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Sorasitthiyanukarn FN, Muangnoi C, Rojsitthisak P, Rojsitthisak P. Stability and biological activity enhancement of fucoxanthin through encapsulation in alginate/chitosan nanoparticles. Int J Biol Macromol 2024; 263:130264. [PMID: 38368987 DOI: 10.1016/j.ijbiomac.2024.130264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/15/2023] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
A response surface methodology based on the Box-Behnken design was employed to develop fucoxanthin (FX) delivery nanocarrier from alginate (ALG) and chitosan (CS). The FX-loaded ALG/CS nanoparticles (FX-ALG/CS-NPs) were fabricated using oil-in-water emulsification and ionic gelation. The optimal formulation consisted of an ALG:CS mass ratio of 0.015:1, 0.71 % w/v Tween™ 80, and 5 mg/mL FX concentrations. The resulting FX-ALG/CS-NPs had a size of 227 ± 23 nm, a zeta potential of 35.3 ± 1.7 mV, and an encapsulation efficiency of 81.2 ± 2.8 %. These nanoparticles exhibited enhanced stability under simulated environmental conditions and controlled FX release in simulated gastrointestinal fluids. Furthermore, FX-ALG/CS-NPs showed increased in vitro oral bioaccessibility, gastrointestinal stability, antioxidant activity, anti-inflammatory effect, and cytotoxicity against various cancer cells. The findings suggest that ALG/CS-NPs are effective nanocarriers for the delivery of FX in nutraceuticals, functional foods, and pharmaceuticals.
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Affiliation(s)
- Feuangthit Niyamissara Sorasitthiyanukarn
- Metallurgy and Materials Science Research Institute, Chulalongkorn University, Bangkok 10330, Thailand; Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Pranee Rojsitthisak
- Metallurgy and Materials Science Research Institute, Chulalongkorn University, Bangkok 10330, Thailand; Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand.
| | - Pornchai Rojsitthisak
- Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand; Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
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Orth LE, Ellingson AS, Azimi SF, Martinez JT, Alhadad AA, Tran BC, Allen CW, Nguyen CT, Duong T, Burkdoll JS, Yoo J, Blackmer AB, Jeffres MN. Allowable room temperature excursions for refrigerated medications: A 20-year review. Am J Health Syst Pharm 2022; 79:1296-1300. [PMID: 35451022 DOI: 10.1093/ajhp/zxac118] [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: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The aim of this review was to build upon previous literature describing the maximum duration for which refrigerated medications can tolerate room temperature excursions while maintaining stability and potency. METHODS During a 12-month period ending in June 2021, the prescribing information and published monographs from multiple pharmacy compendia were reviewed for all medications and biologic products approved by the US Food and Drug Administration (FDA) for human use since January 2000. Products that were subsequently withdrawn from the US market were excluded. When temperature excursion data was unavailable in published form, product manufacturers were surveyed via telephone and/or email. Acceptable storage information for all products for which storage is recommended at temperatures below room temperature (20-25 °C [68-77 °F]) was compiled and arranged in tabular format. RESULTS Of the 705 products or formulations approved by FDA during the predefined time period, 246 were identified as requiring storage at temperatures below room temperature. After review of available prescribing information and manufacturer communications, if applicable, acceptable periods of excursion to temperatures at room temperature or higher were identified for 214 products (87%). CONCLUSION Information related to acceptable periods of room temperature excursion was compiled for a total of 214 products approved for US distribution since 2000. The included tables may increase patient safety and decrease medication loss or related expenditures.
