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Trofimiuk M, Olechno K, Trofimiuk E, Czajkowska-Kośnik A, Ciosek-Skibińska P, Głowacz K, Lenik J, Basa A, Car H, Winnicka K. Utilization of the Drug-Polymer Solid Dispersion Obtained by Ball Milling as a Taste Masking Method in the Development of Orodispersible Minitablets with Hydrocortisone in Pediatric Doses. Pharmaceutics 2024; 16:1041. [PMID: 39204386 PMCID: PMC11359562 DOI: 10.3390/pharmaceutics16081041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
The objective of the conducted research was to design 2 mm orodispersible minitablets of pediatric doses of hydrocortisone (0.5 mg; 1.0 mg) with desirable pharmaceutical properties and eliminate the sensation of a bitter taste using preparation of solid dispersion by ball mill. Hydrocortisone was selected as the model substance, as it is widely utilized in the pediatric population. ODMTs were prepared by compression (preceded by granulation) in a traditional single-punch tablet machine and evaluated using pharmacopoeial tests, DSC, and FTIR analysis. The methods used to evaluate the effectiveness of the taste-masking effect included in vivo participation of healthy volunteers, in vitro drug dissolution and utilization of an analytical device-"electronic tongue". The research employed a preclinical animal model to preliminary investigate the bioequivalence of the designed drug dosage form in comparison to reference products. The study confirmed the possibility of manufacturing good-quality hydrocortisone ODMTs with a taste-masking effect owing to the incorporation of a solid dispersion in the tablet mass.
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Affiliation(s)
- Monika Trofimiuk
- Department of Clinical Pharmacy, Medical University of Bialystok, Mickiewicza 2a, 15-222 Bialystok, Poland
| | - Katarzyna Olechno
- Department of Pharmaceutical Technology, Medical University of Bialystok, Mickiewicza 2c, 15-222 Bialystok, Poland; (A.C.-K.); (K.W.)
| | - Emil Trofimiuk
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15a, 15-274 Bialystok, Poland; (E.T.); (H.C.)
| | - Anna Czajkowska-Kośnik
- Department of Pharmaceutical Technology, Medical University of Bialystok, Mickiewicza 2c, 15-222 Bialystok, Poland; (A.C.-K.); (K.W.)
| | - Patrycja Ciosek-Skibińska
- Chair of Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland; (P.C.-S.); (K.G.)
| | - Klaudia Głowacz
- Chair of Medical Biotechnology, Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00-664 Warsaw, Poland; (P.C.-S.); (K.G.)
| | - Joanna Lenik
- Department of Analytical Chemistry, Institute of Chemical Sciences, Faculty of Chemistry, Maria Curie Sklodowska University, Maria Curie-Sklodowska Square 3, 20-031 Lublin, Poland;
| | - Anna Basa
- Faculty of Chemistry, University of Białystok, Ciołkowskiego 1K, 15-245 Białystok, Poland;
| | - Halina Car
- Department of Clinical Pharmacology, Medical University of Bialystok, Waszyngtona 15a, 15-274 Bialystok, Poland; (E.T.); (H.C.)
| | - Katarzyna Winnicka
- Department of Pharmaceutical Technology, Medical University of Bialystok, Mickiewicza 2c, 15-222 Bialystok, Poland; (A.C.-K.); (K.W.)
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2
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Kaye AD, Khaled ME, Bembenick KN, Lacey J, Tandon A, Kelkar RA, Derouen AG, Ballaera C, Chandler D, Ahmadzadeh S, Shekoohi S, Varrassi G. Alkindi Sprinkle for Pediatric Patients With Primary Adrenocortical Insufficiency: A Narrative Review. Cureus 2024; 16:e56031. [PMID: 38606228 PMCID: PMC11007452 DOI: 10.7759/cureus.56031] [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: 02/16/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Adrenocortical insufficiency, also known as adrenal insufficiency (AI), is an endocrine disorder characterized by inadequate production of adrenal hormones, including glucocorticoids and mineralocorticoids (MCs). The condition can be categorized as primary, secondary, or tertiary AI, depending on the location of the defect. Classical symptoms of AI include weakness, fatigue, abdominal pain, tachycardia, hypotension, electrolyte imbalances, and hyperpigmentation. In children, the most common cause of AI is classical congenital adrenal hyperplasia, which results from a deficiency in the 21-hydroxylase enzyme. The 21-hydroxylase enzyme produces all steroids, such as cortisol and aldosterone. AI management primarily involves hormone replacement therapy, typically with oral hydrocortisone and MC supplementation. However, the administration of hydrocortisone to pediatric patients presents challenges related to the lack of available dose-appropriate formulations. Historically, crushed or split adult tablets were used for the pediatric treatment of AI, although this poses an increased risk of under- or overtreatment. Inadequate dosing in the pediatric population can adversely affect growth, development, and metabolic health. Alkindi Sprinkle is a pediatric-specific hydrocortisone oral granule preparation that manages cortisol levels to help facilitate accurate therapeutic dosing. Alkindi offers several advantages, including accurate dosing, taste masking, and ease of administration. The present investigation describes AI, the management of AI, and the treatment of pediatric AI using Alkindi Sprinkle, including clinical efficacy.
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Affiliation(s)
- Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Munira E Khaled
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - John Lacey
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, USA
| | - Anamika Tandon
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, USA
| | - Rucha A Kelkar
- School of Medicine, Medical University of South Carolina, Charleston, USA
| | - Alyssa G Derouen
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Corrado Ballaera
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Debbie Chandler
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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3
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Liu CL, Jiang Y, Li HJ. Quality Consistency Evaluation of Traditional Chinese Medicines: Current Status and Future Perspectives. Crit Rev Anal Chem 2024:1-18. [PMID: 38252135 DOI: 10.1080/10408347.2024.2305267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Quality consistency evaluation of traditional Chinese medicines (TCMs) is a crucial factor that determines the safe and effective application in clinical settings. However, TCMs exhibit diverse, heterogeneous, complex, and flexible chemical compositions, as well as variability in preparation processes. These characteristics pose greater challenges in researching the consistency of TCMs compared to chemically synthesized and biological drugs. Therefore, it is paramount to develop effective strategies for evaluating the quality consistency of TCMs. From the starting point of quality properties, this review explores the strategy used to evaluate quality consistency in terms of chemistry-based strategy (chemical consistency) and the biology-based strategy (bioequivalence). Among them, the chemistry-based strategy is the mainstream, and biology-based strategy complements the chemistry-based strategy each other. Furthermore, the emerging chemistry-biology strategies (overall evaluation) is discussed, including individually combining strategy and integration strategy. Finally, this review provides insights into the challenges and future perspectives in this field. By highlighting current status and trends in TCMs quality consistency, this review aims to contribute to establishment of generally applicable chemistry-biology integrated evaluation strategy for TCMs. This will facilitate the advancement toward a higher stage of overall quality evaluation.
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Affiliation(s)
- Chun-Lu Liu
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Yan Jiang
- College of Chemical Engineering, Nanjing Forestry University, Nanjing, China
| | - Hui-Jun Li
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
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Al-Rayess H, Lahoti A, Simpson LL, Palzer E, Thornton P, Heksch R, Kamboj M, Stanley T, Regelmann MO, Gupta A, Raman V, Mehta S, Geffner ME, Sarafoglou K. Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1871. [PMID: 38136073 PMCID: PMC10742174 DOI: 10.3390/children10121871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
A Pediatric Endocrine Society (PES) Drugs and Therapeutics Committee workgroup sought to determine the prescribing practices of pediatric endocrinologists when treating children <10 years of age with congenital adrenal hyperplasia (CAH). Our workgroup administered a 32-question online survey to PES members. There were 187 respondents (88.9% attending physicians), mostly from university-affiliated clinics (~80%). Ninety-eight percent of respondents prescribed the short-acting glucocorticoid hydrocortisone to treat young children, as per the Endocrine Society CAH Guidelines, although respondents also prescribed long-acting glucocorticoids such as prednisolone suspension (12%), prednisone tablets (9%), and prednisone suspension (6%). Ninety-seven percent of respondents indicated that they were likely/very likely to prescribe hydrocortisone in a thrice-daily regimen, as per CAH Guidelines, although 19% were also likely to follow a twice-daily regimen. To achieve smaller doses, using a pill-cutter was the most frequent method recommended by providers to manipulate tablets (87.2%), followed by dissolving tablets in water (25.7%) to create a daily batch (43.7%) and/or dissolving a tablet for each dose (64.6%). Thirty-one percent of providers use pharmacy-compounded hydrocortisone suspension to achieve doses of <2.5 mg. Our survey shows that practices among providers in the dosing of young children with CAH vary greatly and sometimes fall outside of the CAH Guidelines-specifically when attempting to deliver lower, age-appropriate hydrocortisone doses.
