Stability and viscosity of a flavored omeprazole oral suspension for pediatric use

Drug administration via feeding tubes-a procedure that carries risks: systematic identification of critical factors based on commonly administered drugs in a cohort of stroke patients

PURPOSE

Drug administration via feeding tubes is considered a process with many uncertainties. This review aimed to give a comprehensive overview of data available on feeding tube application and to carry out risk assessments for drug substances commonly administered to stroke patients.

METHODS

Drugs frequently administered via feeding tubes were identified through a retrospective analysis of discharge letters from a stroke unit. Physicochemical, pharmacokinetic, and stability properties of these drugs and data on drug-enteral nutrition interactions were systematically searched for in the European Pharmacopoeia, Hagers Handbook of Pharmaceutical Practice, Birchers clinical-pharmacological data compilation, and the Martindale Complete Drug Reference, as well as from databases including DrugBank, DrugDex, PubChem, Google Scholar, and PubMed.

RESULTS

Of the drugs most commonly administered via feeding tubes in the present stroke patient cohort, bisoprolol, candesartan, and ramipril could be considered the least critical due to their overall favourable properties. Acetylsalicylic acid, amlodipine, hydrochlorothiazide, omeprazole and esomeprazole, simvastatin, and torasemide pose risks based on pH or light-dependent instability or proposed food effects. The most critical drugs to be administered via feeding tubes are considered to be furosemide, levodopa, and levothyroxine as they show relevant instabilities under administration conditions and substantial food effects; the latter two even possess a narrow therapeutic index. However, little information is available on drug-tube and drug-formula interactions.

CONCLUSION

Feeding tube administration of medications turned out to be a highly complex process with several unmet risks. Therefore, investigations that systematically assess these risk factors using clinically relevant model systems are urgently needed.

A Critical Assessment of Extemporaneous Formulations for Proton Pump Inhibitors: The Importance of Proper Vehicle Selection

OBJECTIVE

To examine the influence of vehicles on the stability of extemporaneous suspensions of proton pump inhibitors (PPIs), to single out the formulation most suitable for children, providing appropriate evidence and arguments.

METHODS

A review was performed of data identified from Medline, Embase, Science Direct, as well as public digital archive PubMed, including reference texts, related to the field of stability testing of extemporaneous PPI suspensions.

RESULTS

Fourteen selected formulations of extemporaneous suspensions are presented and discussed. Depending on the vehicle and its composition, which was analyzed and explained in detail, the suspensions had various beyond-use dates (BUDs).

CONCLUSIONS

Selected vehicles and the process of preparation had great influence on the stability of extemporaneous PPI suspensions. The suspension with the longest BUD has been singled out, which is especially suitable for use in newborns. Because an explanation is provided for the influence of individual vehicle components on the stability of the mentioned suspensions, this can aid not only in the selection of an adequate formulation, but also in the development of new ones, which will be suited to individual patients.

Comparative Stability of Compounded Omeprazole Suspension Versus Commercial Omeprazole Kit When Stored in Oral Syringes Under Refrigerated Conditions

Background: Omeprazole is a proton pump inhibitor used to manage gastrointestinal disorders. Special populations may require omeprazole to be given as an oral suspension. Objective: The purpose of this project was to compare the stability of omeprazole in the FIRST kit product to a traditionally compounded omeprazole suspension, when stored in refrigerated unit-dosed syringes. NG tube delivery of the 2 products was also investigated. Methods: Five batches of compounded omeprazole oral suspension and 5 kits of FIRST-Omeprazole were prepared to an initial concentration of 2 mg/mL. Suspensions were aliquoted into 5-mL doses in clear plastic oral syringes, and stored at 2-8 °C. Syringes from each batch were analyzed at baseline and after 7, 14, 21, and 30 days for omeprazole potency using HPLC. To assess suitability for NG tube administration, 20 mL of each suspension were administered through NG tubes (8Fr, 10Fr, and 18Fr), and percent omeprazole recovery assessed. Results: The chemical potency remained within 90-110% for 14 days and 30 days for compounded samples and FIRST-Omeprazole samples, respectively. There was a statistically significant difference in initial concentration; 1.89 mg/mL versus 1.98 mg/mL for compounded and FIRST-Omeprazole, respectively. After 30 days, FIRST-Omeprazole demonstrated 97.20% API recovery. Neither suspension experienced statistically significant loss of potency following NG tube passage. Conclusion: FIRST-Omeprazole suspension may be stored in refrigerated clear luer-lock oral syringes for 30 days. Traditionally compounded omeprazole suspension should be used within 14 days. Both suspensions are suitable for NG tube administration.