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Affiliation(s)
- Lucas E Orth
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, and Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Amanda S Ellingson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Sara F Azimi
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Joseph T Martinez
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Amal A Alhadad
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Brenda C Tran
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Chase W Allen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Cecilia T Nguyen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Tony Duong
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jordan S Burkdoll
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jenny Yoo
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Allison B Blackmer
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Meghan N Jeffres
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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Castro Espinosa J, Jiménez Urrego ÁM, Botero Carvajal A. Factors related to technical management and adverse drug event reporting in independent retail pharmacies in Cali, Colombia. Heliyon 2022; 8:e09016. [PMID: 35252615 PMCID: PMC8891953 DOI: 10.1016/j.heliyon.2022.e09016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Independent retail pharmacies are required to have a technical manager responsible for the operation and adverse drug event reporting. In this context the following investigation is developed based on one objective: To establish factors related to the technical management and adverse drug event reporting in independent retail pharmacies in Cali. This is a cross-sectional observational study. Data was randomly collected from an estimated sample of 244 independent retail pharmacies. The results show that storage was the area of greatest implementation, 94% of the assessed pharmacies had a technical manager and 50% of them reported adverse drug events. A technical manager, being a chemist, pharmacist, or pharmacy manager, was associated with having computer equipment and dispensing homeopathic products. Adverse drug event reporting was directly associated with having bibliographic resources and inversely associated with the technical manager being a drug retailer. These data show the factors related to technical management of independent retail pharmacies and adverse drug event reporting were identified.
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Alqurshi A. Household storage of pharmaceutical products in Saudi Arabia; A call for utilising smart packaging solutions. Saudi Pharm J 2020; 28:1411-1419. [PMID: 33250648 PMCID: PMC7679471 DOI: 10.1016/j.jsps.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background Limited information is known about the storage conditions of medicinal products post-dispensing in Saudi Arabia (SA). The particularly hot and humid climate in the region may lead to the loss of essential performance specifications. Objective To investigate the conditions in which medications are held after being dispensed, and up until administration by households in SA. In addition, storage practices adopted by households in the region, as well as their knowledge and awareness are explored. This study also discusses the opportunity of utilising Time-Temperature Indicators (TTIs) in the pharmaceutical industry in SA as a quality-assurance enhancement solution. Methods A cross-sectional questionnaire targeted at households in SA was designed to explore storage practices, background knowledge and awareness of factors that can influence drug stability. Additionally, temperature and relative humidity mapping of 35 different rooms in various homes and cities in SA, as well as car interiors, was performed. Results More than 1000 households have participated in this study from all regions of SA. Approximately, 95% have claimed to take part in storing medications at home. First-aid and supplemental purposes were two of the reasons 80.9% have claimed, while 43.2% claimed treatment for chronic conditions. Just over 35% claimed that not knowing how to dispose of medications, is the reason behind their storage. More than 35% of participants could not identify most suitable storage conditions, and >10% were unaware of the effect storage conditions may have on shelf-life. Many were found to store medication in inappropriate areas, liquid dosage forms for example were stored in freezers by more than 3%. Upon monitoring temperatures of all room types, 25ºC was exceeded throughout a 24-hour duration in bathrooms, kitchens and limited use rooms. Temperatures in parked car interiors exceeded 70ºC. Conclusions A significant percentage of households in SA lacked knowledge and awareness of good storage practices. However, due to high temperatures observed in the region, increasing knowledge and awareness is not enough, as medicinal cabinets with basic temperature control (e.g. designated secure fridge) are needed. Additionally, the use of TTIs to provide consumers with accumulated thermal history may enhance quality-assurance of thermally sensitive products.
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Affiliation(s)
- Abdulmalik Alqurshi
- Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taibah University, Al Madinah Al Munawarah, Saudi Arabia
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de Assis Damasce TM, Fernand V, Leite da Silva CA, Candido da Silva AM, Ishikawa Cezar Santo LC, Palmiro da Silva e Lima V. Storage Conditions of Immunobiologicals and their Influence on the Efficacy and Safety in the Treatment of Autoimmune Rheumatic Diseases. Open Rheumatol J 2020. [DOI: 10.2174/1874312902014010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
The study aimed to evaluate the influence of storage temperature on immunobiological efficacy and safety in autoimmune rheumatic disease treatment.
