present work, gel layer formation has been investigated by magnetic resonance imaging (MRI), which is a non-destructive method allowing direct visualization of effective water concentration inside the tablet and its surrounding. Using formulations with Levetiracetam as the active ingredient, HPMC as a hydrophilic matrix former and carnauba wax (CW) as a hydrophobic component in the matrix system, the effect of different ratios of these two ingredients on the kinetics of gel formation (MRI) and drug release (USP 4 like dissolution test) has been investigated and interpreted using a mathematical model.

Raman imaging of drug delivery systems

This review article includes an introduction to the principals of Raman spectroscopy, an outline of the experimental systems used for Raman imaging and the associated important considerations and limitations of this method. Common spectral analysis methods are briefly described and examples of interesting published studies which utilised Raman imaging of pharmaceutical and biomedical devices are discussed, along with summary tables of the literature at this point in time.

Biorelevant dissolution of poorly soluble weak acids studied by UV imaging reveals ranges of fractal-like kinetics

Much pharmaceutical research has been invested into drug dissolution testing and its mathematical modeling. Even today, there is no complete understanding of the dissolution process but novel imaging tools have been introduced into pharmaceutics that may spur further scientific advancement. We used UV imaging to study the intrinsic dissolution of various poorly soluble acidic model drugs to understand the effects of heterogeneity on early intrinsic drug dissolution using a biorelevant medium: celecoxib, ketoprofen, naproxen, and sulfathiazole. All compounds were characterized using X-ray powder diffraction and thermal analysis. Raman spectroscopy and scanning electron microscopy were employed before and after the initial dissolution phase. As a result, ranges of fractal-like dissolution behavior were found with all model compounds. Intrinsic dissolution rate exhibited a power law mainly at early time points. Subsequently, after several minutes, pseudo-equilibrium was reached with a nearly constant dissolution rate. Further research should investigate whether compounds other than acids demonstrate similar early dissolution kinetics in biorelevant media. The observed fractal-like intrinsic dissolution behavior has several pharmaceutical implications. This study primarily helps us to better understand in vitro dissolution testing, particularly on a miniaturized scale. This improved understanding of early dissolution events may advance future correlations with in vivo data. Therefore, fractal-like dissolution should be considered during biopharmaceutical modeling.