Implementation and in vitro characterization of calcium-free in situ gelling oral reconstituted suspension for potential overweight treatment

In this work, oral granules that were easily dissolved in aqueous dispersion, were prepared. These oral suspensions were formulated with sodium alginate (AlgNa), chitosan (CHI) and sodium carboxymethylcellulose (CMC Na). The gels were formulated by pouring the suspensions into 150 ml of simulated gastric fluid (SGF) pH 1.2 at 37° C. The in-situ gelling mechanism was based on the ionization states of the three biopolymers as a function of the pH of the medium. Fourier transform infrared analysis of gels confirmed the interactions between alginate and chitosan. According to the scanning electron microscopy analysis, the gels were characterized by a firm and homogeneous structure. The obtained values of the elastic storage modulus, G', varied between 10 1   and 10 7 Pa. The eliminated volume of the unabsorbed liquid by the gels fluctuated between 25% and 55% of the total liquid volume. The quality of the gels was improved when a maximum concentration of alginate ( 4   g / 100   ml ) , a minimum concentration of chitosan ( 0.5   g / 100   ml ) and a maximum amount of carboxymethylcellulose ( 4   g / 100   ml ) were used. The value of their elastic modulus, G' was around 10 5 Pa and the residual unabsorbed volume of the liquid was 25% of the total liquid volume. According to the obtained results, the prepared gels could induce a feeling of fullness by stimulating the gastric distension and they could potentially be applied as anti-obesity medication.

Formulation and Stability Study of Omeprazole Oral Liquid Suspension for Pediatric Patients

Objectives: To develop and to study the physicochemical and microbiological stability of omeprazole liquid oral formulations used as therapeutic agent in many acid-related disorders, for pediatric use. Furthermore, to optimize and validate a stability-indicating high-performance liquid chromatography (HPLC) method for the analysis of omeprazole in the studied formulations. Method: Oral liquid suspensions of omeprazole were prepared at 2 mg/mL using crushed omeprazole pellets (formulation A) and pure omeprazole (formulation B) with a complete vehicle including humectant, suspending, sweetening, antioxidant, and flavoring agents. Samples were stored at 4°C and 25°C. Omeprazole content of each formulation was analyzed in triplicate using micro-HPLC at 0, 3, 7, 14, 30, 60, 90, 120, and 150 days. Other parameters were also determined, such as appearance, pH, resuspendibility, and viscosity. Microbiological studies were conducted according to the United Stated Pharmacopeia (USP) guidelines for non-sterile products. Results: Formulation A stayed physicochemical and microbiologically stable at refrigerated (4°C) conditions during at least 150 days and it only stayed stable during 14 days at 25°C. Formulation B was stayed physicochemical and microbiologically stable at refrigerated (4°C) conditions at least 90 days, but it is not recommended to store at 25°C for more than 1 day. Conclusions: Formulation A and formulation B can be stored for at least 150 and 90 days, respectively, at refrigerated conditions. Formulation A can be stored at room temperature for 14 days. Both formulations are perfectly suitable for pediatric patients who are usually notable to swallow solid oral formulations. The proposed analytical method was suitable for the study of stability of different formulations.