Methods:
This observational study included adult patients with autoimmune rheumatic diseases who used immunobiologicals stored at home and were followed up at the rheumatology outpatient clinic of the General University Hospital of Cuiabá, Mato Grosso, Brazil, in 2017/2018. Patients were evaluated regarding disease activity and occurrence of adverse events, and a household survey of the temperature of the storage environment of these drugs was conducted.
Results:
Sixty patients with a mean age of 50.4 years were evaluated. Of these, 39 patients (65%) stored their biological drugs outside the recommended temperature range. Storage of the immunobiological at the incorrect temperature was 76% higher among patients with moderate/high rheumatic disease activity (p=0.003).
Conclusion:
Most patients stored their immunobiologicals outside the temperature range recommended in the package insert, and there was an association between incorrect storage temperature and moderate/high autoimmune rheumatic disease activity.
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Rintamaki L, Kosenko K, Hogan T, Scott AM, Dobmeier C, Tingue E, Peek D. The Role of Stigma Management in HIV Treatment Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5003. [PMID: 31835334 PMCID: PMC6950713 DOI: 10.3390/ijerph16245003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/28/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022]
Abstract
Social stigma is linked to improper HIV treatment adherence, but how stigma impairs adherence outcomes is poorly understood. This study included 93 people living with HIV in the United States who participated in focus groups or one-on-one interviews regarding how stigma might affect medication management. Latent content analysis and constant comparative techniques of participant responses that were produced three thematic groupings that described how participants (a) orient to HIV stigma, (b) manage HIV stigma in ways that directly impair treatment adherence, and (c) manage HIV stigma in ways that may indirectly impair adherence. These findings illustrate the need to understand how patients orient to HIV stigma when prescribing medications and the complications that are inherent to such assessments. In addition, these findings provide a simple framework for organizing the different ways in which stigma management strategies may disrupt treatment adherence. Conceptually, these findings also offer a paradigm shift to extent theories on disclosure and concealment, in which only disclosure has been cast as an active process. These findings demonstrate how concealment is far from a passive default, often requiring enormous effort. Ultimately, these findings may guide intervention programs that help to entirely eliminate HIV by promoting optimized counseling and subsequent treatment adherence.
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Affiliation(s)
- Lance Rintamaki
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - Kami Kosenko
- Department of Communication, North Carolina State University, Raleigh, NC 27695, USA;
| | - Timothy Hogan
- Center for Healthcare Organization & Implementation Research, United States Department of Veterans Affairs, Bedford, MA 01730, USA;
- Department of Population and Data Sciences, University of Texas, Southwestern, Dallas, TX 75390, USA
| | - Allison M. Scott
- Department of Communication, University of Kentucky, Lexington, KY 40506, USA;
| | - Christopher Dobmeier
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - Erik Tingue
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - David Peek
- Department of Medicine, Pen Bay Medical Center, Rockport, ME 04856, USA;
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Tabbara N, Brown M, McGeer A, Wyllie A. Stability of Inactivated Influenza Vaccine in Polypropylene Syringes under Various Storage Conditions. Can J Hosp Pharm 2019; 72:462-463. [PMID: 31853147 PMCID: PMC6910846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Najla Tabbara
- , BSc(Hons), PharmD, ACPR, Clinical Pharmacist, Department of Pharmacy, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario
| | - Martha Brown
- , BSc, MSc, PhD, Associate Professor, Department of Molecular Genetics, University of Toronto, Toronto, Ontario
| | - Allison McGeer
- , MSc, MD, FRCPC, Medical Director of Infection Control, Division of Infection Control, Mount Sinai Hospital, Sinai Health System, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Andrew Wyllie
- , BScPhm, ACPR, PharmD, Manager, Pharmacy Practice and Quality, Department of Pharmacy, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario
