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Huang R, Zhu D, Wang J, Berko Y, Yu PA, Parker CM, Yu YC, Feng X, Xu X, Ashraf M. Food selection and effect of home preparation procedure for antibiotic food mixtures on homogeneity, stability, and dissolution. Int J Pharm 2024; 655:123993. [PMID: 38484862 DOI: 10.1016/j.ijpharm.2024.123993] [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: 12/04/2023] [Revised: 02/23/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
Amoxicillin, doxycycline, and clindamycin are among the commonly used antibiotics to treat bacterial infections. However, dosage forms of antibiotics for pediatric patients may not be as readily available as the formulations for adult patients. As such, it is anticipated that during a public health emergency, special instruction may need to be provided on home preparation and administration procedures to dose pediatric patients using available stockpiles of oral tablet and capsule dosage forms. Mixing crushed tablets or capsule contents with soft- or liquid- foods is one of the most common home preparation procedures. To gain knowledge for safe and effective use of prepared drug product instead of the intended intact dosage form, the impact of manipulation of the dosage form was studied. Capsule opening, capsule content assay and uniformity, dissolution, homogeneity, and stability studies of drug mixed with various liquid and soft foods were carried out using intact capsules of amoxicillin, doxycycline, and clindamycin. Higher recovery of capsule contents was achieved when using hands or knives to open capsules compared to using scissors. The capsules of all three antibiotic products contained the labeled amount of active pharmaceutical ingredients (API). The peanut butter-drug mixtures failed both United States Pharmacopeia (USP) assay and dissolution criteria because the peanut butter significantly affected the solubility of the drugs, and hence it was omitted from further study. All drug-food mixtures of the three antibiotic products and 15 selected foods exhibited fast dissolution (e.g., >80 % in 60 min) in the tested medium, except for the amoxicillin-chocolate pudding mixture. Three household containers (cups, plates, and bowls) and four mixing times (0.5 min, 1 min, 2 min, and 5 min) were found to be suitable for preparation of homogeneous mixtures of the antibiotics and foods. For practical purposes, 1 to 2 min mixing time is sufficient to produce homogeneous mixtures. The results of this study provided product quality data on the interactions between the antibiotics and the foods and can potentially support future development of home preparation instructions of antibiotics for pediatric patients or patients with swallowing difficulties.
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Affiliation(s)
- Rong Huang
- FDA, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, USA
| | - Dongkai Zhu
- FDA, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, USA
| | - Jiang Wang
- FDA, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, USA
| | - Yvonne Berko
- FDA, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, USA
| | - Patricia A Yu
- CDC, National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, USA
| | - Corinne M Parker
- CDC, National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, USA
| | - Yon C Yu
- CDC, National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, USA
| | - Xin Feng
- FDA, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, USA
| | - Xiaoming Xu
- FDA, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, USA
| | - Muhammad Ashraf
- FDA, Center for Drug Evaluation and Research, Office of Pharmaceutical Quality, Office of Testing and Research, USA.
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Watanabe H, Nagano N, Tsuji Y, Noto N, Ayusawa M, Morioka I. Challenges of pediatric pharmacotherapy: A narrative review of pharmacokinetics, pharmacodynamics, and pharmacogenetics. Eur J Clin Pharmacol 2024; 80:203-221. [PMID: 38078929 DOI: 10.1007/s00228-023-03598-x] [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: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Personalized pharmacotherapy, including for the pediatric population, provides optimal treatment and has emerged as a major trend owing to advanced drug therapeutics and diversified drug selection. However, it is essential to understand the growth and developmental characteristics of this population to provide appropriate drug therapy. In recent years, clinical pharmacogenetics has accumulated knowledge in pediatric pharmacotherapy, and guidelines from professional organizations, such as the Clinical Pharmacogenetics Implementation Consortium, can be consulted to determine the efficacy of specific drugs and the risk of adverse effects. However, the existence of a large knowledge gap hinders the use of these findings in clinical practice. METHODS We provide a narrative review of the knowledge gaps in pharmacokinetics (PK) and pharmacodynamics (PD) in the pediatric population, focusing on the differences from the perspective of growth and developmental characteristics. In addition, we explored PK/PD in relation to pediatric clinical pharmacogenetics. RESULTS The lack of direct and indirect biomarkers for more accurate assessment of the effects of drug administration limits the current knowledge of PD. In addition, incorporating pharmacogenetic insights as pivotal covariates is indispensable in this comprehensive synthesis for precision therapy; therefore, we have provided recommendations regarding the current status and challenges of personalized pediatric pharmacotherapy. The integration of clinical pharmacogenetics with the health care system and institution of educational programs for health care providers is necessary for its safe and effective implementation. A comprehensive understanding of the physiological and genetic complexities of the pediatric population will facilitate the development of effective and personalized pharmacotherapeutic strategies.
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Affiliation(s)
- Hirofumi Watanabe
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Kami-cho Ooyaguchi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Kami-cho Ooyaguchi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuhiro Tsuji
- Laboratory of Clinical Pharmacometrics, School of Pharmacy, Nihon University, Chiba, Japan
| | - Nobutaka Noto
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Kami-cho Ooyaguchi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Kami-cho Ooyaguchi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Kami-cho Ooyaguchi, Itabashi-ku, Tokyo, 173-8610, Japan
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Freerks L, Arien T, Mackie C, Inghelbrecht S, Klein S. A toolbox for mimicking gastrointestinal conditions in children: Design and evaluation of biorelevant dissolution media for mimicking paediatric gastric- and small intestinal conditions. Eur J Pharm Biopharm 2023; 193:144-157. [PMID: 37852543 DOI: 10.1016/j.ejpb.2023.10.011] [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: 08/10/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
The goal of the present work was to develop an in vitro toolbox to evaluate the oral administration of dosage forms to children of different age groups and under different administration conditions (fasted/fed). Based on current data on the gastrointestinal physiology of children, a set of new biorelevant media was designed to mimic the composition and physicochemical properties of resting gastric and resting small intestinal fluid in children of different age groups. In addition, guidelines were developed on how to generate fasted and fed state gastric and small intestinal fluids by combining these media with age-specific drinking volumes or portions of already established simulated paediatric breakfast meals, respectively. These fluids can simulate the conditions in the paediatric stomach and small intestine after administration of a dosage form in the fasting state or after a breakfast. The in vitro toolbox was evaluated using the example of pre-school children with a total of five paediatric medicines. Results from the corresponding set of in vitro studies highlight the importance of addressing patient-specific characteristics rather than downscaling existing adult in vitro models.