Stability of Partial Doses of Omeprazole–Sodium Bicarbonate Oral Suspension

Background:

Omeprazole-sodium bicarbonate powder for oral suspension has recently been marketed. The manu facturer provides no information regarding the acceptability of using partial doses and recommends that the reconstituted suspension be administered immediately after preparation.

Objectives:

To determine the stability of the powder for oral suspension over 45 days, evaluate the stability of a partial dose (<20 mg) following exposure to Simulated Gastric Fluid USP (SGF) over 2 hours, and determine the feasibility of administering the suspension through neonatal and pediatric nasogastric feeding tubes compared with lansoprazole.

Methods:

Three identical samples of omeprazole–sodium bicarbonate suspension 2 mg/mL were stored in the refrigerator (3–5°C) and assayed by high-performance liquid chromatography immediately after preparation and at 7, 15, 30, and 45 days. Stability of a 1 mg/kg dose with an estimated volume of SGF for a simulated 12.7 kg pediatric patient was determined In triplicate over 2 hours at 37°C. The ability to administer a typical dose of omeprazole suspension and lansoprazole suspension (microgranules and water compounded from lansoprazole oral disintegrating tablets) was assessed in triplicate using 3 different sizes of neonatal/pediatric nasogastric feeding tubes.

Results:

At least 98% of the initial concentration of omeprazole remained throughout the 45 day study period in all suspensions. The suspension maintained at least 93% of the initial concentration following exposure to SGF for 2 hours. The lansoprazole bead mixture partially clogged the 6 French feeding tube and completely clogged the 5 French feeding tube. The omeprazole-sodium bicarbonate suspension was easily administered through all 3 sizes of neonatal/pediatric feeding tubes.

Conclusions:

Omeprazole-sodium bicarbonate suspension 2 mg/mL prepared from 20 mg packets was stable for at least 45 days when stored at 3–5°C. A partial dose of 12.7 mg was stable following exposure to SGF for 2 hours at 37°C. This suspension can be easily administered through 5, 6, and 8 French neonatal/pediatric feeding tubes and, when taking time and ease of preparation into account, it is cost competitive with simple omeprazole suspension.

Compatibility of proton pump inhibitors in a preservative-free suspending vehicle

Objectives

To evaluate the microbiological and physicochemical compatibility of commonly used proton pump inhibitors (PPIs) esomeprazole, lansoprazole, omeprazole and pantoprazole compounded at a single concentration using SyrSpend SF Alka and stored at refrigerated temperatures (omeprazole was also stored at room temperature because it has the most widespread use).

Methods

Compatibility was assessed by measuring the per cent recovery at varying time points throughout a 90-day period. Quantification of the APIs was performed by a validated high performance liquid chromatography (HPLC-UV) method. This same assay was also used to determine the dosage content uniformity of the suspensions. Microbiological stability ('test in use') was assessed during 60 days and total aerobic microbial count (TAMC), total combined yeasts and moulds count (TYMC), detection of Escherichia coli and pH determination were performed. Antimicrobial effectiveness testing was determined following European Pharmacopoeia guidelines.

Results

Beyond-use dates of maximum 60 days for omeprazole (5 mg/mL), pantoprazole (3 mg/mL) and esomeprazole (3 mg/mL) were established. All suspensions that met the physicochemical criteria for stability also met the content uniformity criteria. The suspensions showed no antimicrobial efficiency against bacteria, yeasts and moulds as SyrSpend SF Alka is an unpreserved vehicle, but the 'test in use' showed that the suspensions can remain microbiologically stable for up to 60 days.

Conclusions

SyrSpend SF Alka can be used to compound palatable (taste-masking properties) preservative-free oral suspensions with almost all commonly used PPIs.

Effects of Quince syrup on clinical symptoms of children with symptomatic gastroesophageal reflux disease: A double-blind randomized controlled clinical trial

OBJECTIVE

The aim of this study was to evaluate the efficacy of Quince syrup in pediatrics with symptomatic gastroesophageal reflux disease (GERD).