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Affiliation(s)
- Heba Al-Rayess
- Department of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA;
| | - Amit Lahoti
- Department of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USA; (A.L.); (M.K.)
| | - Leslie Long Simpson
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (L.L.S.); (E.P.)
| | - Elise Palzer
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (L.L.S.); (E.P.)
| | - Paul Thornton
- Division of Endocrinology and Diabetes, Cook Children’s Medical Center, Fort Worth, TX 76104, USA;
| | - Ryan Heksch
- Center for Diabetes and Endocrinology, Department of Pediatrics, Akron Children’s Hospital, Akron, OH 44308, USA;
| | - Manmohan Kamboj
- Department of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USA; (A.L.); (M.K.)
| | - Takara Stanley
- Pediatric Endocrine Unit and Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA;
| | - Molly O. Regelmann
- Division of Pediatric Endocrinology and Diabetes, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Anshu Gupta
- Division of Pediatric Endocrinology, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Vandana Raman
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Shilpa Mehta
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York Medical College, Valhalla, NY 10595, USA
| | - Mitchell E. Geffner
- The Saban Research Institute, Children’s Hospital Los Angeles, The Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA;
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA;
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
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5
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Sundarkumar V, Wang W, Nagy Z, Reklaitis G. Manufacturing pharmaceutical mini-tablets for pediatric patients using drop-on-demand printing. Int J Pharm 2023; 644:123355. [PMID: 37647980 PMCID: PMC10808949 DOI: 10.1016/j.ijpharm.2023.123355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023]
Abstract
The pharmaceutical industry has traditionally manufactured medicines in a limited range of dose strengths, with an emphasis on addressing the needs of the largest patient subgroups. This has disadvantaged smaller patient subsets, such as children, who often cannot find drug products in dosage levels suitable for their requirements. In recent years, development of pharmaceutical mini-tablets has emerged as an attractive solution to this problem. These are small-size dosages that offer attractive features such as flexible and personalized drug dosing, ease of swallowing, and tailored drug release, making them an excellent choice for administering medicines to children. This study presents a novel technique for manufacturing pharmaceutical mini-tablets, using a drop-on-demand (DoD) printing system. In this method, a DoD system is used to generate precise droplets of a melt-based formulation, which are then captured and solidified in an inert solvent bath to produce individual mini-tablets. The study also evaluates the performance of this technique for various formulations, and quantifies two critical quality attributes (CQAs) of the resulting mini-tablets: content uniformity and dissolution behavior. The findings demonstrate that the manufactured mini-tablets can meet regulatory specifications for both CQAs, and that their release profiles can be customized by modifying the excipients used. The study also discusses promising areas of application and limitations of this technique.
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Affiliation(s)
- Varun Sundarkumar
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, USA.
| | - Wanning Wang
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Zoltan Nagy
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Gintaras Reklaitis
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, USA
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Rosch M, Gutowski T, Baehr M, Eggert J, Gottfried K, Gundler C, Nürnberg S, Langebrake C, Dadkhah A. Development of an immediate release excipient composition for 3D printing via direct powder extrusion in a hospital. Int J Pharm 2023; 643:123218. [PMID: 37467818 DOI: 10.1016/j.ijpharm.2023.123218] [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: 05/19/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023]
Abstract
3D printing offers the possibility to prepare personalized tablets on demand, making it an intriguing technology for hospital pharmacies. For the implementation of 3D-printed tablets into the digital Closed Loop Medication Management system, the required tablet formulation and development of the manufacturing process as well as the pharmaceutical validation were conducted. The goal of the formulation development was to enable an optimal printing process and rapid dissolution of the printed tablets for the selected model drugs Levodopa/Carbidopa. The 3D printed tablets were prepared by direct powder extrusion. Printability, thermal properties, disintegration, dissolution, physical properties and storage stability were investigated by employing analytical methods such as HPLC-UV, DSC and TGA. The developed formulation shows a high dose accuracy and an immediate drug release for Levodopa. In addition, the tablets exhibit high crushing strength and very low friability. Unfortunately, Carbidopa did not tolerate the printing process. This is the first study to develop an immediate release excipient composition via direct powder extrusion in a hospital pharmacy setting. The developed process is suitable for the implementation in Closed-Loop Medication Management systems in hospital pharmacies and could therefore contribute to medication safety.
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Affiliation(s)
- Moritz Rosch
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Gutowski
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Baehr
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Eggert
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Gottfried
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Gundler
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sylvia Nürnberg
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Langebrake
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrin Dadkhah
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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7
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Sarafoglou K, Merke DP, Reisch N, Claahsen-van der Grinten H, Falhammar H, Auchus RJ. Interpretation of Steroid Biomarkers in 21-Hydroxylase Deficiency and Their Use in Disease Management. J Clin Endocrinol Metab 2023; 108:2154-2175. [PMID: 36950738 PMCID: PMC10438890 DOI: 10.1210/clinem/dgad134] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
The most common form of congenital adrenal hyperplasia is 21-hydroxylase deficiency (21OHD), which in the classic (severe) form occurs in roughly 1:16 000 newborns worldwide. Lifelong treatment consists of replacing cortisol and aldosterone deficiencies, and supraphysiological dosing schedules are typically employed to simultaneously attenuate production of adrenal-derived androgens. Glucocorticoid titration in 21OHD is challenging as it must balance the consequences of androgen excess vs those from chronic high glucocorticoid exposure, which are further complicated by interindividual variability in cortisol kinetics and glucocorticoid sensitivity. Clinical assessment and biochemical parameters are both used to guide therapy, but the specific purpose and goals of each biomarker vary with age and clinical context. Here we review the approach to medication titration for children and adults with classic 21OHD, with an emphasis on how to interpret adrenal biomarker values in guiding this process. In parallel, we illustrate how an understanding of the pathophysiologic and pharmacologic principles can be used to avoid and to correct complications of this disease and consequences of its management using existing treatment options.
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Affiliation(s)
- Kyriakie Sarafoglou
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
| | - Deborah P Merke
- Department of Pediatrics, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Nicole Reisch
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, 80336 Munich, Germany
| | - Hedi Claahsen-van der Grinten
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, SE-17176, Stockholm, Sweden
| | - Richard J Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Parulski C, Bya LA, Goebel J, Servais AC, Lechanteur A, Evrard B. Development of 3D printed mini-waffle shapes containing hydrocortisone for children's personalized medicine. Int J Pharm 2023:123131. [PMID: 37321464 DOI: 10.1016/j.ijpharm.2023.123131] [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: 05/05/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
Hydrocortisone is mainly used in the substitution treatment of adrenal insufficiency which results in a dysregulation of cortisol. Compounding of hydrocortisone capsules remains the only low-dose oral treatment suitable for the pediatric population. However, capsules often show non-compliance in mass and content uniformity. Three-dimensional printing offers the prospect of practising personalized medicine for vulnerable patients like children. The goal of this work is to develop low-dose solid oral forms containing hydrocortisone by hot-melt extrusion coupled with fused deposition modeling for the pediatric population. Formulation, design and processes temperatures were optimized to produce printed forms with the desired characteristics. Red mini-waffle shapes containing drug loads of 2, 5 and 8 mg were successfully printed. This new 3D design allow to release more than 80% of the drug in 45 minutes indicating a conventional release like the one obtained with capsules. Mass and content uniformity, hardness and friability tests complied with European Pharmacopeia specifications, despite the considerable challenge of the small dimensions of the forms. This study demonstrates that FDM can be used to produce innovative pediatric-friendly printed shapes of an advanced pharmaceutical quality to practice personalize medicine.