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Saavedra MA, Aimo C, Andrade JA, Alvarez D, Sequeira G, Kerzberg E. Survey on transportation and storage of biological therapies by patients. Eur J Rheumatol 2019; 6:94-97. [PMID: 31365344 PMCID: PMC6467330 DOI: 10.5152/eurjrheum.2019.18182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/01/2019] [Indexed: 12/03/2022] Open
Abstract
Objective To assess key aspects of transportation and storage of biological therapies (BTs) on the part of the patients, from the time they collect them from the pharmacy up until the moment of administration. Methods This was a cross-sectional study in the form of a survey completed by outpatients older than 18 years who were administered BTs. The survey was carried out by the authors between August 2016 and January 2017. Results A total of 83 outpatients were interviewed (mean age, 53; standard deviation, 15; 76% female). Sixty percent had rheumatoid arthritis, 24% had psoriatic arthritis, and 16% sustained other rheumatic and inflammatory diseases. Twenty percent had not been informed of the importance of proper refrigeration when they were first prescribed BTs; 77% had acquired the medication at least 7 days before administration; 28% had misplaced the drug in the fridge (65% of them in the freezer); 90% was unaware of the temperature range at which the BT should be kept in the fridge, and only one (1%) of them had once used a thermometer to find out the fridge temperature. Fifty-three percent had suffered frequent power outages the previous summer, 22% had experienced blackouts longer than 48 hours; 37% had taken the BT to another house to avoid wasting it, and four (5%) patients had disposed of the drug due to a prolonged power outage. Conclusion Upon prescribing BTs, it is imperative that physicians brief patients on the relevance of suitable transportation and storage methods, and a treatment failure should prompt a thorough assessment of transportation and storage conditions.
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Affiliation(s)
| | - Carolina Aimo
- Department of Rheumatology, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | - Damaris Alvarez
- Department of Rheumatology, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Gabriel Sequeira
- Department of Rheumatology, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Eduardo Kerzberg
- Department of Rheumatology, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
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Morais EM, Salgado TM, Vazquez Gomez I, Duarte AM, Fernandez-Llimos F. Differences in the information about procedures after cold chain disruption provided by pharmaceutical industry to hospital and community pharmacies. Eur J Hosp Pharm 2016; 23:96-99. [PMID: 31156824 DOI: 10.1136/ejhpharm-2015-000723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/03/2015] [Accepted: 09/07/2015] [Indexed: 11/03/2022] Open
Abstract
Purpose To compare the response of the pharmaceutical industry to information requests from a hospital pharmacy and a community pharmacy regarding the inadvertent exposure of refrigerated medicines (2-8°C) to out-of-range temperatures. Methods A complete list of all authorised medicines labelled for refrigeration was obtained from the Portuguese Medicines Agency. A standard information request regarding cold chain disruption for refrigerated medicines was sent to pharmaceutical companies from a hospital and a community pharmacy in Portugal. For companies who did not provide a response within the first 45 days, a second request was sent and an additional 45 days were allowed before completing data collection. To compare information received from the drug industry with that contained in the official European labelling, the Summaries of Product Characteristics (SmPCs) were retrieved from the regulatory agencies' databases. Response rate, response time and information appropriateness were assessed. Results A total of 792 medicines marketed by 70 different pharmaceutical companies were included. The hospital pharmacy received 560 (70.7%) responses, with a mean response time of 6.5 days (SD=5.3) for the first request. The community pharmacy obtained a response for 411 (51.9%), with a mean response time of 15.5 days (SD=4.8). More appropriate information was provided to hospital pharmacy requests. SmPCs did not contain complete information regarding the inadvertent exposure of medicines to unrefrigerated conditions. Conclusions When enquired about a specific piece of information, the pharmaceutical industry provided quicker, higher quality and more frequent responses to a hospital pharmacy compared with a community pharmacy.