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Affiliation(s)
- Lisa Freerks
- Department of Pharmacy, University of Greifswald, 17489 Greifswald, Germany
| | - Tina Arien
- Janssen Pharmaceutica NV, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - Claire Mackie
- Janssen Pharmaceutica NV, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | | | - Sandra Klein
- Department of Pharmacy, University of Greifswald, 17489 Greifswald, Germany.
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Lemarchand C, Bienaymé H, Rieutord A, Abbou S, Annereau M, Bastid J. Dispensing Oral Temozolomide in Children: Precision and Stability of a Novel and Ready to Use Liquid Formulation in Comparison with Capsule Derived Mixtures. Pharmaceutics 2023; 15:2711. [PMID: 38140052 PMCID: PMC10747876 DOI: 10.3390/pharmaceutics15122711] [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: 10/16/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Temozolomide (TMZ) is part of the therapeutic armamentarium used in managing pediatric cancers; however, available oral forms (capsules) are not adapted for use in children. Our aim was to assess the dose accuracy and stability of TMZ using capsule contents mixed with food compared with a novel, ready-to-use liquid formulation specifically developed for children (Ped-TMZ, brand name KIZFIZO). Dose accuracy and TMZ stability testing were performed with TMZ capsule contents (90 mg) mixed with food vehicles (apple juice, apple sauce, cream, milk, and mashed potatoes) and compared to an equivalent dose of Ped-TMZ. Acceptance criteria were predefined for TMZ (95.0-105.0%) and its degradation product amino-imidazole-carboxamide (AIC; <1%) content. The delivered dose was significantly higher using Ped-TMZ (96.6 ± 1.2%) and within the predefined criteria for TMZ content, whereas it was systematically under the lower specifications of 95% using capsule-derived preparations with apple juice (91.0 ± 1.5%) and apple sauce (91.6 ± 1.4%), respectively (p < 0.0001). In chemical stability tests, the four food vehicles (apple sauce, cream, milk, mashed potatoes) had a significant effect on TMZ stability (p = 0.0042), and the AIC significantly increased with time in three of the four vehicles (p < 0.0001). Only 1/72 of preparations from capsules met the predefined acceptance criteria, whereas Ped-TMZ showed no TMZ loss, and the AIC remained within specifications. In conclusion, mixing TMZ capsule content with food may result in significant underexposure, possibly even greater in routine practice, as complete food intake by the child is unlikely.
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Affiliation(s)
| | | | - André Rieutord
- Clinical Pharmacy Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (A.R.); (M.A.)
| | - Samuel Abbou
- Children and Adolescent Oncology Department, INSERM U1015, Paris-Saclay University, 94805 Villejuif, France;
| | - Maxime Annereau
- Clinical Pharmacy Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (A.R.); (M.A.)
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Gotoh Y, Tabata Y, Sugiura S, Obara M, Tomita T, Suzuki T. Yoghurt as a deglutition aid for oral medication: effects on famotidine powder dissolution rate and pharmacokinetics. Sci Rep 2023; 13:1993. [PMID: 36737669 PMCID: PMC9898255 DOI: 10.1038/s41598-023-29258-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Deglutition aid foods are used to help patients with dysphagia take oral medications. Yoghurt is occasionally used to help swallow medications; however, its influence on pharmacokinetics is poorly understood. Yoghurt made with Lactococcus cremoris subsp. cremoris FC has a characteristic viscous texture that facilitates bolus formation and deglutition due to its metabolite exopolysaccharide. We assessed yoghurt prepared with L. cremoris FC as a food deglutition aid. We performed a dissolution test using famotidine powder mixed with yoghurt and a food thickener. Famotidine dissolution rates without deglutition-assisting foods and with yoghurt or food thickener were 102.3 ± 1.7, 85.7 ± 4.6, and 46.4 ± 1.1% after 15 min, respectively. Next, we orally administered famotidine powder with water, yoghurt, and food thickener to rats and measured plasma famotidine levels. We observed no significant differences between all test groups. The Tmax of famotidine mixed with a food thickener was significantly lower than that with yoghurt. These results suggest that yoghurt with L. cremoris FC did not remarkably affect the dissolution and pharmacokinetic profiles of famotidine powder. Thus, the administration of famotidine with yoghurt might be a suitable alternative to powder administration as a deglutition aid for patients.
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Affiliation(s)
- Yayoi Gotoh
- Fujicco Co., Ltd., 6-13-4 Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-8558, Japan
| | - Yoshiyuki Tabata
- Fujicco Co., Ltd., 6-13-4 Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-8558, Japan
| | - Shinya Sugiura
- Sugi Pharmacy Co., Ltd., 62-1, Shin'e, Yokone-Machi, Obu, Aichi, 474-0011, Japan.,Doctoral Program in Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Michiko Obara
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Takashi Tomita
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Toshio Suzuki
- Fujicco Co., Ltd., 6-13-4 Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-8558, Japan.
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