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Affiliation(s)
- Chloé Parulski
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), Department of Pharmacy, University of Liege (ULiege), Avenue Hippocrate 15, 4000 Liege, Belgium.
| | - Laure-Anne Bya
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), Department of Pharmacy, University of Liege (ULiege), Avenue Hippocrate 15, 4000 Liege, Belgium
| | - Justine Goebel
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), Department of Pharmacy, University of Liege (ULiege), Avenue Hippocrate 15, 4000 Liege, Belgium
| | - Anne-Catherine Servais
- Laboratory for the Analysis of Medicines, Center for Interdisciplinary Research on Medicines (CIRM), Department of Pharmacy, University of Liege (ULiege), Avenue Hippocrate 15, 4000 Liege, Belgium
| | - Anna Lechanteur
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), Department of Pharmacy, University of Liege (ULiege), Avenue Hippocrate 15, 4000 Liege, Belgium
| | - Brigitte Evrard
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), Department of Pharmacy, University of Liege (ULiege), Avenue Hippocrate 15, 4000 Liege, Belgium
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9
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Yang TL, Stogiannari M, Janeczko S, Khoshan M, Lin Y, Isreb A, Habashy R, Giebułtowic J, Peak M, Alhnan MA. Towards Point-of-Care Manufacturing and Analysis of Immediate-Release 3D Printed Hydrocortisone Tablets for The Treatment of Congenital Adrenal Hyperplasia. Int J Pharm 2023:123072. [PMID: 37230368 DOI: 10.1016/j.ijpharm.2023.123072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023]
Abstract
Hydrocortisone (HC) is the preferred drug in children with congenital adrenal hyperplasia due to its lower potency as well as fewer reports of side effects. Fused deposition modelling (FDM) 3D printing holds the potential to produce low-cost personalised doses for children at the point of care. However, the compatibility of the thermal process to produce immediate-release bespoke tablets for this thermally labile active is yet to be established. This work aims to develop immediate-release HC tablets using FDM 3D printing and assess drug contents as a critical quality attribute (CQA) using a compact, low-cost near-infrared (NIR) spectroscopy as a process analytical technology (PAT). The FDM 3D printing temperature (140 °C) and drug concentration in the filament (10%-15% w/w) were critical parameters to meet the compendial criteria for drug contents and impurities. Using a compact low-cost NIR spectral device over a wavelength of 900-1700 nm, the drug contents of 3D printed tablets were assessed. Partial least squares (PLS) regression was used to develop individual calibration models to detect HC content in 3D printed tablets of lower drug contents, small caplet design, and relatively complex formula. The models demonstrated the ability to predict HC concentrations over a wide concentration range (0-15% w/w), which was confirmed by HPLC as a reference method. Ultimately, the capability of the NIR model had preceding dose verification performance on HC tablets, with linearity (R2 = 0.981) and accuracy (RMSECV = 0.46%). In the future, the integration of 3DP technology with non-destructive PAT techniques will accelerate the adoption of on-demand, individualised dosing in a clinical setting.
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Affiliation(s)
- Tzuyi L Yang
- Centre for Pharmaceutical Medicine, Institute of Pharmaceutical Science, Kings College, London, UK
| | - Melpomeni Stogiannari
- Centre for Pharmaceutical Medicine, Institute of Pharmaceutical Science, Kings College, London, UK
| | - Sylwia Janeczko
- Faculty of Pharmacy with the Laboratory Medicine Division, Medical University of Warsaw, Warsaw, Poland
| | - Marva Khoshan
- Centre for Pharmaceutical Medicine, Institute of Pharmaceutical Science, Kings College, London, UK
| | - Yueyuan Lin
- Centre for Pharmaceutical Medicine, Institute of Pharmaceutical Science, Kings College, London, UK
| | - Abdullah Isreb
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Joanna Giebułtowic
- Faculty of Pharmacy with the Laboratory Medicine Division, Medical University of Warsaw, Warsaw, Poland
| | - Matthew Peak
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
| | - Mohamed A Alhnan
- Centre for Pharmaceutical Medicine, Institute of Pharmaceutical Science, Kings College, London, UK
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10
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Chaudhri K, Kearney M, Di Tanna GL, Gnanenthiran SR, Day RO, Rodgers A, Atkins ER. Does splitting a tablet obtain an accurate dose? A systematic review and meta‐ analysis. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2023. [DOI: 10.1002/jppr.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Kanika Chaudhri
- The George Institute for Global Health UNSW Sydney Australia
- Faculty of Medicine UNSW Sydney Australia
| | | | - Gian Luca Di Tanna
- The George Institute for Global Health UNSW Sydney Australia
- Faculty of Medicine UNSW Sydney Australia
| | - Sonali R. Gnanenthiran
- The George Institute for Global Health UNSW Sydney Australia
- Faculty of Medicine UNSW Sydney Australia
| | - Richard O. Day
- Faculty of Medicine UNSW Sydney Australia
- Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Darlinghurst Australia
- St Vincent's Clinical School Faculty of Medicine UNSW Sydney Australia
| | - Anthony Rodgers
- The George Institute for Global Health UNSW Sydney Australia
- Faculty of Medicine UNSW Sydney Australia
| | - Emily R. Atkins
- The George Institute for Global Health UNSW Sydney Australia
- Faculty of Medicine UNSW Sydney Australia
- Westmead Clinical School University of Sydney Sydney Australia
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11
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Bizzarri C, Capalbo D, Wasniewska MG, Baronio F, Grandone A, Cappa M. Adrenal crisis in infants and young children with adrenal insufficiency: Management and prevention. Front Endocrinol (Lausanne) 2023; 14:1133376. [PMID: 36860362 PMCID: PMC9968740 DOI: 10.3389/fendo.2023.1133376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Despite the optimization of replacement therapy, adrenal crises still represent life-threatening emergencies in many children with adrenal insufficiency. OBJECTIVE We summarized current standards of clinical practice for adrenal crisis and investigated the prevalence of suspected/incipient adrenal crisis, in relation to different treatment modalities, in a group of children with adrenal insufficiency. RESULTS Fifty-one children were investigated. Forty-one patients (32 patients <4 yrs and 9 patients >4 yrs) used quartered non-diluted 10 mg tablets. Two patients <4 yrs used a micronized weighted formulation obtained from 10 mg tablets. Two patients <4 yrs used a liquid formulation. Six patients >4 yrs used crushed non-diluted 10 mg tablets. The overall number of episodes of adrenal crisis was 7.3/patient/yr in patients <4yrs and 4.9/patient/yr in patients >4 yrs. The mean number of hospital admissions was 0.5/patient/yr in children <4 yrs and 0.53/patient/yr in children >4 yrs. There was a wide variability in the individual number of events reported. Both children on therapy with a micronized weighted formulation reported no episode of suspected adrenal crisis during the 6-month observation period. CONCLUSION Parental education on oral stress dosing and switching to parenteral hydrocortisone when necessary are the essential approaches to prevent adrenal crisis in children.