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Affiliation(s)
- Eleonora M Morais
- Research Center in Biosciences & Health Technologies (CBIOS), Lusofona University of Humanities and Technologies, Lisbon, Portugal
| | - Teresa M Salgado
- Department of Clinical Pharmacy, University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
| | | | | | - Fernando Fernandez-Llimos
- Faculty of Pharmacy, Department of Social-Pharmacy, Research Institute for Medicines (iMed.ULisboa), University of Lisbon, Lisbon, Portugal
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Vlieland ND, Gardarsdottir H, Bouvy ML, Egberts TCG, van den Bemt BJF. The majority of patients do not store their biologic disease-modifying antirheumatic drugs within the recommended temperature range. Rheumatology (Oxford) 2015; 55:704-9. [PMID: 26672907 DOI: 10.1093/rheumatology/kev394] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To monitor whether biologic DMARD (bDMARD) home storage temperatures comply with the manufacturers' Summary of Product Characteristics (SmPC) recommendations. METHODS This observational study included consenting adult patients from eight Dutch pharmacies who received their bDMARDs with a validated temperature logger. Patients were instructed to store their packages according to standard label instructions and to return the temperature logger(s) after use. Primary outcome was defined as the proportion of patients that stored their bDMARDs within the SmPC recommended temperature range. In addition, the proportion of patients storing bDMARDs below 0°C or above 25 °C for longer than two consecutive hours was estimated. RESULTS A total of 255 (87.0%) patients (mean age 53.2 (s.d.; 13.1) years, 51.4% female) returned their temperature logger(s) to the pharmacy. Of these, 17 patients (6.7%) stored their bDMARD within the recommended temperature range. The proportion of the patients that stored their bDMARD for more than 2 h consecutive time below 0°C or above 25°C was respectively 24.3% (median duration: 3.7 h (IQR 2.2 h; range 2.0-1,097.1 h) and 2.0% (median duration: 11.8 h (IQR 44.3 h; range 2.0-381.9 h). CONCLUSION The majority of patients do not store their bDMARDs within the SmPC-recommended temperature range.
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Affiliation(s)
- Nicolaas D Vlieland
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht
| | - Helga Gardarsdottir
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht
| | - Toine C G Egberts
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek and Department of Pharmacy, Radboud Medical Center, Nijmegen, The Netherlands
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Kumru OS, Joshi SB, Smith DE, Middaugh CR, Prusik T, Volkin DB. Vaccine instability in the cold chain: mechanisms, analysis and formulation strategies. Biologicals 2014; 42:237-59. [PMID: 24996452 DOI: 10.1016/j.biologicals.2014.05.007] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 12/15/2022] Open
Abstract
Instability of vaccines often emerges as a key challenge during clinical development (lab to clinic) as well as commercial distribution (factory to patient). To yield stable, efficacious vaccine dosage forms for human use, successful formulation strategies must address a combination of interrelated topics including stabilization of antigens, selection of appropriate adjuvants, and development of stability-indicating analytical methods. This review covers key concepts in understanding the causes and mechanisms of vaccine instability including (1) the complex and delicate nature of antigen structures (e.g., viruses, proteins, carbohydrates, protein-carbohydrate conjugates, etc.), (2) use of adjuvants to further enhance immune responses, (3) development of physicochemical and biological assays to assess vaccine integrity and potency, and (4) stabilization strategies to protect vaccine antigens and adjuvants (and their interactions) during storage. Despite these challenges, vaccines can usually be sufficiently stabilized for use as medicines through a combination of formulation approaches combined with maintenance of an efficient cold chain (manufacturing, distribution, storage and administration). Several illustrative case studies are described regarding mechanisms of vaccine instability along with formulation approaches for stabilization within the vaccine cold chain. These include live, attenuated (measles, polio) and inactivated (influenza, polio) viral vaccines as well as recombinant protein (hepatitis B) vaccines.
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Affiliation(s)
- Ozan S Kumru
- Macromolecule and Vaccine Stabilization Center, Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66047, USA
| | - Sangeeta B Joshi
- Macromolecule and Vaccine Stabilization Center, Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66047, USA
| | - Dawn E Smith
- Temptime Corporation, Morris Plains, NJ 07950, USA
| | - C Russell Middaugh
- Macromolecule and Vaccine Stabilization Center, Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66047, USA
| | - Ted Prusik
- Temptime Corporation, Morris Plains, NJ 07950, USA
| | - David B Volkin
- Macromolecule and Vaccine Stabilization Center, Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66047, USA.
