Potential pharmacokinetic interaction between orally administered drug and osmotically active excipients in pediatric polypharmacy

Biopharmaceutics Aspects of Sugar Alcohols: Implementation of Patient-Centricity in Pharmaceutical Development and Clinical Use

Sugar alcohols such as mannitol and sorbitol are frequently used as pharmaceutical excipients in oral dosage forms. Their versatility stems from extensive evidence of use in humans. However, investigations over many years have clearly indicated their osmolarity-derived biopharmaceutics effects on oral drug absorption. Despite this, these accumulated insights have not been fully integrated into pharmaceutical formulation development or clinical use, leading to suboptimal industrial and clinical practices. This review provides a comprehensive summary of the biopharmaceutics of sugar alcohols, detailing their mechanisms of action and the magnitude of their osmotic effects on the oral absorption of various drugs. Additionally, the review discusses the implications for bioequivalence studies, BCS-based biowaiver guidelines, drug-excipient interactions in pediatric polypharmacy, and pharmaceutical compounding. The aim is to guide future successful and patient-centric pharmaceutical formulation development.

Assessing the Appropriateness of Formulations on the WHO Model List of Essential Medicines for Children: Development of a Paediatric Quality Target Product Profile Tool

The World Health Organization's Model List of Essential Medicines for Children (EMLc) presents a list of the most efficacious, safe, and cost-effective medicines for priority conditions, intended for use in children up to 12 years of age. However, gaps in global availability and use of age-appropriate formulations of medicines for children still exist. To address these shortcomings, a comprehensive analysis of the appropriateness of formulations of essential medicines for children is being undertaken through the Global Accelerator for Paediatric Formulations (GAP-f) network, a WHO network launched in 2020 to respond to the paediatric treatment gap. This article describes the development and application of a paediatric Quality Target Product Profile (pQTPP) tool by WHO, to retrospectively evaluate the paediatric age-appropriateness of formulations on the EMLc and identify potential formulation gaps, to inform the review of the EMLc in 2023. A combination of paediatric-centric and global health-focused attributes and targets were defined, taking into consideration regulatory agency paediatric development guidelines and literature sources, and a qualitative scoring system was developed and tested. Example evaluations of paracetamol and clofazimine are provided, illustrating the tool's use. The assessment of EMLc formulations is ongoing and shortcomings and gaps in EMLc formulations have already been identified. The pQTTP tool may also be applied to national lists and prospectively when designing new paediatric formulations.