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Affiliation(s)
- Carla Bizzarri
- Unit of Endocrinology, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, European Reference Network on Rare Endocrine Conditions (Endo-ERN), Center for Rare Endocrine Conditions, Naples, Italy
| | | | - Federico Baronio
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Endo-ERN Center for Rare Endocrine Conditions, Bologna, Italy
| | - Anna Grandone
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Cappa
- Unit of Endocrinology, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
- *Correspondence: Marco Cappa,
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12
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Formulation Optimization of Extemporaneous Oral Liquids Containing Naloxone and Propranolol for Pediatric Use. Sci Pharm 2022. [DOI: 10.3390/scipharm90010015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is a need to develop dosage forms suitable for children to improve drug treatment. Extemporaneous compounding of drugs for children is one way to meet these needs. However, excipients generally considered as safe in adults may not be appropriate in dosage forms intended for children. The aim was to optimize the composition of two pediatric liquid preparations by substituting paraben as a microbiological preservative and ethanol as a solubilizer, with excipients more suitable for pediatric use. The oral liquids were Naloxone 1 mg/mL and Propranolol 10 mg/mL. Twelve different formulations were tested with propranolol and naloxone, respectively, during the screening process to select appropriate formulations. Sodium benzoate and glycerol were used as a preservative and solubilizer, respectively, and different pH of the formulations were evaluated. The formulations were characterized according to dispensed dose (dosing accuracy), viscosity and osmolality. The optimized formulations from the screening process were tested with two amounts of sodium benzoate and microbiological assays were performed. These formulations were shown to have satisfactory preservative properties and dosing accuracy. The results showed that the oral liquids could be prepared without the addition of solubilizer and with lower osmolality (naloxone), thus reducing the risk of gastrointestinal side effects.
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13
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Al-Rayess H, Addo OY, Palzer E, Jaber M, Fleissner K, Hodges J, Brundage R, Miller BS, Sarafoglou K. Bone Age Maturation and Growth Outcomes in Young Children with CAH Treated with Hydrocortisone Suspension. J Endocr Soc 2022; 6:bvab193. [PMID: 35047717 PMCID: PMC8758402 DOI: 10.1210/jendso/bvab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Young children with congenital adrenal hyperplasia (CAH) require small doses (0.1-1.25 mg) of hydrocortisone (HC) to control excess androgen production and avoid the negative effects of overtreatment. The smallest commercially available HC formulation, before the recent US Food and Drug Administration approval of HC granules, was a scored 5-mg tablet. The options to achieve small doses were limited to using a pharmacy-compounded suspension, which the CAH Clinical Practice Guidelines recommended against, or splitting tablets into quarters or eighths, or dissolving tablets into water. Methods Cross-sectional chart review of 130 children with classic CAH treated with tablets vs a pharmacy-compounded alcohol-free hydrocortisone suspension to compare growth, weight, skeletal maturation, total daily HC dose, and exposure over the first 4 years of life. Results No significant differences were found in height, weight, or body mass index z-scores at 4 years, and in predicted adult height, before or after adjusting for age at diagnosis and sex. Bone age z-scores averaged 2.8 SDs lower for patients on HC suspension compared with HC tablets (P < 0.001) after adjusting for age at diagnosis and sex. The suspension group received 30.4% lower (P > 0.001) average cumulative HC doses by their fourth birthday. Conclusions Our data indicate that treatment with alcohol-free HC suspension decreased androgen exposure as shown by lower bone age z-scores, allowed lower average and cumulative daily HC dose compared to HC tablets, and generated no significant differences in SDS in growth parameters in children with CAH at 4 years of age. Longitudinal studies of treating with smaller HC doses during childhood are needed.
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Affiliation(s)
- Heba Al-Rayess
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55454, USA
| | - O Yaw Addo
- Department of Global Health, Rollins School of Emory University, Atlanta, GA 30322, USA
| | - Elise Palzer
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Mu'taz Jaber
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
| | - Kristin Fleissner
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55454, USA
| | - James Hodges
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Richard Brundage
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
| | - Bradley S Miller
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55454, USA
| | - Kyriakie Sarafoglou
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55454, USA.,Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
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14
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Zuccari G, Alfei S, Marimpietri D, Iurilli V, Barabino P, Marchitto L. Mini-Tablets: A Valid Strategy to Combine Efficacy and Safety in Pediatrics. Pharmaceuticals (Basel) 2022; 15:108. [PMID: 35056165 PMCID: PMC8779937 DOI: 10.3390/ph15010108] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
In the treatment of pediatric diseases, mass-produced dosage forms are often not suitable for children. Commercially available medicines are commonly manipulated and mixed with food by caregivers at home, or extemporaneous medications are routinely compounded in the hospital pharmacies to treat hospitalized children. Despite considerable efforts by regulatory agencies, the pediatric population is still exposed to questionable and potentially harmful practices. When designing medicines for children, the ability to fine-tune the dosage while ensuring the safety of the ingredients is of paramount importance. For these purposes solid formulations may represent a valid alternative to liquid formulations for their simpler formula and more stability, and, to overcome the problem of swelling ability, mini-tablets could be a practicable option. This review deals with the different approaches that may be applied to develop mini-tablets intended for pediatrics with a focus on the safety of excipients. Alongside the conventional method of compression, 3D printing appeared particularly appealing, as it allows to reduce the number of ingredients and to avoid both the mixing of powders and intermediate steps such as granulation. Therefore, this technique could be well adaptable to the daily galenic preparations of a hospital pharmacy, thus leading to a reduction of the common practice of off-label preparations.
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Affiliation(s)
- Guendalina Zuccari
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy;
| | - Silvana Alfei
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy;
| | - Danilo Marimpietri
- Stem Cell Laboratory and Cell Therapy Center, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy;
| | - Valentina Iurilli
- Pharmacy, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (V.I.); (P.B.)
| | - Paola Barabino
- Pharmacy, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (V.I.); (P.B.)
| | - Leonardo Marchitto
- Department of Sciences for the Quality of Life, University of Bologna, Corso D’Augusto 237, 47921 Rimini, Italy;
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15
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Duncan JC, Bracken LE, Nunn AJ, Peak M, Turner MA. Development and evaluation of an assessment of the age-appropriateness/inappropriateness of formulations used in children. Int J Clin Pharm 2022; 44:1394-1405. [PMID: 36208398 PMCID: PMC9718882 DOI: 10.1007/s11096-022-01478-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medicines designed for adults may be inappropriate for use in children in terms of strength, dosage form and/or excipient content. There is currently no standardised method of assessing the age-appropriateness of a medicine for paediatric use. AIM To develop and test a tool to assess whether a dosage form (formulation) is appropriate for children and estimate the proportion of formulations considered 'inappropriate' in a cohort of hospitalised paediatric patients with a chronic illness. METHOD A multi-phase study: patient data collection, tool development, case assessments and tool validation. Inpatients aged 0-17 years at two UK paediatric/neonatal hospitals during data collection periods between January 2015 and March 2016. Written informed consent/assent was obtained. Medicines assessed were new or regularly prescribed to inpatients as part of their routine clinical care. All medicine administration episodes recorded were assessed using the Age-appropriate Formulation tool. The tool was developed by a consensus approach, as a one-page flowchart. Independent case assessments were evaluated in 2019. RESULTS In 427 eligible children; 2,199 medicine administration episodes were recorded. Two assessors reviewed 220 episodes in parallel: percentage exact agreement was found to be 91.7% (99/108) and 93.1% (95/102). In total, 259/2,199 (11.8%) medicine administration episodes involved a dosage form categorised as 'age-inappropriate'. CONCLUSION A novel tool has been developed and internally validated. The tool can identify which medicines would benefit from development of an improved paediatric formulation. It has shown high inter-rater reliability between users. External validation is needed to further assess the tool's utility in different settings.