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Lefort H, Mendibil A, Margerin S, Cuquel AC, Jost D, Tazarourte K, Domanski L, Tourtier JP. [Storing succinylcholine in prehospital settings following the recommendations of the French National Agency for the safety of medicines]. ACTA ACUST UNITED AC 2014; 33:395-9. [PMID: 24930762 DOI: 10.1016/j.annfar.2014.05.004] [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: 03/25/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The French National Pharmaceuticals Agency (ANSM) has recommanded in July 2012 not to break the cold chain before using succinylcholine (Celocurine®). RESEARCH OBJECTIVE to understand the pre-clinical evolution of the conservation modes of this curare. RESEARCH TYPE Descriptive study before (year 2011) and after (year 2012). PATIENTS AND METHOD Online survey to French Samu/Smur. DATA COLLECTED SMUR location, conservation method at clinical base, in the mobile unit (UMH) and at the patient. Principal decision criteria: evolution of the conservation modes before and after the recommendation (qualitatives variables compared with a Fisher test). RESULTS Out of 101 SAMU/SMUR, 62 answered. Conservation modes of succinylcholine vials were significantly different (P<0.001). Proper conservation was observed in 26 % of the cases before and 43 % after. Mobile units (UMH) equipped with a fridge increased from one out of two to 77 %. The lack of conservation modes passive or active on UMH went from 31 % to 3.4 % with isotherms bags with ice when a fridge was not available. The destruction of capsules at current temperature in a 24-hour period increased: 22 % before, 47 % after (P=0.04). CONCLUSION After recommendations from ANSM, conservation modes and destruction of succinylcholine in a prehospital environment were significantly impacted.
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Affiliation(s)
- H Lefort
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France.
| | - A Mendibil
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - S Margerin
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - A-C Cuquel
- Pharmacie centrale, hôpital d'Instruction des Armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
| | - D Jost
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - K Tazarourte
- Samu Smur de Melun, rue Fréteau-de-Pény, 77011 Melun, France
| | - L Domanski
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - J-P Tourtier
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
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Tawfik KA, Jabeen A. Pharmaceuticals safety practices-a comparative pilot study. Int J Health Sci (Qassim) 2013; 7:317-24. [PMID: 24533025 PMCID: PMC3921061 DOI: 10.12816/0006060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The safety of medicine is essential for the safety of patients. Inappropriate drug storage, expiration dates, sharing prescription drugs, self medication habits and misuse of some drugs are contributing factors affecting medication safety. One or more of these factors may lead to serious health complications and even death. OBJECTIVES The purpose of this study was to highlight the common errors and pharmaceutical malpractices that people usually engage in on a daily basis and to correlate these to culture, gender and educational levels. This may spread awareness in an easy and understandable manner and provide certain guidelines to drug consumers ensuring that pharmaceutical preparations are used correctly and safely. METHODS Two hundred questionnaires were randomly distributed in two countries; Saudi Arabia and India. The collected data were statistically analyzed. OUTCOMES AND CONCLUSION Results showed that alarming percentages of various participants were using pharmaceuticals inappropriately due to carelessness, unawareness or intentional mistakes. Therefore, active participation by health care professionals is essential for the prevention of drug misuse. Increasing population awareness about self medication, products expiration, pharmaceuticals labels and optimum storage conditions would minimize the adverse effects and may even be life saving.