METHOD

Participants (n = 80) were randomly assigned to the Quince group (0.6 cc/kg/day) or the Omeprazole group (1 cc/kg/day). Age specific questionnaires were used to assess the frequency and severity of the GERD symptoms. Mean of cumulative symptom score (CSS) at weeks 4 and 7 were compared with baseline.

RESULTS

The mean CSS value was significantly decreased from baseline in each treatment group without statistically significant differences between them. Although the mean CSS value among infants and young children was slightly decreased in the Quince group at week seven, this value was increased among children aged 5-18 years in both treatment groups without significant differences.

CONCLUSION

Despite the effectiveness of Quince syrup in reducing symptoms in all pediatrics age groups, no significant differences were observed in comparison with the control group.

Stability of extemporaneously prepared lansoprazole suspension at two temperatures

OBJECTIVE

The purpose of this study was to examine the stability of a generic lansoprazole product in a 3 mg/mL sodium bicarbonate suspension under room temperature and refrigerated conditions.

METHODS

Lansoprazole suspensions (3 mg/mL) were prepared in triplicate using an 8.4% sodium bicarbonate vehicle for each storage condition (room temperature and refrigerated). During 1 month, samples from each replicate were periodically removed and analyzed for lansoprazole concentration by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Each sample was spiked with 10 mg/L omeprazole to serve as the internal standard. A positive electrospray LC-MS/MS method was validated over the calibration range of 5 to 25 mg/L using Food and Drug Administration Guidance. The identities of the analyte and internal standard in the samples were verified by monitoring the MS/MS transitions of m/z 370 to m/z 252 and m/z 346 to m/z 198 for lansoprazole and omeprazole, respectively. Additionally, the pH of the suspensions was monitored throughout the study.

RESULTS

The stability of lansoprazole in the oral sodium bicarbonate suspension under refrigeration is compromised prior to what has been previously reported in the literature. Samples kept at room temperature lost >10% of the lansoprazole after 48 hours compared with the refrigerated samples, which maintained integrity up to 7 days. No statistically significant difference was found between the pH of the room temperature and refrigerated suspension samples, indicating that this factor is not the cause for the differences in stability at these two conditions.

CONCLUSIONS

This study suggests that the extemporaneously compounded lansoprazole oral suspension prepared in 8.4% sodium bicarbonate should not be stored in plastic oral syringes longer than 48 hours at room temperature and no longer than 7 days when refrigerated. These data indicate an expiration time earlier than that previously reported for the refrigerated product (14 days).

Influences of sodium carbonate on physicochemical properties of lansoprazole in designed multiple coating pellets

Lansoprazole (LSP), a proton-pump inhibitor, belongs to class II drug. It is especially instable to heat, light, and acidic media, indicating that fabrication of a formulation stabilizing the drug is difficult. The addition of alkaline stabilizer is the most powerful method to protect the drug in solid formulations under detrimental environment. The purpose of the study was to characterize the designed multiple coating pellets of LSP containing an alkaline stabilizer (sodium carbonate) and assess the effect of the stabilizer on the physicochemical properties of the drug. The coated pellets were prepared by layer-layer film coating with a fluid-bed coater. In vitro release and acid-resistance studies were carried out in simulated gastric fluid and simulated intestinal fluid, respectively. Furthermore, the moisture-uptake test was performed to evaluate the influence of sodium carbonate on the drug stability. The results indicate that the drug exists in the amorphous state or small (nanometer size) particles without crystallization even after storage at 40°C/75% for 5 months. The addition of sodium carbonate to the pellet protects the drug from degradation in simulated gastric fluid in a dose-dependent manner. The moisture absorbed into the pellets has a detrimental effect on the drug stability. The extent of drug degradation is directly correlated with the content of moisture absorption. In conclusion, these results suggest that the presence of sodium carbonate influence the physicochemical properties of LSP, and the designed multiple coating pellets enhance the drug stability.