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Affiliation(s)
- Jennifer C Duncan
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Louise E Bracken
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anthony J Nunn
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Matthew Peak
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Mark A Turner
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, UK
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
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16
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Drug-handling problems and expectations of the ideal pediatric drug-reported by children and their parents. Eur J Pediatr 2022; 181:2161-2171. [PMID: 35199240 PMCID: PMC9056485 DOI: 10.1007/s00431-022-04419-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 11/05/2022]
Abstract
Experienced drug-handling problems and inadequately considered expectations for drug therapy have an unfavorable influence on therapy. We performed a questionnaire survey in (i) parents of 0-5-year-old children and (ii) 6-17-year olds and their parents. We assessed (A) experienced drug-handling problems and (B) expectations for drug therapy. (i) Forty-six parents and (ii) 103 children and their parents participated in the study. Experienced drug-handling problems were described by (i) 100% of parents and (ii) 62% of children and 70% of parents. Problems concerned with the preparation of the drug, dosing, compliance with the time interval, and acceptance. (i) Sixty-five percent of parents preferred a peroral route of drug administration, while (ii) 74% of children and 86% of parents did so. Preferred characteristics of peroral drug formulations, e.g., liquid versus solid drug formulations or flavor, were highly heterogeneous. Preferences of 6-17-year-old children and their parents matched in 43 to 66%. Conclusion: Most children and their parents had already experienced drug-handling problems. Preferences concerning the ideal pediatric drug were highly heterogeneous and in about half of cases, preferences of children and their parents differed. Thus, the children should be approached directly. If information is solely gained from parents, the children's needs might remain unmet. What is Known: • Pediatric drug administration is complex and therefore error-prone. • Experiences and expectations of children and their parents should be considered. What is New: •Most pediatric patients and their parents have already experienced drug-handling problems. • Expectations concerning the ideal pediatric drug are highly heterogeneous. Parents are often insufficiently aware of those expectations in their children.
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17
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Pınarbaşlı O, Bulut B, Gurbetoğlu GP, Atılgan N, Sarraçoğlu N, Aybey A. Evaluation of the effect of ethyl acrylate-methyl methacrylate copolymer on Racecadotril dispersible tablet. Turk J Pharm Sci 2021; 19:383-390. [DOI: 10.4274/tjps.galenos.2021.50432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Saito J, Yoshikawa N, Hanawa T, Ozawa A, Matsumoto T, Harada T, Iwahashi K, Nakamura H, Yamatani A. Stability of Hydrocortisone in Oral Powder Form Compounded for Pediatric Patients in Japan. Pharmaceutics 2021; 13:pharmaceutics13081267. [PMID: 34452228 PMCID: PMC8400744 DOI: 10.3390/pharmaceutics13081267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/20/2022] Open
Abstract
Hydrocortisone has been utilized in the management of adrenal insufficiency. For pediatric patients, the commercially available enteral form of hydrocortisone tablets (Cortoril®) is administered in powder form after being compounded by a pharmacist. However, the stability and quality of compounded hydrocortisone powder have not been verified. In this study, we formulated a 20 mg/g oral hydrocortisone powder by adding lactose monohydrate to crushed and filtered hydrocortisone tablets and assessed the stability and physical properties of this compounded product in polycarbonate amber bottles or coated paper packages laminated with cellophane and polyethylene. Stability was examined over 120 days in three storage conditions: closed bottle, in-use bottle, and laminated paper. Drug dissolution and powder X-ray diffraction analysis were conducted to assess its physicochemical stabilities. Validated liquid chromatography-diode array detection was used to detect and quantify hydrocortisone and its degradation products. Although impurity B (cortisone) and G (hydrocortisone-21-aldehyde) were found after 120 days of storage, no crystallographic and dissolution changes were noted. Hydrocortisone content was maintained between 90% and 110% of initial contents for 120 days at 25 ± 2 °C and 60 ± 5% relative humidity in all packaging conditions.
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Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, Setagaya-ku, Tokyo 157-0054, Japan; (N.Y.); (K.I.); (A.Y.)
- Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Tokyo 157-0054, Japan
- Correspondence: ; Tel.: +81-(0)3-3416-0181
| | - Nozomi Yoshikawa
- Department of Pharmacy, National Center for Child Health and Development, Setagaya-ku, Tokyo 157-0054, Japan; (N.Y.); (K.I.); (A.Y.)
| | - Takehisa Hanawa
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba 278-8510, Japan; (T.H.); (A.O.)
| | - Ayuna Ozawa
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba 278-8510, Japan; (T.H.); (A.O.)
| | | | - Tsutomu Harada
- Division of Pharmaceutics, School of Pharmacy, Showa University, Tokyo 142-8555, Japan;
| | - Kana Iwahashi
- Department of Pharmacy, National Center for Child Health and Development, Setagaya-ku, Tokyo 157-0054, Japan; (N.Y.); (K.I.); (A.Y.)
- Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Tokyo 157-0054, Japan
| | - Hidefumi Nakamura
- Department of Research and Development Supervision, National Center for Child Health and Development, Tokyo 157-0054, Japan;
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, Setagaya-ku, Tokyo 157-0054, Japan; (N.Y.); (K.I.); (A.Y.)
- Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Tokyo 157-0054, Japan
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19
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Accuracy of Dose Administered to Children Using Off-Labelled or Unlicensed Oral Dosage Forms. Pharmaceutics 2021; 13:pharmaceutics13071014. [PMID: 34371705 PMCID: PMC8308974 DOI: 10.3390/pharmaceutics13071014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
The pediatric population suffers from a lack of age-appropriate medicines leading to unsafe situations when off-labelled or unlicensed drugs are used. Assessing the best option to administrate medicines when manipulations are required is essential in order to improve child care. This study aimed to compare the accuracy of the administered dose provided by three dosage forms and their techniques of administration. Different techniques of administration were assessed, covering three oral dosage forms (commercially available tablets, capsules, oral suspensions) using two APIs not available in a children-adapted dosage form. Techniques of administration were simulated and administered doses were determined using HPLC-UV. Means were compared to the target dose while distributions of doses were compared between each technique. For both APIs, mean administered doses obtained with capsules and tablets were significantly different from the target dose, whereas there was no statistical difference with oral suspensions. Distributions of doses showed significant difference between the three dosage forms. This study demonstrates that manipulations of solid oral dosage forms provide dramatic underdosing leading to unsafe situations. Compounded oral suspension is the best option to avoid underdosing and dose variation. This solution should be prioritized when age-appropriate commercial medicines are not available.
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20
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Coope H, Parviainen L, Withe M, Porter J, Ross RJ. Hydrocortisone granules in capsules for opening (Alkindi) as replacement therapy in pediatric patients with adrenal insufficiency. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1903871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | - Richard J Ross
- Diurnal Ltd, Cardiff, UK
- Academic Unit of Diabetes, Endocrinology and Reproduction,The University of Sheffield, Sheffield, UK
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21
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Cho JH, Choi HG. Acetaminophen and tramadol hydrochloride-loaded soft gelatin capsule: preparation, dissolution and pharmacokinetics in beagle dogs. Pharm Dev Technol 2021; 26:576-581. [PMID: 33719822 DOI: 10.1080/10837450.2021.1903036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to develop a novel acetaminophen and tramadol hydrochloride-loaded soft capsule (ATSC) with enhanced bioavailability of tramadol. The ATSC was manufactured in a pilot-scale batch size with the capsule contents composed of tramadol, acetaminophen, PEG 400 and Capmul MCM at a weight ratio of 37.5:325:177.5:30. Moreover, its dissolution, stability and pharmacokinetics in beagle dogs were carried out compared to commercial tablet. The dissolved amounts of acetaminophen from the ATSC and commercial tablet were not significantly different. However, compared to the latter, the former had significantly higher dissolution rate of tramadol at the initial times. In beagle dogs, the ATSC provided no significant difference in plasma concentrations and AUC of acetaminophen than did the commercial tablet; however, it significantly improved those of tramadol compared to the other, indicating the enhanced oral bioavailability of tramadol. Compared to the commercial tablet, the ATSC had a larger AUC value for tramadol (55.27 ± 11.06 vs. 92.62 ± 21.52 h·ng/ml). In the accelerated long-term stability, the ATSC offered higher than 96% drug content of acetaminophen and tramadol, suggesting that it was stable for at least six months. Therefore, this ATSC would be a recommendable candidate with enhanced oral bioavailability and excellent stability.