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Affiliation(s)
- Kamilia A. Tawfik
- Riyadh Colleges of Dentistry and Pharmacy, Pharmacy College, 84891 Riyadh, Saudi Arabia
| | - Arshia Jabeen
- Riyadh Colleges of Dentistry and Pharmacy, Pharmacy College, 84891 Riyadh, Saudi Arabia
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De Winter S, Vanbrabant P, Vi NT, Deng X, Spriet I, Van Schepdael A, Gillet JB. Impact of Temperature Exposure on Stability of Drugs in a Real-World Out-of-Hospital Setting. Ann Emerg Med 2013; 62:380-387.e1. [DOI: 10.1016/j.annemergmed.2013.04.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 04/08/2013] [Accepted: 04/22/2013] [Indexed: 11/15/2022]
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15
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Bardin C, Astier A, Vulto A, Sewell G, Vigneron J, Trittler R, Daouphars M, Paul M, Trojniak M, Pinguet F. Guidelines for the practical stability studies of anticancer drugs: A European consensus conference. ANNALES PHARMACEUTIQUES FRANÇAISES 2011; 69:221-31. [DOI: 10.1016/j.pharma.2011.07.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
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16
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Periáñez Parraga L, Gómez-Lobón A, Gamón Runnenberg I, Seco Melantuche R, Delgado Sánchez O, Puigventós Latorre F. Medicamentos termolábiles. Protocolo de actuación en la rotura de la cadena de frío. FARMACIA HOSPITALARIA 2011. [DOI: 10.1016/j.farma.2010.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Merlin MA, Marques-Baptista A, Yang H, Ohman-Strickland P, Aquina C, Buckley B. Evaluating degradation with fragment formation of prehospital succinylcholine by mass spectrometry. Acad Emerg Med 2010; 17:631-7. [PMID: 20624143 DOI: 10.1111/j.1553-2712.2010.00766.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pharmaceutical manufacturers recommend refrigerating succinylcholine at a temperature range of 2-8 degrees C. With widespread use of prehospital succinylcholine on ambulances without refrigeration, it is important to understand the stability of this drug. Using mass spectrometry, this study investigated the degradation of the succinylcholine compound before and after its exposure to ambulance cabin temperatures, while removing light exposure. A 10% degradation threshold was set as not appropriate for human use, in accordance with U.S. Food and Drug Administration guidelines. METHODS The study used 17 vials of succinylcholine sealed with duct tape in light-resistant bags. The bags were placed in climate controlled compartments in two ambulances: one stationed in a garage and the other stationed outdoors. Mass spectrometry analysis was used to examine drug degradation at Time 0, the 14th day of the first month, and monthly from Time 0 to 7 months. RESULTS The degradation products of succinyl monocholine (SMC) and choline are already present at Day 0. Ten percent degradation was achieved at approximately 90 days into the experiment. Temperature in the ambulance climate controlled compartment was 70 degrees F, with a range from 56 to 89 degrees F during the 6-month time period. CONCLUSIONS Identifiable breakdown fragments of succinylcholine have been identified using mass spectrometry with fresh drug upon receipt from the manufacturer. Ten percent degradation was not observed until approximately 90 days after being placed on ambulances. Temperature variations did not significantly contribute to degradation of succinylcholine, and it is safe for injection until approximately 90 days in similar climates.
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Affiliation(s)
- Mark A Merlin
- Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Davis SR, Anderson EA. Creation of a Temperature Stability Database for Refrigerated Medications. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2010. [DOI: 10.1002/j.2055-2335.2010.tb00722.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Elizabeth A Anderson
- Principal Drug Information Pharmacist, Drug Information Unit; Westmead Hospital; Westmead New South Wales
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Ziance R, Chandler C, Bishara RH. Integration of temperature-controlled requirements into pharmacy practice. J Am Pharm Assoc (2003) 2009; 49:e61-7; quiz e68-9. [DOI: 10.1331/japha.2009.08140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Oishi R. Current status of preparation and distribution of medicines. Am J Health Syst Pharm 2009; 66:S35-42. [PMID: 19233970 DOI: 10.2146/ajhp080611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ryozo Oishi
- Department of Pharmacy, Kyushu University Hospital, Higashi-ku Maidashi 3-1-1, Fukuoka, Japan
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