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Affiliation(s)
- Jung Hyun Cho
- College of Pharmacy, Hanyang University, Ansan, Gyeonggi-Do, Republic of Korea.,Pharmaceutical Research Centre, Hanmi Pharm. Co, Hwaseong, Gyeonggi-Do, Republic of Korea
| | - Han-Gon Choi
- College of Pharmacy, Hanyang University, Ansan, Gyeonggi-Do, Republic of Korea
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22
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3D Printing of Mini Tablets for Pediatric Use. Pharmaceuticals (Basel) 2021; 14:ph14020143. [PMID: 33670158 PMCID: PMC7916857 DOI: 10.3390/ph14020143] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
In the treatment of pediatric diseases, suitable dosages and dosage forms are often not available for an adequate therapy. The use of innovative additive manufacturing techniques offers the possibility of producing pediatric dosage forms. In this study, the production of mini tablets using fused deposition modeling (FDM)-based 3D printing was investigated. Two pediatric drugs, caffeine and propranolol hydrochloride, were successfully processed into filaments using hyprolose and hypromellose as polymers. Subsequently, mini tablets with diameters between 1.5 and 4.0 mm were printed and characterized using optical and thermal analysis methods. By varying the number of mini tablets applied and by varying the diameter, we were able to achieve different release behaviors. This work highlights the potential value of FDM 3D printing for the on-demand production of patient individualized, small-scale batches of pediatric dosage forms.
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23
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Hellberg E, Westberg A, Appelblad P, Mattsson S. Evaluation of dissolution techniques for orally disintegrating mini-tablets. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Microencapsulation of black seed oil in alginate beads for stability and taste masking. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.102030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Brustugun J, Notaker N, Paetz LH, Tho I, Bjerknes K. Adjusting the dose in paediatric care by dispersing fragments of four different aspirin tablets. Acta Paediatr 2020; 109:2394-2401. [PMID: 32034802 PMCID: PMC7687227 DOI: 10.1111/apa.15216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
AIM Tablets can be manipulated in several ways to obtain a fraction as the dose-a practice frequently seen in paediatric care due to lack of suitable formulations. Splitting tablets prior to fragment dispersion in a small volume of liquid is one such method. The objective of this study was to investigate the accuracy and precision of this method. METHODS Four different types of aspirin tablets (two dispersible, one conventional and one chewing) were split with a tablet splitter into half and quarter fragments. The fragments were dispersed in a medicine measure or an oral syringe. The amount recovered was determined by UHPLC analysis. RESULTS The largest quarter fragments ranged from 26.7% to 31.5% of the full tablet weight. Dispersing the fragment in an oral syringe, the amount recovered was greater than 90.8% of the fragment manipulated for all four tablet types, when rinsing was performed. Dispersing the fragment in a medicine measure, the amounts recovered spanned from 32.9% for the conventional tablets to 98.7% for one of the dispersible tablets. CONCLUSION Dispersion of half or quarter tablets directly in an oral syringe, but not a medicine measure, could give satisfactory recovery from fragments of all the investigated aspirin tablets.
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Affiliation(s)
| | - Nikolai Notaker
- Department of PharmacyFaculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
| | - Lasse Holtan Paetz
- Department of PharmacyFaculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
| | - Ingunn Tho
- Department of PharmacyFaculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
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26
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Herrada-Manchón H, Rodríguez-González D, Alejandro Fernández M, Suñé-Pou M, Pérez-Lozano P, García-Montoya E, Aguilar E. 3D printed gummies: Personalized drug dosage in a safe and appealing way. Int J Pharm 2020; 587:119687. [PMID: 32730802 DOI: 10.1016/j.ijpharm.2020.119687] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 02/08/2023]
Abstract
Obtention of customized dosage forms is one of the main attractions of 3D printing in pharmaceuticals. In this sense, children are one of the groups within the population with a greater need for drug doses adapted to their requirements (age, weight, pathological state…), but most 3D printed oral dosages are solid forms and, therefore, not suitable for them. This work developed patient-tailored medicinal gummies, an alternative oral dosage form with eye-catching appearance and appropriate organoleptic characteristics. Four inks were formulated, characterised and 3D printed by means of syringe-based extrusion mechanism. Different tests were performed to ensure reproducibility of the process and validate work methodology for dosage unit fabrication applying basic manufacturing standards. Rheological test helped in evaluating inks printability. Visual characterization concluded that drugmies, apart from a high fidelity in the 3D model shape reproduction, had a bright and uniformly coloured appearance and a pleasant aroma, which made them highly appetising and attractive. The printed gummy oral dosages complied comfortably with the mass uniformity assay regardless of the formulated ink used or the 3D model selected for printing. Ranitidine hydrochloride individual contents were determined using uv-vis spectrophotometry, showing successful results both in dose accuracy, uniformity of drug content and dissolution.
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Affiliation(s)
- Helena Herrada-Manchón
- Centro de Innovación en Química Avanzada (ORFEO-CINQA), Instituto Universitario de Química Organometálica "Enrique Moles", Departamento de Química Orgánica e Inorgánica, Universidad de Oviedo, C/ Julián Clavería, 8, 33006 Oviedo, Asturias, Spain; Fundación Idonial, Parque Científico y Tecnológico de Gijón, Avda. Jardín Botánico, 1345, 33203 Gijón, Asturias, Spain.
| | - David Rodríguez-González
- Centro de Innovación en Química Avanzada (ORFEO-CINQA), Instituto Universitario de Química Organometálica "Enrique Moles", Departamento de Química Orgánica e Inorgánica, Universidad de Oviedo, C/ Julián Clavería, 8, 33006 Oviedo, Asturias, Spain; Fundación Idonial, Parque Científico y Tecnológico de Gijón, Avda. Jardín Botánico, 1345, 33203 Gijón, Asturias, Spain
| | - M Alejandro Fernández
- Fundación Idonial, Parque Científico y Tecnológico de Gijón, Avda. Jardín Botánico, 1345, 33203 Gijón, Asturias, Spain
| | - Marc Suñé-Pou
- Departament de Farmàcia, Tecnologia Farmacèutica i Fisicoquímica, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Avda. Joan XXIII, 27-31, 08028 Barcelona, Spain; IDIBELL-UB Research Group, Pharmacotherapy, Pharmacogenomics and Pharmaceutical Technology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Pérez-Lozano
- Departament de Farmàcia, Tecnologia Farmacèutica i Fisicoquímica, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Avda. Joan XXIII, 27-31, 08028 Barcelona, Spain; IDIBELL-UB Research Group, Pharmacotherapy, Pharmacogenomics and Pharmaceutical Technology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación García-Montoya
- Departament de Farmàcia, Tecnologia Farmacèutica i Fisicoquímica, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, Avda. Joan XXIII, 27-31, 08028 Barcelona, Spain; IDIBELL-UB Research Group, Pharmacotherapy, Pharmacogenomics and Pharmaceutical Technology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Enrique Aguilar
- Centro de Innovación en Química Avanzada (ORFEO-CINQA), Instituto Universitario de Química Organometálica "Enrique Moles", Departamento de Química Orgánica e Inorgánica, Universidad de Oviedo, C/ Julián Clavería, 8, 33006 Oviedo, Asturias, Spain
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Al-Rayess H, Fleissner K, Jaber M, Brundage RC, Sarafoglou K. Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH. J Endocr Soc 2020; 4:bvaa091. [PMID: 32803093 PMCID: PMC7417883 DOI: 10.1210/jendso/bvaa091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
Currently there are no commercially available hydrocortisone formulations for the treatment of children with congenital adrenal hyperplasia (CAH) that allow for smaller doses (0.1-1.25 mg) and incremental adjustments needed to control excess androgen production and avoid the negative effects of overtreatment. This lack of availability has led physicians to recommend dividing hydrocortisone 5-mg tablets into 4 to 6 pieces, compounding capsules or hydrocortisone suspension, or crushing 5- or 10-mg tablets in 5 or 10 mL of water. We report a case of iatrogenic Cushing syndrome in a 6-year 11-month-old girl with salt-wasting CAH treated with hydrocortisone tablets that were administered after crushing and dispersing into water to obtain the prescribed dose. She presented with poor growth, increasing body mass index (BMI), excess downy hair, round facies, and gastric ulcers. Her hydrocortisone dose was 8.1 mg/m2/day. Results for all adrenal steroid concentrations were undetectable at 8 am, 12 hours after her last dose. The year prior to presentation her parents began dissolving 10 mg of hydrocortisone in 10 mL of water and using this preparation over the course of 24 hours, which coincided with rapid increase of BMI. We switched her to a pharmacy-compounded alcohol-free hydrocortisone suspension with total daily doses ranging from 6.5 to 8.2 mg/m2/day, which resulted in resolution of her cushingoid features, a decrease in BMI, and catch-up growth. Our case highlights that manipulation of hydrocortisone tablets by parents can result in great variability in dosing and the need for commercially available pediatric formulations allowing for smaller dosing required in young children.
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Affiliation(s)
- Heba Al-Rayess
- Department of Pediatrics, Division of Endocrinology, University of Minnesota, Minneapolis, Minnesota
| | - Kristin Fleissner
- Department of Pediatrics, Division of Endocrinology, University of Minnesota, Minneapolis, Minnesota
| | - Mu'taz Jaber
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota
| | - Richard C Brundage
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Division of Endocrinology, University of Minnesota, Minneapolis, Minnesota.,Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota
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Wei XC, Cao B, Luo CH, Huang HZ, Tan P, Xu XR, Xu RC, Yang M, Zhang Y, Han L, Zhang DK. Recent advances of novel technologies for quality consistency assessment of natural herbal medicines and preparations. Chin Med 2020; 15:56. [PMID: 32514289 PMCID: PMC7268247 DOI: 10.1186/s13020-020-00335-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
Quality consistency is one of the basic attributes of medicines, but it is also a difficult problem that natural medicines and their preparations must face. The complex chemical composition and comprehensive pharmacological action of natural medicines make it difficult to simply apply the commonly used evaluation methods in chemical drugs. It is thus urgent to explore the novel evaluation methods suitable for the characteristics of natural medicines. With the rapid development of analytical techniques and the deepening understanding of the quality of natural herbs, increasing numbers of researchers have proposed many new ideas and technologies. This review mainly focuses on the basic principles, technical characteristics and application examples of the chemical evaluation, biological evaluation methods and their combination in quality consistency evaluation of natural herbs. On the bases of chemical evaluation and clinical efficacy, new methods reflecting their pharmacodynamic mechanism and safety characteristics will be developed, and gradually towards accurate quality control, to achieve the goal of quality consistency. We hope that this manuscript can provide new ideas and technical references for the quality consistency of natural drugs and their preparations, thus better guarantee their clinical efficacy and safety, and better promote industrial development.
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Affiliation(s)
- Xi-Chuan Wei
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
| | - Bo Cao
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
| | - Chuan-Hong Luo
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
| | - Hao-Zhou Huang
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
| | - Peng Tan
- Sichuan Academy of Traditional Chinese Medicine, State Key Laboratory of Quality Evaluation of Traditional Chinese Medicine, Chengdu, 610041 China
| | - Xiao-Rong Xu
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
| | - Run-Chun Xu
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
| | - Ming Yang
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004 China
| | - Yi Zhang
- Chengdu Food and Drug Control, Chengdu, 610000 China
| | - Li Han
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
| | - Ding-Kun Zhang
- School of Pharmacy, State Key Laboratory of Characteristic Chinese Drug Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, No. 1066 Avenue. Liutai, Chengdu, 611137 China
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Cho CH, Kim JY, Park ES. Effects of process parameters of rotary tablet press on die filling behavior during mini-tablet production: Comparison with conventional tablet. POWDER TECHNOL 2020. [DOI: 10.1016/j.powtec.2019.11.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Tahir MA, Ali ME, Lamprecht A. Nanoparticle formulations as recrystallization inhibitors in transdermal patches. Int J Pharm 2020; 575:118886. [DOI: 10.1016/j.ijpharm.2019.118886] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 01/13/2023]
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Rautamo M, Kvarnström K, Sivén M, Airaksinen M, Lahdenne P, Sandler N. A Focus Group Study about Oral Drug Administration Practices at Hospital Wards-Aspects to Consider in Drug Development of Age-Appropriate Formulations for Children. Pharmaceutics 2020; 12:pharmaceutics12020109. [PMID: 32019100 PMCID: PMC7076415 DOI: 10.3390/pharmaceutics12020109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Oral drug administration to pediatric patients is characterized by a lack of age-appropriate drug products and the off-label use of medicines. However, drug administration practices at hospital wards is a scarcely studied subject. The aim of this study was to explore the oral drug administration practices at pediatric hospital wards, with a focus on experiences and challenges faced, methods used to mitigate existing problems, drug manipulation habits, perceptions about oral dosage forms and future needs of oral dosage forms for children. This was a qualitative study consisting of focus group discussions with physicians, nurses and clinical pharmacists in a tertiary university hospital with the objective of bringing forward a holistic view on this research topic. These healthcare professionals recognized different administration challenges that were classified as either dosage form-related or patient-related ones. A lack of depot formulations developed especially for children as well as oral pediatric dosage forms of drug substances currently available as intravenous dosage forms was recognized. The preferred oral dosage forms were oral liquids and orodispersible tablets. Patient-centered drug administration practices including factors facilitating drug administration both at hospital wards and at home after patient discharge were identified. Among all healthcare professionals, the efficient cooperation in drug prescribing and administration as well as in educating the child’s caregivers in correct administration techniques before discharge and improving the overall discharge process of patients was emphasized. This study complements the prevalent understanding that new dosage forms for children of varying ages and stages of development are still needed. It also brings a holistic view on different aspects of oral drug administration to pediatric patients and overall patient-centered drug administration practices.
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Affiliation(s)
- Maria Rautamo
- HUS Pharmacy, HUS Helsinki University Hospital, Stenbäckinkatu 9B, 00290 Helsinki, Finland;
- Faculty of Pharmacy, University of Helsinki, Viikinkaari 5E, University of Helsinki, 00014 Helsinki, Finland; (M.S.); (M.A.)
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Tykistökatu 6A, 20520 Turku, Finland;
- Correspondence: or
| | - Kirsi Kvarnström
- HUS Pharmacy, HUS Helsinki University Hospital, Stenbäckinkatu 9B, 00290 Helsinki, Finland;
- Faculty of Pharmacy, University of Helsinki, Viikinkaari 5E, University of Helsinki, 00014 Helsinki, Finland; (M.S.); (M.A.)
| | - Mia Sivén
- Faculty of Pharmacy, University of Helsinki, Viikinkaari 5E, University of Helsinki, 00014 Helsinki, Finland; (M.S.); (M.A.)
| | - Marja Airaksinen
- Faculty of Pharmacy, University of Helsinki, Viikinkaari 5E, University of Helsinki, 00014 Helsinki, Finland; (M.S.); (M.A.)
| | - Pekka Lahdenne
- Department of Children and Adolescents, HUS Helsinki University Hospital, Stenbäckinkatu 9, 00029 Helsinki, Finland;
| | - Niklas Sandler
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Tykistökatu 6A, 20520 Turku, Finland;
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Rycerz K, Stepien KA, Czapiewska M, Arafat BT, Habashy R, Isreb A, Peak M, Alhnan MA. Embedded 3D Printing of Novel Bespoke Soft Dosage Form Concept for Pediatrics. Pharmaceutics 2019; 11:pharmaceutics11120630. [PMID: 31779123 PMCID: PMC6956071 DOI: 10.3390/pharmaceutics11120630] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022] Open
Abstract
Embedded three-dimensional printing (e-3DP) is an emerging method for additive manufacturing where semi-solid materials are extruded within a solidifying liquid matrix. Here, we present the first example of employing e-3DP in the pharmaceutical field and demonstrate the fabrication of bespoke chewable dosage forms with dual drug loading for potential use in pediatrics. LegoTM-like chewable bricks made of edible soft material (gelatin-based matrix) were produced by directly extruding novel printing patterns of model drug ink (embedded phase) into a liquid gelatin-based matrix (embedding phase) at an elevated temperature (70 °C) to then solidify at room temperature. Dose titration of the two model drugs (paracetamol and ibuprofen) was possible by using specially designed printing patterns of the embedded phase to produce varying doses. A linearity [R2 = 0.9804 (paracetamol) and 0.9976 (ibuprofen)] was achieved between percentage of completion of printing patterns and achieved doses using a multi-step method. The impact of embedded phase rheological behavior, the printing speed and the needle size of the embedded phase were examined. Owning to their appearance, modular nature, ease of personalizing dose and geometry, and tailoring and potential inclusion of various materials, this new dosage form concept holds a substantial promise for novel dosage forms in pediatrics.
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Affiliation(s)
- Katarzyna Rycerz
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK; (K.R.); (K.A.S.); (M.C.); (R.H.); (A.I.)
- Faculty of Pharmacy with the Laboratory Medicine Division, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Krzysztof Adam Stepien
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK; (K.R.); (K.A.S.); (M.C.); (R.H.); (A.I.)
- Faculty of Pharmacy with the Laboratory Medicine Division, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marta Czapiewska
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK; (K.R.); (K.A.S.); (M.C.); (R.H.); (A.I.)
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Jurasza 2 St., 85-089 Bydgoszcz, Poland
| | - Basel T. Arafat
- Faculty of Medical Sciences and Public Health, Anglia Ruskin University, Chelmsford CM1 1SQ, UK;
| | - Rober Habashy
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK; (K.R.); (K.A.S.); (M.C.); (R.H.); (A.I.)
| | - Abdullah Isreb
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK; (K.R.); (K.A.S.); (M.C.); (R.H.); (A.I.)
| | - Matthew Peak
- Paediatric Medicines Research Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Mohamed A. Alhnan
- Institute of Pharmaceutical Sciences, School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9NH, UK
- Correspondence: ; Tel.: +44-(0)20-7848-7265
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Towards Printed Pediatric Medicines in Hospital Pharmacies: Comparison of 2D and 3D-Printed Orodispersible Warfarin Films with Conventional Oral Powders in Unit Dose Sachets. Pharmaceutics 2019; 11:pharmaceutics11070334. [PMID: 31337146 PMCID: PMC6680667 DOI: 10.3390/pharmaceutics11070334] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 01/29/2023] Open
Abstract
To date, the lack of age-appropriate medicines for many indications results in dose manipulation of commercially available dosage forms, commonly resulting in inaccurate doses. Various printing technologies have recently been explored in the pharmaceutical field due to the flexible and precise nature of the techniques. The aim of this study was, therefore, to compare the currently used method to produce patient-tailored warfarin doses at HUS Pharmacy in Finland with two innovative printing techniques. Dosage forms of various strengths (0.1, 0.5, 1, and 2 mg) were prepared utilizing semisolid extrusion 3D printing, inkjet printing and the established compounding procedure for oral powders in unit dose sachets (OPSs). Orodispersible films (ODFs) drug-loaded with warfarin were prepared by means of printing using hydroxypropylcellulose as a film-forming agent. The OPSs consisted of commercially available warfarin tablets and lactose monohydrate as a filler. The ODFs resulted in thin and flexible films showing acceptable ODF properties. Moreover, the printed ODFs displayed improved drug content compared to the established OPSs. All dosage forms were found to be stable over the one-month stability study and suitable for administration through a naso-gastric tube, thus, enabling administration to all possible patient groups in a hospital ward. This work demonstrates the potential of utilizing printing technologies for the production of on-demand patient-specific doses and further discusses the advantages and limitations of each method.
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34
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Miller BS, Spencer SP, Geffner ME, Gourgari E, Lahoti A, Kamboj MK, Stanley TL, Uli NK, Wicklow BA, Sarafoglou K. Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings. J Investig Med 2019; 68:16-25. [PMID: 30819831 PMCID: PMC6996103 DOI: 10.1136/jim-2019-000999] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
Abstract
Adrenal insufficiency (AI) remains a significant cause of morbidity and mortality in children with 1 in 200 episodes of adrenal crisis resulting in death. The goal of this working group of the Pediatric Endocrine Society Drug and Therapeutics Committee was to raise awareness on the importance of early recognition of AI, to advocate for the availability of hydrocortisone sodium succinate (HSS) on emergency medical service (EMS) ambulances or allow EMS personnel to administer patient's HSS home supply to avoid delay in administration of life-saving stress dosing, and to provide guidance on the emergency management of children in adrenal crisis. Currently, hydrocortisone, or an equivalent synthetic glucocorticoid, is not available on most ambulances for emergency stress dose administration by EMS personnel to a child in adrenal crisis. At the same time, many States have regulations preventing the use of patient's home HSS supply to be used to treat acute adrenal crisis. In children with known AI, parents and care providers must be made familiar with the administration of maintenance and stress dose glucocorticoid therapy to prevent adrenal crises. Patients with known AI and their families should be provided an Adrenal Insufficiency Action Plan, including stress hydrocortisone dose (both oral and intramuscular/intravenous) to be provided immediately to EMS providers and triage personnel in urgent care and emergency departments. Advocacy efforts to increase the availability of stress dose HSS during EMS transport care and add HSS to weight-based dosing tapes are highly encouraged.
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Affiliation(s)
- Bradley S Miller
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Sandra P Spencer
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mitchell E Geffner
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Evgenia Gourgari
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amit Lahoti
- Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Manmohan K Kamboj
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Takara L Stanley
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Naveen K Uli
- Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Brandy A Wicklow
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kyriakie Sarafoglou
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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35
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Oprea A, Bonnet NCG, Pollé O, Lysy PA. Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency. Ther Adv Endocrinol Metab 2019; 10:2042018818821294. [PMID: 30746120 PMCID: PMC6360643 DOI: 10.1177/2042018818821294] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/04/2018] [Indexed: 02/04/2023] Open
Abstract
Adrenal insufficiency is defined as impaired adrenocortical hormone synthesis. According to its source, the deficit is classified as primary (adrenal steroidogenesis impairment), secondary (pituitary adrenocorticotropic hormone deficit) or tertiary (hypothalamic corticotropin-releasing hormone deficit). The management of adrenal insufficiency resides primarily in physiological replacement of glucocorticoid secretion. Standard glucocorticoid therapy is shrouded in several controversies. Along the difficulties arising from the inability to accurately replicate the pulsatile circadian cortisol rhythm, come the uncertainties of dose adjustment and treatment monitoring (absence of reliable biomarkers). Furthermore, side effects of inadequate replacement significantly hinder the quality of life of patients. Therefore, transition to circadian hydrocortisone therapy gains prominence. Recent therapeutic advancements consist of oral hydrocortisone modified-release compounds (immediate, delayed and sustained absorption formulations) or continuous subcutaneous hydrocortisone infusion. In addition to illustrating the current knowledge on conventional glucocorticoid regimens, this review outlines the latest research outcomes. We also describe the management of pediatric patients and suggest a novel strategy for glucocorticoid replacement therapy in adults.
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Affiliation(s)
- Alina Oprea
- Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Nicolas C. G. Bonnet
- Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Olivier Pollé
- Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Philippe A. Lysy
- Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Pôle PEDI, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Av. Hippocrate 10, B-1200 Brussels, Belgium
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36
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Trenfield SJ, Awad A, Goyanes A, Gaisford S, Basit AW. 3D Printing Pharmaceuticals: Drug Development to Frontline Care. Trends Pharmacol Sci 2018. [DOI: 10.1016/j.tips.2018.02.006] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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